History of the NHS

Question 1

What was life like before the NHS- pre 1948?

Answer 1

• Healthcare was available but needed to be paid for
• Low paid workers had free healthcare
• Everybody else relied on home remedies or charity – charitable and voluntary hospitals
• Municipal hospitals
• Asylums
• Workhouse

Question 2

Introduction of the NHS- 1948

Answer 2

Era of expectation

• NHS introduced 5th July 1948 by Aneurin Bevan
• Financed from central taxation
• Principle of the NHS – fair and equal access to all, free at the point of delivery
• End of World War II
• Administration difficulties
• High public expectations
• Prescription charges
• Problem balancing demands
• Bevan – expectations will always exceed capacity
• GP acted as gate-keepers to the NHS
• Major innovation - planned the development of community health centres (beginnings of MDT?)

Question 3

NHS: 1988-1997

Answer 3

Era of ‘The Market’

• Introduction of the internal market 1989 (White Paper – Working for Patients) an attempt to resolve problems through competition
• Purchasers – HA and some family Doctors
• Providers – acute hospitals and other health organisations
• To become a provider, hospitals had to become NHS Trusts (formation of NHS Trusts)
• To become a purchaser GPs became GP Fund-holders (GPs managing budgets)
• Accusations of two-tier system
• 1997 – new Government (Labour), abolition of internal market
• New White Paper: The New NHS – Modern, Dependable

Question 4

NHS: 1998-2009

Answer 4

Era of ‘all change!’

• Biggest programme of change (until 2010 comes along!) since start of NHS
• Restructuring of NHS
• Putting patients at centre of the NHS
• Increased use of IT
• NHS Information Highway
• NHS Direct 1998
• Formation of NICE 1999

10 Year NHS Plan – July 2000
Promised:
More hospitals and beds
More Doctors and nurses
Shorter waiting times for hospitals and GP appointments
Cleaner wards, better food and facilities in hospitals
Improved care for older people
Tougher standards for NHS organisations, better rewards for the best
Greater power and more information for patients and the public

Question 5

4 principles for the NHS during this period (1998-2009)

Answer 5

• Patient focused service – patient choice, role of independent sector
• Competitive providers – payment by results, money following patients
• Active purchasers – PCTs had purchasing power, practice-based commissioning
• Cost effectiveness and affordability – tariffs, commissioning

Question 6

2010 onwards…

Answer 6

Era of ‘austerity, major reforms and uncertainty!’