NHS Flashcards
Background info about the NHS
The National Health Service was founded in 1948 under the reforming post-war Labour gov.
It was an important plank of the welfare state that was designed to care for the sick and vulnerable from ‘cradle to grave’
The NHS was to be universally available throughout the UK and ‘free at the point need’ regardless of ability to pay.
But by 1951 charges had already been introduced for prescriptions, spectacles and dentist visits.
Affordability has always been an issue and in the modern UK, an ageing population and the increasing cost of sophisticated medical techniques, have increased these pressures.
What is the NHS like today?
NHS England receives about £130bn of public money
Uk health spending is about 9.8% of GDP
It employs 1.1 m people making it one of the largest employers in the world
in NHS England there are 120,000 doctors and 296,008 nurses
8,000 general practitioners
191 Clinical Commissioning Groups
233 hospital trusts (some of them run more than one hospital)
Funding
80% comes from general taxation; 20% from National Insurance Contributions, land sales and charges to patients.
Since the 1980s there have been a series of reforms and reorganisations designed to make the NHS more efficient and cost effective
Thatcher reforms (conservative)
Introduced the idea of the ‘internal market’ in the 1990 NHS and Community Care Act, and this has remained a controversial part of the NHS ever since.
The idea splits the NHS into ‘purchasers’ or ‘commissioners’ that buy NHS services on the behalf of patients and ‘providers’ such as NHS hospital trusts that supply these services.
The theory is the discipline of the market will drive efficiencies and improvements in service in the similar way as the open market.
Blair reforms (Labour)
Hugely increased funding for the NHS (from 6.7% of GDP in 1997 to 9.7% in 2010), but kept the idea of the internal market largely in tact.
In 2002 Primary Care Trusts were established which ‘commissioned’ health care from the providers i.e. the NHS Trusts. Some NHS trusts were given self-governing status and became Foundation Trusts and 28 Strategic Health Authorities were set up to work with PCTs to buy health care. Foundation trusts are a different type of NHS organisation with a stronger local influence.
The 2003 Health and Social Care Act proved hugely controversial because it allowed PCTs to purchase care from private providers, or even from abroad, to reduce waiting lists.
Cameron reforms (Cons)
From 2010 the Coalition gov wanted to cut out the red tape and hand money directly from the gov to GPs who provided most of the health care to patients.
The 2012 Health and Social Care Act abolished PCTs and handed commissioning of health care to consortia of GPs, nurses, hospital doctors and the public called Clinical Commissioning Groups (CCGs)
All NHS Trusts became Foundation Trusts and were encouraged to become not - for - profit mutual style companies that could generate their own income from selling private treatment. Hospitals could go bust just like private companies.
NHS Trusts have to compete for business from the CCG’s with any ‘qualified provider’ in the voluntary or private sector.
Current situation
The result is a complex network of commissioning groups, NHS Trusts, advisory bodies and regulators.
CCG’s buy in patient care on behalf of patients. Because some clinical decisions require specialist knowledge, the CCG’s are advised by:
Commissioning Support Units - these do number crunching and analysis that CCGs can use.
Clinical Senates - offer expertise in particular areas of patient care that GPs may not know much about.
NHS Foundation Trusts (hospitals, ambulance services and mental health units) provide patient care to CCGs in competition with ‘qualified providers’ in voluntary and private sector.
NHS England (formerly the NHS Commissioning Board) gives a wider view than the CCGs and oversees budget planning, delivery and day to day operation of NHS in England.
Scotland, Wales and Northern Ireland operate under slightly different systems.
Regulators and other bodies
Monitor is the health care regulator that licenses health care providers, regulates prices and makes sure essential services continue if a provider runs into trouble.
The Care Quality Commission - is a regulator that inspects hospitals, care homes, dental and GP surgeries and issues reports.
Healthwatch - represents the views of patients
The Parliamentary and Health Service Ombudsman - deals with complaints
The National Institute for Health and Care Excellence (Nice) - provides national guidance and advice to improve health and social care including approving new drugs.
Local authority role
Public health e.g. smoking cessation and healthy eating, used to be run by the NHS.
But the 2012 Act handed control of public health and the budget to local authorities and another new national body Public Health England.
Local Govs have also been tasked with establishing Health and Wellbeing Boards, bringing together key players in the health and social care system, including local councillors, to improve care in a joined-up way across health, social care and other public services.
Sustainability and Transformation Partnerships
In 44 areas of England STPs have been set up involving NHS groups such as CCGs and Foundation Trusts as well as local authorities and charities.
They are tasked with developing a 5 year plan (2016-2021) to improve health services
They aim to:
Improve quality and develop new models of care
Improve health and well being
Improve efficiency
Improve integration with social care and other local authority services.
How has COVID affected the NHS
Millions of patients living with health problems (including life-threatening conditions such as cancer) have been affected, with their treatment postponed or cancelled. And millions of patients will have missed vital opportunities to receive initial assessment and diagnosis for health problems in the first place.
As the NHS begins the vital task of reopening non-COVID services, it now faces a huge backlog of unmet patient need, with patients now facing long waits for treatment.
