The NHS Flashcards
When was the NHS founded?
The National Health Service (NHS) founded in 1948 under the reforming post-war Labour government.
What was its moto as such?
It was an important plank of the welfare state that was designed to care for the sick and vulnerable from “cradle to grave”.
When did some charges get introduced?
But by 1951 charges has already been introduced for prescriptions, spectacles and dentist visits.
Why has affordability always been an issue?
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.
Today the NHS is a giant:
- It receives about £149bn of public money (18% of total public spending; 6.6% of GDP).
- It employs 1.3 million people making it the fifth largest employer in the world.
- There are 147,000 doctors (37,000 more than in 2003).
- 371,000 nurses (25,000 more than 2003)
- 8,000 General Practitioner (GP) practices
- 2,300 hospitals.
- It treats one million patients every 36 hours.
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?
The Conservative administration, under Margaret Thatcher, 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?
The Labour government under Tony Blair 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 intact.
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.
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?
From 2010 the Coalition government wanted to cut out the red tape and hand money directly from the government 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 CCGs with any ‘qualified provider’ in the voluntary or private sector.
The current situation?
The result is a complex network of commissioning groups, NHS Trusts, advisory bodies and regulators.
• CCGs buy in patient care on behalf of patients.
• Because some clinical decisions require specialist knowledge, the CCGs are advised by
o Commissioning Support Units – these do number crunching and analysis that CCGs can use.
o 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 (see Morrison for details).
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. http://www.monitor-nhsft.gov.uk
- The Care Quality Commission – is a regulator that inspects hospitals, care homes, dental and GP surgeries, and issues reports. http://www.cqc.org.uk
- Healthwatch – represents the views of patients http://www.healthwatch.co.uk
- The Parliamentary and Health Service Ombudsman – deals with complaints. http://www.ombudsman.org.uk
- The National Institute for Health and Care Excellence (Nice) – provides national guidance and advice to improve health and social care including approving new drugs. http://www.nice.org.uk/
Local authority role?
- Public health, for example 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 governments 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 five year plan (2016 – 2021) to improve health services
- They aim to:
- Improve quality and develop new models of care
- Improve health and wellbeing
- Improve efficiency
- Improve integration with social care and other local authority services
