British Government and Politics ( JN 302 ). The National Health Service (NHS). Lecture Outline. 1. NHS structure and operations 2. History of the NHS 3. Coalition government and the NHS 4. Current issues. NHS structure and operations.
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The National Health Service (NHS)
1. NHS structure and operations
2. History of the NHS
3. Coalition government and the NHS
4. Current issues
NHS funded about 80% out of general taxation and 20% deriving from:
NHS element of National Insurance contributions;
Prescription and drugs charges;
Other income such as asset sales and fundraising.
NHS controlled by the Department of Health. Funding is allocated to geographically-based Clinical Commissioning Groups (211 across England).
NHS Trusts and private sector companies are commissioned to provide NHS services.
In addition to providing health care services the NHS is involved in doctor training (about 8,000 places for student doctors each year).
Vision of Health Minister Aneurin Bevin (Nye Bevin) – “We now have the moral leadership of the world”.
But by 1951 charges were introduced for prescriptions, opticians, and dentists.
Led to high profile resignations including Bevin.
For40 years structure and funding remained the same: centrally funded through taxation, government filtering money through to hospitals, surgeries and ambulance services. Health professionals and service staff employed by government.
Management structures set up with generalists appointed to sit alongside clinical staff.
Introduction of general managers to run District Health Authorities (DHAs) - funds directed to local hospitals and surgeries.
Community based health care with GPs , dentists, and other primary care providers given control of budgets - attempt to end ‘one size fits all’ approach to targeted approach.
Outsourcing of medical and health support employment to private agencies.
Department of Health and Social Security (DHSS) split into Department of Health and Department of Social Security.
Further reforms under John Major created NHS trusts.
National Health Service and Community Care Act (1990):
NHS trusts were defined as service providers;
Hospitals, mental health units, ambulance services and others directly involved made up NHS trusts with own management boards (practitioners and general managers);
GPs offered opportunity to become fund holders – could opt out of district health authorities; and
GP fund-holders, DHAs and family health service authorities (FHSAs) became purchasers of NHS primary care.
Criticisms of NHS reforms:
Not all GPs wanted to opt out – by the time Labour came into power 1997 fewer than half had signed up;
Internal market criticised for being too concerned with management - more interested in flow charts;
Major criticism – post code lottery.
Waiting lists increased – horror stories in the press and broadcasting.
By May 1997 1.3 mlnpeople waiting for treatment and operations.
Stories of elderly and vulnerable falling ill and dying while waiting for treatment.
Labour introduced the Health Act 1999. Introduced:
Primary care trusts (PCTs) – local administrative organisations that purchased clinical services;
Strategic health authorities (SHAs) replaced DHAs – more arm’s length administrative bodies. Responsible for monitoring local health care, publishing three-yearly health plans, promoting healthier lifestyles.
Greater power for DH and Secretary of State to set nationwide targets and standards of care.
Alan Milburn’s 10-year NHS plan in 2000 criticised for over-emphasising competition in NHS and allowing patients choice of being treated in private hospitals and clinics.
National Institute for Clinical Excellence (NICE) also established in 1999.
Executive agency of the NHS.
Guidance on prevention of illness to both general public and NHS workers.
Advises governments on whether new and existing clinical treatments, medicines and procedures should be made (or remain) available on the NHS.
Coalition government decided to ‘ring-fence’ NHS from cuts in government spending (along with foreign aid and education).
Andrew Lansley’s Health and Social Care Act:
Abolished Labour’s PCTs and installed clinical commissioning groups (CCGs) that were run more directly by GPs; and
Gave greater powers for NHS Trusts to be more free from the NHS (although accompanied by less financial security). Trusts can now raise up to 49% of their funds through treating private patients.
SHAs replaced by more local authorities to promote health improvement and overall health care provision.
New health regulatory body – Monitor.
After much public criticism, including from the British Medical Association (BMA), and a re-assessment ‘pause’ in the passage of the bill, the Act was finally passed in 2012.
Opposition (and overview) of the bill:
Inquiry into the Mid Staffordshire NHS Foundation Trust.
Cameron’s pledge to have GP surgeries open seven days a week:
Data sharing plans:
Some say NHS still provides good levels of care: