Formation and Development of the NHS: A Timeline of Significant Points in History

This presentation provides a timeline of significant points in the history of the National Health Service (NHS) from its formation in 1948 to 2018. It analyzes the factors that led to its creation and how it responds to changing demands. It also explores the impact of funding changes on the NHS.

UNIT 6 ASSIGNMENT
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Analysis of factors that resulted in the creation
of the National Health Service
How the NHS responds to the changing demands
placed upon it?
Analysis of how changes to funding impact the
NHS
Timeline of significant points in history in
context of formation and development of the
NHS from 1948 till 2018
1946- National Health Service Act was formed
1948- NHS was launched
1967- Creation of GP Charter
1974- Reorganization of NHS occurred which included 3
tier area divisions
1976- Resource Allocation Working Party (RAWP) formula
began and continued till 1991 (Greengross, et al., 1999)
1982- End of Area tier and restructuring of NHS
1984- Introduction of General management
1987- GP Contract White paper
1988- NHS review
1989- White Paper "Working for Patients" reported reforms
for introduction of an internal market for health care of UK
and enacted into law as the NHS and Community Care Act
1990 (Parliament, 1989)
1991- "Health of the Nation" published (The Health of the
Nation, 1992)
1992- Tomlinson Report on health care in London
1996- Formal unison between districts and FHSAs
1998- NHS Direct
1999- Establishment of NICE and Primary Care Groups
2000- The NHS Plan (The NHS Plan, 2000), Commission
for Healthcare Improvement (CHI)
2001- Wanless initial report on financing scheme of NHS,
Health and Social Care Act (2001) passed
2002- National Health Service Reform and Health Care
Professions Act 2002 passed; Nursing and Midwifery
Council (NMC) established; Devolution day; Raise in
Budget funding & Wanless Review (Wanless, 2002);
proposal of NHS Foundation Trusts
2003- GPs' and consultants' contract.
2004- Payment by results; First Foundation Trusts
2005- Building a Patient-led NHS (DoH, 2005)
2006- Our Health, Our Care, Our Say - Community Care
White Paper (Parliament, 2006); SHAs lowered to 10
2007- Ban on smoking; Darzi report Framework for Action;
Reduction in NHS funding
2008- Final Darzi Review Report, High Quality Care for All
2009 NHS Constitution; Mid-Staffs Report on poor quality
health care; Care Quality Commission acquire from
Healthcare Commission; Financial stringency
2010- Equity and Excellence, liberating the NHS Healthy
Lives, Healthy People - public health White Paper
2011- Health and Social Care Bill
2012- Passage of Health and Social Care Act
2013- Restructuring of NHS; introduction of 111 emergency
phone system. NHS England receives warning in July
regarding budget cut of £30bn hole by 2020 in case of
failing to take a radical action
2014-NHS England Five Year Forward View. To assist
the transformation to deal with the financial issues and
maintain sustainability (Campbell, 2016).
2015-Greater Manchester decided to unite health and
social care budgets
NHS has been at the receiving end of several changes
since its inception in 1948. It has experienced
technology advancement, sophisticated surgery and
drug therapy. However, the most overwhelming change
has been the massive increase in the healthcare costs.
Since NHS works on the principle of “the greatest good
for the greatest number”, it becomes difficult for it to
handle the financial stringency. NHS promotes the idea
of reducing the need for healthcare by adopting
preventive approach instead of restorative. To maintain
with the workload NHS increases the staff numbers.
NHS recruited nearly 8000 nurses and doctors between
November 2014 and November 2016. Working
conditions were improved for the frontline staff. The
annual survey 2017 revealed NHS staff engagement
scores at their highest level in five years. Further it
improved workplace culture and employee support.
NHS maintains skill set and productivity of the NHS so
that the staff can adapt to rigorously changing
medicine. The Care Certificate was launched for new
healthcare assistants and social care support workers
laid down15 standards which mentioned basic skills,
knowledge and behaviors needed to give safe, efficient
and compassionate service.
NHS England functioning has progressed in three
separate periods after its launch. The first period was
soon after the Health and Social Care Act was passed
in 2013 and 2014. It efficiently unrisked the economic
and operative change into a novel system, in which
Parliament distributed regulation of two-thirds of the
NHS budget to more than 200 new local groups. The
second period was in 2015 and 2016 in which NHS
used its independence and system leadership role to
outline an organized course based on the wide
consensus for the NHS. After the rolling out of the Five
Year Forward View, particular national development
proposals were formed with key partners for urgent and
emergency care, oncology, mental health, primary care,
and maternity services. NHS was able to gain effective
results in these areas as laid down in the Plan. Third
period is marked in 2017 in which the emphasis was
put on switching to assisting provision and execution of
the key priorities mentioned in this Plan.
NHS shows deflection that is it denies treatment of a
person or bear his/her expenses and rather it
redirects him/her to another place. The deflection for
funding or care provision can be done to another
funding source or to another NHS. NHS deflected to
another NHS when major NHS teaching hospitals
denied the acceptance of patient referrals from
outside their local region, despite the fact that they
are binding through contract to take patients referral
from throughout the England. Deflection also takes
place when patients who failed to seek an
appointment with GP get treatment in different
department like an accident and emergency (A&E)
department. NHS deflects to local authorities by
wrongly declining the applications for Continuing
Health Care (CHC) funding.
Further, the funding impacts by delaying the process
of care by NHS including diagnosis and treatment as
NHS finds it challenging to hire staff or fund the
premises and equipment required to meet the care
demands of everyone within appropriate time. The
length of waiting time in accident and emergency
(A&E) departments has increased. It occurred as
hospitals are stretched, there is lack of beds and lack
of services outside the hospital so the patients can
be discharged early. NHS also gets effected as it
faces delay in leaving patients from the hospital. Due
to shortage of staff, patients face difficulty in getting a
GP appointment have been widely reported in the
press.
Another effect of the funding is seen as denial in
which the patients are unable to get treatment as
their local health commissioner does not approve
funding, or their health care provider believes it to be
unsuitable. As a part of cost-saving plan, there was a
reduction in inpatient mental health bed numbers
which caused
some people with mental health issues unable to get
accessibility to the inpatient treatment required by th
em during a crisis
. It was reported that NHS lowered its use of low-
value treatments after the reduction in funding
growth in 2010.
NHS also manages the effect of funding through
selection in which patients might be refused the
treatment as they are unable to meet specified
eligibility criteria. Another approach is deterrence in
which NHS either knowingly or unknowingly create
barriers for so that patients may find difficulty in
finding out or booking appointments.
Another approach is dilution in which patients get the
fundamental treatment, but due to funding cut, the
resources are disseminated more thinly which may
reduce the quality of care. Due to slowdown in
funding, the appointments are shorter or less
frequent due to the lack of the capability of NHS to
employ more staff. There are some areas like district
nursing and mental health services of the NHS
where acute shortage in the staff and rising demand
of the patient resulted in a compromised quality of
The National Health Service began on July 5, 1948 as
shown in Fig. 1. The core idea behind formation of NHS
was that healthcare must be accessible to all
irrespective of their financial status. A view emerged
before formation of NHS that health care was a right
rather than irregular charity grant. The view that the
existing healthcare services were chaos and required
sorting was agreed bipartitely. When Second World War
occurred, a need for building an emergIn 1930s several
documents were generated by a range of political and
healthcare forces such as BMA. The King's Fund and
the Nuffield Provincial Hospitals Trust were also involved
as they advocated for the future which was voluntary
and efficient. The Beveridge Report (1943) laid down
ideas for the UK after the war and diseases were
identified as one of the main challenges faced by the
population of UK. ency medical service as part of the
war was realized. The tragic impact of the war prompted
a huge change of the structure instead of modifying the
existing system.
These basic reasons led to the creation of NHS but its
establishment has seen a debate over whether this
reform had a wide consensus existed or it was the result
of dispute between advanced and intolerant parties
(Gorsky, 2008). Klein is a historian who believed that
NHS was an outcome of the broad consensus by
remarking the association of paternalistic officials and
medical technocrats who advocated restructuring and
integration. Webster has suggested that NHS is the
result of conflict between the Labour Party which got
support from public and more conservative forces
(Gorsky, 2004).
Fig. 1 (Nuffield Trust, 2012)
The finances of NHS finances are on the verge of crisis. Since
2010, there has been an extraordinary reduction in funding and
increasing demand have made it more challenging for NHS to
sustain within its means. These financial changes affect the NHS in
numerous ways. The reduction in the expenses were expected to
be made by improving the service quality and effectiveness which
involved lowering the implementation of useless, overdone, or
unsuitable procedures.