Analysis of the National Health Service: Historical and Current Issues

This report offers a comprehensive overview of the National Health Service (NHS), tracing its origins back to the post-World War II era and the social and political factors that led to its creation. It details the NHS's funding mechanisms, primarily through taxation and user charges, and explores the initial tripartite structure and subsequent reforms. The report examines key changes, including the Health and Social Care Act of 2012, and the shift towards local and national level organizations. It highlights the impacts of these changes on both service users and providers, including financial pressures, restrictions on access, and challenges faced by healthcare professionals. Furthermore, it discusses the ideological underpinnings of the NHS, its evolution, and the challenges it currently faces in maintaining its core values of universal healthcare access.

NATIONAL HEALTH SERVICE
Name
Institution Affiliation

 National Health Service is an all-inclusive public-
health service that operates under the
government.
 It was established in 1946 through the National
Health Service Act (Bump, 2015).
 Health services are free for the whole Britain’s
population except some certain minor charges.
 Health services are provided by three groups.
 The NHS is primarily financed by taxes and other
small contributions and patient fees (Bump, 2015).
Introduction

 The Great Depression of early 1930’s was a major
factor that saw many Britain people unable to
afford basic healthcare that they dearly needed.
Many were in adverse poverty (Garland, 2016).
 The end Second World War also saw many
people, both soldiers and civilians who were in
great need of healthcare services but could not
afford it. Food was rationed and children
withdrawn while all aspects of national lives were
under government control (Sturgeon, 2014).
Social factors

 The Old Age Pension act of 1908 was the first state
pension funded through general taxation.
 The National Act of 1911 provided lower paid families
who earned less than E160 with compulsory insurance.
 A maternity benefit was offered and free medical care
provided by the government, employer and employee.
 Lord Dawson’s report of 1920 to the minister of health
on a detailed need for a health facility that is cohesive
and unified.
 William Beveridge in his 1942 report he vowed that he
would get rid of disease, ignorant, idleness and squalor
out of Britain (Bump, 2015).
 Later Clement and Bevan oversaw the introduction of
NHS.
Political factors

 In 1906 the liberal party came with an ideology of removing
chains of poverty. Asquith was responsible for the reforms
in the house of lords.
 In 1945 when Labour took over government, Bevan MP and
Clement PM used Beveridge report of 1942 to come up with
their ideology of universal healthcare system (Hanley, 2018).
 The NHS ideology came as post-war aspirations expressed
by Beveridge to slay evils of ignorance, disease, want,
squalor and idleness.
 The idea of Labour was to offer people with free and an all-
inclusive health system that can improve the health of both
the poor and the working class (O’HARA, G.L.E.N. and Gosling,
2014).
Ideological factors

 National Health Service is primarily financed by general
taxes and general insurance contributions. General
taxation accounts for around 80% of NHS funding.
 Other funding are from user charges which are from
dental treatment, prescriptions, and spectacles.
 It also gets income from land sales and parking charges.
 Since its transformation in 2013 the payment system is
controlled by legislation.
 The responsibility of pricing was moved from Department
of Health by the Health and Social Care Act of 2012.
 The pricing responsibility is now shared by NHS England
and NHS Improvement (Hunter, 2016).
Changes of funding of NHS

 Initially, the structure of NHS had a tripartite
system which was made up of these services;
1. Hospital services organized into regional hospital
boards.
2. Primary care that included dentists, GPs and
opticians.
3. Community services that entailed ambulance
services, maternity, child welfare and
vaccination(Sturgeon, 2014).
 Later medical professionals called for a unified
system and was enacted in 1962 by health
minister(O’HARA, G.L.E.N. and Gosling, 2014).
Initial structure of NHS

The Health and Social Care Act of 2012 introduced major
structural reforms to NHS. It is now divided into organizations
working at local and national level.
 NHS providers, CCGs, local authorities and other care
services came together to form a 44 STP ‘footprints’ in
December 2015. These are the areas controlling planning
and delivery of health care and overseeing all areas of NHS
spending on services from 2016-2021.
 Eight areas in England have changed into liable care
systems since mid-2017. commissioners and providers are
taking the responsibility of the budget to offer unified
services to the population (Hunter, 2016).
 Since April 2016 leaders in greater Manchester have taken
control of health and social care budgets of the area.
Changes of NHS structure

NHS has undergone rapid changes in the recent
years. The changes have often been described as
reforms, meaning improving its services. Either many
changes are destroying it by turning it into a
competitive market, making its services privatized,
allowing private companies make profit from a tax-
funded system and in turn bringing about inequalities
of access to services (Appleby, Galea and Murray, 2014).
Patients can be affected by financial pressures.
Restrictions on access to care through deflection,
delay, denial, selection deterrence and dilution can
have huge impacts on patients and their families.
Impacts of changes to the
service users

 In the White Paper, the government cited an increase in
role for GPs and general practices in promoting health
and preventing disease. This was brought about by the
coalition government.
 The NHS Commissioning Board is focused on prevention,
that is preventing illness and staff using every contact
with people to help them stay in good health.
 HWBs have been given a coordinating role which is
questionable how long will they take to fulfill the
mandates placed upon them.
 In district nursing reduction in staff numbers have led to
workload pressures. Many necessary activities are left
undone due to lack of time (Martin, et al, 2015).
Impact of changes to
providers

NHS came into being due to a ideal that good
healthcare should be available to all people, both
rich and poor. It came as a result of socio-economic
and political issues during the first and second
world war. Its funding would be directly from
taxation. The Labour government contributed much
in the formation of NHS. Either drastic changes
have been happening to the system which has seen
many challenges facing it. The Act of 2013 has seen
pressure amounting towards the healthcare system
resulting into many challenges. Both the providers
and the patients are faced by challenges each day.
conclusion

Appleby, J., Galea, A. and Murray, R., 2014. The NHS productivity challenge. Experience from the front line. London:
The King’s Fund.
Bump, J.B., 2015. The long road to universal health coverage: historical analysis of early decisions in Germany, the
United Kingdom, and the United States. Health Systems & Reform, 1(1), pp.28-38.
Garland, D., 2016. The welfare state: a very short introduction. Oxford University Press.
Hanley, J., 2018. Health visitors as agents of change. Journal of Health Visiting, 6(7), pp.362-362.
Hunter, D.J., 2016. Desperately seeking solutions: rationing Health Care. Routledge
.
Martin, G., Beech, N., MacIntosh, R. and Bushfield, S., 2015. Potential challenges facing distributed leadership in health
care: evidence from the UK National Health Service. Sociology of health & illness, 37(1), pp.14-29.
O’HARA, G.L.E.N. and Gosling, G.C., 2014. Healthcare as nation-building in the twentieth century: The case of the
British National Health Service. In Healthcare in Private and Public from the Early Modern Period to 2000 (pp. 137-155).
Routledge.
Sturgeon, D., 2014. The business of the NHS: The rise and rise of consumer culture and commodification in the
provision of healthcare services. Critical social policy, 34(3), pp.405-416.
References