National Health Service

National Health Service
Affordable Health Insurance Plans. Free Quotes, Expert Help, A+ Rated.
www.MostChoice.com

Health Services - $250 Food Debit Card
Get a Free $250 Grocery Card. Check Availability with Your Zip Code.
www.Food-Assistance.com

Affordable Worldwide Medical Insurance
Globalnsure.com is your source for international major medical health insurance, whether for a few days or a lifetime. Visit our site and buy online today.
www.globalnsure.com

Health Services Career Education
Find online and campus degrees. Find Health Services Degree programs and career training at DeVry University. Request complimentary information today.
devry-info.com

Health Service
Find Health Care Items & Services between 1 and 50 Miles of Your Area.
Local.com

International Health Service
Find and Compare prices on 1000's of items at Smarter.com.
www.smarter.com

Health Services Career Degrees
Find Health Services Career Training and Degree Programs at a University of Phoenix Campus Near You. Request Complimentary Information Today.
degrees4success.com

Health Degrees Online
Get Free Info & Earn a Top College Degree in the Health Field Online.
www.NexTag.com

$99/Mo Health Insurance
Health Plans from Blue Cross, Aetna Quick online approvals.
www.HealthInsurance99.com

Corporate Health Events
Call Nexus Health & Lifestyle for your next corporate health event.
www.nexushealth.net




Warning: mkdir() [function.mkdir]: Permission denied in /home/webs/affiliatelib2/CacheManager.php on line 12

Warning: mkdir() [function.mkdir]: No such file or directory in /home/webs/affiliatelib2/CacheManager.php on line 12

Warning: fopen(/home/templatecore2cache//*cluesnet.com/df/df74ec0cac3dda65a3a166af0d214adb4cdef23d.tc2cache) [function.fopen]: failed to open stream: No such file or directory in /home/webs/affiliatelib2/CacheManager.php on line 130

Warning: fwrite(): supplied argument is not a valid stream resource in /home/webs/affiliatelib2/CacheManager.php on line 131

Warning: fclose(): supplied argument is not a valid stream resource in /home/webs/affiliatelib2/CacheManager.php on line 132



. The information in this article describes the current English public health service.

300, coincidentally the same as the blue of the Flag of Scotland), is used on signs and leaflets throughout the NHS in England.

The National Health Service (NHS) is the public ownership health care system In the United Kingdom. Each of the four constituent countries of the UK (England, Scotland, Wales, Northern Ireland) have their own NHS, each of which are run along the same lines but are managed separately and operate without general discrimination toward citizens from each others' areas. This article predominently covers the NHS in England.

The NHS provides the majority of healthcare in England, including primary care (such as general practitioners), hospital, long-term care, ophthalmology and dentistry (NHS dentistry is done by dentists in private practice doing sub-contracted work for the NHS). The National Health Service Act 1946 came into effect on 5 July 1948; subsequently it has become an integral part of British society, culture and everyday life. The NHS was once described by Nigel Lawson, former Chancellor of the Exchequer, as "the national religion". Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used only by a small percentage of the population, and generally as a top-up to NHS services.

The large majority of NHS services are provided free of charge to the patient. The costs of running the NHS (est. £104 billion in 2007-8 ) are met directly from general taxation.

The government department responsible for the NHS is the Department of Health (United Kingdom), headed by a Secretary of State for Health (Health Secretary), who sits in the Cabinet of the United Kingdom.

The NHS is the world's largest, centralised health service, and the world's third largest employer after the Chinese army and the Indian railways.

History In the aftermath of World War II, Clement Attlee's Labour Party (UK) created the NHS as part of the "cradle to grave" welfare-state reforms, based on the proposals of the Beveridge Report, prepared in 1942 by the economist and social reformer William Beveridge.

The idea was that if Britain could work towards full employment and spend huge sums of money during the wartime effort, then in a time of peace equitable measures of social solidarity and financial resources could be redirected towards fostering public goods. This sentiment was widely shared, as the wartime hero Winston Churchill was decisively voted out in a landslide defeat in the 1945 elections. Although most of the British felt that Churchill's leadership during the war was commendable, there were a number of reasons which led to Conservative defeat in the elections following the war. One reason was that the public favoured a push for sweeping social changes that Churchill's Conservative Party vehemently opposed. The driving force behind this reformist agenda was popular enough, that eventually it constituted a 'Postwar Consensus' which continued virtually unchallenged until the early 1970's, no matter which party controlled the government.

The first problem for Labour's reform agenda began when the U.S. war with Japan ended, and the United States subsequently withdrew the funding that had sustained Britain during the war. At this point, Attlee realised that his plans for the rebuilding of postwar Britain and enacting widespread reform were in serious financial trouble. It wasn't until the Cold War began to escalate that the Americans initiated the Marshall Plan which helped rebuild Western Europe from physical and economic ruin. This allowed Attlee to continue moving forward with the "cradle to grave" reforms outlined in the Beveridge Report that his government had promised the British public.

Aneurin Bevan, the newly appointed Health Minister, was given the task of introducing the National Health Service. Bevan based his plan for the NHS on the Tredegar Medical Aid Society which was set up in his place of birth, and in fact, had been a member and later chairman of the Tredegar General Hospital Management Committee in the late 1920s. Doctors were initially opposed to the reform measure and even organized to try to fight against it. Bevan had to get them onside, as, without doctors, there would be no health service. Being a shrewd political operator, Bevan managed to push through the radical health care reform measure by dividing and cajoling opposition, as well as by offering lucrative payment structures for consultants. On this subject he stated, "I stuffed their mouths with gold." On July 5, 1948, at the Park Hospital in Manchester, Bevan unveiled the National Health Service and stated, "We now have the moral leadership of the world."

Dr. A. J. Cronin's highly controversial novel, The Citadel (novel), published in 1937, had fomented extensive dialogue about the severe inadequacies of health care. The author's innovative ideas were not only essential to the conception of the NHS, but in fact, his best-selling novels are even said to have greatly contributed to the Labour Party's victory in 1945.Colin Harrison and Philip B. Gough, "Conversations: Compellingness in Reading Research,"Reading Research Quarterly 31.3 (1996): 334-341. Millions of citizens had been unable to afford the privatized system and were disenfranchised from access to health care before the NHS. Now, every single person has access to quality health care that is financed through progressive taxation, that is, from each according to his ability to pay, to each according to his needs as a patient. To this day, the Labour Party (UK) still considers the creation of the publicly-funded National Health Service its proudest achievement.

Structure Organisation There are several types of NHS trust:

The NHS in England is controlled by the UK government through the British Department of Health. Some NHS agencies (e.g. NICE and Scottish Intercollegiate Guidelines Network) have influence in other parts of the United Kingdom. The service is generally known simply as NHS. Its structure is discussed in this article.

The NHS is managed at the top by the British Department of Health, which takes political responsibility for the service. It controls Strategic Health Authority (SHAs), which oversee all NHS operations in an area of England. There are 10 SHAs, coterminous the nine government office regions in most part, with the South East region split into South East Coast and South Central SHAs.

The SHAs are responsible for strategic supervision of the trusts in their area.

In addition, several Special Health Authority provide services and, in some cases, to the devolved NHS administrations. These include The Information Centre for health and social care, NHS Blood and Transplant, NHS Direct, NHS Professionals, NHS Business Services Authority, National Patient Safety Agency, National Treatment Agency and the National Institute for Health and Clinical Excellence (NICE).

Telephone support services are provided by the NHS:- NHS Direct 0845 46 47 Staff A feature of the NHS, distinguishing it from other public healthcare systems in Continental Europe, is that not only does it pay directly for health expenses, it also employs a large number of the doctors and nurses that provide them. In particular, nearly all hospital doctors and nurses in England are employed by the NHS and work in NHS-run hospitals.

In contrast General Practitioners, dentists, opticians and other providers of local healthcare, are almost all self-employed, and contract their services back to the NHS. They may operate in partnership with other professionals, own and operate their own surgeries and clinics, and employ their own staff, including other doctors etc. However, the NHS does sometimes provide centrally employed healthcare professionals and facilities in areas where there is insufficient provision by self-employed professionals.

As of March 2005, the NHS has 1.3 million workers, and is variously the third or fifth largest workforce in the world, after the People's Liberation Army, Indian Railways and (as argued by Jon Hibbs, the NHS's head of news, in a press release from March 22, 2005) Wal-Mart and the United States Department of Defense. The BBC quotes an alternative workforce of 1.33 million people in 2004.see discussion - dated reference has 1.46M in 2004 BBC "State of the NHS" - Staff Numbers

It should be noted that NHS workforce figures provided by the Department of Health include not only employees of NHS divisions but also local authority social services workers Department of Health - Statistical work area: workforce (retrieved 29 Jul 2007). The full-time equivalent figure for 2005 was about 980,000 staff.

Funding The commissioning system The principal fundholders in the NHS system are the NHS Primary Care Trusts (PCTs), who commission healthcare from hospitals, GPs and others and pay them on an agreed tariff or contract basis, on guidelines set out by the Department of Health. The PCTs receive a budget from the Department of Health on a formula basis relating to population and specific local needs. They are required to "break even" - that is, they must not show a deficit on their budgets at the end of the financial year, although in recent years cost and demand pressures have made this objective impossible for some Trusts. Failure to meet the financial objective can result in the dismissal and replacement of a Trust's Board of Directors.

Patient charges and prescriptions Access to the NHS and patient charges Except for set charges applying to most adults for medical prescription, optician services and dentistry, the NHS is free for all patients "ordinarily resident" in the UK at the point of use irrespective of whether any National Insurance contributions have been paid.

Those who are not "ordinarily resident" (including British nationality law who have paid National Insurance contributions in the past) are liable to charges for services other than that given in Emergency department departments or "walk-in" centres. This includes British citizens who work for a UK-based charity outside the UK (except in certain countries) for more than five years, regardless of their intention to return to the UK or payment of National Insurance contributions. These people are treated as overseas visitors even if they own property, return regularly or have family in the UK and regard their home country as the UK.

NHS costs are met, via the PCTs, from UK government taxation, thus all UK taxpayers contribute to its funding.

Exemption for missionaries who work abroad for a UK based organisation In England, from 15 January 2007, anyone who is working outside the UK as a missionary for an organisation with its principal place of business in the UK will be fully exempt from NHS charges for services that would normally be provided free of charge to those resident in the UK. This is regardless of whether they derive a salary or wage from the organisation, or receive any type of funding or assistance from the organisation for the purposes of working overseas. This is in recognition of the fact that most missionaries would be unable to afford private health care and those working in developing countries should not effectively be penalised for their contribution to development/other work.

Exemption for others There are some other categories of people who are exempt from the residence requirements such as specific government workers and those in the armed forces stationed overseas.

Prescription charges As of April 2007 the prescription charge for medicines in England is £6.85; people over sixty, children under sixteen (or under nineteen, if the child is still in full time education), patients with certain medical conditions, and those with low incomes, are exempt from paying. Those who require repeated prescriptions may purchase a single-charge pre-payment certificate which allows unlimited prescriptions during the period of validity. The charge is the same regardless of the actual cost of the medicine but higher charges apply to medical appliances. For more details of prescription charges, see Prescription drug#Regulation in United Kingdom.

However, the rising costs of some medicines, especially some types of cancer treatment, means that prescriptions can present a heavy burden to the NHS Primary Care Trusts whose limited budgets include responsibility for the difference between medicine costs and the fixed prescription charge. This has led to disputes in certain cases (e.g. over Herceptin), as to whether such drugs should be prescribed.

NHS dentistry NHS dentistry is not as widely available as it once was, and the private sector has expanded to fill the gap. Where available, NHS dentistry charges from 1 April 2007 are: £15.90 for an examination; £43.60 if a filling is needed; and £194 for more complex procedures such as crowns, dentures or bridges.. About 50 per cent of the income of dentists comes from work sub-contracted from the NHS.

Financial outlook As each division of the NHS is required to break even at the financial year-end, the service should in theory never be in deficit. However in recent years overspends have meant that, on a 'going-concern' (normal trading) basis, these conditions have been consistently, and increasingly, breached. Former Secretary of State for Health Patricia Hewitt consistently asserted that the NHS will be in balance at the end of the financial year 2007-8; however, a study by Professor Nick Bosanquet for the Reform think tank predicts a true annual deficit of nearly £7bn in 2010.

NHS policies and programmes Reforms under the Thatcher government The 1980s saw the introduction of modern management processes (General Management) in the NHS to replace the previous system of consensus management. This was outlined in the Griffiths Report of 1983.{{cite book | author=Manfred Davidmann| title=Reorganising the National Health Service: An Evaluation of the Griffiths Report | edition=Second edition | year=1985 | id=ISBN 0-85192-046-2 | url=http://www.solbaram.org/articles/nhs.html--> This recommended the appointment of general managers in the NHS with whom responsibility should lie. The report also recommended that clinicians be better involved in management. Financial pressures continued to place strain on the NHS. In 1987, an additional £101 million was provided by the government to the NHS. In 1988 the then Prime Minister, Margaret Thatcher, announced a review of the NHS. From this review and in 1989, two white papers Working for Patients and Caring for People were produced. These outlined the introduction of what was termed the "internal market", which was to shape the structure and organisation of health services for most of the next decade.

In 1990, the National Health Service & Community Care Act (in England) defined this "internal market", whereby Health Authorities ceased to run hospitals but "purchased" care from their own or other authorities' hospitals. Certain GPs became "fund holders" and were able to purchase care for their patients. The "providers" became NHS Trust, which encouraged competition but also increased local differences.

The Blair government These innovations, especially the "fund holder" option were condemned at the time by the Labour Party (UK); opposition to what was claimed to be the Conservative Party (UK) intention to privatise the NHS became a major feature of Labour campaigning in the 1997 and subsequent British elections. Although the incoming government of Tony Blair (1997) stated its intention to remove the "internal market" and abolished fundholding, in effect the market was strengthened and fundholding reintroduced as part of Blair's ongoing reforms to modernise the NHS.

Driving these reforms have been a number of factors. They include the rising costs of medical technology and medicines, the desire to increase standards and "patient choice", an ageing population, and a desire to contain government expenditure. The National Health Services in Wales, Scotland and Northern Ireland are not directly controlled by the UK government and these reforms have not all been copied uniformly. (See NHS Wales and NHS Scotland for descriptions of their developments).

Reforms have included (amongst other actions) the laying down of detailed service standards, strict financial budgeting, revised job specifications, reintroduction of "fundholding" (under the description "practice-based commissioning"), closure of surplus facilities and emphasis on rigorous clinical governance and corporate governance. In addition Modernising Medical Careers has been restructured. Some new services have been developed to help manage demand, including NHS Direct. A new emphasis has been given to staff reforms, with the Agenda for Change agreement providing harmonised pay and career progression. These changes have, however, given rise to controversy within the medical professions, the media and the public. During 2005 and 2006 hospitals began to lay off staff as a consequence of these reforms and the financial stringency accompanying them, further adding to controversy.

The Tony Blair Government, whilst leaving services free at point of use, has encouraged outsourcing of medical services and support to the private sector. Under the Private Finance Initiative, an increasing number of hospitals have been built (or rebuilt) by private sector consortia; hospitals may have both medical services (such as independent Sector Treatment Centre), and non-medical services (such as catering) provided under long-term contracts by the private sector. A study by a consultancy company which works for the Department of Health shows that every £200 million spent on privately financed hospitals will result in the loss of 1000 doctors and nurses. The first PFI hospitals contain some 28 per cent fewer beds than the ones they replaced.

In 2005, surgicentres (ISTCs) treated around 3% of NHS patients (in England) having routine surgery. By 2008 this is expected to be around 10%. NHS Primary Care Trusts have been given the target of sourcing at least 15% of primary care from the private or voluntary sectors over the medium term.

Given ongoing redundancies within the NHS, accusations of staff cuts and "privatisation" are now made against the Blair government, often by NHS staff unions such as UNISON.

As a corollary to these intitiatives, the NHS has been required to take on pro-active socially "directive" policies, for example, in respect of Tobacco smoking and obesity.

The NHS has also encountered significant problems with the Information technology innovations accompanying the Blair reforms. The NHS's National Programme for IT (NPfIT), believed to be the largest IT project in the world, is running significantly behind schedule and above budget, with friction between the Government and the programme contractors. Originally budgeted at £2.3 billion, present estimates are £20-30 billion and rising. There has also been criticism of a lack of patient information security. The ability to deliver integrated high quality services will require care professionals to use sensitive medical data. This must be controlled and in the NPfIT model it is, sometimes too tightly to allow the best care to be delivered. One concern is that GPs and hospital doctors have given the project a lukewarm reception, citing a lack of consultation and complexity. Key "front-end" parts of the programme include Choose and Book, intended to assist patient choice of location for treatment, which has missed numerous deadlines for going "live", substantially overrun its original budget, and is still (May 2006) available in only a few locations. The programme to computerise all NHS patient records is also experiencing great difficulties. Furthermore there are unresolved financial and managerial issues on training NHS staff to introduce and maintain these systems once they are operative.

Criticism The NHS has frequently been the target of criticism over the years. Examples of such criticism include:

:Supporters of the NHS would argue that the rules are there to ensure that everyone gets treated by the same rules, and that in any case, health is not a consumable commodity like ice-cream. People do not get more sprained ankles or heart attacks just because health care is free at the point of use.

:Supporters of the NHS would point out that the NHS has wide public support and the UK population has as good a health outcome as many other similar countries, and often at much lower cost. Political pressure could work both ways, but the Blair government was elected in 1997 largely on a promise to invest more taxpayers money in health to bring spending closer to the European average. Most people would prefer to see gradual improvements within the current framework and be able to hold politicians to account for the service. This is the position of all the political parties, none of which has an agenda to replace or make a wholesale reform to the system. The mainstream right wing conservative party says its policies are aimed at "Protecting and improving our health service by putting patients back at the heart of the NHS, and trusting the professionals to ensure that they are able to use their skills to make the fullest possible contribution to patient care."http://standupspeakup.conservatives.com/Reports/PublicServices/DiscussionGuide.pdf. Even the ultra-right wing British National Party says that "socialised medicine is not just a hallmark of a decent society, but economically rational as well. If one leaves behind capitalist-romantic theories about private-sector efficiency and looks at real-world privatised medicine, which may be observed in America, it is an obvious disaster. It is vastly more expensive and delivers mediocre results outside of luxury care. Britain spends about 1/3 (!) the money per person and we have public health statistics roughly equivalent to America. Except for the fact that the bottom 1/4 of our population is vastly healthier." http://www.bnp.org.uk/articles/nhs_privatisation.html

:Supporters of the NHS would argue that these people usually do get value from the NHS because almost everyone uses their NHS GP and other health services such as screening, vaccinations etc. and that their opting out from time-to-time is effectively queue jumping because they are utilizing a resource ahead of someone in greater need and that their double payment is the penalty for queue jumping. The concept is well recognized and accepted in the field of public services such as libraries and state-funded schools -- that it is a civic responsibility for every citizen capable of paying legally applicable levels of tax, to do so, regardless of service use. Therefore, the public services can be subsidised for those who wish to use them -- economically, the more people who pay taxes, the less cost to each individual concerned.

:NHS supporters would counter that the access to services is fair to everyone and if the need is urgent it will bring that patient to the front of the queue. Those in the queue are those with less acute need. Patients dissatisfied with the queue can always choose to seek care in the private sector, albeit at their expense. Supporters might also point out that even in free market medicine paid for out-of-pocket or from insurance, there are also many people who are waiting or go untreated because they have to save for their care because their insurance is insufficient or they cannot afford to pay it. They would argue that in the NHS everyone needing treatment will get it eventually, but not everyone in a free market health care system will get what they need.

:Supporters would point out that there is not much evidence to support the argument that this is a problem peculiar to the NHS. Both C. Diff and MRSA are problems in British private hospitals, as well as other western healthcare systems. It is theorised that the increased use of strong antibiotics and disinfectants in modern society may account for the resistance of such a "superbug". Some in the UK argue that the introduction of private cleaning contractors into the NHS has been partly to blame as contractors try to cut costs and hygiene levels may have suffered because of this. There is not much evidence to prove the case either way.

:Supporters would point out that all new systems will have teething troubles and that these can be overcome. In private health care in the USA, there is even less computerisation and therefore little use of computerization to provide consistent data about patients and to check things such as potential drug interactions. A large organization such as the NHS can easily afford the overhead costs of developing and maintaining such systems whereas a fragmented system just could not contemplate doing so.

:NHS supporters would argue that the failings in dentistry are primarily because the NHS opts not to get heavily involved and would argue that this implies more NHS investment in dentistry is required not less, and that this would pay dividends in the longer run. Dentistry outside the NHS is effectively piece work and private dentists are incentivized to do unnecessary and expensive treatments.

:NHS supporters would argue that the NHS has a duty to ensure that taxpayers money is used wisely and such denials are effective controls. People can always choose to go private if the treatment is legally available in the UK or elsewhere.

:Supporters would argue that this problem has been controlled without the taxpayer having to fund the shortfall.

:Supporters would argue that there is nothing endemic about such issues which might equally have occurred in other types of health care establishments. They might also point out that the detection of such issues leads to better controls being established throughout the NHS for the benefit of all.

See also

References External links English NHS and related government sites

Shared and other UK health services and related government sites Shared by two or more countries

Northern Ireland

Scotland/Alba

Wales/Cymru Other sites

Further reading



NHS Choices
Official site of the National Health Service. Get expert information on conditions, treatments, local services and healthy living

NHSDirect Online and NHS.UK Maintenance
Websites down for Maintenance: The www.nhsdirect.nhs.uk website is currently down for essential system maintenance. We aim to have these services back and running normally as ...

NHS Careers
The National Health Service offers a huge range of exciting and challenging opportunities for people who are passionate about making a difference.

National Public Health Service (Wales)
Information on this service for Wales. A new organisation that brings together the public health resources of the five former health authorities.

National Health Service - Wikipedia, the free encyclopedia
England, Scotland, Wales and Northern Ireland each has a separate public healthcare system, established by separate pieces of legislation, that began operating on 5 July 1948.

National Health Intelligence Service
Information on the planning and delivery of healthcare by the National Health Service (NHS) in England. Includes an A-to-Z database about policies and disease conditions.

Welcome to the NHSLA
Enter the NHSLA site | Terms of use

National Health Services - Home
A WebsiteBuilder Website ... Welcome to National Health Services Complete Healthcare Cost Containment Solutions

Rheumatoid arthritis Introduction - Health encyclopaedia - NHS Direct ...
Rheumatoid arthritis is a condition which causes pain, swelling and inflammation in ... Common health questions; Self-help guide; Find a local health service; Mind & body magazine; Send a ...

National Health Service - Every Child Matters
Information on the NHS including National Service Frameworks. ... The aim of the National Health Service (NHS) is to improve the health and wellbeing of the population by promoting ...





 
Copyright © 2008 opini8.com - All rights reserved.
Home | Terms of Use | Privacy Policy
All Trademarks belong to their repective owners.
Many aspects of this page are used under
commercial commons license from Yahoo!