National Health Service

From Academic Kids

The National Health Service (NHS) is the publicly-funded healthcare system of the United Kingdom. The organisation provides the majority of healthcare in the UK, from general practitioners to Accident and Emergency Departments, long-term healthcare and dentistry.

A peculiarity of the NHS compared to other public healthcare systems in Continental Europe is that not only does it pay for the health expenses, it also employs the doctors and nurses that provide them, and runs hospitals and clinics.



Historically, health care in the UK was not free: patients were required to pay for their own healthcare. Systems of health insurance were relatively undeveloped, so many of the poor were simply unable to obtain treatment when they were ill. Many charities were established to operate local hospitals, such as the Royal Free Hospital, and some local authorities operated local hospitals for local ratepayers, but provision was patchy and quality of care varied greatly. The mentally ill were often locked away in asylums, and the destitute elderly could end up in the workhouse.

A "Panel" system was set up in 1911 under the aegis of David Lloyd George (and the primary care records are still stored in "Lloyd George envelopes" although nowadays most working records in primary care are computerised).

In the aftermath of the Second World War, with a new spirit of social provision, Clement Attlee's Labour government created the NHS on 5 July 1948, under health and housing minister Aneurin Bevan, who based the NHS on a coal-miners co-operative that he had seen in operation in his home town of Tredegar. The same services would henceforth be provided by the same doctors and the same hospitals, but:

  • services were provided entirely free of charge at the point of use;
  • instead, services were financed from central taxation;
  • everyone was eligible for care (even people temporarily resident or visiting the country).

The original structure of the NHS had three arms: 14 Regional Hospital Boards, funding and overseeing hospitals; self-employed general practitioners, dentists, opticians & pharmacists; and various services provided by local authorities (such as health visiting and community nursing). In addition, private healthcare continued in parallel to the NHS.

Spiralling costs led to the introduction of a 5-shilling charge for prescriptions, and a 1 charge for dental treatment, in 1952.

The NHS was reorganised in 1974 to bring together services provided by hospitals and services provided by local authorities under the umbrella of Regional Health Authorities, with a further restructuring in 1982. Through the 1970s and 1980s, it became increasingly clear that the NHS would never have the resources necessary to provide unlimited access to the latest medical treatments.

In 1990, the NHS & Community Care Act 1990 introduced an "internal market" into the NHS, whereby Health Authorities ceased to run hospitals directly but instead "purchased" care from their own or other authorities' hospitals. Certain GPs became "fund holders" and were able to purchase case for their patients directly. The "providers" became independent trusts, which encouraged competition but also increased differences.


Responsibility for the NHS has been devolved to the component parts of the UK.


The NHS in England is managed at the top level by the Department of Health, which takes political responsibility for the service. It controls 28 Strategic Health Authorities (SHAs), which oversee all NHS operations in a particular area.

The SHAs supervise:

  • Primary Care Trusts (PCTs), which administer primary care and public health. There are 300 PCTs, which oversee the UK's 29000 GPs and 18000 NHS dentists. In addition, they oversee such matters as primary and secondary prevention, vaccination administration and control of epidemics.
  • NHS Hospital Trusts. These 290 organisations administer hospital and specialist care in the about 1600 NHS hospitals (many trusts maintain between 2 and 8 different hospital sites).
  • Ambulance Trusts
  • Care Trusts
  • Mental Health Trusts


In Wales, the Strategic Health Authorities are called Local Health Boards. A Welsh Trust will typically administer all hospitals in a region, as well as all care and mental health functions.


The Scottish Executive Health Department ( (SEHD) is responsible for health policy and the administration of the National Health Service in Scotland.

Northern Ireland

In Northern Ireland, the NHS is administered by the Department of Health, Social Services and Public Safety (

The Department is organised under a Permanent Secretary into several groups and one agency. These are the Planning and Resources Group, Strategic Planning and Modernisation Group and Primary, Secondary and Community Care Group and the 5 Professional Groups. The Department’s Executive Agency is the Northern Ireland Health and Social Services Estates Agency ( (known as Health Estates).

The five professional groups are


In addition to this hierarchy there are various internal bodies which have authority over particular matters. For example, the National Institute for Clinical Excellence (NICE) is an NHS body which produces guidelines and standards for healthcare.


The NHS was, and largely remains, a system of healthcare intended to be "free at the point of delivery" and paid for by taxes. Nigel Lawson, former Chancellor of the Exchequer once said that it was the national religion. Private medical care remained, and remains, available in the UK.

Contrary to popular misconception, the founding principles of the NHS called for its funding out of general taxation, not through national insurance. As of March 2005, the NHS has 1.3 million employees, and is variously the third or fifth largest employer in the world, after the Chinese 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 US Department of Defence. [1] ( [2] (,11032,1443862,00.html)

Political issues

The long-term future of the NHS and its day to day organisation are major issues in British politics, and the Secretary of State for Health is one of the senior positions in the British Cabinet. Though the Secretary of State and Department of Health (UK) deal with a much wider range of issues, the NHS dominates the department's remit and many government policies, such as anti-smoking and obesity campaigns are implemented by the NHS.

In recent times, UK politicians have being trying to reduce waiting times for surgery, however have failed to meet some of the targets they have set. Nevertheless, the NHS is respected worldwide, [3] ( as a role model for the welfare state.

The NHS' National Programme for IT - a large-scale project to renovate the use of Information Technology in the NHS in England (the Welsh equivalent is called Informing Healthcare) - has been criticised for substantial budget over-runs, from 6billion to a potential 30billion, [4] (,39020645,39169940,00.htm) as well as for a perceived lack of adequate patient information security. [5] (,39020330,39173812,00.htm) Furthermore, GPs and consultants have given the project a lukewarm reception, citing a lack of of consultation and excessive complexity. [6] (

See also

External links


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