Development of the NHS - Essay Example

The history of NHS The development of the NHS was slow - continuing over possibly fifty years or even more. Gradually more from the middle of the 19th century people started believing that entrance to health care was an element of the structure of cultured society. Organizations such as the London County Council came to consider this from a premature stage. The generous had donated to to charities, such as the King's Fund, or left money for the support of their neighboring hospital. The medical occupation in the nineteen thirties had created a most important report on a national hospital service. We take the National Health Service for established now, but it is just a little over 50 years ago that health care was a luxury not everybody could pay for. Immediately before the formation of the NHS, the services obtainable were the same as after; no new hospitals were built nor hundreds of new doctors engaged. Admission to a doctor was free to workers, who were low-paid, but this didn't necessarily cover their relatives, nor did it cover workers with an improved standard of living. Hospitals took money for services, although from time to time poorer people would be compensated. Yet, it often implied paying for the service in the first place - which not everybody could have the funds for. The necessity of free of charge health care was widespread, but it was not possible to reach with no support or resources of the state. After the Second World War there emerged a large need for military hospitals where soldiers could get medical care. After a while, NHS was established .The NHS worked according to the principles different from anything that had gone before in the UK, and not many other countries pursued these. First of all, the service was financed almost 100% from governmental taxation. The wealthy thus paid more than the poor for similar benefits. Then, everybody was entitled for care, even people temporarily resident or those who were visitors of the country. Anyone could receive medical care at any hospital, local or more remote. In addition, care was completely free at the point of use, even though prescription charges and dental charges were introducedlater. Finally, organization was based upon 14 Regional Hospital Boards that supported and managed more local hospital management committees. "It was a momentous achievement and everybody wanted the new service to work. However, food was still rationed, building materials were short, there was a dollar economic crisis and a shortage of fuel. The war had created a housing crisis - alongside post-war re-building of cities, and the designation of overspill areas, the New Towns Act (1946) created major new centres of population and all needed health services" (Dobson, Milburn, Reid, 2002, par. 4). The allocation of services was poor, with main hospitals in big cities but poor services in countryside. In some large counties there were almost no professional services at all. The NHS was established just at the time when immense improvement was happening in the availability of drugs. Antibiotics, better anaesthetic agents, cortisone, drugs for the treatment of mental disease such as depression, good diuretics for heart failure, and the antihistamines all became obtainable. These improvements, as well as better radiology systems, increased the cost of the NHS when treating the lot of the patient. Financial problems were considerable. It had been difficult to cost in advance the day-to-day costs of the newly established service and expectations of people increased. In future this problem was solved with the extension of founds and financing from the government and creating of the insurance system. A few years ago, at the beginning of 50s, a new service was established. Each family received a family doctor or general practitioner (GP). After that, as now, the family doctor worked as gatekeeper to the rest of the NHS, referred patients to proper hospitals or specialist treatment and prescribing medicines. During the period of 1958-1968, the NHS was settling down. Treatment was developing because improved drugs were discovered. For the duration of this decade polio vaccine became available, dialysis for chronic renal failure and chemotherapy for certain cancers were developed, all adding to costs. Also there appeared GPs' Charter, a new agreement that provided financial motivation for practice development, and an extensive review body award greatly increased GPs' morale. Practices gradually became better housed and better staffed, motivating doctors to unite in partnerships and groups and the expansion of the modern group practice. In 1968, medical and organizational optimism took place in the NHS, but financial inflexibility after the oil crisis of 1974 and the seven-day war slowed the growth rate of the NHS. Morale increasingly receded until, by 1977, a variety of factors had combined to take the third decade to a discouraging close. Nevertheless, medical evolution continued, including advances together with the increasingly broad application of endoscopy and the beginning of CAT (Computerised Axial Tomography) scanning as the service's investigative armory was expanded. Also transplant surgery was developing, which gave a large number of people an opportunity to survive. Government's Hospital Plan provided new hospitals giving more people better service with wider range of treatment. The management of hospital nursing services was altered by the Salmon Report (not to everyone's agreement) and nurse training by Briggs, whilst the development of information technology made the first steps in health service computerization and clinical financing. In 1974 "Regional Health Authorities covering in theory all three parts of the NHS replaced Regional Hospital Boards. A new tier of Area Health Authorities intervened in most places between the regions and district health authorities that managed the hospitals"( Dobson, Milburn, Reid, 2002, par.8). Advantages: Health Authorities were to arrange all services for first time and collaborate with local authorities, according to the theory a more useful organization. Disadvantages: the new organization was too complicated and managerially driven. The percentage of private practices was increased, but the situation of medical care was worsening due to the fact that inflation in the country had reached by that time 26 per cent and people often were hardly able to afford expensive private consultation. At the beginning of 1980s the NHS became a victim of its own achievements. New technology was applied and more people were treated according to more complex methods. This caused both increasing expectations of the health service and an ever more elderly population more and more complicated health needs. Financial problems continued existing, since the demands in qualified nursing and medical staff (and thus financial demands) were increasing, Up to the beginning of 1990s health authorities all through the country had been in debt, waiting lists were expanding and hospital wards were being closed - in spite of evidence of higher expenditure, stable increases in staff numbers and the treatment of more patients. Both the public and the health care professionals were dissatisfied and the service was progressively more subjected to examination in the media. The NHS had the most important cultural shift since its setting up with the introduction of the so-called internal market, designed in the 1989 White Paper, Working for Patients, and which passed into law as the NHS and Community Care Act 1990. They had been planned to enlarge the responsiveness of the service to the customer, to promote innovation and to challenge the monopolistic pressure of the hospitals on a health service in which services in the community were even more important. In 1990, 'Health Authorities would cease to run hospitals directly and 'purchase' care for their populations from 'providers' (hospitals / other health organisations). GPs offered 'fund holding budgets' to purchase some care' (Dobson, Milburn, Reid, 2002, par.10) . By 1995, all health care was offered by NHS trusts. The era of Information Technology began in 1998 Information for Health: An Information Strategy for the Modern NHS was created in September 1998. Among other things, the document promised to provide: Electronic Health Records for everybody in the country; online access to records of the patients and support on best clinicaltreatment, for all NHS clinicians. In addition, there was mentioned an electronic lobrary for health and fast access to the information and online advising for clients. Of course, activating the huge potential of IT was and is most important to bringing to life the vision of a modern NHS. But it was only with the publication of the 10-year NHS plan in July 2000 .The NHS Plan included: 'More hospitals and beds More doctors and nurses Much shorter waiting times for hospital and GP appointments. Cleaner wards, better food and facilities in hospitals Improved care for older people Tougher standards for NHS organisations and better rewards for the best' ( The NHS from 1998 to the present, 2005, par.3) Also the plan icnluded so-called 'patient-led health service', built on the preferences of the customer. In April 2001 'Shifting the Balance of Power' was started to give greater authority and decision making power to patients themselves. The main aspect of the change was founding in 2002 of locally-based Primary Care Trusts - institutions which control 80 per cent of the NHS funds and have the role of running the local NHS and developing the health of people in their areas. At the same time, 28 new Strategic Health Authorities replaced the previous Health Authorities and got a strategic role in developing regional health services, whereas also ensuring local NHS organisations are working well. In October 2003 general practicioners in England voted in for a new agreement, the purpose of which was rewarding them more fairly so that more NHS patients receive improved health care due to their skills, whilst also motivating them to accept new ways of working in, for example, multi-disciplinary teams. In April 2004 new agreements were presented also for local family practices, followed by new, increased funding for local health services. The new contracts implied, first of all, that practices are to be appreciably rewarded for the quality of care they provide and not only the numbers of patients they deal with. In August 2004 early patient Choice pilots were expaded giving all consumers waiting longer than six months for their surgery a choice of an alternative place for medical care. This was known as 'choice at six months'. By the end of 2005, everybody referred by their doctor for hospital treatment are to be provided a range of at least four hospitals and be able to decide on a time that is suitable to them. In December 2004 - the new Agenda for Change pay system started national roll-out. Planned for nurses, ambulance staff and all other directly employed NHS personnel (except doctors, dentists and some chief managers) the new system makes sure that all payments are fair and gives more chahces to succeed in career-growth. For the first time employees are paid on the basis of the work they are doing and the skills and knowledge they use to this practice. A new Knowledge and Skills Framework motivates nurses and gives them more chances to progress by accepting greater responsibilities. This encourages directors to design jobs around patient and staff needs, developing overall patient care and the jobgratification. The new system also implies standard arrangements for hours, annual leave and overtime. Bibliography 1) Dobson, Milburn, Reid, 2002. Short NHS History. http://www.nhshistory.net/short_history.htm 2) The history of the NHS number, 2004. http://www.nhshistory.net/nursing.htm 3) The NHS from 1998 to the present, 2005. http://www.nhs.uk/England/AboutTheNhs/History/1998ToPresent.cmsx Read More