National Health Service - Core Principles - Case Study Example

On 5 July 1948, the National Health Service (NHS) was launched with ambitious expectations and purpose. For a century the goal of providing access tohealth care for all was argued as a necessary element in civilized society. Beginning in 1948 with three core principles, post-war Britain and the NHS set out to slay at least one of what Beveridge called the "five giants" of want, disease, squalor, ignorance, idleness. (Beveridge, 1955: 312) Today, we take the NHS for granted, but it is only 60 years ago that health care was a luxury only the well-off could afford. It is difficult for us to imagine what life was like without ‘free’ health care. The difference it has made in people’s lives in incalculable. Poor people who previously went without medical treatment now have access to services. They no longer have to rely on home remedies for relief, or the kindness of doctors applying their Hippocratic Oath for free-of-charge services. Yet despite its noble intent, NHS since the very beginning has been confronted with ever increasing costs and other financial realities common and expected in any centrally funded service operating in an otherwise private economy. This paper traces the evolution of the system from its three stated core principles of 1948 through several metamorphoses to its current ten. The process of analyzing why they have changed reveals the changing nature of British universal health care itself, who it serves, and how well it serves them. From Three Core Principles to Ten The three core principles simply stated were: to meet the needs of everyone; to be free at point of delivery, and based on clinical need, not the ability to pay. (Wikipedia, Core Principles, 2010) While the principles continue to guide the service, in July 2000 a modernisation of the programme saw new principles added relevant to changing times and new ideas about health care, what it should entail and how that care should reflect current social and political thinking on a variety of issue. The main aims of these additional principles were clearly laid out and in total amounted to ten. The following are the ten as stated by Dudley Primary Care Trust (2007): provide a universal and comprehensive service with equal access for all, free at the point of use, based on clinical need, not ability to pay; help keep people healthy and work to reduce health inequalities; work continuously to improve quality and safety; strive for the most effective and sustainable use of resources; treat every patient with dignity and respect; shape our services around the needs and preferences of individual patients, their families and their careers; commit to equality and non-discrimination; support and value our staff; work in partnership with others to ensure a seamless service for patients, and respect the confidentiality of individual patients and provide open access to information about services, treatment and performance. Reading between the lines, the new principles were reflective of both modern technology and advances in the medical field as well as social and cultural considerations. Not only were the new principles designed to provide a wider range of services beyond basic health care, but the care itself was to conform better to the needs and preferences of individual patients, their families and careers and respond to the varying needs of more diverse populations brought about by the influx of immigrants, which occasioned the need for more and better support of the medical community and staff. A main goal was more access to preventative medicine that would not only control costs but provide a more equal health care experience among an economically diverse population. Whereas patients care was often cut off at a critical juncture in treatment under the old principles, efforts to ensure more seamless service were suggested along with respect for rules of confidentiality and access to more and better information regarding services and treatment available. (Wikipedia, 2010, National Health Service, England) Although Newdick wrote before the 2000 update, the author provides some interesting, prophetic and accurate insights into the reasons the additional principles were necessary in a modern health care system. He wrote: Another factor which gives rise to concern is our expanded perception of the conditions for which a visit to the doctor is appropriate. Consider our ideas of illness and health in 1946 when the health service was created. Medicine had recently undergone very rapid development... Originally, it may have been hoped that the creation of a National Health Service would tend to diminish the need for health care by reducing the incidence of ill-health in society... The growth of medical knowledge adds continually to the number and expense of treatments and, by prolonging life, also increases the incidence of slow-killing diseases. (Newdick, 1995: 4) In short, gone are the days when a physician, valise and stethoscope in hand, came to the home to tend a sick family member to provide basic care. Today’s technology and machines have drawn an at times circuitous [and expensive] route to diagnosis and up to the minute treatment. This being the case, to ensure, as the basic principle states, that that treatment is available to all requires new commitments. That quality of health care has also created an additional requirement and burden on the system, that of treating the elderly which, frankly, with access to current technology, are now being kept alive to an older age. Of the many principles, the ones aimed at the health needs of diverse groups relates directly to a stunning fact that Britain’s population has jumped significantly over the past decade, with most attributing the fact to the influx of immigrants. Certainly several of the added principles relate to this reality and the human and legal responsibilities of the country to provide equal access to health care for this rising population. And, as stated, the services provided must be done so with dignity, respect and non-discrimination. Many among this group are also of childbearing age, which means population statistics will continue to rise along with the concomitant costs of health care. Stated privacy principles protect illegal immigrants, resulting in health care provided at a national cost to thousands of individuals who are not technically “on the roles,” making it difficult if impossible to predict costs. Privacy also relates to HIV patients and others for whom the divulging of conditions may have dire affects on their lives. Work in partnership to ensure a seamless service for patients is a principle that obviously stemmed from the following Newdick description of how things used to be versus how they are today. “Previously...little difference was perceived between the relationship of individual doctors and their patients, and the NHS as an institution and its patients. In the modern system...doctors are no longer pre-eminent because aspects of their authority are shared with health service managers and resources are not at their complete disposal’ (Newdick, Introduction, 1995: ixi) Conclusion In conclusion then we have only to look at the last several decades and the changes wrought to understand the necessity for re-thinking basic principles which, while in the post-war 1940s seemed valid, today would seem woefully out of date and inadequate. That was a simpler time with simpler ideas about a many things, including health care, what it was and who provided it. In the modern day health care is a business operated by administrators—an expensive business at that. Obviously the new principles have placed additional burden on the system already financially stressed. And some years after they were announced the NHS finds itself facing ‘the biggest financial crisis in its history, requiring tax rises or large cuts to other government departments just to maintain its budget’ (Rose, 2009: para.1-2). The strain on its commitment to the ten principles should be obvious, and according to Rose (2009) has doubled the NHS budget in one decade since the 2000 modernisation of the programme. As of March 2010,‘NHS funding will only rise with inflation and the Department of Health must make substantial cost savings [f 4.35] under the government’s latest Budget’ (InPharm, 2010: para. 1). Given the above, who knows but the NHS might have to re-think its current principles--deleting, revising and customizing as necessity dictates. Bibliography Beveridge, (Lord) W. (1955). Power and Influence. New York: Beechhurst Press. Dudley Primary Care Trust. (26 April, 2007). Core Values Report: Appendix 1: 10 NHS Principles. 1-3. http://www.nhsdudley.nhs.uk/sites/documents/cms/428-2007-5- 11-4316552.pdf Free Republic. (25 March, 2010). Budget ‘will freeze’ NHS Spending. http://www.freerepublic.com/focus/news/2479486/posts Newdick, C. (1995). Who Should We Treat?Law, Patients and Resources in the NHS. Oxford: Clarendon Press Wikipedia. National Health Service, England: Core Principles. Updated May, 2010. http://en.wikipedia.org/wiki/National_Health_Service_(England)#Core_Principles Read More