National Health Service: 1979 and Beyond - Coursework Example

National Health Service (NHS 1979 and Beyond The National Health Service (NHS) is the public health care system of the United Kingdom and was established in the year 1948. Before its inception the then government published a white paper in the year 1944 describing and outlining the structure and functions of the NHS. The paper also clearly stated the plan and the underlying principles of the organization. The Minister of Health Mr. Aneurin Bevan further elaborated on the three fundamental principles on which the NHS would base itself in his speech during the inauguration of the service. The principles are as follows: The service should be universal offering equal and uniform standards of service to everyone in the United Kingdom. The health care offered by the NHS should be a comprehensive one able to satisfy all the health needs of the people. The health service should be free to all the citizens and should be administered based on the medical need of the people and not on their financial status and ability to pay for the medical service (Higgins, 1988, p13-14). There is no doubt that the NHS was based on lofty principles and successive governments both the conservatives and the labours have tried hard to maintain the standards sometimes with success while sometimes struggling to maintain the basic principles that the NHS was originally based on. This essay details the changes that the NHS has undergone and how far these changes have shifted the health service from its underlying principles from the year 1979. In the year 1979 the conservative government came in to power and introduced two changes in the NHS which has had a significant effect over the years. The administrative and management structure of the NHS was completely overhauled in order to provide better service to the public. The new structure consisted of three tiers after eliminating the middle tier of administration to reduce bureaucracy and to speed up decisions. Also, the non clinical services of the NHS were outsourced to various companies to reduce overhead costs (Leathard, 2001). In October 1983, the Griffith report on NHS management was published which clearly and directly pegged all the problems that the NHS was facing to ineffective management. The report suggested that the NHS should be run like a business and trusts should be set up for providing service to the patients (Levitt, Wall and Appleby, 1999). The report also suggested that the NHS should be governed by a management board functioning under a supervisory board. The board should be vested with the powers to formulate objectives and take strategic decisions. Also the report proposed various levels of hierarchy with a general manager at a district level and various other lower levels for individual hospitals. The report emphasised that the NHS should be run on a business setting with set objectives, performance evaluation and assessing the effectiveness of the service provided to the patients (William, 1994, p.45). A white paper in the year 1987 by the Conservatives set out a new contract for the general practitioners thus deviating from the earlier principle to treat patients according to their need and not on financial considerations. In the white paper that was published in the year 1989 “Working For Patients” (WWP) the government attempted a less radical solution and announced that the NHS would be re-established on modern principles (Winnett & Devlin, 1989). The suggestions of the white paper were then constituted into a NHS and Community Care Act 1990. Under this law it was proposed to dissolve the single common NHS structure into constituent autonomous hospital units which would be given separate budgets to be used as generously as possible to deliver the best possible health care to the people competing in cost and quality with any other health care provider. The units can also behave like private companies generating either a profit or a loss depending on the services they offer. Both the WWP and the Act was responsible for major changes in the health services offered by NHS. The WWP created an internal market in which district health authorities would purchase healthcare on behalf of the local population from hospitals and community units who would be the providers of health care (Winnett & Devlin, 1989). The Community Care Act 1990 entrusted the responsibility for long term care to local authorities and provided an opportunity to increase the user charges through a means tested system. The guidance that followed the act required the NHS to introduce stringent and eligibility criteria, known as continuing care criteria, to ration access to the much reduced long term care sector in the NHS (Levitt, Wall & Appleby, 1999). The Community Care Act also made the NHS hospitals and other services like ambulances and community health services into semi independent trusts and they were forced to behave like businesses and the patient became a customer or consumer of health care (Department of Health, 1989). To become a provider in the health market organisations became independent NHS trusts with their exclusive management competing with each other to provide the required services. Structural reforms in the NHS were a result of the “Working for Patients” white paper which was submitted by the ministerial review established by Margaret Thatcher in 1988 after lack of funds in the NHS was blamed for the hospital bed closures and elective surgery cancellations. The review explored and rejected many options before focusing on the delivery of services (Stevens & Green, 2002, p.132).  A wider perspective of the country’s health problems was analyzed in The Health of the Nation (1992) which clearly listed out the diseases and conditions that might be cured due to the health promotion activities of the NHS. In the year 1997, the new labour government pledged to abolish the internal market. According to the white paper by Dobson (1997) the NHS service would be based on partnership and driven by performance and attempts were made to improve the NHS service by bringing about changes in the structure. In February, 1998 the government outlined a new strategy to tackle the causes of ill health. The government realised the impact of various factors such as poverty, poor housing, unemployment and pollution can have on the health of its citizens. The government aimed to end the inequalities in health between people in different occupations, ethnic groups, geographical areas and between men and women. The NHS plan 2000 and the government’s renewed impetus to reduce the inequality in health became one of the key targets for the NHS and the Department of Health in England (The Housing Investment Program Guidance, 2000). The Labour government introduced the patient satisfaction questionnaires to evaluate the health service offered by the NHS. This questionnaire attempts to gather the opinions of the patients from across the country and this demonstrated the variation in the standard of service. The variations explained how individual health care unit trusts spend their allocated budgets. Research has pointed out that people in certain areas of the society are in poor health as they have less money to spend on the illness and are less aware about their conditions. These areas have more number of people to treat too. Some treatments are widely available across the country whilst some of the treatments depend on where the patients live in the postcode lottery (Newman, 2001). The NHS was based on an idea that no one should be deterred from seeking health services due to lack of resources. However, there has been a lot of controversy surrounding the issue of prescription charges. When the Labour government abolished the prescription charges in the year 1965 the drugs bill of the NHS soared. However, the same government reintroduced the prescription charges three years later that too at higher rates than the previous charges to prevent unnecessary prescribing of medicines and reduce the costs for the NHS. The prescription costs have also been subsequently increased every year since 1982. Many health groups claim that the high cost of prescriptions has had severe repercussions on the health of the people as they are unable to pay for their medicines. The range of exempt conditions has been widely criticised and not been updated since 1968. The present co-payment system has come under a lot of fire. Patients have the option to pay for medical treatment which the NHS considers too expensive to be done for free. However, the government is seriously reviewing the rules after a patient who paid for his bowel cancer treatment died. However, the ministers have been defending the policy saying that scrapping the system would lead to a “two-tier” NHS in which the wealthy have access to better health care. However, “top-ups” or a facility where a patient can pay for a private room already exists in some hospitals (Winnett, 2008) This co-payment system endangers the founding principle of the NHS that health care should be free and equal for all. If in practice the NHS has failed to deliver an equal service to all members of society, co-payments will legitimate existing social inequalities. Private health care providers have existed in the British health system from the 1950’s. Between the British United Provident Association (BUPA), Private Patients Plan (PPP) and the Western Provident Association (WPA) they had over 56,000 subscribers which increased to nearly 6,524,000 in the year 1991 representing nearly 12% of the population which keeps on increasing every year (Calman, 1991). The Labour government has said that it will continue to privatise the NHS delivery system, staff and services by handing taxpayers’ funds to multinational companies and remodelling the service along the lines of US healthcare (Henwood, 1990). The labour government has a series of plans such as introducing a voucher system for people caring for the elderly and disabled, the “franchising” of NHS services to private contractors and the creation of “public interest companies” — similar to independent charities — to run hospitals. If these proposals are accepted they would be included in the Labour party’s next election manifesto (Hughe, 1991). The conservatives have broken the consensus that has existed around the NHS for the last 60 years- that there should be equal access for all, based on clinical need and not ability to pay. It highlights the conservative preference for people having to pay for private health care over public provision. This means that, for the first time, they have made clear that people will have to pay to get the basic health care they need. Conclusion: Traditionally the NHS service was provider orientated rather than consumer in the way in which its services were provided. The conservatives in the year 1979 aimed to improve the health service and maintain the same standards throughout the United Kingdom. Their modification of the structure and management of the NHS converted NHS into a business with patients becoming customers. Budgets were set but utilised differently in different trusts and subsequently the services provided also varied in different parts of the UK. This contradicted the principle of maintaining the same standard of health care throughout the UK. Patient satisfaction questionnaires proved the variation of standards in health service. The NHS 2000 tried to tackle the inequalities in the areas which lacked funds. The post code lottery also showed how health care varied depending on the place of the living. When the Community for Care Act was developed, complications arose during its testing. Also co payments were abolished and then re introduced at a higher rate. Top ups for medications are a big dilemma as the drugs are sometimes not available unless extra payments are made. Subscribers to private health insurance have been increasing every year. The NHS has completely deviated from its fundamental principles and the principles which sounded too good to be true in the 1948 Aneurin Bevan’s speech has now become an impossible task for the NHS to live up to. List of References: Dobson, F. (1997) The new NHS – Modern, Dependable. Cm 3807, London, HMSO. Hughe, M (1991) Fierce competition proves a headache for private sector. The Guardian, 30 November. Henwood, M. (1990) Community Care and Elderly People, Policy, Practice and Research Review, FAMILY POLICY STUDIES CENTRE. Levitt. R, Wall. A. and Appleby. J. (1999) The Reorganised National Health Service. 6th ed. Gloucestershire, Stanley Thornes (Publishers) Ltd. The Health of the Nation (1992) A strategy for health in England.  Cm1986, London , HMSO.  The NHS Plan (2000) A plan for investment, A plan for reform. London, HMSO Winnett, R. and Devlin, K. (1989) Working for Patients. London, HMSO. Williams, F. (1994) Social Policy: A Critical Introduction. 2nd ed. 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The NHS is suffering a haemorrhage of the well-off from which it may not recover. The Guardian, 19 September. Joan, H. (1988) The Business of Medicine: Private Health Care in Britain. Basingstoke, Macmillan Education Ltd, pp. 13-14. Jonathan, M. (2008) Examining co-payments on the NHS. In: National Assembly for Wales, June 25, 2008. Read More