What is the NHS?
The National Health Service (NHS) is the publicly-funded health care system of the United Kingdom. It is made up of four semi-independent systems:
- NHS England
- NHS Scotland
- NHS Wales
- Health and Social Care in Northern Ireland
The NHS is part of the welfare state that was fostered by the Labour Government that came into office in 1945. It was created by the National Health Service Act 1946, the brainchild of pioneering Health Minister Aneurin Bevan.
It was one of Bevan’s founding principles that the NHS should be funded by general taxation as well as National Insurance contributions. It’s the reason why health services (like going to the doctor, having surgery or being treated in hospital) are free at the point of use in the United Kingdom.
Countries without free healthcare normally fund their healthcare systems privately, often through personal health insurance. Private healthcare does exist in the UK, but only accounts for a very small amount of healthcare provision.
What was Healthcare like Before the NHS?
In 1911, the Prime Minster David Lloyd George introduced the National Insurance Act. This Act was designed to partially fund healthcare for working people. A small amount was deducted from weekly wages, and together with employer and government contributions this meant that the worker was entitled to medical care, retirement and unemployment benefits.
However, medicines still had to be paid for. And since women and children were much less likely to be legally employed, they were mostly not entitled to free medical care — a major flaw in the system.
Various calls for state-subsidised healthcare were made by politicians over the years, although there was also much opposition to the idea, including from the British Medical Association.
Who was Aneurin Bevan?
Aneurin Bevan was a Labour politician who was Minister of Health for the post-war Clement Attlee government from 1945 to 1951.
He was the architect of the NHS, driven by his strong belief that ‘no society can call itself civilised if a sick person is denied medical aid because of lack of means’.
But many others contributed to its formation, including his predecessor Henry Willink. Willink wrote the 1944 White Paper that laid out the founding principles of a National Health Service in the UK, which are still in place today.
What are the Founding Principles of the NHS?
In his White Paper, Willink declared that NHS services should be:
- Free at the point of use
- Financed from general taxation (as opposed to National Insurance contributions)
- Available to all: everyone is eligible for free care, including temporary residents and visitors to the UK
What is the Link Between the NHS and the Welfare State?
The creation of the NHS was part of a larger plan of social reforms set out in the 1945 Labour Manifesto, which also included reform of housing, education and employment conditions. These reforms constituted the creation of a welfare state which famously aimed to provide for its citizens ‘from the cradle to the grave’.
Although the Second World War had severely depleted the nation’s financial and material resources, many saw peace-time as a chance to rebuild not just the heavily bombed areas of the UK, but the structure of society too.
It wasn’t easy, and in its first year the NHS overspent by a big margin. But it was argued that this was due to a rush on its services from people who had been desperately lacking in medical care.
Financing the NHS continued to be a point of contention. Bevan himself resigned in 1951 when money began to be redirected to meet the costs of the Korean War, and charges for prescriptions and dental care were introduced.
The NHS has seen some significant reorganisation and restructuring over the years, including devolution to the four countries of the UK, but its major principles have remained intact. Let’s now take a closer look at how the NHS worked in the past – and how it works today.
What Does the Structure of the NHS look like now?
The next big overhaul came with the Health and Social Care Act 2012, which introduced huge structural reforms to the NHS. It is now divided into a series of organisations that work at a local and national level. The structure of NHS England is as follows:
- The Department for Health is the government department responsible for funding and coming up with policies to do with healthcare in the UK.
- NHS England is the umbrella body that oversees healthcare. It is an independent body, which means that the Department for Health cannot interfere directly with its decisions.
- Clinical Commissioning Groups (CCGs) are responsible for commissioning healthcare for their local area. They are run by GPs, nurses and consultants who assess local health needs and commission the services to meet them. They are in charge of around 60% of the NHS budget.
- NHS Foundation Trusts provide the care that the CCGs commission. They include hospital, ambulance, mental health, social care and primary care services.
What are the Main Challenges Facing the NHS?
Some of the key challenges currently facing the NHS are:
- An ageing population
- A growing population
- Evolving healthcare needs, such as the increase in cases of obesity and diabetes, or antibiotic resistance.
- Medical advancements save lots of lives every year, but push up costs considerably. It is estimated that progress in medical technology costs the NHS at least an extra £10bn a year.
- Closure of local services due to centralisation drives
- An increase in reliance on privatised services
The Nuffield Trust estimates that the ageing and growing population alone could mean we need another 17,000 hospital beds by 2022 — and that’s just hospital beds. The number of doctors, nurses, other staff and equipment all have to meet demand.
The Current NHS issues are a common topic at medical school interviews – and you will often be asked your opinion on current news affecting the NHS. For example, you might be asked about:
- Current NHS mental health services
- Brexit’s impact on the NHS
- Junior doctors’ contract
- 7 Day NHS