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Healthcare in The United Kingdom has changed beyond recognition since the formation of the National Health Service (NHS) in 1948. Governments have changed and new acts and policies have been introduced, for example there were major changes to the structure in the 1980s and 1990s. Health professional roles have also changed with the introduction of papers such as The Salmon Report in 1967. The importance of these changes and the affects they have on society need to be considered as the NHS continues to evolve and develop in the twenty-first century.
Prior to the NHS good healthcare in the United Kingdom was poor. Sickness and disease were widespread, mortality rates were high and there was a massive health inequality gap. In 1939 forced by the outbreak of the Second World War the Conservative government set up the Emergency Medical Services (EMS). Towards the end of the war morale and health were low and thought was given to turning the EMS into a more comprehensive health service. As a result in 1942 the Beveridge Report was published, which focused around five “Evil Giants” Disease, Squalor, Idleness, Ignorance and Want. (BBC, 2012) This report had an enormous impact on the welfare state and still forms the basis of today’s welfare system.
In 1945 with Clement Attlee as Prime Minister the Labour party came to power. With their more equality driven ideologies they acted on the Beveridge Report with the clear aim of providing free healthcare to all. It would bring together GPs, nurses, hospitals, dentists, pharmacists and opticians under one regulatory umbrella. The Health Minister, Aneruin Bevan’s mission to bring the NHS to fruition was not an easy one. It was met with opposition from a number of sources including the Conservative Party, well known for supporting the more affluent and white collar professionals. Bevan’s perseverance paid off and the NHS was established on the 5th of July 1948. The service was funded almost 100% through taxes, which would be proportional to earnings. This was a crucial part of Bevan’s plan, allowing a narrowing of the social divide. “In the words of Aneurin Bevan, the Act would create an atmosphere of greater security and serenity up and down the country for families faced by anxiety and the distress of illness” (Rivett, 1998) It was believed that initial demand on the NHS would be high as an influx of patients with existing conditions sought treatment, once treatment was administered spending would reduce. This prediction was inaccurate and the number of people seeking treatment actually increased as peoples standards of health improved. It became clear that health is not fixed and what was acceptable pre-war was no longer acceptable. Taking this into consideration along with medical advancements the system was under massive strain. (Moore, 2002) Bevan’s achievement was monumental and must not be underestimated. The NHS is a leading blueprint for healthcare across the world and it is important to remember the benefits of free healthcare. Money can divide classes determining the type of house someone lives in or the car they drive but irrespective of class everyone is entitled to good health.
Since the formation of the NHS, the United Kingdom’s healthcare system continues to change with the introduction of new policies. In 1952 Winston Churchill’s Conservative Party introduced NHS prescription charges, later adding charges for dental and optical care. Bevan was so outraged he resigned from his position as Health Minister. Bevan saw this as a step backwards, but considering the government’s point of view the expense of the NHS was rising and funding would need to increase. It could be proposed that this was a small amount to contribute towards such a great benefit, yet incentives for these new charges need to be examined. If patients pay for prescriptions it may encourage them to think before seeking medical attention therefore saving NHS time and resources. In addition to this in February 1952 Churchill announced that the United Kingdom was in possession of an atomic bomb and perhaps it needs to be considered that the funding for such an expensive weapon would need to be raised. Prescription charges would contribute towards the funding of the NHS, therefore funds earmarked for healthcare could be reallocated to defence.
By 1962 NHS had settled down, but the structure was under scrutiny. The Porritt Report criticised the separation of services into hospital, general practices and local authorities and called for them to be re-grouped. The right wing Conservative Enoch Powell was appointed Minister of Health and brought into play The Hospital Plan. This was a ten year plan to develop large district general hospitals and modernise the NHS. Management and doctors were consulted and contributed to the plan, but it was a massive project never seen before. Cost and time implications were severely under estimated and the question needs to be asked if the right experts were consulted. Macmillan had led the Conservatives to victory in the 1959 general election with the motto “Life's Better Under the Conservatives" (The National Cold War Exhibition, 2012) The view could be taken that with this phrasing in mind and half way through his term Macmillan needed to meet expectations, causing him to rush through his decision on The Hospital Plan. From a positive point of view the introduction of postgraduate centres improved the training and career prospects for both doctors and nurses.
In 1967 with the Labour Government now in power and Harold Wilson as Prime Minister a new report was released that would change the careers of employees throughout the NHS. The Salmon Report paid attention to the disadvantages of the three part NHS acknowledged in The Hospital Plan, but focused on a development structure for nursing staff, raising the status of senor nurses. It proposed speciality groupings for both clinical and administrative staff and looked to meeting future staffing needs. It is easy to imagine that this report gave women in the profession of nursing a major confidence boost during a time when women’s independence was increasing. The Salmon Report still influences today’s modern profession and health roles continue to develop and evolve. For example nursing in the 1950’s was a profession for single women, perceived as a caring role without too much respect. Today with a growing number of males joining the profession, nurses can work in a variety of settings including health centres and the community. They need a degree to practise and can specialise in a particular area or consider promotions such as clinical nurse lead. Nurses are now so involved in patient care it is acutely apparent that nursing education has a direct impact on the quality of care patients receive. A criticism of the Salmon Report is that it drew senior nurses away from the wards and into Management, leaving less experienced nurses caring for patients. It also abolished the role of Matron which consequently made it difficult to know who was in charge. Eventually the role of Matron albeit to a lesser degree was re-introduced in 2001 and some may suggested that the role needs to be fully re-instated. (NHS, 2011)
Although career progression is important it is imperative that individuals employed within healthcare acknowledge the importance of practise within the profession. This may include working in a team, reflection, evidence based practise and professional accountability. An example of this is the code of conduct set out by the Nursing and Midwifery Council (NMC). “As a professional, you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions.” (NMC, 2010) It is essential that roles of such importance maintain standards, manage risk and avoid negligence to ensure the heath and well being of the public.
Healthcare during the 1980s highlighted spiralling problems with funding. Each health authority was allocated a budget, but due to poor procedures, lack of knowledge and incentive money was wasted. In 1990 as a result of the 1988 Griffiths Report the NHS and Community Care Act was introduced. With the New Right Conservatives in government and Margaret Thatcher in her last year as Prime Minister the NHS was heading for the biggest structural and funding shake up since its formation. The act divided the health service into two sections known as purchasers and providers. Health authorities were the purchasers, required to assess the health needs of a community and then purchase what was needed from the providers, who were the hospitals and health services. (Mark, et al., 2000) This was positive in the sense that it created competition bringing down costs and increasing the quality of care. This act was implemented at a time when the United Kingdom was falling into recession so it would be assumed that cost-saving reforms were at the forefront of the government’s agenda. It does however need to be remembered that it is likely that the restructure itself would have cost money, increasing administration and management costs. It also meant a breakdown of the NHS into many fragmented sections and it could be argued that the NHS would lose its continuity. Views on this act may vary, however it is important to remember that this restructure still forms the basis of today’s NHS.
John Major succeeded in the role of Prime Minister following the resignation of Thatcher in November 1990 and continued to support the Thatcher Legacy of privatisation, launching the Private Finance Initiative (PFI) 1992. The NHS needed to offer improved facilities and the aim was to create partnerships between the private and public sectors. For example a private company would win the contract to build a new hospital allowing the NHS to lease the building back. This initiative came at a time when it was inferred that the United Kingdom was coming out of recession and the government was promising improved services and more public spending. Consequently confident may have been high that this was an affordable way to provide new facilities. The Labour Government won the general election in 1997 giving rise to “New Labour” and with Tony Blair as Prime Minister they continued to support the PFI. Although facilities may have improved, costs were once again spiralling and government run facilities were suffering affecting the quality of care administered by the NHS. “There is evidence that PFI is adversely affecting the health service. Jonathan Fielden, chair of the British Medical Association's consultants' committee, has said that PFI debts are "distorting clinical priorities" and impacting the treatment given to patients.” (Gold, 2011) Trusts had to borrow money to pay PFI contractors, throwing doubt on whether PFI was financially viable.
The modernisation of the NHS continues and in March 2012 with David Cameron as leader of the coalition government the new Health and Social Care Act was passed. This Act has been described as the most radical restructure the NHS has ever seen and draws on 20 years of NHS reforms. The new Act abolishes NHS primary care trusts and strategic health authorities and In April 2013 they will be replaced by Clinical Commissioning Groups. Clinicians will have more control over shaping the new service, providing more choice and competition. Opposition comes from bodies such as the British Medical Association concerned that the NHS is moving in the direction of privatisation. There is anguish that the NHS will be less comprehensive effecting patient care and in response to this a new regulatory body called Monitor has been established which should protect the interest of patients. It is likely that there will be a high number of redundancies in direct response to this change, but one cannot ignore Health Secretary, Andrew Lansley warning that the NHS would face "financial crisis within a matter of years" unless it was reformed. citing an aging population as the main reason for this shake up. He has also been quoted as saying “We will never privatise our NHS” (BBC News, 2011)
The debate on privatisation is on-going. There are major concerns that with privatisation comes a larger division of class, less continuity and more room for corruption and fraud. There is a feeling in certain quarters that privatisation is a step too close to the American healthcare system and with such strong opposition to this there is a high risk of political instability. Despite these concerns privatisation has been in practice since long before the launch of the NHS and offers speed, choice and control, empowering the patient. Private healthcare can also benefit the NHS by shortening waiting lists and reducing costs.
Today the NHS employs more than 1.7 million people, treating over 3 million people every week in England alone and for most people it is hard to imagine a life without the NHS. (NHS, 2011) There have been many changes over the last 65 years and with an aging population, rising costs and the advancement of technology and medical science the NHS is likely to continue to advance and mature. Financial difficulties still threaten the foundations, raising questions in the quality of care and casting a shadow over something that is so important in today’s society. Disadvantages such as NHS bureaucracy and obvious advantages such as free healthcare for all creates an interesting debate which ultimately sits in the hands of the government, although both historically and in current times “Our NHS” is something that society seems prepared to fight for.
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