History Of National Health Service Health And Social Care Essay
1-9. Module Guide
Within this assignment, the author is going to demonstrate knowledge of the political involvement within the NHS. Furthermore, how a political party’s ideologies can influence the NHS. The author is going to demonstrate an understanding of the structure of the British Health System. Moreover, how the National Health Service has developed over 60 years since it opened in 1946. The author is also going to discuss the history of Switzerland’s Health Care System, look at their political system, and discuss their two political movements, Federalism and Liberalism, and how these movements influence their health care system. The author is also going to compare and contrast the Health Care provisions of Britain and Switzerland.
The National Health Service
The 1942 Beverage Report had a significant influence on creating a welfare state. Beverage himself had a distinguished vision, in which he aimed to transform Briton by eradicating the "five giant evils", namely disease, idleness, ignorance, squalor and want. The National Health Service began in 1948 and was brought into being by social democratic Labour Government, in an attempt to combat one of the "five giant evils", specifically to fight disease. However, the socialist theoretical ideologies in practice had significant problems, even though Labour Government had a considerable amount of socialist members within the Parliamentary Labour Party and Extra Parliamentary Party at the time. (Alcock, Erskine, et al. 1998)
Funding for the NHS is obtained through general taxation and is free at the point of use. Furthermore, it has remained essentially unchallenged for over 50 years within the policy making process in the UK. (Alcock and Campling, 1996) Due to excessive costs, in 1950, the NHS implemented a charge for prescriptions to help with the shortfall within funding. In 1974, the National Health Service Act came into power under centre –right wing Labour Government leader Harold Wilson. This act created Regional Health Authorities, District Management Teams and Area Health Authorities as it aimed to provide a more unified body within the NHS. The NHS subsequently became part of a three tier hierarchy system, with the emphasis focused on the planning and delivery of a more co-ordinated structure within the NHS. However, the new three tier structure was seen to be too democratic, and led to unnecessary delays within the system. (Young, 2000)
In 1979, the Conservative party came to power, and leader Margret Thatcher believed that capitalism was the way forward, using a system of economic enterprise based on free and economic enterprise. Moreover, Mrs. Thatcher inherited a struggling NHS, with growing waiting lists and a decline in general practitioner’s services. Health minister Norman Fowler decided, after much consideration that the suggested changes were not necessary. This was partly due to the fact that there were upcoming elections, and the Conservative Party did not want to attack the NHS for fear of declining public support for the party. (Baldock, 1999)
As an alternative, Margret Thatcher's attention switched to the management of the NHS and the "New Public Management". She was of the opinion that this system would increase efficiency as the NHS, in essence, would be seen as a business. Margret Thatcher recruited Sainsbury’s managing director Roy Griffith’s to write a report on appointing specialist managers. (Giddens, 1993) This included removing responsibility from medical professionals. Subsequently, this meant that control went to largely non medical managers, in an attempt to give a more patient centered approach. New Secretary for Health Kenneth Williams published a white paper by the Department of Health in 1989 proposing there was a "quasi- market" within the National Health Service. (Dean, 2006)
Further changes emerged within the NHS with the implementation of the Community Care Act in 1991. Furthermore, the beginning of marketization to public services once again led to re-structuring of the NHS. The "purchasers" are the services managed within the Regional Health Authorities, and these include Family Health Services and District Health Services. However, general practitioners had the opportunity to opt out and become fund-holders. Based on the number of patient’s registrations, fund-holders would receive, and be responsible for their own funding, thus enabling them to arrange contracts directly with the relevant service providers. (Cochrane and Clarke, et al. 2001) The NHS trusts were the "providers" managing services such as hospitals, community health and the focusing on the individual needs of the public. However, this approach was unrealistic, and it was thought that a more generic approach would be more effective as it largely replicated existing practices and provisions. (Bochel, and Bochel, 2004)
In 1997, the newly elected New Labour Party had Marxist political views on stratification and divisions within social class. (Giddens, 1993) A white paper was introduced called The New NHS, initiating a ten year plan to re-structure the NHS. The paper summarizes the six principles which focus on setting the national standards and re-building public confidence in the health service. The National Institute for Clinical Excellence was established up to rectify the problem of expensive new drugs coming on the market. (Jones and Gray, 1991) Health Authorities were reluctant to buy these new and expensive drugs as the expense would have a detrimental effect on their budget. This dilemma was also known as the post code lottery. Moreover, in 1998-99, we saw the induction of the "Health Improvement Programmes" and a pilot of the NHS Direct scheme, a 24 hour telephone service where patients were given medical advice by qualified nurses. In 2000, the scheme covered the whole of the country, and walk-in centres were opened nationally, to treat minor conditions. (Alcock, Erskine, et al. 1998)
Current Structure of the NHS
The Secretary of State for Health is responsible for the whole of the National Health Service within England. The Department of Health has eight regional areas and these are under the umbrella of the NHS Executive. The executive is responsible for the development and implementation of policies for the Health Service. Britain is divided into England, Scotland and Wales. In England, there are one hundred health authorities and these are responsible for identifying the Health Care needs of the residents of a particular area. (Barnard, 2011) Privately ran companies own primary health care services, and these companies use self- employed contractors who work for the health service. Furthermore, these include doctors, opticians and pharmacists who all receive fees and allowances for their work. They also have additional staff employed by the health service. (Baldock, 1999)
The first initial contact for treatment is your GP (General Practitioner). They are the main person for primary health care within England. However, an individual has to be registered with their local GP, although registration is free. An individual would have to be referred by their own GP to any of the many other services provided by the NHS. Over the Years, the role of the GP has changed significantly as many surgeries’ offer additional services such as health care visitors, nurses and also social workers. (Mcnaughton, 2003) As indicated earlier, prescriptions have to be paid for by the person to help with budgeting costs for the National Health Service. Services such as dentists, pharmacies, and opticians are means tested. This is where a calculation of a person disposable income gives an indication of whether paying for treatment would be affordable. If the individual has no or little disposable income, treatment cost would be met by the government using tax payer’s money. (Alcock and Campling, 1996)
Hospitals are a significant part of the NHS and account for two thirds of total expenditure within the NHS. There are two types of hospitals within the NHS: those under control of the health authority and those who opted of being under the control of the health authority, and consequently became hospital trusts. A board of Directors Control Hospital trusts and is a self-governing organization. This allows the trust to make their own decisions and also have freedom in planning and use of resources. (Young, 2000)
Funding is a significant concern within the NHS, as organizational changes and the restructuring of the health service, all deplete funds within the national budget. There was a significant rise in spending as expensive drugs and new advances in medicine all contribute to rising costs. Government spending rose considerably in 2002 as £40 billion was projected to be spent over a five year period (Mcnaughton, 2003), with government expenditure expecting to reach a total of 105 billion in 2011/12. This is compared to 23 .7 billion when the National Health Service first began in 1975. Primary care trusts received 80% of the budget as they are responsible for contracting health services to meet local demand. Furthermore, they are also responsible for the allocation and distribution of these funds. The additional 20% is dispersed to deliver regional and national programmes. (Young, 2000)
History of Switzerland’s Health Care
Switzerland is a federal state and has been since 1847, and this is the foundation of the modern federal state we see today. In the first half of the Twentieth Century economic prosperity was at an all time low. Furthermore, with an increase of infectious diseases, the Swiss Confederation, and the health policy of the cantons, focused on prevention at a population level. After the Second World War, the infrastructure of the health care system expanded to develop the excellent health care system we see in Switzerland today. (Costa-Font and Greer, 2013) In the 1970's, there was a significant shortage of doctors and dentists, especially in rural areas, leading to inadequate provisions in many rural areas, while the numbers have increase of over the past three decades. There were a number of attempts to try and reform the health care service in 1974 and 1984, including two referendums. There has been a significant rise in expenditure within the health care system, and this is due to complex proposals relating to the control of cost within the health service. The referendum, which was passed in 1994, had two principal objectives. These were to contain cost and strengthen solidarity. (Okma and Crivelli, 2010)
Political and Administrative Structure
The new constitution of 1999 found that was no notable changes within the structure of the federal state. The political system In Switzerland is both Federalism and Liberalism and are capitalist’s, a system of economic enterprise, based on free and economic enterprise. Furthermore, these political movements can be seen reflected within the Health Care System. The Liberal aspect within the government relates to The Swiss confederation and the Constitution. (Rovner, 2008) If a canton is not producing satisfactory results, then the state will intervene as a precautionary measure. Federalism relates to the Federal Constitution and the federal council can only intervene within legislative policies taken from the Constitution. The Swiss Confederation has limited authority over the Health Care Service. Moreover, each canton delegate’s provisions to Municipalities ho cover a range of services which include; care for the elderly and public mental health services. (Bk.admin.ch, 2013)
Switzerland’s government consists of four main parties, although there are seven member parties in total. The parties include; The Radical Free Democratic Party, Social Democrats, Liberal Democrats, Christian Democrats and the Democratic Union of the Centre associated within Switzerland’s Federal Two- Chamber Parliament. The National Council which has 200 hundred members who are elected every four years and are also a part of the government. The Council of States has 46 members and has two representatives from each canton. Furthermore, each canton governs their own area and has their own constitution as long as they abide by the Federal Constitution. (Princton.edu. 2013)
Switzerland’s Current Health Care System
Switzerland’s current health care system was established in 1996, and each canton is responsible for their provisions within the health service. There are four different categories into which the health service is divided. These include; regulation of health professions in the field in which they practice. The Implementation of federal law relates to how the Federal Government implements powers for cantons to follow. Health care provisions relates to in-patient care within hospitals and nursing homes. Fees are agreed between each service provider and association’s health service in each canton. Health education and disease prevention run a vast number of projects within each canton: however, there are no national campaigns until the Swiss-Foundation for Health Promotion was set up in 1996. (Daley and Gubb, et al. 2013)
Furthermore, to receive treatment within the health service, a person needs to acquire health insurance. There are two packages available, a basic and a universal package. However, the price is regulated by the Federal Office of Social Insurers. Insurance companies have a standard price within each canton, offering a range of services which include sickness insurance, maternity insurance and accidental insurance. On the other hand, insurance companies have supplementary packages to offer individuals at an additional cost. (Bk.admin.ch, 2013) Furthermore, if an individual is struggling financially, financial assistance is available. Health insurance companies offer health plans delivered by managed care organisations (MCO’s). By doing so, they cut costs and limit the number of providers used by the insurance company. Furthermore, these are often private medical centres owned by the insurance company. (Okma and Crivelli, 2010)
The National Association for Promotion of Quality in Health Care regulates the provision of health care. Primary care providers, such as hospitals and general practitioners, are reimbursed through the insurance company. An individual will register with a local GP in a specific hospital or polyclinic. However, an individual who does not have a care plan with a registered GP can use any medical provider within their canton. All doctors are required by law, to explain to the patient what is entailed within the health plan. Any additional services will be available but to further costs of their basic plan. Secondary services and tertiary care plans are set according to local need within each canton. (Rovner, 2008)
The main comparison is funding of the Health Care System. Britain’s Health Care System is funded through tax and national insurance contributions. Furthermore, this accounts for the £105 billion pound which is spent within England in primary and secondary Care. (Alcock and Campling, 1996) Compared to Switzerland’s Health Care System where an individual has to buy health a basic level of insurance. However, for an additional cost, an individual can buy a premium health package. Primary Care Trust’s and Cantons are very similar when it comes to delivering their health service. However, primary care trusts only deliver their health service where as a canton is responsible for a number of different provisions including health care. (Goodwin, 2006)
In- patient care within the EU is highly costly and labour intensive, with an average of 3.2 % available hospital beds, per 1000 inhabitants. Britain’s average number of hospital beds available in 2008 was 3.8%, slightly over the national average. Switzerland’s average is significantly higher, at 5.8%, a total of 2% higher than in Britain. A higher rate of hospital beds will mean more people will be seen and also shorter waiting times. Moreover, In Britain, there were 190 physicians per 100.000 Inhabitants in 1998. (Tabernig and Schnackenberg, 2011) In 2009, these figures rose to 265 physicians per 100,000 inhabitants. This is a great indication of the increase within the National Health Budget. Furthermore from 2008/09 the Swiss had the largest number of physicians totaling 495 physicians. That is an astonishing 235 physicians extra per 100,000 inhabitants; again, this will have a major impact on the quality of service and waiting times. There is a ratio, in Switzerland, of 1500 nurses per 100,000 inhabitants, compared to Britain where there are 950 nurses per 100,000 inhabitants. This means that the quality of care will be significantly better, waiting times will be reduced, and patient satisfaction will be at all time high. (Tabernig and Schnackenberg, 2011)
1 in every 10 Euro’s is implemented in to the Health Care System. Furthermore, Switzerland has one of the highest expenditures within Europe, with a rate of 10.5% GDP (Gross Domestic Product) compared to Britain’s rate at 9.0% GDP. The government’s total expenditure on NHS health care in Britain is 85%, with private health care at fewer than 20%. England has a free health service, and this is an indication of the economic climate is which we live. With rising prices and high unemployment rates, the British population relies on a free health service. Social class plays a significant role in the total expenditure within the private and public health service. (World Health Organization, 2011)
Switzerland further reinforces this notion as their governments total expenditure is 60% compared to their private which is at 40%. This relates to Switzerland’s healthy economy and financial standing in health care expenditure. Furthermore, Switzerland has a higher basic lever of income, a lower level of unemployment rates and better job security. The population of Switzerland enjoys a better lifestyle, leading to more disposable income. If Britain chose to have a private health care system, it would still have to subsidizes a significant part of the budget due to high unemployment rates and low income wages. (Rovner, 2008)
The author’s transferrable skills include; further understanding of history and the structure of the NHS. The author has also developed a better understanding of political views and ideologies, in addition to how different political parties influence their Health Care System. Furthermore, the author used secondary research to compare two European countries Health Care Systems. The author has also developed ICT and literacy skills. The author will be able to use this information within future volunteering and social care related job roles with clients. The author is also continuing their education so will use these skills within their BA Honor’s in Social Care.
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