The National Health Service

Question 1

What is the National Health Service (NHS) and when was it founded?

Answer 1

• The NHS is an essential plank of the modern welfare state.
• It was founded in 1948 under the reforming post-war Labour government.

Question 2

What was the core principle behind the NHS’s foundation?

Answer 2

• It was designed to care for the sick and vulnerable from “cradle to grave”.
• The NHS was intended to be universally available throughout the UK and “free at the point of need” regardless of ability to pay.

Question 3

Were there early challenges or changes to the “free at the point of need” principle?

Answer 3

• Yes, by 1951, charges had already been introduced for prescriptions, spectacles, and dentist visits.
• Affordability has always been an issue.

Question 4

What is the size and scale of the NHS today (NHS England)?

Answer 4

• ## It receives about £200 billion of public money a year.
• UK health spending is 9.3% of GDP.
• It employs 1.3 million people, making it the largest employer in Europe and fourth largest in the world.
• There are about 140,000 doctors and 377,600 nurses and midwives.
• There are 42 Integrated Care Systems

Question 5

How is the NHS funded?

Answer 5

• 80% comes from general taxation.
• 20% comes from National Insurance Contributions, land sales, and charges to patients

Question 6

What were the key elements of the Thatcher reforms in the 1990s?

Answer 6

• Introduced the idea of the “internal market” in the 1990 NHS and Community Care Act.
• This split the NHS into “purchasers” or “commissioners that buy services on behalf of patients, and “providers” (like NHS hospital trusts) that supply services.
• The theory was that market discipline would drive effciencies and services improvements.

Question 7

How did the Blair government reform the NHS in the 2000s?

Answer 7

• Hugely increased funding (from 6.7% of GDP in 1997 to 9.7% in 2010).
• Kept the idea of the internal market largely intact.
• Established Primary Care Trusts (PCTs) in 2002 to commission healthcare from providers.
• Some NHS trusts were given self-governing status and became Foundation Trusts.
• The 2003 Health and Social Care Act allowed PCTs to purchase care from private providers to reduce waiting lists.

Question 8

What were the key changes under the Cameron government reforms (from 2010)?

Answer 8

• The 2012 Health and Social Care Act abolished PCTs.
• Commissioning was handed to consortia of GPs, nurses, hospital doctors, and the public called Clinical Commissioning Groups (CCGs).
• All NHS Trusts became Foundation Trusts and were encouraged to become not-for-profit companies that could generate income from private treatment.
• NHS Trusts had to compete for business from CCGs with any “qualified provider” in the voluntary or private sector.

Question 9

What reforms were introduced by the Health and Care Act 2022?

Answer 9

• Clinical Commissioning Groups were abolished.
• The Act is designed to support collaboration, rather than competition, and provide “joined-up” services.
• The tendering rule for providers and private companies completing for contracts was scrapped.
• Set up new partnerships called Integrated Care Systems (ICS) to bring providers and commissioners together with local authorities to plan healthcare.

Question 10

What is the current structure of the NHS in England?

Answer 10

• The Secretary of State for Health has overall responsibility.
• Money flows from central government to NHS England, which provides national leadership and supports NHS organisations.
• NHS England supports 42 Integrated Care Systems (ICSs).
• Each ICS consists of an Integrated Care Board (ICB) responsible for NHS strategic planning and allocation, and an Integrated Care Partnership (ICP) which brings together a wider range of partners (not just NHS) to address broader health, public health, and social care needs.
• Note: Labour has announced the abolition of NHS England, bringing running of the NHS back under central government control.

Question 11

What are some key issues currently facing the NHS?

Answer 11

• Ageing population.
• Health care inflation.
• Lack of adult social care leading to delayed hospital discharges.
• Waiting times for treatment and ambulances.
• Nurses’ and doctors’ pay.
• Funding levels.
• Access to GPs and A&E departments.
• Impact of private, profit-making healthcare companies.
• Access to mental health services.

Question 12

Who regulates the NHS and what are some other key bodies?

Answer 12

• The Care Quality Commission (CQC) is an independent regulator that inspects hospitals, care homes, etc., and issues reports.
• Healthwatch represents the views of patients.
• The Parliamentary and Health Service Ombudsman deals with complaints.
• The National Institute for Health and Care Excellence (NICE) provides national guidance and advice, including approving new drugs.