National Health Service

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National Health Service. Established in 1948, the NHS grew out of the Second World War's reconstruction planning of social and medical services, after long debate over health-care provision (Dawson Report, 1920; Cathcart Report, 1936; Sankey Commission, 1937). The 1942 Beveridge Report assumed that a satisfactory social security scheme depended on ‘comprehensive health and rehabilitation services for prevention and cure of disease and restoration of the capacity to work’, available to all the community. The subsequent deadlock arising from self-interested opposition was broken by Aneurin Bevan, who established a tripartite administration: local authorities (for existing clinics and new health centres), panel practice, and nationalized hospitals (conceding some private practice for consultants, and giving teaching hospitals special status). Since the new service was entirely free to patients, funding had to come from taxation, but Beveridge's view that costs would lessen as the nation's health slowly improved had not allowed for the massive backlog of unmet need nor for technological advances such as joint replacements. The introduction of charges for prescriptions, dental, and ophthalmic treatment (1951) led to Bevan's resignation on grounds of principle. Accusations of extravagance proved unfounded (Guillebaud Report, 1956), and hospital-building, application of medical advances, and staff expansion continued to be sustained by economic growth. Under the aims of improved management and services, the 1960s saw recommendations for the abolition of tripartite administration (new structure implemented 1974), with such reorganization being associated with more professional management. But implementation of policies formulated in a more confident economic climate led to increasing criticism of the use of business theory to solve the NHS's financial problems. Total spending continued to rise. As resources were shifted away from patient care into administration, justifications for internal markets to produce savings were unconvincing to many commentators; economies from ward/hospital closures or sale of assets seemed illusory, while the morale of many NHS employees plummeted. The opting-out of newly formed hospital trusts from local health board control and introduction of fund-holding for general practitioners threatened to recreate earlier inequality and fragmentation, despite the perceived need for better community and preventive medicine. Centralized bureaucracy, changing needs of patients, and serious under-funding have contributed to a now crumbling structure, with significant shortage of trained staff. Governmental reviews continue to promise reform, but public scepticism persists.

A. S. Hargreaves/ and Professor J. A. Cannon

National Health Service (NHS) (UK) The public health service established under the 1946 National Health Service Act. This act applied to England and Wales, with separate legislation being passed for Scotland and Northern Ireland. The legislation had been opposed by many medical practitioners, who feared that it would threaten their professional independence and private practice. However, the Minister of Health, Aneurin Bevan, skilfully pushed the plans through Parliament, making some concessions to doctors by allowing private practice to continue. The Act took effect from July 1948, and established a comprehensive health service aimed at diagnosing and treating illness. The vast majority of hospitals, as well as general practitioners, joined the scheme, which was to be administered by regional health authorities. One of its main principles was that treatment should be free at the point of delivery. Therefore, the NHS was funded partly from national insurance, but mainly from taxation. This principle was modified in 1951, when Hugh Gaitskell introduced prescription charges covering half the cost of adult spectacles and dentures. This caused Bevan to resign from the cabinet. Charges have been steadily increased, and their range extended.

In the 1960s a hospital building scheme was instituted, but rising costs have caused problems for all governments, as a result partly of the NHS being successful in prolonging expectation of life, and partly of the increase in the number of treatments possible. In 1989–90 the NHS was reorganized by Thatcher's government, which instituted a controversial internal market to increase efficiency through competition. During the governments of John Major and the first Blair government, public spending on the NHS increased only insignificantly in real terms, despite the greater costs of treating an ageing population. It became an important issue in the 2001 elections, and in 2002 Blair staked the future of his second government on improving the NHS. He announced an effective income tax rise (in the form of national insurance contributions) and pledged unprecedent increases in funding to bring public spending on health up to the EU average.

Medicare

National Health Service Established in 1948, the NHS grew out of the Second World War's reconstruction planning of social and medical services, after long debate over health‐care provision (Dawson Report, 1920; Cathcart Report, 1936; Sankey Commission, 1937). The 1942 Beveridge Report assumed that a satisfactory social security scheme depended on ‘comprehensive health and rehabilitation services for prevention and cure of disease and restoration of the capacity to work’. Aneurin Bevan established a tripartite administration: local authorities (for existing clinics and new health centres), panel practice, and nationalized hospitals (conceding some private practice for consultants, and giving teaching hospitals special status). Since the new service was entirely free to patients, funding had to come from taxation, but Beveridge's view that costs would lessen as the nation's health slowly improved had not allowed for technological advances such as joint replacements. The introduction of charges for prescriptions, dental, and ophthalmic treatment (1951) led to Bevan's resignation on grounds of principle. Accusations of extravagance proved unfounded (Guillebaud Report, 1956), and hospital‐building, application of medical advances, and staff expansion continued to be sustained by economic growth. Total spending continued to rise. As resources were shifted away from patient care into administration, the morale of many NHS employees plummeted. Though the widespread consensus of earlier decades had been shattered by the strains of 1980s' confrontational government, public confidence in the service continued high. But concern at the ever‐rising cost of the service has prompted proposals for closer collaboration with the private sector.

National Health Service (NHS) In Britain, system of state provision of health care established in 1948. The NHS undertook to provide free, comprehensive coverage for most health services, including hospitals, general medical practice and public health facilities. It is administered by the Department of Health. General practitioners (GPs) have registered patients; they may also have private patients and may contract out of the state scheme altogether. They refer patients, when necessary, to specialist consultants in hospitals. Health visitors, such as midwives and district nurses, are the third arm of the service. Hospitals are administered by regional boards. In 1990, the Conservative government introduced the concept of the ‘internal market’ into health care, establishing GP fund-holding practices and NHS Trusts independent of local health authority control. In 1997, the Labour government announced that it would replace the internal market with primary care groups consisting of GPs and community nurses. The NHS is the largest employer in the UK.

National Health Service (NHS) n. (in the UK) a comprehensive service offering therapeutic and preventive medical and surgical care, including the prescription and dispensing of medicines, spectacles, and medical and dental appliances. Exchequer funds pay for the services of doctors, nurses, and other professionals, as well as residential costs in NHS hospitals, and meet a substantial part of the cost of the medicines and appliances.

National Health Service, see health services.

National Health Service See HEALTH SERVICES.