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

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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.

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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.