Politics and Healthcare: A short history of the National Health Service

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The origins of the National Health Service go back to the 1911 National Insurance Act which contained some medical benefit provisions however the NHS was first proposed in the 1942 Beveridge Report, run through local health centres and regional hospital administrations. Labour opposed this idea, preferring a state run body.

As Beveridge said, “For Ernest Bevin, with his trade-union background of unskilled workers… social insurance was less important than bargaining about wages.”

Bevin derided the Beveridge Report as a “Social Ambulance Scheme” and followed the Coalition Government’s view that it should not be implemented until the end of the war and was furious in February 1943 when a large number of Labour back-benchers ignored their leaders and voted against delay in implementation.  A white paper was published in 1944 and had 3 core principles, which survive to this day:

  • Services were provided free at the point of use;
  • Services were financed from central taxation;
  • Everyone was eligible for care (even people temporarily resident or visiting the country).

Bevan overruled the White Paper’s proposals for Local Authorities to be involved with running hospitals “the only thing to do was to create an entirely new hospital service, to take over the voluntary hospitals, and to take over the local government hospitals and to organise them as a single hospital service”

The 1946 National Health Service included the 3 core principles and also stated:

“It shall be the duty of the Minister of Health….to promote the establishment…of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness and of that purpose to provide or secure the effective provision of services…”

There was opposition from the British Medical Association to the new service but Bevan was able to make a deal, saying he had “stuffed their mouths with gold”.

The National Health Service formally began on 5 July 1948 with a budget of £437m (equal to £9 billion in 2013). From the start the NHS was very popular and soon expenditure exceeded expectations, so the Labour Government proposed prescription and dental charges in 1951 which were introduced by the Conservatives in 1952. By 1956 the service was overstretched and Doctors disaffected, leading to a Royal Commission on Doctors’ pay in 1957.

The Charter for General Practice agreed in 1966 gave financial incentives for practice development and encouraged the creation of modern group practice. Prescription Charges were abolished in 1965 then re-introduced in 1968. In 1969 the NHS in Wales was split from NHS in England.

The NHS was reorganized in 1974 and 1982 with the “Internal Market” introduced in 1990, which was condemned by the Labour Party who committed themselves to abolishing it after winning the 1997 general election. However as the financial costs of the NHS continued to rise, Tony Blair changed his mind and after 2001 decided to strengthen the internal market to help modernize the NHS.

1999 saw responsibilies for the NHS devolved to the Scottish Parliament and Welsh Assembly from the respective Secretaries of State.

In 2004, Blair introduced the Agenda for Change, a harmonized grading and pay system for all NHS staff except Doctors, Dentists and senior managers. It covered more than a million people and including career progression and is still in place today with some amendments in 2013.

Out of Hours treatment from GP surgeries has been an issue for the NHS since the 1990s, in 1992 the BMA campaigned for reform which following some contract changes in 1996 led to many GP out of hours co-operatives being formed. Concerns were raised at the varying quality of service and looked into by the 2000 Carson Report, which called for an integrated approach to out of hours care.

This would ultimately lead to the 2004 contract which moved the responsibility for out of hours care from the GPs to the Primary Care Trusts. Rather than choosing to work with the existing Out of Hours GP co-operatives most PCT’s chose other arrangements.

In March 2009 a damning report was released on the running on Stafford Hospital, estimating that between 400-1,200 more patients died at the hospital between 2005 and 2008 than would usually be expected. A full Public Inquiry was ordered in 2010 and its report in 2013 made 290 recommendations.

In 2010 a Conservative led coalition Government was formed and it also chose to reform the NHS with the 2012 Health and Social Care Act, which replaced the 152 Primary Care Trusts and 10 Strategic Health Authorities with 211 Clinical Commissioning Groups, who would be in charge of over £60 billion of commissioning through a single NHS Commissioning Board for England.

The changes were very controversial, especially the wider use of “any qualified provider” (which under Labour had been “any willing provider”) allowing greater access from non-NHS bodies i.e. private, independent, charity etc. to provide NHS services.

In the winter of 2014/15 there was severe pressure on Accident & Emergency services across the UK, which brought the matter to the top of the political agenda.  http://www.bbc.co.uk/news/health-30679949

The NHS has been under financial pressure since it was first created, mainly due to its own success combined with advancements in medical science which means more and more people live longer with more expensive medicines and treatments.

Demographics are playing their part, over the last 30 years (1982 to 2012) period life expectancy at birth has increased by around 8 years for males and 6 years for females from 71.1 and 77.0 years respectively. The corresponding life expectancies in 2012 were 79.0 years for males and 82.7 years for females.

People also are more likely to go for medical treatment, indeed during the difficult 2014/5 winter this A&E Doctor was quite scathing: http://www.itv.com/news/2015-01-06/people-come-to-a-e-when-they-could-take-a-paracetamol/

The scale of the issues affecting the NHS can be summed up in a simple financial statistic:

The total budget for the NHS for its first year of operation in 1948 was £437 million, equivalent to £9 billion in 2013. The NHS budget in 2012/13 was however £108.9 billion. In essence even adjusting for inflation the budget of the NHS has increased twelvefold in under 65 years.

So what is the solution to all this? I would recommend a Royal Commission to look at the future of the NHS as unfortunately whilst no doubt some of the troubles of the NHS have been caused by Politicians, each side simply blames the other, there are far wider non-political reasons as to why the NHS is under so much pressure and more money is not going to be only solution.

6 Jan 2015

Sources:

NHS England: http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx

Wikipedia: http://en.wikipedia.org/wiki/National_Health_Service_%28England%29

Dr Eric Rose https://abetternhs.wordpress.com/2013/05/10/true-history/

ONS Life Expectancy: http://ons.gov.uk/ons/rel/lifetables/historic-and-projected-data-from-the-period-and-cohort-life-tables/2012-based/stb-2012-based.html

Additional 8 Jan 2017

In the 2 years since I wrote this article, the demographics move on, as the “baby-boomers” are starting to enter their 70’s, the NHS, health and social care continue to be under severe pressure however too many continue to use the NHS and healthcare as a political football.

Many on the left continue to insist it as valid at every election to insist there is only “24 hours to save the NHS” and the Brexit campaign also felt just justified to use people’s concerns for the NHS as well.

Spot the difference:

24 hrs to save

(From Private Eye)

CHRISTCHURCH, DORSET - MAY 12: Journalists wait for the arrival of Boris Johnson and the Vote Leave bus as he visits Reidsteel, a Christchurch company backing the Leave Vote on the 23rd June 2016. on May 12, 2016 in Christchurch, Dorset. The Vote Leave battle bus has been touring the South West of England hoping to persuade voters to back a Brexit from the European Union in the Referendum (Photo by Matt Cardy/Getty Images)

(Photo by Matt Cardy/Getty Images)

Meanwhile another “NHS crisis” looms, the previous years are forgotten e.g.

Guardian December 2000: https://www.theguardian.com/society/2000/dec/04/health2

Guardian January 2017: https://www.theguardian.com/society/2017/jan/08/theresa-may-denies-humanitarian-crisis-in-britains-nhs