Since its inception in 1948, the NHS has been a cornerstone of British Society, and something upon which many pride this country on. The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of their wealth. Since coming into the position of Secretary of State for Health in 2012, Jeremy Hunt has received large amounts of criticism surrounding his treatment of the service, and the future of the NHS currently lies in the balance. In this article, I will further analyse the roots of the NHS, the journey the organisation has taken since its creation and where it lies today.
NHS Core Principles
At the time of the creation of the NHS, the organisation was based on three core principles:
- That it meet the needs of everyone
- That it be free at the point of delivery
- That it be based on clinical need, not ability to pay
These three principals have guided the NHS for over more than 60 years and to largely remain at its core today. These moves to make it available to everyone and free at the point of use were revolutionary at a time where bar a few voluntary hospitals, people had to pay for their healthcare and therefore many people were being left behind on this front.
The NHS: 1948-1980s
The new service immediately became Britain’s third largest employer with around 364,000 staff across England and Wales. Including:
9,000 full-time doctors
19,000 professional and technical staff
25,000 administrative and clerical staff
149,000 nurses and midwives
128,000 ancillary staff (catering, laundry, cleaning and maintenance)
By the early 1950’s, spending on the NHS exceeded the planned amount and in 1952 this led to the first exception of the free at the point of use promise (1 shilling charge for prescriptions and a £1 charge for dental care). Other than this the 1950s was characterised by the planning of hospital services, dealing in part with some of the gaps and duplications that existed across the system, whilst it also saw a further growth in the number of medical staff and a more even distribution of them.
If the 1950s was characterised by this planning, then the 1960s can be seen as a period of real growth for the organisation. New drugs came into the market improving healthcare largely across the board, including the polio vaccine, dialysis for chronic renal failure and chemotherapy for certain cancers being developed.
The 1970s saw the NHS in England being reorganised to bring together services provided by hospitals and services provided by local authorities under the umbrella of the Regional Health Authorities. This time period also, however, saw the end of the economic optimism which had characterised the previous decade and there was an increasing pressure to reduce the amount of money spent on public services and to increase the efficiency in which this money was spent.
In 1982, Thatcher promised the public that the NHS is ‘safe in our hands’. Despite the Thatcher government moving away from a lot of the post-war policy that had come before them, Thatcher was adamant that one thing that would not be affected was the NHS, arguably down to its large popularity with the public.
In the 1980s, General Management was introduced in the NHS to replace the previous system of consensus management. There were recommendations to appoint general managers in the organisation whom responsibility would lie with. Financial pressures continued to loom over the NHS, but in 1987, an additional £101 million was provided by the government.
In 1989, the Thatcher government released two white papers named ‘Working for Patients and Caring for People.’ In these papers, the introduction of the ‘Internal Market’ was laid out, which was to shape the structure of the service for the next decade. This ‘internal market’ effectively meant that the Health Authorities ceased to run the hospitals, now just simply purchasing care from their own or other local authorities’ hospitals. This encouraged competition, however, it also increased local differences.
Blair Government Reforms
Blair’s government came to power in 1997 with the promise to remove this internal market and abolish fundholding, as they saw this as being part of the Conservative’s intention to privatise the NHS. However, in Blair’s second term, he did a U-turn on this policy and pursued measures to strengthen the internal market as part of a plan to modernise the NHS. This was largely due to the rising costs of the organisation, and the ageing population of the nation. It is worth noting at this point that the Health Services in Scotland, Wales and Northern Ireland are no longer under the control of the British Government, and therefore these reforms have increased the differences between the Health services across the union.
Some new services such as NHS Direct were introduced in order to help manage demand, whilst there was also a new emphasis given to staff reforms. Whilst the Blair government left services free at the point of use, they were very encouraging of the outsourcing of medical services and in their support to the private sector. This has been damaging for the employment of many doctors and nurses inside the NHS, with every £200 million spent on privately financed hospitals resulting in the loss of 1000 doctors and nurses, whilst the first Privately financed hospitals contained 28% fewer beds than the ones they replaced, suggesting this has also been a downgrade in the health service people can receive.
Conservative Government 2010-
The finances of the NHS have been in steady decline since the coalition government of 2010-15 implemented sweeping cuts to the public sector and in 2015 regulators revealed that the NHS had been plunged into its worse financial crisis in a generation. It is believed that this demise has come about due to an over-reliance on costly agency staff, a problem which Labour blame the Conservatives for due to their cuts to nurse training places. This has resulted in a shortage of trained nurses, a shortage which the agency staff have to cover. Under this government, the NHS has also gone from surplus to deficit, with a surplus of nearly £2 billion in 2009-10, compared with a deficit of nearly £1 billion last year. Many of the opposition believe this demise of the NHS is a direct impact from the actions of the Conservative party. With junior doctors strikes occurring recently and general discontent surrounding the service, there is no clear way upon which this situation is going to improve in the near future.