NATIONAL HEALTH SCIENCE (NHS)

NATIONAL HEALTH SCIENCE (NHS)

NATIONAL HEALTH SCIENCE (NHS)

Introduction

The NHS emerged from wartime political consensus, with all parties agreeing that there should be universal access to a comprehensive healthcare service. The proposal to introduce the NHS was originally contained in the 1942 Beveridge Report, with the key aim being public funding of health care providers. However, it was not until 1948 that the NHS was finally established. The structure of the NHS was shaped to a large extent by the Labour party's approach to social reform.

The NHS was established by the nationalisation of voluntary hospitals, combining them with hospitals previously run by local authorities. General practitioners became independent contractors to the NHS. The 1948 NHS had a “tripartite” structure, with the three separate administrative areas being hospitals, community health services, and GPs, pharmacists, dentists and opticians.

From the beginning, the concept of “equal access to all” was implicit within the Health Service, with the intention that a full range of services was to be made available for all. NHS finance was raised through a combination of taxes and insurance contributions. In 1951, the NHS entered its first cash crisis. This led to additional funds to be raised through the introduction of charges for eye tests, dental treatments and prescriptions. The Guillebaud Committee of Enquiry 1956, was set up to examine why costs of the NHS continued to spiral. The report, however, found no evidence of inefficiency in the system, concluding that the rising costs were simply owing to demographic change. Interestingly, what this particular problem highlighted was that the government had no clear mechanism to control the NHS, and, despite various strategic initiatives, changes were difficult to implement owing to the sheer size of the NHS (McFerran 1998).

Managing the New NHS

After heightening criticisms of the rising management costs in the NHS, a review of NHS functions and manpower was instigated by the government. Following the review, the government published its response in the form of the document, Managing the New NHS. This proposed the abolition of RHAs, the integration of DHAs and FHSAs and a streamlining of the management executive. The new regimentation of the NHS featured prominently the split between purchaser and provider (Figure 1).

Without doubt much of the recent debate with reference to the changes in the NHS has centred on the concept of the internal market. The key feature of the concept being the separation of purchasers and providers with contractual relationships between them. There has been a lot of public controversy attached to the idea of introducing market principles within the NHS, and a lot of ensuing political debate. Notwithstanding the theoretical arguments, it is important to note that the government's intention never was to allow a free market to reign and the term “managed market” is probably more appropriate than internal market (Martin 2004).

Separation between purchaser and provider roles

The “efficiency trap” of the 1980s in hospitals potentially penalised hospitals for improvements in their productivity. During this time, DHAs were responsible for managing both acute and ...