British Government and Politics ( JN 302 )

1. British Government and Politics(JN 302) The National Health Service (NHS)

2. Lecture Outline 1. NHS structure and operations 2. History of the NHS 3. Coalition government and the NHS 4. Current issues

3. NHS structure and operations • Largest and oldest public healthcare system in the world. • http://www.nhs.uk/Pages/HomePage.aspx • NHS net expenditure was £105 billion in 2012/13. • In 2012 the NHS employed 146,075 doctors, 369,868 qualified nursing staff, 153,472 qualified scientific, therapeutic and technical staff and 37,314 managers. • http://www.nhsconfed.org/Pages/home.aspx

4. NHS structure and operations • NHS Constitution • http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Documents/2013/the-nhs-constitution-for-england-2013.pdf • Core principles: • Meets the need of everyone • Free at point of delivery • Based on clinical need, not ability to pay.

5. NHS structure and operations NHS funded about 80% out of general taxation and 20% deriving from: NHS element of National Insurance contributions; Prescription and drugs charges; Other income such as asset sales and fundraising.

6. NHS structure and operations NHS controlled by the Department of Health. Funding is allocated to geographically-based Clinical Commissioning Groups (211 across England). NHS Trusts and private sector companies are commissioned to provide NHS services. In addition to providing health care services the NHS is involved in doctor training (about 8,000 places for student doctors each year).

7. History of the NHS • National health Service (NHS) started in 1948 by Attlee’s post-war Labour government. • Provided high-quality medical treatment ‘free at the point of need’. • Mounting concern over inequality between richest and poorest. • Roots in the BeveridgeReport (welfare state) and Lloyd George’s (1911) National Insurance (NI) scheme (meant to insure low paid against sickness and unemployment). • http://www.youtube.com/watch?v=-ywP8wjfOx4

8. History of NHS Vision of Health Minister Aneurin Bevin (Nye Bevin) – “We now have the moral leadership of the world”. But by 1951 charges were introduced for prescriptions, opticians, and dentists. Led to high profile resignations including Bevin. For40 years structure and funding remained the same: centrally funded through taxation, government filtering money through to hospitals, surgeries and ambulance services. Health professionals and service staff employed by government.

9. History of NHS • Neo-liberal, Thatcherite ‘reforms’ of NHS and creation of internal health market saw end of post-war consensus from the late 1980s.

10. History of NHS Management structures set up with generalists appointed to sit alongside clinical staff. Introduction of general managers to run District Health Authorities (DHAs) - funds directed to local hospitals and surgeries. Community based health care with GPs , dentists, and other primary care providers given control of budgets - attempt to end ‘one size fits all’ approach to targeted approach. Outsourcing of medical and health support employment to private agencies. Department of Health and Social Security (DHSS) split into Department of Health and Department of Social Security. Further reforms under John Major created NHS trusts.

11. History of NHS National Health Service and Community Care Act (1990): NHS trusts were defined as service providers; Hospitals, mental health units, ambulance services and others directly involved made up NHS trusts with own management boards (practitioners and general managers); GPs offered opportunity to become fund holders – could opt out of district health authorities; and GP fund-holders, DHAs and family health service authorities (FHSAs) became purchasers of NHS primary care.

12. History of NHS Criticisms of NHS reforms: Not all GPs wanted to opt out – by the time Labour came into power 1997 fewer than half had signed up; Internal market criticised for being too concerned with management - more interested in flow charts; Major criticism – post code lottery.

13. History of NHS Waiting lists increased – horror stories in the press and broadcasting. By May 1997 1.3 mlnpeople waiting for treatment and operations. Cancelled operations. Stories of elderly and vulnerable falling ill and dying while waiting for treatment.

14. History of NHS Labour introduced the Health Act 1999. Introduced: Primary care trusts (PCTs) – local administrative organisations that purchased clinical services; Strategic health authorities (SHAs) replaced DHAs – more arm’s length administrative bodies. Responsible for monitoring local health care, publishing three-yearly health plans, promoting healthier lifestyles. Greater power for DH and Secretary of State to set nationwide targets and standards of care. Alan Milburn’s 10-year NHS plan in 2000 criticised for over-emphasising competition in NHS and allowing patients choice of being treated in private hospitals and clinics.

15. History of NHS National Institute for Clinical Excellence (NICE) also established in 1999. Executive agency of the NHS. Guidance on prevention of illness to both general public and NHS workers. Advises governments on whether new and existing clinical treatments, medicines and procedures should be made (or remain) available on the NHS.

16. Coalition government and the NHS

17. Coalition government and the NHS Coalition government decided to ‘ring-fence’ NHS from cuts in government spending (along with foreign aid and education). Andrew Lansley’s Health and Social Care Act: Abolished Labour’s PCTs and installed clinical commissioning groups (CCGs) that were run more directly by GPs; and Gave greater powers for NHS Trusts to be more free from the NHS (although accompanied by less financial security). Trusts can now raise up to 49% of their funds through treating private patients. SHAs replaced by more local authorities to promote health improvement and overall health care provision. New health regulatory body – Monitor.

18. Coalition government and the NHS After much public criticism, including from the British Medical Association (BMA), and a re-assessment ‘pause’ in the passage of the bill, the Act was finally passed in 2012. http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx Opposition (and overview) of the bill: http://www.bbc.co.uk/news/uk-politics-17171039 http://www.telegraph.co.uk/health/9106880/Read-this-and-prepare-to-fight-for-your-NHS.html

19. Current Issues Inquiry into the Mid Staffordshire NHS Foundation Trust. http://www.independent.co.uk/news/uk/home-news/jeremy-hunt-mid-staffordshire-nhs-trust-will-be-dissolved-9154787.html

20. Current Issues Cameron’s pledge to have GP surgeries open seven days a week: http://www.theguardian.com/society/2013/oct/18/gps-condemn-cameron-surgeries-plan A&E overcrowding: http://www.theguardian.com/society/2013/may/21/hospital-overcrowding-more-death-serious-illnesses-mps

21. Current Issues Data sharing plans: http://www.theguardian.com/society/2014/feb/18/nhs-delays-sharing-medical-records-care-data

22. Current Issues Some say NHS still provides good levels of care: http://www.theguardian.com/society/2013/dec/31/healthcare-leaders-end-criticism-nhs-letter