The NHS

The National Health Service refers to the public health services in Britain- the National Health Service in England, NHS Wales, NHS Scotland, and Health and Social Care in Northern Ireland.

Originally established as one system in 1948 by the then Minister of Health, Aneurin Bevan, as part of the major social reforms after WW2, the NHS had three core principles: to meet the needs of everyone, be free at the point of delivery and be based on clinical need, not ability to pay.

Funding

As the NHS was originally based on Beveridge's model, it is mainly funded by taxation, the majority being through general taxation and a smaller proportion from national insurance. England, Scotland, Wales and Northern Ireland each receive a block grant from UK-wide taxes and the relevent government can then decide how much of this grant to spend on health care, and whether to provide additional funding from other sources.

The Role of the Government

The Secretary of State for Health and Social Care's responsibilities is largely restricted to NHS England with there being equivalent roles in Scotland, Wales and Northern Ireland. This structure is largely the same compared to before devolution in 1999, when the NHS split into four systems.

On the other hand, the Department of Health and Social Care had a comparatively much larger role than now in implementing and coordinating health policies across Britain. Since devolution, the Department of Health has been responsible for government policy on health and adult social care matters in England, as well as a few elements which are not devolved to the Scottish Government, the Welsh Government or the Northern Ireland Executive.

Health and Social Care Act 2012

Primarily the Health and Social Care Act (2012) aimed to create an independent NHS board, promote patient choice and reduce NHS administration costs by keeping the government out of the day-to day running of the NHS, strengthening the role of the Care Quality Commission and increasing competition.

Following the Health and Social Care Act, Clinical Commissioning Groups (CCGs) were created.

Clinical Commissioning Groups

NHS England commissions some services itself, but passes two thirds of the budget onto CCGs across England. CCGs then identify local health needs, and plan and buy care for people in their area. CCGs buy care from a range of bodies including those in the NHS as well as charities and from the private sector.

What services are provided by the NHS?

For residents in the UK, coverage is universal. Nonresidents with a European Health Insurance Card (EHIC) are also entitled to care which is generally free at the point of use. For those who do not fit into these categories, only emergency intervention and for certain infectious diseases is free.

The services provided by the NHS are extensive, ranging from inpatient and outpatient hospital services to home visits by community-based nurses. However, apart from households which are entitled the NHS Low Income Scheme, costs that may be endured include charges for prescriptions, dental treatment or eye care.

Private Health Insurance in the UK

Despite of health care being universal and aiming to provide comprehensive cover, in 2015, it was estimated that 10.5% of the UK population had private health insurance. This could be due to a variety of reasons, such as reduced hospital waiting times, a wider range of specialist treatments and a private room. For some treatments which are not available on the NHS because they are too expensive or not approved to standards that are necessary for them to be implemented on the NHS, private insurance may allow access to such medical services, whether that be in a private hospital or in a private ward in an NHS hospital. In general, it's expected that with buying power comes increased choice and privacy.

However, insurance premiums can be expensive and tends to increase year on year. Private insurers also frequently refuse to cover some chronic conditions, for example heart disease, diabetes and some terminal cancers, unlike the NHS where, with some exceptions, care aims to meet the needs of everyone. As a result, despite the influence of private health insurance, the NHS still serves those in need at a rate of over 1 million patients every 36 hours.

References:

• The Conversation, Britain’s National Health Service: one model, four systems (http://theconversation.com/britains-national-health-service-one-model-four-systems-81579)
• www.parliament.co.uk, Health and Social Care Act 2012 (https://services.parliament.uk/bills/2010-11/healthandsocialcare.html)
• NHS Clinical Commissioners, About CCGs (https://www.nhscc.org/ccgs/)
• NHS, Guide to the Healthcare System in England (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/194002/9421-2900878-TSO-NHS_Guide_to_Healthcare_WEB.PDF)
• The Commonwealth Fund, The English Health Care System (https://international.commonwealthfund.org/countries/england/)
• NCBI, Overview of healthcare in the UK (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405352/)
• NHS, NHS Low Income Scheme (https://www.nhsbsa.nhs.uk/nhs-low-income-scheme)
• The Telegraph, The pros and cons of private medical insurance (https://www.telegraph.co.uk/insurance/health/pros-cons-private-medical-insurance/)
• NCBI, Role of private sector in United Kingdom healthcare system (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118448/)
• NHS Confederation, NHS statistics, facts and figures (http://www.nhsconfed.org/resources/key-statistics-on-the-nhs)

Go back to SOHAW home page

_____________________________________________________________________________________________

Emilia Chen, Oxford