In this essay I intend to discuss how relevant the original three core principles of the NHS are today, and will be into the future of the 21st Century. This will be in regard to technological and political developments that have taken and are currently taking place.
On the 5th July 1948 the National Health Service was born. This was developed in response to The Beveridge Report of 1942 that named five ‘Great Evils’ rife in Great Britain following World War II. These were want, disease, ignorance, squalor and idleness.
Although Winston Churchill and his Coalition Government commissioned the report in 1941, it was Clement Attlee and his Labour Government who outlined the measures that would be taken. The National Health Service has the following three core principles: Universal – standards are to be the same nationwide, Comprehensive – to cover all areas of healthcare and finally free at point of entry to all.
On the 5th July 1948 when the NHS was born it had the following resources, 1143 Voluntary Hospitals – these accounted for 90,000 beds and 1545 Municipal Hospitals – these accounted for 390,000 beds. Of these beds 190,000 were mental health beds and a further 66,000 were geriatric beds. Not one additional doctor or nurse was employed, what changed was the way the system operated. Point of access was free and the patient no longer paid every time they needed healthcare – instead it was paid collectively through their taxes – making the system much fairer and more accessible to all.
The management structure in 1948 consisted of 14 Regional Hospital Boards (RHBs), 36 Boards of Governors (BGs), 388 Hospital Management Committees (HMCs) and 38 Executive Councils (ECs).
At this time the service was low tech and healthcare provision was very basic, and the doctors and nurses that worked within it mostly managed the NHS. Due to the NHS becoming free access to all at point of entry the demand for provisions increased dramatically.
During the 1960s staffing levels increased and new technologies like heart and lung machines and kidney dialysis were being introduced. The first kidney transplant was performed in 1960 and the first heart transplant in 1968. A set of sextuplets was born in 1968 following fertility treatment. Costs for newly developed drugs were rising, but this was all in the main funded by the government.
The first major restructuring of the NHS took place in the 1970s. This was when NHS Managers came to the forefront of the NHS (much opposed by many clinicians). First attempts were made to rationalize spending into local areas. Technology was advancing – in 1972 CT scans were introduced and in 1978 the first test-tube baby was born.
In the 1980s ‘The NHS Management Enquiry’ introduced general management in charge of clinical staff and in 1989 reforms were introduced to differentiate between the providers and the purchasers of healthcare. Under the Margaret Thatcher Conservative Government, bed numbers were reduced and funding cutbacks were harsh. Private finance was also being introduced into the system. Advancements in science brought us the MRI scan and in 1987 the first heart, lung and liver transplant was performed. In 1986 the public health campaign over AIDS awareness was the biggest in the history of the NHS.
When we reach the 1990s the new Labour government makes many reforms. GP fundholding and NHS Trusts were established showing a major move in this area. Fundholding was subsequently abolished and Primary Care Groups set up. Postcode lotteries became a political issue and the NHS was beset by scandals such as incorrect cancer results and dirty hospitals. In 1998 NHS Direct is launched – a nurse-led service available over the phone.
A new century brings huge changes in the NHS. Significant funds are given in addition to bring the system up to date. Regulators are established to oversee NHS practise - Healthcare Commission and Commission for Social Healthcare Inspection,...