Unit 6 - History of NHS - Distinction Achieved PDF

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The History of The National Health Service – Unit 6 Timeline For the Creation of the NHS Figure 1: Aneurin Bevan (BBC Wales, 2014) 1948 – ‘The NHS is founded on 5 July 1948, following an official unveiling at Park Hospital (now Trafford General Hospital) in Manchester.’ (nuffieldtrust.org, date unknown). The National Health Service Act was produced by Aneurin Bevan. 1951 – Bevan resigns in protest against new fees being introduced for dental treatments and glasses/spectacles. 1958 – ‘The NHS delivers first mass vaccination programme, with everyone under the age of 15 vaccinated against polio and diphtheria.’ (england.nhs.uk, 2020) 1959 – The Mental Health Act is introduced and helps to establish mental health services within the NHS for the first time. 1967 – The Abortion Act is passed and legalises abortions up to 28 weeks gestation. 1971 – The NHS acquires its first CT machine and carries out the first scan in Atkinson Morley Hospital in London (now part of St Georges Hospital). 1977 – The first MRI scan was carried out in the UK. 1983 – At St Marys Hospital, Manchester the first NHS IVF service was created. 1990 – ‘The Abortion Act is replaced by the Human Fertilisation and Embryology Act. It states that abortion is no longer legal after 24 weeks except if: the mother’s life is in danger; there is extreme foetal abnormality; or there is a grave risk of physical or mental injury to the mother.’ (nuffieldtrust.org, date unknown). 1998 – NHS Direct is created to provide expert advice and support for health inquires. 2000 – The NHS Plan is introduced. It outlines a 10-year initiative to provide more staff, hospitals and beds. 2007 – ‘A ban on smoking in nearly all enclosed work places and public places in England is I introduced’ (nuffieldtrust.org, date unknown) 2009 – The Care Quality Commission (CQC) is introduced as a health and social care regulator. Figure 2: CQC logo (CQC, date unknown) 2014 – NHS publishes a Five Year Forward View. This is a plan for changes to be made within the NHS over the next 5 years. 2018 – NHS celebrates its 70th anniversary. 2019 – The Long-Term Plan is announced, which sets out the goals the NHS wishes to achieve over the next 10 years. 2020- Coronavirus hits the UK, forcing the UK into a national lockdown and places extreme pressure on the NHS. Figure 3: Campaign launched by the department of health and social care to help stop the spread of Coronavirus (gov.uk, 2020) 2021 – Coronavirus Vaccination Programme is ongoing with over 46.8 million people in the UK having received the first dosage.

Factors That Led to The Creation of the NHS

There are many factors that led to the NHS being created and these factors stem back to the early 1900’s. Before the 19th century, the only legal recourse in place to help those in poverty was the Poor Laws. The poor were categorised as deserving or underserving and would or wouldn’t receive help based on these categories. After an investigation carried out by Edwin Chadwick, the Public Health Act (1848) was brought out as an early attempt to improve public health. Chadwick's argument was that if the health of the poor were improved, it would mean less people seeking poor relief. Therefore, money spent on improving public health was a better solution.. Between 1906 and 1914 a range of welfare reforms were introduced. These reforms were designed to help those who were affected by poverty caused by sickness, unemployment and old age. ‘By the beginning of the 20th century, most areas of Britain had hospital provision of some sort. However, the system was fragmented. Some were private fee-paying hospitals, some were voluntary hospitals run by charities, while others had been set up by local councils.’ (BBC Bitesize, date unknown). In 1911 the National Insurance Act was introduced. This allowed workers to access free medical care and sickness benefits if they fell ill. It was a vital step but it had restrictions, such as only covering certain jobs and not being available to worker’s families. This meant that healthcare was unevenly distributed and that most women and children still had to pay for their health care as during this time men were more commonly the workers of the family.

The NHS’s funding has on average increased by 3.7% a year. However, since 2010 the NHS has received on average a 1.4% increase . The reason that the budget increase has slowed is due to government budgets coming under pressure. In 2018, a new 5-year funding deal was announced with funding rising by £33.9 billion by 23/24. Although this increase is closer to the overall average, there are certain conditions to this deal. For example, it excludes important areas such as capital investment and education/training of staff. Thanks to the increase in funding over the years more staff have been hired to keep up with the demand. ‘Thenumber swor ki ngf ort heNHShav eboomed.Ther ear eno w 1. 7m peopl eempl oy ed byt heheal t hs er vi c eacr osst heUK,mak i ngi tt hefi f t hl ar ges templ oy eri nt hewor l d. ’(Triggle, 2018) Due to being over budget in the early years of the NHS, cuts were made as the government struggled to keep up. Due to this, charges were introduced for prescription, dental treatment and glasses. These charges came into force in 1952 and have risen in price throughout the years. A prescription in England now costs £9.35 (unless exempt). What happens when funding is cut but the NHS still have to same demand? Certain services or staff get cut or severely reduced. For example, according to nhsfunding.com (2021) ‘Nurses and health visitors in Staffordshire could lose their jobs due to council budget cuts’. When cuts like this happen, there is more demand on the service due to less staff and the service become less accessible to the public.

In 1939, World War 2 started and the government established an Emergency Hospital Service in order to cope with the increase in casualties and to plan for the future. In 1942, a report by William Beveridge identified five evil giants (want, disease, ignorance, squalor and idleness). By finding disease as a factor, he proposed a free national health service. It wasn’t until 1946 that the National Health Service Act was introduced by Aneurin Bevan. Due to opposition from various parties, it took 2 years of debates and negotiations until finally the first NHS hospital was founded. To summarise, the main factor that led to the creation of the NHS was the inaccessibility to healthcare for the poor. The labour government believed in equality for all and that support should be made available regardless of social class. Reports from people such as Chadwick and Beveridge were key parts of a free healthcare system being introduced and real change being made.

How The NHS Responds to Changing Demands The NHS is constantly having to respond and adapt to changing demands. The biggest demands on the NHS are costs and budget. Bevan had not anticipation the level of demand, leaving the NHS with the problem of over-demand and underfunding. In order to combat these demands, various plans and tactics have been implemented over the years. For example, the NHS is now not completely free. From 1952, prescription fees have been charged and some services such has dental treatments and optical appointments require payment. More recently, initiatives have been put in place in an attempt to reduce costs and ease demands. For example, NHS Direct was introduced in order to provide advice and support over the phone 24/7 – alleviating the number of unnecessary visits to GPs and hospitals. Figure 4: NHS Direct logo (Logopedia, date unknown) With better accessibility, more people visited their GP. Along with newer technology and medicines, the average life expectance rose. This was a great success but it meant that there are now problems with an aging population and more patients with age-related illness. This puts a strain on the NHS as more hospital beds were being occupied. The NHS’s response to this demand, was by moving care out of hospital and into the community. This allows hospital beds to become more available. Newer technology and medicines came at a financial cost. At the end of the 20th century, hospitals were not only treating common illnesses but also a plethora of more complex illness. ‘The Blair government responded to the revolution in medicine by setting up an independent body, NICE, to ration what could and could not be afforded. It has seen a host of treatments not being approved for NHS - despite protests from patients’ groups.’ (Triggle, 2012) The understanding of mental health is also a factor that has dramatically changed over the years. In the 1950s, mental health had a stigma of fear. People with mental health issues were branded insane and sent to asylums. Over the years, the NHS has evolved and taken drastic steps within mental health – Asylums were closed, care was moved into hospitals/community and an increase in use of talking therapies. Research has allowed for medications to be produced that can help mental health, more understanding of illness and actual diagnosis being given.

Figure 5: Show prescription charges from 1948-2018 (Triggle, 2018) An other example of the effects budget cuts have is from ‘An unpublicised cut to the NHS repairs budget. This capital budget, used to fund maintenance and replace out-of-date or broken equipment, was slashed by £1.1bn in George Osborne’s 2016 Budget.’ (Patients4NHS, 2016)

How The Introduction of Market Forces Attempted to Make More Effective Use of Funding The introduction of market forces has both advantages and disadvantages. By opening up to the market it allows the NHS to change and evolve. According to Black (2011) ‘This can be seen in a scenario where new technology became available for non-invasive cardiac diagnostics that is safer than traditional approaches, but which requires expensive equipment. The old technique involves an invasive procedure that requires a catheter to be inserted into the heart, which requires skilled staff and is risky. Yet a typical NHS hospital will not rush to use the new kit because it requires investment and would seem to waste money already spent on equipment and training.’ ‘Over the past 30 years or so, different governments have introduced measures to open up the NHS to market forces and competition (‘marketisation’).’ (Patients4NHS, 2019). Marketisation started as a result of the Heath and Social Care Act (2012) . The HSC Act (2012) made it mandatory for the NHS to outsource certain service. However according to Patients4NHS (2019) ‘data collected from 126 NHS Trusts during the period 2010-2014 shows that those Trusts that outsourced their cleaning services reported significantly higher rates of MRSA infection. MRSA is a type of infection that is resistant to many antibiotics. It can cause considerable distress to patients and prolong their stay in hospital. It can also have an impact on waiting times for other patients, reduce the availability of NHS resources and cause sickness and absence in staff. So, while outsourcing may appear at face value to be the cheapest option, when the full costs are taken into account, it may prove to be a false economy.’ Also according to Patients4NHS (2019), ‘Estimates of the extra costs arising from ‘marketisation’ are difficult to calculate but have been estimated as between £4.5 billion and £10 billion a year – or enough to pay for either ten specialist hospitals; 174,798 extra nurses; 42,413 extra GPs; or 39,473,684 extra patient visits to A&E’ In conclusion, as much as there is dislike of the idea of market forces, there are advantages that outweigh the disadvantages.

How Changes to Funding Impacts The NHS Since the start of the NHS, funding has always been an issue. Compared to when the NHS was founded the budget has increased by over 12 times the amount it was in 1948. Changes to funding impact all parts of the NHS. Some examples include more staff, higher prescription charges, cuts to certain health service and even cuts to the maintenance budget.

By Victoria Turner...