Health Policy in Britain: The Politics and Organisation of the National Health Service

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In across England and Wales there were hospital management committees, and 36 teaching hospitals, each with its own board of governors.

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There were also local health authorities , running health centres, ambulances services and other community services, and executive councils, managing general practices, NHS dentistry , pharmacists and opticians. These included 9, full-time doctors, 19, professional and technical staff including 2, physiotherapists, 1, laboratory technicians and 2, radiographers , 25, administrative and clerical staff, , nurses and midwives 23, of whom were part-time , and , ancillary staff catering, laundry, cleaning and maintenance. Political concerns about spiralling NHS costs later receded in the wake of the Guillebaud Report , which praised the "responsible attitude among hospital authorities" towards the "efficient and economical" use of public funds.

The period also saw growth in the number of medical staff and a more even distribution of them with the development of hospital outpatient services. By , the NHS was stretched financially and doctors were disaffected, resulting in a Royal Commission on doctors' pay being set up in February The investigation and trial of alleged serial killer Dr John Bodkin Adams exposed some of the tensions in the system. The s have been characterised as a period of growth.

Prescription charges were abolished in and reintroduced in New drugs came to the market improving healthcare, including polio vaccine, dialysis for chronic renal failure and chemotherapy for certain cancers were developed, all adding to upfront costs. Health Secretary Enoch Powell undertook three initiatives:. Concern continued to grow about the structure of the NHS and weaknesses of the tripartite system.

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Further development came in the form of the Charter of General Practice, negotiated between new Health Minister Kenneth Robinson and the BMA, that provided financial incentives for practice development. This resulted in the concept of the primary health care in better-housed and better-staffed practices, stimulating doctors to join together and the development of the modern group practice.

After the publication by the British Medical Journal on 24 December of University of Cambridge consultant paediatrician Douglas Gairdner 's landmark paper detailing the lack of medical benefit and the risks attached to non-therapeutic routine circumcision, [6] the National Health Service took a decision [ when? Both the cost and the non-therapeutic, unnecessary, harmful nature of the surgical operation were taken into account.

The NHS in England was reorganised in to bring together services provided by hospitals and services provided by local authorities under the umbrella of regional health authorities , with a further restructuring in The s also saw the end of the economic optimism which had characterised the s and increasing pressures coming to bear to reduce the amount of money spent on public services and to ensure increased efficiency for the money spent.

The 's and 's saw issues with contaminated blood and blood products which was referred to later as the "worst treatment disaster in the history of the NHS". In the s, Thatcherism represented a systematic, decisive rejection and reversal of the Post-war consensus , whereby the major political parties largely agreed on the central themes of Keynesianism, the welfare state, nationalised industry, public housing and close regulation of the economy. There was one major exception: the National Health Service, which was widely popular and had wide support inside the Conservative Party.


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In the s modern management processes General Management were introduced in the NHS to replace the previous system of consensus management. This was outlined in the Griffiths Report of The report also recommended that clinicians be better involved in management. Financial pressures continued to place strain on the NHS. From this review and in , two white papers Working for Patients and Caring for People were produced.

These outlined the introduction of what was termed the "internal market", which was to shape the structure and organisation of health services for most of the next decade. In spite of intensive opposition from the BMA, who wanted a pilot study or the reforms in one region, the internal market was introduced. Certain GPs became "fund holders" and were able to purchase care for their patients.

The "providers" became NHS trusts , which encouraged competition but also increased local differences. Studies suggest that while the competition introduced in the "internal market" system resulted in shorter waiting times it also caused a reduction in the quality of care for patients. These innovations, especially the "fund holder" option, were condemned at the time by the Labour Party. Opposition to what was claimed to be a Conservative intention to privatise the NHS became a major feature of Labour's election campaigns.

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Labour came to power in with the promise to remove the "internal market" and abolish fundholding. It replaces the internal market with "integrated care". We will put doctors and nurses in the driving seat. For the first time the need to ensure that high quality care is spread throughout the service will be taken seriously. National standards of care will be guaranteed. There will be easier and swifter access to the NHS when you need it.

Our approach combines efficiency and quality with a belief in fairness and partnership. Comparing not competing will drive efficiency.

However, in his second term Blair pursued measures to strengthen the internal market as part of his plan to "modernise" the NHS. Driving these reforms were a number of factors including the rising costs of medical technology and medicines, the desire to increase standards and "patient choice", an ageing population, and a desire to contain government expenditure. Since the national health services in Wales, Scotland and Northern Ireland are not controlled by the UK government, these reforms have increased the differences between the national health services in different parts of the United Kingdom.

Reforms included amongst other actions the laying down of detailed service standards, strict financial budgeting, revised job specifications, reintroduction of a modified form of fundholding — "practice-based commissioning", closure of surplus facilities and emphasis on rigorous clinical and corporate governance.

In addition Modernising Medical Careers medical training had an unsuccessful restructuring which was so badly managed that the Secretary of State for Health was forced to apologise publicly. It was then revised but its flawed implementation left the NHS with significant medical staffing problems. Some new services were developed to help manage demand, including NHS Direct. A new emphasis was given to staff reforms, with the Agenda for Change agreement providing harmonised pay and career progression. These changes gave rise to controversy within the medical professions, the media and the public.

The Blair Government, whilst leaving services free at point of use, encouraged outsourcing of medical services and support to the private sector. Under the Private Finance Initiative , an increasing number of hospitals were built or rebuilt by private sector consortia; hospitals may have both medical services such as independent sector treatment centre ISTC or "surgicentres" , [14] and non-medical services such as catering provided under long-term contracts by the private sector.

The first PFI hospitals contained some 28 per cent fewer beds than the ones they replaced. In , surgicentres treated around three per cent of NHS patients in England having routine surgery. By this was expected to be around 10 per cent. As a corollary to these initiatives, the NHS was required to take on pro-active socially "directive" policies, for example, in respect of smoking and obesity. The NHS encountered significant problems with the information technology IT innovations accompanying the Blair reforms.

This must be controlled and in the NPfIT model it is, sometimes too tightly to allow the best care to be delivered. One concern is that GPs and hospital doctors have given the project a lukewarm reception, citing a lack of consultation and complexity.

Atscale will catalyse new technologies and service delivery models, spark 30 new start-ups and mobilise the private sector to help at least 3 million people access assistive technologies by The UK hosts 58 WHO collaborating centres , institutions such as research institutes, universities or academies, which are designated by the Director-General to carry out activities in support of the Organization's programmes. Among them are top global institutions that share data and lend their expertise to WHO in areas such as nursing, occupational health, communicable diseases, nutrition, mental health, chronic diseases and health technologies.

Public Health England PHE is a strong partner with nine collaborating centres in the areas of global health security, mass gatherings, antimicrobial resistance research, special pathogens, chemical exposures, radiation protection, and nursing and midwifery. W HO's Health Emergencies team partners with PHE in areas including capacity building, knowledge transfer, quality assurance for outbreak, simulation exercise management, human resources exchange and emergency trainings.

The goal of the Global Polio Eradication Initiative is to complete the eradication and containment of all wild, vaccine-related and Sabin polioviruses, such that no child ever again suffers paralytic poliomyelitis. In early , malaria was claiming more lives in Nigeria's Borno State than all other diseases combined. Most of the deaths were among children aged under 5 years. The UK contributed US 9.

In collaboration with the Borno State Ministry of Health, WHO launched a special campaign in July aimed at rapidly reducing the malaria burden among under-5 children in 5 high-transmission areas.

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The 4-month campaign reached 1. This integrated campaign - a collaborative effort between the malaria, polio and health emergency teams at WHO headquarters, the WHO Regional Office for Africa and the WHO Nigeria country office - marked the first time that antimalarial medicines had been delivered on a mass scale alongside the polio vaccine in an emergency humanitarian setting. WHO's High Burden to High Impact response is consistent with the UK focus on making impact in high burden countries; guided by the strategic use of evidence to achieve value for money and enabled by good development practice.

Since , UKaid has supported 34 million people to cope with the effects of climate change and improved access to clean energy for 12 million people Braced pic. An increase in the number of countries with health adaptation plans that meet WHO criteria from a baseline of two countries in to eleven in including the four pilot countries. A direct increase of 1. United Kingdom Partner in global health. Delivering impact for health with development aid.

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