Case Study Analysis of National Health Services: Past, Present and Future

Case Study Analysis of National Health Services: Past, Present and Future

                        

National Health Services: Past, Present and Future

National Health Service (NHS) started working on the 5th of July 1948 aiming to provide quality healthcare services to people of Britain. The standards of the NHS focus on providing the best medical care facilities to patients to save patients’ lives. The historical context of the organisation indicates a series of events and challenges it has gone through since its establishment. During the due course of time, the organisation has faced political influence, the pressure of changing social needs, the impact of the declining economic situation of Britain, innovation needs, and leadership issues (Rivett, 2021). However, the core values of the organisation based on a commitment for providing quality health care services, compassion, respecting the dignity of patients never changed despite all above-mentioned challenges (NHS Foundation Trust, 2021). The resilience of the organisation in terms of handling Covid-19 pandemic issues has proved that the organisation has strong healthcare infrastructure which ensures that the organisation can compete with any healthcare challenges appearing at a smaller or larger scale (Morris & Barnes, 2020). This paper critically focuses on different perspectives related to NHS history, working infrastructures and funding issues in the context of social changes since the establishment of the organisation.

Needs that led to the Establishment of the NHS

The healthcare facilities in the pre-NHS establishment time were not sufficient enough to meet the health needs of patients. The impact of the Second World War made the hospitals empty from healthcare facilities and the financial spectrum of health organisations was in a poor state. The war increased the need for reforms in medical organisations. The story of NHS revolves around three actors related to healthcare involving, patients who need healthcare facilities, service providers (medical professionals) and financiers (political government) who raise money or responsible for NHS expenditures (Rivett, 2021).

Welfare State Reforms and Medical Facilities

The struggle for liberal reforms started long before the start of the First World War. The study conducted by Booth and Rowntree focused on poverty issues. The research conducted by Booth and Rowntree highlighted various issues related to healthcare resulting from poverty. Poor people were neither able to pay for their treatment nor could afford to see a doctor.

Poverty related issues were first discussed in 1906 which laid the foundation for The People’s Budget of 1909 and it was passed by the parliament in 1910. From 1906 to 1911 different acts were passed to eradicate social problems involving health care issues as well. These reforms particularly focused on children who were suffering from malnourishment due to poverty, the unemployed, and the elderly. During 1919, Lloyd George introduced ‘The National Health Insurance Act’. The aim was to provide healthcare facilities to deprived communities with lower income status. In 1939, the Emergency Medical Scheme was established to treat wartime injured soldiers, however, in later times this service was extended to civilians.

How NHS Works?

A major portion of NHS funding is shared from tax money and insurance money. The beginning of NHS facilitated everyone to enjoy health services regardless of their profession or social status. The NHS system allows home visiting and home check-up for patients. There were not many hospitals in the beginning.

The Establishment of NHS with Extended Medical Facilities

The introduction of NHS aimed to establish new hospitals during the coming years with improved health care facilities. In the beginning, the services were free, however, since 1952 patients have to pay for prescriptions and dental treatment. Seeing a professional for consultation is free. The modernising of hospitals started in the 1950s which led to making a comprehensive plan for NHS known as '1962 Hospital Plan for England and Wales’ (Future Learn, 2021). There is a need to understand different factors that led to the creation of NHS. These factors are diverse in nature and are elaborated on in the following discussion.

The Beveridge Report and Diagnosed Factors

The Beveridge Report presented by William Beveridge in 1942 highlight the need for ‘social insurance and allied services’. The report emphasized the need for contribution from the earners to establish a social insurance system to provide caring facilities to unemployed, needy, retired and widowed. The report identified five miseries behind the poor social structure of England involving

· Disease

· Idleness

· Ignorance

· Squalor

· Want    (The National Archives, 2021)

From 1929 to onward the economic depression halted any reforms to social structures of England. However, Beveridge's report emphasised the need for radical changes. The political and public reaction to the report was of a mixed kind. The political reaction from some conservatives and labour party members was of mixed attitude. Labour opposed the ideas of ‘individualists’ responsibility’ for caring expenditures and some labour members criticised the socialist ideas regarding the state's responsibility. Medical professionals appeared as a third actor resisting the change due to the concerns for losing economic benefits (UK Parliament, 2021). The establishment of NHS faced three challenges;

· Political challenges

· Resistance from medical professionals

· Resources (financial issues) (Rivett, 2021; Lecture Notes, 2021)

Aneurine Bevan’s Services for NHS

Aneurin Bevan advocated the idea of NHS emphasising the care facilities for the poor. His agenda was highly opposed by all three mentioned parties. Churchill's Tory leadership was on upfront to oppose Bevan social idea of health series for all. The opposition groups thought the plan was an economic burden on the Kingdom's financial resources (Rick, 2011). The idea of welfare state flourished in Clement Atlee's time, then Prime Minister of England who bestowed the responsibility to Anuran Bevan, the minister of health. People of English saw this scheme as an improvement to the social system especially in struggling years of the post-World War II period (Rivett, 2021).

Political and Medical Bias against NHS Establishment

The idea of establishing a National Health Service was severely opposed by the medical professionals and their political body known as the British Medical Association BMA. Private medical consultants and charities were resisting thinking they would be nationalised as well. There was a political divide among conservatives and labour parties' members. However, people were happy from this political move. The consensus between all the parties made the life of common British easier.

Thatcherism and NHS

For almost 30 years, this consensus was observed by all the members of the kingdom. However, the 1970s economic crisis lead Margret Thatcher, the Prime Minister of England to start neo-liberalism also known as Thatcherism. Thatcher promoted privatisation, free trade, financial deregulation and quality of services and products (Scott-Samuel, 2014). The economic, political and social conditions of the United Kingdom were in the poor state especially after the 1950s. The electric shortfall, the collapse of political consensus on issues and economic crisis led Thatcher to take strong decisions. The unemployment rate was 26% and companies were shutting down. Thatcher announced her commitment to “principles of self-reliance and Victorian values”.

Griffith’s report and the Impact of Thatcher’s Policies

A lot of funding was cut during Thatcher’s period. Griffiths report indicates management issues behind poor management at NHS. The proposed recommendations involved the restructuring and presence of strong management, effective constant decision making, requiring more budget for the organisation, the presence of accountability system, and the presence of general managers at all levels of the organisation. The 1982 restructuring of NHS did not alter its basic structure. The increasing burden of expenditures forced the conservative government to release 101 million to improve services. In 1988 the review of NHS services structure was initiated. Thatcher's period was seen as one of the difficult times for the NHS (Ranade & Haywood, 1989; Rivett, 2021). Thatcher’s second term election campaign focused on opposing the socialist idea of state’s responsibility about everything. “I am personally against the socialist ideas” because the “economic condition of Britain cannot afford” to pay for everything (Thatcheritescot, 2012).

Advancement in NHS during Thatcher’s Period

NHS made considerable progress during the 1st term of Thatcher. ‘Patients' first’ documentation by NHS was the introduction in 1979. Black Report on inequalities in NHS was published in 1980. Nurses pay issues were debated in the parliament in the same year. Primary health care services were initiated in inner London in 1981. Mandatory GP vocational training was initiated in 1982 and NHS restructuring was started in the same year. Griffiths report and mental health act were passed in 1983. Measles vaccination was started in 1988 and project 2000 was agreed to reform NHS unanimously (Rivett, 2021).

Blair, Cameron & Clegg and NHS

Since the first term of Toney Blair in office, NHS restricting and funding was the top priority. The biggest issue was patients' waiting time which was more than 18 months and facilities were not up to standards in some areas of the country (The Lancet, 2007).

Reduction in Patients’ Waiting Time

Blair's target was to reduce patients waiting time and the first target was set for 100,000 patients. The waiting time for surgery patients without any emergency needs was exceeding two years and Blair promised that "no one should wait longer than 18 weeks". During Blair's tenure in office,

Structural Reforms at NHS

England initiated NICE reforms to NHS with an improved framework. In 2000, NHS kicked off a new 10 years program to reduce waiting time and improve food for patients. In 2008, the Labour Party initiated a 5-year plan to increase the NHS budget to bring it to European healthcare budgets and standards (Triggle, 2007).

In 2007 Blair announced integrated healthcare facilities leading to the end of the internal market. The National Institute for Clinical Excellence was established in 1999. The heart patients were allowed to choose alternative hospitals for treatment in 2001 if the waiting time exceeded 6 months (The Lancet, 2007).

Aging Population

The demographic changes are affecting NHS. One of the biggest concerns is ageing population. NHS is trying it best to deal with ageing patients. It is believed that 2/3 patients in hospitals are over the age of 65 which is a major concern. For minor surgeries and for care treatment, NHS has designed a policy which involves GPs to treat these patients. However, this has increased financial burden on NHS. For instance, South London Healthcare suffered from £65m deficit in this context (Triggle, 2013).

Medical Advancement

More patients have been receiving modern healthcare facilities and being treated for cancer, heart attacks, and disability problems. IVF treatment is one of the best options NHS is using to treat patients. The statistics indicate that NHS contributes to saving more than 3000 lives every year. NHS spends £10b to install medical technology in hospitals (Triggle, 2013).

NHS and Lifestyle Awareness

NHS spends almost £4b on the treatment for obesity issues and similarly, £3b on patients suffering from lives disease due to smoke or alcohol consumption. NHS with the involvement of city or town councils and food companies have launched a campaign in 2012 to label every food to highlight the level of sugar, salt, and fats to make people aware about changing lifestyle trends (RCPSG, 2013).

The Impact of Funding Change on NHS

A regular restructuring caused NHS a deficit of more than 500 million during 2005-6 which some of the professionals observed as a waste of money. However, it is a reality that Blair invested huge sum to restructure and improve NHS which none of the governments in Britain had done so. Medical professionals received high salaries and the total budget increase was estimated at 7% (Triggle, 2007).



During Cameron's tenure in office, NHS was under heavy financial pressure. Cameron promised, "seven-day GP access by 2020" (Sheeler, 2014). The Health and Social Care Act 2012 laid the grounds for all medical bodies to abolish any medical inequalities. The equal treatment for patients suffering from mental health issues was one of the primary concerns highlighted in this Act (NHS England, 2021). This Act ensures the involvement of patients and their carers to decide the provision of health care facilities, and freedom of choosing health care facilities (Clinical Commission Group, 2021).

Although the mental health was already on the priority list, however, since the enforcement of the 2012 Act, people with mental health issues were given priority. Clinicians account 23% of the human physical disease have a direct link with mental health. The statistics indicate that 13% of NHS expenditures are spent on mental health treatment (Glover-Thomas, 2013).

Present Funding Analysis

From 2018 to onward, the present government of England has invested in a considerable amount in NHS to improve medical facilitation. The statistics indicate that in 2018 the government was spending £148.8bn. However, the spread of Covid-19 has generated extreme pressure on the NHS. The spending plan for 2020/2021 increased to £201.7bn. This funding includes an amount of £51.9bn as Covid funding. The regular funding increase has been determined as £160.9bn during 2021 and an extra £20.9bn has been set up to counter Covid pandemic (Kingsfund, 2021).

From 2008 till date the annual budget rise has been determined 1.4% while from 2009 to 2019 the overall increase is 3.7%. Most of the NHS funding is used for salaries and improvement of equipment along with medicine purchasing. The new “five-year funding deal” of NHS ending on 2023/24 ensures £33.9bn increase in cash.

Summary

NHS is one of the largest health care facilities providing organisations and it has contributed to on a massive scale for the wellbeing and good health of patients. The 70-year story is full of success, pressures, political disputes, and restructuring of the organisation. However, the presence of NHS is a proof of its success and people working for the NHS. At present, 8% of the national income is spent on the NHS. The Office for Budget Responsibility (OBR) projections indicate that by 2064-65 England needs to spend almost 14% of the national income on NHS. The estimations indicate that in the next 20 years the spending would reach 10.2% which is £66bn.

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