National Health Service
The systems are primarily funded through central taxation. They provide a comprehensive range of health services, the vast majority of which are free at the point of use for people legally resident in the United Kingdom. The four systems are mostly independent from each other although some functions might be routinely performed on behalf of the UK Department of Health or for one of the other three systems (e.g. Northern Ireland has no high security mental hospitals and thus depends on using hospitals in Great Britain, routinely Carstairs State Mental Hospital in Scotland for male patients and Rampton Secure Hospital in England for female patients); otherwise, they operate under different management, rules, and political authority.
The individual systems are:
All services are often referred to as "the NHS", although only the English NHS is officially called the "National Health Service". All of the services were founded in 1948, based on legislation passed in 1946, 1947 and 1948. NHS Wales was part of the same structure as England until powers over the NHS in Wales were transferred to the Secretary of State for Wales in 1969, and responsibility for NHS Wales was passed to the Welsh Assembly (now the Welsh Government) under devolution in 1999.
The Labour Government elected in 1945 had made manifesto commitments to implement the recommendations of the Beveridge Report of 1942. The report's recommendation to create "comprehensive health and rehabilitation services for prevention and cure of disease" was implemented across the United Kingdom on 5 July 1948. The services were initially funded through general taxation and National Insurance as part of the introduction of a wider Welfare State. They were initially free at the point of use, although some prescription charges were soon introduced in response to economic difficulties. These charges are still in place with the English NHS, but not in the other three systems.
- The National Health Service Act 1946, creating the National Health Service in England and Wales
- The National Health Service (Scotland) Act 1947, creating the National Health Service in Scotland
From 1969 the National Health Service in Wales became a separate entity under the Secretary of State for Wales.
- Health Services Act (Northern Ireland) 1948, creating a Health Service in Northern Ireland.
Recent (2010 - Present)
Following devolution in the United Kingdom from 1998 onward, control over the non-English services (other than those reserved to the UK Parliament) passed to the devolved national governments, with the UK Government retaining control over the English NHS. The English NHS underwent a major reorganization in the years after 2010 in the run-up to and passing of the Health and Social Care Act 2012.
Each system operates independently, and is politically accountable to the relevant government: the Scottish Government, Welsh Government, the Northern Ireland Executive, and the UK Government which is responsible for England's NHS.
Despite their separate funding and administration, there is no discrimination when a resident of one country of the United Kingdom requires treatment in another, although a patient will often be returned to their home area when they are fit to be moved. The financial and administrative consequences are dealt with by the organisations involved and no personal involvement by the patient is required.
Treatment of people not resident in the United Kingdom is subject to mostly uniform arrangements made by or delegated to the UK Department of Health rather than any individual health service. Foreign nationals always receive treatment free at the time of use for emergencies.
Foreign nationals also receive free treatment if they have been legally resident in the UK for 12 months, have recently arrived to take up permanent residence, are claiming asylum or have other legal resident status. Citizens of European Economic Area nations, as well as those from countries with which the UK has a reciprocal arrangements, are also entitled to free treatment by using the European Health Insurance Card. Foreign nationals may be subject to an interview to establish their nationality and residence status, which must be resolved before non-emergency treatment can commence. Patients who do not qualify for free treatment are asked to pay in advance, or to sign a written undertaking to pay.
Treatment for injuries caused in a road traffic accident has been chargeable since the 1930s, but such charges were not generally enforced until the Road Traffic (NHS Charges) Act 1999 came into force to direct the charges to the insurers of the vehicles involved. This necessarily involves patients in the charging process even though they are not personally billed for treatment.
Funding and expenditures
Each National Health Service is mainly funded ultimately from general taxation (with a much smaller amount from National Insurance contributions). Other, less significant sources of income include charging overseas visitors and their insurers for the cost of NHS treatment, charges to patients for prescriptions and dental treatment, hospital car parking, patient telephone services, etc. NHS Trusts can earn income through treating patients privately; in England Trusts generate 0.6% of core revenues this way, much less in the rest of the UK.
Expenditure can be measured in a number of ways to be able to compare it from year to year. The amount of money spent is one way, and is either reported in actual or real (adjusted for inflation) terms. After rising during the Labour government (1997-2010), in real terms funding has remained broadly constant during the Conservative-led coalition government since it came to power in 2010. The Conservatives had promised to 'ring-fence' the health budget and protect it from cuts. Another way to look at expenditure is as a percentage of economic output, or GDP. According to indicators from the World Bank, the UK spent about 9.4% of its GDP on health in 2013. This is lower than both the average of all European Union countries, 10.2%, and industrialised countries (i.e. OECD countries), 12.4% of GDP. Finally, expenditure can be considered on a per person basis or even an age-adjust person basis. This is important because the population of the UK is both growing and ageing. In 2013, NHS England only (the figures are not available for the whole UK at the moment) spent £1980.97 per age-adjusted person.
Expenditure for 2012/13 was projected to be:
- £108.9 billion for National Health Service (England)
- £3.9bn for Health and Social Care in Northern Ireland
- £9.38bn for NHS Scotland
- £5.3bn for NHS Wales
The UK Parliament sets the overall budget available to the NHS in England. It also allocates a block grant to each devolved national government to spend on local needs. Each government may choose how much of its block grant to spend on its health care system.
- Healthcare in the United Kingdom
- Scottish Government Health and Social Care Directorates
- British Medical Association
- Royal College of General Practitioners
- Gibraltar Health Authority
- The Transfer of Mentally Disordered Patients - Guidance on the transfer of mentally disordered patients detained under the Mental Health (NI) Order 1986 to and from Hospitals in Great Britain - August 2011
- "Let Us Face the Future: A Declaration of Labour Policy for the Consideration of the Nation". Labour Party. 1945. Retrieved March 3, 2013.
- Beveridge, William (November 1942). "Social Insurance and Allied Services" (PDF). HM Stationery Office. Retrieved March 3, 2013.
- "NHS charges for people from abroad". Citizens Advice. Retrieved 2010-11-16.
- "Bilateral healthcare agreement countries". UK Department of Health. Retrieved 2011-07-22.
- "NHS funding" (PDF).
- "UK spending on public and private health care". Nuffield Trust. Retrieved 12 January 2015.
- Barker, Alex. "Cameron keeps pledge to raise NHS spending in real terms". Financial Times. Retrieved 12 January 2015.
- . Nuffield Trust http://www.nuffieldtrust.org.uk/data-and-charts/uk-health-spending-share-gdp. Retrieved 12 January 2015. Missing or empty
- "Public spending on health care in England per age-adjusted person". Nuffield Trust. Retrieved 12 January 2015.
- About the National Health Service (NHS) in England - NHS Choices. Nhs.uk (2013-01-28). Retrieved on 2013-08-24.
- 20120628 - June 2012. Hscboard.hscni.net. Retrieved on 2013-08-24.
- [dead link]
- NHS expenditure by budget category and year. Statswales.wales.gov.uk (2013-03-27). Retrieved on 2013-08-24.
- Gorsky, Martin. "The British National Health Service 1948-2008: A Review of the Historiography," Social History of Medicine, Dec 2008, Vol. 21 Issue 3, pp 437–460
- Hacker, Jacob S. "The Historical Logic of National Health Insurance: Structure and Sequence in the Development of British, Canadian, and U.S. Medical Policy," Studies in American Political Development, April 1998, Vol. 12 Issue 1, pp 57–130
- Rivett G C From Cradle to Grave - the first 50 (65) years of the NHS. King's Fund, London, 1998 now updated to 2014 and available at www.nhshistory.co.uk
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- Valier, Helen K. "The Manchester Royal Infirmary, 1945-97: a microcosm of the National Health Service," Bulletin of the John Rylands University Library of Manchester, 2005, Vol. 87 Issue 1, pp 167–192
- Webster, Charles. "Conflict and Consensus: Explaining the British Health Service," Twentieth Century British History, April 1990, Vol. 1 Issue 2, pp 115–151
- Webster, Charles. Health Services since the War. 'Vol. 1:' Problems of Health Care. The National Health Service before 1957 (1988) 479pp
- NHS Choices official website for England's NHS
- Health and Social Care in Northern Ireland official website for Health & Personal Social Services in Northern Ireland
- NHS Scotland official website for NHS Scotland
- Health in Wales official website for NHS Wales
- Birth of the national Health Service BBC archive collection of programmes and documents