Talk:National Health Service (England)

• /Archive 1 - 2003

2007 Budget

The figure listed in the article is est £104bn, citing the official treasury pdf of the budget report. I get £91.8bn summing resource and capital expenditure limits- see page 293 of http://www.hm-treasury.gov.uk/media/3/4/bud07_completereport_1757.pdf

Either I'm missing the point or this amount needs to be changed —Preceding unsigned comment added by 87.80.60.90 (talk) 00:17, 22 November 2007 (UTC)

Rating

I have rated this article as B class. I think it will be a candidate for nomination for good article (GA) status with a bit more work. It needs a few more citations and some general tidying first. --Vince 11:04, 17 August 2007 (UTC)

Lawson Quote

I cannot find a verbatim source, but Nigel Lawson did not call the NHS "the national religion", but (something like) "the closest thing [we/the British people] have to a national religion".unsigned comment by 204.4.130.140 3rd Nov 2006

The unsourced phrase on Health insurance is that Lawson described the NHS as 'the national religion'. According to Comparing Health Systems (and lots of other sources) the quote is from Lawsons memoirs when he wrote that "the NHS is the closest thing the English have to a religion." The reference for his memoirs is Lawson, Nigel, The View from No.11: Memoirs of a Tory Radical, London Bantam Press, 1992, but I don't have a copy to hand to refer to. According to The spectator the quote is " the NHS is the closest thing we now have as a people to a collective religion". The telegraph has it as: "the closest thing the English have to a religion". Probably the best sources I can find for the direct quote is the book Health, Civilization and the State: a history of public health from ancient to modern times. by Dorthy Porter who gives the direct quote as "the NHS is the closest thing the English have to a religion, with those who practice in it considering themselves as a priesthood." Mary Langan in her book "Welfare: needs, rights and risks" has it as "the NHS is the only religion the English have". I think for the definitive answers someone is going to have to get a copy of Lawson's memoirs. — Rod ^talk 11:49, 3 November 2006 (UTC)

I have a copy, and the quote is on page 613:

The National Health Service is the closest thing the English have to a religion, with those who practice in it regarding themselves as a priesthood.

--Johnbull 00:23, 8 May 2007 (UTC)

Expansion

Given the scale on which the NHS operates, this article is really too short. Some things I would recommend:

• Public vs private
• Hierarchy
  • What is the line of command
  • What is the relationship between the DoH, strategic health authorities, primary care trusts, hospital trusts
  • How are targets set (by whom, on what basis)
• Criticism (waiting lists, medical and clerical mistakes)
• Attempts at modernisation (NHS Trusts, The NHS Plan) and their implementation
• Political views vs. the NHS (patient choice, reducing waitings lists, foundation trusts, privatisation/deregulation).

As a lowly staffer I have little oversight - does anyone know if systematic studies of the NHS decision-making process have been published? JFW | T@lk 12:43, 28 Nov 2004 (UTC)

• ...could be a lot longer, what about the internal market, and something about the computer systems they use. Edward 13:03, 14 Nov 2004 (UTC)

I agree. The history stops at 1990 for starters. I'd expected to see big arguments in this article and discussion page, but it isn't there. Maybe there is a healthcare debate page somewhere, but I fear it'll be dominated by USA issues. Glarner 17:35, 26 April 2006 (UTC)

I came here to get an idea as to why so many hospitals seem to be in financial deficit - and was disappointed to find no information on that subject here. Rather than try to make this one article cover everything people might want to know, I suggest having more articles, with this one at the root. I have fixed many maths articles that needed improving - but I don't have the expertise to fix this one, so can others do it, please? New Thought 19:52, 2 October 2006 (UTC)

Situation with family doctors less simple than portrayed

Most GPs (family doctors, generalists) are self-employed, and the NHS _contracts_ with them, but not exclusively.

NHS size -- Interview with MP today

Today on TV, some MP was being quizzed over the NHS. He said that the NHS is the fourth largest employer; we say "The NHS is the third largest employer in the world after the Chinese army and Indian Railways.". He cited the US Army, iirc, as the fourth. Can anyone verify this (I'm loathe to change the article based merely on a throw-away verbal comment)? Also, I think he claimed that the NHS employed 1.2 million people; again, can anyone verify this? Cheers! — Matt Crypto 20:20, 13 Feb 2005 (UTC)

"The NHS is the largest employer in Europe. It employs approximately 1.2 million staff" according to this site ; Chenxlee 01:01, 9 Mar 2005 (UTC)

I've fixed this, with two newspaper references, although I've left the issue somewhat open. The NHS man, whose name is Jon without a H, argues that the NHS is the fifth-largest employer behind the above plus Walmart and the US DoD. However, the articles quibble with the inclusion of the DoD, as it is not a single employer, and for that matter neither is the NHS any more.-Ashley Pomeroy 22:27, 5 Apr 2005 (UTC)

Thanks for digging those up! — Matt Crypto 23:15, 5 Apr 2005 (UTC)

A Commons written reply dated 9 Jan 2006 suggests an itemised total of 1461574 employees as of 30 Sep 2004 for the English NHS. I doubt if a loss of about a quarter of a million would have gone unnoticed so the "approximately 1.2 million" looks like an underestimate, possibly based on full-time equivalent.--MBRZ48 01:49, 20 July 2006 (UTC)

I know about the 'third largest employer' thing, but can you put in that if the NHS was a country it would be the 33rd richest in the world. Plus, you Americans have no grasp I belive of the truly gargantuan size of the NHS. I its a mavelous organisation, and I believe the article does not do justice to the sheer size of it. —Preceding unsigned comment added by 150.237.47.2 (talk) 13:56, 4 February 2007

You, Americans? Most of us (the contributors to the article) are British. -- Derek Ross | Talk 20:22, 4 February 2007 (UTC)

Regional Differences

The structure listed only applied to the NHS in England; there are subtle differences (not enough to justify seperate pages though) in how the NHS operates in Wales, Scotland, Northern Ireland etc. I don't know how things work in Scotland or Northern Ireland, so if anyone does, go for it.

I would also agree with JFW that there is lots that could be added to this article. Perhaps when I have the time I will try to add some bits. Proto 10:43, 6 Apr 2005 (UTC)

This section should actually be titled National Differences. There is not, and never has been, a single NHS in the UK, the original three (now four with devolution to Wales) systems were all the product of similar but separate Acts. To someone who arrives by ambulance there is little difference apparent but to less urgent users the differences can become apparent WRT prescription charges, drug approval and the availability of treatment.--MBRZ48 23:26, 19 July 2006 (UTC)

Style points

"Before 1948, health care in the UK was not free: patients were required to pay for their own healthcare." Is there any need to say the same thing twice? Why not edit to: "Before 1948 patients were required to pay for their own healthcare."

Some newbie suggestions

A few suggestions.

This opening definition:

The National Health Service (NHS) is the publicly-funded healthcare system of the United Kingdom. The organisation provides the majority of healthcare in the UK, from general practitioners to Accident and Emergency Departments, long-term healthcare and dentistry.

According to the World Health Organisation total UK spending on health is 7.7% of GDP or $2,160 per capita. The NHS makes up 83.4% of this expenditure

[1]

[2]

“the majority” seems a bit weak. It could be “vast majority” or maybe “accounts for over 80% of health expenditure in the UK”

Also I think opening couple of paragraphs should include that the NHS is a universal service available to all free at the point of delivery.

This is a link to the NHS Chief Executives report – I would propose adding it to the links as it is a good reference piece

[3]

Finally the funding section contains quite a lot of big numbers in terms of inputs (employment and funding), it might be worth also including some output measures (from the Chief Execs report or the statistical supplement to it) Here are a few examples for 2004/05

686m prescriptions (£8bn) 14.8m Accident and Emergency (or minor injury unit) first attendances (plus 3m additional follow up visits) 9.5m GP referrals to outpatients 13.5m outpatient first attendances 6.5m calls to NHS direct 5.4m elective hospital admissions 4.5m emergency hospital admissions 1.8m visits to NHS walk in centres 5.4m elective hospital admissions 4.5m emergency hospital admissions 3.3m Emergency Ambulance journeys

I doubt that all are worth including but some? Newbie --Richasdotcom 20:02, 28 October 2005 (UTC)

Go ahead. It's a wiki. JFW | T@lk 01:15, 30 October 2005 (UTC)

Thank you for your suggestion regarding [[: regarding [[:{{{1}}}]]]]! When you feel an article needs improvement, please feel free to make whatever changes you feel are needed. Wikipedia is a wiki, so anyone can edit almost any article by simply following the Edit this page link at the top. You don't even need to log in! (Although there are some reasons why you might like to…) The Wikipedia community encourages you to be bold. Don't worry too much about making honest mistakes—they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills. New contributors are always welcome. -- ALoan (Talk) 09:46, 30 October 2005 (UTC)

POV

There is, or was, some POV in this piece...I've fixed one sentence. Perhaps it could be given a more thorough scrub. No offense intended. What I fixed was this:

The mentally ill were often locked away in asylums, and the destitute elderly could end up in the workhouse.'

Thanks --Dpr 16:25, 30 October 2005 (UTC)

With respect this is irrelevant to discussion of the NHS for the following 2 reasons. firstly "The mentally ill were often locked away in asylums" pertains to the history of psychiatry, and secondly "destitute elderly could end up in the workhouse" pertains to the history of the provision of social services. whilst both these points are interesting, this statement has no proper place in a description of the NHS.Jellytussle 05:55, 20 December 2005 (UTC)

National Health Service

At the end of the first paragraph, the following comment is not relevant: "For example, under their new national General Medical Services (GMS) contract GPs, on average, earn more than £80,000 a year for a 8am to 6pm Monday to Friday job (with no out-of-hours work, unlike before this contract came into force in April 2004)." Therefore suggest edit out.Jellytussle 06:24, 20 December 2005 (UTC)

I agree. It's off-topic and POV. JFW | T@lk 08:28, 20 December 2005 (UTC)

actually very relevant to provision of out of hours care, which less than 20% of GPs now provide. statement of fact - ajvphilp

I am not disagreeing with that. However, still not relevant to the introductory paragraph on the NHS.Jellytussle 19:59, 20 December 2005 (UTC)

Overseas Doctors and the NHS

"In recent years,several overseas doctors won race disrimination claims against the NHS, highlighting the absence of career progression and other difficulties faced by doctors from overseas."

Is there a reference for this? Needs qualification and expansion. Many successful GPs are from overseas, and career progression is not necesarily an issue. Also, many senior hospital consultants and academics are from overseas. It would be relevant to discuss the effect the NHS has on the countries that train doctors and nurses who leave for the the UK; this is a topical issue.Jellytussle 16:21, 27 December 2005 (UTC)

Mental health in Scotland

Recent edit stated "Mental Welfare Commission for Scotland is an independent organisation ... It is not part of the NHS." This can not be correct, or at least can only be a partial explaination. Presuming that they are not funded by private donations to offer care on a charity basis, nor that they provide private health care for fee paying customers, then they are instead an independant contractor to whom the NHS commissions a level of service for an agreed fee. As such they are still free at point-of-contact for patients and are in a similar position to the independant contractor status of almost all General Practioners. Hence I presume that they ARE part of the NHS service, allbeit perhaps not directly owned by the NHS ? Clarification seems needed. David Ruben ^Talk 18:05, 9 May 2006 (UTC)

• Here is a link to a page at the Scottish Executive listing the role of the Mental Welfare Commission. It appears to be an organisation set up to give advice to and protect the legal rights of patients. It does not appear to be an organisation that offers treatment like services contracted out from the NHS. I hope this is helpful. Road Wizard 18:16, 9 May 2006 (UTC)

The Mental Welfare Commission for Scotland is not part of NHS Scotland. It is rather an independent body set up by previous mental health law, and whose remit was recently adjusted by the Mental Health (Care and Treatment)(Scotland) Act 2003. As http://www.scotland.gov.uk/Publications/2003/11/18547/29204 details: "Part 2 of the 2003 Act sets out provisions relating to the continued existence of the Mental Welfare Commission for Scotland. The Commission will have:

• new duties to monitor the operation of the Act and to promote best practice;
• specific powers and duties in relation to carrying out visits to patients, investigations, interviews and medical examinations, and to inspect records; and
• powers and duties to publish information and guidance, and to give advice or bring matters to the attention of others in the mental health law system.

These powers and duties should enable the Commission to maintain and develop its vital role in protecting the rights of service users, and in promoting the effective operation of mental health law. Schedule 1 of the Act sets out more detail on the membership, organisation and general powers of the Commission and makes provision for regulations to specify some matters in more detail, if necessary." See http://www.mwcscot.org.uk for more details. --Ajvphilp 06:50, 10 May 2006 (UTC)

I have adapted this for an article Mental Welfare Commission for Scotland. Please check and edit as necessary. The general standard of NHS and NHS related articles on WikiPedia is pretty abysmal. I am drafting a WikiProject:NHS - if any readers are interested, do contact me - toodle-pip --Smerus 15:56, 10 May 2006 (UTC)

Thank you. Reading some of teh material you kindly linked to, it indeed seems to be the independant monitoring bosdy for the social aspects of mental health care (i.e. monitoring compulsory admission & treatment). As such it seems equivalent to the Mental Health Act Commission in England, whose website. I would agree neither are NHS bodies and thus should not be included in teh main descriptions. I see that NICE gets listed as a separate NHS organisation, might there not be a place for mentioning external organisations that help monitor or regulate activities within the overall health care in the UK ? I'm thinking of very brief mentions more as redirections, might include all the mental health monitoring organisations, GMC regulating behaviour of Doctors, RCN for nurses etc David Ruben ^Talk 15:34, 10 May 2006 (UTC)

The Mental Welfare Commission is an NHS body. See Audit Scotland's list (as the MWC prepare their using NHS accounting rules). Astrotrain 15:51, 10 May 2006 (UTC)

Does not its inclusion on the Audit Scotland's list merely prove that it is (a) an offical body with powers to audit (b) that its auditing is on health matters. Surely inclusion on the list does not in itself prove it is part of the NHS (vs part of Department of Social Services monitoring vunerable persons). Similarly a commercial law firm might be instructed to help review a hospital's complaints proceedure - they would be performing an "official" task for the NHS and could be included in a list of bodies that have been involved with NHS proceedures, but they would still not be an NHS body. The two questions seem to be:

1. Are they funded directly from Scottish Executive Health Department rather that Scottish Social Services ?
2. Are they exclusively monitoring individual clinics/hospitals/patient-care cases or are they truely independant and able to also inspect & critise the Scottish Executive Health Department itself - i.e. is it truely independant and an "outside body" reporting to the Scotish Executive itself ? David Ruben ^Talk 03:16, 11 May 2006 (UTC)

No- the Audit Scotland list is a list of all the public sector health bodies in Scotland that it has the responsbility to audit ie all the NHS Boards, Special Boards and the MWCS. The MWCS receive a resource revenue limit (RRL) from the SEHD. The RRL is they way all UK NHS bodies are funded. The MWCS are required to meet NHS financial targets; and provide their annual accounts using the NHS manual of accounts. The MWCS are responsible to the SEHD, and are only independent in the sense of their monitoring activities etc. So to summarise, the MWCS is an NHS body. Astrotrain 12:16, 11 May 2006 (UTC)

Should give more emphasis to "free" aspects of service

People from other countries will be reading this. I'm thinking about the poor medical care for the less-well-off in the USA for example. To encourage them to improve the US system, we should emphasise that it is "free": that no matter how poor you are, you still get the best medical care.

Therefore I propose moving the content of the current "Funding" section nearer the top of the page, perhaps under the heading "Free at the point of use", while leaving brief details in the "Funding" section about it being funded by tax for latter expansion.

Unfortunately, altering the article in an attempt to convince others that the British way is "the right way" contravenes Wikipedia's policies on soapboxing and maintaining a neutral point of view. I don't see any particular need to move the funding section from where it currently resides. Road Wizard 18:35, 14 June 2006 (UTC)

I agree with Road Wizard; Wikipedia isn't to preach 'right' and 'wrong', but to give objective information.--Smerus 10:32, 15 June 2006 (UTC)

Dentistry?

At present the article appears to claim that the NHS provides the majority of healthcare including dentistry. This certainly doesn't tie in with my observations, where NHS dentists are practically impossible to find and the majority of people are effectively forced to go private, with the NHS sometimes covering part of the cost of treatment for those who can prove financial hardship...

Should this be changed, or have I just been very unlucky and really everywhere else in the country it's easy to get NHS dental treatment? -- (unsigned)

I used NHS dentistry right up till I moved from Northeast Scotland to Western Canada in 2003. Most of the dentists did both NHS and private work. I only knew of one who only took private patients. But perhaps things have changed since then. -- Derek Ross | Talk 15:07, 15 June 2006 (UTC)

Depends on where you live. There has been a constant portrayal in the media that there's no dentists anywhere, and the truth is that the numbers have grown - but not at the rate they should have done, and few stay very long - finding private work financially more viable (not that they're poorly paid anyway). In my hometown there are quite a few Dentists, most take NHS - but if you aren't registered with them (or haven't registered with them for a while) you could find yourself off the list. Kids still get seen though.--Koncorde 23:05, 14 August 2006 (UTC)

In many areas there are NHS-only dentists around, and joint NHS/private dentists who are accepting patients. However there has been a marked expansion in private dentistry over the past 25 years, to the extent that it features much more in provision of dental services than private GPs and Hospitals do in the provision of medical care. IMHO it would be worth pointing out this trend (and even greater trend towards private eyecare) in the main article.BaseTurnComplete 10:21, 17 December 2006 (UTC)

Opticians?

No mention of NHS funded eye-tests/examinations and glasses? It's not an area I know a lot about, but surely it should be covered? Markb 10:30, 15 September 2006 (UTC)

External link to Dept of Health Policy and guidance

Accidentally submitted the form before finishing off my edit comment. I'd meant to say that the link wasn't really a reference because it wasn't being used as a citation for any article text, and there was already an external link to the DofH website in the main external links section, so it seemed superfluous. --VinceBowdren 14:38, 15 September 2006 (UTC)

Wikipedia edit block from NHS IPs? If true, what are the particulars?

The article at http://3cspracticemakesperfect.blogspot.com/2006/12/wikipedia-and-nhs.html states that there is a block on editing from NHS IPs. Is this true? - Bevo 17:37, 4 December 2006 (UTC)

A block on NHS Ip addresses wouldn't surprise me. It happens frequently with universities where large numbers of users share IP addresses - hopefully it will be temporary but the article doesn't give the specific IP address that was blocked otherwise we could try to get it lifted. I'll take a look at the Agnes Hunt article.— Rod ^talk 20:07, 5 December 2006 (UTC)

Isle of man NHS

The Isle of Man's National Health service website mentions that they provide treatment in UK hospitals see http://www.gov.im/dhss/health/offisland/off_island.xml. Is their NHS separate from the four UK ones or is it somehow linked and should it be integrated into this article somehow? Zagubov 19:33, 4 December 2006 (UTC)

Man is not part of the United Kingdom. Unless there is enough to justify a separate article the appropriate place for Manx health service information would seem to be within the "Isle of Man" article. WRT the English NHS they are one variety of various foreign patients treated by the English NHS (or by other NHSs in the EU).

--MBRZ48 18:43, 5 December 2006 (UTC)

English / UK-wide meaning

Although "National Health Service" is both the collective name for the NHSs in England, Wales and Scotland, it is also the name for the English service. It seems that this article suffers slightly from describing two slightly different concepts with the same name, mixing up the NHS concept in general with the specific English NHS.

Whilst I'm not saying the article should necessarily be split, it might be beneficial to make the distinction clearer (and/or separate the generic NHS material)- or to be either one thing or the other.

When did NHS Scotland and Wales officially "split off"? Was this at the inception of the respective parliaments, or before?

Fourohfour 13:39, 6 December 2006 (UTC)

The NHS in Scotland was budgeted and administered separately long before the Scottish Parliament existed. I suppose that it has something to do with the separate Scottish legal jusidiction but I don't really know. -- Derek Ross | Talk 21:06, 9 March 2007 (UTC)

Before the NHSs were created in 1947/1948 there was provision of public health services by various forms of local authorities who in turn were carrying out functions which ultimately go back well before the creation of the UK.--MBRZ48 02:30, 18 September 2007 (UTC)

The NHS in Scotland was set up as a result of separate legislation passed in 1947 but the date the NHS began to operate was the same north and south of the border. (fishiehelper2 - 29th November, 2007)

I thought the explanation in the header was OK before fishiehelper2 so I reverted it. I know that some people are confused and even at times I have been among them, but it did explain already that there were 4 services in the UK and that this article was about England's NHS. The other three services have prominent links to their own article ahead of that. I just did not think that the header was a good place to talk about misconceptions and the complexities of devolution. I hope you don't mind.--Tom (talk) 23:43, 29 November 2007 (UTC)

Hi there - I don't want to cause trouble! As I see it, when we say that "the National Health Service began in 1948", we are not just discussing England. If you don't like the changes I suggested, perhaps changing the title to "the National Health Service (in England) would suffice? Fishiehelper2 —Preceding unsigned comment added by Fishiehelper2 (talk • contribs) 00:56, 5 December 2007 (UTC)

saturday's copy of manchester evening news

the saturday copy of men said something about nhs. does anyone know what? —The preceding unsigned comment was added by 194.70.181.1 (talk) 19:00, 11 December 2006 (UTC).

bno

are bno's (british national overseas) entitled to nhs treatment (for example, seeing a gp) when they are visiting the uk?

I don't think so, eligibility is based on residence so anyone who lives overseas loses the right to NHS treatment even if British, and a foreign national resident in the UK gains (after I think 3 months) the right to treatment. PeteThePill 23:52, 13 December 2006 (UTC)

Report out today from DoH on this see EU enlargement and overseas visitors' rights to primary care treatment in the UK which updates Implementing the Overseas Visitors Hospital Charging Regulations Guidance for NHS Trust Hospitals in England— Rod ^talk 12:59, 19 December 2006 (UTC)

NHS Scandals

All from:http://www.timesonline.co.uk/tol/global/article1471409.ece

The NHS has been giving girls as young as 13 contraceptive injections and implants that make them infertile for up to three years, in an attempt to cut teenage pregnancies.

Thousands of women are getting breast enlargements, tummy-tucks and nose jobs on the NHS

Health tourists received free NHS kidney treatment worth about £30,000 a year, potentially competing with British patients for scarce transplants

Some NHS dentists earn up to £250,000 a year in fees, as demand for those who have remained in the public sector increases Peoplez1k 16:25, 9 March 2007 (UTC)

Anglocentric

I know it's been mentioned above, but this article is very anglocentric at present and doesn't adequately describe the structures and ways of working of the NHS in the other three countries. I've made a start but there's much more to do! Any help appreciated. Waggers 15:25, 25 May 2007 (UTC)

Well, people in Wales, Scotland and Northern Ireland insist on keeping "their" part of the NHS separate from the Englsih core, so why should this article include them? They've chosen separation. We're either one state or we're not: no picking and choosing. -- 86.17.211.191 10:30, 15 June 2007 (UTC)

That's a political point, and the last sentence is certainly POV, so I'll ignore it. The article is entitled "National Health Service", not "National Health Service in England", so I agree with Waggers. We could certainly do with a mention of the abolition of prescription charges in Wales: I think that's significant enough to be in the main article, not just the prescription drugs one. 86.132.137.231 01:01, 26 July 2007 (UTC)

There never was a single UK NHS so it isn't a case of people keeping "their part" separate. That is why there are separate articles (and a referring "see also" at the top of this one) for each service. It would be helpful to change the title to e.g. National Health Service (England) to clarify the difference and avoid confusion.--MBRZ48 02:37, 18 September 2007 (UTC)

Hi - I've just come across this article after being informed about it by confused students (I teach about the NHS)- I don't mind an article about the NHS in England, but if the title is just 'National Health Service' there needs to be some explanation around the issue. Fishiehelper2, 30/11/07

I would support the change in title idea, but we would then have to make a decision about where National Health Service should re-direct too. The renamed article is the logical choice. But I still wish to take issue with you Fishiehelper2. Just because your students were confused, is that really a good reason for making the changes you made to the header paragraph? Anyone reading the text that was there BEFORE you made that change would have come immediately to the realization that there are 4 different services. So it was an unneccessary change. Furthermore, the main paragraph is a signpost to what the article is about. It really should not carry that kind of observation. --Tom 00:04, 1 December 2007 (UTC)

So wouldn't it be an idea to have this page about the NHS in general (i.e. its history, and principals etc) and then have articles about the NHS's in the four UK countries. Given that three of the four NHS's have the same name and are all run along roughly the same lines. G-Man ^? 22:05, 3 December 2007 (UTC)

You could be right but I have not thought through the implications. It could be a lot of effort and I think you should get the agreement of a large number of editors here to be committed to the change before kicking it off. I don't think I have the time right now to be involved in that effort. It would seem wasteful to repeat common information in all 4 articles.--Tom 19:29, 4 December 2007 (UTC)

First suggestion of an NHS

I remember seeing a TV programme in which a little known fact was revealed, being that the first ever mention of a need to establish a health service free for all at the point of delivery was actually in a speech in The House from a Conservate Member of Parliament. Anyone know anythong about this? -- 86.17.211.191 10:33, 15 June 2007 (UTC)

please add reference

hi, i added some stuff from andrew marrs history of modern britain in the history section of the nhs wiki. if anyone could add in the ref for me as i cant figure it out that would be great.

http://www.amazon.co.uk/History-Modern-Britain-Andrew-Marr/dp/1405005386

"Free at the point of delivery" meaning you get sent a bill later?

I think the phrase "free at the point of delivery" is confusing, it could suggest to people unfamiliar with the NHS that you get sent a bill later on, or have to pay the costs off in instalments. Whereas the essential point about the NHS is that anyone no matter how poor can have the most expensive treatments. I propose changing:

NHS services are largely "free at the point of delivery", paid for by taxes; the NHS's budget for 2007-08 is £104 billion.[3]

to

NHS services are largely free, paid for by taxes; the NHS's budget for 2007-08 is £104 billion.[3]

As the position of this near the top means you have to edit the whole page I'm not sure my dial-up could upload the whole page, so perhaps someone else could make the change please.

Of course if you are poor - in other words on benefits of some kind - then it is completly free and you dont even pay any prescription charges or dental charges (which always seem to me to be against the sprit of the NHS).

80.2.194.68 09:37, 30 June 2007 (UTC)

It would be wrong to suggest the the NHS is free. In fact it costs a lot (£104 billion sounds reasonable) but the costs are paid every day by National Insurance contributors whether they use the service or not. In this the NHS is like any other insurance-funded service: the contributors pay a little every day in order to avoid a large cost when their health goes bad. And of course this is a Good Thing. It is also what is meant by "free at the point of delivery": You pay upfront -- not afterwards. The main differences from insurance provided by a private organisation are that

1) any contributor who meets the relevant criteria will have their insurance contributions paid for them by the British Government and

2) there is basically no limit to the amount which the NHS is prepared to spend on meeting its obligations. Any shortfall in revenue from NI contributions is filled from general taxation revenue whereas pure insurance-based schemes can only fund their obligations to the limit of their contributions.

So I think your suggested changes still need more work to explain things clearly. -- Derek Ross | Talk 06:38, 2 July 2007 (UTC)

In fact there is nowadays absolutely no connection between the National Insurance System and the National Health System, either in funding of rights of access according to NI contributions. HM Treasury regards NI as just another source of revenue for the government, but contributions to the NI Fund are still tracked for certain social security benefits such as old age pensions and unemployment benefit. So its not really like any other health insurance funded service - its more like the road system. The government raises taxes to build the roads and maintain them and everyone is then free to use them. NHS financing is remarkably Marxist..."from each according to their means and to each according to their needs". The amazing thing is that in spite of the British rejecting Marxism, they by and large love the NHS! The term "Free at the point of delivery" came up I think in Thatcher's time when it was suggested that "hotel" charges would be raised for hospital stays, rather as happens in many European countries, like Ireland, where something like 60€ per night is billed to the patient up to a maximum per year. Labour in Opposition stressed that they were committed to keeping the NHS "Free at the point of delivery". The Tories backed away from the plan under the weight of overwhelming public opposition and even pledged themselves to supporting the "Free at the point of Delivery" concept themselves. One thing that many people will not be aware of is that pensioners will have their state pension reduced if they are in hospital for more than a certain time (6 weeks I think, but I am not sure).

As for the article, I rather like the idea of removing the reference to the phrase because as the anonymous editor makes clear, it could be misconstrued.--Tom 01:07, 3 August 2007 (UTC)

True enough. Particularly your point about NI being treated as just another tax by successive UK governments. I was describing the initial intent rather than the current practice. NHS funding has indeed evolved as you describe over the years. -- Derek Ross | Talk 04:13, 3 August 2007 (UTC)

NHS history question

There's a sentance in the history section - "Washington subsequently withdrew the funding that had sustained Britain during the war."

What funding was this, exactly?

I'm aware of Lend-Lease, but the quoted sentance does not seem in its nature to be refering to this, as Lend-Lease was not funding (positive provision of funds), but rather the abrogation of billing (removal of bills). In some ways they amount to the same thing, but it is obvious that with the end of the war Lend-Lease would stop, so the continuation sentance in the history section, "At this point, Attlee realised that his plans for the rebuilding of postwar Britain and enacting widespread reform were in serious financial trouble." makes no sense.

Toby Douglass 11:20, 5 August 2007 (UTC)

I agree. Lend-Lease was essentially for munitions. The article as written seems to imply that Atlee had originally intended to use US money to create the NHS which was never (as far as I know) the intention. I was always under the impression that the plan was to issue bonds to purchase existing hospitals and that National Insurance was intended to be the main form of ongoing finance. And, as far as I know, that is what in fact happened.--Tom 20:10, 5 August 2007 (UTC)

"Washington"... this would be a synecdoche for the U.S government, presumably, not the president of the same name? Swanny18 14:59, 19 September 2007 (UTC)

It was Lend-Lease. Lend-Lease was rather more subtle than just munitions. It included food and capital goods as well. Take a look at our Lend-Lease article. There were two separate phases which were agreed during the War and an intended third phase which was dropped without warning at its end. Since the first two phases had intentionally distorted the British economy to make it more suited to war production, the lack of the third phase caused big problems to the UK at the end of the war -- and not just with plans for the NHS -- since the UK had no chance to adjust its economy back to peace-time conditions. A recently published book, "The Last Thousand Days of the British Empire" discusses Lend-Lease and its effects (among other things). -- Derek Ross | Talk 16:52, 19 September 2007 (UTC)

Criticisms

Specific criticisms that have levied at issues within NHS read a if they are criticimsof the NHS itsel: The NHS has frequently been the target of criticism over the years. Examples of such criticism includes:

Due to excessive delays and low quality treatment[citation needed], those who can afford it sometimes opt for private health care. When this occurs, these patients are being forced to pay twice for their health care,

Is there evidence of it being costed twice? In countries such as the USA insurance and direct costs may or may not be higher than the individual level of tax burden for the NHS and the redulting LOWER private healthcare insurance that exists as a result of the NHS being there to pay for emergency and primary level care

The levels of antibiotic-resistant bacteria ("superbugs"), such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, in hospitals.

This is a criticism of the privatisation of cleaning contracts. It is argued that under stricter NHS control MRSA did not occur.

The decreasing availability of NHS dentistry and the trend towards dentists accepting private patients only.

This is a criticism of there being less NHS involvement in this area and the governments bureaucratic controols that force dentists away, not a critiscism of the NHS.

Hospitals and trusts running a financial deficit and getting into debt. Specific funding/,anagement issue not a critsicism of the NHS

Dainamo 17:04, 7 August 2007 (UTC)

I personally call into question the accuracy of this section of the NHS article. Much of the criticism was part of a PR campaign helmed by Henry J. Kaiser at the behest of US President Richard M. Nixon. Ronald Reagan even was paid to record a propaganda album warning Americans about the encroaching "Communist menace" of socialized medicine. Much of the criticisms are derived from this propaganda campaign despite it's well-monied source.

--Kulturvultur 02:16, 1 October 2007 (UTC)

NHS

I live in the United States and I have been reading about the NHS and how it works and I would like to know more from the people who actually have NHS. Of course in America Health Care is a big issue because to put it directly we do not have a health care system, if you have insurance you are one of the lucky ones, if you don't then you don't get treatment. i have talked to many people about their stories of how they are treated in America. Just last night a friend of mine dad went to the emergency room and he was refused treatment. So to me that says if you can't pay then you suffer. Could any one please tell me how the NHS works and does it work.Chandrahouseholder 18:58, 10 August 2007 (UTC)

When the NHS was founded, many thought that the cost of healthcare would go down as it becamr a huge preventative measure for people becoming ill. Medicine and consumer demands have expanded and the NHS faces lots of questions on what t should and shouldn't provide. Anecdotally,it seems many Britons complain about the state of the NHS from media reports but say that their own experience has been very positive which is kind of weird and suggests the media isn't exactally accurate. I persoanlly have private healthcare insurance for the comfort of the facilities available if I have hospital stay and to avoid any waiting for non-emrgency treatment but I understand that it is a lot cheaper than healthcare in the US as I will use both systems. E.g. If I have to attend A&E (ER) it will be the NHS paying. I remember being shocked in the US when a co-worker of mine cut his hand on the wire connecting the net to s basket-ball hoop we were playing round and he had to pay for stitches as he was uninsured. In the UK whether one is left or right wing, the NHS is mostly seen as an important part of the national fabric. I know from people in healthcare insurance that the US is also incredibly expensive (I am told this is because the bill covers everything from the smallest plaster or swab) Also there is the argument that it adds to the social divide in the US. I don't know what cooments you would make or contribute with valid evidence to the article? Dainamo 13:25, 12 August 2007 (UTC)

Another anecdote; I saw a documentary on the Cook County Hospital in Chicago which showed an interview with a woman in A+E with a blood-soaked towel round her hand, having cut it on a breadknife. The local fee-paying hospital had declined to treat her, but did phone a taxi to take her to CCH, for which they had billed her 50 dollars. Nuff Sedd? Swanny18 14:54, 19 September 2007 (UTC)

Let me summarise how it works. Everyone is registered with a GP (general practitioner), a qualified doctor paid for by the NHS whose job it is to get you the health care you need. He or she can prescribe drugs and will follow your treatment to recovery. You do not pay for these visits. If you need a drug you take the prescription to a local pharmacy. They will issue with the drug you need and you will pay a flat fee for that drug. The pharmacist bills the NHS for the prescriptions less the flat fees it has received from you. If you need specialist care at a hospital or clinic the GP will discuss with you the hospitals you can go to. You choose the hospital together, and he writes to the specialist at that hospital where again the services are not billed. If you are treated in hospital, your drugs and all the treatments you receive there are free of charge. Therefore the GP is the first gatekeeper to these specialized services. This prevents people making frivolous appointments and people not entitled to NHS treatments from getting free treatment. The hospital also has gatekeeper responsibilities. But the net effect is, that if you need a treatment that has been proven to be effective then you will get treated for free. All treatments given at the hospital are reported back to the GP, so there is a single record of your medical history. The taxpayer picks up the cost of the NHS. I hope that answers your question. I may update the article as I think it actually summarises how the NHS works from the patient view quite well, especially to people not familiar with the system.--Tom 13:13, 22 September 2007 (UTC)

I have created a new article Health care in the United Kingdom which describes the overal system in the UK as it is seen by a user of the system. Its a new article and at the moment focusses mainly on the NHS but it does try to show how the private system fits in and how choice is exercised. --Tom 16:15, 24 September 2007 (UTC)

Most people in the UK would regard the US system with horror, and personally reckon the system is pretty good, critical press reports notwithstanding. In my own case, I've been a taxpayer for about 30 years, and my use of the NHS has been limited to use of the GP for minor illnesses, and the dental and opthamological services (reminds me, I'm due to pay £43.60 next Tuesday for a couple of fillings...); the only time I've needed to call on the NHS for a medical emergency, about 4 years ago when I slipped on the stairs at home, a paramedic arrived within about 5 minutes of my phone call who confirmed that yes, my leg really was broken, and started treatment until the ambulance arrived about another 5 minutes later. Five hours later I was in theatre having a substantial amount of metalwork put in my leg, followed by a week's stay in hospital, six weeks with my leg in plaster, followed by another 4 months or so of hospital physiotherapy sessions once or twice a week, all at no cost to myself.

My mother, on the other hand, as a farmers' wife was never in paid employment in her life so didn't pay National Insurance, yet made substantial use of the NHS - she was on pills for a kidney condition from before my earliest memory, she had me by caesarian section (not a common thing in late 1950s UK), had two replacement hip joints in the late 1970s, and for the last nearly five years of her life was on about six different drugs each day and had visits from the nurse at least once a week. We weren't too impressed when she was sent home undiagnosed two days after being taken to hospital by ambulance in the middle of the night, but two months later it happened again and she was diagnosed with two leaking heart valves; she decided against surgery at her age (81), not because of the 3% risk of dying on the table but because of the higher risk of a stroke, which is what dissuaded her, so she decided to be treated by drugs instead, with the understanding that there'd come a day when they no longer worked. Four years later (we get the impression that the doctors were rather surprised she survived so long) she went into the local community hospital (a small hospital, with no operating facilities, it's somewhere to go to recover from operations and be nearer home and family) for a week or two's rest late last March, but took a turn for the worse just before she was due to go home; we were told in the middle of April that there was nothing more that could medically be done for her, but she stayed there until early June, then was transferred to a nursing home for the last five weeks of her life - all of this was paid for by the NHS. All-in-all, I'd reckon my family has got good value from the NHS for the taxes we've paid. -- Arwel (talk) 13:10, 14 October 2007 (UTC)

Balance

The article contains a section called criticisms, and that is fair enough. But the NHS has almost universal public support in the UK and provides excellent health care overall at very low cost. Because the article has a criticisms section with lots of negatives without any balancing arguments or section conveying its successes or the level or public support, I think the article in its present form lacks balance.

Really? I thought this article was far too positive. The private care practitioners are all portrayed as avaricious scoundrels who perform unnecessary procedures at the drop of a hat. In the US, that never happens because people will shop around and go with what seems to them to be the best option because of competition, the threat of litigation and peer pressure. The bad teeth of UK subjects is a stereotype that many outside the UK take at face value.-G 14:25, 16 October 2007 (UTC)

Well that's a bit odd since the private practitioners are mostly NHS practitioners who do a couple of days per week (or after-hours work) for the private hospitals. And as for the teeth, dental care is the only part of UK heath care where private practitioners have a really strong presence. So does that mean that the NHS is staffed by avaricious medical staff or that private dental care produces worse results than NHS care ? It doesn't seem likely. -- Derek Ross | Talk 15:03, 16 October 2007 (UTC)

I am particularly interested because health care is currently a big issue in the US and I have read a lot of negative criticism about the NHS, much of it untrue, coming from the US press and pressure groups supported by businesses in the health care sector. Many US WP readers will now be reading the NHS article and I therefore think that the balance needs to be there. Do any other editors share this concern and have views about how to achieve this?--Tom 12:50, 22 September 2007 (UTC)

I for one would like a more scholarly comparison of NHS, Canaduan and free market health care.-G 14:25, 16 October 2007 (UTC)

NPOV

"This includes British citizens who work for a UK-based charity outside the UK (except in certain countries) for more than five years, regardless of their intention to return to the UK or payment of National Insurance contributions. These people are treated as overseas visitors even if they own property, return regularly or have family in the UK and regard their home country as the UK."

- This section seemed to be a bit focused - perhaps written by someone to whom this applied; is it appropriate? Simonjp 16:44, 11 October 2007 (UTC)

Call for Assisitance

In the United States, the form of health care represented by the UK's NHS is tagged with the politcally charged tag "socialized medicine" though its also used to describe other forms of subsidization and control. I have been making edits to the WP article socialized medicine to add informative and accurate information as far as I can about the pros and cons of socialized medicine to a US audience whose main knowledge of real world socialized medicine comes from tabloid new articles and pressure groups that distort those articles and use other information to paint a false portrait of socialized medicine.

I am having trouble with one editor who has been reverting, amongst many other edits, the following assertion about the benefits of socialized medicine

* Health care is distributed according to need rather than the ability to pay '

To me, the statement is non controversial.

Here is the support from the UK http://www.nhs.uk/aboutnhs/nhshistory/Pages/NHSHistorySummary.aspx and as far as I know was firmly founded on Beveridge's recommendation.

and one for New Zealand

The inauguration of health benefits under the social security programme was thus long overdue and constituted a most necessary and sweeping reform. The benefits are available to all persons ordinarily resident in New Zealand, regardless of economic status. The scheme is non-contributory, benefits being available as of right irrespective of the amount, if any, of social security taxes paid by the recipients of the benefits. The right to benefits is restricted only in cases where a person receiving medical or other treatment is entitled to recover the expenses of such treatment by way of compensation or damages.

I have called for general comments here... http://en.wikipedia.org/wiki/Talk:Socialized_medicine#Health_care_.22distributed_according_to_need_rather_than_the_ability_to_pay.22_as_a_benefit_of_Socialized_medicine

I am asking WP editors to intervene to support either the inclusion or exclusion of this statement. Your assistance in resolving the dispute would be appreciated.

Also I am feeling a bit battle weary with a few editors there and I'm actually suffering from a medical condition myself at the moment (of all things!... fortunately not stress from WP editing!) and I cannot be heavily involved with the article over the next few days. Any assistance that editors can give to improving the article would be appreciated.--Tom 21:21, 31 October 2007 (UTC)

I hope that some editors active in the management of this article may be interested to help develop the article further.

Largest employer?

"The NHS is the world's largest, centralised health service, and the world's third largest employer after the Chinese army and the Indian railways".

Any source of that? The French Education minister alone employs 2 million people, twice the NHS. --89.97.35.70 14:00, 4 November 2007 (UTC)

More exactly, due to competencies tranferences, the French National Education System employs now (approx.) 1,450,000 people (sources from Education Nationale and Enseignement supérieur). Nevertheless, it's still more than the NHS. Maybe the usual contributors should correct this or I'll do it. Stymphal 19:07, 4 November 2007 (UTC)

Please do. You know, if we don't already have a cited list of the World's largest employers, we should have. Perhaps someone would like to create it. -- Derek Ross | Talk 20:06, 4 November 2007 (UTC)

It is an excellent example of a Factoid. Should be deleted, or at least apologized for ("is often claimed to be"...). 131.111.164.208 14:05, 16 November 2007 (UTC)

Major overhaul - requested move

I did some major edits and reformatting as part of the Wikipedia:The Core Contest. To avoid edit conflicts and general messy editing, I copied it over to User:RHB/NHS before I began editing. Points of note are hiving off some of the Criticism section into an article on Criticism of the National Health Service, which is forming up at User:RHB/Criticism of the National Health Service and just needs to be moved over into the mainspace, and the addition of a number of redlinks. As this is a relatively controversial move (a history merge from RHB/NHS to here) involving lots of editing, I thought I'd seek opinions here first. Thanks, RHB - Talk 20:37, 10 December 2007 (UTC)

Any comments at all? RHB - Talk 18:14, 12 December 2007 (UTC)

Yes. I don't really understand the need to do this at all. The competition, which looks like it is not part of WP policy is over. What do you mean "history merge"? Please say in plain English what you want to do

and why.--Tom (talk) 10:20, 16 December 2007 (UTC)

I could just copy and paste the section over but then the history of the page would be lost, including my reasoning/edit summaries, and I can't move that page over this one because this page has more than one edit. I edited in userspace because of the likelihood of edit conflicts/accidental removals/vandalism and the like. I only asked because I removed some large sections of text that had been left in by innate consensus for an extended period of time. RHB - Talk 17:11, 16 December 2007 (UTC)

I do not support the changes you are making. I don't think a respectable encylopaedia would split off criticism into a special article. Its un-encylopedic. You have not explained your rationale for doing all this.--Tom (talk) 00:56, 18 December 2007 (UTC)

I apologise for my lateness in replying - I've just got back from a medical course that I've been on since the 18th, and got very little sleep. I split it off because I doubt a day goes by without the NHS being criticised in some form by those in the public eye or newspapers, whether they be tabloid or broadsheet.Google News shows 199 stories containing the words NHS and failure in the past month, as an example. Many books have been written criticising the NHS, of which I have access to only a selection. We do, for instance, have a long-standing article on the Criticism of Wal-Mart, and an entire category dedicated to it - Category:Criticisms. RHB - Talk 19:41, 22 December 2007 (UTC)

Hey... What ´have you done??? Where are all the edits since 26 September??? Are they all in National Health Service (version 2). I think it is totally unacceptable for you to make changes this way with the aid of an admin (I presume). You may have improved or wrecked the article but there are now so many changes that it is hard to see what you have done and we cannot compare across the old and new versions. You asked about making this change and did not get approval. Now you see to have just gone ahead and done it anyway. Please explain and put it all back together again. We need to see the edits that have been made since 26 Sept and why they were made.--Tom (talk) 22:47, 19 December 2007 (UTC)

What about the edits other users have made since you started editing this article in you userspace? Some at least seem to have been lost!--Tom (talk) 00:31, 20 December 2007 (UTC)

I believe the copy I took from the mainspace was that of the 26 November. The majority of the edits since then have been reversions to improve the article or against vandalism, and little has changed massively. Quite why an encyclopaedia article should have sections on Exemptions for missionaries who work abroad for a UK based organisation is beyond me. I don't believe the current article is particularly effective in communicating information about the NHS to the lay reader, and regardless of whether you believe editing the article in userspace is right, or that some edits have been lost (which I am by no means against losing), the versions I've edited has more references, less unencyclopedic information, and a greater depth than the version that currently exists here. RHB - Talk 19:41, 22 December 2007 (UTC)

Apart from the other edits which have been overwritten, it's not a good idea to do editing on a local copy and then replace the main article. All edits should be made in the open, where everyone can see them; not suddenly revealed from behind a curtain in one go. --VinceBowdren (talk) 09:11, 20 December 2007 (UTC)

In retrospect, I agree. Editing the article "behind closed doors" so to speak, although probably being easier and less stressful, was not especially good in the case of a relatively controversial article such as that of the NHS, that was bound to engender controversy. I apologise for what appears to have been unilateral action. RHB - Talk 19:41, 22 December 2007 (UTC)