National Health Service

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For the individual national healthcare services of England, Scotland, Wales and Northern Ireland, see National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care in Northern Ireland.
Aneurin Bevan, who spearheaded the establishment of the National Health Services

Each of the four countries of the United Kingdom has a publicly funded health care system referred to as the National Health Service (NHS). The terms "National Health Service" or "NHS" are also used to refer to the four systems collectively. All of the services were founded in 1948, based on legislation passed in 1946, 1947 and 1948, by the Labour Government that had been elected in 1945 with a manifesto commitment[1] to implement the Beveridge Report recommendation to create "comprehensive health and rehabilitation services for prevention and cure of disease".[2] NHS Wales was originally part of the same structure as England until powers over the NHS in Wales were firstly transferred to the Secretary of State for Wales in 1969 and thereafter, in 1999, to the Welsh Assembly (now the Welsh Government) as part of Welsh devolution.

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. However, some functions might be routinely performed by one health service on behalf of another. For example, 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.[3] Similarly, patients in North Wales use specialist facilities in Manchester and Liverpool which are much closer than facilities in Cardiff, and more routine services at the Countess of Chester Hospital NHS Foundation Trust. There have been issues about cross-border payments.[4]

The systems are 98.8% funded from general taxation and National Insurance contributions, plus small amounts from patient charges for some services.[5] Each provides a comprehensive range of health services, the vast majority of which are free for people ordinarily resident in the United Kingdom[6] and free at the time of use, for general practitioner (GP) and emergency treatment not including admission to hospital,[7] to non-residents. People with the right to medical care in European Economic Area (EEA) nations are also entitled to free treatment by using the European Health Insurance Card; those from other countries with which the UK has reciprocal arrangements also qualify for free treatment.[8][9] Some detailed regulations may vary to some extent in different countries of the UK; others are UK-wide.

People not ordinarily resident in the UK are in general not entitled to free hospital treatment, with some exceptions such as refugees.[6][10]

Taken together, the four National Health Services in 2015-16 employed around 1.6 million people with a combined budget of £136.7 billion.[11] In 2014 the total health sector workforce across the UK was 2,165,043. This broke down into 1,789,586 in England, 198,368 in Scotland, 110,292 in Wales and 66,797 in Northern Ireland.[12]

UK residents are not charged for most medical treatment, with exceptions such as a fixed charge for prescriptions; dental treatment is administered differently, with standard charges for most procedures.

People not eligible for free treatment[edit]

People not ordinarily resident may be subject to an interview to establish their eligibility, 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, except for emergency treatment.

The provision of free treatment to non-UK-residents, formerly interpreted liberally, has been increasingly restricted, with new overseas visitor hospital charging regulations introduced in 2015.[13]

People from outside the EEA coming to the UK on a temporary stay of more than six months may be required to pay an immigration health surcharge at the time of visa application, and will then be entitled to NHS treatment on the same basis as a resident. As of 2016 the surcharge was £200 per year, with exemptions and reductions in some cases.[14]

Comparative performance[edit]

Although there have been increasing policy divergence between the four systems there is very little evidence linking these policy differences to a matching divergence of performance.[15] It has been suggested that this is because of the uniform professional culture. There are national terms and conditions of employment across the UK, regulation of clinicians is performed on a UK basis and the health trades unions operate across the UK. But of course it does not help that, as Nick Timmins noted "Some of the key data needed to compare performance – including data on waiting times – is defined and collected differently in the four countries."[16][17]

For details see:

See also[edit]

References[edit]

  1. ^ "Let Us Face the Future: A Declaration of Labour Policy for the Consideration of the Nation". Labour Party. 1945. Retrieved 3 March 2013. 
  2. ^ Beveridge, William (November 1942). "Social Insurance and Allied Services" (PDF). HM Stationery Office. Retrieved 3 March 2013. 
  3. ^ 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
  4. ^ "Breakdown of cross-border agreements is costing English trusts millions". Health Service Journal. 14 February 2008. Retrieved 19 January 2016. 
  5. ^ "How the NHS is funded". TheKing'sFund. 15 January 2016. Retrieved 6 June 2016. 
  6. ^ a b "NHS entitlements: migrant health guide - Detailed guidance". UK Government. Retrieved 6 June 2016.  Since 6 April 2015, non-EEA nationals who are subject to immigration control must have the immigration status of indefinite leave to remain at the time of treatment and be properly settled, to be considered ordinarily resident.
  7. ^ "Visiting or moving to England? - How to access NHS services (see "Hospital Services" section)". NHS Choices. 26 June 2015. Retrieved 6 June 2016. 
  8. ^ "NHS charges for people from abroad". Citizens Advice. Retrieved 2010-11-16. 
  9. ^ "Non-EEA country-by-country guide - Healthcare abroad". NHS Choices. 1 January 2016. Retrieved 6 June 2016. 
  10. ^ "Categories of exemption - Healthcare in England for visitors - NHS Choices". NHS England. 18 August 2015. Retrieved 6 June 2016. 
  11. ^ "10 truths about Britain's health service". Guardian. 18 January 2016. Retrieved 19 January 2016. 
  12. ^ Cowper, Andy (23 May 2016). "Visible and valued: the way forward for the NHS's hidden army". Health Service Journal. Retrieved 28 July 2016. 
  13. ^ "Guidance on overseas visitors hospital charging regulations - Publications - GOV.UK". UK Government. 6 April 2016. Retrieved 6 June 2016.  Links to many relevant documents: Guidance on implementing the overseas visitor hospital charging regulations 2015; Ways in which people can be lawfully resident in the UK; Summary of changes made to the way the NHS charges overseas visitors for NHS hospital care; Biometric residence permits: overseas applicant and sponsor information; Information sharing with the Home Office: guidance for overseas patients; Overseas chargeable patients, NHS debt and immigration rules: guidance on administration and data sharing; Ordinary residence tool; and documents on Equality analysis.
  14. ^ "Moving from outside the EEA - Access to healthcare in England - NHS Choices". Nhs.uk. 18 August 2015. Retrieved 6 June 2016. 
  15. ^ Bevan, Gwyn; Mays, Nicholas (11 April 2014). "The four health systems of the UK: How do they compare?". Nuffield Trust. Retrieved 2 February 2016. 
  16. ^ "Outcomes in EHCI 2015" (PDF). Health Consumer Powerhouse. 26 January 2016. Retrieved 27 January 2016. 
  17. ^ Timmins, Nick. "The four UK health systems: Learning from each other,". Kings Fund. Retrieved 2 February 2016. 

Further reading[edit]

  • Brady, Robert A. Crisis in Britain. Plans and Achievements of the Labour Government (1950) pp 352-41 excerpt
  • 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.
  • Loudon, Irvine, John Horder and Charles Webster. General Practice under the National Health Service 1948-1997 (1998) online
  • Rintala, Marvin. Creating the National Health Service: Aneurin Bevan and the Medical Lords (2003) online.
  • 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
  • Stewart, John. "The Political Economy of the British National Health Service, 1945–1975: Opportunities and Constraints," Medical History, Oct 2008, Vol. 52 Issue 4, pp 453–470
  • 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 online

External links[edit]