The National Health System in the United Kingdom: History, present situation and a need for reforms?

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1.0 Development of the British Health System since the Industrial Revolution....................... 2

2.0 Present Situation and ‘The NHS Plan’ ................................................................................. 4

3.0 Conclusion............................................................................................................................ 6

4.0 References ............................................................................................................................ 7

1.0 Development of the British Health System since the

Industrial Revolution

The time of the Industrial Revolution induced significant changes in Britain. Different segments of the daily life were involved such as economy, society, culture, politics or environment. Therefore, the following economic expansion was not only an ‘abstract’ one that affected machines, industries or finances but also people. On the one hand, Britain was transformed into a powerful nation and center of global trade, for example due to its resources, manufactur ing inventions or improved fabrication methods. On the other hand, for many reasons this development was at the expense of the common population. More and more people came into the cities in order to find work, which was not so easy since new machines partly replaced human workforces. During the eighteenth and nineteenth century, many people had to face dehumanizing exploitation and long working hours or unemployment and poverty. Rapid increase of the population even worsened the situation.

Numerous completely new problems arose that demanded quick and efficient solutions. For example, people started to live in overcrowded slums under disastrous hygienic circumstances, the growing cities lacked an effective sewage system and the resulting epidemics could no t be resisted, let alone prevented by adequate medical services. Therefore, diseases like diphtheria, smallpox, typhoid and tuberculosis spread and threatened the whole country. The fact that under such conditions practically everybody could be infected, finally caught the government’s attention. Nevertheless, “an effective apparatus was not created until the Public Health Act of 1848, and a national system of health was not created until a second Public Health Act of 1875.” 1 But in fact required reforms concerning sanitation, sewage, housing and medical care were not established and the changes only touched the problems’ surface.

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During the following years only little progress was made, which was also due to the mentality of that time, stating the individual is responsible for its fate itself and consequently has to help itself. (This common attitude was influenced e.g. by scientist Charles Darwin and his conviction for a “natural selection” and “survival of the fittest” or by philosopher Herbert Spencer, who refused interference of the state in the individual’s life. 2 ) Later, a standstill was caused by the exertions of World War I and the connected economic and social crisis. However, a post-war atmosphere with new motivation, the struggle for a modern state with more social justice and a need for a welfare system that works, probably affected the set up of the British National Health Service (NHS) in 1948. Its initiation was mainly based on the socalled “Beveridge-Report“, which was already written in 1942 by the Liberal William Beveridge and examined the social situation in Britain. According to this report, a comprehensive health care system should be created that involved free medical treatment for everyone. “It was intended that the system would be largely financed by a national insurance scheme, to which workers would contribute, and out of which they and their families would receive benefits when required.” 3 Although this original plan was modified by the Labour government under Prime Minister Clement Attlee, Britain finally got a health system, whose founding principles of providing access to health care for all on the basis of need, not ability to pay, are still valid today.

During the first years of its existence, the NHS had to face various difficulties, not few of them typical marks of a post- war situation: material, fuel and food shortages, insufficiency of finances and a housing crisis. Furthermore, other questions arose, connected with the fact that completely new structures had to be developed, for example referring to administration, research, funds, staff etc.

Over the years, better drugs and new technologies were introduced, which meant more complex and therefore improved treatment. On the one hand, this was a desirable progress, standing for the modernity, quality and functionality of the NHS. On the other hand, this led to rising expectations concerning the health service and had the long-time effect of an increasingly elderly population with all its medical needs.

At the end of the 20th century, the NHS “is recognized as one of the best health services in the world by the World Health Organisation[. Nevertheless,] there need to be improvements to cope with the demands of the 21st century.” 4 For that reason, in 1997 the Department of Health launched a white paper, which announced a “new NHS”, namely “modern and dependable”. According to that paper, the health service should be renewed and the public’s confidence restored. These aims were to be reached by some changes that can be summarized

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as follows: The NHS should become an improved, more efficient and less bureaucratic system, with more power for local authorities and closer collaboration instead of competitive thinking.

2.0 Present Situation and ‘The NHS Plan’

Today, the NHS consists of a complex apparatus of professionals, workers, facilities and organizations. On the one hand, the service’s significance is due to the fact that it has the task to diagnose and treat illnesses and provide support for long-term illnesses and disability. Hence, for the Britons it provides security and guarantees a certain quality of life. On the other hand, the health system is a major employer in the UK, for example merely in England it gives work to about one million people. 5 Most people in Britain have to rely on the health service - a lack of choice, which also causes certain dependence. In fact, the NHS has been integral part of the welfare state for over 50 years and fulfills a surprisingly extensive function. For example, “in a typical week:

• more than 800,000 people will be treated in NHS hospital outpatient clinics

• 1.4 million people will receive help in their home from the NHS

• NHS district nurses will make more than 700,000 visits

• NHS ambulances will make over 50,000 emergency journeys

• NHS direct nurses will receive around 25,000 calls from people seeking medical advice

• pharmacists will dispense approximately 8.5 million items on NHS prescriptions” 6

Nevertheless, the NHS is still not efficient enough and has to be adapted to changing requirements.

A look at the political parties’ current manifestos underlines of what importance the advance

of the National Health Service and the improvement of the patients’ rights is, since all political parties declare more choice of doctors or hospitals and better standards a priority. However, the politicians’ concern about health issues might be caused by the fact that the

NHS is mainly financed by the taxpayer and gradually more patients complain about long

waiting times and criticize outdated structures, regional variable standards, which indicates that there is a call for reform and progress. As a result, in the year 2000 the government set up the “NHS Plan”, an ambitious strategy for the next ten years in order to meet the patients’ requests, which include more choice and influence, easier and quicker access to medical