Universität Kassel, Anglistik Landeswissenschaften
PS: Britain under New Labour
SS 2005

The NHS: An Antiquated System of Healthcare

by: Katharina Fischer

Table of Contents

1. Introduction  1

2. The British System of Health Care

2.1 Health care as part of the welfare state  2
2.2 Funding and Expenditure  2
2.3 Structure 3

3. The National Health Service (NHS) in an existential crisis

3.1 Social change  5
3.2 Antiquated funding and structure  6

4. Reforms and perspectives for the future  8

5. Bibliography  11

1. Introduction

At the turn of the 21st century the British system of health care is to be found in serious difficulties. Expenditure constantly grows and the medical services are not able to meet the needs of the population. Patients have to set their names on waiting lists for hospital treatments, staff is underpaid and the top-down structure of the system antiquated and inefficient. In fact, we are facing three major problems: Funding, social change and structure. Funding is almost entirely based on a tax model, combined with a certain demographic model. However during the past fifty years the population has changed, which led to a budget deficit and a dramatically worsening of the services. If there has been a high unemployment, the governmental tax income decreased. On the one hand, life expectancy increases and therefore the demand for medical support. On the other hand, the state is confronted with a declining birth-rate. Children represent the next generation of taxpayers and so the governmental tax income will decrease and the gap between financial resources and expenditure enlarges. The NHS was once founded after the Second World War as an institution of social security and justice to provide free health care for all. In former times, concerning medical supply, people were dependent on themselves, respectively on their financial status. The new model promised to be an advancement. Now the NHS is about to regress. Today, costs for certain medical services are transferred from state to citizens. The system is antiquated, a more flexible model is needed here, which resists major social changes and financial fluctuations. This implies a completely different model of funding and a structural modernisation. A general private insurance is only one alternative. An other opportunity would be the privatisation of the administrative and clinical sector.

2. The British System of Health Care

2.1 Health Care as part of the welfare state

The National Health Service (NHS) was founded in 1948, in order to provide British citizens social security after they had suffered during the Second World War.¹ The innovated services promised social support and were therefore highly welcomed:

“Poor health and the inability to pay for adequate medical treatment have traditionally been amongst people’s greatest fears. In the 1940s, therefore, the promise of comprehensive medical care, free to all equally in time of need, represented as revolutionary a social advance as the guarantee of social security […].”²

Its priority objective, as part of the newly created welfare state, was to offer primary and free health care for the entire population, independent of their financial situation, profession, sex, age or social class.³ Unfortunately the government forgot, that market orientation also applied to a social service. Nevertheless the system is very popular among the British, but funding was and still is a controversial issue.

2.2 Funding and Expenditure

The British health service is mainly funded on taxation and NHS contributions.

“In 2004-05 it is estimated that 95,5 per cent of financing for the NHS in England will be met from these two sources, 74 per cent from the Consolidated Fund, that is from general taxation and 21,5 per cent from the NHS element of National Insurance Contributions.”⁴ The remainder comes from charges and receipts.⁵ “Charges were first introduced for prescribed medicines […] as early as 1951. […] […] Since then the levels of prescription charges have increased […] and charging for optical and dental care has been expanded […].”⁶

[...]

1 Rudney Lowe, “Healthcare”, in: Ders. (Hrg.), The Welfare State in Britain since 1945, Houndmills/Basingstoke3 2005, 175-203, 182.

2 Rudney Lowe: “Healthcare”, 2005, 175.

3 www.britischebotschaft.de/pdf/NHS_ger/pdf - The British Health System, 2004, 1 (23.09.2005).

4 Department of Health: Departmental Report 2004: Chapter 3 Expenditure, 6, http://www.dh.gov.uk/assetRoot/04/08/09/44/04080944.pdf (letzter Besuch am 23.09.2005).

5 Department of Health: Departmental Report 2004, 6.

6 Pete Alcock, , „Health“, in: Ders. (Ed.), Social Policy in Britain, Houndmills/ Basingstoke 2 2003, 69.