National Health Service

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UK specific information

The logo for the NHS in England
The logo for NHS Scotland

Usually termed in the United Kingdom the NHS. Founded in 1948 and now the English NHS, the Scottish NHS, the Welsh NHS (although this shares most of its regulations with the English NHS) and Northern Ireland NHS. It is a generally available and free at the point of delivery health service funded from general taxation, rather than through social insurance schemes (National Insurance in the UK would be regarded in most other countries as a general tax as its rate bears no relationship to the state benefits that result).

The NHS is the fourth largest employer in the world, after the Chinese People's Liberation Army (2.3 million), Wal-Mart (1.8 million)and the Indian State Railway (1.4 million). The NHS employs c. 1.3 million people.

QuotationMarkLeft.png The NHS reflects the society around it – both society’s aspirations towards good health and its careless attitudes towards bad health. Then again, the NHS mirrors, and always will, not only the imperfect nature of medical science but the diffuse and ill-defined understanding we have of our own health, whether good or bad. QuotationMarkRight.pngRoyal Commission on the National Health Service 1979[1]

NHS expenditure as a proportion of UK GDP reached 9.6% in 2006 (OHE 2007) and as of 2015/16 it consumed 29.7% of central government expenditure. This was in line with the previous Prime Minister's (1997-2007) expressed wish that UK expenditure on health should reach the European average although it is in fact just behind as of 2014 with some hoping that Brexit will pull it past this goal.

The political nature of the NHS is marked. How many local hospitals you have is determined by the relative power of your individual vote[2].

There is little doubt as to the influence of politics on the NHS. An illustration is provided by the observation that small hospitals are more likely to be preserved in marginal political constituencies. This is postulated to be because a decision to close a hospital is likely to have election implications for the sitting MP only in marginal constituencies[2]


State of the NHS in February 2018

On 21 February 2018 NHS Improvement published a report for quarter 3 of the 2017-18 financial year.[3] It revealed that one in 11 posts across NHS hospital, ambulance and mental health trusts were unfilled, and the figures also show an overall decline in several key performance areas including waiting times.

The BMA Council Chair commented:

"These figures paint an extremely worrying picture, with NHS performance in decline in several key areas. Waiting times targets are not being met, the deficit is much greater than anticipated and there are significant staff shortages.
"It is clear from these figures that the health service just doesn’t have the resource nor capacity to meet rising demand. Without the necessary investment in staff and services the NHS will continue to struggle to meet demand, and current staff will be stretched even more thinly, compounding recruitment and retention problems.
"These figures must act as a wake-up call to the government. The NHS urgently needs greater funding to halt the decline and put the health service on a sustainable footing for the future."

The NHS Confederation also reported on the data:

"Responding to the figures, Niall Dickson, chief executive of the NHS Confederation, commended NHS staff for doing a “heroic job”. But he said the numbers “reflect the intolerable pressure on a system which currently has a staggering 100,000 vacancies to fill.
"We have repeatedly pointed to severe underfunding in health and care and a year-to-date deficit in the English NHS of £1,281 million is just the latest evidence of this.
"Our members are at the end of their tether. It is simply not realistic or reasonable to expect the NHS to go on delivering a comprehensive universal service with inexorably rising demand and demonstrably inadequate funding.
The organisation is working with the Institute of Fiscal Studies and Health Foundation to conduct a study into the funding needs of the UK’s health and care systems over the next 15 years.
"The work is designed to identify the challenges faced by health and care services and provide objective evidence of what will be needed going forward."[4]

Experts say the vacancies would be enough to staff ten large hospitals; and this does not probably include the stats for general practice. Many across the UK are struggling to recruit GPs and nurses.

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