This essay will look at the contemporary structure of the NHS and discuss the factors that have propelled it to its current position. It will look at the changes in society and how these changes influenced the changes in the NHS. In 1974, the NHS worked on a tripartite system; however, this was to change to a more ‘unified’ structure. The advantages were that local health authorities were able to organise and plan there own service. The reorganisation was heavily criticised, for being too complex. In 1979 the Royal Commision report critiscied the reorganisation and advised that the system was simplified.
During this time poor financial expenditure due to the countries poor economy as a result of the oil crisis and high unemployment rates, the moral of the health service dropped but there were still many advances in medicine. These included transplants, heart surgery and greater access to intensive care units. It became apparent that the NHS was a vicitim of its own success and could not be everything to everybody. The reality of an aging population and its evolving health needs had to be addressed.
The media has always critisced the NHS but in 1978 there was heavier criticism than usual with what the Papers called the winter of discontent the media scrutinised waiting times and economic management. However, Enoch Powell, a former Minister for Health, had commented back in 1966 “the continual, deafening chorus of complaint ” which characterises the NHS. By contrast with the private sector, where people always pretend that things are better than they are, the system of finance in the NHS endows everyone providing as well as using it with a vested interest in denigrating it. ”
Althought the NHS as Enoch Powell had pointed out always came under fire and this was to be expected. Labour tried to address these issue by setting priorities and allocating resources fairly through differen’t parts of the country. This still led to the demise of James Callaghan the PM at the time as questions that he had answered had led to the belief that he was out of touch with the rest of the country and this opened the door for Thatchers election win in 1979. Thatcher’s government continued with the labour policies and intoduced far reaching reform that were said to create effeciency and effectivness.
These reforms included ‘The Health Service Act 1980’ which encouraged private medical health care, the critics complained that these reforms were undermining the very principles of the Health service. As Nye Bevan said in 1952 ” the essence of a satisfactory health service is that the rich and poor are treated alike” With the onset of private medical health care it became very apparent that the rich would be able to jump waiting lists whilst the poor whom were those most often in need would be subjected the long waiting lists.
Further reforms saw a belief that consensus management had failed and doctors became more involved with decisions on budgeting and simplified tiered management system. By 1987, the health authorities were in debt, due to over spending, advances had bought about more successful but also more expensive treatments. Public expectations had grown; the public expected a better NHS. To overcome this spending waiting lists grew and beds were closed. This led to industrial action and the worst financial crisis of the NHS.
In 1990 NHS & Community Care Act/ 1991 NHS reforms was executed. The Internal market came to fruition with the purchase/provider system. GPs were offered fund-holding budgets to enable them to buy some care. All providers became independent NHS Trust, which encouraged competing and inequalities. The fact that the state did not have the monopoly for providing services would encourage competitiveness on prices and more importantly quality of care by having an assortment of welfare agencies that would create a wider range of provision.
Funding could be spent on problems specific to the trusts own area and was therefore responsive to local needs and there was the opportunity to tap into the charity organisations for help with care and welfare. Further advantages of this system included, cost efficiency; more flexibility and plans of care that could be tailored to suit the individual. Conversely, this system suffered the disadvantages of lack of standardisation, with a gross lack of particular types of medication or medical care in certain areas of the UK.
Another problem was the quality service and some of the agencies were criticised for being unreliable and disorganised. These problems were probably due to the lack of provision to monitor the quality of service. The theory that this system would create a competitive quality market was not to come to realization as financial restriction were tight, the purchaser tended to end up purchasing from the cheapest provider. The community care act also had an impact on mental health, this act followed Sir Roy Griffiths ‘community care: Agenda for Action’ report in 1988.
This report promoted the smaller units in the community for the seriously mental and supervision for those with less serious conditions. The mental health campaigners praised this, but the campaign groups criticised the government for closing the hospitals without first putting in making enough money available for adequate community care. The 90’s also saw the ‘Carers Act’, which came into effect in 1996. It required the LA to asses circumstances of carers who were substantial providers of the patients care This act does not provide any new funding or guarantee of direct support for carers beyond the right to assessment” David Mottram June 1996 .
Under John Major, the Conservatives introduced hospital performance tables, the Patient’s Charter which aimed to clarify health organisations’ duties towards patients (1992) and A Code of Practice on Openness in the NHS in (1995). All though these charters were supposed to lead to the hospitals being made more accountable, it was argued that the fact that the hospital were able to bypass the health authorities made the organisation being less accountable.
In 1996 saw yet more reforms of the NHS structure. These reforms were in response to the continuing complaints from media, staff and patients of bureaucracy and the hope was that the new simplified system would encourage a smoother running of the NHS, and the following year saw the need to move away from the internal market to a collaborative approach to care. Communication improved with electronic patient record keeping in 1993 and 1999 Audit Commission Report Update – found significant improvements in medical record keeping following 1995 report.
The labour Government in 1998 faced the fact the NHS had been grossly under funded and was under staffed, money was put forward to fund more medical schools and better hospitals. July 2000 saw the implementation of the NHS 10 Year Plan. This placed Emphasis on ‘patients always coming first’ and frontline staff having more responsibility. This would attempt to develop health, reduce inequalities and integrate health and social care.
The reforms throughout this period have been an immense the major drivers of change have been advances in medicine and these advances leading to very ill patients being kept alive longer and needing further medical treatment sometimes for a life time and an aging population. A perspective can be gained of these advances by the fact that it now costs the NHS four times more to treat a patient than it did at the start of the service. The issue of varying standards is still to be overcome with incompetent practice still manifesting.
Many of the problems that were present at the beginning of the NHS are still prevalent today. Nevertheless, with the abundance of IT many of the problems of communication between different agencies can be overcome. There is unfortunately still and inequality in health with children of manual workers likely to have a life expectancy of seven years shorter than those with professional parents. The government is trying to address these issues by opening clinic of excellence for medics and constantly reviewing structure and spending there success in these areas will probably determine the next office within government.