The NHS and healthcare in the UK

So, completely off topic (if there is one on this blog) and in danger of infringing on the content more usual on my other blog (which no I am not linking to) I bring you my take on the NHS and healthcare generally in the UK. This post is brought at the request of Florida Dom.

The National Health Service (NHS) is an now an institution of its own. It was founded in 1948, shortly after WW2. It formed part of something now called the ‘welfare state’, at a time when the country was still recovering from war, when many people were living in poverty and post war rationing still existed. The philosophy of the NHS was (and still is) that healthcare should be provided free at the point of delivery. It meant that for the first time, everyone in the UK could see a GP (primary care practitioner) or attend hospital, have an operation etc without worrying about whether they could pay for it.

All those who provided care within this context became direct or indirect employees of the NHS.

To begin with dental care, prescriptions etc were also free, but within a few years charges were introduced. However, there are parts of the population (children, elderly, people with certain health conditions) who receive all healthcare free.

Over the years, people began to see the entitlement to free healthcare as a right rather than a privilege. Also over those years there have been massive advances in medical technology and in the medicines available. Costs have spiralled, and the demands of the population have grown with them. People seek more healthcare, and demand more from their practitioners. What is more, people often have no idea of the costs associated with providing good quality care and what’s more most people appear not to care. In some cases they think healthcare is the responsibility of others rather than of themselves. They demand the best, to receive the newest treatment and perceive that they and their families should be saved at all cost. However they do not always see that they have a role in preventing ill health and in managing their own recovery. This has led to gatekeeping of healthcare and from there what is akin to rationing. It has also led to a challenge that those working in healthcare have lost compassion for those who they treat, and that what is delivered by the NHS is not as good as it can be.

One of the greatest myths is that the NHS is one organisation. While everyone who is employed is part of the NHS family, each hospital, primary care provider, community provider is a separate (or a group) of employers in their own right. True, there is still national pay and conditions for employees but each of those organisations is run as its own separate entity, with its own budget. The standards set and  expected by the department of health are unified, but the policies and procedures and management structures of each provider are different. This means that the delivery of care across the country is not the same. What exists is a complicated web of organisations that commission (or buy) services, those that provide them and then the different governments that govern them (Scotland, Wales, Northern Ireland all have slightly different arrangements from England).

In practice though, for most people the NHS is about being able to see your GP if you are ill, being referred for investigations and having treatment without cost. Medicines are not free unless you belong to one of the groups above (though while you are admitted to hospital all medication is free). You can attend A&E (ER), be admitted, have your life saved etc. at no cost. You can have a baby, see a midwife / doctor regularly during pregnancy and that baby will receive immunisations and checks from relevant professionals at no cost. And so on…

It is what people know, what they expect and it is what people see as their right. The debate over what is free and what isn’t and who can be treated and where is a hot political topic that will be debated for ever. Maybe that’s another subject in itself.

Information can be found here


2 thoughts on “The NHS and healthcare in the UK”

  1. 10 years ago, i would have said that yes there were long waits. Firstly to have investigations (say ultrasound or MRI), then to see a specialist doctor and then to have non urgent surgery. There were reports of people waiting for hours to be seen in the ER. But through a system of targets these came down dramatically, patients in the ER must be seen and dealt with within 4 hours and all those referred for non urgent surgical opinion must be seen and treated within 18 weeks. Now there is little in the way of waiting time for anything, which meant that providers of private healthcare had to change tack in their adverts.

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