NHS

when and why was the NHS founded?

• in 1948 by the post war government as part of the welfare state

• designed to provide universal healthcare that is free at the point of need

what early challenges to NHS principles emerged by 1951?

charges were introduced for prescriptions, spectacles, and dental charges, challenging the idea of free care at the point of need

what financial pressures has the NHS faced over time?

affordability has always been a problem due to an ageing population and the rising cost of sophisticated medical treatments

what is the current scale of the NHS in england?

• NHS receives £200bn a year

• employs 1.3 million people

• 140,000 doctors, 377,600 nurses/midwives

• 42 integrated care systems

what is the breakdown of NHS funding sources?

• 80% from general taxation

• 20% from national insurance, land sales, patient charges

what was the aim of thatchers NHS reforms?

• 1990 NHS and community care act introduced the ‘internal market’

• splitting the NHS into purchasers and providers to encourage market-like efficiency

how did Blair’s government reform the NHS?

• increased NHS funding from 6.7% to 9.7%

• retained internal market

• created primary care trusts to commission services

• introduced foundation trusts and strategic health authorities

what was controversial about the 2003 health and social care act?

allowed PCTs to purchase services from private or foreign providers to reduce NHS waiting lists, sparking debates about privatisation

what was the goal of cameron’s coalition reforms?

• reduce bureaucracy and give GPs control over funding

• the 2012 health and social care act handed commissioning to clinical commissioning groups

what happened to NHS trusts under the 2012 act?

all NHS trusts were to become Foundation Trusts and operate like not-for-profit that could generate income. hospitals could ‘go bust’ like private firms

how did the 2012 act increase competition?

NHS trusts had to compete for contracts from CCGs alongside any “qualified provider” including voluntary or private sector organisations

what replaced CCGs under the 2022 health and care act?

INTEGRATED CARE SYSTEMS

• system aimed to promote collaboration, not competition, and ended the competitive tendering rule

what are the role of ICBs and ICPs within ICSS?

ICBs (integrated care boards) - oversee NHS planning and allocate funding

ICPs (integrated care partnerships) - include non-NHS partners to develop strategies for public and social care needs

what is the role of NHS england today?

• distributes central funding

• supports the 42 ICSs

• ensures quality care

• provides national leadership

• currently accountable for NHS spending and performance

what do ICSs aim to achieve in the health system?

• promote joined up services by coordinating NHS providers, commissioners and local authorities to improve public health and social care outcome

how do foundation trusts operate?

• semi-autonomous

• self governing NHS bodies with the ability to earn income and make independent decisions

• though still part of the NHS

• around 150 exist

how do NHS systems differ across the UK?

scotland, wales and northern ireland each have their own health systems with different structures and policies

what are the major current issues facing the NHS?

• ageing population

• health care inflation

• lack of adult social care

• NHS staff pay and retention

• underfunding

• difficulty accessing GPs

• crisis in A&E departments

• private sector influence

• mental health service access

what are the key NHS regulators and watchdogs?

CARE QUALITY COMMISSION (CQC)

• inspects hospitals, care homes, Gps

HEALTHWATCH

• represents patient views

PARLIMENTARY AND HEALTH SERVICE OMBUDSMAN

• handles complaints

NICE

• approves new drugs and provides health guidance