HealthManagement, Volume 13, Issue 3/2011
Healthcare in the United Kingdom (UK) is mainly provided by the National Health Service, a public health service, which provides healthcare that is free at the point of use to all permanent residents of the UK, and is paid for from general taxation. Though the public system dominates healthcare provision in the UK, private healthcare and a wide variety of alternative and complementary treatments are available for those willing to pay.
History
Since its launch in 1948, the NHS has grown to become the world's largest publicly funded health service. The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth. That principle remains at its core. With the exception of charges for some prescriptions and optical and dental services, the NHS remains free at the point of use for anyone who is resident in the UK, currently more than 60 million people. It covers everything from antenatal screening and routine treatments for coughs and colds to open heart surgery, accident and emergency treatment and end-of-life care.
Although funded centrally from national taxation, NHS services in England, Northern Ireland, Scotland and Wales are managed separately. While some differences have emerged between these systems in recent years, they remain similar in most respects and continue to be talked about as belonging to a single, unified system.
Employment
The NHS employs more than 1.7 million people. Of those, just under half are clinically qualified, including 120,000 hospital doctors, 40,000 general practitioners (GPs), 400,000 nurses and 25,000 ambulance staff. Only the Chinese People's Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ more people.
The NHS in England is the biggest part of the system by far, catering to a population of 51 million and employing more than 1.3 million people. The NHS in Scotland, Wales and Northern Ireland employ 165,000, 90,000 and 67,000 people respectively.
The number of patients using the NHS is equally huge. On average, it deals with 1 million patients every 36 hours. That's 463 people a minute or almost eight a second. Each week, 700,000 people will visit an NHS dentist, while a further 3,000 will have a heart operation. Each GP in the nation's 10,000-plus practices sees an average of 140 patients a week.
Funding
When the NHS was launched in 1948 it had a budget of 437 million pounds (roughly 9billion pounds at today's value). In 2008/9 it received over 10 times that amount (more than 100 billion pounds). This equates to an average rise in spending over the full 60-year period of about four percent a year once inflation has been taken into account. However, in recent years investment levels have been double that to fund a major modernisation programme.
- 60 percent of the NHS budget is used to pay staff
- 20 percent pays for drugs and other supplies, with the remaining
- 20 percent split between buildings, equipment and training costs on the one hand and medical equipment, catering and cleaning on the other.
Nearly 80 percent of the total budget is distributed by local trusts in line with the particular health priorities in their areas. The money to pay for the NHS comes directly from taxation. According to independent bodies such as the King's Fund, this remains the "cheapest and fairest" way of funding health care when compared with other systems. The 2008/9 budget roughly equates to a contribution of 1,980 pounds for every man, woman and child in the UK.
NHS Structure
The Department of Health controls the NHS. The Secretary of State for health is the head of the Department of Health and reports to the Prime Minister. The Department of Health controls England's 10 Strategic Health Authorities (SHAs), which oversee all NHS activities in England. In turn, each SHA supervises all the NHS trusts in its area. The devolved administrations of Scotland, Wales and Northern Ireland run their local NHS services separately.
The National Health Service in the UK is divided into two sections: Primary and secondary care. Primary care is the first point of contact for most people and is delivered by a wide range of independent contractors, including GPs, dentists, pharmacists and optometrists.
Secondary Care
Secondary care is known as acute healthcare and can be either elective care or emergency care. Elective care means planned specialist medical care or surgery, usually following referral from a primary or community health professional such as a GP.Primary Care Trusts
Primary care trusts (PCTs) are in charge of primary care and have a major role around commissioning secondary care, providing community care services. They are central to the NHS and control 80 percent of the NHS budget.
As they are local organisations, they understand what members of their community need, so they can make sure that the organisations providing health and social care services are working effectively. The PCTs oversee 37,000 GPs and 21,000 NHS dentists
