Britain's Health Service

  The National Health Service - or NHS - the public health care system operating in Great Britain - was introduced in 1948, as a pillar of the welfare state, set up by the Labour government after the Second World War.
   The establishment of the Welfare State was one of the great social reforms of British history. It was the national coalition government, during the Second World War, that set up a commission chaired by  William Beveridge, professor of economics at Oxford University, to review the systems of medical and social insurance that existed in Britain at the time. The Beveridge Report, published in 1942, recommended the establishment of national system providing social and medical coverage for all citizens " from the cradle to the grave ".
    
    For the first few years, the new National Health Service (NHS) provided completely free medical cover for all people in Britain, regardless of wealth or work status. Citizens did not pay into the scheme; the contributions paid by all people in work (called National Insurance contributions) were meant to pay for social security benefits and allowances, not for the health service.
    The new health service was funded directly out of the general finances of the state, not from any individual state health care contributions; so technically it could not run at a loss, nor be in deficit. Britain was the first country in the world to offer its citizens this kind of totally free public health service, available to all citizens.
     However, even directly funded by the state, the system was from the beginning more expensive than expected, and it only took three years for the Labour government to admit that the idea of a totally free service was perhaps not sustainable. In 1952 the new Conservative government introduced the first prescription charge, a flat rate paid by the patient for each medical prescription to pick up at the chemist's.
   Visits to the doctor and hospital care remained free, but charges were introduced for other services such as dental care or ophthmalic care . Generally speaking this remains the situation today. Hospital care and visits to doctor's surgery are free (if carried out under the National Health Service), prescriptions, dental work and eye care are paid for - in varying degrees - by the patient. Children and seniors are eligible for more free services than people of working age.

   Like all systems of public health care the National Health Service (with the Scottish NHS and Welsh NHS) has seen its costs escalate over the years due to the ageing of the UK population and the development of new drugs, new equipment, and new forms of treatment that are much more expensive than those available in 1948. All governments, Labour or Conservative have tried to control system costs while maintaining or improving the quality of service but the problem of financing the system is still a major headache.

     The first major restructuring of the system took place under Margaret Thatcher. At the time the high cost of running the NHS was at least partially due to its poor organization and poor management. Reforms in the 1980s thus established a decentralized administration of hospital services, known as Hospital Trusts,  and introduced notions of competitive bidding and market forces into the provision of hospital services . Yet forced to respect strict financial limits, many NHS trusts or regional hospital services responded by closing departments or rationing the provision of services not in response to patient needs, but to stay within their budgets. 
   The results were predictable: on the one hand the scandal of "hospital waiting lists", patients being kept waiting for months even when they needed urgent treatment; on the other hand the the development of private health insurance systems for those who could pay to get faster, but more expensive, private health care. The private health care sector had never ceased to exist in Britain, even during the early years of the NHS; but during the Thatcher years of the 1980's, private health care providers expanded rapidly, offering faster and more complete health care services to those who could afford to pay. Many employers  began including complementary private health care as part of their employee benefits, notably with BUPA,  a non - profit organization that was already a major health insurance providers before the days of the NHS.
   The falling quality and increasing cost of the National Health Service during the 1980s and early 1990s did not go down well with the British public, who remained and remain to this day almost universally in favour of maintaining a good quality public health service.
    One of the many reasons that helped the Labour Party return to power in 1997 was their commitment to make reform of the health service one of their main priorities. And in this field promises were followed by action. With the British economy in better shape, the NHS budget could be increased, allowing hospitals to reduce waiting lists; in addition, many new more efficient public hospitals were built . But the operating costs of the health service remained very high and the government seemed unable to bring them down.

Recent changes and continuing NHS problems

     Since 2010, governments have pledged strong commitment to maintaining a high quality public health care system for all, reducing waiting times, and reducing operating costs too.  To achieve this, they have set in motion the most fundamental reform of the whole National Health Service since the system was first set up.  The Health and Social Care Act of 2012 provided for the abolition of NHS Trusts and regional authorities, and the transfer of the management of regional resources to doctors (clinicians) themselves.
    Among other reforms, it aimed to give patients (or their doctors) the right – within the National Health Service – to choose services offered either in public or in private hospitals which charge standard NHS approved rates for the services they provide. While this is a departure from traditional practice in the NHS, it is actually the system used in other successful state health care systems, such as the French public health care system, which operates exactly in this way.
    However, in spite of repeated commitments from successive governments,  the UK Health service continues to lurch from problem to problem  for one major reason: underfunding. Compared to health services in other advanced economies, Britain's NHS is seriously underfunded and understaffed. Although the UK has an ageing population, OECD PPP-adjusted figures for 2015 (the latest available) show the UK spending over 50% less per person on health than Switzerland, 25% less than Germany, the Netherlands, Austria, Ireland, Sweden or Norway, and over 10% less than France, Belgium, Denmark, Canada or Australia.
     If people in the UK complain bitterly about the time it takes to see a GP (an ordinary doctor), and British TV news regularly shows pictures of patients waiting on trolleys in hospital corridors, because there are no nurses to look after them, or no beds free,  this is hardly surprising either, as the following table shows (figures from Eurostat 2017)

	Belgium	Germany	France	UK
Health Spending as share of GDP	10.6%	11.3%	11.5%	9.1%
Number of GPs for 1000 population	4.9	3.9	3.2	2.8
Hospital beds per 1000 population	6.5	8.2	6.4	2.9
Nurses and midwives per 1000 population	16.8	11.5	9.3	8.8

Using the NHS in brief:

Anyone wishing to use NHS services must be registered with a GP or General practitioner (GP) . The vast majority of GP operate in group practices or health centres. To be seen by a specialist or a sent for treatment in a hospital (except in emergencies) a patient must be referred by his GP.
   Seeing a doctor under the NHS is free,  but GPs do not usually do free home visits except for patients who can not move or are very sick.