The NHS its organisation and structure NHS History

NHS • • History Organisation Finance Staff

NHS - History 1802 - Act introduced to limit the employment of children to

NHS - History 1875 - Public Health Act allowed local authorities to perform slum

NHS - History 1941 - National Insurance Act - compensation for industrial diseases &

NHS - History Hospitals pre-WW 2 • Voluntary hospitals - charge fees (means tested)

NHS - History Beveridge report on social insurance: named the 5 giants: disease, ignorance,

NHS - History Mental Health 1807 - Recommends County asylums 1847 - County asylums

NHS - History 1954 - peak at 140, 000 patients Sudden turn-around: penicillin &

NHS Organisation NHS Aims: • To provide medical care free at point of use

NHS Organisation Constant change 5 phases: 1948 - 74: Administrative 1974 - 82: Planning

NHS Organisation 1) Administrative phase • Persistence of inequalities - social, geographical, by patient

NHS Organisation 2) Planning phase • Themes of effectiveness, efficiency and equity appeared •

NHS Organisation 3) Management phase • Griffiths report - need for good general mgt

NHS Organisation 4) Market Phase • Thatcher’s belief in free markets efficiency • Purchaser

NHS Organisation Current ideas • Partnership working - “joined up thinking” • Inequalities &

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The NHS - its organisation and structure

NHS • • History Organisation Finance Staff

NHS - History 1802 - Act introduced to limit the employment of children to under 12 hours per day 1806 - First steam powered loom 1834 - Poor law amendments - Poor houses & infirmaries 1842 - First anaesthetic 1848 - Cholera kills 70, 000 1853 - Smallpox vaccination made compulsory 1858 - Medical Act - minimal qualifications laid down 1860 - Florence Nightingale sets up training school for nurses 1862 - Pasteur - demonstrates link between bacteria & disease 1867 - Lister - introduced antiseptic surgery surgical mortality reduce by 2/3

NHS - History 1875 - Public Health Act allowed local authorities to perform slum clearance 1876 - Koch identifies bacteria 1880 - education to age 10 made compulsory 1904 - Interdepartmental committee on physical deterioration 1911 - National Health Insurance Act + Census introducing social classes 1919 - Ministry of Health established 1928 - Universal adult suffrage 1929 - Marriage act increased minimum age from 12 (girls) & 14 (boys) to 16 1932 - Sulphonamide (antibiotic) discovered

NHS - History 1941 - National Insurance Act - compensation for industrial diseases & injuries 1948 - National Health Service Act + National Assistance Act 1952 - Polio vaccine 1960 s - Benzodiazepines developed 1962 - Smoking & Health published 1964 - Congenital anomalies reported nationally 1968 - Legalisation of abortion 1979 - Thatcher 1981 - First AIDS cases reported

NHS - History Hospitals pre-WW 2 • Voluntary hospitals - charge fees (means tested) • Poor sick care provided often by workhouse infirmaries • 1929 - Local authorities could take over poor law infirmaries - place under Health dept • Fever hospitals - to protect public • Lunatic asylums - under County Council - 140, 000 patients

NHS - History Beveridge report on social insurance: named the 5 giants: disease, ignorance, squalor, idleness and want Focused government to attend to NHS, social security, housing, education & policy of full employment

NHS - History Mental Health 1807 - Recommends County asylums 1847 - County asylums compulsory 1930 - 89 asylums average size 1200 beds Built in rural areas 1940 s - declared insane by Judicial Committee - hence run like a prison, high walls, locked doors, self-sufficient Treatments: - psychosurgery, ECT, insulin induced fits, hysterectomy, physical confinements Gross overcrowding

NHS - History 1954 - peak at 140, 000 patients Sudden turn-around: penicillin & phenothiazines, old asylums needed rebuilding, patient rights, growth of welfare state Result: community care policy 1959 - Mental Health Act - doctors control entry & exit 1962 - Hospital plan - falling asylum bed numbers 1983 - Mental Health Act -

NHS Organisation NHS Aims: • To provide medical care free at point of use • To rich and poor alike • in accordance with medical need 2 beliefs: • Those who need care will come forward • Those who provide care know what is required and how to provide it

NHS Organisation Constant change 5 phases: 1948 - 74: Administrative 1974 - 82: Planning 1982 - 90: Managed 1990 - 97: Market 1997 - : The New NHS!!

NHS Organisation 1) Administrative phase • Persistence of inequalities - social, geographical, by patient category

NHS Organisation 2) Planning phase • Themes of effectiveness, efficiency and equity appeared • Managed by consensus • RAWP BUT: • bureaucratic & unresponsive

NHS Organisation 3) Management phase • Griffiths report - need for good general mgt + financial accountability of clinicians • Stronger lines of accountability

NHS Organisation 4) Market Phase • Thatcher’s belief in free markets efficiency • Purchaser - Provider split • Fundholding BUT: • no market-place • decreased choice • increased bureaucracy • decreased equity

NHS Organisation

NHS Organisation Current ideas • Partnership working - “joined up thinking” • Inequalities & Our Healthier Nation • Devolving decision making to GPs - “closer to the patient”

NHS Finance

NHS Staff