History of The National Health Service

Question :

This assessment will cover following questions:

  • In what manner the structure, funding and expectations of the National Health Service has changed since its introduction in 1948.
  • Determine the effectiveness of NHS service in relation to the current changes.
  • National Health Service deals in providing medical aid to people. Evaluate factors that lead to creation of National Health Service.
  • Examine how changes to funding have impacted on the NHS.


Answer :


NHS has been actively providing medical and healthcare services to the patients in England since the year 1948 when it was first set up. In the current essay, it will be evaluated how the structure of NHS has evolved with time and how the funding of this organisation has changed with time has also been highlighted in this essay. The ideologies that were formulated under Thatcher government, Blair government and Cameron government have been highlighted in the essay and appropriate conclusion is drawn.


Change in structure, funding and expectations of NHS since it’s establishment in 1948

National Health Service (NHS) was first set up under National Health Service Act 1946 and was established with the aim of giving medical care and assistance to the patients. It was tripartite system when it was set up in the year 1948 addressing three aspects namely:

Hospital Services:

There were 14 hospital boards operating at regional level in England and Wales and included 400 committees whose task was to monitor the hospitals (National Health Service History, 2019). There were teaching hospitals as well and these were governed by another board of governors.

Primary Care:

Executive Councils were created so that contracts that were being entered into by the general and local practiotners could be administered and payment could be made (Simmons, 2015). GP’s, LP’s, Dentists, Pharmacists were hired as individual contractors i.e. they were paid for the each number of patient that they treated and not as a salaried employee.

Community Services:

The local authorities were made responsible for the Maternity and welfare clinics for child, midwives, vaccination, immunisation, health education, ambulances etc.

However, with time it was found that the tripartite structure was not feasible and there were huge gaps and duplications in the England and Wales which led to passing of the responsibility of NHS in Wales to the Secretary of state for health and further led to restructuring of the NHS in England in 1974 (Jiong and Shaolong, 2015). In 1970s and 1980s the pressure regarding the increasing costs increases and there were many disasters like contaminated blood products etc.

Margaret Thatcher Ideology

The conservative party led by PM Margaret Thatcher was a huge supporter of the concept of NHS and introduced modern management process in 1980s. In Griffith’s report of 1983, it was outlined that previous system of consensus management in 1980s was removed and the appointment of general managers was recommended who would be responsible for all the activities and the role of clinicians in the management of NHS was increased. The government granted an additional financial budget of £101 million in 1987 to NHS but the increasing financial strain led to the Thatcher government deciding that they would review the NHS in 1988 (National Health Service History, 2019). From the review that was conducted, in the year 1989, there were two papers that were produced i.e. Working for Patients and another one i.e. Caring For people (Hunter, 2016). Both the papers were focused on the introduction of internal market and was heavily opposed by the BMA who argued that instead of implementing these papers on the entire NHS operating hospitals in England and Wales, first, a pilot study should be conducted that would help in ensuring that whether the reforms that are proposed are worthy and ensure that the quality of care that is given is not compromised with.

However, despite this protest, the internal market was implemented with full effect and this basically involved structuring the organisation for the upcoming decade. The authorities instead of running the hospitals focused on purchasing the care that was given either from their own authorities or from other authorities. The general practitioners, some of them, became fund holders and they were authorised to purchase the desired care for their patients and therefore the NHS Trusts were developed which led to increase in the competition (Stafford and Sutcliffe-Braithwaite, 2017). Although this increase in competition reduced that waiting time for the patients and the number of patient s that were given care was also increased along with reduction the spilling costs and fund requirements thus addressing the problem of financial crisis. But it was observed by National Health Service and Community Care Act in 1990 as well as by a series of studies that were conducted over time that this internal market strategy heavily decreased the quality of care that was provided to the patients and this decrease was also assisted by the increase in local differences under the Thatcherism Ideology.  

Tony Blair Ideology

When Tony Blair came to power in the year 1997, they proposed and promised to abolish this strategy of internal market within NHS and the criteria of fund holder was also condemned. The Blair government introduced another white paper under which the internal market approach was replaced with integrated market approach where the doctors and nurses were put into the frontline and the higher quality care was given first priority. The Blair government guaranteed that the National standards would be complied with and the access to get a quality care and treatment form NHS would be more (Oliver, 2017). The reforms that were proposed by the Blair government involved stricter financial budgeting, detailed service standards, modification of the fund holding practices and increased emphasis on rigorous clinical as well as corporate governance. The Blair government made services free for the patients and also formulated additional services such as NHS direct so that the changes could be implemented. The private medical sector was also tried to encourage by the means of outsourcing and the medical as well non-medical services were encouraged in the private sector as well. The surgicentres were developed who were given the target of treat around 3% of the NHS patients in the year 2005 and this was expected to grow to 10% just by the year 2008 (Benbow, 2017).

However the information technology became a major problem for the NHS and in order to keep up with the reforms that were proposed by the Blair government, it was essential to develop IT department. NPfIT i.e. National Programme for IT which was the largest IT project in the entire world was launched and it is still running with over budgeting and far behind schedule. It was originally budgeted just at £2.3 billion but now the cost has already reached £20 to 30 billion and is still increasing. The computerisation of all the records of the patients was a significantly difficult task and has yet not been achieved (National Health Service History, 2019). The admissions in the hospital increased, the attendance of medical professionals increased and community care activities especially increased along with reduction in the death rates overall by the year 2013 (Smallwood, 2016). Overall the government was able to actually reform the NHS structure and practices during their party’s rule.

David Cameron Ideology

When the conservative led government under the PM David Cameron returned, the deterioration of the industrial relations was set off. The integration of the private sector in the public sector healthcare services provided by NHS was largely revolted and protested against. These were led by health workers and many NHS workers also participated in these strikes and demonstrations where their reduction in pay and restraint was the major problem that they were revolting against. Additionally, when the junior doctors were informed about the policy of extended weekend working in 2016, there were wide demonstrations and protestations where they refused to give any services until their pay matched the working hours or the extended weekend was reduced back to normal (Willis, 2017). The Cameron ministry segregated the social objective of starting NHS as opposed to the management decisions that are to be made so that the social policy objective can be fulfilled accordingly. There was no particular ideology that was developed under the Cameron government but focus was on ensuring that every single person could have access to a safer and secure medical treatment rather than giving trainings etc. the Cameron government focused on giving highest quality care to all the patients that were registered in the NHS and rather than spending the taxpayers hard earned money on the establishment of NHS (which was proposed by Margaret Thatcher), focus was again on giving a higher quality care and actually giving the care.

Also Read -Determinants of Health & Illness

With the advent of year 2019, many of the experienced doctors and MPs have warned that the ongoing privatisation activities would lead to increase in the harm induced to the patient and therefore have protested against it (Klein, 2019). The newly appointed PM Boris Johnson although promised that his part would initiate the process of healing and yet, the protest have been increased due to the series of actions that have been taken such as cutting down the beds. The condition for NHS has deteriorated significantly and the practitioners hope that certain measures will be adopted and implemented so that the situation can be brought control.

The essay concluded that the ideologies of different government present different conflicts and although NHS has evolved with each of the ideology, it is still an ongoing process.To get more details about the online assignment help you can ask our experts.

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