The National Health Service (NHS), founded in 1948, is the largest organisation in Europe, dedicated to providing the UK with universal healthcare - free at the point of delivery. This means that, with one or two exceptions, it is possible simply to visit a hospital or doctors' surgery and receive treatment with no question of payment or insurance. A fixed charge is made to claim prescriptions however, and dental treatment is not free, although people such as pregnant women, children and the unemployed do not have to pay these costs. Ninety percent of the NHS's funding comes from income tax.

Prior to 1948, hospitals were private institutions that charged, with a limited degree of reimbursement for those on low incomes. The only way that the poor could receive treatment was to rely on charitable institutions, such as the Royal Free hospital, where doctors volunteered their services for free. But charities like this had difficulty providing for the demand that there was, so healthcare for the poor was inadequate. Despite economic hardship in the only recently post-war Britain, the NHS became a reality on 5th July 1948, at the lead of Aneurin Bevan, the Health Minister for the Labour government. And even though the political climate at the turn of the 21st century is a much more conservative one, the socialistic ideals of the institution are still a great source of national pride.

In following years, new medical breakthroughs and advancing technology have meant improved health and an increased life expectancy for the population, but the constant introduction of new drugs and techniques have been a headache for the NHS, who are now obliged to provide much more than they did in the old days, if they are to provide the universal service they promise. In 1987, Margaret Thatcher introduced a number of reforms designed to give the NHS something of an internal market, based on the liberal economic principle that says greater competition equals greater efficiency. Hospitals were given performance indicators to measure how well they were achieving. Another of the changes was that districts would make their own purchasing decisions, leading to the 'postcode lottery' for drugs - a patient may have wanted a particular drug, but the Health Authority in their area may not have supplied it, even if neighbouring ones did. Nowadays the reforms are heavily criticised. It is claimed that the system was not in fact very much more decentralised, but that the "adversarial nature of the relationships" between Health Authorities had been increased. The right wing Prime Minister brought massive changes to the country, bringing Britain closer to an American style free market, but she was unable to go far in dismantling the NHS despite her distaste for the welfare state.

More recently, the Labour government, led by Tony Blair, has gone further toward the private sector than Thatcher would have dared, but at the same time has brought hope for the future of the NHS. It is widely agreed that at the time of writing, the NHS is in crisis, with a shortage of beds, years long waiting lists for certain operations and regular horror stories coming out of the media. One positive innovation has been NHS Direct, a service which provides advice over the phone to patients with minor ailments, often saving them a doctor's visit.

Part of New Labour ideology is that anything new that is to be built will be built with private money. As such, a number of new hospitals have been built with PFI (Private Finance Initiative) and PPP (Public Private Partnership) schemes. In his book Captive State, George Monbiot tells of how in Coventry, instead of improving the two hospitals that currently existed, it was decided to demolish them both and build a single new one with private finance, which the government would then lease from a private company. The new hospital would be difficult to access, at the edge of town, and there would be big staff cuts from the previous arrangement. The government insisted it was the best way to go ahead.

Less controversial is the recent budget, where the Chancellor of the Exchequer Gordon Brown announced that funding for the NHS in 2007 will be double, in real terms, what it was in 1997. This is to be paid for by a 1p in the pound increase in National Insurance Contributions (a kind of income tax). Amazingly, a survey found that even 54 per cent of the vehemently anti-tax Conservative supporters approve of the budget, as do 76 per cent of the public as a whole. This is despite much talk from the Tories of alternative systems. Iain Duncan Smith and shadow Chancellor of the Exchequer Michael Howard felt that the country should be looking to continental Europe for an answer to the problems of the NHS, where they use social insurance systems. In his budget statement, however, Brown dismissed the alternatives:

There is no free way of increasing health service spending and the question for Britain today is whether a case has been made for moving to paying through social insurance, private insurance or charging.

The Budget and the review's documents published today contain very detailed information on alternative systems of financing: funding by private insurance where, in the case of the USA, family premiums average around £100 a week and are set to rise next year on average by £13 a week, and because of its cost it is a system that insures only some of the people for some of their care; funding by social insurance whose narrower base for contributions means in France, for example the typical employer pays £60 a week; and charging for clinical services which also means patients paying rising bills for individual operations and treatments basing our health care system on medical charges would, in my view, mean the sick paying more for being sick.

There is another consideration as we look to the long term. With advanced technology and life-saving drugs, the cost of treating one individual falling ill can today run into tens of thousands, sometimes hundreds of thousands, of pounds. Because none of us knows when costs could overwhelm our family budgets if we had to pay privately we seek to pool risks and, more than ever, it is important to have health coverage with the minimum of ifs, buts and small print, and exclusions from that insurance. So it is the Government's view not just that the NHS system of funding is the most equitable, but that a reformed NHS, by offering the most comprehensive insurance policy to meet the rising costs of medical advances, can give British people the greater security they want. It is therefore my duty to set out what we, as a nation, need to pay in tax to fund, for the long term, the health service that we want.
The government, it seems, have taken a gamble on making the health service work in the next few years or losing power. But given how cherished the NHS is by the public, it would have perhaps been a greater gamble for them to decide that they were going to dismantle it in favour of an alternative system.

sources: (Hansard)

George Monbiot - Captive State (Macmillan, 2000)


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