The NHS - its organisation and structure
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Transcript of The NHS - its organisation and structure
The NHS - its organisation and structure
NHS
• History
• Organisation
• Finance
• Staff
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
NHS - History1875 - 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
1960s - 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-WW2
• 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 Health1807 - Recommends County asylums
1847 - County asylums compulsory
1930 - 89 asylums average size 1200 beds
Built in rural areas
1940s - 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
N H S structure post 1996
G P s
P R O V ID E R SP U R C H A S E R S
G P fu n d h o ld ers
H ea lth A u th orit ies N H S Tru s ts
D ep artm en t o f H ea lthN H S M g t execu tive
R eg ion a l O ffices
S ec re ta ry o f S ta te
NHS Organisation
The New NHS
H ea lthIm p rovem en tP rog ram m e
L oca lA u th orit ies
P rim ary C are G rou p s
H ea lth A u th orit ies N H S Tru s ts
D oHN H S E
R eg ion a l O ffices
S ec re ta ry o f S ta teTyp e t it le h ere
NHS Organisation
Current ideas
• Partnership working - “joined up thinking”
• Inequalities & Our Healthier Nation
• Devolving decision making to GPs - “closer to the patient”
NHS Finance
Public Spending - 1997 Total = £267 billion
Health (Eng)Local GovtDefenceScot/Wales/NILA-selfEducationSocial SecurityOther
NHS Finance
Growth in NHS funding 1994-99
0
5
10
15
20
25
30
35
40
1994 1995 1996 1997 1998 1999
Year
£ -
Bill
ion
s
NHS Finance
Pie Chart of division of NHS resources
Hospital & CommunityHealth Services
Family Health Services
Central Health (misc)
Admin
Capital
NHS Finance
Age cost curve
0
500
1000
1500
2000
2500
3000
Births 0-4 5 to 15 16-44 45-64 75-84 85+
Age Bands
£ p
er
he
ad
of
po
pu
lati
on
NHS Staff
NHS staff: changes seen since 1987
0
100
200
300
400
500
600
700
800
900
1987 1992 1993 1994 1995 1996 1997
Year
Nu
mb
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(th
ou
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plo
yed
wte
Total staff
Medical/dental
Nursing
Management/support
NHS Staff
Pie chart showing proportion of main staff groups within the NHS
Nursing
Medical/dental
Other direct care staff
Clinical Psychologist
Admin & estates
Other management &support
NHS StaffNHS directly employed staff, 1997
Female
Male
NHS Staff
Psychologists in the N.H.S. (England)
0500
10001500200025003000
Year
Who
le T
ime
Equ
ival
ents