The first national strike in the NHS for nearly 20 years took place in London in September last year. This seems to be of bad omen for the British Health Care system. Before we go further into the subject, let us remember how health care used to be before any protection system existed in the UK. Throughout the 19th century, in Great Britain, philanthropists tried to provide free medical care for the poor. Some people, like William Marsden, a young surgeon, opened dispensaries for advice and medicines. Any poor and sick person could go and be provided with care free of charge. Charitable and voluntary hospitals as well as municipal hospitals also existed, but they mainly tended to look after people suffering from serious diseases like smallpox, tuberculosis or mental handicap. In fact, social protection has long been based on familial solidarity and private initiatives. Nevertheless in 1911, David Lloyd George, the Chancellor of the Exchequer, introduced the National Insurance Act which dealt with old age pensions, unemployment benefit and state financial support for the sick and infirm.
[...] The government also forced hospitals to operate big cuts to services and to centralise care in regional centres. Hundreds of jobs losses resulted from this and the quality of care is under permanent critics survey even revealed nursing shortage are linked to an increase by 26% in patient death rates!). Since 1997, NHS spending in the UK has doubled to £94bn in 2006. Consultants and GPs have had salary increases worth up to 50 per cent over three years, making them the highest-paid doctors in the world outside the US. [...]
[...] In fact, the crucial question was of how the NHS should best be organised (local government reorganisation, better co-ordination of health and social services, more fairly distribution of resources). Its management was too complex and managerially driven. As a consequence, a number of concessions were admitted by Bevan and the principle of universality and gratuity wished both by Beveridge and Bevan had to be given up. B. The turning point of the 1980s: the NHS in crisis In the 1980s, it became obvious that the NHS simply could no longer do everything that had become medically possible. [...]
[...] Beveridge wanted a system based on the principles of universalism and uniformity which would make every British citizen able to benefit from health protection: The NHS made it compulsory for every British citizen of working age to have insurance (except women who were protected by their husband's insurance and independent workers who earned less than £104 per year). The NHS concerns the entire population It brings free hospital services, family practitioner services (doctors, dentists, opticians, pharmacists . A major innovation was the community health centres - a special premise with accommodation and equipment to enable family doctors, dentists and others to work together. [...]
[...] The white paper described this approach as new model for a new century", based on a number of principles such as the following: A consistently high quality, prompt and accessible service right across the country; To get the NHS to work in partnership and forging stronger links with local authorities; To drive efficiency through a more rigorous approach to performance, cutting bureaucracy to maximise every pound spent in the NHS for the care of patients; To rebuild public confidence in the NHS as a public service. [...]
[...] However, soon after its birth in 1948, tensions emerged within the system and ever since, they have challenged the successive Governments. If the 1950s seemed to be the Golden Age of the NHS, the following decades have seen a long decline towards financial crisis. The first deep reforms were taken in the late 1980s and at the beginning of the 1990s. The implementation of market principles turned out to be necessary but the state-regulation remains high. However, nowadays, the NHS is still coping with many difficulties, in spite of the recent reforms that [...]
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