The NHS - its organisation and structure. NHS History Organisation Finance Staff.

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

er

(th

ou

sa

nd

s)

em

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