Health Policy, NHS

A2 G&P UK Political Issues - The Welfare State - NHS basics

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  • Health Policy, NHS
    • History of Health Policy
      • -1948- Labour Government sets up NHS Despite opposition from Doctors. Clear Demonstration of the universal principles of the NHS & Welfare State.
      • 1949 - Prescription Charges
      • 1974 - Reorganisation of the NHS
      • 1990 -  NHS and Community Care Act - another restructure, The Major Government launches the internal market
      • 1997 - White Paper - 'The New NHS - Modern, Dependable'
      • 2004 - Payment by results for NHS foundation trusts
      • 2010 - Health and Social Care Bill
    • The Conservatives 1979 - 1997
      • Philosophy
        • - a desire to attack the so called 'dependency culture'
        • a belief that the free market was best in supplying services
        • a belief that competition breeds efficiency
        • a desire to make cuts in public expenditure
        • a wish to increase patient choice
      • Reform
        • tried large - scale reogranisation in 1974, into regions, areas and districts
          • Mrs Thatcher removed 1 whole layer of health serve management and created a separate Department of Health
            • placed emphasis on management and appointed General Managers
              • Griffiths Report 1983
        • Regular increases in the cost of prescriptions and charges for eye tests and dental checks
        • Ancillary services, hospital cleaning and catering put out to tender
          • Compulsory Competitive Tendering scrapped by Labour in 1997
        • Tory government won 1983 general election. NHS 'safe in our hands' didn't move away from principles of a universal free service
        • Thatcher government wanted to promote private healthcare as an alternative but would have been politically unpopular
          • Quasi - market within the NHS
      • NHS and Community Care Act - 1990
        • set up an internal market between purchasers and providers
          • Purchasers; fund holding GPs, health authorities
          • Providers; NHS Trusts, non fund holding GPs who stayed out of the system
          • Power decentralised from Whitehall, self-governing hospital trusts and fund holding GPs
        • NHS trusts run by trustees drawn from local community
          • care of elderly, long term, less seriously mentally ill taken from NHS, transferred to local authorities
        • Labour, BMA criticised changes, 'two-tier' health service
          • Labour retained many reforms, got rid of GP fund holder scheme
    • Aneurin Bevan, 1948, NHS Founder
    • New Labour 1997-2010
      • Principles
        • Healthcare should be free at the point of use and according to need
        • NHS funded through general taxation (Wanless Report 2007)
        • Increase in resources, Blair doubled spending since 1997 (2010 £100Billion P.A)
        • Labour accepted marketisation an continued the policy introduced 'payment by results' continued PFI
      • Tony Blair warned voters on the eve of the General Election that they had 'only 24 hours to save the NHS'
      • apply for foundation status
      • White Paper (97) The New NHS Modern, Dependable
        • 10 year programme of modernisation
      • Abolished purchaser and provider competition but principle of dividing them up was kept
      • 2000 Health Act
        • Screening, Walk in Centres, health scheme and new IT Scheme
      • 2002
        • Department of Health
          • 28 regional Health Authorities and 315 PCTs
            • then became 11 and 152 respectively
      • Private Treatment paid for by the NHS if treatment cannot be found in public sector, treatment abroad paid for by the NHS
      • Targets introduced, improve efficiency, performance tables introduced
      • Payment by results 2004 - charge fixed price for an operation, claim back according to number of patients treated
    • The Coalition 2010 -
      • Competition - staff won't work together in the interests of patients
        • NHS confederation argued reforms lead to closure of hospitals to make way for new providers
      • 2012 - Budget was set at £104 Billion or £3000 per second
        • GPs will have more responsibility for spending the NHS budget in England
      • Plan to free hospitals has led to claims that this has effectively privatised/ing the NHS
        • Unions and pressure groups, private health firms leads to 'cherry picking' easy cases, leaving complex cases to the NHS
      • Objections
        • The speed of reforms has been criticised
        • GPs will have too much power
          • Services may be cut
        • Unison have claimed that 50,000 jobs may be lost
        • cost of the programme is estimated at £1.4billion (£1bn redundancies)
      • Restructuring allows more money to be used to tackle death rates. Clinicians able to design services in best interests of patients UK can catch up with other countries
        • Free NHS from political interference. Reform give the NHS a more stable financial footing
      • Monitor promote competition, set prices for hospital admissions
        • Care Quality Commission will be responsible for health standards
      • Hospitals will be set free from central control
        • Expertise of those in PCTs will be lost
        • Public Health responsibility of local authorities
      • Healthcheck collate info and feedback on services from patients
      • The NHS Commissioning Board will oversee services

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