The NHS in the 21st century
This extract from an NHS plan states that the NHS is one of the world’s biggest employers. It is hardly surprising that it costs a lot of money to run.
The NHS is the biggest employer in Europe and the world’s largest employer of highly skilled professionals. 1.3 million people across the health service in England are devoting their working lives to caring for others.
Increasing pressure on services
Over the past 30 years or so, various initiatives have been introduced to give patients access to medical advice 24 hours a day. The aim has been to reduce costs and make the NHS more efficient. An example is the creation of NHS Direct in 1996.
Some of the more recent changes to the organisation of the NHS have included:
- In 2002, primary care trusts were created to organise health care at a local level.
- In 2004, foundation trusts were set up to allow NHS staff, and the general public, to have more freedom over how money was spent and which services were used.
- The 2012 Health and Social Care Act brought further reorganisation. Clinical commissioning groups were created to buy in services for patients from a particular area. This could come from the NHS in other areas or non-NHS companies.
- In 2013, NHS England and Public Health England were split into two separate organisations so that one could concentrate on patient care (NHS England) while the other focused on preventing illness (Public Health England). Both are still under the control of the Secretary of State for Health in the government.
- The 2019 NHS Long Term Plan aimed to bring together hospital and community medical care. The goal is to create integrated care providers so as to more effectively organise medical treatment.
- From April 2020, the NHS worked with the armed forces to create regional ‘Nightingale’ temporary hospitals to deal with the increase in demand for hospital beds during the Covid-19 health care crisis.
- In 2022, the Health and Care Act replaced Clinical Commissioning Groups with Integrated Care Systems, to improve coordination between health and social care services.
Despite these reforms, the NHS continues to face significant pressures. An ageing population, advances in medical technology and increased patient expectations have all led to greater demand. In recent years, there have also been ongoing staffing shortages in some areas, particularly among nurses and GPs.
The cost of health services
Government spending on health services has increased significantly since 1948. Today, the UK government spends over £190 billion per year on healthcare. Health spending represents a substantial proportion of total government expenditure. Although the NHS is funded mainly through taxation and remains free at the point of use for most services, charges still apply for some treatments, such as prescriptions in England and certain dental and optical services.
Waiting lists for some treatments have increased in recent years, particularly following the Covid-19 pandemic. This has contributed to the debate about how the NHS should be funded and organised in the future.
