In the aftermath of World War II, countries across Europe implemented various social programs to promote a sense of community and prevent another war from occurring. The most important of these programs was the National Health Service (NHS), Britain’s publically funded healthcare system, which was established in 1948. The NHS’s mission statement was to provide ‘universal, comprehensive, and free healthcare, with ultimate responsibility residing in the minister appointed from the governing party’. (Gorsky) However, while the NHS was founded with the intention of helping the British people, it has faced various challenges since its inception. These problems include underfunding, disputes between the Labour and Conservative governments over healthcare policy, and recently, decreased accessibility. This paper will provide an overview of the NHS’s history, focusing on the political and social influences leading to its creation. Next, I will analyze the current climate of healthcare policy in Britain, explaining how the NHS works, the problems with the NHS, its politicization, and how Brexit will affect the NHS. Finally, I will compare and contrast the British NHS with the NHS in Scotland, Wales, and Northern Ireland, as well as the healthcare systems in France and Germany.
History
Post World War II, the British government sought to provide universal, accessible healthcare to all British citizens. The NHS was initially proposed to Parliament in the Beveridge Report, a government report that suggested various reforms to the United Kingdom’s welfare state, one of them being a nationwide healthcare service. The Beveridge Report argued that these widespread reforms would alleviate the ‘five giant evils’ in society: squalor, ignorance, want, idleness, and disease. (Wood) Although the Beveridge Report was published in 1942, implementation of the NHS was stalled due to arguments within the Coalition government of the time. Thus, the NHS did not become operational until 1948 due to the efforts of Aneurin Bevan, the British Minister of Health from 1945 to 1951.
A variety of political influences led to the creation of the NHS. First, there was bipartisan agreement that the existing health services were insufficient. The atrocities of World War II opened the eyes of British citizens and politicians that they need to establish a better emergency medical system. Immediately after the war, there was political agreement amongst the major parties regarding what the nation’s priorities should be. But further, Labour held such a huge majority in parliament that political dissent wouldn’t have done much.
Current climate/problems
The NHS is the largest single-payer healthcare system in the world. The NHS is funded through taxation, and in turn provides healthcare to all legal English residents.
The NHS is made up of organizations such as Clinical Commissioning Groups and Health and Wellbeing Boards. These organizations have varying responsibilities within the NHS. The NHS devolves some of its authority to Clinical Commissioning Groups (CCGs). CCGs are statutory NHS bodies that are in charge of planning health services for their respective local areas. These CCGs can be nurses, general practitioners, or consultants. CCGs are responsible for 60% of the NHS’s budget and are in charge of secondary care services. These include rehabilitative care, urgent and emergency care, community health services, and mental health services. (NHS website) The NHS is also made up of ‘Health and Wellbeing Boards’, groups of people who act as a forum for local commissioners across the NHS. Their duties include “increasing democratic input into strategic decisions about health and wellbeing services, strengthening working relationships between health and social care, and encouraging integrated commissioning of health and social care services”. (NHS website) Health and Wellbeing Boards are important because it allows for people to give input to the NHS. Participation in the process by normal people makes the NHS more fair and receptive to changes.
Historical opposition:
Historically, the National Health Service has faced massive opposition and is highly politicized. The NHS was founded under the Labour party and even today, many political scientists and historians attribute the problems of the NHS to the under-funding and reforms made by subsequent Conservative governments. Scandals involving the NHS arose under Prime Minister Margaret Thatcher’s conservative government in the 1980s. Thatcher created a plan to dismantle the British welfare state which included proposals for compulsory private health insurance and private medical facilities, which would dismantle the National Health Service. (guardian) This was extremely problematic because Thatcher was publically in favor of the NHS. Thatcher’s government was criticized for implementing a number of reforms that decreased the size of the welfare state and privatized various industries. One of these reforms was the establishment of the internal market, created by Thatcher’s health secretary, Ken Clarke. The internal market separated the parts of the NHS that pay for services from those that provide them. Under the internal market reforms, certain general practitioners became ‘fund holders’ and were able to purchase care for their patients. This purchaser-provider split aimed to improve efficiency of healthcare through ‘managed competition’. However, it did not have this effect. Opponents of the internal market argued that the reforms led to a decrease in the quality of medical care. In his article “The British National Health Service 1948-2008: A Review of the Historiography”, Martin Gorsky describes the ‘Thatcherization’ of the NHS between 1979 and 1997. He notes that during this period, real expenditure grew at the lowest rate in the past fifty years, there was a strengthening of the power of bureaucrats over clinicians, and private sector involvement was encouraged through the promotion of private insurance. (Gorsky!) Gorsky does not criticize the Thatcher government for these reforms, but rather believes that they were intended to preserve the NHS within the welfare state even though the government wanted to decrease overall government spending. Nonetheless, he concludes that these reforms were inherently destructive and garnered mass amounts of criticism.
The Thatcher Government’s efforts to privatize healthcare received criticisms from both Labour and Conservatives because the NHS held wide support among Conservatives. Therefore, Labour started to campaign off of the notion that the Conservatives wanted to privatize the NHS. This worked for labor, and in 1997, Tony Blair of the Labour party became the Prime Minister. This was significant for healthcare policy. Initially, Blair criticized the former government’s cuts to healthcare spending. Blair went on national television and pledges he would raise NHS spending to meet the European average. Gorsky asserts that Blair’s government oversaw a softening of the internal market, and replaced purchasing with commissioning. (Gorsky) However, eventually Blair’s actions did not reflect his promises to the people. Rising technology costs and demands to cut government spending resulted in Blair attempting to privatize the NHS, similar to his predecessor. Both the Conservative and Labour parties have failed in carrying out their promises to the people regarding Britain’s healthcare service.