One of the biggest public health organizations in the world, set up in 1948 to provide free health care for everybody in Britain. The hopes of its founders, that it would so improve public health that its cost could easily be contained, have proved Britain vain. Better and more expensive treatments have sent costs soaring, though it has succeeded in its basic aims. The Labout government elected in 1997 announced that it would cut waiting lists, reduce the running costs of the service, and by 1999 would end the internal martket introduced by the previous government.

History and Structure

When the National Health Service (NHS) began there were a number of counties without even one consulting physician, surgeon or obstetrician, and many other specialities were also lacking. Now all parts of the country have good medical facilities. In spite of the existence of the NHS, some poeple prefer to pay into private schemes such as BUPA, to avoid longer waiting lists for treatment.

The National Health Service Act (1946) was largely the work of Aneurin Bevan, Labour minister of health. It instituted a heakth service from July 1948 that sought to provide free medical, dental and optical treatment. Successive governments, both Labour and Conservative, introduced charges for some services. The NHS offers free hosptial care, but limited fees are made for ordinary doctors' prescriptions, eye tests and spectacles and dental treatment, except for children and people on low incomes.

A White Paper introduced by the Conservative government in 1989 proposed legislation for decetralizing the control of hospitals and changes in general practive giving greater responsibilites to doctors to manage their general practice. Foloowing the NHS and Community Care Act (1990), health authorities and some general practititioners were in receipt of funding to purchase health care for their patients from health care providers. Hospitals became self-governing NHS Trusts, financing their work from income from contracts to provide services to the health authorities and GPs.

In 1998 the NHS was administered by 100 health authorities in England, five in Wales, 15 health boards in Scotland and four health and social services boards in Northern Ireland. The devolution of central government power to the Northern Ireland Assembly. Welsh Assembly and Scottish Parliament will have an impact on the organization of health care in these areas.

Vital Statistics

The NHS employs roughly 1 million people, including part-timers. In 1996-97 it spent £34,900 million. It offers free health care to the population at a cost of 5.8% of the GDP (gross domestic product), compared with an average cost among developed countries of 7.6% of GDP. However, the number of available hospital beds in public hospitals decreased by 25% between 1971 and 1987, while the number of private hospital beds increased by 157%. On average 317,000 beda are occupied in NHS hospitals. The number of frontline NHS staff (nurses and midwives) on hospital wards fell by 13%, to 349,800 between 1985 and 1995, while the number of managerial and administrative staff increased from 110,900 to 161,000 in England and from 14,315 to 19,778 in Scotland.