Transcript The NHS - its organisation and structure NHS • • • • History Organisation Finance Staff NHS - History 1802 - Act introduced to limit the employment of children to under.

The NHS - its organisation and
structure
NHS
•
•
•
•
History
Organisation
Finance
Staff
NHS - History
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
1875 - 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 Health
1807 - 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
NHS structure post 1996
Secretary of State
Department of Health
NHS Mgt executive
Regional Offices
Health Authorities
GP fundholders
PURCHASERS
NHS Trusts
GPs
PROVIDERS
NHS Organisation
The New NHS
Secretary of State
Type title here
DoH
NHSE
Regional Offices
Local
Authorities
Health Authorities
Primary Care Groups
NHS Trusts
Health
Improvement
Programme
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 Govt
Defence
Scot/Wales/NI
LA-self
Education
Social Security
Other
NHS Finance
Growth in NHS funding 1994-99
40
35
£ - Billions
30
25
20
15
10
5
0
1994
1995
1996
1997
Year
1998
1999
NHS Finance
Pie Chart of division of NHS resources
Hospital & Community
Health Services
Family Health Services
Central Health (misc)
Admin
Capital
NHS Finance
Age cost curve
£ per head of population
3000
2500
2000
1500
1000
500
0
Births
0-4
5 to 15
16-44
Age Bands
45-64
75-84
85+
NHS Staff
NHS staff: changes seen since 1987
Number (thousands) employed wte
900
800
700
Total staff
600
Medical/dental
500
Nursing
400
Management/support
300
200
100
0
1987
1992
1993
1994
Year
1995
1996
1997
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 Staff
NHS directly employed staff, 1997
Female
Male
NHS Staff
Whole Time
Equivalents
Psychologists in the N.H.S. (England)
3000
2500
2000
1500
1000
500
0
9 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93
5
19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19
Year