The Health Care System in the UK

Résumé du document

The first national strike in the NHS for nearly 20 years took place in London in September last year. This seems to be of bad omen for the British Health Care system. Before we go further into the subject, let us remember how health care used to be before any protection system existed in the UK. Throughout the 19th century, in Great Britain, philanthropists tried to provide free medical care for the poor. Some people, like William Marsden, a young surgeon, opened dispensaries for advice and medicines. Any poor and sick person could go and be provided with care free of charge. Charitable and voluntary hospitals as well as municipal hospitals also existed, but they mainly tended to look after people suffering from serious diseases like smallpox, tuberculosis or mental handicap. In fact, social protection has long been based on familial solidarity and private initiatives. Nevertheless in 1911, David Lloyd George, the Chancellor of the Exchequer, introduced the National Insurance Act which dealt with old age pensions, unemployment benefit and state financial support for the sick and infirm.

Extraits

[...] The NHS: birth and crisis A. The creation of the NHS: the “Beveridgian” legacy of universalism and uniformity broken? a. Birth of the NHS on 5th July 1948: a hierarchical (state regulated) model. In the aftermath of the Second World War, Clement Attlee's Labour government created the NHS, based on the proposals of the Beveridge Report, prepared in 1942. Beveridge wanted a system based on the principles of universalism and uniformity which would make every British citizen able to benefit from health protection: The NHS made it compulsory for every British citizen of working age to have insurance (except women who were protected by their husband's insurance and independent workers who earned less than £104 per year). [...]

[...] Consultants and GPs have had salary increases worth up to 50 per cent over three years, making them the highest-paid doctors in the world outside the US. Nurses have had smaller but still substantial rises. Lastly, plenty of extra staff has joined the NHS since 1997 ( nurses and 2400 family doctors only between 2003 and 2005). The NHS is facing huge problems today. In spite of all the measures taken, the crisis is still affecting the NHS today: NHS productivity has not risen in line with the resources. [...]

[...] The necessity to reform the NHS leads to a new system A. Reforms were taken so as to redress the situation of the NHS: the (1990s) a. The introduction of the internal market and the NHS Trusts The NHS experienced the most significant cultural shift with the introduction of the so-called internal market, outlined in the 1989 White Paper, Working for Patients, and which passed into law under John Major (the NHS and Community Care Act 1990). The reform follows two main lines: the internal market was the Conservative Government's attempt to address problems. [...]

[...] The universal and free system, imagined by Bevan, had to be reconsidered and restricted as soon as it was created: free care couldn't be achieved because of the numerous people who took advantage of the system, especially in regard of medicines consumption. Financial problems appeared very quickly. It was impossible to predict the day-to-day costs of the new service and public expectations rose: more mothers were wanting their babies delivered in hospital, cardiac surgery was being applied to rheumatic heart disease etc. [...]

[...] This internal market has enabled the British government to control their expense, since the patient is tightly guided in his possibility to go to a doctor's (except in case of emergency of course, the patient is obliged to go and see a GP, and then the latter decides if the patient really needs to consult a specialist. If so, the patient has to go to the hospital, where all the specialists work). As a result, this system avoids many misuses. However, not all GPs joined this scheme of the NHS trusts. [...]