History of the Health Care System in the UK
History of the Health Care System in the UK
The United Kingdom of Great Britain and Northern Ireland (UK) is comprised of four constituent countries: England, Wales, Scotland, and Northern Ireland. The first half of the 20th Century saw the UK decline as a world power after the independence of many colonies and two world wars. In the second half of the 20th Century, the UK reemerged as a modern and prosperous European nation, though far short of its former stature on the world stage.
Hospital-based outpatient departments delivered specialty medical care with primary care administered by community-based general practitioners (GPs). Hospitals were organized by altruistic individuals who banded together to raise the necessary capital or individually endow a facility. Health care services by the hospitals were provided free of charge, but financial constraints led them to request “voluntary” payment from those who could afford it.
Emergence of the Modern Healthcare System
The Ministry of Health was established in 1919, combining the medical and public health functions of central government. Later renamed the Department of Health (DH), the DH is headed by the Secretary of State for Health who is appointed by the Prime Minister from members of Parliament. The department is responsible for strategic planning, resource allocation, risk management and quality assurance, and policy development for the National Health System (NHS) and social care. The DH has seven key strategic objectives:
- Improve and protect the health of the people of Great Britain
- Enhance the quality and safety of services
- Deliver a better experience for patients and users
- Improve the capacity, capability, and efficiency of the system
- Ensure system reforms, service modernization, IT investment, and new staff contracts
- Improve the service provided as a Department of State
- Become more capable and efficient in the department
The National Health Insurance Act provided payment for health care for workers, funded by a combination of taxes and employee and employer contributions.
The National Program for Information Technology (NPfIT), now known as “Connecting for Health,” was established in 2002. The program is responsible for procurement, development, and implementation of a nationwide health information network. The initiatives for Connecting for Health include:
- Creation of an NHS Care Record Service to improve sharing of patient information across NHS
- Making it easier for patients and GPs to book hospital appointments
- Developing an electronic prescription service
- Maintaining an up-to-date IT infrastructure
The NHS Care Record Service consolidates an individual’s healthcare records and enables GPs to view a patient’s medical and prescription history. In 2004, Choose and Book was implemented to allow the GP to make an appointment electronically with a hospital consultant directly from the surgery rather than through a hospital appointment desk.
Description of the Health Care System
There are 360 district general and teaching hospitals and 390 local community hospitals in the UK. Full-time specialists staff district general hospitals, whereas teaching hospitals are associated with medical schools and provide training for medical students and postgraduate education for physicians. Local community hospitals are generally located in rural areas and staffed by GPs, with specialty services provided by specialists from district general and teaching hospitals. In addition to the hospitals previously mentioned, there are approximately 190 private hospitals for private insurance patients.
Doctors are employed by NHS trusts under a national consultant contract last negotiated in 2003. The contract requires a full-time consultant to work a set schedule of 10 programmed activities. A programmed activity is a four-hour block during which the consultant provides patient services. If the consultant will be away, appropriate arrangements must be made to ensure the schedule is covered. The contract allows the consultant to have a private practice as long as it doesn’t interfere with NHS duties.
Lovett-Scott, M., & Prather, F. (2014). Global health systems: Comparing strategies for delivering health services. Burlington, MA: Jones & Bartlett Learning.