The NHS - its organisation and structure

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The NHS - its organisation and structure
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NHS

• History
• Organisation
• Finance
• Staff

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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

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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

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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

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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

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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

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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

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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 -

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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

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NHS Organisation

• Constant change
• 5 phases
• 1948 - 74 Administrative
• 1974 - 82 Planning
• 1982 - 90 Managed
• 1990 - 97 Market
• 1997 - The New NHS!!

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NHS Organisation

• 1) Administrative phase
• Persistence of inequalities - social,
  geographical, by patient category

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NHS Organisation

• 2) Planning phase
• Themes of effectiveness, efficiency and equity
  appeared
• Managed by consensus
• RAWP
• BUT
• bureaucratic unresponsive

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NHS Organisation

• 3) Management phase
• Griffiths report - need for good general mgt
  financial accountability of clinicians
• Stronger lines of accountability

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NHS Organisation

• 4) Market Phase
• Thatchers belief in free markets ?efficiency
• Purchaser - Provider split
• Fundholding
• BUT
• no market-place
• decreased choice
• increased bureaucracy
• decreased equity

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NHS Organisation
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NHS Organisation
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NHS Organisation

• Current ideas
• Partnership working - joined up thinking
• Inequalities Our Healthier Nation
• Devolving decision making to GPs - closer to the
  patient

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NHS Finance
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NHS Finance
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NHS Finance
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NHS Finance
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NHS Staff
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NHS Staff
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NHS Staff
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NHS Staff