NHS

   The NHS (National Health Service) was among the greatest reforms made by Clement Attlee’s Labour government following the Second World War. The Beveridge Report (Sir William Bever-idge’s 1942 Report on Social Insurance and Allied Services) recommended the introduction of universal comprehensive lifelong cover, replacing the various provisions for public health dating from Victorian times and for personal health insurance and social security introduced by the Liberal government early in the twentieth century, as well as many voluntary and self-help schemes. Labour prioritized these health policy proposals. Under health minister Aneurin Bevan, the National Health Services Act of 1946 took effect in 1948. All UK residents became entitled to medical, dental, optical and related services, and also to medicines, dentures, spectacles and so on, as needed without charge or reference to a contributions record (unlike various social security benefits). Integrating general practitioners (GPs) into the new system caused difficulties, and although most came into the NHS from the start, they retain some contractual independence. Administratively, the NHS is divided into regions, under the Ministry of Health in England and elsewhere under the Secretaries of State for Scotland, Wales and Northern Ireland. The public, apparently not identifying with its health region despite indirect local representation, focuses on its GPs and the nearest hospitals, or on the NHS centrally. A vast organization, the NHS employs one million workers of every category. There are 32,000 GPs, 19,000 dentists and 300 district hospitals. Funding, which Beveridge underestimated, has escalated. Charges for prescriptions were introduced in 1951 by Gaitskell, but 80 percent of patients are exempt, including the young, pregnant women, the unemployed, the chronically sick and pensioners. Attempts to reduce costs—by allocating to GPs certain funds to manage, creating an ‘internal market’ to promote efficiency through competition between providers of medical services and making hospitals self-governing trusts— were not marked successes. The Patient’s Charter (1992) brought scant benefits. Waiting lists for nonemergency hospital treatment remain lengthy.

   Bevan, foresee-ing ever-increasing demands for health services, if not the soaring costs of high-tech medicine, predicted that the NHS would always need more cash, but pioneers like him failed to emphasize that although the NHS would provide treatment free at point of use, taxpayers would have to pay up in the end. Costing £1,700 per household a year (17 percent of government expenditure or 5 percent of GDP), the NHS claims huge resources, but is not expensive by international standards, and its contribution to the nation’s health and the relief of suffering is inestimable.

   See also: health policies and the NHS

   Further reading

    Ranade, W. (1994) A Future for the NHS, London: Longmans.

   CHRISTOPHER SMITH