Health service

The National Health Service- the health of the community is the responsibility of the NHS, free to everyone who normally lives in Britain.The NHS is a central element of the welfare state, present on virtually every high street in the form of local pharmacists and in every community and neighbourhood in the form of General Practitioners (GPs) and dental services. On a typical day in England, nearly three quarters of a million people will visit their doctor and one and a half million prescription items will be dispensed by pharmacies. Ambulances will make 8,000 emergency journeys, 2,000 babies will be delivered, 90,000 people will visit a hospital outpatient clinic and more than half a million households will receive help in the home.The NHS which provides all these services has a yearly budget of more than ₤41 billion. With one million staff, it is one of the largest employers in the world.The principles on which it was founded at its creation in 1948 remain true today: that there should be a free, comprehensive health service for everyone according to need, regardless of their income. The aims of the NHS are clear. They are to improve the health of the nation as a whole by: promoting health,preventing ill health,diagnosing and treating injury and disease and caring for those with long-term illness and disability.To achieve these aims, the NHS provides a comprehensive range of care, nearly all of which is free:primary carethrough family doctors, dentists and other health care professionals,secondary carethrough hospitals and ambulance services,tertiary carethrough specialist hospitals treating particular types of illness or disease.The NHS also collaborates with social services to provide community care. Primary care-The vast majority of people are seen by primary care services in the community. They remain the first point of contact most people have with the NHS: between them they cater for about 90 per cent of patient contact with the health service, at half the cost of hospital care. The Government's long-standing policy is to build up and extend these services to relieve the more costly secondary care services of hospital and specialist services. Primary care is provided by family doctors, dentists, opticians and pharmacists, who work within the NHS as independent practitioners. Other professionals involved in primary care include district nurses, health visitors, midwives, speech therapists, physiotherapists, chiropodists, dieticians and counsellors.GPsor family doctors are present in every community and they remain the backbone of the health service. They provide essential primary care and act as gatekeepers to other services, referring patients on when necessary. Every year there are some 250 million GP consultations and some six million people visit a pharmacy every day.Visits to doctors or dentists may be for treatment or for preventative advice. Preventing ill-health is an important part of a GP's work, and most GPs run programmes to prevent heart disease and stroke, to manage chronic diseases such as asthma and diabetes and to improve childhood immunisation rates.About 80 per cent of GPs work in partnerships or group practices - often as members of primary health care teams. Primary health care teams also include health visitors, district nurses and midwives who are salaried NHS staff, and sometimes social workers and other professionals employed by the health authorities. GPs often work in health centres which offer people a range of health services in one place. Other key primary care professionals include:midwives who care for women throughout pregnancy, birth and for 28 days after the baby is born. Some are based in hospital and some go out into the community.health visitorswho promote health for families and are responsible for preventative action. They aim to identify the health needs of the local population and work closely with other NHS colleagues. district nurseswho care for people in their homes or elsewhere outside the hospital setting. Like health visitors, they offer advice in health promotion and education.Secondary care-While Primary Care Groups may be the first point of call, secondary care, managed by NHS Trusts, deal with any further treatment or care someone may need. This can range from health advice to some of the most sophisticated treatment in the world. There are around 300 district general hospitals in England, found in many large towns and cities. They provide a range of services from the care of the elderly to maternity services, supported by services such as anaesthetics, athology and radiology. Almost all district hospitals have accident and emergency departments for emergency admissions.Patients either attend as day cases, in-patients for a longer stay or out-patients. There are also patients who attend wards for treatments such as dialysis. The advent of new treatments has meant the trend has been towards more patients treated as day care and fewer long-stay wards. Tertiary care- Some hospitals provide specialist services such as heart and liver transplants, treatments for rare cancers and craniofacial services. These specialist services cover patients over more than one district or region. There are also specialist hospitals of international renown such as the Hospital for Sick Children at Great Ormond Street, Moorfields Eye Hospital and the National Hospital for Neurology and Neurosurgery. As well as offering highly specialised treatments, these hospitals are also centres for teaching and international research. Community Care-Social services have the lead responsibility for community care services to meet the needs of older people, people with disabilities, mentally ill people or other vulnerable members of society. The NHS, however, has an important role in providing some services and in collaborating closely with social services to plan and deliver community care. Here the role of the NHS includes helping to assess people's needs for community care, liaising with social services over hospital discharges to make sure people get the continuing care they need, as well as delivering some services. The NHS makes an important contribution to community care services, for example, district nurses provide nearly 2.5 million episodes of care annually. How is the NHS organised? Central Government is directly in charge of the NHS, led by the Secretary of State for Health and a team of ministers at the Department of Health. The Department is responsible for planning a health strategy in England.Within that department, management of the service is led by the NHS Management Executive. The NHS Management Executive is responsible for developing policies which ensure the quality of health services. The Executive has eight regional offices, which liaise with the health authorities in their region.Services are administered by a range of health authoritiesand health boardsthroughout Britain. There are 100 health authorities in England and five in Wales, 15 health boards in Scotland and four health and social services boards in Northern Ireland. They are all responsible for identifying the health care needs of the people living in their area. They also arrange for services from doctors, dentists, pharmacists and opticians and administers their contracts.Community health councils(local health councils in Scotland) represent the opinion of local people on the health services provided and on any planned changes.Health authorities and boards cooperate closely with the local authoritiesin charge of social work, environmental health, education and other services. Recent reforms-The new Health Act 1999 encourages partnership within the NHS and between the health service and local authorities to improve health care, and has created two bodies to drive quality in the NHS. Its main aspects are: the creation of Primary Care Groups and Trusts, teams of GPs, community nurses and social services staff, to take control of most of the NHS budget from April 1999. The new teams put local doctors and nurses in the driving seat in shaping local health care; new powers to break down barriers between health and social services and between the NHS and local authorities, to encourage partnership working and deliver health improvements; the introduction of new legal duties of quality of care and of partnership to drive up standards of care; two new national bodies, the National Institute for Clinical Excellence and the Commission for Health Improvement, to encourage best practice, spread good-value new treatments across the NHS and sort out problems - all to improve quality; Health Action Zones, formed in some of the most deprived areas of the country and covering some 13 million people, which will tackle health problems of local people; NHS Direct - a 24-hour telephone hotline staffed by nurses to help reduce pressure on hospitals and GPs by giving on-the-stop health advice.Private medicine-About 11 per cent of the population in Britain is covered by private medical insurance and it is estimated that about three quarters of people receiving treatment in private hospitals or NHS pay beds are funded by health insurance schemes.NHS patients are occasionally treated in the private sector (at public expense) in cases where doctors and managers consider it will be good value for money. The scale of private medicine compared to the NHS, however, is small.Many overseas patients come to be treated in British private hospitals: Harley Street in London is world famous as a centre for medical consultants.

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