1. Health Care in the UK
The NHS

2. In this unit you will learn:
How and why the NHS was created
What the original aims of the NHS were
Individualist and collectivist views of health care
New Labour’s “Third way”
Improvements in health
New health problems
The growth of private health care
The advantages and disadvantages of private health care

3. The Five Giants Disease Ignorance Squalor Idleness Want
The NHS was set up in 1948 as a result of the Beveridge report.
Beveridge had identified five problems:
Disease
Ignorance
Squalor
Idleness
Want

4. The NHS 1948
Nye Bevan was the Minister of Health who oversaw the creation of the NHS.
“Administration will be the chief headache for years to come” Aneurin (Nye) Bevan
The main political parties all agreed on the basic principles of the NHS: a comprehensive service, caring for all and free at the point of use.

5. Why was the NHS created?-Qs
1) Describe the five giant evils identified by Beveridge. Page 65
2) What did the government do to address each of the “five Giants”? Page 65
3) Make notes on the aims/features of the NHS Page66
4) Describe health conditions for the poor before the introduction of the NHS. Page 66
5) Why has expenditure continued to rise in the NHS?
6) What issues have affected the income of the NHS?

6. Individualist Vs Collectivist!
Ideology -socialism
Strong link between poverty & ill health.
Poverty related ill health is wider than scope of NHS - housing & benefits
Government has a responsibility to narrow inequalities of society
Lifestyle choices linked to poverty - stress of unemployment & lack of knowledge
Ideology - part of Thatcherism
Responsible for own health
Lifestyles- smoking drinking
poor diet, little exercise
Individuals are aware of the health risks of these
Individuals should be allowed to opt out of paying for NHS & allowed to put this money towards Private Medical Insurance (PMI)

7. The Third Way
Labour governments since 1997 have drawn on both individualist & collectivist ideas to come up with the Third Way idea.
The need to address the issue of poverty: -improving housing improving education get unemployed back to work
The need for individuals to take responsibility: -promotion of healthier diet -promote taking exercise -discourage bad habits - drinking, -prevention better than cure

8. Responsibility for health Qs
1) What evidence is there that individuals are being asked to pay more for their health care? P14-15
2) “The UK Government spent less money on health in 1997 than most comparable countries.” What evidence is there in the table on p12 to support this view?
3) What evidence is there that the NHS manages a huge amount of resources? P16-17
4) What evidence is there that the NHS provides jobs outside of health care? P18
5) To what extent did the Conservative Governments increase spending on the NHS?P19-20

9. Health Improvements
Life expectancy has increased:
Men 66 years years Women 71 years years
Why?
Setting up of NHS
Better nutrition (rationing into 1950s)
Better Housing
Improvements in medical care
Reduced infant mortality
Preventative treatment of disease
In the future life expectancy might reach 100 years!

10. Vaccinations
TB - Tuberculosis - major killer made worse by overcrowding. Now drug resistant strain of TB becoming a problem.
Whooping Cough
Diphtheria
Tetanus
MMR controversy
HPV - cancer

11. Improved drugs & surgery
Better detection & treatments of cancers
Transplant operations
Heart by-passes
More drugs
Use of technology

12. Better Lifestyles? Less people smoking
Greater awareness of health issues
Preventative programmes
But: will same be true in 50 years time? Elderly today had a healthier diet & more exercise than children growing up today have.
Problems:
Junk food, additives & processed meals
TV & PC
Cars
Mobiles???
Less exposure to germs!

13. New Health Problems Can you think of any others? HIV & AIDS MS & ME
Meningitis
E-Coli
BSE and variant CJD (mad cow disease)
Increase in allergies & asthma
High death rates from cancer & heart disease
Lack of exercise
Poor diet
More elderly people
Can you think of any others?
Type 2 diabetes linked to some of the above

14. Challenges for the NHS Qs
1) Describe the main reasons why life expectancy in the UK has improved? P21-22
2) Why did the creators of the NHS believe that demands placed on the NHS would decline, rather than increase?P22-23
3) Describe the new demands now made on the NHS?P23-27
Outcome 2 - use chapter
4) “The NHS is a victim of its own success.” Discuss
5) Examine the view that there was a funding crisis in the NHS in the 1980’s.

15. Reforms of the NHS Qs
1) Why could the reforms of the Conservative Governments be seen as a challenge to the fundamental aims of the NHS? P29-30
2) Why is it inaccurate to describe a NHS Trust hospital as a “private hospital”?P33-34
3) What rights do patients have under the Patients’ Charter?P34-35
4) Describe the main features of the internal market.P31-36
5) What is meant by the Private Finance Initiative(PFI) & give examples of it in health care.P48-50

16. Reforms of the NHS Qs Outcome 2
1) Examine the arguments against competitive tendering.
2) To what extent did the internal market create a “two-tier” NHS?
3) Examine the arguments in favour of private medical insurance.
4) “the Labour government has abolished all of the reforms recent Conservative Governments have made in the NHS.” Discuss.

17. Private Health Care
12.7% of the population have private medical insurance (PMI).
More PMI companies: BUPA & AXA
These companies advertise - get examples.
People pay for one off operations or treatments.
Cosmetic operations have greatly increased.
NHS viewed as not always providing the best and most up to date treatments.
The NHS often has long waiting lists to see specialists & have operations.
Thatcher encouraged individual responsibility - tax relief for over 65s paying PMI.

18. Advantages of Private Health Care
Individual choice - how to spend your money
Takes some pressure off NHS - cuts waiting lists
Focus on individual responsibility - you smoke you pay more PMI
Some treatments/surgery not available on NHS - Some fertility treatments
Doctors can top up wages doing private work - prevents brain drain
Creates additional employment - medical & non-medical
Allows top executives & key workers to get fast treatment - preventing a slowing of the economy

19. Private health gives the patient greater comfort - choice of meals, private room, TV and phone.
Private patients still contribute to the NHS
Patients have greater choice on the timing of operations
Private hospitals can operate on NHS patients - further cutting waiting lists
Private Health care has always been available in the UK and could not now be reasonably removed.
The private sector shares resources and facilities with the NHS.
The private sector conducts a great deal of medical research

20. Disadvantages of Private Health Care
Choice only for the well-off
Makes NHS look second class
Queue jumping
Common reward from companies to employees for good work
All medical staff trained by NHS - private sector never pays for training
Moonlighting - working in both NHS & private - results in overworked & tired doctors
Lessens pressure on the government to improve NHS if “cream” using private

21. Primary Health care not private - only London has good coverage of private doctors - private patients still have to use NHS doctors
Some groups of people may find it hard to get PMI - elderly, disabled & terminally ill
Not subject to same controls - Intensive Care Units in NHS have to have ICU trained nurse on duty at all times - private hospitals don’t
No emergency treatment facilitates

22. Essay question
How does this private sector contribute to health care in the UK? This question requires you to look at PPP/PFI as well as private health care.
15 Marks