2In this unit you will learn: How and why the NHS was createdWhat the original aims of the NHS wereIndividualist and collectivist views of health careNew Labour’s “Third way”Improvements in healthNew health problemsThe growth of private health careThe advantages and disadvantages of private health care
3The 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:DiseaseIgnoranceSqualorIdlenessWant
4The NHS 1948Nye 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) BevanThe 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.
5Why was the NHS created?-Qs 1) Describe the five giant evils identified by Beveridge. Page 652) What did the government do to address each of the “five Giants”? Page 653) Make notes on the aims/features of the NHS Page664) Describe health conditions for the poor before the introduction of the NHS. Page 665) Why has expenditure continued to rise in the NHS?6) What issues have affected the income of the NHS?
6Individualist Vs Collectivist! Ideology -socialismStrong link between poverty & ill health.Poverty related ill health is wider than scope of NHS - housing & benefitsGovernment has a responsibility to narrow inequalities of societyLifestyle choices linked to poverty - stress of unemployment & lack of knowledgeIdeology - part of ThatcherismResponsible for own healthLifestyles- smoking drinkingpoor diet, little exerciseIndividuals are aware of the health risks of theseIndividuals should be allowed to opt out of paying for NHS & allowed to put this money towards Private Medical Insurance (PMI)
7The Third WayLabour 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 workThe need for individuals to take responsibility: -promotion of healthier diet -promote taking exercise -discourage bad habits - drinking, -prevention better than cure
8Responsibility for health Qs 1) What evidence is there that individuals are being asked to pay more for their health care? P14-152) “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? P16-174) What evidence is there that the NHS provides jobs outside of health care? P185) To what extent did the Conservative Governments increase spending on the NHS?P19-20
9Health ImprovementsLife expectancy has increased:Men 66 years years Women 71 years yearsWhy?Setting up of NHSBetter nutrition (rationing into 1950s)Better HousingImprovements in medical careReduced infant mortalityPreventative treatment of diseaseIn the future life expectancy might reach 100 years!
10VaccinationsTB - Tuberculosis - major killer made worse by overcrowding. Now drug resistant strain of TB becoming a problem.Whooping CoughDiphtheriaTetanusMMR controversyHPV - cancer
11Improved drugs & surgery Better detection & treatments of cancersTransplant operationsHeart by-passesMore drugsUse of technology
12Better Lifestyles? Less people smoking Greater awareness of health issuesPreventative programmesBut: 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 mealsTV & PCCarsMobiles???Less exposure to germs!
13New Health Problems Can you think of any others? HIV & AIDS MS & ME MeningitisE-ColiBSE and variant CJD (mad cow disease)Increase in allergies & asthmaHigh death rates from cancer & heart diseaseLack of exercisePoor dietMore elderly peopleCan you think of any others?Type 2 diabetes linked to some of the above
14Challenges for the NHS Qs 1) Describe the main reasons why life expectancy in the UK has improved? P21-222) Why did the creators of the NHS believe that demands placed on the NHS would decline, rather than increase?P22-233) Describe the new demands now made on the NHS?P23-27Outcome 2 - use chapter4) “The NHS is a victim of its own success.” Discuss5) Examine the view that there was a funding crisis in the NHS in the 1980’s.
15Reforms of the NHS Qs1) Why could the reforms of the Conservative Governments be seen as a challenge to the fundamental aims of the NHS? P29-302) Why is it inaccurate to describe a NHS Trust hospital as a “private hospital”?P33-343) What rights do patients have under the Patients’ Charter?P34-354) Describe the main features of the internal market.P31-365) What is meant by the Private Finance Initiative(PFI) & give examples of it in health care.P48-50
16Reforms 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.
17Private Health Care12.7% of the population have private medical insurance (PMI).More PMI companies: BUPA & AXAThese 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.
18Advantages of Private Health Care Individual choice - how to spend your moneyTakes some pressure off NHS - cuts waiting listsFocus on individual responsibility - you smoke you pay more PMISome treatments/surgery not available on NHS - Some fertility treatmentsDoctors can top up wages doing private work - prevents brain drainCreates additional employment - medical & non-medicalAllows top executives & key workers to get fast treatment - preventing a slowing of the economy
19Private health gives the patient greater comfort - choice of meals, private room, TV and phone. Private patients still contribute to the NHSPatients have greater choice on the timing of operationsPrivate hospitals can operate on NHS patients - further cutting waiting listsPrivate 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
20Disadvantages of Private Health Care Choice only for the well-offMakes NHS look second classQueue jumpingCommon reward from companies to employees for good workAll medical staff trained by NHS - private sector never pays for trainingMoonlighting - working in both NHS & private - results in overworked & tired doctorsLessens pressure on the government to improve NHS if “cream” using private
21Primary Health care not private - only London has good coverage of private doctors - private patients still have to use NHS doctorsSome groups of people may find it hard to get PMI - elderly, disabled & terminally illNot subject to same controls - Intensive Care Units in NHS have to have ICU trained nurse on duty at all times - private hospitals don’tNo emergency treatment facilitates
22Essay questionHow 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