2. Health Care in the UK The NHS

3. 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. Tony Blair’s “Third way”. Improvements in health. New health problems. The growth of private health care. The advantages and disadvantages of private health care.

4. Introduction- Qs 1) Why could the creation of the NHS be seen as a “genuine landmark in the development of British Society”? Page 5 2) What are the challenges facing health care in the 21st Century? Page 5 & 21 3) What is the consensus (agreement) among the main political parties on the future of health care? Page 5

5. The Five Giants The NHS was set up in 1948 as a result of the Beveridge report. Beveridge had identified five problems: Squalor idleness ignorance want disease

6. 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.

7. Why was the NHS created?- Qs 1) Describe health conditions for the poor before the introduction of the NHS. Page 7 2) Describe the five giant evils identified by Beveridge. Page 8 3) What did the government do to address each of the “five Giants”? Page 8 4) Copy the aims of the NHS - green box page 9 5) What do the tables on page 7 demonstrate? 6) Copy the table on Page 16 - Employment in the NHS

8. Five Giants Video Qs 1)Why did the Second World War change peoples attitudes? 2)What were the main benefits of the NHS to people in 1948? 3)In what ways does the story of Amy Jamieson show the need for free health care? 4)What were the results of the heavy demands placed on the NHS?

9. Individualist Vs Collectivist! Popular in Thatcher years 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) Believe -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 & need escapism.

10. The Third Way The Labour government of Tony Blair has 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

11. 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

12. Health Improvements Life expectancy has increased: 1950 2000 Men66 years74.4 years Women71 years79.6 years Why? Setting up of NHS Better nutrition (rationing) Better Housing Improvements in medical care Reduced infant mortality Preventative treatment of disease In the future life expectancy might reach 100 years!

13. Vaccinations TB - Tuberculosis - major killer made worse by overcrowding. Now drug resistant strain of TB becoming a problem. Whooping Cough Diphtheria Tetanus

14. Improved drugs & Surgery Better detection & treatments of cancers Transplant operations Heart By-passes More drugs Use of Technology

15. 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!

16. New Health Problems HIV & AIDS MS & ME Meningitis E-Coli 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?

17. 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.

18. 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

19. 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.

20. 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.

21. 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

22. 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

23. 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

24. 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

25. Essay question Choose one: a) Examine the arguments for and against private health care. or b) Critically assess how private health care contributes to health care in the UK? c) Discuss how the private sector contributes to health care in the UK? This question requires you to look at PPP/PFI as well as private health care. 15 Marks