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The NHS - its organisation and structure. NHS History Organisation Finance Staff.

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Presentation on theme: "The NHS - its organisation and structure. NHS History Organisation Finance Staff."— Presentation transcript:

1 The NHS - its organisation and structure

2 NHS History Organisation Finance Staff

3 Act introduced to limit the employment of children to under 12 hours per day First steam powered loom Poor law amendments - Poor houses & infirmaries First anaesthetic Cholera kills 70, Smallpox vaccination made compulsory Medical Act - minimal qualifications laid down Florence Nightingale sets up training school for nurses Pasteur - demonstrates link between bacteria & disease Lister - introduced antiseptic surgery surgical mortality reduce by 2/3 NHS - History

4 Public Health Act allowed local authorities to perform slum clearance Koch identifies bacteria education to age 10 made compulsory Interdepartmental committee on physical deterioration National Health Insurance Act + Census introducing social classes Ministry of Health established Universal adult suffrage Marriage act increased minimum age from 12 (girls) & 14 (boys) to Sulphonamide (antibiotic) discovered

5 NHS - History National Insurance Act - compensation for industrial diseases & injuries National Health Service Act + National Assistance Act Polio vaccine 1960s - Benzodiazepines developed Smoking & Health published Congenital anomalies reported nationally Legalisation of abortion Thatcher First AIDS cases reported

6 NHS - History Hospitals pre-WW2 Voluntary hospitals - charge fees (means tested) Poor sick care provided often by workhouse infirmaries Local authorities could take over poor law infirmaries - place under Health dept Fever hospitals - to protect public Lunatic asylums - under County Council - 140,000 patients

7 NHS - History Beveridge report on social insurance: named the 5 giants: disease, ignorance, squalor, idleness and want Focused government to attend to NHS, social security, housing, education & policy of full employment

8 NHS - History Mental Health Recommends County asylums County asylums compulsory asylums average size 1200 beds Built in rural areas 1940s - declared insane by Judicial Committee - hence run like a prison, high walls, locked doors, self-sufficient Treatments: - psychosurgery, ECT, insulin induced fits, hysterectomy, physical confinements Gross overcrowding

9 NHS - History peak at 140,000 patients Sudden turn-around: penicillin & phenothiazines, old asylums needed rebuilding, patient rights, growth of welfare state Result: community care policy Mental Health Act - doctors control entry & exit Hospital plan - falling asylum bed numbers Mental Health Act -

10 NHS Organisation NHS Aims: To provide medical care free at point of use To rich and poor alike in accordance with medical need 2 beliefs: Those who need care will come forward Those who provide care know what is required and how to provide it

11 NHS Organisation Constant change 5 phases: : Administrative : Planning : Managed : Market : The New NHS!!

12 NHS Organisation 1) Administrative phase Persistence of inequalities - social, geographical, by patient category

13 NHS Organisation 2) Planning phase Themes of effectiveness, efficiency and equity appeared Managed by consensus RAWP BUT: bureaucratic & unresponsive

14 NHS Organisation 3) Management phase Griffiths report - need for good general mgt + financial accountability of clinicians Stronger lines of accountability

15 NHS Organisation 4) Market Phase Thatchers belief in free markets efficiency Purchaser - Provider split Fundholding BUT: no market-place decreased choice increased bureaucracy decreased equity

16 NHS Organisation


18 Current ideas Partnership working - joined up thinking Inequalities & Our Healthier Nation Devolving decision making to GPs - closer to the patient

19 NHS Finance




23 NHS Staff




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