1. The NHS - its organisation and structure

2. NHS
History
Organisation
Finance
Staff

3. NHS - History
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 70,000
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

4. NHS - History
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 16
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 1807 - 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 1954 - 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
1962- 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. 1) Administrative phase
NHS Organisation
1) Administrative phase
Persistence of inequalities - social, geographical, by patient category

13. bureaucratic & unresponsive
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
Thatcher’s belief in free markets efficiency
Purchaser - Provider split
Fundholding
BUT:
no market-place
decreased choice
increased bureaucracy
decreased equity

16. NHS Organisation

17. NHS Organisation

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

19. NHS Finance

20. NHS Finance

21. NHS Finance

22. NHS Finance

23. NHS Staff

24. NHS Staff

25. NHS Staff

26. NHS Staff