National Health Service
National Health Service (NHS) is the name used for each of the
public health services in the
United Kingdom – the National Health
Service in England, NHS Scotland, NHS Wales, and Health and Social
Care in Northern Ireland – as well as a term to describe them
collectively. They were established together in 1948 as one of the
major social reforms following the Second World War. The founding
principles were that services should be comprehensive, universal and
free at the point of delivery. Each service provides a
comprehensive range of health services, free for people ordinarily
resident in the United Kingdom, apart from dental treatment and
optical care. (The English NHS also requires patients to pay
prescription charges with a range of exemptions from these charges.)
Each of the UK's health service systems operates independently, and is
politically accountable to the relevant government: the Scottish
Government; Welsh Government; Northern Ireland Executive; and the UK
Government, responsible for England's NHS.
NHS Wales was originally
part of the same structure as that of England until powers over the
NHS in Wales were firstly transferred to the Secretary of State for
Wales in 1969 and thereafter, in 1999, to the
Welsh Assembly as part
of Welsh devolution. Some functions may be routinely performed by one
health service on behalf of another. For example, Northern Ireland has
no high-security psychiatric hospitals and depends on hospitals in
Great Britain, routinely at Carstairs hospital in Scotland for male
Rampton Secure Hospital
Rampton Secure Hospital in England for female
patients. Similarly, patients in North Wales use specialist
facilities in Manchester and Liverpool which are much closer than
facilities in Cardiff, and more routine services at the Countess of
Chester hospital. There have been issues about cross-border
Taken together, the four National Health Services in 2015–16
employed around 1.6 million people with a combined budget of £136.7
billion. In 2014 the total health sector workforce across the UK
was 2,165,043. This broke down into 1,789,586 in England, 198,368 in
Scotland, 110,292 in Wales and 66,797 in Northern Ireland. In 2017,
there were 691,000 nurses registered in the UK, down 1,783 from the
previous year. However, this is the first time nursing numbers have
fallen since 2008.
Although there has been increasing policy divergence between the four
National Health Services in the UK, it can be difficult to find
evidence of the effect of this on performance since, as Nick Timmins
says: "Some of the key data needed to compare performance –
including data on waiting times – is [sic] defined and collected
differently in the four countries." Statistics released in
December 2017 showed that, compared with 2012/3, 9% fewer patients in
Scotland were waiting more than four hours in accident and emergency,
whereas in England the number had increased by 155%.
2 Eligibility for treatment
3 Current issues
3.2 Effect of Brexit
3.3 Rising social care costs
3.4 Security breaches
4 See also
6 Further reading
7 External links
Further information: History of the
National Health Service
National Health Service (England),
History of NHS Scotland, and History of NHS Wales
Aneurin Bevan, who built on Sir Henry Willink's vision of a National
Health Service with the establishment of the NHS
The National Health Services began their work on the 5 July 1948. This
put into practice Westminster legislation for England and Wales from
1946 and Scotland from 1947, and the Northern Ireland Parliament's
1947 Public Health Services Act. (
NHS Wales was split from NHS
(England) in 1969 when control was passed to the Secretary of State
for Wales before transferring to the Welsh Executive and Assembly
under devolution in 1999.)
Calls for a "unified medical service" can be dated back to the
Minority Report of the Royal Commission on the Poor Law in 1909,
but it was following the 1942 Beveridge Report's recommendation to
create "comprehensive health and rehabilitation services for
prevention and cure of disease" that cross-party consensus emerged on
National Health Service
National Health Service of some description. When
Clement Attlee's Labour Party won the 1945 election he appointed
Aneurin Bevan as Health Minister. Bevan then embarked upon what the
official historian of the NHS, Charles Webster, called an "audacious
campaign" to take charge of the form the NHS finally took. The NHS
was born out of the ideal that good healthcare should be available to
all, regardless of wealth. At its launch by Bevan on 5 July 1948 it
had at its heart three core principles: That it meet the needs of
everyone, that it be free at the point of delivery, and that it be
based on clinical need, not ability to pay.
Three years after the founding of the NHS, Bevan resigned from the
Labour government in opposition to the introduction of charges for the
provision of dentures and glasses. The following year, Winston
Churchill's Conservative government introduced prescription charges.
These charges were the first of many controversies over reforms to the
NHS throughout its history.
From its earliest days, the cultural history of the NHS has shown its
place in British society reflected and debated in film, TV, cartoons
and literature. The NHS had a prominent slot during the 2012 London
Summer Olympics opening ceremony directed by Danny Boyle, being
described as "the institution which more than any other unites our
Eligibility for treatment
UK residents are not charged for most medical treatment though NHS
dentistry does have standard charges in each of the four national
health services in the UK. In addition, some patients in England have
to pay charges for prescriptions though most are exempted.
Aneurin Bevan in considering the provision of NHS services to overseas
visitors wrote, in 1952, that it would be "unwise as well as mean to
withhold the free service from the visitor to Britain. How do we
distinguish a visitor from anybody else? Are British citizens to carry
means of identification everywhere to prove that they are not
visitors? For if the sheep are to be separated from the goats both
must be classified. What began as an attempt to keep the Health
Service for ourselves would end by being a nuisance to everybody."
The provision of free treatment to non-UK-residents, formerly
interpreted liberally, has been increasingly restricted, with new
overseas visitor hospital charging regulations introduced in 2015.
Citizens of the EU holding a valid
European Health Insurance Card
European Health Insurance Card and
persons from certain other countries with which the UK has reciprocal
arrangements concerning health care can get emergency treatment
The NHS is free at the point of use, for general practitioner (GP) and
emergency treatment not including admission to hospital, to
non-residents. People with the right to medical care in European
Economic Area (EEA) nations are also entitled to free treatment by
using the European Health Insurance Card. Those from other countries
with which the UK has reciprocal arrangements also qualify for free
treatment. Since 6 April 2015, non-EEA nationals who are
subject to immigration control must have the immigration status of
indefinite leave to remain at the time of treatment and be properly
settled, to be considered ordinarily resident. People not ordinarily
resident in the UK are in general not entitled to free hospital
treatment, with some exceptions such as refugees.
People not ordinarily resident may be subject to an interview to
establish their eligibility, which must be resolved before
non-emergency treatment can commence. Patients who do not qualify for
free treatment are asked to pay in advance or to sign a written
undertaking to pay, except for emergency treatment.
People from outside the EEA coming to the UK for a temporary stay of
more than six months are required to pay an immigration health
surcharge at the time of visa application, and will then be entitled
to NHS treatment on the same basis as a resident. This includes
overseas students with a visa to study at a recognised institution for
6 months or more, but not visitors on a tourist visa. In 2016 the
surcharge was £200 per year, with exemptions and reductions in some
cases. It is to increase to £400 in 2018. The discounted rate for
students and those on the Youth Mobility Scheme will increase from
£150 to £300.
From 15 January 2007, anyone who is working outside the UK as a
missionary for an organisation with its principal place of business in
the UK is fully exempt from NHS charges for services that would
normally be provided free of charge to those resident in the UK. This
is regardless of whether they derive a salary or wage from the
organisation, or receive any type of funding or assistance from the
organisation for the purposes of working overseas. This is in
recognition of the fact that most missionaries would be unable to
afford private health care and those working in developing countries
should not effectively be penalised for their contribution to
development and other work.
Those who are not ordinarily resident (including British citizens who
may have paid
National Insurance contributions in the past) are liable
to charges for services.
There are some other categories of people who are exempt from the
residence requirements such as specific government workers and those
in the armed forces stationed overseas.
NHS Spending 1948/49-2014/15
The systems are 98.8% funded from general taxation and National
Insurance contributions, plus small amounts from patient charges for
some services. About 10% of
GDP is spent on health and most is
spent in the public sector. The money to pay for the NHS comes
directly from taxation. The 2008/9 budget roughly equates to a
contribution of £1,980 per person in the UK.
When the NHS was launched in 1948 it had a budget of £437 million
(roughly £9 billion at today’s prices). In 2008/9 it received
over 10 times that amount (more than £100 billion). In 1955/6 health
spending was 11.2% of the public services budget. In 2015/6 it was
29.7%. This equates to an average rise in spending over the full
60-year period of about 4% a year once inflation has been taken into
account. Under the
Blair government spending levels increased by
around 6% a year on average. Since 2010 spending growth has been
constrained to just over 1% a year.
Some 60% of the NHS budget is used to pay staff. A further 20% pays
for drugs and other supplies, with the remaining 20% split between
buildings, equipment, training costs, medical equipment, catering and
cleaning. Nearly 80% of the total budget is distributed by local
trusts in line with the particular health priorities in their
areas. Since 2010, there has been a cap of 1% on pay rises for
staff continuing in the same role. Unions representing doctors,
dentists, nurses and other health professionals have called on the
government to end the cap on health service pay, claiming the cap is
damaging the health service and damaging patient care. The pay
rise is likely to be below the level of inflation and to mean a
real-terms pay cut. The
House of Commons Library
House of Commons Library did research
showing that real-terms NHS funding per head will fall in 2018–19,
and stay the same for two years afterwards.
There appears to be support for higher taxation to pay for extra
spending on the NHS as an opinion poll in 2016 showed that 70% of
people were willing to pay an extra penny in the pound in income tax
if the money were ringfenced and guaranteed for the NHS. Two
thirds of respondents to a
King's Fund poll favour increased taxation
to help finance the NHS.
The Guardian has said that GPs face excessive workloads throughout
Britain, and that this puts the GP's health and that of their patients
at risk. The
Royal College of Physicians
Royal College of Physicians did a survey of doctors
in England, Wales, Scotland and Northern Ireland. Two thirds of
doctors surveyed maintained patient safety had deteriorated during the
year to 2018, 80% feared they would be unable to provide safe patient
care in the coming year while 84% felt increased pressure on the NHS
was demoralizing the workforce.
Jane Dacre said, “We simply cannot
go through this [a winter when the NHS is badly overstretched] again.
It is not as if the situation was either new or unexpected. As the NHS
reaches 70, our patients deserve better. Somehow, we need to move
faster towards a better resourced, adequately staffed NHS during 2018
or it will happen again.”
62% of Intensive Care Units function below normal because there are
not enough nurses, a survey of ICU consultants by the Faculty of
Intensive Care Medicine (FICM) stated. The survey found the 210
intensive care units throughout the UK were short of 12 nurses each on
average and nurses are vital caring for critically ill patients.
Theresa May is under pressure from MP's of both the main political
parties to increase funding for the NHS and for social care, also to
consider tax rises to achieve this. 98 signatories to a letter
maintain the NHS, public health and social care are “overstretched,
poorly integrated and no longer able to keep pace with rising demand
and the cost pressures of new drugs and technologies”. Without
action, patients will experience a serious further decline in
services.” One possibility is a NHS tax where the money would be
earmarked for the NHS.
Effect of Brexit
The plan to exit the European Union will affect physicians from EU
countries, about 11% of the physician workforce. Many of these
physicians are considering leaving the UK if
Brexit happens, as they
have doubts that they and their families can live in the country.
A survey suggests 60% are considering leaving. Record numbers of
EU nationals (17,197 EU staff working in the NHS which include nurses
and doctors) left in 2016. The figures, put together by NHS Digital,
led to calls to reassure European workers over their future in the
UK. EU nurses registering to work in the UK are down 96% since the
Brexit vote aggravating shortages of nurses. Janet Davies of the Royal
College of Nursing, said, “We rely on the contributions of EU staff
and this drop in numbers could have severe consequences for patients
and their families. Our nursing workforce is in a state of crisis.
Across our health service, from A&E to elderly care, this puts
patients at serious risk.”
There is also concern that a disorderly
Brexit may compromize
patients' access to vital medicines. Many medical organizations are
diverting resources from patient care to managing a possible worst
Rising social care costs
Social care will cost more in future according to research by
Liverpool University, University College London, and others and higher
investment are needed. Professor
Helen Stokes-Lampard of the Royal
College of GPs said, “It’s a great testament to medical research,
and the NHS, that we are living longer – but we need to ensure that
our patients are living longer with a good quality of life. For this
to happen we need a properly funded, properly staffed health and
social care sector with general practice, hospitals and social care
all working together – and all communicating well with each other,
in the best interests of delivering safe care to all our
On 12 May 2017, a major cyber-attack occurred that affected a large
number of NHS computer systems.
History of the
National Health Service
National Health Service (England)
History of NHS Scotland
History of NHS Wales
Healthcare in the United Kingdom
^ Choices, NHS. "The principles and values of the NHS in England".
www.nhs.uk. Retrieved 2016-11-23.
^ a b "NHS entitlements: migrant health guide - Detailed guidance". UK
Government. Retrieved 6 June 2016.
^ "Guidance on the Transfer of Mentally Disordered Patients August
^ "Breakdown of cross-border agreements is costing English trusts
millions". Health Service Journal. 14 February 2008. Retrieved 19
^ "10 truths about Britain's health service". Guardian. 18 January
2016. Retrieved 19 January 2016.
^ Cowper, Andy (23 May 2016). "Visible and valued: the way forward for
the NHS's hidden army". Health Service Journal. Retrieved 28 July
^ "Outcomes in EHCI 2015" (PDF). Health Consumer Powerhouse. 26
January 2016. Retrieved 27 January 2016.
^ Timmins, Nick. "The four UK health systems: Learning from each
other,". Kings Fund. Retrieved 2 February 2016.
^ "Scottish A&E bucks trend on long waits". BBC. 7 December 2017.
Retrieved 10 December 2017.
^ Ruth Barrington, Health, Medicine & Politics in Ireland
1900–1970 (Institute of Public Administration: Dublin, 1987) pp.
^ Wales, NHS. "
NHS Wales 1960's". www.wales.nhs.uk. Retrieved
^ Brian Abel-Smith, The Hospitals 1800–1948 (London, 1964), p.229
^ Beveridge, William (November 1942). "Social Insurance and Allied
Services" (PDF). HM Stationery Office. Retrieved 3 March 2013.
^ Charles Webster, The Health Services since the War, Volume 1:
Problems of Health Care, The
National Health Service
National Health Service Before 1957
(London: HMSO, 1988), p. 399.
^ "The NHS in England - About the NHS - NHS core principles". Nhs.uk.
23 March 2009. Retrieved 27 June 2017.
^ Kenneth O. Morgan, 'Aneurin Bevan' in Kevin Jeffreys (ed.), Labour
Forces: From Ernie Bevin to Gordon Brown (I.B. Taurus: London &
New York, 2002), pp. 91–92.
^ Martin Powell and Robin Miller, 'Seventy Years of Privatizing the
British National Health Service?', Social Policy & Administration,
vol. 50, no. 1 (January 2016), pp. 99–118.
^ Adams, Ryan (27 July 2012). "Danny Boyle's intro on Olympics
programme". Awards Daily. Retrieved 27 November 2016.
^ Bevan, Aneurin (1952). In Place of Fear. Retrieved 2 April
^ "Guidance on overseas visitors hospital charging regulations". UK
Government. 6 April 2016. Retrieved 6 June 2016. Links to many
relevant documents: Guidance on implementing the overseas visitor
hospital charging regulations 2015; Ways in which people can be
lawfully resident in the UK; Summary of changes made to the way the
NHS charges overseas visitors for NHS hospital care; Biometric
residence permits: overseas applicant and sponsor information;
Information sharing with the Home Office: guidance for overseas
patients; Overseas chargeable patients, NHS debt and immigration
rules: guidance on administration and data sharing; Ordinary residence
tool; and documents on Equality analysis.
^ Nardelli, Alberto (11 August 2015). "Are foreigners really gaming
the NHS to pay for their medical treatment abroad?". the
^ "Visiting or moving to England? - How to access NHS services (see
"Hospital Services" section)". NHS Choices. 26 June 2015. Retrieved 6
^ "NHS charges for people from abroad". Citizens Advice. Retrieved
^ "Non-EEA country-by-country guide – Healthcare abroad". NHS
Choices. 1 January 2016. Retrieved 6 June 2016.
^ "Categories of exemption - Healthcare in England for visitors - NHS
Choices". NHS England. 18 August 2015. Retrieved 6 June 2016.
^ Bruno Rodrigues, "Important NHS charges in visa applications",
"Immigration Media", 18 March 2015
^ NHS Choices (18 August 2015). "Moving from outside the EEA –
Access to healthcare in England". Nhs.uk. Retrieved 6 June 2016.
^ "Increase in health charge paid by temporary migrants". OnMedica. 6
February 2018. Retrieved 2 April 2018.
National Health Service
National Health Service (Charges to Overseas Visitors) Regulations
^ "Health spending".
^ "How the NHS is funded". TheKing'sFund. 15 January 2016. Retrieved 6
^ "Underfunded, underdoctored, overstretched: The NHS in 2016". 21
^ "Health care spending compared to other countries".
^ NHS Choices The NHS in England: The NHS: About the NHS: Overview.
Retrieved 22 June 2010.
^ "The NHS in England". NHS choices. 28 January 2013. Retrieved 27
^ a b "10 charts that show why the NHS is in trouble". BBC News. 8
February 2017. Retrieved 10 February 2017.
^ Health unions urge Theresa May to ditch NHS pay cap The Guardian
^ NHS staff suffer pay cuts in real terms as salaries rise by one per
cent The Independent
^ Conservatives will break NHS funding pledge, Labour claims The
^ editor, Rowena Mason Deputy political (30 December 2016). "People
may be ready to pay extra penny on tax for NHS, Tim Farron says" –
via The Guardian.
^ Two-thirds support higher taxes to maintain NHS funding The Observer
^ Family doctors working 'beyond safe levels', says GPs' leader The
^ Patient safety getting worse, say two-thirds of NHS doctors The
^ NHS intensive care units sending patients elsewhere due to lack of
beds The Guardian
^ May must consider tax rises to fund NHS and social care, say MPs The
^ a b mamk (February 23, 2017). "
Brexit gelungenn, Patient tot" (in
German). Der Spiegel. Retrieved February 23, 2017.
^ O'Carroll, Lisa; Campbell, Denis (28 February 2017). "Poll shows 60%
of European doctors are considering leaving UK" – via The
^ Marsh, Sarah; Duncan, Pamela (30 March 2017). "Record number of EU
citizens quit working in NHS last year" – via The Guardian.
^ 96% drop in EU nurses registering to work in Britain since Brexit
vote The Guardian
Brexit deal delay could put NHS patients at risk, Tory MP warns The
^ NHS faces staggering increase in cost of elderly care, academics
warn The Guardian
^ "Statement on reported NHS cyber attack". digital.nhs.uk.
Brady, Robert A. Crisis in Britain. Plans and Achievements of the
Labour Government (1950) pp. 352–41 excerpt
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NHS Choices official website for England's NHS
Health and Social Care in Northern Ireland
Health and Social Care in Northern Ireland official website for Health
& Personal Social Services in Northern Ireland
NHS Scotland official website for NHS Scotland
Health in Wales official website for NHS Wales
Birth of the national Health Service archive collection of programmes