The NHS - its organisation and structure

NHS
‡ ‡ ‡ ‡ History Organisation Finance Staff

Florence Nightingale sets up training school for nurses 1862 .Poor law amendments .Act introduced to limit the employment of children to under 12 hours per day 1806 .000 1853 .minimal qualifications laid down 1860 .First anaesthetic 1848 .Pasteur .introduced antiseptic surgery  surgical mortality reduce by 2/3 .Smallpox vaccination made compulsory 1858 .NHS .Medical Act .History 1802 .Cholera kills 70.Poor houses & infirmaries 1842 .demonstrates link between bacteria & disease 1867 .Lister .First steam powered loom 1834 .

Marriage act increased minimum age from 12 (girls) & 14 (boys) to 16 1932 .Interdepartmental committee on physical deterioration 1911 .Universal adult suffrage 1929 .Koch identifies bacteria 1880 .History 1875 .Ministry of Health established 1928 .Sulphonamide (antibiotic) discovered .NHS .National Health Insurance Act + Census introducing social classes 1919 .Public Health Act allowed local authorities to perform slum clearance 1876 .education to age 10 made compulsory 1904 .

National Health Service Act + National Assistance Act 1952 .Thatcher 1981 .compensation for industrial diseases & injuries 1948 .Legalisation of abortion 1979 .Polio vaccine 1960s .National Insurance Act .Smoking & Health published 1964 .First AIDS cases reported .Benzodiazepines developed 1962 .Congenital anomalies reported nationally 1968 .History 1941 .NHS .

000 patients .140.NHS .History Hospitals pre-WW2 ‡ Voluntary hospitals .place under Health dept ‡ Fever hospitals .charge fees (means tested) ‡ Poor sick care provided often by workhouse infirmaries ‡ 1929 .to protect public ‡ Lunatic asylums .Local authorities could take over poor law infirmaries .under County Council .

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

psychosurgery.declared insane by Judicial Committee . locked doors. insulin induced fits.NHS . ECT. high walls. physical confinements Gross overcrowding .Recommends County asylums 1847 .County asylums compulsory 1930 .History Mental Health 1807 . self-sufficient Treatments: .hence run like a prison.89 asylums average size 1200 beds Built in rural areas 1940s . hysterectomy.

Hospital plan .peak at 140.NHS . growth of welfare state Result: community care policy 1959 .Mental Health Act .falling asylum bed numbers 1983 .000 patients Sudden turn-around: penicillin & phenothiazines.Mental Health Act - . patient rights.doctors control entry & exit 1962. old asylums needed rebuilding.History 1954 .

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 .

74: Administrative 1974 .97: Market 1997 .82: Planning 1982 .90: Managed 1990 .: The New NHS!! .NHS Organisation Constant change 5 phases: 1948 .

geographical. by patient category .NHS Organisation 1) Administrative phase ‡ Persistence of inequalities .social.

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

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

Provider split ‡ Fundholding BUT: ‡ no market-place ‡ decreased choice ‡ increased bureaucracy ‡ decreased equity .NHS Organisation 4) Market Phase ‡ Thatcher¶s belief in free markets efficiency ‡ Purchaser .

NHS Organisation NHS structure post 1996 Secretary of State Department of Health NHS Mgt executive Regional Offices Health Authorities NHS Trusts GPs GP fundholders PURCHASERS PROVIDERS .

NHS Organisation The New NHS Secretary of State Type title here Health Improvement Programme DoH NHSE Regional Offices Local Authorities Health Authorities NHS Trusts Primary Care Groups .

³joined up thinking´ ‡ Inequalities & Our Healthier Nation ‡ Devolving decision making to GPs .NHS Organisation Current ideas ‡ Partnership working .³closer to the patient´ .

1997 Total = £267 billion Health (Eng) Local Govt Defence Scot/Wales/NI LA-self Education Social Security Other .NHS Finance Public Spending .

Billions 25 20 15 10 5 0 1994 1995 1996 1997 1998 1999 Year .NHS Finance Growth in NHS funding 1994-99 40 35 30 £ .

NHS Finance Pie Chart of division of NHS resources Hospital & Community Health Services Family Health Services Central Health (misc) Admin Capital .

NHS Finance Age cost curve 3000 £ per head of population 2500 2000 1500 1000 500 0 Births 0-4 5 to 15 16-44 45-64 75-84 85+ Age Bands .

NHS Staff NHS staff: changes seen since 1987 900 Number (thousands) employed wte 800 700 600 Total staff Medical/dental 500 400 300 200 100 0 Nursing Management/support 1987 1992 1993 1994 1995 1996 1997 Year .

NHS Staff Pie chart showing proportion of main staff groups within the NHS Nursing Medical/dental Other direct care staff Clinical Psychologist Admin & estates Other management & support .

NHS Staff NHS directly employed staff. 1997 Female Male .

S. (England) 3000 2500 2000 1500 1000 500 0 Whole Time E quivalents 9 1 3 5 7 9 1 3 5 7 9 1 3 5 7 9 1 3 95 196 196 196 196 196 197 197 197 197 197 198 198 198 198 198 199 199 1 Year .NHS Staff Psychologists in the N.H.

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