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National Health Service

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"NHS" redirects here. For other uses, see NHS (disambiguation).
For the individual national healthcare services of England, Scotland, Wales and Northern Ireland, see National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care in Northern Ireland.

NHS logo in England
File:NHS Scotland.svg
NHS Scotland logo


The National Health Service or also known as No Show Holly' (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.[1] 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.[2] (The English NHS also requires patients to pay prescription charges with a range of exemptions from these charges.)

History

Further information: History of the National Health Service, History of the National Health Service (England), History of NHS Scotland, and History of NHS Wales
Aneurin Bevan, often described as the founder of the NHS.[3]

Dr Somerville Hastings, President of the Socialist Medical Association, successfully proposed a resolution at the 1934 Labour Party Conference that the party should be committed to the establishment of a State Health Service.[4]

Conservative MP and Health Minister, Henry Willink, first proposed the National Health Service in 1944 with the publication of a White Paper "A National Health Service" which was widely distributed in full and short versions as well as in newsreel by Henry Willink himself. (White Paper – A National Health Service) Henry Willink's National Health Service received cross party support and became Westminster legislation for England and Wales from 1946 and Scotland from 1947, and the Northern Ireland Parliament's 1947 Public Health Services Act.[5] (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.[6])

Calls for a "unified medical service" can be dated back to the Minority Report of the Royal Commission on the Poor Law in 1909,[7] 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 introducing a National Health Service of some description.[8] 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.[9] The NHS was born out of the ideal that good healthcare should be available to all, regardless of wealth. Although being freely accessible regardless of wealth maintained Henry Willink's principle of free healthcare for all, Conservative MPs were in favour of maintaining local administration of the NHS through existing arrangements with local authorities fearing that an NHS which owned hospitals on a national scale would lose the personal relationship between doctor and patient.[10] Conservative MPs voted in favour of their amendment to Bevan's Bill to maintain local control and ownership of hospitals and against Bevan's plan for national ownership of all hospitals. The Labour Government defeated Conservative amendments and went ahead with the NHS which is broadly the same as we have today with a single large national organisation (with devolved equivalents) forcing the transfer of ownership from local authority and voluntary hospitals to the new NHS. Bevan's principle of ownership with no private sector involvement has been diluted with future Labour Governments which implemented large scale financing arrangements with private builders in Private Finance Initiatives and joint ventures. (kingsfund, July 2013)

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.[11]

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.[12] 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.[13]

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 nation".[14]

UK health services

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 patients and Rampton Secure Hospital in England for female patients.[15] 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 payments.[16]

Taken together, the four National Health Services in 2015–16 employed around 1.6 million people with a combined budget of £136.7 billion.[17] 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.[18] 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 defined and collected differently in the four countries."[19][20] 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%.[21]

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, most patients in England have to pay charges for prescriptions though some 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." [22]

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.[23]

Citizens of the EU holding a valid European Health Insurance Card and persons from certain other countries with which the UK has reciprocal arrangements concerning health care can get emergency treatment without charge.[24]

The NHS is free at the point of use, for general practitioner (GP) and emergency treatment not including admission to hospital, to non-residents.[25] 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.[26][27] 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.[2][28]

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.[29] In 2016 the surcharge was £200 per year, with exemptions and reductions in some cases.[30] 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.[31]

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.[32] 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.

See also Immigration health surcharge.

Some cancer patients stop getting follow up treatment when they are still at risk of dying from cancer. Joyce Robins of 'Patient Concern' said, it was “terrifying that cancer patients are being abandoned like this. This is such a life-changing disease and to think that after recovering you’re on your own is very scary. People should be getting the full follow-up they deserve at the time when they are still at high-risk.”[33]

Current issues

The NHS is underresourced compared to health provision in other developed nations. A King’s Fund study of OECD data from 21 nations, revealed that the NHS has among the lowest numbers of doctors, nurses and hospital beds per capita in the western world.[34] Nurses within the NHS maintain that patient care is compromised by the shortage of nurses and the lack of experienced nurses with the necessary quailfications.[35] According to a YouGov poll, 74 percent of the UK public believes there are too few nurses.[36] The NHS performs below average in preventing deaths from cancer, strokes and heart disease.[37] Death rates for babies at birth and during the month following birth were also higher.[38]

Funding

NHS Spending 1948/49–2014/15[39]

The systems are 98.8% funded from general taxation and National Insurance contributions, plus small amounts from patient charges for some services.[40][41] About 10% of GDP is spent on health and most is spent in the public sector.[42] 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.[43]

When the NHS was launched in 1948 it had a budget of £437 million (roughly £9 billion at today’s prices).[44] 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%.[45] 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.[45] Many minor procedures may no longer be available from 2019 and the real reason may be to cut costs.[46]

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.[47] 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.[48] The pay rise is likely to be below the level of inflation and to mean a real-terms pay cut.[49] NHS staff resort to high interest payday loans in large numbers.[50] The 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.[51]

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.[52] Two thirds of respondents to a King's Fund poll favour increased taxation to help finance the NHS.[53]

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.[54] The 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 demoralising 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.”[55] At a time when the NHS is short of doctors foreign doctors are forced to leave the UK due to visa restrictions.[56]

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.[57]

Prescriptions for drugs to help patients stop smoking fell by 75% in England by 40% in Scotland and by two thirds in Wales over ten years to 2018. Combining medication with support has been found to help smokers quit most effectively and is three times more effective than leaving smokers to try on their own. The combination is recommended by the National Institute for Health and Care Excellence (Nice). Lack of funding is blamed.[58]

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.[59] 61% of voters favour higher taxes to pay for improvements to the NHS. The NHS is a major concern for voters and consensus for finding more money exists.[60]

According to a BMA poll 4 out of 5 doctors think quality and safety of patient care is threatened by underfunding. 3 in 4 doctors polled believe financial targets have higher priority than patient care, doctors maintain more staff and better IT systems could improve their working environment. Chaand Nagpaul of the BMA said, 'We know the NHS has been systematically and scandalously starved of resources for years. It lacks doctors, it lacks nurses, it lacks beds. It’s not just the channel that separates us from our European neighbours, but a vast funding gap equating to 35,000 hospital beds or 10,000 doctors. (...) A health service of gaps and stopgaps where two out of three juniors report holes in their rota and one third of GP practices have long-term vacancies. It’s the new norm. It’s a new low. (...) All this is inevitably affecting patient safety, with bed occupancy in some trusts running up to 100% – well above recommended safe limits of 85%. Is it safe for patients who should be admitted in an emergency to suffer ambulance delays of several hours with some not surviving the wait as reported last winter? Is it safe to work in an understaffed environment of perpetual rota gaps? Is it safe to manage patients in car parks because the hospital has no space, or to treat patients on trolleys in corridors rather than the facilities of a ward? Is it safe for GPs to spend just 10 minutes with patients with four or more complex problems? The prime minister’s belated and desperately needed announcement of increased NHS funding after years of denial is a positive step. But the investment is still well short of what’s needed and we need it now. We will continue to campaign to be at parity with our European neighbours. Meanwhile it’s crucial that this money is delivered to treat patients and attract and retain staff.'[61] Amyas Morse of the National Audit Office also maintains spending on the NHS should provide substantially more than has been promised. Morse would like the NHS’s to expand into a “bigger and better” and “fully developed” healthcare provider that would be able to give better care to Britain’s ageing and growing population and the 15 million patients with at least one chronic health problem like diabetes, cancer, heart or lung issues, dementia or depression.[62]

Staffing

The plan to exit the European Union will affect physicians from EU countries, about 11% of the physician workforce.[63] 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.[63] A survey suggests 60% are considering leaving.[64] 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.[65] 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.”[66] 3,962 nurses and midwives from the European Economic Area (EEA) left in 2017 and 2018.[67]

In June 2018 the Royal College of Physicians calculated that medical training places need to be increased from 7,500 to 15,000 by 2030 to take account of part-time working among other factors. At that time there were 47,800 consultants working in the UK of which 15,700 were physicians. About 20% of consultants work less than full time.[68]

Brexit

There is also concern that a disorderly Brexit may compromise patients' access to vital medicines. Many medical organisations are diverting resources from patient care to managing a possible worst case Brexit scenario.[69] Doctors' and nurses' organisations both say Brexit is bad for the nation's health. Paul Willims said, “Instead of the £350m a week for the NHS we were promised by the Brexiters, we have had cuts and closures as the NHS loses staff and struggles with budgets that are limited by the Brexit economic squeeze. If Brexit actually happens, it seems certain it will only make things worse – with new drug treatments, investment in research and sustainable funding all under threat.”[70]

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 patients.”[71]

2018 funding increase

In 2018, British Prime Minister Theresa May announced that NHS in England would receive a 3.4% increase in funding which would allow it to receive an extra £20bn a year in real terms funding by 2024.[72] Some expressed doubt over whether May could carry out this proposed increase in funding.[73] The next day, Health Secretary Jeremy Hunt backed the extra £20bn annual increase in NHS funding and responded to criticism by stating that taxation would be used to carry out the funding and that details would be revealed when the next budget is unveiled in November.[74][75] The Institute for Fiscal Studies has stated a 5% real-terms increase was needed for real change. Paul Johnson of the IFS pointed out the 3.4% was greater than recent increases, but less than the long-term average.[76]

See also

References

  1. ^ Choices, NHS. "The principles and values of the NHS in England". www.nhs.uk. Retrieved 23 November 2016.
  2. ^ a b "NHS entitlements: migrant health guide – Detailed guidance". UK Government. Retrieved 6 June 2016.
  3. ^ Thomas-Symonds, Nick (3 July 2018). "70 years of the NHS: How Aneurin Bevan created our beloved health service". The Independent. Retrieved 5 July 2018.
  4. ^ "Health Service debate". Labour Party. October 1934. Retrieved 30 June 2018.
  5. ^ Ruth Barrington, Health, Medicine & Politics in Ireland 1900–1970 (Institute of Public Administration: Dublin, 1987) pp. 188–89.
  6. ^ Wales, NHS. "NHS Wales | 1960's". www.wales.nhs.uk. Retrieved 22 November 2016.
  7. ^ Brian Abel-Smith, The Hospitals 1800–1948 (London, 1964), p.229
  8. ^ Beveridge, William (November 1942). "Social Insurance and Allied Services" (PDF). HM Stationery Office. Retrieved 3 March 2013.
  9. ^ Charles Webster, The Health Services since the War, Volume 1: Problems of Health Care, The National Health Service Before 1957 (London: HMSO, 1988), p. 399.
  10. ^ "NHS Bill Second Reading". Hansard. 30 April 1946.
  11. ^ "The NHS in England – About the NHS – NHS core principles". Nhs.uk. 23 March 2009. Retrieved 27 June 2017.
  12. ^ 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.
  13. ^ Martin Powell and Robin Miller, 'Seventy Years of Privatising the British National Health Service?', Social Policy & Administration, vol. 50, no. 1 (January 2016), pp. 99–118.
  14. ^ Adams, Ryan (27 July 2012). "Danny Boyle's intro on Olympics programme". Awards Daily. Retrieved 27 November 2016.
  15. ^ "Guidance on the Transfer of Mentally Disordered Patients August 2011".
  16. ^ "Breakdown of cross-border agreements is costing English trusts millions". Health Service Journal. 14 February 2008. Retrieved 19 January 2016.
  17. ^ "10 truths about Britain's health service". Guardian. 18 January 2016. Retrieved 19 January 2016.
  18. ^ Cowper, Andy (23 May 2016). "Visible and valued: the way forward for the NHS's hidden army". Health Service Journal. Retrieved 28 July 2016.
  19. ^ "Outcomes in EHCI 2015" (PDF). Health Consumer Powerhouse. 26 January 2016. Retrieved 27 January 2016.
  20. ^ Timmins, Nick. "The four UK health systems: Learning from each other,". Kings Fund. Retrieved 2 February 2016.
  21. ^ "Scottish A&E bucks trend on long waits". BBC. 7 December 2017. Retrieved 10 December 2017.
  22. ^ Bevan, Aneurin (1952). In Place of Fear. Retrieved 2 April 2018.
  23. ^ "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.
  24. ^ Nardelli, Alberto (11 August 2015). "Are foreigners really gaming the NHS to pay for their medical treatment abroad?". the Guardian.
  25. ^ "Visiting or moving to England? – How to access NHS services (see "Hospital Services" section)". NHS Choices. 26 June 2015. Retrieved 6 June 2016.
  26. ^ "NHS charges for people from abroad". Citizens Advice. Retrieved 16 November 2010.
  27. ^ "Non-EEA country-by-country guide – Healthcare abroad". NHS Choices. 1 January 2016. Retrieved 6 June 2016.
  28. ^ "Categories of exemption – Healthcare in England for visitors – NHS Choices". NHS England. 18 August 2015. Retrieved 6 June 2016.
  29. ^ Bruno Rodrigues, "Important NHS charges in visa applications", "Immigration Media", 18 March 2015
  30. ^ NHS Choices (18 August 2015). "Moving from outside the EEA – Access to healthcare in England". Nhs.uk. Retrieved 6 June 2016.
  31. ^ "Increase in health charge paid by temporary migrants". OnMedica. 6 February 2018. Retrieved 2 April 2018.
  32. ^ National Health Service (Charges to Overseas Visitors) Regulations 1989
  33. ^ NHS cancer patients 'failing to be correctly monitored' The Guardian
  34. ^ Shock figures from top thinktank reveal extent of NHS crisis The Observer
  35. ^ Danger to patients revealed in reports by 18,000 NHS nurses The Observer
  36. ^ 'Three-quarters of public worried about nurse staffing' BBC
  37. ^ NHS no longer the envy of the world, says independent report BBC
  38. ^ NHS 'worse than average in treating eight common causes of death' The Guardian
  39. ^ "Health spending".
  40. ^ "How the NHS is funded". TheKing'sFund. 15 January 2016. Retrieved 6 June 2016.
  41. ^ "Underfunded, underdoctored, overstretched: The NHS in 2016". 21 September 2016.
  42. ^ "Health care spending compared to other countries".
  43. ^ NHS Choices The NHS in England: The NHS: About the NHS: Overview. Retrieved 22 June 2010.
  44. ^ "The NHS in England". NHS choices. 28 January 2013. Retrieved 27 July 2014.
  45. ^ a b "10 charts that show why the NHS is in trouble". BBC News. 8 February 2017. Retrieved 10 February 2017.
  46. ^ [1]
  47. ^ https://portal.rcem.ac.uk/LIVE/docs/International/6.5.2%20Part-2---The-structure-and-funding-of-the-NHS.pdf
  48. ^ Health unions urge Theresa May to ditch NHS pay cap The Guardian
  49. ^ NHS staff suffer pay cuts in real terms as salaries rise by one per cent The Independent
  50. ^ NHS workers top list of those applying for payday loans The Guardian
  51. ^ Conservatives will break NHS funding pledge, Labour claims The Guardian
  52. ^ 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. {{cite web}}: |last= has generic name (help)
  53. ^ Two-thirds support higher taxes to maintain NHS funding The Observer
  54. ^ Family doctors working 'beyond safe levels', says GPs' leader The Guardian
  55. ^ Patient safety getting worse, say two-thirds of NHS doctors The Guardian
  56. ^ Doctors told to leave UK after Home Office refuses to issue them visas The Independent
  57. ^ NHS intensive care units sending patients elsewhere due to lack of beds The Guardian
  58. ^ Smokers forced to quit on their own after funding cuts The Observer
  59. ^ May must consider tax rises to fund NHS and social care, say MPs The Guardian
  60. ^ Majority of voters back tax rises to bolster NHS The Guardian
  61. ^ NHS 'run ragged' by scandalous underfunding, warns BMA
  62. ^ May's extra cash for NHS is not enough, says spending watchdog The Guardian
  63. ^ a b mamk (23 February 2017). "Brexit gelungenn, Patient tot" (in German). Der Spiegel. Retrieved 23 February 2017.
  64. ^ O'Carroll, Lisa; Campbell, Denis (28 February 2017). "Poll shows 60% of European doctors are considering leaving UK" – via The Guardian.
  65. ^ Marsh, Sarah; Duncan, Pamela (30 March 2017). "Record number of EU citizens quit working in NHS last year" – via The Guardian.
  66. ^ 96% drop in EU nurses registering to work in Britain since Brexit vote The Guardian
  67. ^ Brexit blamed as record number of EU nurses give up on Britain The Guardian
  68. ^ "Medical school places must double by 2030 to meet demand for doctors, college warns". GP Online. 25 June 2018. Retrieved 27 June 2018.
  69. ^ Brexit deal delay could put NHS patients at risk, Tory MP warns The Guardian
  70. ^ Brexit is bad for Britain’s health, doctors say The Guardian
  71. ^ NHS faces staggering increase in cost of elderly care, academics warn The Guardian
  72. ^ https://news.sky.com/story/live-theresa-may-reveals-funding-boost-for-nhs-11407445
  73. ^ https://www.theguardian.com/society/2018/jun/17/theresa-may-nhs-funding-budget-rise-brexit
  74. ^ https://news.sky.com/story/live-theresa-may-reveals-funding-boost-for-nhs-11407445
  75. ^ https://jerseyeveningpost.com/news/uk-news/2018/06/18/nhs-spending-boost-will-increase-burden-of-taxation-says-jeremy-hunt/
  76. ^ May's NHS 'Brexit dividend' claim draws scepticism and doubt The Guardian

Further reading

  • Brady, Robert A. Crisis in Britain. Plans and Achievements of the Labour Government (1950) pp. 352–41 excerpt
  • Gorsky, Martin. "The British National Health Service 1948–2008: A Review of the Historiography," Social History of Medicine, Dec 2008, Vol. 21 Issue 3, pp. 437–60
  • Hacker, Jacob S. "The Historical Logic of National Health Insurance: Structure and Sequence in the Development of British, Canadian, and U.S. Medical Policy," Studies in American Political Development, April 1998, Vol. 12 Issue 1, pp. 57–130.
  • Hilton, Claire. (26 August 2016). Whistle-blowing in the National Health Service since the 1960s History and Policy. Retrieved 11 May 2017.
  • Loudon, Irvine, John Horder and Charles Webster. General Practice under the National Health Service 1948–1997 (1998) online
  • Rintala, Marvin. Creating the National Health Service: Aneurin Bevan and the Medical Lords (2003) online.
  • Rivett G C From Cradle to Grave – the first 50 (65) years of the NHS. King's Fund, London, 1998 now updated to 2014 and available at www.nhshistory.co.uk
  • Stewart, John. "The Political Economy of the British National Health Service, 1945–1975: Opportunities and Constraints," Medical History, Oct 2008, Vol. 52 Issue 4, pp. 453–70
  • Valier, Helen K. "The Manchester Royal Infirmary, 1945–97: a microcosm of the National Health Service," Bulletin of the John Rylands University Library of Manchester, 2005, Vol. 87 Issue 1, pp. 167–92
  • Webster, Charles. "Conflict and Consensus: Explaining the British Health Service," Twentieth Century British History, April 1990, Vol. 1 Issue 2, pp. 115–51
  • Webster, Charles. Health Services since the War. 'Vol. 1:' Problems of Health Care. The National Health Service before 1957 (1988) 479pp online
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