National Health Service - History and Prospects
The National Health Service was established in 1948, following the enactment of the National Health Service Bill in 1946. The passage of the Act had been overseen by Aneurin (Nye) Bevan, hero of the Labour left, and the NHS became the 'jewel in the Crown' of the Labour Party's post-war achievements. The new NHS brought together a network of private, charitable and local authority hospitals within a single organisation. The founding principle of the NHS was that its services would be universal (i.e. available to all) and freely available on the basis of clinical need not ability to pay. The NHS would be funded by the taxpayer.
When the NHS was established, in the face of stiff opposition from the medical profession, initial thinking was that demand for services would decline as the population became healthier. However, the reality has been that demand for services, and consequently for extra resources, has been inexorable. Technological innovation and medical discoveries have meant that an ever increasing range of conditions can be treated. The public's expectation that this growing list of treatments should be freely available on the NHS has placed tremendous pressure on its resources and led to much debate about the future affordability of a state funded National Health Service.
Public Opinion
Historically, health is a very strong issue for Labour, the party which was responsible for bringing the NHS into being in the 1940s. In spite of determined efforts by the Conservatives under John Major's leadership to reassure the public that the NHS is 'safe in Tory hands' Labour continues to enjoy a consistent opinion poll lead on the issue:
| Best Party on the National Health Service | |||||||
| December 1996 | September 1996 | ||||||
| Con | Lab | LibDem | Don't Know | Con | Lab | LibDem | Don't Know |
| 13% | 65% | L6% | 15% | 10% | 66% | 7% | 16% |
| Source: Gallup, Fieldwork 27.11-2.12 1996; n=1072 | |||||||
Funding of the NHS
Total Department of Health spending in 1996-7 was estimated at £33.1bn. This accounted for about 15% of all public expenditure. Spending has increased in real terms by more than 50% since 1978-79, when the health budget was £8 billion. The National Health Service share of GDP has increased from 4.7% in 1978-9 to 5.9% in 1996 (Department of Health/OECD figures).
The two tables below show Government Expenditure on Health, 1960-94, as % of GDP at current and constant prices:
| At current prices | ||||
| 1960 | 1979 | 1984 | 1989 | 1995 |
| 3.3% | 4.6% | 5.1% | 4.9% | 5.8% |
| At constant prices | ||||
| 1960 | 1979 | 1984 | 1989 | 1995 |
| 5.1% | 5.7% | 5.7% | 4.9% | 5.4% |
Comparative Health Care Expenditure
Spending on healthcare in the UK is relatively low in comparison to some of its international competitors:
| Country | Per Capita Expenditure (US$)* |
| Australia | 1,415 |
| Canada | 1,912 |
| Germany | 1,831 |
| Japan | 1,411 |
| Luxembourg | 1,817 |
| Norway | 1,531 |
| Switzerland | 2,133 |
| UK | 1,181 |
| USA | 3,094 |
| Source: OECD Health Data, CREDES, 1995. * US$ calculated in current US dollars using purchasing power parity exchange rates. | |
Some health policy analysts, however, argue that higher spending does not necessarily mean improved performance.
Private Health Care
The share of healthcare services provided by the private sector in the UK is particularly small in comparison to some of its major competitors:
| Country | Private Provision (%GDP) | Public Provision (%GDP) |
| UK | 1.2% | 5.9% |
| European Union | 1.7% | 6.0% |
| USA | 7.9% | 6.2% |
| Source: OECD | ||
Waiting Lists
The Conservatives have placed great emphasis on reducing the length of time people wait to be treated.
| Patients waiting over 12 months (%) * | ||||||
| Specialty | 1991 | 1992 | 1993 | 1994 | 1995 | 1996 |
| Plastic Surgery | 48 | 27 | 17 | 16 | 7 | 2 |
| Oral Surgery | 21 | 10 | 6 | 6 | 4 | 1 |
| Trauma & Orthopaedics | 20 | 10 | 8 | 7 | 4 | 1 |
| Urology | 20 | 10 | 6 | 6 | 4 | 1 |
| General Surgery | 18 | 9 | 6 | 6 | 3 | 1 |
| Opthalmology | 14 | 9 | 6 | 6 | 2 | - |
| Ear, Nose & Throat | 14 | 8 | 5 | 5 | 2 | 1 |
| Obstetrics & Gynaecology | 10 | 6 | 4 | 4 | 2 | 1 |
| All Specialties | 18 | 9 | 6 | 6 | 3 | 1 |
| *Ordinary (in-patient) and day cases combined. Excludes repeat and deferred waiting lists. data for Northern Ireland include self-deferrals. At March each year. Source: DoH, NHS Scotland, DoH & SS Northern Ireland . | ||||||
The table shows that the Conservatives have been successful in reducing those waiting longer than 12 months for treatment. Over the past 5 years the Government has reduced the longest waits for treatment from 200,000 to just 5,000 as at March 1996. However, DoH figures released on 20 January 1997 showed overall hospital waiting lists in England rose by over 3% to a record high of 1.1 million at the end of December 1996. The increase included a considerable rise in the number of people waiting more than one year, up by 6,900 to 21,900 (a 46% increase).
Length of Hospital Stays
Technological and medical developments have meant that more and more conditions can be treated directly in the primary care sector without recourse to lengthy and expensive periods of hospitalisation. The chart below shows the dramatic decrease in the average length of stay of patients in hospital since 1962, and in the number of inpatient beds per 1000 population:
| 1962 | 1972 | 1982 | 1992 | |
| Average length of stay | 18.7 | 14.1 | 12.4 | 7.6 |
| Number of Inpatient beds per 1,000 population | 10.0 | 9.1 | 8.0 | 5.4 |
| Source: OECD Health Data, Credes, 1995 | ||||