National Health Service

(NHS)

   The publicly funded system of health provision which provides the majority of medical assistance in the UK. Established by Labour in 1948, the NHS was for many years widely regarded as one of the most effective and comprehensive system of health care in the world. It is the largest organisation in Europe. Structural reform has been undertaken by the Thatcher and Blair Governments, designed to change the way in which different organisations within the NHS are organised and relate to each other. Under the present arrangements, the overall strategic direction and matters of standards and targets are set by the Department of Health, which takes political responsibility for the service. It controls 28 Strategic Health Authorities (SHAs), which are the key link between the Department and the delivery of the NHS at the local level. They ensure that national priorities are reflected in local health service plans, oversee all NHS operations in their area and are responsible for improving the quality of services. Within each SHA, there are a variety of NHS trusts that have responsibility for providing the range of NHS services in the community. In addition, several Special Health Authorities provide a health service to the whole of England. These include NHS Blood and Transplants, NHS Direct and the National Institute for Health and Clinical Excellence (NICE).

   Having at first adhered to Tory spending levels, Tony Blair promised to take spending levels on health care nearer to European levels in the new millennium. Labour has put extra money in, with spending being at an unprecedented level, up by £20 billion since 2000, a 40 per cent rise of more than 7 per cent per annum. Yet in 2006 there is renewed concern about the state of the NHS. For all the extra money put in, there remain serious problems. The NHS continues to cause difficult headlines for ministers, with occasional stories of people left on trolleys awaiting treatment, more common stories about people having their treatment indefinitely postponed because of a lack of nurses or hospital beds, problems with computerisation, and alarming and recurring stories of trusts in debt, leading to serious staffing cutbacks.