How is the NHS structured in the UK?
The NHS is the UK’s Government-funded medical service. We will describe its main services then a bit about how it works and is funded.
It is led by the Department of Health and Social Care (DHSC), and its Secretary of State. Examples of NHS services include:
- Visiting a GP, nurse or other health professional at a GP’s surgery
- Hospital treatment including operations – led by consultants, who are supported by registrars and junior doctors
- Mental health and disability – through your GP, counsellor (IAPT) and hospital-based psychiatrist (doctor)
- Maternity and midwives – if you are pregnant
- Getting urgent help – e.g. ambulance service (including hospital transport), NHS111, A&E, Urgent Treatment and Walk-in Centres, and Minor Illness/Injury Unit – and hospital transport
- Health services for prisons, schools and the armed services
- NHS ‘Arms Lengths Bodies’ – e.g. UK Health Security Agency (UKHSA), National Institute of Health and Care Excellence (NICE), Care Quality Commission (CQC), Health Education England (HEE), NHS Digital
- Some aspects of social care
- Research.
But what is the NHS?
Let’s look at the word ‘NHS’ ..
1. National. While the NHS covers all four constituent nations of the United Kingdom. It has taken different routes in each nation.
There’s more than one NHS in the UK, as the responsibility of health care has been passed from the UK government to the Scottish Government, Welsh Government, and Northern Irish Assembly. NHS England, NHS Wales (GIG Cymru), and NHS Scotland provide health care services in Great Britain.
The publicly funded health care service in Northern Ireland isn’t officially called the NHS, it’s actually called Health and Social Care Services (HSC).
2. Health. When the NHS was founded in 1948, male life expectancy at birth was 66 years. In 2020, it was 81. With this demographic transition comes an increased burden of chronic disease.
Our ideas of health have similarly altered to include a more holistic account of health, supplementing physical fitness with mental, social, and spiritual wellbeing.
3. Service. What it means for the NHS to serve its public has changed over the course of its existence. Are the people sitting in the waiting room patients, clients, service users, or well-informed customers?
The NHS in England has a Constitution that describes the rights of patients and staff. It was last updated in January 2021.
Free at the point of use (delivery)
According to the Full Fact website, “People often refer to these health services as ‘free at the point of use (or delivery)’. This means that any UK resident can, for example, go and see a doctor who will offer diagnosis or treatment for an illness without asking the individual to pay for this service during or after the visit.
Each NHS organisation provides health care services free at the point of delivery. But there are slight differences in what is fully funded by government and what services are available across the different UK countries.”
=NHS England, for example, asks some people to pay part of the cost of prescriptions, dentistry and optometry. Whereas, in Wales, Scotland, and Northern Ireland prescription costs are paid for by the government.
NHS Number
All UK citizens are given a ‘NHS Number’ at birth. Your NHS number is a 10 digit number, like 485 777 3456. This is how to find it.
Is the NHS really free?
No. The services described above are not cheap, and the NHS is not free.
If we add the funding for the three nations, the cost of the NHS in the UK is about £180 bn per year, which is 10% of GDP. This is in line with other developed countries.
NHS England runs the NHS in England for the DHSC. It receives the largest amount (£113 billion), as it has the biggest population. £108 billion of this budget was allocated to the 42 Integrated Care Systems (which took over from CCGs in April 2022).
Of the DHSC’s ‘arms lengths bodies’, the largest in terms of investment, are UKHSA (public health) and Health Education England (HEE) – receiving £4.0 and £4.4 billion respectively.
NHS Digital was merged into NHSE in February 2023.
HEE was merged into NHSE in April 2023, and HEE become the new Workforce, Training and Education Directorate within the NHS England organisation.
NHSE retains around a quarter of the budget for other responsibilities, including about £30 billion in 2022/23 for ‘Specialised Commissioning’ (about 17% of the NHS budget). This funds, for example, rare and expensive diseases like dialysis, transplantation, cardiac surgery. The rest funds other services (e.g. NICE, CQC, prisons and armed services), and itself.
How is the NHS funded?
The NHS is funded via general taxation, National Insurance and user charges. General taxation accounts for most of the funding (81%) whilst National Insurance provides 17.9%, and patient charges (prescription and dental) 1.2%. The amount of funds allocated to the NHS each year is determined by central government.
The government distributes these funds to the DHSC (for England) and the NHS in Scotland, Wales and Northern Ireland. In 2018/19 health services expenditure per head was highest in Northern Ireland per year (£2,436) and lowest in England (£2,269). Funds are distributed to the devolved nations according to the Barnett Formula.
Most would consider these prices as good value for money, especially when compared to the USA, where the average cost of private health insurance, which most people have, is about £4,000 a year. In the UK, it is estimated about 10% of the population is covered by private medical insurance, but most use the NHS as their primary provider.
Early history of the NHS
1910. Origin of the phrase ‘NHS’. Dr Benjamin Moore was probably the first to use the words ‘NHS’ in The Dawn of the Health Age. He established the State Medical Service Association in 1912, replaced by the Socialist Medical Association in 1930.
1911. National Insurance Act 1911. Previously, systems of health insurance consisted of private schemes such as friendly societies or welfare societies. But in 1911, David Lloyd George (then Chancellor of the Exchequer) created a system whereby a small amount was deducted from weekly wages, supplemented by contributions from the employer.
Under this Act, all eligible working males could register with a GP. GPs who took part in this scheme were called ‘panel doctors’ and received an annual ‘capitation’ fee; a funding mechanism still used today. This was a very important act and in some ways, the real ‘birth’ of the NHS, not 1948. For the first time, central government finance was used to provide medical care for the people.
1942. The Beveridge Report identified ‘five giants on the road to post-war reconstruction’ – Want, Disease, Ignorance, Squalor and Idleness. Tackling these giants was a primary focus of the post-war government’s social programme; and has remained important throughout the second half of the 20th century, and 21st century.
1948. As part of this programme, Britain’s first majority Labour government, in 1945, led by Clement Attlee, formulated plans for a comprehensive Welfare State. A free at point-of-delivery NHS was the cornerstone of these plans. The chief architect of the NHS was Labour Minister of Health, Aneurin Bevan. On 5 July, he launched the NHS at Park Hospital in Manchester (Trafford General Hospital).
Summary
We have described how is the NHS structured in the UK. We who work in it, are very proud to do so. But we are aware of its strengths and weaknesses, and promise to work harder on the latter, on your behalf.
