You will be expected to know about
the NHS for your
Medical School interview – and also because it’s likely that you’ll
work for the NHS once you qualify. Don’t forget to read up on the
structure of the NHS and
hot topics too.
What is the NHS?
The National Health Service (NHS) is the publicly-funded healthcare system of the United Kingdom. It is made up of four semi-independent systems:
The NHS is part of the welfare state which was fostered by the Labour Government that came into office in 1945. It was created by the National Health Service Act 1946 — the brainchild of pioneering Health Minister Aneurin Bevan.
It was one of Bevan’s founding principles that the NHS should be funded by general taxation as well as National Insurance contributions. It’s the reason why health services (like going to the doctor, having surgery or being treated in hospital) are free at the point of use in the United Kingdom.
Countries without free healthcare normally fund their healthcare systems privately, often through personal health insurance. Private healthcare does exist in the UK, but only accounts for a very small amount of healthcare provision.
What was Healthcare like Before the NHS?
In 1911, Prime Minister David Lloyd George introduced the National Insurance Act. This Act was designed to partially fund healthcare for working people. A small amount was deducted from weekly wages, and together with employer and government contributions, this meant that the worker was entitled to medical care, retirement and unemployment benefits.
However, medicines still had to be paid for. And since women and children were much less likely to be legally employed, they were mostly not entitled to free medical care — a major flaw in the system.
Various calls for state-subsidised healthcare were made by politicians over the years, although there was also much opposition to the idea, including from the British Medical Association.
Who was Aneurin Bevan?
Aneurin Bevan was a Labour politician who was Minister of Health for the post-war Clement Attlee government from 1945 to 1951.
He was the architect of the NHS, driven by his strong belief that ‘no society can call itself civilised if a sick person is denied medical aid because of lack of means’.
But many others contributed to its formation, including his predecessor Henry Willink. Willink wrote the 1944 White Paper laying out the founding principles of a National Health Service in the UK which are still in place today.
What are the Founding Principles of the NHS?
In his White Paper, Willink declared that NHS services should be:
- Free at the point of use
- Financed from general taxation (as opposed to National Insurance contributions)
- Available to all, so everyone is eligible for free care, including temporary residents and visitors to the UK
The NHS Constitution
In 2011, the Department of Health published the NHS Constitution, underpinned by the original founding values. As part of the constitution, seven key principles were derived, coupled with research into the views of NHS staff, patients, and the public.
The Secretary of State for Health and all NHS services are legally obligated to consider this Constitution in any decisions or actions. It’s renewed every 10 years, with input from patients, staff and the public.
The seven key principles in the NHS Constitution are:
- The NHS provides a comprehensive service available to all. The NHS has a duty to equally provide for the health needs of any individual, regardless of their wealth, religion, gender, race, age, disability, sexual orientation, pregnancy or marital status. It is the aim of the NHS to focus on the healthcare of sectors of society who experience a lower standard of care.
- Access to NHS services is based on clinical need, not an individual’s ability to pay. NHS services are free of charge at the point of delivery and financed instead through taxation. Neither patients nor medical professionals need to focus on financial matters, allowing everyone to concentrate on healthcare and recovery. Only in limited circumstances sanctioned by Parliament will an individual have to pay.
- The NHS aspires to the highest standards of excellence and professionalism. Patients should receive care provision of the highest quality, staff should obtain high-calibre training, education and professional support, and there should be ample research into the latest technology and practices. Everyone involved with the NHS should be treated with respect, compassion, dignity and care.
- The NHS aspires to put patients at the heart of everything it does. Patients, families and carers should be the focal point of the NHS structure. Wherever possible, patients should be included and consulted on all decision appertaining to their care. The NHS should also support patients to promote and manage their own health. Feedback must be listened to and, when appropriate, actioned to improve its services.
- The NHS works across organisational boundaries. The NHS must work in partnership with other organisations to prioritise patients, local communities and the wider population. Conversations between its constituents is encouraged, as is the sharing of data and new initiatives. Links with external partners are also incredibly valuable, such as the relationship between NHS organisations and local education authorities, which allow remote vaccination sessions (such as the BCG vaccine).
- The NHS is committed to providing the best value for taxpayers’ money. The NHS aims to provide the most effective, fair and sustainable use of finite resources. All public funds for healthcare must be used for the people that the NHS serves. However, with an ever-expanding, ageing population, many services are closing or becoming privatised as costs exceed finances.
- The NHS is accountable to the public, communities and patients that it serves. As the organisation’s funders, the taxpaying public have a right to access records of NHS spending, and the NHS must aim for complete openness in its activities. The government sets the framework for the NHS and is accountable to Parliament. As most decisions within the NHS often take place in local NHS authorities and by patients with clinicians, there should be a responsibility for transparency to the public, staff and patients.
View the updated NHS Constitution published in 2021.
