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Reforming The National Health System In Uk In 1990. Sucess Or Failure ?

1871 words - 8 pages

REFORMING THE NHS IN THE 1990s . SUCCESS OR FAILURE ?The health care system of many countries throughout the developed world are being reformed and restructed. In the current ferment of change and experimentation, the British Health service is in the forefront. A pioneering concept in 1948, the NHS remained the prime example of a centrally planned and funded public health servive. In 1990 it again pioneered a new model of organising and delierening health services.By the late 1980s, the NHS was suffering from a severe lack of resouces. This was the result of three factors. Firstly, becouse of the policies of the government ,which was cutting back on public expenditure. Secondly, becouse of ...view middle of the document...

This idea of competition between hospitals and community care units was the basis for the NHS and Community Care Act of 1990. The NHS reforms, which came into effect in 1991, aimed to give patients, wherever they lived in Britain, better health care and greater choise of service. Therefore the concept of the internal market was introduced, according to which, the 'providers' of healthcare were to be separated from the ' purchasers ' of healthcare. The idea was that by giving the purchasers the freedom to choose where to buy the best care , including the private sector, the system would place competitive pressure on the providers to offer greater quality, efficiency and value for money.Fundamental changes had to be made to the traditional relationship between the various parts of the NHS to make the new system work. Health authorities ceased to run the service directly and become purchasers of healthcare from a range of providers ( hospitals,community services, ambulance services ) who, in turn, were given the opportunity of becoming NHS Trusts. They were to be self- governing bodies with the freedom to decide things like staff numbers, rates of pay and what to charge for their services. Though independent of local health authority control, trusts remained part of the NHS. They had to provide a range of care accident and emergency services, but can choose which other services to concentrated on.A central role in the new system was reserved for family doctors who, for the first time, were offered budgets to buy a range of services for their own patients, such as non- emergency surgery, out-patient treatment and specialist nursing care. Familly doctors who had more than 7,000 patients on their books could become 'funholders' and negotiate annual contracts with providers of healthcare, making them competitors with health authorities as purchasers of healthcare.To those who supported the reforms, like some of the fundholders themselves, this meant unprecedented freedom to obtain the best for patients, control budgets and shape what hospitals did. Opponents believed that it was creating a two-tier system, in which patients of fundholders, and which placed fundholders under pressure to buy cheap care before effective one.The reforms introduced in 1990 were never widely understood and have never won public support. The introduction of a market element have led to fears that commercial considerations will take precedence over medical ones and that the NHS is being broken down in favour of private health care. And certainly, although pride and confidence in the NHS was fairly strong, it was decreasing. There had been a steady rise in the number of people paying for private medical insurance. Opinion pools indicated that the majority of people would prefer the service to continue without any changes but to have more funds provided for it ( Broomhead, 1993, p. 127). Also within the NHS many staff were bewildered, confused and deeply worried about the...

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