1. Describe the reasons why the NHS was established
   1. Welfare State: Beveridge's Five Giants
      1. Want
         1. National insurance act
      2. Disease
         1. NHS
      3. Ignorance
         1. Education act
      4. Squalor
         1. New Towns act
      5. Idleness
         1. employment including nationalisation
2. Describe the main structures, functions and fundings of the NHS
   1. Functions
      1. have generally remained the same
      2. 'to provide the service free of charge and to encourage a new attitude to health - the easier obtaining of advice early, and the promotion of good health rather than only the treatment of bad'
      3. 'to ensure that everybody in the country - irrespective of means, age, sex and occupation - shall have equal opportunity to benefit from the best and most up-to-date medical and allied services available.. a comprehensive service.
      4. to improve health of people of Scotland by:
         1. preventing illness
         2. encouraging and maintaining healthier lifestyles
         3. providing care closer to patients
         4. securing hospital services of the highest quality
         5. improving the quality and effectiveness of healthcare interventions
         6. making effective use of available resources
   2. Fundings
      1. constantly an issue
      2. basic principles
         1. free, universal, comprehensive
      3. ... but became too costly to provide everything to everyone...
         1. Charges
            1. = prescriptions
         2. Rationing
            1. delay and deterrence
            2. presence of queues/waiting lists/limited access
            3. denial
            4. prioritising services, not fundint others
            5. dilution
            6. of quality
            7. deflection
            8. by referral to another agency
         3. Managerial/Clinical Efficiencies vs. medical/clinical autonomy and local interests
            1. resulted in hospital closures
            2. and staff substitutions
         4. Market incentives/competition
            1. fundholding
            2. Private Finance Initiative
      4. largely tax funded
      5. minor contributions from direct payments
      6. NHS owned by state
      7. payment of doctors increasingly performance related
   3. Structures
      1. is constantly changing
      2. differences in structures between Scotland and England are increasing
      3. Services you can access:
         1. GP
         2. GP refer patients to hospital (can't self- refer)
         3. Hospital A&E in emergency only
         4. NHS 24 (Scotland) , NHS Direct (England)
         5. Walk- in clinics
3. Review of relative merits and disadvantages of NHS
   1. UK = higher than average on health expenditure (OECD 2011)
   2. higher Life expectancy (m+f) and lower infant mortality rate in UK than USA and Turkey but lower Life expectancy (m+f) and higher infant mortality rate than Sweden
   3. US: direct consumer service/ private insurance health care services owned by a variety of agencies fee for service paid direct then reclaim from insurance company UK: largely state funded
   4. effectiveness
      1. no clear advantages/ disadvantages between different systems of health service finance and organisation in terms of mortality
      2. overall national GDP more of predictor of LE than expenditure on health care
      3. differentials in come distribution between different and within countries
         1. life expectancy longer in more equal rich countries (where income gap is smaller) (Wilkinson & Pickett 2009)
         2. same principle applied to mental illness and childcare
      4. theory : market system more efficient as competition forces providers to operate at low prices/costs to attract purchasers
         1. but...
            1. over doctoring
            2. passing costs to others
            3. high costs of admin
            4. health insurance not perfect market
            5. unequal
            6. access
            7. inequalities in health generally less extreme in state funded as compared to private health care systems
            8. national system 'excludes' people by delaying provision of medical care through waiting lists
      5. social acceptability
         1. private sector provides more consumer choice
         2. most surveys of patient/public satisfaction tend to reveal few significant differences between countries and systems
         3. private encourages litigation
   5. Summary
4. NHS in general
   1. NHS act passed
      1. 1946
   2. NHS established
      1. 1948
   3. Main Principles
      1. Free
         1. provision of care based on need and not ability to pay
      2. Universal
         1. everyone is covered
      3. Comprehensive
         1. all services are provided