“Health is a state of complete
physical, mental and social well-being and not merely the absence of disease or
infirmity” (WHO, 1946). Health can be defined from a variety of different
perspectives and dimensions, for example, physical, mental, social and
spiritual dimensions of health all contribute towards defining the term.

the 1940’s, England’s health was at an all-time low. The Second World War claimed the lives of nearly 500,000 Britons, causing
the death of three per cent of the world’s population. Post war
trauma meant that food was still rationed, a dollar economic crisis and fuel
shortage were still present. The Beveridge Report (1942) encouraged state
intervention to tackle the 5 giant evils of want, disease, ignorance, squalor
and idleness. Resulting in the birth of the Welfare state. The state
aims to protect the health and well-being of its citizens. Whether that be supporting
individuals financial needs or social needs. Support is provided by means of pensions,
grants, and similar benefits. 

The NHS was founded by Aneurin Bevan in July 1948, a
period when huge development’s empowered by the second world war occurred
(Rivett, 1998). The pharmaceutical business was making a surge of new
medications. Antibiotics and anaesthetic agents became easily accessible. The NHS
was created out of a long-held ideal that good healthcare should be
available to all, regardless of wealth. The three core principles include that
the NHS meets the needs of everyone, that it be free at the point of delivery
and that it be based on clinical need, not the ability to pay.


With the NHS being one of the proudest achievement of our modern
society, it is expected that there are some drawbacks. Unaware to Bevan (1948),
the NHS was set to face many challenges in its life time. In 2017, the pressure on the NHS is at an all-time high. With NHS
bursaries due to be scrapped in August this year, and Brexit on the horizon,
the healthcare sector has become more challenging than ever. Challenges facing
the NHS include rising living costs and an aging
population. The Nuffield Trust (2014) estimates that the ever ageing and growing
population will require another 17,000 hospital beds by 2022. Similar challenges
include the high accident and emergency demand, increasing
diversity and migration, health sector staffing shortages, marketization,
neoliberalism and austerity. In 2016, 3,216 more
people attended accident and emergency each day than in 2015 (House of Commons
Library, 2017).

The Health and Social Care Act
was introduced in 2010 with the intent to liberate the NHS. Changing the way
that health care is commissioned and provided proved to be controversial.
According to the Government, the Health and Social Care Act 2010 ‘puts
clinicians in the centre of commissioning, freeing up providers to innovate,
empower patients and give a new focus to public health’ (Edwards, 2013). The
aim of the act was to tackle financial constraints and the challenge of meeting
the future demands of the current populations. A wide range of issues affecting
the delivery of health and social care services where to be amended in hope for
improvement within this act. With the introduction of clinically led
commissioning groups, the Act puts clinicians in charge of shaping services,
enabling NHS funding to be spent more effectively. Previously clinicians in
many areas were frustrated by negotiating with primary care trusts to get the
right services for their patients.

The Health and Social Care Act 2012 allowed a greater voice
for patients by establishing new Healthwatch patient organisations locally and
nationally to drive patient involvement across the NHS. With higher public involvement
available, the Act also provides the underpinnings for Public Health England, a
new body to drive improvements in the public’s health.

The NHS five year forward view (Forward View), published by
NHS England and other national NHS bodies (2014), sets out a shared view on how
services need to change and what models of care will be required in the future.
The key arguments presented by the forward view are that much more attention
should be given to prevention and public health; patients should have far
greater control of their own care; and barriers in how care is provided
should be broken down.  Main aims of the five year
forward view include a radical upgrade in prevention and public health;
in particular national action on obesity, smoking, alcohol, and new workplace
incentives. Providing individuals with greater control of their own care, with
much greater support being provided for the 1.4 million full time unpaid carers
in England. Attention to be provided upon breaking down the barriers in how
care is provided between doctors and hospitals, between physical and mental
health, and between health and social care. Whilst moving towards “triple
integration” to support people with multiple health conditions, not just single
diseases. Addressing that a simple “one size fits all” approach will not work,
instead a small number of radical new care delivery options. Including the Multispeciality
Community Provider and Primary and Acute Care Systems.

Within the Five Year
Forward View, urgent and emergency care services will be redesigned to integrate between A departments, general practitioner out-of-hours services, urgent care centres, NHS 111 and ambulance services. Also, The NHS will aim to provide a lot more support for frail older individuals living in care homes. A new deal for GPs, GP-led
Clinical commissioning groups will have management over the wide NHS budget, enabling a shift in investment from acute to primary and community

One particular aim of
the Five Year Forward View is that of improving the employment of technology and innovation and empowering native leaders to drive this. Developing new ‘test bed’ sites
for worldwide innovators and new ‘green field’ sites where completely new NHS services are going to be designed from scratch. This technology based aim will contribute
to closing the gap in care and quality identified within the Five Year Forward

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