“Health is a state of completephysical, mental and social well-being and not merely the absence of disease orinfirmity” (WHO, 1946). Health can be defined from a variety of differentperspectives and dimensions, for example, physical, mental, social andspiritual dimensions of health all contribute towards defining the term. Inthe 1940’s, England’s health was at an all-time low. The Second World War claimed the lives of nearly 500,000 Britons, causingthe death of three per cent of the world’s population. Post wartrauma meant that food was still rationed, a dollar economic crisis and fuelshortage were still present. The Beveridge Report (1942) encouraged stateintervention to tackle the 5 giant evils of want, disease, ignorance, squalorand idleness.
Resulting in the birth of the Welfare state. The stateaims to protect the health and well-being of its citizens. Whether that be supportingindividuals 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, aperiod when huge development’s empowered by the second world war occurred(Rivett, 1998). The pharmaceutical business was making a surge of newmedications. Antibiotics and anaesthetic agents became easily accessible. The NHSwas created out of a long-held ideal that good healthcare should beavailable to all, regardless of wealth.
The three core principles include thatthe NHS meets the needs of everyone, that it be free at the point of deliveryand that it be based on clinical need, not the ability to pay. With the NHS being one of the proudest achievement of our modernsociety, 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 NHSbursaries due to be scrapped in August this year, and Brexit on the horizon,the healthcare sector has become more challenging than ever. Challenges facingthe NHS include rising living costs and an agingpopulation.
The Nuffield Trust (2014) estimates that the ever ageing and growingpopulation will require another 17,000 hospital beds by 2022. Similar challengesinclude the high accident and emergency demand, increasingdiversity and migration, health sector staffing shortages, marketization,neoliberalism and austerity. In 2016, 3,216 morepeople attended accident and emergency each day than in 2015 (House of CommonsLibrary, 2017).The Health and Social Care Actwas introduced in 2010 with the intent to liberate the NHS. Changing the waythat health care is commissioned and provided proved to be controversial.According to the Government, the Health and Social Care Act 2010 ‘putsclinicians in the centre of commissioning, freeing up providers to innovate,empower patients and give a new focus to public health’ (Edwards, 2013).
Theaim of the act was to tackle financial constraints and the challenge of meetingthe future demands of the current populations. A wide range of issues affectingthe delivery of health and social care services where to be amended in hope forimprovement within this act. With the introduction of clinically ledcommissioning groups, the Act puts clinicians in charge of shaping services,enabling NHS funding to be spent more effectively. Previously clinicians inmany areas were frustrated by negotiating with primary care trusts to get theright services for their patients.
The Health and Social Care Act 2012 allowed a greater voicefor patients by establishing new Healthwatch patient organisations locally andnationally to drive patient involvement across the NHS. With higher public involvementavailable, the Act also provides the underpinnings for Public Health England, anew body to drive improvements in the public’s health.The NHS five year forward view (Forward View), published byNHS England and other national NHS bodies (2014), sets out a shared view on howservices 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 attentionshould be given to prevention and public health; patients should have fargreater control of their own care; and barriers in how care is providedshould be broken down. Main aims of the five yearforward view include a radical upgrade in prevention and public health;in particular national action on obesity, smoking, alcohol, and new workplaceincentives. Providing individuals with greater control of their own care, withmuch greater support being provided for the 1.4 million full time unpaid carersin England. Attention to be provided upon breaking down the barriers in howcare is provided between doctors and hospitals, between physical and mentalhealth, and between health and social care.
Whilst moving towards “tripleintegration” to support people with multiple health conditions, not just singlediseases. Addressing that a simple “one size fits all” approach will not work,instead a small number of radical new care delivery options. Including the MultispecialityCommunity Provider and Primary and Acute Care Systems. Within the Five YearForward 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-ledClinical commissioning groups will have management over the wide NHS budget, enabling a shift in investment from acute to primary and communityservices. One particular aim ofthe 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’ sitesfor worldwide innovators and new ‘green field’ sites where completely new NHS services are going to be designed from scratch. This technology based aim will contributeto closing the gap in care and quality identified within the Five Year ForwardView.