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It is well known that the United Kingdom is a welfare state. A welfare state means a government that provide a range of policy and public facilities so that all citizens can have a good life. However, in terms of the welfare state in the United Kingdom, when the first welfare state was established is a subject of intense debate. The objectives of the welfare state were announced in 1942 by William Beveridge, the architect of the post-war welfare reforms, as the abolition of 'Want, Idleness, Squalor, Ignorance and Disease', by which he meant poverty, unemployment, poor housing, and lack of access to decent education and health care (Abercrombie, et al. 2000, p. 429). The period from 1945 to 1970 is known as the 'golden age' of the welfare state. In terms of health care, it is a significant part of welfare from the past to now.
The National Health Service (NHS) and health system
The most spectacular feature of the welfare state was the National Health Service (NHS) introduced by Bevan in 1946, and coming into effect in July 1948 (Morgan 2000, p. 62). The ideal of the National Health Service was that all citizens could get medical and dental services for free, such as hospitals, doctors, nurses, dentists, ambulance services and other health facilities. To some extent, this aim has been achieved. Nowadays, according to the NHS, most medical treatment is free for British and EU citizens, but people have to pay for prescriptions, dental checks, eye test etc. However, prescriptions are free for children under 16, pensioners and people who have received Social Security benefits. It is reasonable that people are divided into different groups by their age, employment status and income and different groups pay for different payment of medical treatment. National Insurance and taxation provide large amounts of money for the NHS and the UK government have responsibilities for the National Health Service and reform its restructure in order to make the NHS run effectively.
In Britain, there are approximately 35,000 NHS-funded doctors (GPs and non-specialist general practitioners), and most people have their local doctor. That means that about 2,000 patients have a same doctor. Some people compare that they have a long waiting time. On the other hand, patients can benefit from the NHS Direct Service and it is a timesaving way. They can seek help from nurses by the telephone directly. If patients require further treatment or examination, the GP refers them to specialists and consultants, normally at local NHS hospitals or NHS Trusts (Oakland, 2006, p. 195).
Rationale (what is the purpose of your report?):
The impact of the National Health Service on the United Kingdom
There are plenty of effects on the United Kingdom, such as population, infant mortality and expectancy of life. People can live better than before. The NHS also provided many job positions. It is obvious that the number of the population and life expectancy has been rising and infant mortality has been falling since the NHS was established.
General background to your chosen topic:
Before the NHS was established, some British citizens suffer from poor health and cannot afford adequate medical treatment. Although the National Health Insurance (NHI), which provided financial benefit in times of unemployment for insured workers in specified industries, was implemented in the 1940s, dependants - non-working wives and children were excluded from the scheme (Baggott, 2000, p. 38). In order to change this bad situation, Beveridge wrote that 'the purpose of victory is to live in a better world than the old world each individual is more likely to concentrate upon his war effort if he feels that his government will be ready with plans for that better world.' in his December 1942 report (Alderman, 1986, p. 230). On 9 February 1948, Bevan urged ministers and doctors to 'take pride in the fact that, despite our financial and economic anxieties, we are still able to do the most civilised thing in the world: put the welfare of the sick in front of every other consideration' in parliament (NHS Choices, 2008).
The NHS has been reformed several times and the significant changes were happened in 1980S and 1997. In 1980S, the previous system of management in the NHS was replaced by the modern management processes (General Management), which were outline by Griffiths in his report of 1983 (Lowe, 2005, p. 354). The report also recommended that clinicians be better involved in management. In 1988 Prime Minister Management Thatcher announced a review of the NHS and from this review in 1989 two white papers were produced which were 'Working for Patient and Caring for People' (Lowe, 2005, p. 355). In terms of financial problems of the NHS, in 1997 the most relevant issue was that 'fund holder' option was disagreed by the Labour Party at the time. The Labour government came to power with the promise to take the internal market away and abolish fundholding which were beneficial for people, especially the poor patient, so that they could have a medical treatment without a lot of money.
Outline the main argument with key and supporting ideas:
The impact of the NHS on the population
According to the table 1.1 (Appendix A), the population of UK rose from almost 56 million in 1971 to over 61 million in 2008, which was a remarkable increase of about 5 million people since introduction of the National Health Service between 1971 and 2008. As the table 1.1 (Appendix A) shows, there was a change in different age distribution of the population since 1971, with a large growth in the percentage of older people aged 75 years and over, whose rose from 4.7 per cent of the population in 1971 to 7.8 per cent in 2008.
The impact of the NHS on infant mortality
As the table 1.2 (Appendix A) and figure C (Appendix B) show that the number of infant death decreased stably from 7,899 to 3,284 between 1980 and 2008 in England and Wales. There was a long-term reduction trend in childhood death in all ages (from 1 years old to 14 years old) in England and Wales between 1980 and 2008. At the same time, the death rates among early neonatal death, neonatal and post-neonatal declined steadily in England and Wales.
The impact of the NHS on expectancy of life
According to the table 1.3 (Appendix A), for the latest three years period life expectation at birth in England and Wales was about 81.6 years for females and approximately 77.5 years for males. The expectancy of life has increased steadily from around 77.0 years for females and almost 71.0 years for males in 1981. The average life expectancy in Northern Ireland at people who are 70 years old was 9.7 years for males and 12.8 years for females in 1981, and there was an increase from 13.2 years for males and 15.7 for females in the same area 2007. As the table 1.3 (Appendix A) shows, there were some increases in different period expectation of life at birth and selected ages both male and female in all regions of UK.
The British citizens' attitudes towards current state of the NHS
MORI polls in 2005 consistently reported that a majority of British worried about the National Health Service, although the Labour government took some effective action to improve the NHS, such as investing in patient care, rising standards of living and medicine and updating medical facilities. Respondents believed that the government provided with amount of money to improve the National Health Service and medical resources, but there has not been a great improvement (see Figure D). They do not consider that the NHS is as well run as other institutions and there has been growing support for a comprehensive, better-funded and more efficient state health care service (John, 2006, p. 206).