National Health Service (England)

National Health Service (England)

The National Health Service (NHS) is the publicly funded healthcare system in England. It is the largest and the oldest single-payer healthcare system in the world. It is able to function in the way that it does because it is primarily funded through the general taxation system, in a similar fashion to the funding model for fire departments, police departments, and primary schools. The system provides healthcare to anyone normally legally resident in England, and also any other part of the United Kingdom (should a person from another UK area be travelling in England, for example), with almost all services free at the point of use for all such people.

The idea of the NHS being free at the point of use is contained in its core principles from the original NHS set-up, which are non-negotiable at their root but have variously been open to some interpretation over the years. In practice, "free at the point of use" normally means that anyone legitimately fully registered with the system (i.e. in possession of an NHS number), including UK citizens and legal immigrants, can access the full breadth of critical and non-critical medical care without any out-of-pocket payment of any kind. Some specific NHS services do however require a financial contribution from the patient. Since 1948, patients have been charged for some services such as eye tests, dental care, prescriptions, and aspects of long-term care. However, these charges are often lower than equivalent services provided by a private health care provider.

In addition to the range of medical services available to legal residents and citizens of the UK, the NHS also provides free emergency care to those within UK borders, regardless of their legal status or national origin. People of questionable legal status or a different national origin who do not have the legal right to be in the UK long-term — including legitimate travellers and tourists from abroad — are not entitled to the full NHS, but are entitled to emergency care in an accident and emergency department without having to pay.

The NHS has further agreed a formal constitution which sets out the legal rights and responsibilities of the NHS, its staff, and users of the service and makes additional non-binding pledges regarding many key aspects of its operations.

The current primary legislation is the National Health Service Act 2006, but the controversial Health and Social Care Act 2012, whose provisions include allowing private companies to provide health care under the auspices of the NHS, will come into effect in April 2013. NHS Trusts are responding to the "Nicholson challenge" which involves making £20 billion in cuts across the service by 2015.

The NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare, ophthalmology and dentistry. The National Health Service Act 1946 came into effect on 5 July 1948. Private health care has continued parallel to the NHS, paid for largely by private insurance: it is used by about 8% of the population, generally as an add-on to NHS services. In the first decade of the 21st century, the private sector started to be increasingly used by the NHS to increase capacity. According to the BMA, a large proportion of the public opposed this move.

The NHS is largely funded from general taxation (including a proportion from National Insurance payments). The UK government department responsible for the NHS is the Department of Health, headed by the Secretary of State for Health. Most of the expenditure of The Department of Health (£98.7 billion in 2008-9) is spent on the NHS.