The NHS For Beginners project is intended to help more people get involved in their local NHS. Most people have very little idea about how the NHS is organised.  We plan to run classes across England directed at people who are not currently involved in the NHS.  We will do our best to be factual and unbiased.  Of course we hope that people will get fired up to join campaigns, but these sessions are intended to be educational and open to people from any political persuasion or none.

Our syllabus needs to be flexible, because different audiences will want to know more about some aspects than others. This is intended to be a reasonably comprehensive list of what we think people should know, but any individual group may want to know more about one part than another.  The plan is to deal with the situation as of April 2013, and not to complicate matters by talking too much about what went before.

What is the NHS in England?

Arrangements in Scotland, Wales and Northern Ireland are different. Even more different in the isle of Man and the Channel Islands.

Official explanation of the structure

  • The NHS logo
  • The Pension Scheme
  • The Buildings
    • Propco
    • PFI
    • The Staff(numbers at September 2011) 1,350,377 (1,148,844 Full time equivalent)
      • Doctors and dentists:  105,711 Hospital and Community Health Service Medical and Dental Staff,  including 39,088 Consultants, 39,780 GPs,
      • Nurses:  370,327 qualified nurses
      • Managers: 38,214 managers & senior managers,
      • Qualified Scientific, Therapeutic & Technical staff: 152,216
      • Unqualified staff: 347,064 support to clinical staff, 219,624 staff within NHS Infrastructure Support (this includes managers)
    • Contracts

Principles

NHS Constitution

  • Free
    • Charges The current prescription charge is £7.65. A 12 month certificate is £104.00 and saves money if 15 or more items are needed in 12 months. In Scotland, Wales and Northern Ireland there is no prescription charge. Help with optical charges for spectacles and lenses is provided by means of vouchers.
    • Travel Costs
    • Social Care
    • Continuing Healthcare
  • Comprehensive
  • Universal
  • Choice

Where does the money come from?

When the NHS was launched in 1948 it had a budget of £437 million (roughly £9 billion at today’s value). For 2011/12 it is around £106 billion – about £2000 per preson.

  • Taxation
  • National Insurance: The 1911 National Insurance Act  set up the first publicly funded healthcare in the UK.  All workers who earned under £160 a year had to pay 4 pence a week to the scheme; the employer paid 3 pence, and general taxation paid 2 pence. The insured workers were then eligible for free medical treatment from a panel doctor. Some of the National Insurance fund still goes to the NHS, but since 1948 there has been no link between contributions and health benefits.
  • Charges:  NHS charges are collected by NHS contractors, but the money goes into the central funds, not the contractors pocket
    • Prescriptions: Charges come to about £420 million a year – about 6% of the total drugs bill
    • Teeth Dental charges bring in about £570 million per year – about 30% of the cost of the services
    • Eyes: There are no NHS charges for optical services, but free services are targeted.
    • Commercial Income

Where does the money go?

Historical account of income and expenditure

  • Institutions
    • NHS Commissioning Board
    • Foundation Trusts  Foundation Trust Network
    • NHS Trusts – the old way of doing things
    • Primary Care:  Most patient contacts – probably 90% are with primary care, and most of the providers are self employed contractors, not NHS employees.
      • GPs
      • Dentists
      • Opticians
    • Special Health Authorities
    • Voluntary: NHS spends around £3.39 billion per year on health services provided by voluntary and community organisations.
    • Commercial
  • Services
    • Primary
      • GPs
      • Dentists
      • Opticians
      • Pharmacists
      • Ambulances
      • Casualty
    • Secondary
    • Tertiary
    • Regulatory
  • Interventions
  • Age
    • Birth
    • Children
    • Working population
    • Elderly
    • Mortality from 1841 to 2005

      Mortality from 1841 to 2005

Who is accountable?

  • Nationally
    • NHS Commissioning Board
    • Regionally
      • Clusters
    • Locally
      • Health and Well Being Boards
      • Clinical Commissioning Groups
      • Foundation Trusts
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6 Comments

  1. Hannah Cooke says:

    Under Principles maybe there should also be something on democracy and voice

    1. socadmin says:

      I’m not sure we can say that is a principle, or that it happens. This is supposed to be a description of the NHS as it is, not as we would like it to be.

  2. Arun says:

    Also, training- the NHS contributes to the training of junior doctors and nurses. Hugely important function that wasn’t thought about in the initial drafts and is still unclear currently.

  3. socadmin says:

    Hmm. We should include that somewhere. I am sure most patients are quiet conscious of it.

  4. Hester Dunlop says:

    Also need to include public health if only to say where it will move to .
    Need to add administration under cost .
    ? Community staff as a separate group or type of intervention ie health visitors, school nurses,

  5. socadmin says:

    All these are things councillors will be very interested in, and they are a target group. But my impression is that the organisation, funding and provision of community staff varies enormously from place to place, and that its continually being reorganised. It may be very hard to give a clear picture.

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