Talk:National Health Service (England)/Archive 1

Old text
I think this should be reverted to the page on the British National Health Service, and make that page a redirect to here. So many pages link to this on the assumption that it's the British NHS. Also, the first paragraph of the current page is very hard to parse.

Also also, is there a term that means something like "national health service" that we could use as the name for the page that's currently here.

-- Evercat 21:15 May 3, 2003 (UTC)


 * National Health Services are in another countries than UK.On the other hand, it´s interesting remark that only the resident people in the country or territory automatically belongs to the NHS:


 * National citizens can reside in another country and are not covered by the NHS.
 * Foreign citizens can reside in the country and have right to the health protection.

This is the universal coverage.

The difference with the social security system ít´s every resident has right, nevertheless s/he is not a worker paying or not to the Social Security (NHS recieves the money from general taxation, like VAT and so on).

The British NHS should be moved to this page. Other countries do not use the capitalised term 'National Health Service'. A quick google search using the term for sites with .ie, .es and .se domains were all referring to the British NHS. Mintguy 18:11, 12 Sep 2003 (UTC)

I would second that, the term National Health Service is a particularly British term, and is not used in any other country but Britain G-Man 18:15, 12 Sep 2003 (UTC)
 * I thought it was also used in Jamaica(?) Dainamo 11:53, 28 Nov 2004 (UTC)

I've moved the content. I placed the old content of this page on Talk:Publicly funded medicine as that article (and Socialized medicine) has some overlap Mintguy 19:14, 27 Dec 2003 (UTC)

Situation with family doctors less simple than portrayed
Most GPs (family doctors, generalists) are self-employed, and the NHS _contracts_ with them, but not exclusively. — Preceding unsigned comment added by 82.152.46.201 (talk) 03:03, 27 December 2004 (UTC)

Style points
"Before 1948, health care in the UK was not free: patients were required to pay for their own healthcare." Is there any need to say the same thing twice? Why not edit to: "Before 1948 patients were required to pay for their own healthcare." — Preceding unsigned comment added by Rossjamesparker (talk • contribs) 10:16, 5 October 2005 (UTC)

Some newbie suggestions
A few suggestions.

This opening definition:

''The National Health Service (NHS) is the publicly-funded healthcare system of the United Kingdom. The organisation provides the majority of healthcare in the UK, from general practitioners to Accident and Emergency Departments, long-term healthcare and dentistry.''

According to the World Health Organisation total UK spending on health is 7.7% of GDP or $2,160 per capita. The NHS makes up 83.4% of this expenditure





“the majority” seems a bit weak. It could be “vast majority” or maybe “accounts for over 80% of health expenditure in the UK”

Also I think opening couple of paragraphs should include that the NHS is a universal service available to all free at the point of delivery.

This is a link to the NHS Chief Executives report – I would propose adding it to the links as it is a good reference piece



Finally the funding section contains quite a lot of big numbers in terms of inputs (employment and funding), it might be worth also including some output measures (from the Chief Execs report or the statistical supplement to it) Here are a few examples for 2004/05

686m prescriptions (£8bn) 14.8m Accident and Emergency (or minor injury unit) first attendances (plus 3m additional follow up visits) 9.5m GP referrals to outpatients 13.5m outpatient first attendances 6.5m calls to NHS direct 5.4m elective hospital admissions 4.5m emergency hospital admissions 1.8m visits to NHS walk in centres 5.4m elective hospital admissions 4.5m emergency hospital admissions 3.3m Emergency Ambulance journeys

I doubt that all are worth including but some? Newbie --Richasdotcom 20:02, 28 October 2005 (UTC)


 * Go ahead. It's a wiki. JFW | T@lk  01:15, 30 October 2005 (UTC)


 * Thank you for your suggestion&#32;regarding &]]! When you feel an article needs improvement, please feel free to make whatever changes you feel are needed. Wikipedia is a wiki, so anyone can edit almost any article by simply following the  link at the top. You don't even need to log in! (Although there are some reasons why you might like to…) The Wikipedia community encourages you to be bold. Don't worry too much about making honest mistakes&mdash;they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills.  New contributors are always welcome. -- ALoan (Talk) 09:46, 30 October 2005 (UTC)

POV
There is, or was, some POV in this piece...I've fixed one sentence. Perhaps it could be given a more thorough scrub. No offense intended. What I fixed was this:
 * ''The mentally ill were often locked away in asylums, and the destitute elderly could end up in the workhouse.'

Thanks --Dpr 16:25, 30 October 2005 (UTC)

With respect this is irrelevant to discussion of the NHS for the following 2 reasons. firstly "The mentally ill were often locked away in asylums" pertains to the history of psychiatry, and secondly "destitute elderly could end up in the workhouse" pertains to the history of the provision of social services. whilst both these points are interesting, this statement has no proper place in a description of the NHS.Jellytussle 05:55, 20 December 2005 (UTC)

National Health Service
At the end of the first paragraph, the following comment is not relevant: "For example, under their new national General Medical Services (GMS) contract GPs, on average, earn more than £80,000 a year for a 8am to 6pm Monday to Friday job (with no out-of-hours work, unlike before this contract came into force in April 2004)." Therefore suggest edit out.Jellytussle 06:24, 20 December 2005 (UTC)


 * I agree. It's off-topic and POV. JFW | T@lk  08:28, 20 December 2005 (UTC)

actually very relevant to provision of out of hours care, which less than 20% of GPs now provide. statement of fact - ajvphilp
 * I am not disagreeing with that. However, still not relevant to the introductory paragraph on the NHS.Jellytussle 19:59, 20 December 2005 (UTC)

Overseas Doctors and the NHS
"In recent years,several overseas doctors won race disrimination claims against the NHS, highlighting the absence of career progression and other difficulties faced by doctors from overseas."

Is there a reference for this? Needs qualification and expansion. Many successful GPs are from overseas, and career progression is not necesarily an issue. Also, many senior hospital consultants and academics are from overseas. It would be relevant to discuss the effect the NHS has on the countries that train doctors and nurses who leave for the the UK; this is a topical issue.Jellytussle 16:21, 27 December 2005 (UTC)

Mental health in Scotland
Recent edit stated "Mental Welfare Commission for Scotland is an independent organisation ... It is not part of the NHS." This can not be correct, or at least can only be a partial explaination. Presuming that they are not funded by private donations to offer care on a charity basis, nor that they provide private health care for fee paying customers, then they are instead an independant contractor to whom the NHS commissions a level of service for an agreed fee. As such they are still free at point-of-contact for patients and are in a similar position to the independant contractor status of almost all General Practioners. Hence I presume that they ARE part of the NHS service, allbeit perhaps not directly owned by the NHS ? Clarification seems needed. David Ruben Talk 18:05, 9 May 2006 (UTC)


 * Here is a link to a page at the Scottish Executive listing the role of the Mental Welfare Commission. It appears to be an organisation set up to give advice to and protect the legal rights of patients. It does not appear to be an organisation that offers treatment like services contracted out from the NHS. I hope this is helpful. Road Wizard 18:16, 9 May 2006 (UTC)

The Mental Welfare Commission for Scotland is not part of NHS Scotland. It is rather an independent body set up by previous mental health law, and whose remit was recently adjusted by the Mental Health (Care and Treatment)(Scotland) Act 2003. As http://www.scotland.gov.uk/Publications/2003/11/18547/29204 details: "Part 2 of the 2003 Act sets out provisions relating to the continued existence of the Mental Welfare Commission for Scotland. The Commission will have:
 * new duties to monitor the operation of the Act and to promote best practice;
 * specific powers and duties in relation to carrying out visits to patients, investigations, interviews and medical examinations, and to inspect records; and
 * powers and duties to publish information and guidance, and to give advice or bring matters to the attention of others in the mental health law system.

These powers and duties should enable the Commission to maintain and develop its vital role in protecting the rights of service users, and in promoting the effective operation of mental health law. Schedule 1 of the Act sets out more detail on the membership, organisation and general powers of the Commission and makes provision for regulations to specify some matters in more detail, if necessary." See http://www.mwcscot.org.uk for more details. --Ajvphilp 06:50, 10 May 2006 (UTC)
 * I have adapted this for an article Mental Welfare Commission for Scotland. Please check and edit as necessary. The general standard of NHS and NHS related articles on WikiPedia is pretty abysmal. I am drafting a WikiProject:NHS - if any readers are interested, do contact me - toodle-pip --Smerus 15:56, 10 May 2006 (UTC)

Thank you. Reading some of teh material you kindly linked to, it indeed seems to be the independant monitoring bosdy for the social aspects of mental health care (i.e. monitoring compulsory admission & treatment). As such it seems equivalent to the Mental Health Act Commission in England, whose website. I would agree neither are NHS bodies and thus should not be included in teh main descriptions. I see that NICE gets listed as a separate NHS organisation, might there not be a place for mentioning external organisations that help monitor or regulate activities within the overall health care in the UK ? I'm thinking of very brief mentions more as redirections, might include all the mental health monitoring organisations, GMC regulating behaviour of Doctors, RCN for nurses etc David Ruben Talk 15:34, 10 May 2006 (UTC)


 * The Mental Welfare Commission is an NHS body. See Audit Scotland's list (as the MWC prepare their using NHS accounting rules). Astrotrain 15:51, 10 May 2006 (UTC)


 * Does not its inclusion on the Audit Scotland's list merely prove that it is (a) an offical body with powers to audit (b) that its auditing is on health matters. Surely inclusion on the list does not in itself prove it is part of the NHS (vs part of Department of Social Services monitoring vunerable persons). Similarly a commercial law firm might be instructed to help review a hospital's complaints proceedure - they would be performing an "official" task for the NHS and could be included in a list of bodies that have been involved with NHS proceedures, but they would still not be an NHS body. The two questions seem to be:


 * 1) Are they funded directly from Scottish Executive Health Department rather that Scottish Social Services ?
 * 2) Are they exclusively monitoring individual clinics/hospitals/patient-care cases or are they truely independant and able to also inspect & critise the Scottish Executive Health Department itself - i.e. is it truely independant and an "outside body" reporting to the Scotish Executive itself ? David Ruben Talk 03:16, 11 May 2006 (UTC)

No- the Audit Scotland list is a list of all the public sector health bodies in Scotland that it has the responsbility to audit ie all the NHS Boards, Special Boards and the MWCS. The MWCS receive a resource revenue limit (RRL) from the SEHD. The RRL is they way all UK NHS bodies are funded. The MWCS are required to meet NHS financial targets; and provide their annual accounts using the NHS manual of accounts. The MWCS are responsible to the SEHD, and are only independent in the sense of their monitoring activities etc. So to summarise, the MWCS is an NHS body. Astrotrain 12:16, 11 May 2006 (UTC)

Should give more emphasis to "free" aspects of service
People from other countries will be reading this. I'm thinking about the poor medical care for the less-well-off in the USA for example. To encourage them to improve the US system, we should emphasise that it is "free": that no matter how poor you are, you still get the best medical care.

Therefore I propose moving the content of the current "Funding" section nearer the top of the page, perhaps under the heading "Free at the point of use", while leaving brief details in the "Funding" section about it being funded by tax for latter expansion.


 * Unfortunately, altering the article in an attempt to convince others that the British way is "the right way" contravenes Wikipedia's policies on soapboxing and maintaining a neutral point of view. I don't see any particular need to move the funding section from where it currently resides. Road Wizard 18:35, 14 June 2006 (UTC)


 * I agree with Road Wizard; Wikipedia isn't to preach 'right' and 'wrong', but to give objective information.--Smerus 10:32, 15 June 2006 (UTC)

Regional Differences
The structure listed only applied to the NHS in England; there are subtle differences (not enough to justify seperate pages though) in how the NHS operates in Wales, Scotland, Northern Ireland etc. I don't know how things work in Scotland or Northern Ireland, so if anyone does, go for it.

I would also agree with JFW that there is lots that could be added to this article. Perhaps when I have the time I will try to add some bits. Proto 10:43, 6 Apr 2005 (UTC)

This section should actually be titled National Differences. There is not, and never has been, a single NHS in the UK, the original three (now four with devolution to Wales) systems were all the product of similar but separate Acts. To someone who arrives by ambulance there is little difference apparent but to less urgent users the differences can become apparent WRT prescription charges, drug approval and the availability of treatment.--MBRZ48 23:26, 19 July 2006 (UTC)

Opticians?
No mention of NHS funded eye-tests/examinations and glasses? It's not an area I know a lot about, but surely it should be covered? Markb 10:30, 15 September 2006 (UTC)

External link to Dept of Health Policy and guidance
Accidentally submitted the form before finishing off my edit comment. I'd meant to say that the link wasn't really a reference because it wasn't being used as a citation for any article text, and there was already an external link to the DofH website in the main external links section, so it seemed superfluous. --VinceBowdren 14:38, 15 September 2006 (UTC)

Expansion
Given the scale on which the NHS operates, this article is really too short. Some things I would recommend:
 * Public vs private
 * Hierarchy
 * What is the line of command
 * What is the relationship between the DoH, strategic health authorities, primary care trusts, hospital trusts
 * How are targets set (by whom, on what basis)
 * Criticism (waiting lists, medical and clerical mistakes)
 * Attempts at modernisation (NHS Trusts, The NHS Plan) and their implementation
 * Political views vs. the NHS (patient choice, reducing waitings lists, foundation trusts, privatisation/deregulation).

As a lowly staffer I have little oversight - does anyone know if systematic studies of the NHS decision-making process have been published? JFW | T@lk  12:43, 28 Nov 2004 (UTC)


 * ...could be a lot longer, what about the internal market, and something about the computer systems they use. Edward 13:03, 14 Nov 2004 (UTC)

I agree. The history stops at 1990 for starters. I'd expected to see big arguments in this article and discussion page, but it isn't there. Maybe there is a healthcare debate page somewhere, but I fear it'll be dominated by USA issues. Glarner 17:35, 26 April 2006 (UTC)


 * I came here to get an idea as to why so many hospitals seem to be in financial deficit - and was disappointed to find no information on that subject here. Rather than try to make this one article cover everything people might want to know, I suggest having more articles, with this one at the root. I have fixed many maths articles that needed improving - but I don't have the expertise to fix this one, so can others do it, please? New Thought 19:52, 2 October 2006 (UTC)

Isle of man NHS
The Isle of Man's National Health service website mentions that they provide treatment in UK hospitals see http://www.gov.im/dhss/health/offisland/off_island.xml. Is their NHS separate from the four UK ones or is it somehow linked and should it be integrated into this article somehow? Zagubov 19:33, 4 December 2006 (UTC)


 * Man is not part of the United Kingdom. Unless there is enough to justify a separate article the appropriate place for Manx health service information would seem to be within the "Isle of Man" article. WRT the English NHS they are one variety of various foreign patients treated by the English NHS (or by other NHSs in the EU).

--MBRZ48 18:43, 5 December 2006 (UTC)

Dentistry?
At present the article appears to claim that the NHS provides the majority of healthcare including dentistry. This certainly doesn't tie in with my observations, where NHS dentists are practically impossible to find and the majority of people are effectively forced to go private, with the NHS sometimes covering part of the cost of treatment for those who can prove financial hardship...

Should this be changed, or have I just been very unlucky and really everywhere else in the country it's easy to get NHS dental treatment? -- (unsigned)


 * I used NHS dentistry right up till I moved from Northeast Scotland to Western Canada in 2003. Most of the dentists did both NHS and private work. I only knew of one who only took private patients. But perhaps things have changed since then. -- Derek Ross | Talk 15:07, 15 June 2006 (UTC)
 * Depends on where you live. There has been a constant portrayal in the media that there's no dentists anywhere, and the truth is that the numbers have grown - but not at the rate they should have done, and few stay very long - finding private work financially more viable (not that they're poorly paid anyway).  In my hometown there are quite a few Dentists, most take NHS - but if you aren't registered with them (or haven't registered with them for a while) you could find yourself off the list.  Kids still get seen though.--Koncorde 23:05, 14 August 2006 (UTC)
 * In many areas there are NHS-only dentists around, and joint NHS/private dentists who are accepting patients. However there has been a marked expansion in private dentistry over the past 25 years, to the extent that it features much more in provision of dental services than private GPs and Hospitals do in the provision of medical care.  IMHO it would be worth pointing out this trend (and even greater trend towards private eyecare) in the main article.BaseTurnComplete 10:21, 17 December 2006 (UTC)

NHS size -- Interview with MP today
Today on TV, some MP was being quizzed over the NHS. He said that the NHS is the fourth largest employer; we say "The NHS is the third largest employer in the world after the Chinese army and Indian Railways.". He cited the US Army, iirc, as the fourth. Can anyone verify this (I'm loathe to change the article based merely on a throw-away verbal comment)? Also, I think he claimed that the NHS employed 1.2 million people; again, can anyone verify this? Cheers! &mdash; Matt Crypto 20:20, 13 Feb 2005 (UTC)


 * "The NHS is the largest employer in Europe. It employs approximately 1.2 million staff" according to this site ; Chenxlee 01:01, 9 Mar 2005 (UTC)


 * I've fixed this, with two newspaper references, although I've left the issue somewhat open. The NHS man, whose name is Jon without a H, argues that the NHS is the fifth-largest employer behind the above plus Walmart and the US DoD. However, the articles quibble with the inclusion of the DoD, as it is not a single employer, and for that matter neither is the NHS any more.-Ashley Pomeroy 22:27, 5 Apr 2005 (UTC)
 * Thanks for digging those up! &mdash; Matt Crypto 23:15, 5 Apr 2005 (UTC)


 * A Commons written reply dated 9 Jan 2006 suggests an itemised total of 1461574 employees as of 30 Sep 2004 for the English NHS. I doubt if a loss of about a quarter of a million would have gone unnoticed so the "approximately 1.2 million" looks like an underestimate, possibly based on full-time equivalent.--MBRZ48 01:49, 20 July 2006 (UTC)

I know about the 'third largest employer' thing, but can you put in that if the NHS was a country it would be the 33rd richest in the world. Plus, you Americans have no grasp I belive of the truly gargantuan size of the NHS. I its a mavelous organisation, and I believe the article does not do justice to the sheer size of it. —Preceding unsigned comment added by Special:Contributions/ (talk)


 * You, Americans? Most of us (the contributors to the article) are British. -- Derek Ross | Talk 20:22, 4 February 2007 (UTC)

NHS Scandals
All from:http://www.timesonline.co.uk/tol/global/article1471409.ece
 * The NHS has been giving girls as young as 13 contraceptive injections and implants that make them infertile for up to three years, in an attempt to cut teenage pregnancies.
 * Thousands of women are getting breast enlargements, tummy-tucks and nose jobs on the NHS
 * Health tourists received free NHS kidney treatment worth about £30,000 a year, potentially competing with British patients for scarce transplants
 * Some NHS dentists earn up to £250,000 a year in fees, as demand for those who have remained in the public sector increases Peoplez1k 16:25, 9 March 2007 (UTC)

Lawson Quote
I cannot find a verbatim source, but Nigel Lawson did not call the NHS "the national religion", but (something like) "the closest thing [we/the British people] have to a national religion".unsigned comment by 204.4.130.140 3rd Nov 2006
 * The unsourced phrase on Health insurance is that Lawson described the NHS as 'the national religion'. According to Comparing Health Systems (and lots of other sources) the quote is from Lawsons memoirs when he wrote that "the NHS is the closest thing the English have to a religion." The reference for his memoirs is Lawson, Nigel, The View from No.11: Memoirs of a Tory Radical, London Bantam Press, 1992, but I don't have a copy to hand to refer to. According to The spectator the quote is " the NHS is the closest thing we now have as a people to a collective religion". The telegraph has it as: "the closest thing the English have to a religion". Probably the best sources I can find for the direct quote is the book Health, Civilization and the State: a history of public health from ancient to modern times. by Dorthy Porter who gives the direct quote as "the NHS is the closest thing the English have to a religion, with those who practice in it considering themselves as a priesthood." Mary Langan in her book "Welfare: needs, rights and risks" has it as "the NHS is the only religion the English have". I think for the definitive answers someone is going to have to get a copy of Lawson's memoirs. &mdash; Rod talk 11:49, 3 November 2006 (UTC)
 * I have a copy, and the quote is on page 613:


 * "The National Health Service is the closest thing the English have to a religion, with those who practice in it regarding themselves as a priesthood."--Johnbull 00:23, 8 May 2007 (UTC)

First suggestion of an NHS
I remember seeing a TV programme in which a little known fact was revealed, being that the first ever mention of a need to establish a health service free for all at the point of delivery was actually in a speech in The House from a Conservate Member of Parliament. Anyone know anythong about this? -- 86.17.211.191 10:33, 15 June 2007 (UTC)

please add reference
hi, i added some stuff from andrew marrs history of modern britain in the history section of the nhs wiki. if anyone could add in the ref for me as i cant figure it out that would be great.

http://www.amazon.co.uk/History-Modern-Britain-Andrew-Marr/dp/1405005386 — Preceding unsigned comment added by Yer maw (talk • contribs) 00:39, 17 June 2007 (UTC)

"Free at the point of delivery" meaning you get sent a bill later?
I think the phrase "free at the point of delivery" is confusing, it could suggest to people unfamiliar with the NHS that you get sent a bill later on, or have to pay the costs off in instalments. Whereas the essential point about the NHS is that anyone no matter how poor can have the most expensive treatments. I propose changing:

NHS services are largely "free at the point of delivery", paid for by taxes; the NHS's budget for 2007-08 is £104 billion.[3]

to

NHS services are largely free, paid for by taxes; the NHS's budget for 2007-08 is £104 billion.[3]

As the position of this near the top means you have to edit the whole page I'm not sure my dial-up could upload the whole page, so perhaps someone else could make the change please.

Of course if you are poor - in other words on benefits of some kind - then it is completly free and you dont even pay any prescription charges or dental charges (which always seem to me to be against the sprit of the NHS).

80.2.194.68 09:37, 30 June 2007 (UTC)


 * It would be wrong to suggest the the NHS is free. In fact it costs a lot (£104 billion sounds reasonable) but the costs are paid every day by National Insurance contributors whether they use the service or not. In this the NHS is like any other insurance-funded service: the contributors pay a little every day in order to avoid a large cost when their health goes bad. And of course this is a Good Thing. It is also what is meant by "free at the point of delivery": You pay upfront -- not afterwards. The main differences from insurance provided by a private organisation are that


 * 1) any contributor who meets the relevant criteria will have their insurance contributions paid for them by the British Government and


 * 2) there is basically no limit to the amount which the NHS is prepared to spend on meeting its obligations. Any shortfall in revenue from NI contributions is filled from general taxation revenue whereas pure insurance-based schemes can only fund their obligations to the limit of their contributions.


 * So I think your suggested changes still need more work to explain things clearly. -- Derek Ross | Talk 06:38, 2 July 2007 (UTC)


 * In fact there is nowadays absolutely no connection between the National Insurance System and the National Health System, either in funding of rights of access according to NI contributions. HM Treasury regards NI as just another source of revenue for the government, but contributions to the NI Fund are still tracked for certain social security benefits such as old age pensions and unemployment benefit. So its not really like any other health insurance funded service - its more like the road system. The government raises taxes to build the roads and maintain them and everyone is then free to use them. NHS financing is remarkably Marxist..."from each according to their means and to each according to their needs".  The amazing thing is that in spite of the British rejecting Marxism, they by and large love the NHS! The term "Free at the point of delivery" came up I think in Thatcher's time when it was suggested that "hotel" charges would be raised for hospital stays, rather as happens in many European countries, like Ireland, where something like 60€ per night is billed to the patient  up to a maximum per year. Labour in Opposition stressed that they were committed to keeping the NHS "Free at the point of delivery". The Tories backed away from the plan under the weight of overwhelming public opposition and even pledged themselves to supporting the "Free at the point of Delivery" concept themselves. One thing that many people will not be aware of is that pensioners will have their state pension reduced if they are in hospital for more than a certain time (6 weeks I think, but I am not sure).


 * As for the article, I rather like the idea of removing the reference to the phrase because as the anonymous editor makes clear, it could be misconstrued.--Tom 01:07, 3 August 2007 (UTC)


 * True enough. Particularly your point about NI being treated as just another tax by successive UK governments. I was describing the initial intent rather than the current practice. NHS funding has indeed evolved as you describe over the years. -- Derek Ross | Talk 04:13, 3 August 2007 (UTC)

Rating
I have rated this article as B class. I think it will be a candidate for nomination for good article (GA) status with a bit more work. It needs a few more citations and some general tidying first. --Vince 11:04, 17 August 2007 (UTC)

NHS history question
There's a sentance in the history section - "Washington subsequently withdrew the funding that had sustained Britain during the war."

What funding was this, exactly?

I'm aware of Lend-Lease, but the quoted sentance does not seem in its nature to be refering to this, as Lend-Lease was not funding (positive provision of funds), but rather the abrogation of billing (removal of bills). In some ways they amount to the same thing, but it is obvious that with the end of the war Lend-Lease would stop, so the continuation sentance in the history section, "At this point, Attlee realised that his plans for the rebuilding of postwar Britain and enacting widespread reform were in serious financial trouble." makes no sense.

Toby Douglass 11:20, 5 August 2007 (UTC)


 * I agree. Lend-Lease was essentially for munitions. The article as written seems to imply that Atlee had originally intended to use US money to create the NHS which was never (as far as I know) the intention. I was always under the impression that the plan was to issue bonds to purchase existing hospitals and that National Insurance was intended to be the main form of ongoing finance. And, as far as I know, that is what in fact happened.--Tom 20:10, 5 August 2007 (UTC)


 * "Washington"... this would be a synecdoche for the U.S government, presumably, not the president of the same name? Swanny18 14:59, 19 September 2007 (UTC)


 * It was Lend-Lease. Lend-Lease was rather more subtle than just munitions. It included food and capital goods as well. Take a look at our Lend-Lease article. There were two separate phases which were agreed during the War and an intended third phase which was dropped without warning at its end. Since the first two phases had intentionally distorted the British economy to make it more suited to war production, the lack of the third phase caused big problems to the UK at the end of the war -- and not just with plans for the NHS -- since the UK had no chance to adjust its economy back to peace-time conditions. A recently published book, "The Last Thousand Days of the British Empire" discusses Lend-Lease and its effects (among other things). -- Derek Ross | Talk 16:52, 19 September 2007 (UTC)

Criticisms
Specific criticisms that have levied at issues within NHS read a if they are criticimsof the NHS itsel: The NHS has frequently been the target of criticism over the years. Examples of such criticism includes:

''Due to excessive delays and low quality treatment[citation needed], those who can afford it sometimes opt for private health care. When this occurs, these patients are being forced to pay twice for their health care,''
 * Is there evidence of it being costed twice? In countries such as the USA insurance and direct costs may or may not be higher than the individual level of tax burden for the NHS and the redulting LOWER private healthcare insurance that exists as a result of the NHS being there to pay for emergency and primary level care

The levels of antibiotic-resistant bacteria ("superbugs"), such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, in hospitals.
 * This is a criticism of the privatisation of cleaning contracts. It is argued that under stricter NHS control MRSA did not occur.

The decreasing availability of NHS dentistry and the trend towards dentists accepting private patients only.
 * This is a criticism of there being less NHS involvement in this area and the governments bureaucratic controols that force dentists away, not a critiscism of the NHS.

Hospitals and trusts running a financial deficit and getting into debt. Specific funding/,anagement issue not a critsicism of the NHS

Dainamo 17:04, 7 August 2007 (UTC)

I personally call into question the accuracy of this section of the NHS article. Much of the criticism was part of a PR campaign helmed by Henry J. Kaiser at the behest of US President Richard M. Nixon. Ronald Reagan even was paid to record a propaganda album warning Americans about the encroaching "Communist menace" of socialized medicine. Much of the criticisms are derived from this propaganda campaign despite it's well-monied source.

--Kulturvultur 02:16, 1 October 2007 (UTC)

NPOV
"This includes British citizens who work for a UK-based charity outside the UK (except in certain countries) for more than five years, regardless of their intention to return to the UK or payment of National Insurance contributions. These people are treated as overseas visitors even if they own property, return regularly or have family in the UK and regard their home country as the UK."

- This section seemed to be a bit focused - perhaps written by someone to whom this applied; is it appropriate? Simonjp 16:44, 11 October 2007 (UTC)

Balance
The article contains a section called criticisms, and that is fair enough. But the NHS has almost universal public support in the UK and provides excellent health care overall at very low cost. Because the article has a criticisms section with lots of negatives without any balancing arguments or section conveying its successes or the level or public support, I think the article in its present form lacks balance.


 * Really? I thought this article was far too positive.  The private care practitioners are all portrayed as avaricious scoundrels who perform unnecessary procedures at the drop of a hat.  In the US, that never happens because people will shop around and go with what seems to them to be the best option because of competition, the threat of litigation and peer pressure.  The bad teeth of UK subjects is a stereotype that many outside the UK take at face value.-G 14:25, 16 October 2007 (UTC)


 * Well that's a bit odd since the private practitioners are mostly NHS practitioners who do a couple of days per week (or after-hours work) for the private hospitals. And as for the teeth, dental care is the only part of UK heath care where private practitioners have a really strong presence. So does that mean that the NHS is staffed by avaricious medical staff or that private dental care produces worse results than NHS care ? It doesn't seem likely. -- Derek Ross | Talk 15:03, 16 October 2007 (UTC)

I am particularly interested because health care is currently a big issue in the US and I have read a lot of negative criticism about the NHS, much of it untrue, coming from the US press and pressure groups supported by businesses in the health care sector. Many US WP readers will now be reading the NHS article and I therefore think that the balance needs to be there. Do any other editors share this concern and have views about how to achieve this?--Tom 12:50, 22 September 2007 (UTC)


 * I for one would like a more scholarly comparison of NHS, Canaduan and free market health care.-G 14:25, 16 October 2007 (UTC)

Largest employer?
"The NHS is the world's largest, centralised health service, and the world's third largest employer after the Chinese army and the Indian railways".

Any source of that? The French Education minister alone employs 2 million people, twice the NHS. --89.97.35.70 14:00, 4 November 2007 (UTC)


 * More exactly, due to competencies tranferences, the French National Education System employs now (approx.) 1,450,000 people (sources from Education Nationale and Enseignement supérieur). Nevertheless, it's still more than the NHS. Maybe the usual contributors should correct this or I'll do it. Stymphal 19:07, 4 November 2007 (UTC)


 * Please do. You know, if we don't already have a cited list of the World's largest employers, we should have. Perhaps someone would like to create it. -- Derek Ross | Talk 20:06, 4 November 2007 (UTC)

It is an excellent example of a Factoid. Should be deleted, or at least apologized for ("is often claimed to be"...). 131.111.164.208 14:05, 16 November 2007 (UTC)

2007 Budget
The figure listed in the article is est £104bn, citing the official treasury pdf of the budget report. I get £91.8bn summing resource and capital expenditure limits- see page 293 of http://www.hm-treasury.gov.uk/media/3/4/bud07_completereport_1757.pdf

Either I'm missing the point or this amount needs to be changed —Preceding unsigned comment added by 87.80.60.90 (talk) 00:17, 22 November 2007 (UTC)

Anglocentric
I know it's been mentioned above, but this article is very anglocentric at present and doesn't adequately describe the structures and ways of working of the NHS in the other three countries. I've made a start but there's much more to do! Any help appreciated. Waggers 15:25, 25 May 2007 (UTC)
 * Well, people in Wales, Scotland and Northern Ireland insist on keeping "their" part of the NHS separate from the Englsih core, so why should this article include them? They've chosen separation. We're either one state or we're not: no picking and choosing. -- 86.17.211.191 10:30, 15 June 2007 (UTC)
 * That's a political point, and the last sentence is certainly POV, so I'll ignore it. The article is entitled "National Health Service", not "National Health Service in England", so I agree with Waggers. We could certainly do with a mention of the abolition of prescription charges in Wales: I think that's significant enough to be in the main article, not just the prescription drugs one. 86.132.137.231 01:01, 26 July 2007 (UTC)
 * There never was a single UK NHS so it isn't a case of people keeping "their part" separate. That is why there are separate articles (and a referring "see also" at the top of this one) for each service. It would be helpful to change the title to e.g. National Health Service (England) to clarify the difference and avoid confusion.--MBRZ48 02:37, 18 September 2007 (UTC)

Hi - I've just come across this article after being informed about it by confused students (I teach about the NHS)- I don't mind an article about the NHS in England, but if the title is just 'National Health Service' there needs to be some explanation around the issue. Fishiehelper2, 30/11/07

I would support the change in title idea, but we would then have to make a decision about where National Health Service should re-direct too. The renamed article is the logical choice. But I still wish to take issue with you Fishiehelper2. Just because your students were confused, is that really a good reason for making the changes you made to the header paragraph? Anyone reading the text that was there BEFORE you made that change would have come immediately to the realization that there are 4 different services. So it was an unneccessary change. Furthermore, the main paragraph is a signpost to what the article is about. It really should not carry that kind of observation. --Tom 00:04, 1 December 2007 (UTC)


 * So wouldn't it be an idea to have this page about the NHS in general (i.e. its history, and principals etc) and then have articles about the NHS's in the four UK countries. Given that three of the four NHS's have the same name and are all run along roughly the same lines. G-Man  ? 22:05, 3 December 2007 (UTC)


 * You could be right but I have not thought through the implications. It could be a lot of effort and I think you should get the agreement of a large number of editors here to be committed to the change before kicking it off. I don't think I have the time right now to be involved in that effort. It would seem wasteful to repeat common information in all 4 articles.--Tom 19:29, 4 December 2007 (UTC)

English / UK-wide meaning
Although "National Health Service" is both the collective name for the NHSs in England, Wales and Scotland, it is also the name for the English service. It seems that this article suffers slightly from describing two slightly different concepts with the same name, mixing up the NHS concept in general with the specific English NHS.

Whilst I'm not saying the article should necessarily be split, it might be beneficial to make the distinction clearer (and/or separate the generic NHS material)- or to be either one thing or the other.

When did NHS Scotland and Wales officially "split off"? Was this at the inception of the respective parliaments, or before?

Fourohfour 13:39, 6 December 2006 (UTC)

The NHS in Scotland was budgeted and administered separately long before the Scottish Parliament existed. I suppose that it has something to do with the separate Scottish legal jusidiction but I don't really know. -- Derek Ross | Talk 21:06, 9 March 2007 (UTC)


 * Before the NHSs were created in 1947/1948 there was provision of public health services by various forms of local authorities who in turn were carrying out functions which ultimately go back well before the creation of the UK.--MBRZ48 02:30, 18 September 2007 (UTC)

The NHS in Scotland was set up as a result of separate legislation passed in 1947 but the date the NHS began to operate was the same north and south of the border. (fishiehelper2 - 29th November, 2007)

I thought the explanation in the header was OK before fishiehelper2 so I reverted it. I know that some people are confused and even at times I have been among them, but it did explain already that there were 4 services in the UK and that this article was about England's NHS. The other three services have prominent links to their own article ahead of that. I just did not think that the header was a good place to talk about misconceptions and the complexities of devolution. I hope you don't mind.--Tom (talk) 23:43, 29 November 2007 (UTC)

Hi there - I don't want to cause trouble! As I see it, when we say that "the National Health Service began in 1948", we are not just discussing England. If you don't like the changes I suggested, perhaps changing the title to "the National Health Service (in England) would suffice? Fishiehelper2  —Preceding unsigned comment added by Fishiehelper2 (talk • contribs) 00:56, 5 December 2007 (UTC)

Major overhaul - requested move
I did some major edits and reformatting as part of the The Core Contest. To avoid edit conflicts and general messy editing, I copied it over to User:RHB/NHS before I began editing. Points of note are hiving off some of the Criticism section into an article on Criticism of the National Health Service, which is forming up at User:RHB/Criticism of the National Health Service and just needs to be moved over into the mainspace, and the addition of a number of redlinks. As this is a relatively controversial move (a history merge from RHB/NHS to here) involving lots of editing, I thought I'd seek opinions here first. Thanks, RHB - Talk 20:37, 10 December 2007 (UTC)
 * Any comments at all? RHB - Talk 18:14, 12 December 2007 (UTC)


 * Yes. I don't really understand the need to do this at all. The competition, which looks like it is not part of WP policy is over. What do you mean "history merge"? Please say in plain English what you want to do

and why.--Tom (talk) 10:20, 16 December 2007 (UTC)


 * I could just copy and paste the section over but then the history of the page would be lost, including my reasoning/edit summaries, and I can't move that page over this one because this page has more than one edit. I edited in userspace because of the likelihood of edit conflicts/accidental removals/vandalism and the like. I only asked because I removed some large sections of text that had been left in by innate consensus for an extended period of time. RHB - Talk 17:11, 16 December 2007 (UTC)


 * I do not support the changes you are making. I don't think a respectable encylopaedia would split off criticism into a special article. Its un-encylopedic. You have not explained your rationale for doing all this.--Tom (talk) 00:56, 18 December 2007 (UTC)


 * I apologise for my lateness in replying - I've just got back from a medical course that I've been on since the 18th, and got very little sleep. I split it off because I doubt a day goes by without the NHS being criticised in some form by those in the public eye or newspapers, whether they be tabloid or broadsheet.Google News shows 199 stories containing the words NHS and failure in the past month, as an example. Many books have been written criticising the NHS, of which I have access to only a selection. We do, for instance, have a long-standing article on the Criticism of Wal-Mart, and an entire category dedicated to it - Category:Criticisms. RHB - Talk 19:41, 22 December 2007 (UTC)
 * Hey... What ´have you done??? Where are all the edits since 26 September??? Are they all in National Health Service (version 2). I think it is totally unacceptable for you to make changes this way with the aid of an admin (I presume). You may have improved or wrecked the article but there are now so many changes that it is hard to see what you have done and we cannot compare across the old and new versions. You asked about making this change and did not get approval. Now you see to have just gone ahead and done it anyway. Please explain and put it all back together again. We need to see the edits that have been made since 26 Sept and why they were made.--Tom (talk) 22:47, 19 December 2007 (UTC)
 * What about the edits other users have made since you started editing this article in you userspace? Some at least seem to have been lost!--Tom (talk) 00:31, 20 December 2007 (UTC)
 * I believe the copy I took from the mainspace was that of the 26 November. The majority of the edits since then have been reversions to improve the article or against vandalism, and little has changed massively. Quite why an encyclopaedia article should have sections on Exemptions for missionaries who work abroad for a UK based organisation is beyond me. I don't believe the current article is particularly effective in communicating information about the NHS to the lay reader, and regardless of whether you believe editing the article in userspace is right, or that some edits have been lost (which I am by no means against losing), the versions I've edited has more references, less unencyclopedic information, and a greater depth than the version that currently exists here. RHB - Talk 19:41, 22 December 2007 (UTC)
 * Apart from the other edits which have been overwritten, it's not a good idea to do editing on a local copy and then replace the main article. All edits should be made in the open, where everyone can see them; not suddenly revealed from behind a curtain in one go. --VinceBowdren (talk) 09:11, 20 December 2007 (UTC)
 * In retrospect, I agree. Editing the article "behind closed doors" so to speak, although probably being easier and less stressful, was not especially good in the case of a relatively controversial article such as that of the NHS, that was bound to engender controversy. I apologise for what appears to have been unilateral action. RHB - Talk 19:41, 22 December 2007 (UTC)

What on earth is National_Health_Service/RHB doing existing ? See WP:SUBPAGES re "Articles do not have sub-pages (main namespace)" (and nor is the NHS known as "National_Health_Service/RHB")? Discussion on article development should occur on this talk page. I've tagged the "subpage", prior to speedy deletion, but will allow editors to extract out any useful changes first (ie a stay of execution for a few days). David Ruben Talk 04:19, 21 January 2008 (UTC)

I think the final copy still exists over as one of my sub-userpages, now that copies gone - but I've just checked and that deleted version was redirected from my userspace copy. I think that was created by Anthony as he was trying to sort out moving it over this page, but I don't have much of an idea myself. Did anyone have problems with specific sections of the page that I edited ages ago, and have explained the reasoning for here? It's a shame its been so long so I'd have to look at edits since and ensure contributions were deleted off the bat if I were to edit the article again. RHB - Talk 21:37, 21 January 2008 (UTC)

Call for Assisitance
In the United States, the form of health care represented by the UK's NHS is tagged with the politcally charged tag "socialized medicine" though its also used to describe other forms of subsidization and control. I have been making edits to the WP article socialized medicine to add informative and accurate information as far as I can about the pros and cons of socialized medicine to a US audience whose main knowledge of real world socialized medicine comes from tabloid new articles and pressure groups that distort those articles and use other information to paint a false portrait of socialized medicine.

I am having trouble with one editor who has been reverting, amongst many other edits, the following assertion about the benefits of socialized medicine

* Health care is distributed according to need rather than the ability to pay '

To me, the statement is non controversial.

Here is the support from the UK http://www.nhs.uk/aboutnhs/nhshistory/Pages/NHSHistorySummary.aspx and as far as I know was firmly founded on Beveridge's recommendation.

and one for New Zealand The inauguration of health benefits under the social security programme was thus long overdue and constituted a most necessary and sweeping reform. The benefits are available to all persons ordinarily resident in New Zealand, regardless of economic status. The scheme is non-contributory, benefits being available as of right irrespective of the amount, if any, of social security taxes paid by the recipients of the benefits. The right to benefits is restricted only in cases where a person receiving medical or other treatment is entitled to recover the expenses of such treatment by way of compensation or damages.

I have called for general comments here... http://en.wikipedia.org/wiki/Talk:Socialized_medicine#Health_care_.22distributed_according_to_need_rather_than_the_ability_to_pay.22_as_a_benefit_of_Socialized_medicine

I am asking WP editors to intervene to support either the inclusion or exclusion of this statement. Your assistance in resolving the dispute would be appreciated.

Also I am feeling a bit battle weary with a few editors there and I'm actually suffering from a medical condition myself at the moment (of all things!... fortunately not stress from WP editing!) and I cannot be heavily involved with the article over the next few days. Any assistance that editors can give to improving the article would be appreciated.


 * Yess you're compltely correct in stating that about Beveridge. Seems you're hitting abit of a biased editor, who doesn't know any better 87.194.134.71 (talk) 02:29, 23 February 2008 (UTC)

I hope that some editors active in the management of this article may be interested to help develop the article further.--Tom 21:21, 31 October 2007 (UTC)

Name change?
Could I suggest that this article should be renamed "National Health Service (in England)". This article is clearly about the NHS in England, but occasionally editors try to change words from 'England' to 'United Kingdom' without really realising. Cheers Fishiehelper2 (talk) 19:52, 17 March 2008 (UTC)


 * I don't support changing the name, but we could certainly add some text at the top explaining the difference and flagging articles for other NHS articles (are there any?) Nmg20 (talk) 11:57, 18 March 2008 (UTC)
 * There is an article NHS Scotland about the NHS that was developed in Scotland at the same time as the NHS was developed in England and Wales - separate legislation set up the NHS in Scotland though both the Scottish and English and Welsh systems started on the same day in 1948. Any reason you are against a name change? I thought it seemed sensible to help make the issue clearer, and would also free the "National Health Service" to become a disambiguation page. Cheers Fishiehelper2 (talk) 17:13, 18 March 2008 (UTC)


 * Perhaps the National Health Service page could be turned into a general page about the NHS with its history etc with split away pages refering too the national variations? G-Man  ? 22:41, 20 March 2008 (UTC)

NHS in England or UK
Let's be clear that this article is about the NHS in England. Just because the name of the NHS is not NHS England does not mean that it covers the whole of the UK. Think of the FA - the Football Association covers England and the SFA covers Scotland. Same with this - the NHS covers England and NHS Scotland covers Scotland. Cheers 86.156.3.70 (talk) 15:21, 21 March 2008 (UTC)
 * Perhaps we need to change the name to National Health Service (England) for the avoidance of any doubt. Any views on this? Fishiehelper2 (talk) 15:30, 21 March 2008 (UTC)
 * I'm going to have to be bold and do something - one editor seems determined to change this article from dealing with the NHS as it applies to England, to trying to make it a UK article. To be fair, the editor sent me a message suggesting that he/she wouldn't object to a name change. I'll turn the 'National Health Service' page into a disambiguation page.  Fishiehelper2 (talk) 19:37, 21 March 2008 (UTC)
 * I actually agree with the editor at 86.156.3.70. It was wrong to change the title of the article. The National Health Service is the correct name for the NHS in England and it is not National Health Service (England). --Tom (talk) 00:44, 22 March 2008 (UTC)
 * Hi Tom. In principle I agree with you that the name should be 'National Health Service', but it was becoming clear that this was causing confusion with some editors trying to edit the article by replacing 'England' with 'United Kingdom' etc. By putting 'England' in brackets, I was hoping it would be clear that 'England' was being given for clarification and not as part of the name.  (Other articles use this approach to aid clarification.) Fishiehelper2 (talk) 09:45, 22 March 2008 (UTC)


 * User:Fishiehelper2 was correct in moving this article the name NHS used to refer to the body in Scotland putting (England) is used to disambiguate -- Barryob  (Contribs)   (Talk)  18:06, 12 April 2008 (UTC)

Please note that while we generally use the name of the topic for the name of the article, there are occasions when we don't. Monarchs are a prime example: just how many Alexanders are there! In this case it is quite sensible to use an article name of "National Health Service (England)" to describe the organisation named "The National Health Service" in order to avoid confusion with other national health services. -- Derek Ross | Talk 20:01, 12 April 2008 (UTC)

Paying twice
The current comparison in the "paying twice" section, between private education and private healthcare, is not ideal. It looks like it was added on 13th December 2007 in a set of alterations to what was there before. Looking at it, I very much prefer the older text - any thoughts? Nmg20 (talk) 16:30, 20 May 2008 (UTC)
 * I agree. The private education situation isn't really comparable for a whole load of reasons, and in general the earlier text was better. However, I don't think the and that their opting out from time-to-time is effectively queue jumping because they are utilizing a resource ahead of someone in greater need and that their double payment is the penalty for queue jumping holds water. It assumes that privately-funded services are delivered using NHS resources, and ignores the existence of private-sector infrastructure (physiotherapists, testing labs, private hospital buildings, MRI machines etc). Without a citation that bit looks like original research to me, and not very WP:NPOV either. - Pointillist (talk) 18:03, 20 May 2008 (UTC)
 * BTW the queue jumping text is also reproduced in Criticism of the National Health Service - Pointillist (talk) 18:46, 20 May 2008 (UTC)

Superbugs
I'm concerned about the last paragraph of the "superbugs" section. It makes reference to "germs", a term typically avoided in even lay discussions of medicine, has grammatical errors, and is uncited. I think it should be removed - it doesn't add much. —Preceding unsigned comment added by 91.85.189.29 (talk) 23:26, 29 May 2008 (UTC)

Consultants?
"... Bevan managed to push through the radical health care reform measure by dividing and cajoling the opposition, as well as by offering lucrative payment structures for consultants." There is no further mention of "consultants," or any explanation of the difference between a doctor (or GP) and a consultant. What is a consultant? What role do consultants play within the NHS? Why were they crucial to the formation of the NHS? 213.7.17.134 (talk) 08:52, 15 July 2008 (UTC)

Wikipedia edit block from NHS IPs? If true, what are the particulars?
The article at http://3cspracticemakesperfect.blogspot.com/2006/12/wikipedia-and-nhs.html states that there is a block on editing from NHS IPs. Is this true? - Bevo 17:37, 4 December 2006 (UTC)
 * A block on NHS Ip addresses wouldn't surprise me. It happens frequently with universities where large numbers of users share IP addresses - hopefully it will be temporary but the article doesn't give the specific IP address that was blocked otherwise we could try to get it lifted. I'll take a look at the Agnes Hunt article.&mdash; Rod talk 20:07, 5 December 2006 (UTC)

BLASTED USER: Drahaugh!... —Preceding unsigned comment added by 86.138.208.211 (talk) 19:34, 21 August 2008 (UTC)

Duplication or Generalisation?
I think that most if not all of the criticisms section applies to all of the British NHSs and not just the English one. For example access and superbugs. We could have the information in all of the articles (creating duplication and possible differences) or surely we could just have it at National Health Service with a "See also National Health Service (England)" hatnote on the devolved NHS criticisms sections. I'm sure this could apply to other areas. I think that the NHS article should have the infor common to all with the devolved NHSs' articles discussing the specifics of those systems, though perhaps that's giving an inaccurate view of the situation. What do you think? Scroggie (talk) 22:36, 8 October 2008 (UTC)

bno
are bno's (british national overseas) entitled to nhs treatment (for example, seeing a gp) when they are visiting the uk?


 * I don't think so, eligibility is based on residence so anyone who lives overseas loses the right to NHS treatment even if British, and a foreign national resident in the UK gains (after I think 3 months) the right to treatment. PeteThePill 23:52, 13 December 2006 (UTC)
 * Report out today from DoH on this see EU enlargement and overseas visitors' rights to primary care treatment in the UK which updates [Implementing the Overseas Visitors Hospital Charging Regulations Guidance for NHS Trust Hospitals in England]&mdash; Rod talk 12:59, 19 December 2006 (UTC)
 * If you live in another EU country get a free EU Health card from your local health admins... you can get emergency treatment for free with that card. UK citizens can come back at any time and as long as they can demonstrate that they are making the UK again their permanent residence can get permanent and not just emergency NHS treatment from the date of their resettlement.--Tom (talk) 13:56, 22 January 2008 (UTC)

Visitors to UK while on UK soil may visit the emergency services if needed. They will be subjected to a fee which need not be paid on the spot. I have read in the Health Services Journal about the PCT which covers the Heathrow area complain about the large number of emergency visits from foreign visitors which it has to cater for but they weren't sufficiently compensated by the DH funding formula. —Preceding unsigned comment added by 87.115.81.175 (talk) 00:30, 27 December 2008 (UTC)

Funding Allocation Formula, Payment by Result, etc
How funding is allocated across different areas in England is not being mentioned anywhere on the page. The Needs Formula, Market Forces Factors adjustments, and Payment by Result are the three key elements of the formula that distribute money across trusts in England. Needs Formula has been around since the 80s, Market Forces Factor has been around since 1973 (?) and Payment by Result is what the New Labour Government has introduced to encourage competitions between trusts. These three elements are particular to NHS England - no where else in UK are they used with real impact on access to care and treatments. They should be at least mentioned if not discussed in details. Pelikan4001 (talk) 01:27, 27 December 2008 (UTC)

IT system.
There is a good article here [] we ought to include sometime. Springnuts (talk) 09:58, 21 February 2009 (UTC) Also here [], [], [] [] ... maybe it needs its own article. Springnuts (talk) 10:01, 21 February 2009 (UTC)

Reciprocal agreement
Hi,

I am a British citizen living in New Zealand. Is there a reciprocal agreement between the two countries, and if so, how do I go about getting a national health number that I can use over here.

Many thanks Ernie Phythian —Preceding unsigned comment added by 122.57.67.26 (talk) 04:38, 25 February 2009 (UTC)


 * If you were born in Britain, you were assigned a National Health number at birth. There is a reciprocal agreement between New Zealand and the UK. However you probably aren't eligible for free treatment in the UK unless you have been paying National Insurance contributions -- and I'm not sure that Class III (voluntary) contributions would count. I think that you have to be resident in the UK. Anyway check here for New Zealanders in Britain. Or here for Britons in New Zealand. -- Derek Ross | Talk'' 06:25, 25 February 2009 (UTC)

Query by user
A user added the following query direct into the article. I removed it, and thought it best to add it here:

"So why did they build the NHS in the first place was it to cure the sick from the war? This does not explain who thought of the NHS in the first place." Allventon (talk) 02:26, 3 March 2009 (UTC)


 * Our article, History of the National Health Service is brief but it gives the background plus links to external sources for those who want to know more. -- Derek Ross | Talk'' 16:26, 5 March 2009 (UTC)

I am Dutch and don't understand the relation between the NHS and the Department of Health. —Preceding unsigned comment added by 81.59.216.70 (talk) 15:29, 5 March 2009 (UTC)


 * The Minister of Health makes UK government health policy with the support of the rest of the Cabinet. The Department of Health ensures that the structure of the UK health system (both NHS and private) meets his requirements and that his regulations are being followed by all healthcare providers by overseeing the health system. It also collects statistics on how well the health system is doing. The National Health Service is the group of semi-autonomous, government funded agencies which provides the vast majority of healthcare services in the UK. The Department of Health also supervises a small number of UK commercial healthcare providers, which are mostly funded via private insurance or overseas clients, in order to ensure that they are meeting UK standards.


 * So the Minister says how it is supposed to work, the Department checks that it is working, and the NHS (plus the private providers) do the actual work. -- Derek Ross | Talk'' 16:21, 5 March 2009 (UTC)
 * Just for clarification, healthcare is a fully devolved area - therefore, the Minister of Health makes government health policy for England (not for the whole UK). The Department of Health ensures that the structure of the English health system (both NHS and private) meets his requirements. The National Health Service is the collective name for the four separate health services that provide public health care in the four countries of the United Kingdom, as well as being the name used by the National Health Service in England.

Cheers Fishiehelper2 (talk) 16:40, 5 March 2009 (UTC)


 * Good point. -- Derek Ross | Talk'' 18:27, 5 March 2009 (UTC)

Criticisms and perceptions
I added some observations about criticisms of the NHS. First of all, I accept that I added the observations without references. But those references are available. It wll take a little time to pull them together. This edit has since been pulled http://en.wikipedia.org/w/index.php?title=National_Health_Service_(England)&curid=14780936&diff=298220777&oldid=298203972.

Before going off to get the references, I want to understand why the editor that pulled the edit believes that it is one sided. What other side exists? Or is just that all news tends to be bad news? I'd also be interested to know the opinions of other editors. Does this issue of perceptions exist in reality and if so how should we get it into the article. --Hauskalainen (talk) 23:18, 23 June 2009 (UTC)
 * Must admit that I agreed with your addition. It may have been unsourced but it nevertheless stated pretty accurately how most people in the UK feel about the NHS. I wouldn't worry about the "one-sided" dig. Just find a reference or two for your addition. NPOV means describing the one-sided opinions that exist: not pretending that they don't. -- Derek Ross | Talk'' 01:19, 24 June 2009 (UTC)


 * Documenting the differences between how people view the "system" and how they view their own care is important. If it can be done with solid objective sources, documenting how press coverage may feed into this would be important as well.  I'd caution us to be careful about drawing conclusions from those differences, though.  You see the same dynamic in the U.S. as well - a recent survey found that eight out of ten (85%) Americans support some sort of basic reform, but almost eight out of ten (77%) said they were very or somewhat satisfied with their own personal health care.  This pattern has shown up in U.S. polls consistently over a period of decades.  Might that "indicate that at least some of the negative press coverage leads people to think their own experiences must be better than those of the rest of the population"?  I suspect that's not the conclusion you would draw in the case of the U.S. - and I really don't see any benefit in debating the U.S. health system here - but it illustrates the dangers in drawing broad conclusions based on the difference between two poll numbers.


 * Of course, if we can find reliable sources making that argument in the case of the NHS, we should report what they say and the conclusions they draw. EastTN (talk) 14:20, 24 June 2009 (UTC)


 * I described it as one-sided because it was entirely about casting doubt on the criticisms of the NHS, in such a way (putting it at the head of the section) as to prejudge every individual criticism. It came across as just opinion, without important context e.g. does the NHS attract this kind of attack more than other UK government services, or more than health-care services in other countries? Are the attacks typically from particular organisations or countries or political viewpoints, in a way which suggests they are systematically biased? Are the defenders of the NHS under-represented for any institutional reason? Once you start debating the nature of criticisms of the NHS in general, there's a lot of ground to cover to make sure you're getting to the truth of the matter and not just yourself voicing one slant.
 * To put it another way; the most important reply to any criticism is to check the facts about that criticism; and the way a neutral encyclopedia should go about reporting these issues is (IMO) to firstly report the criticisms, secondly to report the responses, and only thirdly to report on discussion of how/why the whole debate may be imbalanced.
 * My personal opinion: I suspect that what you said is mostly true, but you need to adjust the tone, the scope, the balance and the context of your addition before it would be a good neutral improvement to the article (and bring in some heavy-weight citations). --VinceBowdren (talk) 23:51, 24 June 2009 (UTC)

The source for my comments came from an IPSOS-MORI poll for the NHS or the DoH (I can't remember which= but unfortunately I don't have the time to track it down. That poll certainly says that most people trust the NHS and their doctor as the most reliable source of info about the NHS and that newspapers are the least trusted. It also showed that people's own experiences were much better than their opinions of the service, and, if I remember rightly that people who use the service the most are the ones who are most satisfied. All those things are indicators that the press is the source of distorting images of the NHS and that the service is actually very highly rated by the people of the UK. This is totally in contrast to the stories depicted in the US which use these garish stories from the press, often taken out of context, to paint a picture of the NHS totally distorted from reality---Hauskalainen (talk) 13:40, 27 June 2009 (UTC)


 * Again, I'd suggest caution in introducing our own interpretation of what these differences mean. We see the same phenomenon in the U.S., where large majorities of people say the system needs to be changed, but almost as great a majority say their own personal care is good.  This parallels people in the U.K. scoring "their own experiences of the NHS much more highly than when they are just asked for their general opinion."  You may be right in saying that this is due to misperceptions created by U.K. press coverage - but if so, there should be a solid source available making that point.  If we can't find that source, then no matter how strong the indicators may be, we're ultimately doing our own original research.  As for the rest, I'm not always happy with the way the U.S. is characterized by non-U.S. press; that's one of the downsides of living in a global community. EastTN (talk) 21:06, 27 June 2009 (UTC)


 * Aamen Brother (or Sister). But I think the MORI-IPSOS poll did say something like that as the pollsters interpretation. I will try to find it if no one beats me to it.--Hauskalainen (talk) 17:41, 28 June 2009 (UTC)

Here is the web page where the series of surveys are published.http://www.dh.gov.uk/en/FreedomOfInformation/Freedomofinformationpublicationschemefeedback/Classesofinformation/Communicationsresearch/DH_4129933 Looking at the latest survey,  the thing that strikes me is that people that actually use the service the most, who of course tend to be the elderly, are the ones who are most likely to express satisfaction. But even the age group most likely to express dissatisfaction (those aged 35-64) are just as positive as the other groups about their own recent hospital or GP experiences. When asked about their last experience of their last hospital visit, statisfieds outnumber dissatisfides by about 8 to 1 (5 to 1 for accident and emergency). For GP services, satisfides exceed dissatisfieds by a whopping 10 to 1. When asked about NHS services in their area, people rate it more highly than they rate the service nationally (though of course people only ever experience their local NHS, so the perception for the nation has to be based on something other than personal experience. Of course the press is the obvious source but I see that the latest report does not imply this. Fot the national picture, the satisifieds exceed the dissatisfied by 3 to 1. That is not a bad picture but it clearly does not match up to the very high standard reflected in people's own experiences. I'll see if I can now find the survey that included the "sources if information" reliability issue.--Hauskalainen (talk) 22:51, 28 June 2009 (UTC)

The Winter 2004 survey (from the site listed above) has the data about what sources are reliable. The 3 most highly regarded sources were leaflets obtained from GPs, friends, and medical professionals. The 3 least reliable sources were TV/radio, the local press, and least reliable of all was the national press. Needless to say the national press is where most people get their national news from, and I would contend, distorts people's perceptions about the NHS. The national press is also perceived by people as most likely to be critical of the NHS.--Hauskalainen (talk) 23:10, 28 June 2009 (UTC)


 * All comments on the above welcome of course. Also how best to get it into the article. I do think that this has to be said. People in the UK well understand that the national press is not reliable when it comes to stories about the NHS. People outside the country will not realize this.--Hauskalainen (talk) 23:13, 28 June 2009 (UTC)


 * This letter http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1118072 from a medical professional about one example (albeit from 9 years ago) gives a flavour of the very bad, sensationalist and misleading reporting that goes on. The other thing I would mention, and it applies very much to the reporting that goes on in the United States about the NHS is that stories get badly reported in the UK and then they get reported in the US as though this was the norm!  An example was the practice in one hospital, now ceased, where a bed may be "top and tailed" (i.e. the sheet is turned round when the patient is out of the bed so that the head end is switched to the foot end). The story wrongly reported as if this was a cost cutting measure, that the sheets were not changed between patients and the last patient's sheet was turned over (dirty side to the mattress) to accommodate the next patient. None of this which was true. Even the paper that carried the story said that the hospital ward sister admitted that the practice of topping and tailing happened but NEVER BETWEEN PATIENTS. Now, one would not expect bed sheets to be changed every day and as an isolated practice topping and tailing I would imagine would be better than having the same sheet in the previous situ if it was not due to be changed. But the press thrashed the hospital remorselessly. The infections expert in the hospital had actually approved the practice. But I've heard this reported in the USA that "Britain's NHS is now so short of money that they don't change the sheets between patients - they just turn them over". As with the cancer patient's diagnosis, you cannot characterize an entire system by a piece of bad reporting about an isolated or unusual incident. This is clearly why people in the UK have a lesser opinion about the NHS nationally than their own experience tells them, and undoubtedly it is why people in the USA regard the NHS with a lot of disdain. It is mostly misjudged based on poor reporting. With a press like ours, who needs enemies.--Hauskalainen (talk) 23:44, 28 June 2009 (UTC)


 * My suggestion is to play it absolutely straight. Report the survey results on both public opinion of the system as a whole and on people's own personal contacts with the system.  Report the survey results on what people consider the most reliable sources of information.  There's no need to interpret the statistics - readers can do that for themselves. EastTN (talk) 15:31, 29 June 2009 (UTC)

This article needs serious work
This article needs serious work. There is a lot of good stuff in there but it is riddled with problems. There are un-referenced, POV and weasel-word statements throughout the article. For example:


 * "In addition medical training has undergone an unsuccessful restructuring which was so badly managed that the Secretary of State for Health was forced to apologise publicly. MMC is now being revised but its flawed implementation has left the NHS with significant medical staffing problems which are unlikely to be resolved before 2010."


 * "Supporters of the NHS would point out that the NHS has wide public support..."


 * "Doctors were initially opposed to Bevan's plan, primarily on the grounds that it reduced their level of independence. Bevan had to get them onside, as, without doctors, there would be no health service. Being a shrewd political operator, Bevan managed to push through the radical health care reform..."

The "criticism" section should be incorporated into the article as a whole and not just tagged on at the end. Some of the criticisms given are merely brief statements of things which have been brought up in the press, without any context, elaboration, discussion or counter argument. For example:


 * "The lack of availability of some treatments due to their perceived poor cost-effectiveness sometimes leads to what some call a "postcode lottery"."

Here there should at the very least be a discussion of how hospitals got into debt, whether it is a problem, and why.


 * "Some hospitals and trusts were running a financial deficit and getting into debt."

Here there should be a discussion of how "postcode lotteries" come about, and a discussion of whether they are merely anunavoidable outcome of any system in which decision making is regionally devolved; the only alternative to which is further centralisation. These discussions should come in the main section of the article concerning the structure and history of the health service; not just tagged on to a criticism section at the end.

Finally, the article is over-dependent on news sources for its references. There is a vast wealth of academic literature out there on the NHS, its structure, its management and its history. Very little of it is referenced in the article. I think academic sources would be very useful in improving this article and overcoming the problems I've highlighted. Alboran (talk) 21:33, 21 August 2009 (UTC)

The so-called references are terrible. The politisation section talks about how opponents to a universal healthcare system say it's evil or Orwellian and then has a link to an article about Obama's mother praising the system. I expected to find an article with criticisms saying why it's evil or Orwellian. —Preceding unsigned comment added by 150.228.40.141 (talk) 20:38, 4 September 2009 (UTC)
 * Hmm, okay. I'll remove that reference and replace it with a citation needed then. -- Derek Ross | Talk'' 20:59, 4 September 2009 (UTC)

NHS in General
I think that much of this article would be better placed in the National Health Service article. The Superbugs, American criticism etc apply to the whole of the British NHS not just the English part. I think that the National Health Service article needs a lot of work but should be the home of where the more general subjects are discussed with just the England specifics discussed in detail on hear. Anyone agree? Scroggie (talk) 14:21, 25 October 2009 (UTC)


 * I don't support this idea. I don't think much information is published about NHS type service in Scotland Wales or Northern Ireland. The issue you raise was an inevitable problem that arose as soon as the split was made to rename this article National Health Service (England). The problem will be that you cannot actually distinguish very easily between the different services, especially in most news stories, though much of inevitably is associated with the larger, English NHS.


 * Also it is very difficult to credit much of the criticism, especially that coming from the U.S., because it is so badly informed. I heard one CNN reporter the other day saying that some people in the UK (or was it England or Britain? - I don't think she would have cared what she said) won't take private insurance because otherwise they'll lose their NHS cover. How ignorant can you get? Things like MRSA are medical sector problems that exists in hospitals all around the world. In fact Britain has a better record on the control of MRSA than in many other countries, including the U.S. People in the UK are rightly concerned because it is their health and they want the politicians to do something about it. But that is actually a STRENGTH in the UK. The pressure from the public did push the NHS into being more aggressive and cutting rates of hospital infections. I cannot imagine that people in the U.S. would complain to their political representatives about MRSA in American hospitals, even though rates there are double the UK level, and neither can I envisage British or American hospitals publishing their hospital infection rates voluntarily as the UK public hospitals do. If British and American private hospitals had to be audited and have their infection rates notified publicly, then maybe their rates would come down too.--Hauskalainen (talk) 15:28, 25 October 2009 (UTC)


 * I understand what you're saying but I don't see how it's relevant to the layout of the Wikipedia articles on the NHS in the UK. It seems arbitrary, to me, to put the details of the American criticisms in the English NHS article. Why this article? Why don't we move this section to the NHS Wales article instead? Because it is relevant to the British NHS as a whole. The differences between the four British NHSs are arguably small. I certainly think that the Superbugs can be mentioned on this article with respect of their extent in England and how the English NHS are battling them. I just think that the National Health Service article should be the main article for general NHS topics. I can't see any argument for having the American Criticism section on this article instead of the National Health Service article. It's typical of the UK government to have an ambiguous name for things. They clearly didn't consider Wikipedia when they set up the NHS. Scroggie (talk) 17:17, 25 October 2009 (UTC)
 * My answer is that National Health Service is in effect a disambiguation page, given that there isn't one NHS in the UK but four. The only NHS that calls itself as just National Health Service is the service in England. I don't see much point spreading this information into all 4 articles as it would be hard to find references for each of them. I don't think any editor would claim that the differences in the services are so different that what is in the England article is in anyway not representative. --Hauskalainen (talk) 18:03, 25 October 2009 (UTC)

Shilling and pennies
Concerning this sentence : "proposed that there should be a one shilling (5p) prescription charge" According to http://en.wikipedia.org/wiki/Shilling, a shilling is worth 12 pences. So what is this 5p? —Preceding unsigned comment added by 91.199.6.44 (talk) 11:54, 18 November 2009 (UTC)


 * It's the difference between pre-decimal and post-decimal UK coinage. In the old system, a pound was divided into twenty shillings which were each divided into twelve pence. At decimalisation they kept the pound the same, but divided it into a hundred pence instead. The shilling coins were therefore equal to five new pence - and were indeed kept in circulation for that amount.
 * P.S. If you see them written down, old pence used a 'd' suffix so or example 4 old pence is written 4d; but new pence uses a 'p' suffix so five new pence is written 5p. --VinceBowdren (talk) 18:47, 18 November 2009 (UTC)


 * Absolutely. 1s = 12d = 5p (one shilling equals 12 old pence equals 5 new pence). -- Derek Ross | Talk'' 23:21, 18 November 2009 (UTC)

Scandals section
In an organization as big as the NHS there are bound to be cases where things go wrong and which eventually come to light. I am not entirely sure that looking at exceptional things like this tell us anything about the NHS as a whole. I am not entirely sure what the ecyclopaedic worth is of this section.

I am not for editing out references to Alder Hey and the like but I do not think they deserve to be separated out in a special section. Such scandals as there have been are very rare and on their own they tell us nothing about the service as a whole which in practice operates in a very professional manner.

Some so called "scandals" get reported in the press with very little investigation. I came across a case reported in the national press of a so called scandal in Colchester where a patient, a professional cleaner, told the press that the hospital room she was in was "filthy" and had to clean it herself. The press had a field day. What did not get reported was that the Care Quality Commission (or some similar body) put a team into that hospital to examine the room and others the day after publication to investigate it. It found no evidence of any filthy conditions and it confirmed that the cleanliness in the hospital was still exactly as it had found it in its earlier investigations - above average. Even more surprising was that the hospital put out a statement saying that the woman concerned had NOT raised her concerns to the hospital staff before contacting the press. They had been trying unsuccessfully to contact the woman to get her to make a formal complaint. Some of these so called scandals often turn out to be nothing of the sort and one wonders what the motive is of people who make claims like this but never raise them even with hospital staff. What patient would so that?

Also coming to mind was a story in the Observer which claimed that patients were being "stacked" in ambulances outside hospital A&E departments because the A&E departments were afraid they might break A&E wait time targets if the patient were admitted through the doors. I have tried very hard to verify this story without suceess. But because one newspaper reports the story it is assumed to be true. That particular story went across the atlantic and has been repeated in many american blogs as if it is a general problem in the UK. But as far as I can tell, it never happens. Certainly one person (a trade union official) claimed it DID happen and that one claim was indeed the basis of the story. But it had no general applicabilty at all and was probably false. --Hauskalainen (talk) 01:11, 16 December 2009 (UTC)

The 18-week waiting-list target
The article currently states:

"A major programme is underway in the NHS to reduce all wait times to 18 weeks by December 2008"

Since this is stated in the present tense, but the specified date passed more than a year ago, could someone update it appropriately? Was the goal achieved? What has it been replaced by (if anything)? 86.7.22.39 (talk) 07:43, 27 January 2010 (UTC)

Should give more emphasis to the fact that it is NOT a "free" service
The idea that NHS provides healthcare from "cradle to grave" and that it is "free at the point of delivery" may have been true once, but it not true any longer. Unless you are on rock-bottom income or living off benefits, you pay for prescriptions, dentistry (if you can actually get to see an NHS dentist!)and opticians. Doctor and hospital appointments are so chaotic that it can involve taking a whole day off work to achieve a five minute appointment, and hospital waiting lists are so long that some patients are forced to pay for private health care simply in order to get treated. And when you get old, the state washes its hands of you, and farms you out into private nursing homes.
 * If you ever have been charged for an NHS service then you been robbed! All NHS services are free of charge at the point of use. The services you mention are private services which are subsidized by the NHS. Prescriptions from private pharmacies are your responsibilty to fulfill. As are dentistry and optometric services from private dentists and optometrists. If an NHS hospital gives you drugs, then you don't pay for them. But if you lived in England then you would know this. An NHS dentist is really a private dentist offering NHS subsidized services at a price to the patient agreed with the NHS. Waiting lists are not as long as they were in the Thatcher era when people could wait 18 months or more. Most people in England can see their doctor on the same day or the next day and surgeries are non-urgent scheduled within weeks. Yes, if the waiting list is so long that you have to go elsewhere, either at home or abroad (extremely rare) then the NHS has to pay for it!  It has recently been passed in a bill through parliament!! But if you really live in England then you would know that. I am puzzled by the issue you raise of nursing homes. If you need nursing care because you have a medical illness then the NHS will pay for the nursing element of your private care (at its standard rate). You have the free choice of nursing homes. Nobody gets "farmed out"!! Its called patient choice and its a standard feature of the NHS these days. But then if you lived in England you would know that.--Hauskalainen (talk) 19:43, 26 January 2010 (UTC)
 * I live in England, and I can vouch for the fact that NHS prescriptions ARE charged for (see [here] for the scale of charges). These are not "private prescriptions" as you imply, but prescriptions issued to patients by their General Practitioner.  Although large numbers of people are entitled to exemption from charges, this is by no means universal.  As for your comments on nursing homes, it is clear you don't live in England.  The issue is that (as you probably know, from the way you phrase your comment) the *nursing* element of the care is paid for by the NHS, but other costs are not.  This is contraversial because people whose health gives them no other real choice than to enter a nursing home are presented with the bill for "personal care" services, even though they would not have needed those services if they hadn't been ill. 86.7.22.39 (talk) 08:08, 27 January 2010 (UTC)