Analysis of the 4 Pillars of the NHS

Introduction

The National Health Service (NHS) represents one of the fundamental elements of healthcare provision within the United Kingdom (UK). Established on 5 July 1948, this publicly funded and operated healthcare system is characterized by four core objectives: it meets the needs of everybody, is free at the point of delivery, is based on clinical need, and is not centrally controlled. Its first three principles highlight the importance placed on ensuring accessibility and high-quality standards of care that are universally distributed on the basis of need.

In practice, this means that patients are able to access a core set of treatments for all clinical specialties, which include primary care, prescriptions, allied health professionals, and drugs, without cost at the point of use. Other specialized treatments and services are also available but may be limited by budget constraints, meaning that some restrictions for their provision may apply and waiting lists may occur. Access to these high-cost medications and specialized treatments is therefore regulated.

The NHS offers all four core healthcare services: unified care; primary; secondary; and tertiary care services. An emphasis is placed on outpatient, day care, and emergency care treatment, alongside inpatient care. Care is enshrined to be comprehensive and essentially free at the point of use for patients; however, patients must pay for costs associated with social care services. The NHS is funded primarily through general taxation, national insurance contributions, and cost recoveries on prescription drug charges and primary care dental and optical services. It also has income from user charges for those who are not residents in the UK and has earned income from medical tourism. The NHS is one of the four statutory systems of healthcare in the UK, and most healthcare is provided by the public sector, operating variously through primary, secondary, and tertiary care facilities. General practitioners and their clinician staff have the leading roles in providing comprehensive primary care services. Despite its many achievements, the NHS is currently facing numerous challenges associated with financing and other areas of care delivery. The importance of the NHS in the UK is also reflected in the various focus group studies that have demonstrated that UK citizens value the NHS. In an international context, the NHS has the highest standard of patient access and health outcomes.

The Historical Development

The four pillars of the NHS have developed across 70 years, from the seminal creation of a National Health Service in 1948. The evolution took account of the different challenges of the day, and the different attitudes and abilities of Britain’s politicians and civil society of the time. The four pillars are full of confidence and optimism, especially in the context of the creation of the NHS. For nearly all of the history of the NHS, the idea of the NHS Act serving as the lead in a series of discrete, major transformations has been politically and intellectually engaging, but it is as yet still unclear what the vision behind this is.

When health and social structures were brought under a national government in 1948, of which the largest and most comprehensive part was the NHS, discussions began about whether the NHS was the embodiment of all four pillars or whether the NHS had a core, the first pillar of 'free at the point of use', supported by the other three pillars. The NHS is frequently used to express concerns, particularly in health economics, of such thinking, such as in the terminology of the 'gift relationship', when there is evidence of it. This too often, unfortunately, implies an underestimation of the British people as if they do not really understand what they have been given for free. The NHS came neither in a day nor as a void. Every Act to start and update the NHS did not occur in a vacuum – indeed, health policy was perhaps framed rather more by World War II than by the Beveridge Report. Economic difficulties and indeed public health crises throughout the years have differentially impacted every section of the NHS. Additionally, every source of health care and services historically has been at once a result of public policy and a reply to public concerns.

Exploring the Four Pillars of the NHS

The National Health Service (NHS) seeks to maximize the potential for good public health. Fundamentally, there are four key components to public health that can only be delivered by healthcare professionals: health promotion by increasing awareness so individuals make choices that support their health; disease prevention by minimizing their opportunities to present with preventable conditions; diagnosing and treating individuals when they are unwell; and restoring people to health via the process of rehabilitation. This can also be expressed as the four pillars of prevention, inquiry, treatment, and support. Although they have different functions, the pillars are interdependent, and it is impossible to completely separate them because knowing how to reduce each risk factor will influence the priority to treat the associated illness and vice versa. Practically, these functions cannot be done in sequence and are therefore carried out concurrently.

The concept of prevention has developed, and it is now understood and accepted that while identifying and managing illness at an early stage is part of the prevention pillar, it is also the pivot between the different pillars. The single most important aspect of health promotion is stroke awareness - if the public can recognize a risk factor that increases their chances of having a stroke, then they will seek help early and therefore have the possibility of a reversal of their symptoms with treatment. As part of the prevention pillar, the aim of delaying the onset of dementia has been launched. The subsequent health checks program aims to identify and treat certain 50-year-old members of the public with their modifiable risk factors for heart disease and diabetes. While still not universally effective, we know that early diagnosis and treatment of cancer saves lives and also means less aggressive treatment for those in whom cancer is diagnosed at a later stage.

Impact and Future Prospects

Evidence based on current UK healthcare outcomes does suggest that the four pillars of the NHS contribute to the overall health and well-being of our population. Results suggested that the NHS was the most efficient healthcare system in the world. The review also reported that most indicators of healthcare efficiency were in broad agreement that the NHS was delivering greater value for money compared to its European neighbors. Some outcomes on specific treatments were also world-leading, especially in the areas of cervical cancer, hip restoration in childhood rheumatoid arthritis, and ankle replacement. However, some aspects of outcomes were identified as requiring further improvement, especially in the area of disparities in help-seeking in the treatment of mental health and in access to care following breast, lung, and bladder cancer.

Despite suggesting efforts made towards clinical improvements, the future sustainability of the four pillars of the NHS remains uncertain. These days, people are living longer, and innumerable advances have been made in medical technology, which consequently has changed the pattern of public health needs. The NHS was widely felt to be set up for needs that existed 70 years ago, and possibly more reform was required to adapt to a more diverse and possibly older society. Several stakeholders, including healthcare practitioners and key policymakers, also believe that the four pillars are now coming under extreme pressure once again, citing a lack of resilience in the subsequent drug-only approach with the rise of antibiotic-resistant organisms. Furthermore, changes in public need for healthcare also have direct implications for all four of the NHS pillars. Moreover, a range of mental health conditions, which typically sit under the banners of most deficiencies, are likely to be strongly influenced by adverse childhood experiences, where the influence of drugs is likely to be relatively minor. Some who had been involved in this work believed that out-of-hospital care has more potential for health improvement than hospital care, which also has the benefit of being cheaper. Some thought that there could be the potential to reintegrate hospitals into the community again. Therefore, most of the people spoke to strongly reflected an evaluation which stated that there would be a return to using all four NHS principles to guide future service planning and development again. We recommend an in-depth understanding of the model and its many-stage development. More discussions must be had in order to adapt the model to the specific needs of the target group.

Did you like this example?

244

10