History of the National Health Service (England)

Political concerns about spiralling NHS costs later receded in the wake of the 1956 Guillebaud Report, which praised the "responsible attitude among hospital authorities" towards the "efficient and economical" use of public funds.

The investigation and trial of alleged serial killer John Bodkin Adams exposed some of the tensions in the system.

[4] Indeed, if he had been found guilty (for, in the eyes of doctors, accidentally killing a patient while providing treatment) and hanged, the whole NHS might have collapsed.

New drugs came to the market improving healthcare, including polio vaccine, dialysis for chronic kidney failure and chemotherapy for certain cancers were developed, all adding to upfront costs.

Health Secretary Enoch Powell undertook three initiatives: Concern continued to grow about the structure of the NHS and weaknesses of the tripartite system.

[8] In the 1980s, Thatcherism represented a systematic, decisive rejection and reversal of the post-war consensus, whereby the major political parties largely agreed on the central themes of Keynesianism, the welfare state, nationalised industry, public housing and close regulation of the economy.

These outlined the introduction of what was termed the "internal market", which was to shape the structure and organisation of health services for most of the next decade.

In spite of intensive opposition from the BMA, who wanted a pilot study or the reforms in one region, the internal market was introduced.

Studies suggest that while the competition introduced in the "internal market" system resulted in shorter waiting times it also caused a reduction in the quality of care for patients.

In a speech given by the new Prime Minister, Tony Blair, at the Lonsdale Medical Centre on 9 December 1997, he stated that: The White Paper we are publishing today marks a turning point for the NHS.

The result will be that £1 billion of unnecessary red tape will be saved and the money put into frontline patient care.

Reforms included (amongst other actions) the laying down of detailed service standards, strict financial budgeting, revised job specifications, reintroduction of a modified form of fundholding – "practice-based commissioning", closure of surplus facilities and emphasis on rigorous clinical and corporate governance.

A new emphasis was given to staff reforms, with the Agenda for Change agreement providing harmonised pay and career progression.

A study by a consultancy company which worked for the Department of Health showed that every £200 million spent on privately financed hospitals resulted in the loss of 1000 doctors and nurses.

[18] The ability to deliver integrated high quality services will require care professionals to use sensitive medical data.

One concern is that GPs and hospital doctors have given the project a lukewarm reception, citing a lack of consultation and complexity.

2016 also saw major industrial action by junior doctors, protesting at the imposition of a new contract aiming to extend weekend working.

The Health and Social Care Act 2012 did not extend patient choice as envisaged (as this policy subsequently took a backseat) but did lead to an increasing amount of the NHS budget being diverted to private providers.

[21] In 2019, doctors and MPs warned that the ongoing privatisation of certain NHS England cancer screening services would lead to patient harm.