The NHS was established on the 5th of July 1948. Its founding father and chief architect was the Minister of Health and Welshman Aneurin Bevan. Before the NHS was set up healthcare was provided on a piecemeal and patchwork basis with many people having to pay directly for primary and hospital care services and others not receiving the services they needed. The NHS was to be funded out of general taxation and was to be based on the following principles - Free at the point of delivery, Comprehensive, Equity, Equality.
The aim of the NHS was to promote “the establishment of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness” (1946 NHS Act).
The values which underpinned the establishment of the NHS still hold true today but the founders of the NHS could not have anticipated the pressures which would be placed on the system over more than 50 years. Advances in technology, a growing elderly population, increased expectations and knowledge have all increased the demands for health care which have to be met out of a limited budget.
In May 2005 the Welsh Government (WG) published ‘Designed for Life - Creating World Class Health and Social Care for Wales in the 21st century’ is a strategy for the future of health and social care in Wales. This describes the way in which by 2015, the people of Wales will benefit from “world class healthcare and social services in a healthy, dynamic country”.
Much of the achievement in the delivery of this strategy over the next ten years will rely on good partnerships, especially across the NHS, public health, local government and voluntary organisations working towards a single goal of improving the quality of life in Wales.
Some 3 million people live in Wales and use the services of the NHS. Wales faces a number of challenges in improving the health of the people of Wales, some of whom are the poorest and with the worst health status in Europe. Wales has some of the highest rates of cancer and heart disease and has a high proportion of elderly people. The delivery of health services in Wales also has to take account of the mix of rural, urban and valleys areas that exist across Wales.
Wales has for 30 years somewhat different policy and structural arrangements from England but these powers have been significantly advanced by the advent of devolution.
The Government of Wales Act of 1998 gave powers over a number of areas including education, agriculture, social services, local government and health and health services to the Welsh Government. The first elections took place in 1999 and from this the Welsh Government was formed.
The Minister for Health and Social Services is the person within the Welsh Government who holds cabinet responsibilities for both health and social care.
The Health and Social Services Committee which is composed of assembly members from all of the political parties contributes to the development and scrutiny of health and social care policy. Civil servants including those with professional backgrounds provide support to the Minister and the government in formulating and implementing health and social care policy.
The NHS in Wales employs some 90,000 staff which makes it Wales’ biggest employer. The NHS is a labour intensive service and its pay bill accounts for at least 75% of its total annual cost.
NHS Staff are drawn from many professions and occupational groups and work in variety of settings across Wales. In addition to staff employed directly by the NHS there are contractor professions including dentists, opticians, pharmacists and nearly 2,000 General Practitioners (GPs) who predominantly work in primary care settings.
New contracts for doctors and other professional groups, new systems of pay under 'Agenda for Change' and the European Working Times Directive have all impacted on workforce planning and development.
When most people think of the Health and Social Care Services they think of hospitals, GPs and social workers although the area is much wider and covers a range of services provided in a variety of settings serving many different client groups.
Most people in Wales will have access to a District General Hospital which provides a range of services on an outpatient, inpatient and day case basis. Some of these hospitals also provide specialist services such as burns and plastics and cardiac surgery.
The NHS and Local Authorities also provide community based speech therapists, physiotherapists and occupational therapists.
The NHS also provides mental health services, predominantly in community settings in partnership with social services departments and also supports social services departments in providing emergency and paramedic treatment and patient transport services on an all Wales basis.
Primary care services are provided by General Practitioners and members of the primary care team in health centres and surgeries across Wales. NHS Wales also provide a 24 hours primary care services through the 111 telephone helpline and website providing information and advice about health, illness and health services. In addition primary care services are also provided by the contractor professions of opticians, dentists and pharmacists in a variety of settings including the high street. 20 Community Health Councils represent the community’s interest in their health service.
When we talk about health policy what we usually mean are the decisions and actions taken to change things in the NHS. Health policy is usually written down in a formal document but can also be expressed informally. Health policy can be made at variety of levels in the NHS including by Trusts, Local Health Boards and in primary care. However, policy is usually made at a government level and in Wales this means the Welsh Government.
The NHS is mainly paid for from general taxation with a small proportion raised through national insurance contributions.
NHS Wales receives its allocation as part of the process of negotiation between Westminster and the Wales, Scotland and Northern Ireland offices. The sum available for health and health services in Wales forms part of what is called the ‘block grant’ which is the total amount of money for all the areas for which the Welsh Government has responsibility for and is devolved to them. Increases over and above the overall share of the NHS are subject to the Barnett formula which seeks to ensure that all increases are based on actual population. Wales spends over four billion every year on its health services and this figure is set to continue to rise.