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National Health Service (England)

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National Health Service (England)

The National Health Service (NHS) is the publicly funded healthcare system in England, and one of the four National Health Service systems in the United Kingdom. It is the second largest single-payer healthcare system in the world after the Brazilian Sistema Único de Saúde. Primarily funded by the government from taxation and National Insurance contributions, and overseen by the Department of Health and Social Care, the NHS provides healthcare to all legal UK residents, with most services free at the point of use for most people. The NHS also conducts research through the National Institute for Health and Care Research (NIHR).

A founding principle of the NHS was providing free healthcare at the point of use. The 1942 cross-party Beveridge Report established the principles of the NHS which was implemented by the government, whilst under Labour control in 1948 and the NHS was officially launched at Park Hospital in Davyhulme, near Manchester, England (now known as Trafford General Hospital). Labour's Minister for Health Aneurin Bevan is popularly considered the NHS's founder, despite never formally being referred to as such. In practice, "free at the point of use" normally means that anyone legitimately registered with the system (i.e. in possession of an NHS number), that is a UK resident in clinical need of treatment, can access medical care, without payment. The exceptions include NHS services such as eye tests, dental care, prescriptions and aspects of long-term care. These charges are usually lower than equivalent services offered privately and many are free to vulnerable or low-income patients.

The NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare, ophthalmology and dentistry. The National Health Service Act 1946 was enacted on 5 July 1948. Private health care has continued alongside the NHS, paid for largely by private insurance: it is used by about 8% of the population, generally as an add-on to NHS services.

The NHS is largely funded from general taxation and National Insurance payments, fees levied by changes in the Immigration Act 2014 and a small amount from patient charges. The UK government department responsible for the NHS is the Department of Health and Social Care, led by the Secretary of State for Health and Social Care. The Department of Health and Social Care had a £192 billion budget in 2024–25, most of which was spent on the NHS.

A. J. Cronin's controversial novel The Citadel, published in 1937, had fomented extensive debate about the severe inadequacies of healthcare. The author's innovative ideas contributed to the conception of the NHS. Bevan commented in 1948 that "All I am doing is extending to the entire population of Britain the benefits we had in Tredegar for a generation or more". This comment came from his experience of his local community healthcare provisions.

A national health service was one of the fundamental assumptions in the Beveridge Report. The Emergency Hospital Service established in 1939 provided an example of what a National Health Service might look like.

Healthcare before the war had been an unsatisfactory mix of private, municipal, and charity schemes. Bevan decided that the way forward was a national system rather than a system operated by local authorities. He proposed that each resident of the UK would be signed up to a specific General Practice (GP) as the point of entry into the system, building on the foundations laid in 1912 by the introduction of National Insurance and the list system for general practice. Patients would have access to all medical, dental, and nursing care they needed without having to pay for it. The British Medical Association initially objected to the formation of the NHS.

In 1956 the first kidney dialysis was performed. Preventing disease also became a focus, with a polio immunisation programme and another for whooping cough in 1957. 1960 saw the first kidney transplant and implantable heart pacemaker usage. In 1962 the NHS completed its first hip replacement. A measles vaccine was introduced in 1968 and the first heart transplant was at an NHS hospital. In 1979, the first bone marrow transplant was completed at Great Ormond Street Hospital.

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