Looking forward to the next 70 years: from a National Ill-Health Service to a National Health System

AbstractAmidst the NHS’s (National Health Service) success lies its major weakness, although one that Klein overlooks in his reflections on the NHS as it approaches 70. The focus on, and investment in, curing ill-health has been at the expense of attending to the public’s overall health and well-being. This preoccupation poses a greater threat to the NHS’s future than privatisation. Despite the weakness having been diagnosed decades ago, redressing the imbalance has proved stubbornly hard to achieve. Rhetoric has not been translated into reality. Yet, we may be on the cusp of a tipping point where in order to ensure a sustainable NHS, and one that is capable of meeting the 21st century challenges facing it, there is a renewed and overdue interest in promoting health and well-being in communities. But for this to succeed, the NHS will need to embrace its bete noire, local government.

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The creation of the National Health System in Italy (1961-1978)

Dynamis ◽

10.30827/dynamis.v39i1.8665 ◽

2019 ◽

Vol 39 (1) ◽

Cited By ~ 1

Author(s):

Giovanna Vicarelli

Keyword(s):

Health Service ◽

Health System ◽

National Health ◽

Catholic Church ◽

National Health System ◽

Well Being ◽

Health Claims ◽

Social Events ◽

Institutional Model ◽

The 1960S

The Italian health system has changed its welfare model three times over the course of its 160-year existence. From a form of "residual welfare" during the liberal period (1861-1921), it became "meritocratic welfare" during the fascist period (1922-1943) and in the years of the first republic (1945-1977). Finally, in 1978, the "universalistic institutional" model of health protection was approved. For a long time, therefore, the main responsibility for citizens’ well-being was attributed to families, to the Catholic Church and its welfare networks, to entrepreneurial paternalism, and to the different health insurance institutions associated with employment sectors. Only with Law 833, which established the National Health Service (NHS), did the State recognise full and direct responsibility for citizens’ health. This paper describes the complex path that led to the establishment of the Italian NHS, highlighting the diversity of the actors involved, the multiplicity of their social and health claims, the configuration of the public health service designed in the 1960s, and the political and social conditions that led to the effective enactment of Law 833. On the whole, it was a long, non-linear path with various barriers, where the conditions of implementation were determined by the particularity of the Italian political, economic, and social events that characterised the 1970s.

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Proposal of a Learning Health System to Transform the National Health System of Spain

Processes ◽

10.3390/pr7090613 ◽

2019 ◽

Vol 7 (9) ◽

pp. 613 ◽

Cited By ~ 1

Author(s):

Rafael Carnicero ◽

David Rojas ◽

Ignacio Elicegui ◽

Javier Carnicero

Keyword(s):

Big Data ◽

National Health Service ◽

Health Service ◽

Health System ◽

Information And Communication Technologies ◽

National Health ◽

Perfect Match ◽

National Health System ◽

World Health ◽

Learning Health System

This article identifies the main challenges of the National Health Service of Spain and proposes its transformation into a Learning Health System. For this purpose, the main indicators and reports published by the Spanish Ministries of Health and Finance, Organization for Economic Co-operation and Development (OECD) and World Health Organization (WHO) were reviewed. The Learning Health System proposal is based on some sections of an unpublished report, written by two of the authors under request of the Ministry of Health of Spain on Big Data for the National Health System. The main challenges identified are the rising old age dependency ratio; health expenditure pressures and the likely increase of out-of-pocket expenditure; drug expenditures, both retail and consumed in hospitals; waiting lists for surgery; potentially preventable hospital admissions; and the use of electronic health record (EHR) data to fulfil national health information and research objectives. To improve its efficacy, efficiency, and quality, the National Health Service of Spain should be transformed into a Learning Health System. Information and communication technologies (IT) enablers are a fundamental tool to address the complexity and vastness of health data as well as the urgency that clinical and management decisions require. Big Data solutions are a perfect match for that problem in health systems.

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The Battle for the National Health Service: England, Wales, and the Socialist Vision

Monthly Review ◽

10.14452/mr-068-10-2017-03_3 ◽

2017 ◽

Vol 68 (10) ◽

pp. 25 ◽

Cited By ~ 1

Author(s):

David Matthews

Keyword(s):

Health Care ◽

National Health Service ◽

Health Service ◽

National Health ◽

Well Being ◽

First Century ◽

England And Wales ◽

Monthly Review ◽

Twenty First Century ◽

Health And Well Being

England and Wales represent two very different, indeed incompatible, approaches to health care. In the former, health care has come under increasing threat from the predatory forces of privatization. In Wales, however, an explicit effort has been made to defend socialist values and formulate them for the twenty-first century, defending and expanding a system that puts the health and well-being of its citizens over profit.Click here to purchase a PDF version of this article at the Monthly Review website.

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The Impact of Austerity on the Portuguese National Health Service, Citizens’ Well-Being, and Health Inequalities

e-cadernos CES ◽

10.4000/eces.4187 ◽

2019 ◽

Cited By ~ 1

Author(s):

Pedro Hespanha

Keyword(s):

National Health Service ◽

Health Service ◽

Health Inequalities ◽

National Health ◽

Well Being ◽

The Impact

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The Health System in Costa Rica: Toward a National Health Service

Journal of Public Health Policy ◽

10.2307/3342089 ◽

1980 ◽

Vol 1 (3) ◽

pp. 258 ◽

Cited By ~ 19

Author(s):

Antonio Casas ◽

Herman Vargas

Keyword(s):

Costa Rica ◽

National Health Service ◽

Health Service ◽

Health System ◽

National Health

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Reflections on Health Management from a Systems Perspective: A Reinterpretation of the Italian National Health System

International Journal of Business and Management ◽

10.5539/ijbm.v16n5p79 ◽

2021 ◽

Vol 16 (5) ◽

pp. 79

Author(s):

Armando Masucci ◽

Antonietta Megaro

Keyword(s):

Health System ◽

National Health ◽

Systems Approach ◽

Health Management ◽

Health Sector ◽

National Health System ◽

Well Being ◽

Economic Activities ◽

Viable Systems ◽

Italian National Health

The provision of health services represents a set of central activities in the social context since, through the offer of prevention, diagnostic, treatment, care and rehabilitation services, they allow the pursuit of the ultimate goal of any health system, the well-being of the population and public health. The considerable relevance of the topic, supported by the ethical-social purposes that the health system ultimately assumes, make it an important field of analysis in business studies in general, and in management in particular, considering the economic activities developed by the many actors involved in the dispensing process. The importance of these activities and their strategic nature make them a highly regulated context, in which over time the reference legislative framework has developed and articulated for the determination of reciprocal relations between the actors, for the regulation of the flow of resources, for the control of medical activities to protect citizens. However, the proliferation of laws and regulations at the various levels of government (community, national and regional) has contributed to increasing the interpretative complexity of the health system. This work proposes the use of the Viable Systems Approach (VSA) for the interpretation and management of complex phenomena in the health sector, concerning the Italian National Health System (NHS). The deepening of the implications arising from the analysis enables the VSA as a useful approach to the advancement of research in health management, through the understanding of complexity, stimulating the observer with analysis methodologies capable of better understanding the health context under exam.

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Gaining approvals for mental health research in the NHS

BJPsych Advances ◽

10.1192/apt.bp.114.014035 ◽

2016 ◽

Vol 22 (1) ◽

pp. 64-72

Author(s):

Miriam Cooper ◽

Olga Eyre ◽

Joanne Doherty ◽

Rhys Bevan Jones

Keyword(s):

Mental Health ◽

National Health Service ◽

Health Service ◽

National Health ◽

Health Research ◽

Well Being ◽

Mental Health Research ◽

Ethical Aspects ◽

Future Developments ◽

Conducting Research

SummaryWhen embarking on mental health research it is often necessary to apply for approvals from one or more review bodies to ensure that the research is ethical and that the safety and well-being of participants are safeguarded. This can be complicated and time consuming, particularly to those unfamiliar with the process. In this article we describe the approvals commonly required for National Health Service-based research involving patients and endeavour to clearly explain what is involved at each stage. We then highlight some of the main considerations, including ethical aspects, which are particularly pertinent to conducting research in the field of mental health, and finish with general advice and considerations for future developments in the area.

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