How does the NHS work?

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How does the NHS work?

The NHS, or National Health Service, has become an intrinsic part of our country’s identity, a beloved institution that helps millions of people every year. As a government-funded service that is ‘free at the point of use’, there is no cost for any UK citizen who needs to be treated. So how does the NHS work and will it last? 

What does the NHS do?

The NHS is publicly funded by taxes, providing a free service for any UK citizen needing to see a doctor, nurse, or any health professional. It is split up into four different branches for each country within the UK: NHS England, NHS Scotland, NHS Wales, and Health and Social Care for Northern Ireland.

There are many treatments that fall under the NHS, like GP appointments, surgery, cancer treatment, physical and mental therapy, and admission to hospital. Dental care and optical care fall outside of the NHS and is usually private for those over the age of 18. Under NHS England, patients pay for prescriptions, although there are many exemptions including for those on benefits or life-long medication.

As a government-funded service, the NHS is a socialist programme that is intended to help people by treating them equally, regardless of income, and provides care to over one million people every 36 hours.

History of the NHS

The NHS began in 1948 after World War II as part of a major social reform greatly needed in the country. It was founded by Health Minister Aneurin Bevan during Labour Party rule and was created around the idea of quality, accessible healthcare for all, regardless of income or wealth.  

One of its core values was to be ‘free at the point of delivery’, meaning that upon seeking and receiving care, there would be no cost. The service was to be funded by taxes, and regardless of how much you contributed in taxes, you would be treated the same as anyone else.

How has it changed?

Since it began in 1948, NHS England in particular has been through many changes with each political party that has seen power. Under Prime Minister Winston Churchill, the then Conservative government of England introduced charges for prescriptions, where they were previously free. 

A particular point of debate has been around NHS eligibility and those who qualify for treatment. Founder Aneurin Bevan insisted on equal treatment for overseas visitors to the UK, on the basis that asking every user for proof of citizenship “would end by being a nuisance to everybody.” This principle has since been restricted, with new regulatory measures made in 2015, introducing hospital charges for overseas visitors (with the exception of Covid-19 care). 

NHS England has seen multiple changes to its regulations and functioning, most of which concern funding. Many governments over the years have implemented harsh budget cuts and salary freezes on the service, resulting in staff shortages, long waiting times, and a general lack of money to treat patients quickly and efficiently.


As the NHS is a complex system that works on a national scale, there are many people and departments that help it run smoothly. The Department for Health controls healthcare and funding for NHS England, while the Secretary of State is responsible for setting policies and targets. 

For the overseeing of local budgets, the NHS Commissioning Board contains 207 Clinical Commissioning Groups that are responsible for healthcare services within their respective areas. These groups are made up of local GPs, nurses, and consultants who assess and commission services. Once these services have been commissioned, the NHS Foundation Trusts provide this care through hospitals, ambulances, primary care, social care, and mental health care.


Many of the challenges facing the NHS concern money and how it is fairly distributed across the system, although these issues don’t necessarily come from lack of funding. Factors such as a growing and ageing population are a large drain on its budget, as the care required for a 90-year-old costs roughly seven times as much as it does for the average 30-year-old. 

The UK is also seeing an obesity problem, with around a third of adults in the country overweight. Obesity can cause health problems that cost the NHS more and more every year.

These factors are compounded by rising staff shortages, with almost 100,000 vacancies currently available, the increasing cost of drug prices, and longer waiting times for treatment. With all of these issues, the NHS is facing many strains within its service, and overall satisfaction is falling.

What's next for the NHS?

The year of 2020 and Covid-19 has taken precedence over most health service concerns, and has shown us that even in a pandemic, the NHS is invaluable. However, the global virus has highlighted the ways in which the NHS can improve.

In a growingly digital world, how does the NHS work on an analogue system? The future of it relies on embracing and adopting new technologies and online services to enable faster and more efficient ways for patients to be treated and workers to do their jobs. This also requires a flexible approach for those who aren’t au fait with the online world, and for times when technology falters. 

A speech given by Health Secretary at the time Matt Hancock highlighted how the NHS has lost a little of its original human touch, and how we need to reintroduce good communication and mend the relationships between patients and their carers, as well as between doctors, nurses, and consultants. 

2021 will bring us the next obstacle: how does the NHS work after Brexit? With 90% of our drug supply coming from the EU single market, the future is currently unknown. The institution’s capacity may be greatly affected after the UK’s departure from the European Union.

The year 2020 has shown us how integral and vital the NHS is to our country’s makeup, and is consistently named as one of the top things Brits love about their country. If you’re looking to start a career in the NHS and need financial help, get in touch with Salad Money and see how we can help.

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