Health coverage in England has been universal since the creation of the National Health Service (NHS) in 1948. The NHS was set up under the National Health Service Act of 1946, based on the recommendations of a report to Parliament by Sir William Beveridge in 1942. The Beveridge Report outlined free health care as one aspect of wider welfare reform designed to eliminate unemployment, poverty, and illness, and to improve education. Under the 1946 Act, the Minister of Health had a duty to provide a comprehensive, free health service, replacing voluntary insurance and out-of-pocket payments.2
Cost-sharing and out-of-pocket spending: The NHS has very limited cost-sharing arrangements for publicly covered services. Services are free at the point of use for outpatient and inpatient hospital services. Out-of-pocket payments for GP visits apply only to certain services, such as the provision of certificates for insurance purposes and travel vaccinations. NHS screening and vaccination programs are not subject to copayments.
Hospitals: Publicly owned hospitals are organized either as NHS trusts (currently 64) directly accountable to the Department of Health or as foundation trusts (currently 142) regulated by NHS Improvement.24 Foundation trusts have more freedom to borrow and invest and have local people and staff involved in governance.
All other long-term services and supports are paid either out of pocket or by local authorities. Local authorities are legally obliged to assess the needs of all people who request these services. Unlike NHS services, however, locally funded social care is not typically free at the point of use, except for certain services (such as time-limited rehabilitation services for people recovering from illnesses or injuries, the provision of some equipment, and home modifications).
The NHS number assigned to every registered patient serves as a unique identifier. All general practice patient records are computerized. Since April 2015, all GP practices have been contractually obliged to offer patients the choice of booking appointments and ordering prescriptions online. As of March 31, 2016, practices are required to offer patients access to their own detailed coded record, including information about diagnoses, medications and treatments, immunizations, and test results. Practices are not required to allow patients access to information that clinicians enter in free-text fields. When electronic records are not available to patients, such as in dentistry, they can request a paper copy. 1e1e36bf2d