Clinical Governance in the UK National Health Service.

Authors Avatar
Clinical Governance in the UK National Health Service

Dr Alastair Baker

King's Colloge Hospital, London, UK

The UK National Health Service (NHS) was formed in 1948 by the Labour government. It was based on a vision of healthcare that still has a powerful influence in the UK including care for all equally 'from the cradle to the grave' and 'free at the point of delivery'. Funding was and remains from central taxation. The NHS is the largest single employer in Europe.

Initially, the NHS was administered by Area Health Authorities who exerted little influence on day-to day running of clinical services. Management was weak and doctors held the major control over service delivery in a paternalistic manner. Lines of accountability were unclear and there was no transparency in the supervision of standards by the medical professional bodies; the Royal Colleges and General Medical Council.
Join now!

In 1991, the Conservative Government under Mrs. Thatcher, realising that there were cost inflation pressures within the NHS for which there was no mechanism for control or accountability, designed the 'Internal Market'. The whole service was divided into notional 'purchasers', Area Health Authorities and larger family doctor practices, who would control their own defined budget on behalf of their population by commissioning services, and 'providers', hospitals and community services designated 'Trusts' from whom care would be 'bought'. Funding would, in theory, follow the patient who would go where services were best and cheapest. This experiment was at best ...

This is a preview of the whole essay