National Health Service

(in Britain) a comprehensive service offering therapeutic and preventive medical and surgical care, including the prescription and dispensing of medicines, spectacles, and medical and dental appliances. Exchequer funds pay for the services of doctors, nurses, and other professionals, as well as residential costs in NHS hospitals, and meet a substantial part of the cost of the medicines and appliances. Legislation enacted in 1946 was implemented in 1948 and the services were subjected to substantial reorganization in 1974 and again in 1982, 1991, and 1999. In England overall responsibility is vested in the Secretary of State for Health assisted by a comprehensive department (see Department of Health). Administration was based on a system of delegation downwards and accountability upwards through a hierarchy of regions, each subdivided into a number of districts. In 1991 District Health Authorities (DHAs) developed a new role as purchasers of health care, assessing the health needs of local populations and negotiating contracts with a range of health-care providers to meet those needs. Family Health Service Authorities (FHSAs) were responsible for the regulation, management, and funding of general practitioners, pharmacists, opticians, and dentists. In 1999 Primary Care Trust were established to take responsibility for most of the functions originally carried out by DHAs and FHSAs and subsequently (from 1996) by Health Authorities. Health Authorities still exist but have a much more limited role in most areas.

Some of the special resources for patients with rarer complaints are shared on a regional or supraregional basis. Wherever possible, districts have common boundaries with local authorities in order to try and ensure liaison with the social service departments, which provide many important services to support the sick and aged (see social services). However, many districts include part of more than one local authority since the division tends to be made on the basis of the catchment area of a district general hospital.

Different arrangements apply in Northern Ireland, Wales, and Scotland.