National Health Service

National Health Service



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The National Health Service is a health service that is currently being used in the UK by everybody and it ensures that one gets treated for free at the point of delivery (NHS Choices, 2015). National Health Service (NHS) constitutes all medical practitioners who have come together to provide healthcare for all. NHS was launched in January 1948 by the then secretary of health Aneurin Bevan, at Park Hospital in Manchester (currently known as Trafford General Hospital) (NHS Choices, 2015). It is the work of any nation to ensure that its citizens get the best medical services, even when they cannot afford to pay for the services. The latter prompted England to adopt the National Health Service policy that ensured that all citizens accessed medical services regardless of their economic status. The central principles of the National Health Service were that health services would be made available to all people and be financed wholly from taxation (NHS Choices, 2016). The National Health Service was launched for a purpose and the purpose is to be discussed in detail later in this essay. The NHS is a national organization and therefore, prone to challenges that may arise from leadership and from other avenues. The aim of the essay is to find out the challenges and the implications of the same on both leadership and the functioning of the National Health Service. The essay also aims to find out if NHS has undergone any changes and the implications of the same.

Purpose of the National Health Service

The major purpose of the National Health Service was to provide healthcare to all citizens of the United Kingdom, regardless of their wealth status (NHS Choices, 2016). In many countries around the world, people suffer healthwise but they cannot access healthcare due to poverty. The UK did not want such a scenario to happen to its citizens, thus adopted the National Health Service policy. The other purpose of the NHS was to meet the needs of all people (NHS Choices, 2016). The policy was not aimed at serving some people and leaving others out. The National Health Service was also aimed at making medical services ‘free at the point of delivery’ and it was based on the clinical need of the patient, and not their ability to cater to the bills (NHS Choices, 2015). An organization must be guided by various core principles so as to achieve its purpose. Therefore, the National Health Service is guided by seven principles which are in the NHS Constitution (NHS Choices, 2015).

The Constitution outlines the rights of the patients and the staff. It also sets out the rights of the public and outlines the respect the three parties mentioned earlier owe one another (GOV.UK, 2015). By committing to one another, the three parties bring out another purpose of the National Health Service which is to operate fairly and effectively. The first principle guiding NHS is the commitment to provide comprehensive services to all people (NHS Choices, 2015). It is the purpose of the National Health Service to serve all people regardless of gender, sexual orientation, race, pregnancy and maternity, age, and other social and emotional factors. The second principle has been mentioned earlier in the essay and it involves serving people based on clinical need. The third principle involves excellence and professionalism in that NHS provides high-quality care and is always focused on patient experience (NHS Choices, 2015). This principle is also directed at the employees, such that NHS ensures that its employees receive the best training and are supported in their development process. Empowering of the employees ensures proper treatment of the patients, which is a core purpose of the National Health Service (NHS Choices, 2015). For an organization to carry out its purpose successfully, it must put the interests of its dependents at hand. Therefore, the NHS puts patients at the heart of everything it does (NHS Choices, 2015). It is, therefore, the work of the National Health Service to ensure that the needs of the patients and their families are looked into and to also involve the family members during decision-making on issues concerning the patients. NHS is also tasked with supporting individuals in the promotion and management of their own health (NHS Choices, 2015).

Successful organizations are those that go beyond boundaries and work with other organizations and the public as well, with the best interests of their dependents at heart. Such is the case with the National Health Service as its fifth principle entails going across organizational boundaries.  NHS involves other organizations in its activities, with the aim of improving the health of its patients and the well-being of the wider community (NHS Choices, 2015). The external organizations include; private-sector voluntary organizations and public-sector organizations among others. As seen earlier, the services provided by NHS are catered for by the taxes paid by citizens of the United Kingdom. The National Health Service must therefore ensure that the services it offers to the public are equivalent to the taxes collected (NHS Choices, 2015). The resources may be scarce as compared to the patient turnout and NHS is therefore tasked with ensuring they are used effectively to cater to everybody’s medical needs. Due to the fact that NHS receives funds from taxpayers’ money, it is bound to be accountable to the public and the patients it offers its services (NHS Choices, 2015). Last but not least, the NHS covers everything with regard to the patient’s well-being. Here are some of the services provided by the National Health Service; ‘antenatal screening, routine screening, treatment for long-term conditions, transplants, emergency treatment, and end-of-life care (NHS Choices, 2016).

Problems Faced by the National Health Service

One major problem faced by the National Health Service is staffing. As of 2016, NHS was said to be struggling in recruiting and retaining permanent staff (McKenna, 2016). According to statistics, the National Health Service had registered a fall equivalent to 5.9% of the number of caregivers that were required and the number that was actually available (McKenna, 2016). These statistics were registered in 2014. The number of medical practitioners required is greater than the number of trained practitioners, thus the problem at NHS. Permanent workers are not available and this is another problem faced by the NHS. An estimated 25.4% of workers are said to be leaving their role every year, thus the creation of voids (McKenna, 2016).

The National Health Service has recently been faced with the problems of poor performance, mounting deficits, and a decline in staff morale (King’s Fund, 2015). The issue of mounting deficits is noted when an organization spends more than the budget indicates and still portrays poor results. In the financial year 2014/15, it was noted that hospitals and other facilities providing NHS services overspent their budgets by more than £800 million (King’s Fund, 2015). The latter happened in England. The same trend was observed for the financial year 2015/16, whereby health facilities offering NHS services were seen to be struggling to remain within the set budget. Auditors confirmed that the levels of deficits were growing rapidly, with a prediction that NHS was to experience a deficit of over £2bn in the year 2015 (Triggle, 2015). Initially, the National Health Service had been experiencing years of surpluses.

Staff morale was one of the issues raised by finance directors and the trusts felt that the National Health Service would not be in a position to achieve the targets set for 2015/16 (King’s Fund, 2015). If the staff are not satisfied with the treatment they receive from their employer, they are then bound not to perform. The result of the latter is poor productivity and failed deadlines. Indeed, NHS performance was seen to decline, with missed targets and an increased number of irregularities (King’s Fund, 2015). Some of the irregularities included; patients seen to wait longer in A&E departments which is not the norm (Usually a patient should wait for less than four hours), the rising number of delayed transfers of care, and the issue of patients waiting for more than 18 weeks in order to receive treatment (King’s Fund, 2015).

According to Dr Peter Carter who is the general secretary of the Royal College of Nursing, strategic decisions that are poorly formulated and budget cuts to healthcare services are some of the problems being faced by the NHS (Independent, 2015). These factors have also put a lot of pressure on emergency care, thus causing problems for the NHS. Dr Peter also observed that the dismantling of NHS and replacing it directly with NHS 111 was a mistake as it caused the loss of clinical expertise (Independent, 2015). The National Health Service was well staffed with medical practitioners such as nurses but NHS 111 is lacking these staff. Chris Ham who is the chief executive of the King’s Fund think tank says that more people are becoming sick, thus the waiting time extension at the A&E (Independent, 2015). High bed occupancy cannot allow for admission of the many patients in need of this service. Chris also observed that there is delayed discharging of patients which has been caused by the cuts in social care funding. The emergency care system confusion is also a problem faced by the National Health Service and it forces most people to use A&E for lack of an alternative (Independent, 2015).

The National Health Service faces a humanitarian crisis as the number of patients requiring medical attention continues to grow by day (Campbell, Morris and Marsh, 2017). The rising demand overwhelms the hospitals and ambulances offering NHS services. People die due to a lack of emergency services such as ambulances. The Worcestershire Royal Hospital is the latest victim of patients dying after waiting on trolleys for long hours with no medical attention; so far more than three deaths have been reported to have occurred at this facility (Campbell et.al. 2017).

Changes at the National Health Service and their Implications

The NHS is changing as the challenges it faces increase (Triggle, 2012). The demands of the patients are rising every day, as are costs. The implications of these changes are problems of low productivity and loss of life. In 2013, the National Health Service underwent changes concerning decision-makers (leaders) and the spenders of money (BBC News, 2013). New organizations were created from the main organization. Other changes that took place in the same year included the handing over of legal responsibilities meant for budget management to the new organizations (BBC News, 2013). One major change by the NHS has been medical achievement, whereby patients get cured of some lifestyle diseases such as cancer, stroke, and heart attacks as a result of the services offered by the National Health Service (Triggle, 2012). The National Health Service has led to positive change in terms of life expectancy, whereby life spans for both men and women have been observed to rise (Triggle, 2012). However, this positive change comes with challenges such as the rise recorded in the grey population. The more old people there are, the higher the number of patients with multiple ailments (Triggle, 2012).

Leadership changes will and have had implications on the functioning of the National Health Service. NHS applied the contractual and/ or transactional style of leadership and there were benefits associated with these changes (Barr and Dowding, 2015). There was remarkable growth in terms of policies and procedures. The employment law also benefited from the bureaucracy of the NHS (Barr and Dowding, 2015). The leadership style changes brought satisfaction to leaders and groups as each party knew where it stood within the National Health Service.

What kind of Leadership does the National Health Service require?

An organization’s success is determined by the leaders and the leadership style being applied. Given the challenges faced by the National Health Service in present times, the organization requires a leadership style whereby leaders give greater priority to both the patients and the staff (King’s Fund, 2011). Good leadership is that which incorporates all concerned parties in the decision-making process. To achieve the latter, NHS ensures the participation of patients and staff (doctors, nurses, and other medical practitioners) in leadership roles (King’s Fund, 2012). When all parties are involved, the organization is bound to run smoothly and effectively deliver the services for which it is required.

Leadership crises were seen to exist within the many departments of the National Health Service (McLellan, 2015). One of the areas that was most challenged was recruitment of new staff. According to a survey that was conducted in 2014 by HSJ inquiry and the King’s Fund, a third of trusts have vacancies for key leaders at the board levels (McLellan, 2015). The largest vacancies recorded were those of finance directors and others for chief operating officers. According to McLellan (2015), NHS has been observed to be in a position whereby it cannot provide outcomes and experiences that are best for its patients. The latter suggests that the traditional leadership at the National Health Service requires revision. The National Health Service has also been observed to not be able to solve its problems on its own (McLellan, 2015). The latter means that NHS requires inputs from other organizations such as the ones that were formed in 2014.

The National Health Service requires leaders in most of its departments. ‘High quality leadership is required in hospitals, mental health and community providers, general practice and commissioning’ (McLellan, 2015, pg. 4). System leadership is also required in areas of partnership and those areas whereby direct management line control is applicable. Traditionally, leaders at the National Health Service did not require many skills as it is today (McLellan, 2015). Leaders of today must have a lot of experience to effectively run such an organization, given the current rate of globalization. Traditional leaders were applying the “command and control” and “protectionism” policies, but these are not needed anymore (McLellan, 2015). However, NHS requires modern-day leaders who can deliver. Leaders who are in a position to build partnerships and operate across institutions and departments are best suited for the National Health Service (McLellan, 2015). For NHS to achieve its purpose of providing medical services to all for free, it requires the type of leaders mentioned in the latter statement. For the leadership across the National Health Service to be successful, more manageable, attractive, and sustainable tasks must be carried out (McLellan, 2015).

The United Kingdom is experiencing a change in the health leadership programs and the National Health Service is one of the organizations affected (Dickson and Tholl, 2014). Modern-day organizations will only thrive well with shared leadership across various boundaries. The National Health Service is therefore compelled to adopt this new approach to leadership if it is to achieve its purpose. Traditionally, NHS leadership laid its main focus on individuals (Dickson and Tholl, 2014). However, things have changed and the program changes in the UK are aimed at changing leadership styles which will assist health organizations such as NHS and others achieve their purpose.


The National Health Service is the largest free healthcare provider in the UK. NHS was created to ensure that all citizens received free medical care at the point of delivery regardless of their financial status. The money is, however, paid to the National Health Service by the government through the taxes accumulated. NHS is dedicated to providing equal services to all regardless of their age, gender, and other social and economic factors.  The National Health Service is guided by principles. These principles ensure that the organization offers the best services to the patients. The principles also guide NHS on how to handle its employees so as to experience maximum productivity. The National Health Service has faced many challenges throughout the years it has been in operation. The major challenges include; humanitarian crises such as the death of patients due to lack of emergency care, staffing (lack of enough staff members), mounting deficits, poor performance, and decline in staff morale among others. These challenges have had a negative impact on the National Health Service. Through the years, the NHS has undergone various changes and it has also brought changes in the health sector. Change in leadership style has had positive implications for NHS. NHS has also led to a rise in life expectancy and a rise in the aged population. The National Health Service is required to continually achieve its purpose and for the same to happen, the leaders must be up-to-date with current affairs. NHS therefore, requires new leadership styles, different from the traditional styles of focusing on individuals.


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BBC News. 2013. ‘The changing NHS.’ BBC News.  [Online]

Campbell D, Morris S and Marsh Sarah. 2017. ‘NHS faces ‘humanitarian crisis’ as demand rises, British Red Cross warns.’ The Guardian. [Online]

Dickson G and Tholl B. (2014). Bringing Leadership to Life in Health: LEADS in a Caring Environment: A new perspective. Springer Science and Business Media.

GOV.UK. 2015. ‘NHS Constitution for England.’ GOV.UK. [Online]

Independent. 2015. ‘Five experts give their take on the current situation.’ Independent. [Online]

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King’s Fund. 2012. ‘The future of leadership and management in the NHS.’ [Online]

King’s Fund. 2015. ‘NHS enters 2015/16 facing biggest challenges in recent history, warns the King’s Fund.’ The King’s Fund. [Online]

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McLellan Alastair. 2015. ‘Ending the crisis in NHS leadership: A plan for renewal – June 2015.’ HSJ. [Online]

NHS Choices. 2015. ‘About the NHS: Principles and values that guide NHS.’ NHS Choices. [Online]

NHS Choices. 2016. ‘The NHS in England: About the National Health Service (NHS).’ NHS Choices. [Online].

Triggle N. 2015. ‘Financial problems ‘endemic ‘ in NHS.’ BBC News. [Online]

Triggle N. 2015. ‘NHS problems ‘at the worst since 1990’s’.’ BBC News. [Online]

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