The NHS was first launched back in 1948, and was born out of a long-held ideal that good healthcare should be available, for free, to everyone – regardless of their wealth. The NHS deals with over one million patients every 36 hours, and covers all treatments from emergency to routine screenings, antenatal screenings and end-of-life care. It is one of the world’s largest publicly funded health services.
The NHS is mainly funded by general taxation and National Insurance contributions, and is set out by central government through the spending review process. This is a process that aims to estimate how much income the NHS will receive from sources such as user charges, National Insurance, and general taxation. If National Insurance or patient charges raise less funding for the NHS than estimated, funds from general taxation are used to ensure the NHS gets the level of funding originally allocated to it.
Some NHS funding is generated through charges for things like prescriptions, spectacles and dental treatments, as well as parking charges and land sales. However, this only accounts for a very small proportion of the NHS income.
Breaking down who makes the decisions surrounding NHS funding is quite a complicated process, as there are several different stakeholders involved. The government ultimately is the decision-maker when it comes to NHS funding, with the Secretary of State having overall responsibility for the work of the Department of Health. In turn the Department of Health is responsible for funding for both health and social care in England. NHS England managed around £100 billion of the overall NHS budget, ensuring that trusts and other organisations are spending funds effectively.
Clinical Commissioning Groups (CCGs) are also involved in decisions surrounding NHS funding. They are responsible for around 60% of the overall NHS budget, and play a part in commissioning GP services as well as commissioning most secondary care services.
At present, the amount spent on health in England is almost £124 billion, and is set to rise to above £127 billion by 2020/21. In terms of how the spending is broken down, the majority of it (£110 billion) is spent on the day-to-day running of the NHS. The remainder is usually spent by the Department of Health on things such as education, training and public health initiatives.