Prior to build a health service based upon four

to the NHS, quality of healthcare was determined by factors such as social
class and location. More than 1 in 15 children died before their eleventh birthday(1),
because families had to wait until illness had progressed
to advanced
stages due to lack of funds or simply could not afford the treatments at all.

 GPs were attracted to high income urban
positions, so it was harder to access healthcare in rural areas. The higher
classes could afford more access to healthcare, but this made no guarantee that
they were better served. During childbirth a more expensive doctor may rush
between appointments spreading infection and deliver babies
early to
save time, whereas the less expensive midwives provided safer care. (2)

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Second War is sometimes credited with the initial idea that all healthcare
should be provided and governed by one state service, the sheer volume of
casualties almost led to the bankruptcy of the health service at this time with
medical professionals being asked to work for little pay. (3) In
1945 the newly appoint Labour government and health minister Aneurin Bevan
stated it’s intention to build a health service based upon four cornerstones
values. It promised
meet the needs of everyone, to be based upon clinical need and not financial
factors and to be free at the point of use. (4) The proposal faced resistance from
consultants, doctors, the Conservative Party and the BMA. In order to attract
the doctors and nurses the national health system would depend upon Bevan
increased wages and allowed consultants to keep their private practises. This
seemed to be effective and despite the residual opposition the NHS was
launched on the 5th of July 1948. (3)Jeremy
Secretary of
State for Health since
8 January
governs over the Department of Health – 
a governmental
body coordinating health and social care.

NHS England
is an independent organisation, that aims to maintain, develop and improve healthcare for the British

It is
for the
main primary care services
and specialised
although clinical commissioning groups are now also undertaking the
responsibility of primary care services as well. They already are responsible for secondary
care, community services, mental health and rehabilitation services. (5)Some
key challenges facing the NHS in the 21st C
include: changing
demographic factors,
funding, structural
of the NHS and
unstable political leadership. The first of which is that the population
has aged since
the NHS was created. This means
there are a higher number of patients with chronic and complex conditions
that require treatment
for longer, thus demanding more from the NHS. The expanding
population has a similar effect with a greater number of patients requiring

challenge is that the common lifestyle factors in modern society
generally have a negative impact upon our health, for example:- alcohol abuse, smoking, lack of exercise
and obesity. These
factors can
all lead to conditions requiring care from various health services.
modern challenge for the NHS is the rising cost of the resources necessary for
maintenance and the developments in technology and development that help keep
the NHS up-to-date, which would require further financial input. The current
predicted funding gap for 2020 is predicted at £30 billion.(6) Problems in accessing
care service
represent a challenge for the NHS. This leads to increasing numbers of people using A
& E departments when
the GP may have been more appropriate, putting unprecedented demand upon A &
E departments.(6) In
2010 the NHS faced one of the most turbulent debates since it’s conception as
the newly
Democrat coalition released
it’s vision for one of the
most radical NHS reform
history. The
Health and
Social Care Act
was implemented in 2012, despite claims that the plans were forced.(7)
This was condemned
as an ‘unholy mess’ in a combined statement from the BMJ, Health Service Journal, and Nursing Times.
Some claim that the NHS is still experiencing instability as a
result of this act.(8)The
‘seven-day NHS’ was put forward in the 2015 Conservative party manifesto, which
outlined the plan to roll out 8am-8pm seven-day access to healthcare to include
all GPs by 2020 and to source the funding for this. (9) In 2013 a report by NHS England suggested
there are four main reasons for
providing seven day services including reduced mortality. This is exemplified in the quote ‘patients
16% more likely to die if they are admitted on a Sunday compared with a
although some have argued that this is due to the fact that patients admitted
on the weekend are sicker and that this is not due to reduced weekend services . The
other reasons include:- increasing
hospital efficiency, providing easier access to NHS services, such as certain
diagnostic scans and local GP services and ensuring the maintenance of quality
of care
throughout the week. (11)The argument
for would include providing greater consistency in the quality of care provided
by the NHS, it
would mean that more diagnostic
would be available
the weekend meaning patient’s could be diagnosed earlier and mortality decreased. GP waiting
times overall could
due to extended
meaning patients are seen quicker and diagnosed earlier. There would be greater
access to consultants meaning that high dependency patients experience a
consistent level of irrespective of the day of the week. (12) A seven-day NHS
could also optimise the discharge service in hospital meaning that prolonged
stays are avoided
as senior clinicians are available to assess and review patients, which reduced
length of stays in hospitals patients can also more effective follow their
route into social care if that is required, allowing extra capacity for new
patients. (13)The central
argument against
seven-day NHS is the
financial input required.
This would include staff
and the
high cost required to upgrade rural trusts to suitably support a seven-day
system. One way
of reducing the costs
proposed was the
 altering of junior doctor pay rates so
that a greater
of weekend and evening hours would be classified as ‘basic’
and not ‘overtime’
pay, although
basic pay would be increased. This left junior doctors feeling disempowered and
neglected by the government, leading to a stalemate and strike
2016. (14)
It is also claimed that there
is a lack of demand for GP appointments over
the weekend and that this could lead to the closure of GP surgeries during the week.(15)
warns that these
plans are ‘unfunded,
undefined, unrealistic and would see routine operations cancelled on weekdays’,
which puts forward the idea that, although patient care may be increased at the
weekend it could have implications to care during the week potentially having a
negative effect overall.(16)A
seven-day NHS, could allow easier access to the GP at weekends which may relieve
some of the pressures put upon the A & E department. This may
allow the A & E department to function better. As mentioned earlier it may
be more expensive to recruit staff for weekends in rural areas this may lead to
different levels of care being offered in different locations if funds are tied
up in staffing.
In addition at the article mentioned earlier the seven-day NHS may actually put
more pressure on small weekday primary care services, potentially decreasing
their relationship with other health care services, if there are not able to
keep up.(15)  The greater availability of
senior clinicians at the weekends may prevent prolonged hospital stays
improving the connection between primary, secondary and social care services
through more swift, but still appropriate discharges. This benefits both
patient care and the efficiency of the system overall. (13) The
NHS constitution
is a summary
of all
the principles
pledges of the NHS. It
the rights of patients and staff with regard to these. At this point, the effects of the
seven-day NHS can only be judged hypothetically. For example, if it
were true that overall patient care was compromised by the introduction of a
seven-day service then this would challenge the pledge to provide the
best quality of care possible, however if the system reduced patient morality
then this would support NHS constitution. If the NHS suffered financially as a
result of the new
system then funding
would be required elsewhere, if this were to ever to affect the
provision of free healthcare then this would contravene the main principle
of NHS constitution – all
care should be free of charge. An important unknown is public response to a
seven-day NHS, and whether the services would be utilised and effective. In conclusion,
it is
impossible to determine the
of this
system upon the
NHS constitution as it would need to be fully implemented in order
to judge in which ways it works and falls short.