Post 1997 and the election of the Labour Government the basic mechanism has changed again. The idea is that rather than running for a single year they will run for a three year period thereby giving the Health Authorities a greater degree of stability.
RAWP - Regional Allocations Working Party. The original committee that came up with the method of funding the various RHAs.
RHA - Regional Health Authority. The second level tier of NHS bureaucracy. A number of HAs were assigned to an RHA but it was not unknown for a single HA to be contiguous to it's RHA (i.e. one-on-one), usually in very rural areas.
HA - Health Authority. These are the people actually responsible for the provision of health care within a particular locality and are thus what people usually mean by 'the NHS'. Prior to 1991 they controlled all aspects of health provision within their area - deciding (within limits) what health care was required, what sort of primary care would be provided, then what sort of secondary care would be available at the hospitals. Now, after deciding what sorts of care are required, they will look at the hospitals in their area (usually) and at the specialties they supply along with the cost and buy in a number of beds at the start of a year. If they go over target, or require services they have not contracted for, they then pay on a per patient basis.
Hospital Trust - this is is the organisation tasked with actually running a group of hospitals. It is up to the management of these Trusts to decide what services they offer and how much they will charge the various HAs who wish to buy services from them.
Primary care - this is when you visit your local GP i.e. your first contact with the NHS. It is generally expected that you start off here. You can, of course, still just turn up at Accident & Emergency, though this is generally discouraged. There are trials afoot that allow GP services to offer small day-case surgery on-site and somewhat further down the road, the closer integration of hospitals within GP services.
Secondary care - the local hospital. You would generally be referred to hospital if your GP can not diagnose your complaint, or you require specialist care. Most hospitals will offer a basic core of specialties but many will also tend to find areas where they can specialise - a nearby hospital does nothing but study and treat cancer patients. The Trust for which I work is a recognised centre for Renal Transplants and Artificial Insemination. Indeed, the world's first test tube baby was conceived at Saint Mary's Hospital, part of the Central Manchester Healthcare NHS Trust. If you need really specialist care, for example a heart transplant or oncology (cancer), treatment you would get refered to one of these specialist units - tertiary care!
Most hospitals will only offer a limited range of services - they will not see enough cases of a particular type of case to make it worthwhile having that specialty in the unit, though someone suffering from that illness may, understandably, disagree with this policy. Teaching hospitals on the other hand are supposed to have as wide a range of specialties as possible whilst having a large number of beds for general surgery and medicine. Balancing these needs can prove... interesting <G>.
Order The National Health Service which discusses the history of the NHS
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