The History of the National Health Service- Key Historical moments When the NHS began it was the first time there was availability for free healthcare based on citizenship basis rather than insurance or payment. It unified healthcare workers such as dentists, nurses and doctors under one collective service although much has changed since. The demand was increasing and in the 1950s, the budget was cut as the government was beginning to struggle. This was the reason why prescription fees were introduced and charges for spectacles and dental work. This is still the case today; however, there are some exemptions in prescriptions. Today, the government and the NHS are still trying to cope with huge healthcare demands. Nevertheless, regardless of the financial crisis it faces, the NHS has made a lot of discoveries over the years as shown in the timeline below.1946 The National health Service Act1948 NHS begins, 5th of July, founded by health secretary Aneurin Bevan (Gorsky, 2008) (BBC News, 2018)1952 Prescription charges started and it marks the most important scientific breakthroughs, when Watson and Crick discovered the deoxyribonucleic acid (DNA) molecular structure. (Chadarevian, 2003)1954 Sir Richard Doll establishes the smoking and cancer link1958 This made the first mass diphtheria and polio vaccination programme. In 2006 babies began being vaccinated against pneumococcal meningitis. In 2008, girls between 12-13 were being vaccinated against human papilloma virus which is known to cause most cases of cervical cancer. (BBC News, 2018)1960 The first kidney transplant was completed at Edinburgh Royal Infirmary with both recipient and donor living 6 more years. (BBC NEWS.2018)1961 The contraceptive pill became available, which was a milestone in women’s rights. The restriction that only married women could access it was removed in 1967.1967 Abortion Act was passed, this legalised the termination of pregnancy up to 28 weeks. 1968 United Kingdom’s first heart implant was led by Donald Ross at National Heart Hospital London. (Sliwa and Zilla, 2017)1972 3D image CT scanners used for the first time (Rubin, 2014)1978 Louise Brown was delivered by a C- section she is known as the world’s first ‘test tube baby’. (BBC News, 2018)1988 Breast screening programme begins. Mammograms were being offered to women over 50 alongside drugs such as Herceptin and Tamoxifenswf, this reduced breast cancer mortality by 20%. (BBC News, 2018)1990 NHS and Community Care Act, a legislation which introduced the NHS internal market1994 Organ donor register established after a 5 year campaign by Rosemary and John Cox2002 Great Ormond Hospital carried the first successful gene therapy in a boy who had severe SCID2006 Smoking was banned in restaurants, public houses and other public places in Scotland. In 2007, Northern Ireland, Wales and England followed suit. At the time it was controversial, this was later credited with a great reduction in strokes and heart attacks.2010 The ‘NHS constitution’ was established by the Health Act 2009, bringing together the principles and purpose of NHS in England especially its values as developed by the public, staff, patients and staff in conjunction with their pledges, rights and responsibilities. 2012 Mark Cahill has the first ever hand transplant in the UK (BBC News, 2018)2016 Following the E.U referendum, the uncertainty around Brexit caused a 96% crash in nurse applicants from Europe.2017 A 23% fall in nursing degree applicants in England occurred when the Conservative government abolished the student nurse bursary.In the year 1946, NHS was established under the National Health Service act. This provided a comprehensive health service for England and Wales however, separate Acts which covered Northern Ireland and Scotland were passed in 1947 and 1948 (Jones, 2015). Many factors resulted in the formation of NHS. The public desired better conditions after there were many casualties in the cities caused by bombings of World war ll. In addition, it was required to organise hospitals and staff due to war casualties. Many medical discoveries and breakthroughs also meant that more could be done for patients.Today the NHS has become a large organisation which has several hospital departments, roles and also covers community services. The services have greatly improved overtime, through the use of Information and Technology which keeps advancing and more breakthroughs are being discovered.Department Roles Function Emergency Physicians, paramedics, porters, radiographers Acute patient careCardiology Cardiologists, health care assistants Diagnosis and treatment of heart related issuesIntensive care Respiratory therapists, anaesthesiologists, nurses Treatment of severe or life threatening illnesses Neurology Neurologists, psychiatrists Deals with disorders of the nervous systemOncology Oncologists, radiologists, pathologist Diagnosis, prevention and treatment of cancerObstetrics and gynaecology Obstetricians, gynaecologists, midwives Deals with pregnancies, postpartum and the health of the female reproductive systemPathology Clinical scientists, Biomedical scientists, Pathologists such as Microbiologists, haematologists etc The study and diagnosis of diseases and its effects. Community and Outpatients General Practitioners, Dentists, Social workers, Pharmacists. Health and Social well being maintenance Source: (Nhs.uk, 2019) FindingFunding is of great concern within the NHS; the national budget is easily depleted due to restructuring and organisational changes. Expensive medicine and new advancement in therapies are all a huge contribution to the rising costs (Fig 1). In 2002, £40 billion was projected to be spent over a period of five years, with the government’s expenditure being expected to triple in the next few years . Primary care trusts received approximately 80% of the budget as they have a responsibility to meet local demands. Furthermore, the other 20% is dispersed to national and regional programmes (BBC News, 2019) .Fig 1. NHS spending from 1949 to 2019 Source: (BBC News, 2019) The budget has been increasing considerably since the early 1950s due to a high demand based on several factors such as lifestyle, staffing, research and development.The highest rises were between 1997 and 2010 under the Labour governments (Fig 2). Fig 2. Government healthcare spending over the years Source: (BBC News, 2019)Under the coalition government, there was a drop in spending to 1%, in recent years, this figure rose once more under the majority Conservative government. There is a five year funding plan which will increase the budget by 3.4% yearly until 2023. The costs continue to rise due to patient expectations, prevalence of communicable diseases, rise in elderly patients, drug/ technology innovation and chronic disabilities. There has been an exponential rise in people with multiple chronic conditions over the past years (Murray et al., 2013). In hospitals, the use of ICU beds has increased steeply, particularly in elderly patients. Neonatal intensive care is also negatively affecting the budget and resources especially in disabled neonates and in low gestational births. All this brings an increase in emotional, physical and fiscal costs especially in relation to education and social care (Montgomery et. al, 2017).Social factors impacting the NHS Obesity National Health Service(NHS.co.uk) describes obesity as medical condition that occurs when a person carries excessive body fat that might have a negative impact on their health. Studies have shown that obesity does not happen overnight, however it develops gradually over time. There are many factors that could contribute to these, however there are two common factors and these include poor diet and life style choices. People eat a large amount of processed or fast foods drink too much alcohol, eating a lot more than one need and also comfort eating. It could also be argued that some people are pre disposed to the obesity gene. So many people have these underlying problems but the choices made by individual end up having negative impact on their health and that has a negative impact on the NHS financially. The department of health and social care (nhs.co.uk) recommends that adults should have at least more than 2hours a week of moderate exercise. However people do not follow this as they might have more other day to day struggles, for example physical disabilities, environment of work might have an impact or just poor lifestyle choice like seating down and watching television with no movement at all. In the the following the writer shows the figures and types of illnesses on how obesity has an impact on the National Health Service According to Agha.M and Agha.R 2017 Obesity rates have increased vastly and people are living longer due to the quality of life and the retirement age has gone up. It is predicted that chronic illnesses which arise from obesity (Table 1) are going to continue costing the NHS and the costs will continue to rise. Obesity rates have tripled between 1975 and 2016 according to Agha and Agha, 2017. Approximately, in 2016, 2 billion adults worldwide were overweight with at least 650 million being classified as obese; the UK had an estimate of 27.8% contribution to that figure. Obesity has increased rates in morbidity and mortality due to several conditions it causes, such as stroke; type 2 diabetes etc (van Baal et al., 2008). Stroke and coronary heart disease have shown a great increase in 2015 (Table 1). Table 1. Current and estimated NHS costs of diseases in relation to obesity, 2007 -2050 (£billion/year) Source: (Agha and Agha, 2017) Source BBC.News,2014-2015Ageing populationThe UK’s population is ageing; this poses a great demand and consequence on the healthcare system. People aged 65 and older have great social needs due to the inability of living independently or to self-care. Most require assistance with daily living activities such as dressing, eating and toileting (Fox et al., 2017). Their incontinence and cognitive status usually requires long-term care. The ageing population tend to develop a few chronic illnesses and infections. Care for older patients costs between 2.5 to 5 times more than an average 30 year old . Fig 3. Annual costs by service area and age for Torbay (population 145,000) in 2010/11 (Patterson, 2014)An increase in ageing population means a reduction in social housing, which is critical in elderly people and patients. Well designed homes have shown to appropriately support most needs of the elderly and promote their independence which in turn greatly impacts their physical and emotional health. Elderly people in standard housing are prone to more illnesses and disabilities (Fox et al., 2017). They also become very fragile as they age and this results in a lot of injuries which puts a high demand on the accident and emergency department. This demand requires staffing, beds, technology which puts a strain on the budget. Another issue that has had a major impact is understaffing issues especially in nursing and this is because of student nursing bursary funding being cut. Other factors such as an increase in sickness of hospital staff sometimes due to the jobs being more demanding in order to meet the targets, staff are becoming greatly stressed and having long term conditions such as musculoskeletal problems .ConclusionIn my own opinion a few changes need to be made in order to maintain financial stability so that the NHS is still an ongoing service for the future. therefore increase in community staff is required to raise awareness to the public on how obesity and other social factors such as smoking and drinking are affecting the NHS and what that might mean in the future in regards to treatment. Gyms need to be more readily available and affordable. The National Health Service needs to educate people more in health education in terms of healthy eating and other social choices have negative impacts on one’s health. Some studies have shown that the work force is reducing, while the population is growing and the people are getting older and unhealthy. A reintroduction of the NHS student nurse bursary will combat staffing issues and also making sure that staff’s health is monitored and services such as counselling, intensive manual handling training etc are readily available. The government needs to also set a budget for more social housing, this would reduce the demands elderly people have on the NHS especially, emergency and accident department. However ageing is inevitable as England has the highest ageing population, therefore health inequality is growing and the ageing population is increasing and the NHS will need to adapt in order provide the best care. However having said this to create a healthier society we as people we all have responsibilities to help our elderly people to live more fulfilling and healthy lives. The National health service need to recognise that many people are lonelier and less connected therefore providing more Social housing and other activities for the elderly will have a great impact on their wellbeing.References Agha, M. and Agha, R. (2017). The rising prevalence of obesity. International Journal of Surgery Oncology. 2(7), 17.BBC News. (2018). 10 charts that show why the NHS is in trouble. [online] Available at: https://www.bbc.co.uk/news/health-42572110 [Accessed 4 Dec. 2019].BBC News. (2018). The NHS at 70: A timeline in pictures. [online] Available at: https://www.bbc.co.uk/news/in-pictures-44613043 [Accessed 3 Dec. 2019].BBC News. (2019). 11 charts on what’s happened to the NHS. [online] Available at: https://www.bbc.co.uk/news/health-50290033 [Accessed 6 Dec. 2019].Chadarevian, S. (2003). Portrait of a Discovery. Isis. 94(1),90-105.Fox, S., Kenny, L., Day, M., O’Connell, C., Finnerty, J. and Timmons, S. (2017). 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