Community Care

Social services have the lead responsibility for community care services to meet the needs of older people, people with disabilities, mentally ill people or other vulnerable members of society. The NHS, however, has an important role in providing some services and in collaborating closely with social services to plan and deliver community care.

Here the role of the NHS includes helping to assess people's needs for community care, liaising with social services over hospital discharges to make sure people get the continuing care they need, as well as delivering some services. The NHS makes an important contribution to community care services, for example, district nurses provide nearly 2.5 million episodes of care annually.

How is the nhs funded?

The NHS is free at the point of delivery to anyone normally resident in Britain. All taxpayers and employees contribute to its cost.

About 82 per cent of the coast of the health service is paid for by general taxes. The rest comes from:

• a proportion of National Insurance contributions (paid by working people and employers) - 12.2 per cent

• charges towards the costs of certain items, such as drugs prescribed by GPs, dental treatment and sight tests - 2.3 per cent. (Children and adults who may have difficulties paying are exempted from these charges.).

• land sales and other schemes for generating income - less than one per cent.

In addition:

• health authorities are free to raise funds from voluntary sources and

• some NHS hospitals take private patients who pay the full cost of their accommodation and treatment.

How is the money spent?

The NHS is one of the largest employers in the world, and staff costs account for two-thirds of all expenditure. About one tenth of the budget, some ₤4 billion, is spent each year on medicines.

In terms of spending on patients, more than two-fifths of total hospital and community health services expenditure, is on people aged 64 and over, while they make up just 16 per cent of the population.

The pie chart on the left shows spending in terms of different services:

• Hospital and Community Health Services provide hospital care and a wide range of community services

• Family Health Services (FHS) provide general medical, dental, pharmaceutical and some ophthalmic services, and covering the cost of medicines prescribed by GPs

• Central Health and Miscellaneous Services provide services which are most effectively administered centrally such as welfare food (such as free milk and vitamins for the children of families on Income Support) and support to the voluntary sector

• The administrative costs of the health departments are included under Departmental Administration.

Increased spending

Spending on health is one of the Government's top priorities. Spending on the NHS has increased in real terms for many years: the total in 1996-1997 was ₤35 billion; in 1997-1998 this figure increased to nearly ₤42 billion, which amounts to ₤1,700 for every household in the country.

In July 1998 the Government announced it would provide an extra ₤20 billion over the next three years. That amounts to an increase of 4.7% a year above inflation between 1998-1999 and 2001-2002.

This investment in the NHS is planned to bring a host of improvements to services:

• improve hospitals and GP services

• provide for the largest hospital building plan ever

• reduce waiting lists

• finance reform, based on partnership of all health bodies, with GPs and nurses playing a more important role

• begin to reduce avoidable illness, disease and injury and

• reduce the rate of growth in emergency admissions.