The National Health Service (NHS) was established in 1948 to provide equitable healthcare for all citizens. Over the years the NHS has gone under different reforms and changes. In 2002 the NHS launched one of its biggest changes in structure since its commencement in 1948. The scale of these changes are greater than those established following the white paper “Working for Patients” in 1989 (Conservative Government) that indicated the introduction of the internal market (focus on efficiency). This review therefore proposes to give a brief summarize of the structural changes and current structure of the NHS in the England. The NHS plan was published in July 2000 (Labour Government) and outlined a 10 year plan of investment in the NHS. This delineates a vision for a service planned around the patients and more responsive to patients’ needs. The Government emphasizes on the empowering of staff at all levels as a way to achieve this vision. "Shifting the Balance of Power" is part of the Government’s plans for implementation of the NHS Plan and has directed to the establishment of new structures. The main feature of change has been giving locally based Primary Care Trusts the role of running the NHS and, with the local authorities, improving health in their areas. The PCTs are receiving 75% of the NHS budget to act as primary services provider, commissioner (service purchaser), network developer and controller. In addition, all former Health Authorities have been abolished and new Strategic Health Authorities (SHA) have been created to serve larger areas and with a more strategic role. The SHAs are responsible for developing strategic frameworks for the local health service; performance of the local health service; and building capacity in the local health service. The Department of Health is also refocusing to reflect these changes, including the abolition of its Regional Offices and relegating some of its operational responsibilities to SHAs and other rganizations. While NHS Trusts (the organizations responsible for running most NHS hospitals, mental health and learning disability services, ambulance services and patient transport) continue to have the similar functions as before, they will have to create new working relationships with PCTs and SHAs. In addition Foundation Trust, which often referred ‘Foundation Hospitals’, were set up in April 2004 and are freestanding hospitals with greater autonomy within the NHS. New structures signify new relationships and partnerships both between NHS organizations and with other stakeholders. All NHS organizations locally - PCTs, Care Trusts and NHS Trusts -are now part of a single structure in which they are supposed accountable to SHAs, which are in turn accountable to Department of Health and ultimately to Secretary of State for Health. Relationships with other collaborators such as Local Authorities and voluntary organizations are also crucial, particularly for PCTs as they work towards improving health and integrating health and social care.  

This commentary explores some of the issues raised by Gilbert et al. short communication, Morality and Markets in the NHS. The increasing role of market mechanisms and the changing types of healthcare providers together with the use of choice and competition to drive improvements in quality in the National Health Service (NHS), all have important ethical implications. In order for the NHS to continue providing the level of service quality that out performs many high-income countries, despite spending much less on healthcare, we need a re-think of creeping marketization and privatisation and a consolidation of the NHS as a publically owned resource run for the benefit of patients and the public, not commercial interests.

Since its establishment in 1948, the history of the National Health Service (NHS) has been characterized by organisational turbulence and system reform. At the same time, progress in science, medicine and technology throughout the western world have revolutionized the delivery of healthcare. The NHS has become a much loved, if much critiqued, national treasure. It is against this backdrop that the role of this state-funded health service has been brought into moral question. Certainly, the challenges facing healthcare policy-makers are numerous and complex, but in the wake of the Health and Social Care Act (2012), no issue is more divisive than that of market-based reform. Here we explore the turbulent history of the NHS, from its foundation to the birth of the healthcare marketplace. We explore arguments for and against the healthcare market and resolve that, amid an evolving economic and moral framework, the NHS must ensure that its original tenets of equity and autonomy remain at its core. We propose a values-explicit, systems-based approach to renew focus on both the processes and the outcomes of care.

The paper by Gilbert et al. should be on the table of every politician and National Health Service (NHS) manager in the run up to the general election, when the NHS is at the hustings. They have raised profound moral dilemmas of the internal and external market in their present form, such as the practicalities of distributive justice and the enhancement of autonomy – to which are added the preservation of personhood, the values of listening, the maintenance of altruism and the origins of compassion. It is asserted that the quality of healthcare is dependent on the quality of the caring relationship between healthcare staff members, and between staff and patients. The nature of Compassionate Resilience is outlined with respect to Health Visitor training – and the contribution of faith communities to public health is also considered. The four Quality Indicators of an enabling environment first proposed by Cox and Gray are summarised, and the need for increased conceptual clarity of these key values recognised.

Background: Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital.Methods: We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual.Results: We found that the score for vigor and dedication is significantly lower than comparison group (P<0.0001 for both). The score for absorption was significantly higher than comparison group (P<0.0001). However, total score is not significantly different.Conclusion: The study shows that work engagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience.