Evolution of Health and Social Care Services in the UK Assignment

Historical development and organizational structure of healthcare in the UK, alongside reflections on evidence-based practice and regulatory frameworks.

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Unit 1 - Context And Reflection

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Introduction Of Evolution of Health and Social Care Services in the UK 

This assessment is aiming to highlight the current health and social care service and development process of the United Kingdom. In this essay, the first focus will be given on the historical development of the current health and social care service of the respective country along with an in-depth discussion about how the care services are used to be organized and offered to the people of the country. The second focus will be given to reflective practice and theoretical concepts related to evidence-based practice in health and social care services.


Task 1: The development of health and social care services (chronology, legislation

The basic development of health and social care services in the UK is based on the foundation of the National Health Service or NHS.

In 1946 the NHS was founded and became responsible for offering care services to the people of the country.

Though, NHS became operational on 5th July 1948. The development of NHS was first proposed to Parliament in the 1942 Beveridge Report on Social Insurance and Allied Services.

In 1949, Nurse Act came into force which established a modern framework for the role and responsibilities of the nurses within the NHS. In 1946, the National Health Service Act came into force, which contained the notion, that NHS service should be offered free of cost. This legislation provided a prescription charge and was passed by the Labour Government through the NHS Act, of 1949 (amended) (Dupree, 2019).

In 1950, JS Colling’s survey report on English General Healthcare Practice had published which was funded by the Nuffield Trust. According to his findings, “ the overall state of general practice is deteriorating in the UK and some of the working practice within NHS need condemnation in the public interest”. These findings further led to the foundation of the College of General Practitioners in 1952 and forced the government to take action for assisting the development of health and social care services in the UK (NHS Reform timeline (2022).

In 1953, January, a report by the Nuffield Provincial Hospitals Trust, UK was published focusing on the job analysis and assessment of the nurses in NHS.

In August 1954 the Bradbeer Committee published a report on the Internal administration of the hospitals in the UK for the Central Health Services Council. In 1950, this committee was developed under the supervision of Alderman Bardbeer, and the main aim of this committee was to examine the hospital administration arrangement in NHS, England.

In 1962, the Medical Services Review Committee published the final report (The Porritt Report). This report suggested the reformation of the tripartite structure of NHS by transferring the responsibility for the administration and coordination of all the medical and auxiliary services to the hands-on authority, which would be known as the "health board" (NHS Reform Timeline (2022).

In 1967, the Abortion Act in the UK got legalisation, where it was mentioned that women can abort up to 28 weeks of gestation, specifically those who were living at risk.

In 1968, September, the Ministry of Health, UK merged with the Ministry of Social Security and formed the Department of Health and Social Security. In this scenario, the Ministry of State and Department of Health and Social Security, UK made a statement that the basic purpose of the government is to unite the NHS and integrate the separate health and social care services, locally.

In 1969, the Seebohm reports recommended the integration of the health and social care service. The NHS events during this period were as followed:

  • The Ministry of Health and Ministry of Social Security Form, DHSS, Richard Crossman, the secretary of the State tried to put the Hong Kong Influenza epidemics into the national healthcare service provision
  • This year, the first green paper was published on the NHS reorganization. The green paper recommended the creation of more than 50 areas in healthcare services under a single organisational tier.

In July 1973 reorganisation of the NHS took place-after a year of debates, major structural changes took place within the NHS Reorganisation Act. The Management arrangement for the reorganised NHS (1972), which is commonly known as the “Grey Book” recommended the system of consensus management and shed light on the specification of roles and responsibilities of the NHS officers.

In June 1975, the Morrison report was published which suggested that the GMC or General Medical Council should be responsible to regulate the medical education and training processes in the UK and for all specialists and GPs. This report can be considered as the key shaper of the Medical Regulation Act, of 1978 (Tennison et al., 2021).

In August 1980, the Black Report was published which showcased the persistent health inequalities within the healthcare service provider of the NHS.

In October 1982, the Korner Steering Group recommended developing a basic statistic for the health authorities. Concern was rise regarding the cost and management resources that were essential to set up the NHS data model. Afterwards, in 1987, the arraignment was implemented in NHS, in this year, a Committee for Regulation Information Requirement was also established.

In June 1990 NHS and Community Care Act came into force which stressed upon the creation of an internal market and split in purchaser-provider within healthcare facilities.

In November 1990, the Human Fertilisation and Embryology Act replaced the Abortion Act. As per this legislation, abortion will no longer be legal after 24 weeks of gestation.

In November 1991, the Patient’s Charter outlined the rights of patients in terms of getting the quality of services that they should expect to receive.

In 1993 the NHS executive was established as a separate body within the Department of Health.

In 1997, the Primary Care Act came into force by highlighting the new possibilities of delivering primary care.

In April 1998, The Nation Institute for Health and Clinical Excellence or NICE was established.

In July 2000, the NHS plan for 10 years of modernisation program of investment and reform came into force.

In January 2001 a Commission for Healthcare Improvement was created under the Vigilance of Healthcare Act, of 1999. It was the first organisation that formally can assess the performance of the NHS.

In November 2003, The health and social care (community health and Standards) Act, of 2003 came into force which provided an establishment for the NHS Foundation trusts.

In April 2009, the CQC or the Care Quality Commission was created as the new health and social care regulator for the NHS. This was created by merging three regulators: the Commission for Social Care Inspection, Mental Health Act Commission, and the Healthcare Commission (Vindrola-Padros et al., 2020).

In November 2012, the Health and Social Care Act was published by implementing the first mandate to the NHS Commissioning Board.

In May 2022, The Health and Care Act 2022 is passed through the parliament by restructuring the NHS as an “Integrated Care System”

Task 2: Discussion on how healthcare services are organized and provided

The key strategy of public health in England is “Healthy lives, Healthy people in England”. The Health care services in the UK are provided and organized by the National Health Service or NHS, a publicly funded system. The NHS offered a wide range of service provisions, including primary care, hospital services, mental health care, and social care. CCGs or Clinical commissioning groups are the local-level organizations responsible for providing secondary care services and public health services (Vindrola-Padros et al., 2020). NHS also includes the Local Authority department which is responsible for delivering and enforcing public health powers related to environmental health issues, as per the Public Health Act, of 1936 (Bassot, 2023). Additionally, as per the Health and Social Care Act, of 2012, the local authorities of NHS are also responsible to transfer power for planning, commissioning and delivering local public health priorities (Bucci et al., 2019). The local authorities contain upper-tier and unitary local authorities who are responsible to improve public healthcare service and approach.

On the other hand, NHS is coordinated with NICE or the National Institute for Health Care Excellence. The NICE is responsible to produce a guideline for health service provision for drugs and other clinical intervention services by aiming at the local government, public health care supporters and professionals, and GPs. CQC plays an important role in health care service organisation and provision in the UK. in the country, the majority of the public health care service providers used the commission by the PHE and local authorities which are in turn have to be registered under the Care Quality Commission (Rolfe and Freshwater, 2020). CQC is the independent regulator of the health and social care service provision of England. Health Education is another important body in the UK which is responsible for planning and implementation of workforce training and development for NHS (Sivarajasingam et al., 2021). This authority is used to fund the specialist training program in NHS within the clinical specialities. Additionally, the NHS or UK's healthcare service is comprised of many statutory bodies like

  • The UK Faculty of Public Health, Royal College of Physicians of London
  • The Royal Society for Public Health
  • The Association of Directors of Public Health- these authorities are responsible to improve and protect the health of the population and ensure the provision of healthcare services to the people on time.

The Royal Society for Public Health, for example, was formed in October 2008 and it comprises with more than 6000 public health professionals and different healthcare sectors (Ramsey et al., 2022). The major role of this organization is to focus on health promotion, medicine, environmental health and food safety assurance for the people.

Task 3: Evaluation of the reflective practice on the delivery of care service

Reflection can be defined as the thought process where an individual focuses on their own experiences to acquire insights about the whole practice related to the delivery of care service. The benefit of reflective practice in the delivery of care services are:

  • Through this practice, an individual can support healthcare professionals in multi-disciplinary teamwork
  • With reflective practice, improvement in practice and services can be fostered
  • With reflective practice on the delivery of care service, it can be assured that health and social care professionals avail the scope of continuous learning and improvement (Cunningham et al., 2019).).

Table 1: the regulatory requirements for reflection practice:

Professional Regulator Approach to reflection
General Dental Council I can introduce reflective practice through the enhanced CPD scheme and can encourage dental care professionals to reflect on the outcome of the CPD activities.
General Medical Council Here the employers of the medical council will encourage reflective practice to identify the complex issue within health and social care service provision and measure the effect of changes within the system (Dang et al., 2021). Here time management is important for self-reflection and reflecting on the groups.
Health and care profession council Here, I can take an outcome-based approach to provide care support and services to the people based on their needs. The CPD guidance under the NHS will encourage learning and follow development to reflect on the practice. The evidence-based learning can also be considered the most effective learning activity (Ramsey et al., 2022). In this activity session, interaction with the healthcare professionals can encourage the self-reflection

Task 4: Analysis of the theoretical concepts related to the evidence-based practice

John Hopkins Evidence-based practice model in health and social care service can be defined as an important problem-solving approach when it comes to making decisions. This model includes the feedback process for evidence-based practice (Speroni et al., 2020). As per the model feedback from a wide variety of end-users can help professionals to maintain continuous development and improvement in the healthcare practice. According to the John Hopkins Health System, the EBP model includes a three-phase approach which can be referred to as the PET process. The PET approach includes:

  • Practice questions
  • Evidence
  • Translation

(Figure: John Hopkins Evidence-Based Practice Model)

(Source: Dang et al., 2021)

As per the model, the individual will develop a practice question as a team to identify the patient population, intervention and outcome (PICO) (Speroni et al., 2020). In the second phase, a search of the literature will be carried out to appraise the evidence and in the third phase, the finding will be synthesized for developing further recommendations in the healthcare service process and practice (Bassot, 2023). With this approach, as a nurse or healthcare professional, one can get project management guidelines, use the question development tool, and stakeholder analysis guideline which in turn can strengthen the evidence-based practices in the healthcare sector to a considerable extent.


To conclude this assessment, it can be stated that, in the UK, the health and social care service provision is based on the NHS. In this country, the health and social care services, and NHS have gone through many development and reforms. In this assessment, depth analysis of the development of NHS and the way the healthcare service is being provided in the UK have been carried out.


Bassot, B., (2023). The reflective practice guide: An interdisciplinary approach to critical reflection. Taylor & Francis.

Bucci, S., Schwannauer, M. and Berry, N., (2019). The digital revolution and its impact on mental health care. Psychology and Psychotherapy: Theory, Research and Practice, 92(2), pp.277-297.

Cunningham, D.E., Alexander, A., Luty, S. and Zlotos, L., (2019). CPD preferences and activities of general practitioners, registered pharmacy staff and general practice nurses in NHS Scotland–a questionnaire survey. Education for primary care, 30(4), pp.220-229.

Dang, D., Dearholt, S.L., Bissett, K., Ascenzi, J. and Whalen, M., (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines. Sigma Theta Tau.

Dupree, M., (2019). Towards a History of the NHS in Glasgow and the West of Scotland: an Agenda for Future Research. In The NHS in Scotland (pp. 138-149). Routledge.

NHS Reform timeline (2022) The Nuffield Trust. Available at: https://www.nuffieldtrust.org.uk/health-and-social-care-explained/nhs-reform-timeline (Accessed: April 4, 2023).

Ramsey, L., Lawton, R., Sheard, L. and O’Hara, J., (2022). Exploring the sociocultural contexts in which healthcare staff respond to and use online patient feedback in practice: In-depth case studies of three NHS Trusts. Digital Health, 8, p.20552076221129085.

Rolfe, G. and Freshwater, D., (2020). Critical reflection in practice: generating knowledge for care. Bloomsbury Publishing.

Sivarajasingam, V., Tai, M. and Steeghs, K., (2021). How eConsult has transformed patient care and staff well-being in an NHS practice. Primary Health Care, 31(1).

Speroni, K.G., McLaughlin, M.K. and Friesen, M.A., (2020). Use of Evidence?based practice models and research findings in Magnet?Designated hospitals across the United States: national survey results. Worldviews on Evidence?Based Nursing, 17(2), pp.98-107.

Tennison, I., Roschnik, S., Ashby, B., Boyd, R., Hamilton, I., Oreszczyn, T., Owen, A., Romanello, M., Ruyssevelt, P., Sherman, J.D. and Smith, A.Z., (2021). Health care's response to climate change: a carbon footprint assessment of the NHS in England. The Lancet Planetary Health, 5(2), pp.e84-e92.

Vindrola-Padros, C., Andrews, L., Dowrick, A., Djellouli, N., Fillmore, H., Gonzalez, E.B., Javadi, D., Lewis-Jackson, S., Manby, L., Mitchinson, L. and Symmons, S.M., (2020). Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the UK. BMJ open, 10(11), p.e040503.

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