Annex A > Chapter 2 - A Historical Background to the NHS > Introduction

Introduction

1 The services provided to children undergoing paediatric cardiac surgery at Bristol from 1984 to 1995 could not be properly examined without an understanding of the context within which the Bristol Paediatric Cardiac Unit functioned. To inform itself of that context, and to assist the Inquiry in its task to `make recommendations which could help secure high quality care across the National Health Service' (NHS), the Inquiry sought evidence from interested bodies or individuals, upon the national, regional and local scene. This evidence concentrated upon the years 1984-1995, although it looked also at the years immediately preceding 1984, and also at the changes and developments that have taken place since 1995. The account that follows sets out the evidence relating to 1984-1995 which was received by the Inquiry. But the service that existed in 1984 was shaped by the history of the NHS prior to that date. For this reason, we have attempted to summarise the main features of the history of the NHS from 1948 onwards. This brief history is intended to serve as a useful introduction to the more detailed survey of the years 1984-1995 which follows it.

2 We concentrate principally on care in hospital. In fact, three basic elements make up the NHS. They are: the hospital service, the family practitioner services and community-based services. During its hearings, the Inquiry heard evidence of matters that touched upon all three elements. Children were referred for more specialised investigation and treatment by hospital-based consultants by their general practitioners. After discharge from hospital, they and their families received care from general practitioners, and support from community-based practitioners. Parents whose children had died spoke of the services that were available to help them in the community; or the absence of such support. However, the greatest bulk of the evidence received related to services provided by the hospital sector. This is reflected in the following account which deals at greater length with that sector. Equally, the discussion is restricted to the NHS in England and Wales. The Inquiry's Terms of Reference do not deal with Scotland.

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