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Vocabulary development
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Vocabulary development is a process by which people acquire words. Babbling shifts towards meaningful speech as infants grow and produce their first words around the age of one year. In early word learning, infants build their vocabulary slowly. By the age of 18 months, infants can typically produce about 50 words and begin to make word combinations.
In order to build their vocabularies, infants must learn about the meanings that words carry. The mapping problem asks how infants correctly learn to attach words to referents. Constraints theories, domain-general views, social-pragmatic accounts, and an emergentist coalition model have been proposed to account for the mapping problem...
From an early age, infants use language to communicate. Caregivers and other family members use language to teach children how to act in society. In their interactions with peers, children have the opportunity to learn about unique conversational roles. Through pragmatic directions, adults often offer children cues for understanding the meaning of words.
Throughout their school years, children continue to build their vocabulary. In particular, children begin to learn abstract words. Beginning around age 3–5, word learning takes place both in conversation and through reading. Word learning often involves physical context, builds on prior knowledge, takes place in social context, and includes semantic support. The phonological loop and serial order short-term memory may both play an important role in vocabulary development.
Reading is an important means through which children develop their vocabulary.
Contents
[hide]
1 Early word learning
1.1 Phonological development
1.2 Babbling
1.3 Vocabulary spurt
2 Mapping problem
2.1 Theories of constraints
2.2 Domain-general views
2.3 Social pragmatic theories
2.4 Emergentist coalition model
3 Pragmatic development
3.1 Pragmatic influences
3.2 Pragmatic directions
4 In school-age children
4.1 Means
4.1.1 Physical context
4.1.2 Prior knowledge
4.1.3 Social context
4.1.4 Semantic support
4.2 Pictures support
4.3 Memory
5 See also
6 References
7 Bibliography
Early word learning[edit]
Infants begin to understand words such as "Mommy", "Daddy", "hands" and "feet" when they are approximately 6 months old.[1][2] Initially, these words refer to their own mother or father or hands or feet. Infants begin to produce their first words when they are approximately one year old.[3][4] Infants' first words are normally used in reference to things that are of importance to them, such as objects, body parts, people, and relevant actions. Also, the first words that infants produce are mostly single-syllabic or repeated single syllables, such as "no" and "dada".[4] By 12 to 18 months of age, children's vocabularies often contain words such as "kitty", "bottle", "doll", "car" and "eye". Children's understanding of names for objects and people usually precedes their understanding of words that describe actions and relationships. "One" and "two" are the first number words that children learn between the ages of one and two.[5] Infants must be able to hear and play with sounds in their environment, and to break up various phonetic units to discover words and their related meanings.
Phonological development[edit]
Main article: Phonological development
Studies related to vocabulary development show that children's language competence depends upon their ability to hear sounds during infancy.[3][6][7] Infants' perception of speech is distinct. Between six and ten months of age, infants can discriminate sounds used in the languages of the world.[3] By 10 to 12 months, infants can no longer discriminate between speech sounds that are not used in the language(s) to which they are exposed.[3] Among six-month-old infants, seen articulations (i.e. the mouth movements they observe others make while talking) actually enhance their ability to discriminate sounds, and may also contribute to infants' ability to learn phonemic boundaries.[8] Infants' phonological register is completed between the ages of 18 months and 7 years.[3]
Children's phonological development normally proceeds as follows:[3]
6–8 weeks: Cooing appears
16 weeks: Laughter and vocal play appear
6–9 months: Reduplicated (canonical) babbling appears
12 months: First words use a limited sound repertoire
18 months: Phonological processes (deformations of target sounds) become systematic
18 months–7 years: Phonological inventory completion
At each stage mentioned above, children play with sounds and learn methods to help them learn words.[6] There is a relationship between children's prelinguistic phonetic skills and their lexical progress at age two: failure to develop the required phonetic skills in their prelinguistic period results in children's delay in producing words.[9] Environmental influences may affect children's phonological development, such as hearing loss as a result of ear infections.[3] Deaf infants and children with hearing problems due to infections are usually delayed in the beginning of vocal babbling.
Babbling[edit]
Main article: Babbling
Babbling is an important aspect of vocabulary development in infants, since it appears to help practice producing speech sounds.[10] Babbling begins between five and seven months of age. At this stage, babies start to play with sounds that are not used to express their emotional or physical states, such as sounds of consonants and vowels.[6] Babies begin to babble in real syllables such as "ba-ba-ba, neh-neh-neh, and dee-dee-dee,"[6] between the ages of seven and eight months; this is known as canonical babbling.[3] Jargon babbling includes strings of such sounds; this type of babbling uses intonation but doesn't convey meaning. The phonemes and syllabic patterns produced by infants begin to be distinctive to particular languages during this period (e.g., increased nasal sounds in French and Japanese babies) though most of their sounds are similar.[3][6] There is a shift from babbling to the use of words as the infant grows.[11]
Vocabulary spurt[edit]
As children get older their rate of vocabulary growth increases. Children probably understand their first 50 words before they produce them. By the age of eighteen months, children typically attain a vocabulary of 50 words in production, and between two and three times greater in comprehension.[4][6] A switch from an early stage of slow vocabulary growth to a later stage of faster growth is referred to as the vocabulary spurt.[12] Young toddlers acquire one to three words per month. A vocabulary spurt often occurs over time as the number of words learned accelerates. It is believed that most children add about 10 to 20 new words a week.[12] Between the ages of 18 to 24 months, children learn how to combine two words such as no bye-bye and more please.[4] Three-word and four-word combinations appear when most of the child's utterances are two-word productions. In addition, children are able to form conjoined sentences, using and.[4] This suggests that there is a vocabulary spurt between the time that the child's first word appears, and when the child is able to form more than two words, and eventually, sentences. However, there have been arguments as to whether or not there is a spurt in acquisition of words. In one study of 38 children, only five of the children had an inflection point in their rate of word acquisition as opposed to a quadratic growth.[12] This study suggests that most children do not have a vocabulary spurt.
Mapping problem[edit]
In word learning, the mapping problem refers to the question of how infants attach the forms of language to the things that they experience in the world.[13] There are infinite objects, concepts, and actions in the world that words could be mapped onto.[13] Many theories have been proposed to account for the way in which the language learner successfully maps words onto the correct objects, concepts, and actions.
While domain-specific accounts of word learning argue for innate constraints that limit infants' hypotheses about word meanings,[14] domain-general perspectives argue that word learning can be accounted for by general cognitive processes, such as learning and memory, which are not specific to language.[15] Yet other theorists have proposed social pragmatic accounts, which stress the role of caregivers in guiding infants through the word learning process.[16] According to some[who?] research, however, children are active participants in their own word learning, although caregivers may still play an important role in this process.[17][18] Recently, an emergentist coalition model has also been proposed to suggest that word learning cannot be fully attributed to a single factor. Instead, a variety of cues, including salient and social cues, may be utilized by infants at different points in their vocabulary development.[19]
Theories of constraints[edit]
Theories of word-learning constraints argue for biases or default assumptions that guide the infant through the word learning process. Constraints are outside of the infant's control and are believed to help the infant limit their hypotheses about the meaning of words that they encounter daily.[14][20] Constraints can be considered domain-specific (unique to language).
Critics[who?] argue that theories of constraints focus on how children learn nouns, but ignore other aspects of their word learning.[21] Although constraints are useful in explaining how children limit possible meanings when learning novel words, the same constraints would eventually need to be overridden because they are not utilized in adult language.[22] For instance, adult speakers often use several terms, each term meaning something slightly different, when referring to one entity, such as a family pet. This practice would violate the mutual exclusivity constraint.[22]
Below, the most prominent constraints in the literature are detailed:
Reference is the notion that a word symbolizes or stands in for an object, action, or event.[23] Words consistently stand for their referents, even if referents are not physically present in context.[23]
Mutual Exclusivity is the assumption that each object in the world can only be referred to by a single label.[14][24]
Shape has been considered to be one of the most critical properties for identifying members of an object category.[25] Infants assume that objects that have the same shape also share a name.[26] Shape plays an important role in both appropriate and inappropriate extensions.[25]
The Whole Object Assumption is the belief that labels refer to whole objects instead of parts or properties of those objects.[14][27] Children are believed to hold this assumption because they typically label whole objects first, and parts of properties of objects later in development.[27]
The Taxonomic Assumption reflects the belief that speakers use words to refer to categories that are internally consistent.[28] Labels to pick out coherent categories of objects, rather than those objects and the things that are related to them.[14][28] For example, children assume that the word "dog" refers to the category of "dogs", not to "dogs with bones", or "dogs chasing cats".[28]
Domain-general views[edit]
Domain-general views of vocabulary development argue that children do not need principles or constraints in order to successfully develop word-world mappings.[15] Instead, word learning can be accounted for through general learning mechanisms such as salience, association, and frequency.[15] Children are thought to notice the objects, actions, or events that are most salient in context, and then to associate them with the words that are most frequently used in their presence.[15] Additionally, research on word learning suggests that fast mapping, the rapid learning that children display after a single exposure to new information, is not specific to word learning. Children can also successfully fast map when exposed to a novel fact, remembering both words and facts after a time delay.[21]
Domain-general views have been criticized for not fully explaining how children manage to avoid mapping errors when there are numerous possible referents to which objects, actions, or events might point.[29] For instance, if biases are not present from birth, why do infants assume that labels refer to whole objects, instead of salient parts of these objects?[29] However, domain-general perspectives do not dismiss the notion of biases. Rather, they suggest biases develop through learning strategies instead of existing as built-in constraints. For instance, the whole object bias could be explained as a strategy that humans use to reason about the world; perhaps we are prone to thinking about our environment in terms of whole objects, and this strategy is not specific to the language domain.[21] Additionally, children may be exposed to cues associated with categorization by shape early in the word learning process, which would draw their attention to shape when presented with novel objects and labels.[30] Ordinary learning could, then, lead to a shape bias.[30]
Social pragmatic theories[edit]
Social pragmatic theories, also in contrast to the constraints view, focus on the social context in which the infant is embedded.[16] According to this approach, environmental input removes the ambiguity of the word learning situation.[16] Cues such as the caregiver's gaze, body language, gesture, and smile help infants to understand the meanings of words.[16] Social pragmatic theories stress the role of the caregiver in talking about objects, actions, or events that the infant is already focused-in upon.[16]
Joint attention is an important mechanism through which children learn to map words-to-world, and vice versa.[31] Adults commonly make an attempt to establish joint attention with a child before they convey something to the child. Joint attention is often accompanied by physical co-presence, since children are often focused on what is in their immediate environment.[31] As well, conversational co-presence is likely to occur; the caregiver and child typically talk together about whatever is taking place at their locus of joint attention.[31] Social pragmatic perspectives often present children as covariation detectors, who simply associate the words that they hear with whatever they are attending to in the world at the same time.[32] The co-variation detection model of joint attention seems problematic when we consider that many caregiver utterances do not refer to things that occupy the immediate attentional focus of infants. For instance, caregivers among the Kaluli, a group of indigenous peoples living in New Guinea, rarely provide labels in the context of their referents.[32] While the covariation detection model emphasizes the caregiver's role in the meaning-making process, some theorists[who?] argue that infants also play an important role in their own word learning, actively avoiding mapping errors.[18] When infants are in situations where their own attentional focus differs from that of a speaker, they seek out information about the speaker's focus, and then use that information to establish correct word-referent mappings.[17][32] Joint attention can be created through infant agency, in an attempt to gather information about a speaker's intent.[32]
From early on, children also assume that language is designed for communication. Infants treat communication as a cooperative process.[33] Specifically, infants observe the principles of conventionality and contrast. According to conventionality, infants believe that for a particular meaning that they wish to convey, there is a term that everyone in the community would expect to be used.[33][34] According to contrast, infants act according to the notion that differences in form mark differences in meaning.[33][34] Children's attention to conventionality and contrast is demonstrated in their language use, even before the age of 2 years; they direct their early words towards adult targets, repair mispronunciations quickly if possible, ask for words to relate to the world around them, and maintain contrast in their own word use.[33]
Emergentist coalition model[edit]
The emergentist coalition model suggests that children make use of multiple cues to successfully attach a novel label to a novel object.[19] The word learning situation may offer an infant combinations of social, perceptual, cognitive, and linguistic cues. While a range of cues are available from the start of word learning, it may be the case that not all cues are utilized by the infant when they begin the word learning process.[19] While younger children may only be able to detect a limited number of cues, older, more experienced word learners may be able to make use of a range of cues. For instance, young children seem to focus primarily on perceptual salience, but older children attend to the gaze of caregivers and use the focus of caregivers to direct their word mapping.[19] Therefore, this model argues that principles or cues may be present from the onset of word learning, but the use of a wide range of cues develops over time.[35]
Supporters of the emergentist coalition model argue that, as a hybrid, this model moves towards a more holistic explanation of word learning that is not captured by models with a singular focus. For instance, constraints theories typically argue that constraints/principles are available to children from the onset of word learning, but do not explain how children develop into expert speakers who are not limited by constraints.[36] Additionally, some argue[who?] that domain-general perspectives do not fully address the question of how children sort through numerous potential referents in order to correctly sort out meaning.[36] Lastly, social pragmatic theories claim that social encounters guide word learning. Although these theories describe how children become more advanced word learners, they seem to tell us little about children's capacities at the start of word learning.[36] According to its proponents, the emergentist coalion model incorporates constraints/principles, but argues for the development and change in these principles over time, while simultaneously taking into consideration social aspects of word learning alongside other cues, such as salience.[37]
Pragmatic development[edit]
Both linguistic and socio-cultural factors affect the rate at which vocabulary develops.[38] Children must learn to use their words appropriately and strategically in social situations.[39] They have flexible and powerful social-cognitive skills that allow them to understand the communicative intentions of others in a wide variety of interactive situations. Children learn new words in communicative situations.[40] Children rely on pragmatic skills to build more extensive vocabularies.[41] Some aspects of pragmatic behaviour can predict later literacy and mathematical achievement, as children who are pragmatically skilled often function better in school. These children are also generally better liked.[42]
Children use words differently for objects, spatial relations and actions. Children ages one to three often rely on general purpose deictic words such as "here", "that" or "look" accompanied by a gesture, which is most often pointing, to pick out specific objects.[41] Children also stretch already known or partly known words to cover other objects that appear similar to the original. This can result in word overextension or misuses of words. Word overextension is governed by the perceptual similarities children notice among the different referents. Misuses of words indirectly provide ways of finding out which meanings children have attached to particular words.[41] When children come into contact with spatial relations, they talk about the location of one object with respect to another. They name the object located and use a deictic term, such as here or "there" for location, or they name both the object located and its location. They can also use a general purpose locative marker, which is a preposition, postposition or suffix depending on the language that is linked in some way to the word for location.[41] Children's earliest words for actions usually encode both the action and its result. Children use a small number of general purpose verbs, such as "do" and "make" for a large variety of actions because their resources are limited. Children acquiring a second language seem to use the same production strategies for talking about actions. Sometimes children use a highly specific verb instead of a general purpose verb. In both cases children stretch their resources to communicate what they want to say.[41]
Infants use words to communicate early in life and their communication skills develop as they grow older. Communication skills aid in word learning. Infants learn to take turns while communicating with adults. While preschoolers lack precise timing and rely on obvious speaker cues, older children are more precise in their timing and take fewer long pauses.[43] Children get better at initiating and sustaining coherent conversations as they age. Toddlers and preschoolers use strategies such as repeating and recasting their partners' utterances to keep the conversation going. Older children add new relevant information to conversations. Connectives such as then, so, and because are more frequently used as children get older.[44] When giving and responding to feedback, preschoolers are inconsistent, but around the age of six, children can mark corrections with phrases and head nods to indicate their continued attention. As children continue to age they provide more constructive interpretations back to listeners, which helps prompt conversations.[45]
Pragmatic influences[edit]
Caregivers use language to help children become competent members of society and culture. From birth, infants receive pragmatic information. They learn structure of conversations from early interactions with caregivers. Actions and speech are organized in games, such as peekaboo to provide children with information about words and phrases. Caregivers find many ways to help infants interact and respond. As children advance and participate more actively in interactions, caregivers adapt their interactions accordingly.[46] Caregivers also prompt children to produce correct pragmatic behaviours. They provide input about what children are expected to say, how to speak, when they should speak, and how they can stay on topic. Caregivers may model the appropriate behaviour, using verbal reinforcement, posing a hypothetical situation, addressing children's comments, or evaluating another person.[47]
Family members contribute to pragmatic development in different ways. Fathers often act as secondary caregivers, and may know the child less intimately. Older siblings may lack the capacity to acknowledge the child's needs. As a result, both fathers and siblings may pressure children to communicate more clearly. They often challenge children to improve their communication skills, therefore preparing them to communicate with strangers about unfamiliar topics. Fathers have more breakdowns when communicating with infants, and spend less time focused on the same objects or actions as infants. Siblings are more directive and less responsive to infants, which motivates infants to participate in conversations with their older siblings.[48] There are limitations to studies that focus on the influences of fathers and siblings, as most research is descriptive and correlational. In reality, there are many variations of family configurations, and context influences parent behaviour more than parent gender does.[49] The majority of research in this field is conducted with mother/child pairs.
Peers help expose children to multi-party conversations. This allows children to hear a greater variety of speech, and to observe different conversational roles. Peers may be uncooperative conversation partners, which pressures the children to communicate more effectively. Speaking to peers is different from speaking to adults, but children may still correct their peers. Peer interaction provides children with a different experience filled with special humour, disagreements and conversational topics.[42]
Culture and context in infants’ linguistic environment shape their vocabulary development. English learners have been found to map novel labels to objects more reliably than to actions compared to Mandarin learners. This early noun bias in English learners is caused by the culturally reinforced tendency for English speaking caregivers to engage in a significant amount of ostensive labelling as well as noun-friendly activities such as picture book reading.[50] Adult speech provides children with grammatical input. Both Mandarin and Cantonese languages have a category of grammatical function word called a noun classifier, which is also common across many genetically unrelated East Asian languages. In Cantonese, classifiers are obligatory and specific in more situations than in Mandarin. This accounts for the research found on Mandarin-speaking children outperforming Cantonese-speaking children in relation to the size of their vocabulary.[38]
Pragmatic directions[edit]
Pragmatic directions provide children with additional information about the speaker's intended meaning. Children's learning of new word meanings is guided by the pragmatic directions that adults offer, such as explicit links to word meanings.[51] Adults present young children with information about how words are related to each other through connections, such as "is a part of", "is a kind of", "belongs to", or "is used for". These pragmatic directions provide children with essential information about language, allowing them to make inferences about possible meanings for unfamiliar words.[52] This is also called inclusion. When children are provided with two words related by inclusion, they hold on to that information. When children hear an adult say an incorrect word, and then repair their mistake by stating the correct word, children take into account the repair when assigning meanings to the two words.[51]
In school-age children[edit]
Children in school share an interactive reading experience.
Vocabulary development during the school years builds upon what the child already knows, and the child uses this knowledge to broaden his or her vocabulary. Once children have gained a level of vocabulary knowledge, new words are learned through explanations using familiar, or "old" words. This is done either explicitly, when a new word is defined using old words, or implicitly, when the word is set in the context of old words so that the meaning of the new word is constrained.[53] When children reach school-age, context and implicit learning are the most common ways in which their vocabularies continue to develop.[54] By this time, children learn new vocabulary mostly through conversation and reading.[55] Throughout schooling and adulthood, conversation and reading are the main methods in which vocabulary develops. This growth tends to slow once a person finishes schooling, as they have already acquired the vocabulary used in everyday conversation and reading material and generally are not engaging in activities that require additional vocabulary development.[53][56]
During the first few years of life, children are mastering concrete words such as "car", "bottle", "dog", "cat". By age 3, children are likely able to learn these concrete words without the need for a visual reference, so word learning tends to accelerate around this age.[57] Once children reach school-age, they learn abstract words (e.g. "love", "freedom", "success").[58] This broadens the vocabulary available for children to learn, which helps to account for the increase in word learning evident at school age.[59] By age 5, children tend to have an expressive vocabulary of 2,100–2,200 words. By age 6, they have approximately 2,600 words of expressive vocabulary and 20,000–24,000 words of receptive vocabulary.[60] Some claim that children experience a sudden acceleration in word learning, upwards of 20 words per day,[56] but it tends to be much more gradual than this. From age 6 to 8, the average child in school is learning 6–7 words per day, and from age 8 to 12, approximately 12 words per day.[21]
Means[edit]
Exposure to conversations and engaging in conversation with others help school-age children develop vocabulary. Fast mapping is the process of learning a new concept upon a single exposure and is used in word learning not only by infants and toddlers, but by preschool children and adults as well.[21] This principle is very useful for word learning in conversational settings, as words tend not to be explained explicitly in conversation, but may be referred to frequently throughout the span of a conversation.
Reading is considered to be a key element of vocabulary development in school-age children.[53][60][61][62] Before children are able to read on their own, children can learn from others reading to them. Learning vocabulary from these experiences includes using context, as well as explicit explanations of words and/or events in the story.[63] This may be done using illustrations in the book to guide explanation and provide a visual reference or comparisons, usually to prior knowledge and past experiences.[64] Interactions between the adult and the child often include the child's repetition of the new word back to the adult.[65] When a child begins to learn to read, their print vocabulary and oral vocabulary tend to be the same, as children use their vocabulary knowledge to match verbal forms of words with written forms. These two forms of vocabulary are usually equal up until grade 3. Because written language is much more diverse than spoken language, print vocabulary begins to expand beyond oral vocabulary.[66] By age 10, children's vocabulary development through reading moves away from learning concrete words to learning abstract words.[67]
Generally, both conversation and reading involve at least one of the four principles of context that are used in word learning and vocabulary development: physical context, prior knowledge, social context and semantic support.[68]
Physical context[edit]
Physical context involves the presence of an object or action that is also the topic of conversation. With the use of physical context, the child is exposed to both the words and a visual reference of the word. This is frequently used with infants and toddlers, but can be very beneficial for school-age children, especially when learning rare or infrequently used words.[62] Physical context may include props such as in toy play. When engaging in play with an adult, a child's vocabulary is developed through discussion of the toys, such as naming the object (e.g. "dinosaur") or labeling it with the use of a rare word (e.g., stegosaurus).[68] These sorts of interactions expose the child to words they may not otherwise encounter in day-to-day conversation.
Prior knowledge[edit]
Past experiences or general knowledge is often called upon in conversation, so it is a useful context for children to learn words. Recalling past experiences allows the child to call upon their own visual, tactical, oral, and/or auditory references.[68] For example, if a child once went to a zoo and saw an elephant, but did not know the word elephant, an adult could later help the child recall this event, describing the size and color of the animal, how big its ears were, its trunk, and the sound it made, then using the word elephant to refer to the animal. Calling upon prior knowledge is used not only in conversation, but often in book reading as well to help explain what is happening in a story by relating it back to the child's own experiences.[69]
Social context[edit]
Social context involves pointing out social norms and violations of these norms.[70] This form of context is most commonly found in conversation, as opposed to reading or other word learning environments. A child's understanding of social norms can help them to infer the meaning of words that occur in conversation. In an English-speaking tradition, "please" and "thank you" are taught to children at a very early age, so they are very familiar to the child by school-age. For example, if a group of people is eating a meal with the child present and one person says, "give me the bread" and another responds with, "that was rude. What do you say?", and the person responds with "please", the child may not know the meaning of "rude", but can infer its meaning through social context and understanding the necessity of saying "please".[70]
Semantic support[edit]
Semantic support is the most obvious method of vocabulary development in school-age children. It involves giving direct verbal information of the meaning of a word.[61][71] By the time children are in school, they are active participants in conversation, so they are very capable and willing to ask questions when they do not understand a word or concept. For example, a child might see a zebra for the first time and ask, what is that? and the parent might respond, that is a zebra. It is like a horse with stripes and it is wild so you cannot ride it.[71]
Pictures support[edit]
Pictures support involves two memory techniques – association and visualization. Associating an image with a word helps a user learn word in a more effective way. Anshul Agarwal, Founder of dailyvocab.com mentioned in his interview to Career360 – "memory aid for each word help student learn words more faster and effectively".[72]
Memory[edit]
Memory plays an important role in vocabulary development, however the exact role that it plays is disputed in the literature. Specifically, short-term memory and how its capacities work with vocabulary development is questioned by many researchers[who?].
The phonology of words has proven to be beneficial to vocabulary development when children begin school. Once children have developed a vocabulary, they utilize the sounds that they already know to learn new words.[73] The phonological loop encodes, maintains and manipulates speech-based information that a person encounters. This information is then stored in the phonological memory, a part of short term memory. Research shows that children's capacities in the area of phonological memory are linked to vocabulary knowledge when children first begin school at age 4–5 years old. As memory capabilities tend to increase with age (between age 4 and adolescence), so does an individual's ability to learn more complex vocabulary.[73]
Serial-order short-term memory may be critical to the development of vocabulary.[74] As lexical knowledge increases, phonological representations have to become more precise to determine the differences between similar sound words (i.e. "calm", "come"). In this theory, the specific order or sequence of phonological events is used to learn new words, rather than phonology as a whole.[74]
See also[edit]
Semantic mapping (literacy)
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Jump up ^ Nippold 2004, pp. 1–8.
Jump up ^ McKeown & Curtis 1987, p. 7.
^ Jump up to: a b Lorraine 2008.
^ Jump up to: a b Newton, Padak & Rasinski 2008.
^ Jump up to: a b Tabors, Beals & Weizman 2001, p. 97.
Jump up ^ Nagy, Herman & Anderson 1985.
Jump up ^ Tabors, Beals & Weizman 2001, pp. 101–103.
Jump up ^ Tabors, Beals & Weizman 2001, p. 101.
Jump up ^ Kamil & Hiebert 2005.
Jump up ^ McKeown & Curtis 1987, p. 8.
^ Jump up to: a b c Tabors, Beals & Weizman 2001, p. 105.
Jump up ^ Newton, Padak & Rasinski 2008, pp. xvii.
^ Jump up to: a b Tabors, Beals & Weizman 2001, p. 106.
^ Jump up to: a b Tabors, Beals & Weizman 2001, pp. 107.
Jump up ^ Nimesh Chandra (March 11, 2014). "DailyVocab: Easy way to learn English". Retrieved August 20, 2016.
^ Jump up to: a b Gathercole et al. 1992.
^ Jump up to: a b Leclercq & Majerus 2010.
Bibliography[edit]
Anglin, Jeremy M.; Miller, George A. (2000). Vocabulary Development: A Morphological Analysis. Wiley-Blackwell. pp. 131–132, 136. ISBN 978-0-631-22443-3.
Baker, S. K.; Simmons, D. C.; Kameenui, E. J. (1995). Vocabulary acquisition: Synthesis of the research. Technical Report No. 13. Eugene, OR.: National Center to Improve the Tools of Educators.
Baldwin, D. (1995). "Understanding the link between joint attention and language". In Moore, C.; Dunham, P. J. Joint attention: Its origins and role in development. Hillsdale, NJ: LEA. pp. 131–158.
Barner, D.; Zapf, J.; Lui, T. (2012). "Is two a plural marker in early child language?". Developmental Psychology. 48 (1): 10–17. doi:10.1037/a0025283. PMID 21928879.
Bloom, L. (2000). "The intentionality model of word learning: How to learn a word, any word". In Golinkoff, R. M.; Hirsh-Pasek, K.; Bloom, L.; Smith, L. B.; Woodward, A. L.; Akhtar, N.; Hollich, G. Becoming a word learner: A debate on lexical acquisition. New York: Oxford University Press. pp. 19–50.
Bloom, P.; Markson, L. (1998). "Capacities underlying word learning". Trends in Cognitive Sciences. 2 (2): 67–73. doi:10.1016/S1364-6613(98)01121-8.
Bryant, J. B. (2009). "Pragmatic development". In Bavin, E. L. The Cambridge Handbook of Child Language. New York: Cambridge University Press. pp. 339–357.
Chan, C.Y.; Tardif, T.; Chen, J.; Meng, X.; Zhu, Liqi; Meng, Xiangzhi (2009). "English- and Chinese-learning infants map novel labels to objects and actions differently". Developmental Psychology. 47 (5): 1459–1471. doi:10.1037/a0024049. PMID 21744954.
Clark, E. V. (1978). "Strategies for communicating". Child Development. 49 (4): 953–959. doi:10.2307/1128734. JSTOR 1128734.
Clark, E. V. (1993). The lexicon in acquisition. New York: Cambridge University Press. pp. 32–66. ISBN 978-0-521-48464-0.
Clark, E. V. (2009). "Lexical meaning". In Bavin, E. L. The Cambridge Handbook of Child Language. New York: Cambridge University Press. pp. 283–300.
Clark, E. V.; Andrew, D.-W., W. (2002). "Pragmatic directions about language use: Offers of words and relations". Language in Society. 31 (2): 181–212. doi:10.1017/s0047404501020152.
Clark, E. V.; Grossman, J. B. (1998). "Pragmatics directions and children's word learning". Journal of Child Language. 25 (1): 1–18. doi:10.1017/S0305000997003309. PMID 9604566.
Fagan, M. (June 2009). "Mean length of utterance before words and grammar: Longitudinal trends and developmental implications of infant vocalizations". Journal of Child Language. 36 (3): 495–527. doi:10.1017/S0305000908009070. PMID 18922207.
Ganger, J.; Brent, M. R. (2004). "Reexamining the vocabulary spurt". Developmental Psychology. 40 (4): 621–632. doi:10.1037/0012-1649.40.4.621. PMID 15238048.
Gathercole, S. E.; Willis, C. S.; Emslie, H.; Baddeley, A. D. (1992). "Phonological memory and vocabulary development during the early school years: A longitudinal study". Developmental Psychology. 28 (5): 887–898. doi:10.1037/0012-1649.28.5.887.
Hirsh-Pasek, K.; Golinkoff, R. M.; Hollich, G. (2000). "An emergentist coalition model for word learning: Mapping words to objects is a product of the interaction of multiple cues". In Golinkoff, R. M.; Hirsh-Pasek, K.; Bloom, L.; Smith, L. B.; Woodward, A. L.; Akhtar, N.; Hollich, G. Becoming a word learner: A debate on lexical acquisition. New York: Oxford University Press. pp. 136–164.
Hoff, E (2005). Language Experience and Language Milestones During Early Childhood. In K. McCartney & D. Phillips (Eds). Blackwell Handbook of early childhood development: Blackwell Publishing, blackwell reference online.
Hulit, L. M.; Howard, M. R. (2002). Born to talk. Toronto: Allyn and Bacon.
Kamil, M. L.; Hiebert, E. H. (2005). "Teaching and learning vocabulary: Perspectives and persistent issues". In Hiebert, E. H.; Kamil, M. L. Teaching and learning vocabulary: Bringing research to practice. Hillside, NJ: Lawrence Erlbaum. pp. 1–26.
Keren-Portnoy, T.; Majorano, M.; Vihman, M. M. (2009). "From phonetics to phonology: The emergence of first words in Italian". Journal of Child Language. 36 (2): 235–267. doi:10.1017/S0305000908008933. PMID 18789180.
Leclercq, A.; Majerus, S. (2010). "Serial-order short-term memory predicts vocabulary development: Evidence from a longitudinal study". Developmental Psychology. 46 (2): 417–427. doi:10.1037/a0018540. PMID 20210500.
Lorraine, S. (2008). Vocabulary development: Super duper handouts number 149. Greenville, SC: Super Duper Publications. [1]
McKeown, M. G.; Curtis, M. E. (1987). The nature of vocabulary acquisition. Hillside, NJ: Lawrence Erlbaum. ISBN 978-0-89859-548-2.
Merriman, W. E.; Bowman, L. L.; MacWhinney, B. (1989). "The mutual exclusivity bias in children's word learning". Monographs of the Society for Research in Child Development. 54 (3–4, Serial No. 220): 1–30. doi:10.2307/1166130.
Nagy, W. E.; Herman, P. A.; Anderson, R. C. (1985). "Learning words from context". Reading Research Quarterly. 22 (2): 233–253. doi:10.2307/747758.
Newton, E.; Padak, N. D.; Rasinski, T. V. (2008). Evidence-based instruction in reading: A professional development guide to vocabulary. Boston, MA: Pearson Education.
Nippold, M. (2004). "Research on later language development:International perspectives". In Berman, R. A. Language Development Across Childhood and Adolescence. Amsterdam: John Benjamins. pp. 1–8.
Pinker, S. (1994). The language instinct: How the mind creates language. New York: Morrow and Co. pp. 262–296. ISBN 0-688-12141-1.
Sabbagh, M. A.; Baldwin, D. (2005). "Understanding the role of communicative intentions in word learning". In Elain, N.; Hoerl, C.; McCormack, T.; et al. Joint Attention: Communication and Other Minds: Issues in Philosophy and Psychology. New York: Clarendon/Oxford University Press. doi:10.1093/acprof:oso/9780199245635.001.0001.
Smith, L. B. (2000). "Learning how to learn words: An associative crane". In Golinkoff, R. M.; Hirsh-Pasek, K.; Bloom, L.; Smith, L. B.; Woodward, A. L.; Akhtar, N.; Hollich, G. Becoming a word learner: A debate on lexical acquisition. New York: Oxford University Press. pp. 51–80.
Tabors, P. O.; Beals, D. E.; Weizman, Z. O. (2001). "'You know what oxygen is?': Learning new words at home". In Dickinson, D. K.; Tabor, P. O. Beginning literacy with language. Baltimore, ML: Paul H. Brookes. pp. 93–110.
Tardif, T.; Fletcher, P.; Liang, W.; Kaciroti, N. (2009). "Early vocabulary development in Mandarin (Putonghua) and Cantonese". Journal of Child Language. 36 (5): 1115–1144. doi:10.1017/S0305000908009185. PMID 19435545.
Teinonen, T.; Aslin, R.; Alku, P.; Csibra, G. (2008). "Visual speech contributes to phonetic learning in 6-month-old infants". Cognition. 108 (3): 850–855. doi:10.1016/j.cognition.2008.05.009. PMID 18590910.
Tomasello, M. (2000). "The social-pragmatic theory of word learning". Pragmatics: Quarterly Publication of the International Pragmatics Association. 10 (4): 401–413.
Vihman, M. (1993). "Variable paths to early word production". Journal of Phonetics. 21: 61–82.
Waxman, S. R.; Booth, A. E. (2000). "Principles that are invoked in the acquisition of words, but not facts". Cognition. 77 (2): B33–B43. doi:10.1016/S0010-0277(00)00103-7. PMID 10986366.
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National Health Service
From Wikipedia, the free encyclopedia
Jump to: navigation, search
"NHS" redirects here. For other uses, see NHS (disambiguation).
For the individual national healthcare services of England, Scotland, Wales and Northern Ireland, see National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care in Northern Ireland.
NHS logo in England
NHS Scotland logo
NHS Wales logo
Logo of Health and Social Care in Northern Ireland, the equivalent in Northern Ireland
The National Health Service (NHS) is the public health services of England, Scotland and Wales, and is commonly used to refer to those of Northern Ireland. They were established together by the Labour Party as one of the major social reforms following the Second World War. The founding principles were being comprehensive, universal and free at the point of delivery.[1] Today, each provides a comprehensive range of health services, the vast majority of which are free for people ordinarily resident in the United Kingdom.[2] Charges are made for prescriptions (in England), dental treatment and optical care, but there is a range of exemptions from these charges.
Taken together, the four National Health Services in 2015–16 employed around 1.6 million people with a combined budget of £136.7 billion. UK residents are not charged for medical treatment.
Contents
[hide]
1 History
2 Structure
3 Eligibility for treatment
4 Funding
4.1 Paying for higher spending
5 Mental health services
6 Sexual health
7 Staffing
7.1 Effect of Brexit
8 Capacity
8.1 Rising social care costs
9 Outsourcing and privatisation
10 Vulnerability of information systems
10.1 Proprietary operating system
10.2 Internal mail lost by part-privatised subsidiary
11 Comparative performance
12 See also
13 References
14 Further reading
15 External links
History[edit]
Further information: History of the National Health Service
Aneurin Bevan, who spearheaded the establishment of the National Health Services
The NHS began on the 'Appointed Day' of 5 July 1948. This put into practice Westminster legislation for England and Wales from 1946 and Scotland from 1947, and the Northern Ireland Parliament's 1947 Public Health Services Act.[3] Calls for a "unified medical service" can be dated back to the Minority Report of the Royal Commission on the Poor Law in 1909,[4] but it was following the 1942 Beveridge Report's recommendation to create "comprehensive health and rehabilitation services for prevention and cure of disease" that cross-party consensus emerged on introducing a National Health Service of some description.[5] When Clement Attlee's Labour Party won the 1945 election he appointed Aneurin Bevan as Health Minister. Bevan then embarked upon what the official historian of the NHS, Charles Webster, called an "audacious campaign" to take charge of the form the NHS finally took.[6] The NHS was born out of a long-held British ideal that good healthcare should be available to all, regardless of wealth. At its launch by Bevan on 5 July 1948 it had at its heart three core principles: That it meet the needs of everyone, that it be free at the point of delivery, and that it be based on clinical need, not ability to pay.[7]
Three years after the founding of the NHS, Bevan resigned from the Labour government in opposition to the introduction of charges for the provision of dentures and glasses.[8] The following year, Winston Churchill's Conservative government introduced prescription charges. These charges were the first of many controversies over reforms to the NHS throughout its history.[9]
Each of the UK's four nations has their own separate NHS, each with its own history. NHS Scotland and Health and Social Care in Northern Ireland (HSC) were separate from the foundation of the NHS, whereas the NHS in Wales was originally combined with England until devolved to the Secretary of State for Wales in 1969 and then to the Welsh Executive and Assembly under devolution in 1999,[10] the same year as responsibility for the Scottish NHS was transferred from the Secretary of State for Scotland to the new Scottish Government and Parliament.
From its earliest days, the cultural history of the NHS has shown its place in British society reflected and debated in film, TV, cartoons and literature. The NHS had a prominent slot during the 2012 London Summer Olympics opening ceremony directed by Danny Boyle, being described as "the institution which more than any other unites our nation".[11]
Ted Baker, Chief Inspector of Hospitals has said that the NHS is still running the model it had in the 1960s and 1970s and has not modernised due to lack of investment.[12]
Structure[edit]
Each of the UK's health service systems operates independently, and is politically accountable to the relevant government: the Scottish Government, Welsh Government, the Northern Ireland Executive, and the UK Government which is responsible for England's NHS. NHS Wales was originally part of the same structure as England until powers over the NHS in Wales were firstly transferred to the Secretary of State for Wales in 1969 and thereafter, in 1999, to the Welsh Assembly (now the Welsh Government) as part of Welsh devolution. However, some functions might be routinely performed by one health service on behalf of another. For example, Northern Ireland has no high-security psychiatric hospitals and thus depends on using hospitals in Great Britain, routinely at Carstairs hospital in Scotland for male patients and Rampton Secure Hospital in England for female patients.[13] Similarly, patients in North Wales use specialist facilities in Manchester and Liverpool which are much closer than facilities in Cardiff, and more routine services at the Countess of Chester hospital. There have been issues about cross-border payments.[14]
Taken together, the four National Health Services in 2015-16 employed around 1.6 million people with a combined budget of £136.7 billion.[15] In 2014 the total health sector workforce across the UK was 2,165,043. This broke down into 1,789,586 in England, 198,368 in Scotland, 110,292 in Wales and 66,797 in Northern Ireland.[16]
Eligibility for treatment[edit]
UK residents are not charged for most medical treatment, with exceptions such as a fixed charge for prescriptions; dental treatment is administered differently, with standard charges for most procedures. The NHS is free at the time of use, for general practitioner (GP) and emergency treatment not including admission to hospital, to non-residents.[17] People with the right to medical care in European Economic Area (EEA) nations are also entitled to free treatment by using the European Health Insurance Card. Those from other countries with which the UK has reciprocal arrangements also qualify for free treatment.[18][19] Since 6 April 2015, non-EEA nationals who are subject to immigration control must have the immigration status of indefinite leave to remain at the time of treatment and be properly settled, to be considered ordinarily resident. People not ordinarily resident in the UK are in general not entitled to free hospital treatment, with some exceptions such as refugees.[2][20]
People not ordinarily resident may be subject to an interview to establish their eligibility, which must be resolved before non-emergency treatment can commence. Patients who do not qualify for free treatment are asked to pay in advance or to sign a written undertaking to pay, except for emergency treatment.
The provision of free treatment to non-UK-residents, formerly interpreted liberally, has been increasingly restricted, with new overseas visitor hospital charging regulations introduced in 2015.[21]
People from outside the EEA coming to the UK for a temporary stay of more than six months may be required to pay an immigration health surcharge at the time of visa application, and will then be entitled to NHS treatment on the same basis as a resident. As of 2016[update] the surcharge was £200 per year, with exemptions and reductions in some cases.[22]
Funding[edit]
NHS Spending 1948/49-2014/15[23]
The systems are 98.8% funded from general taxation and National Insurance contributions, plus small amounts from patient charges for some services.[24][25] About 10% of GDP is spent on health and most is spent in the public sector.[26] The money to pay for the NHS comes directly from taxation. The 2008/9 budget roughly equates to a contribution of £1,980 per person in the UK.[27]
When the NHS was launched in 1948 it had a budget of £437 million (roughly £9 billion at today’s prices).[28] In 2008/9 it received over 10 times that amount (more than £100 billion). In 1955/6 health spending was 11.2% of the public services budget. In 2015/6 it was 29.7%.[29] This equates to an average rise in spending over the full 60-year period of about 4% a year once inflation has been taken into account. Under the Blair government investment levels increased to around 6% a year on average. Since 2010 spending growth has been constrained to just over 1% a year.[29]
Some 60% of the NHS budget is used to pay staff. A further 20% pays for drugs and other supplies, with the remaining 20% split between buildings, equipment, training costs, medical equipment, catering and cleaning. Nearly 80% of the total budget is distributed by local trusts in line with the particular health priorities in their areas.[30] Since 2010, there has been a cap of 1% on pay rises for staff continuing in the same role. Unions representing doctors, dentists, nurses and other health professionals have called on the government to end the cap on health service pay, claiming the cap is damaging the health service and damaging patient care.[31] The pay rise is likely to be below the level of inflation and to mean a real terms pay cut.[32] The House of Commons Library did research showing that real-terms NHS funding per head will fall in 2018-19, and stay the same for two years afterwards.[33]
Paying for higher spending[edit]
70% of people say they would willingly pay an extra penny in the pound in income tax if the money were ringfenced and guaranteed for the NHS.[34] Two thirds of respondents to a King's Fund poll favour increased taxation to help finance the NHS.[35] The BMA has called for £10bn more annually for the NHS to get Britain in line with what other advanced European nations spend on health. The BMA argues this could pay for at least 35,000 more hospital beds daily and many thousand more GPs. Dr Mark Porter of the BMA, wrote, “Our members report that services are truly at breaking point, with unprecedented rising patient demand met only with financial restraint and directives for the NHS and social care to make huge, unachievable savings through sustainability and transformation plans (STPs) across England.” Porter emphasised he was not asking for more than comparable nations, merely for the spending of other leading European nations to be matched. The increase, Porter said was desperately needed.[36]
Mental health services[edit]
See also: Mental health in the United Kingdom
The NHS provides mental health services free of charge, but normally requires a referral from a GP first. Services which don't need a referral include psychological therapies and treatment for those with drug and alcohol problems. The NHS also provides online services which can help patients find the resources which are most relevant to them.[37] Many psychiatric inpatients are being treated very far away from where they live when beds are not available locally, some even stay in police cells. The extent of the problem varies between trusts. Louise Rubin of Mind said: “It’s unacceptable that people who are at their most unwell and in desperate need of care find themselves travelling across the country to get help ... When you’re experiencing a mental health crisis, you’re likely to feel scared, vulnerable and alone, so your support network of family and friends are instrumental to recovery.”[38] The numbers of mental health staff needing sick leave due to work pressure is increasing. Dave Munday of Unite said, "Our members tell us workplace stress is increasing and that cuts to staff and services mean they're working longer hours with fewer resources. Staff themselves are feeling the impact of austerity."[39] The use of restraints in UK psychiatric facilities is increasing. Sridevi Kalidindi of the Royal College of Psychiatrists maintains that cuts to bed numbers and cuts to community care mean patients admitted to psychiatric units are now more ill. Also Kalidindi maintains increased use of agency staff means fewer permanent staff with training in de-escalating situations are available.[40]
Sexual health[edit]
Funding for sexual health services has been cut despite an increase in demand for treatment of sexually transmitted infection. Demand rose 25% in the five years to 2017 while funding was cut by 10%. This leads to a risk that STD will spread while patients are waiting for treatment. Nearly 2.5 million new people attended sexual health clinics in 2016 compared to 1.9 million in 2012. Debbie Laycock of the Terrence Higgins Trust said, “There is still much to do to address the nation’s poor sexual health and the inequalities that are faced by those most at risk. In this climate of cuts to local authorities’ public health budgets, it is inevitable that the progress that has been made against STIs will be reversed. We are already witnessing the closure of busy sexual health clinics and, without proper funding, this will only continue and have a negative impact on people’s sexual health. Cutting sexual health services is considered shortsighted because every £1 spent on sexual health saves £11 later through, for example preventing unwanted pregnancy.[41][42]
Staffing[edit]
In the year ending at March 2017, there were 1.187 million staff in the NHS, 1.9% more than in March 2016.[43]
In the same year, there were 691,000 nurses registered in the UK, down 1,783 from the previous year. However, this is the first time nursing numbers have fallen since 2008 and there are 13,000 more nurses in the NHS than in 2010. Poor working conditions, staffing levels and workload also dissatisfaction with the quality of patient care were given as reasons as were poor pay and benefits. Saffron Cordery of NHS Providers said, "These figures provide further evidence of the severe workforce problems NHS trusts face. Burseries to nursing students are to be stopped forcing nurses to pay for their training, it is expected this will also be a discouragement.[44] Commentators are increasingly arguing that staffing shortages are endangering the sustinability of the NHS. There are too few health workers, nurses and midwives, doctors are also in short supply. Hospitals, Community Trusts and Mental Health Trusts all face shortages.[45] Some General practitioners are losing sleep because they worry work pressure may have lead them to miss something that puts a patient at risk.[46] In hospitals junior doctors are sometimes forced to do work beyond what they have been trained for. This is stressful for doctors and puts patients at risk. Overworked consultants do not have the time to carry out proper supervision of less qualified doctors.[47]
Effect of Brexit[edit]
The plan to exit the European Union will affect physicians from EU countries, about 11% of the physician workforce.[48] Many of these physicians feel unwelcome and are considering leaving the UK if Brexit happens, as they have doubts that they and their families can live in the country.[48] A survey suggests 60% are considering leaving.[49] Record numbers of EU nationals (17,197 EU staff working in the NHS which include nurses and doctors) left last year. The figures, put together by NHS Digital, lead to calls to reassure European workers over their future in the UK.[50] EU nurses registering to work in the UK are down 96% since the Brexit vote aggravating shortages of nurses. Janet Davies of the Royal College of Nursing, said, “We rely on the contributions of EU staff and this drop in numbers could have severe consequences for patients and their families. Our nursing workforce is in a state of crisis. Across our health service, from A&E to elderly care, this puts patients at serious risk.”[51]
Capacity[edit]
The NHS was severely stretched in winter 2016-17 and there are fears the situation could be worse in 2017-18. Chris Hopson of NHS Providers wrote in summer 2017, "Worryingly, 92% of trusts reported a lack of capacity in primary care to manage next winter; 91% a lack of capacity in social care; 80% a lack of capacity in mental health services; 76% a lack of community service capacity; 71% a lack of acute hospital capacity and 64% a lack of ambulance capacity. Only 57% of trusts were confident they could provide safe and high quality care this winter."[52] England, Wales and Northern Ireland missed every one of their three key targets (cancer care, operations and A&E) over 18 months. Patients are waiting longer for treatment.[53] 6,932 patients waited more than 3 hours in A&E in October 2010, but this rose to 45,532 patients in October 2017.[54] NHS Improvement also fears the NHS will be more severely overstretched in 2017-18 than it was the previous winter though the British Red Cross declared the state of UK hospitals in 2016-17 a humanitarian crisis.[55]
Rising social care costs[edit]
Social care will cost more in future according to research by Liverpool University, University College London, and others and higher investment are needed. Professor Helen Stokes-Lampard of the Royal College of GPs said, “It’s a great testament to medical research, and the NHS, that we are living longer – but we need to ensure that our patients are living longer with a good quality of life. For this to happen we need a properly funded, properly staffed health and social care sector with general practice, hospitals and social care all working together – and all communicating well with each other, in the best interests of delivering safe care to all our patients.”[56]
Rising social costs have led to a significant increase in the time between patients being declared "medically fit" and finding social care placements in many cases.[57]
Outsourcing and privatisation[edit]
Although the NHS routinely outsources the equipment and products that it uses and dentistry, eye care, pharmacy and most GP practices have always been provided by the private sector, the outsourcing of hospital health care has always been controversial.[58]
According to a BMA survey over two-thirds of doctors are fairly uncomfortable or very uncomfortable about the independent sector providing NHS services. The BMA believes it is important the independent sector is held to the same standards as the NHS when giving NHS care. The BMA recommends: data collection, through impact analysis before independent providers are accepted to ensure existing NHS services are not disrupted, risk assessment to find out likely results if NHS staff are unwilling to transfer to the private sector, transparent reporting by the private sector of patient safety and performance, independent providers should be regulated like NHS providers, patients should be protected if independent providers terminate a contract early, transfers from independent providers to the NHS should be regularly reviewed to establish how much this costs the NHS, private sector contracts should be amended so private sector providers contribute to the cost of staff training financially or by providing training opportunities.[59] There were renewed calls for transparent reporting in the private sector following Ian Patterson's criminal conviction for wounding private sector patients by carrying out unnecessary operations.[60]
Vulnerability of information systems[edit]
Proprietary operating system[edit]
In 2001 the NHS entered into a licensing deal with Microsoft, ignoring the advice of some of its own IT specialists that had recommended investing in Linux instead.[61] Concerns about the vulnerability of NHS computer systems to cyber-attack have been expressed since at least 2016.[62] NHS computer systems have been subject to cyber attacks of which one in May 2017 was notable.[63] The May 2017 attack lead to the cancellation of at least 6912 appointments including operations, 139 suspected cancer patients had urgent referrals cancelled. The number of GP appointments cancelled, the number of ambulances diverted from A&E departments unable to treat some patients, the number of delays in receiving information like test results are unknown. North Korea is strongly suspected of starting the attack. The attack happened on a Friday in May. A cyberattack on a Monday in winter would be even more damaging.[64] NHS computers have been vulnerable because a minority still use or used Windows XP, an outdated system that originated in 2001, and one which Microsoft stopped supporting with security patches. Complacency among NHS staff and among government departments that pay for computer security are blamed. Unless systems are upgraded, more cyber attacks are feared.[65] Dr David Wrigley of the British Medical Association said, “It’s been known about for years, that the software isn’t up to date across the NHS, so it’s not unpredictable that this situation should have arisen. But it’s disappointing that funding hasn’t been given to upgrade the system. It needs urgent action by politicians.”[66]
Internal mail lost by part-privatised subsidiary[edit]
In 2017, it was reported that NHS Shared Business Services, a part state-owned, part-privately owned company tasked with internal mail delivery for NHS England, had lost 864,000 documents relating to patient healthcare.[67]
Comparative performance[edit]
Although there has been increasing policy divergence between the four national NHS services (listed below), there is very little evidence linking these policy differences to a matching divergence of performance.[68] It has been suggested that this is because of the uniform professional culture. There are national terms and conditions of employment across the UK, regulation of clinicians is performed on a UK basis and the health trades unions operate across the UK. However, it does not help that, as Nick Timmins noted: "Some of the key data needed to compare performance – including data on waiting times – is defined and collected differently in the four countries."[69][70]
For details see:
National Health Service (England)
Health and Social Care in Northern Ireland
NHS Scotland
NHS Wales
See also[edit]
History of the National Health Service (England)
History of NHS Scotland
History of NHS Wales
Healthcare in the United Kingdom
Scottish Government Health and Social Care Directorates
References[edit]
Jump up ^ Choices, NHS. "The principles and values of the NHS in England". www.nhs.uk. Retrieved 2016-11-23.
^ Jump up to: a b "NHS entitlements: migrant health guide - Detailed guidance". UK Government. Retrieved 6 June 2016.
Jump up ^ Ruth Barrington, Health, Medicine & Politics in Ireland 1900–1970 (Institute of Public Administration: Dublin, 1987) pp. 188–89.
Jump up ^ Brian Abel-Smith, The Hospitals 1800–1948 (London, 1964), p.229
Jump up ^ Beveridge, William (November 1942). "Social Insurance and Allied Services" (PDF). HM Stationery Office. Retrieved 3 March 2013.
Jump up ^ Charles Webster, The Health Services since the War, Volume 1: Problems of Health Care, The National Health Service Before 1957 (London: HMSO, 1988), p. 399.
Jump up ^ "The NHS in England - About the NHS - NHS core principles". Nhs.uk. 23 March 2009. Retrieved 27 June 2017.
Jump up ^ Kenneth O. Morgan, 'Aneurin Bevan' in Kevin Jeffreys (ed.), Labour Forces: From Ernie Bevin to Gordon Brown (I.B. Taurus: London & New York, 2002), pp. 91–92.
Jump up ^ Martin Powell and Robin Miller, 'Seventy Years of Privatizing the British National Health Service?', Social Policy & Administration, vol. 50, no. 1 (January 2016), pp. 99–118.
Jump up ^ Wales, NHS. "NHS Wales | 1960's". www.wales.nhs.uk. Retrieved 2016-11-22.
Jump up ^ Adams, Ryan (27 July 2012). "Danny Boyle's intro on Olympics programme". Awards Daily. Retrieved 27 November 2016.
Jump up ^ NHS 'not fit for 21st Century', says chief hospital inspector BBC
Jump up ^ "Guidance on the Transfer of Mentally Disordered Patients August 2011".
Jump up ^ "Breakdown of cross-border agreements is costing English trusts millions". Health Service Journal. 14 February 2008. Retrieved 19 January 2016.
Jump up ^ "10 truths about Britain's health service". Guardian. 18 January 2016. Retrieved 19 January 2016.
Jump up ^ Cowper, Andy (23 May 2016). "Visible and valued: the way forward for the NHS's hidden army". Health Service Journal. Retrieved 28 July 2016.
Jump up ^ "Visiting or moving to England? - How to access NHS services (see "Hospital Services" section)". NHS Choices. 26 June 2015. Retrieved 6 June 2016.
Jump up ^ "NHS charges for people from abroad". Citizens Advice. Retrieved 2010-11-16.
Jump up ^ "Non-EEA country-by-country guide – Healthcare abroad". NHS Choices. 1 January 2016. Retrieved 6 June 2016.
Jump up ^ "Categories of exemption - Healthcare in England for visitors - NHS Choices". NHS England. 18 August 2015. Retrieved 6 June 2016.
Jump up ^ "Guidance on overseas visitors hospital charging regulations". UK Government. 6 April 2016. Retrieved 6 June 2016. Links to many relevant documents: Guidance on implementing the overseas visitor hospital charging regulations 2015; Ways in which people can be lawfully resident in the UK; Summary of changes made to the way the NHS charges overseas visitors for NHS hospital care; Biometric residence permits: overseas applicant and sponsor information; Information sharing with the Home Office: guidance for overseas patients; Overseas chargeable patients, NHS debt and immigration rules: guidance on administration and data sharing; Ordinary residence tool; and documents on Equality analysis.
Jump up ^ NHS Choices (18 August 2015). "Moving from outside the EEA – Access to healthcare in England". Nhs.uk. Retrieved 6 June 2016.
Jump up ^ "Health spending".
Jump up ^ "How the NHS is funded". TheKing'sFund. 15 January 2016. Retrieved 6 June 2016.
Jump up ^ "Underfunded, underdoctored, overstretched: The NHS in 2016". 21 September 2016.
Jump up ^ "Health care spending compared to other countries".
Jump up ^ NHS Choices The NHS in England: The NHS: About the NHS: Overview. Retrieved 22 June 2010.
Jump up ^ "The NHS in England". NHS choices. 28 January 2013. Retrieved 27 July 2014.
^ Jump up to: a b "10 charts that show why the NHS is in trouble". BBC News. 8 February 2017. Retrieved 10 February 2017.
Jump up ^ https://portal.rcem.ac.uk/LIVE/docs/International/6.5.2%20Part-2---The-structure-and-funding-of-the-NHS.pdf
Jump up ^ Health unions urge Theresa May to ditch NHS pay cap The Guardian
Jump up ^ NHS staff suffer pay cuts in real terms as salaries rise by one per cent The Independent
Jump up ^ Conservatives will break NHS funding pledge, Labour claims The Guardian
Jump up ^ editor, Rowena Mason Deputy political (30 December 2016). "People may be ready to pay extra penny on tax for NHS, Tim Farron says" – via The Guardian.
Jump up ^ Two-thirds support higher taxes to maintain NHS funding The Obsrver
Jump up ^ Siddique, Haroon (5 March 2017). "BMA calls for extra £10bn a year for NHS in Hammond's budget" – via The Guardian.
Jump up ^ http://www.nhs.uk/NHSEngland/AboutNHSservices/mental-health-services-explained/Pages/accessing%20services.aspx
Jump up ^ Almost 6,000 mental health patients sent out of area for care last year The Guardian
Jump up ^ Mental health staff on long-term stress leave up 22% BBC
Jump up ^ Mental health trusts restrain patients 'every 10 minutes' BBC
Jump up ^ Government cuts 'leave sexual health services at tipping point' The Guardian
Jump up ^ Sexual health clinics 'at tipping point' after Government cuts and huge rise in demand, councils warn The Independent
Jump up ^ http://www.content.digital.nhs.uk/catalogue/PUB24214/nhs-work-stat-mar-2017-pdf.pdf
Jump up ^ More UK nurses and midwives leaving than joining profession BBC
Jump up ^ The NHS's sustainability is under threat if more isn't done to look after its staff New Statesman
Jump up ^ GPs losing sleep over patient safety fears, says head of profession The Guardian
Jump up ^ Safety fears as junior doctors left to run A&Es and other hospital units The Guardian
^ Jump up to: a b mamk (February 23, 2017). "Brexit gelungenn, Patient tot" (in German). Der Spiegel. Retrieved February 23, 2017.
Jump up ^ O'Carroll, Lisa; Campbell, Denis (28 February 2017). "Poll shows 60% of European doctors are considering leaving UK" – via The Guardian.
Jump up ^ Marsh, Sarah; Duncan, Pamela (30 March 2017). "Record number of EU citizens quit working in NHS last year" – via The Guardian.
Jump up ^ 96% drop in EU nurses registering to work in Britain since Brexit vote The Guardian
Jump up ^ Give the NHS more money – or it will face trouble this winter The Guardian
Jump up ^ NHS waits for cancer care, A&E and ops worsen across UK BBC
Jump up ^ Long waits in A&E have increased by 557% in seven years, NHS data reveals The Observer
Jump up ^ NHS faces even worse winter crisis than last year, watchdog warns The Guardian
Jump up ^ NHS faces staggering increase in cost of elderly care, academics warn The Guardian
Jump up ^ "A patient has waited 1,338 days for hospital discharge". NursingNotes. 2017-04-24. Retrieved 2017-06-01.
Jump up ^ "Is the NHS being privatised?". The King's Fund. 19 March 2015. Retrieved 11 October 2016.
Jump up ^ "Privatisation and independent sector providers". www.bma.org.uk. BMA.
Jump up ^ Surgeons call for review of safety standards in private hospitals The Guardian
Jump up ^ Rogers, James (October 2001). "Is Microsoft deal best medicine for NHS?". Computer Weekly. UK. Retrieved 16 June 2017.
Jump up ^ Murdock, Jason (23 March 2016). "NHS hospitals are 'ripe and vulnerable targets' for ransomware cyberattacks".
Jump up ^ "NHS hospitals in England hit by massive crippling cyber-attack". NursingNotes. 2017-05-12. Retrieved 2017-06-01.
Jump up ^ NHS 'could have prevented' WannaCry ransomware attack BBC
Jump up ^ "The ransomware attack is all about the insufficient funding of the NHS". 13 May 2017 – via The Guardian.
Jump up ^ Warning of NHS cyber-attack risk was not acted on, says cybersecurity adviser The Guardian
Jump up ^ Syal, Rajeev; Campbell, Denis (16 October 2017). "NHS data loss scandal deepens with further 162,000 files missing". The Guardian. Retrieved 17 October 2017.
Jump up ^ Bevan, Gwyn; Mays, Nicholas (11 April 2014). "The four health systems of the UK: How do they compare?". Nuffield Trust. Retrieved 2 February 2016.
Jump up ^ "Outcomes in EHCI 2015" (PDF). Health Consumer Powerhouse. 26 January 2016. Retrieved 27 January 2016.
Jump up ^ Timmins, Nick. "The four UK health systems: Learning from each other,". Kings Fund. Retrieved 2 February 2016.
Further reading[edit]
Brady, Robert A. Crisis in Britain. Plans and Achievements of the Labour Government (1950) pp. 352–41 excerpt
Gorsky, Martin. "The British National Health Service 1948–2008: A Review of the Historiography," Social History of Medicine, Dec 2008, Vol. 21 Issue 3, pp. 437–60
Hacker, Jacob S. "The Historical Logic of National Health Insurance: Structure and Sequence in the Development of British, Canadian, and U.S. Medical Policy," Studies in American Political Development, April 1998, Vol. 12 Issue 1, pp. 57–130.
Hilton, Claire. (26 August 2016). Whistle-blowing in the National Health Service since the 1960s History and Policy. Retrieved 11 May 2017.
Loudon, Irvine, John Horder and Charles Webster. General Practice under the National Health Service 1948–1997 (1998) online
Rintala, Marvin. Creating the National Health Service: Aneurin Bevan and the Medical Lords (2003) online.
Rivett G C From Cradle to Grave – the first 50 (65) years of the NHS. King's Fund, London, 1998 now updated to 2014 and available at www.nhshistory.co.uk
Stewart, John. "The Political Economy of the British National Health Service, 1945–1975: Opportunities and Constraints," Medical History, Oct 2008, Vol. 52 Issue 4, pp. 453–70
Valier, Helen K. "The Manchester Royal Infirmary, 1945–97: a microcosm of the National Health Service," Bulletin of the John Rylands University Library of Manchester, 2005, Vol. 87 Issue 1, pp. 167–92
Webster, Charles. "Conflict and Consensus: Explaining the British Health Service," Twentieth Century British History, April 1990, Vol. 1 Issue 2, pp. 115–51
Webster, Charles. Health Services since the War. 'Vol. 1:' Problems of Health Care. The National Health Service before 1957 (1988) 479pp online
External links[edit]
NHS Choices official website for England's NHS
Health and Social Care in Northern Ireland official website for Health & Personal Social Services in Northern Ireland
NHS Scotland official website for NHS Scotland
Health in Wales official website for NHS Wales
Birth of the national Health Service archive collection of programmes and documents
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