<P> The NHS is the world's largest health service and the world's fourth - largest employer; only the Chinese People's Liberation Army, Indian Railways, and Wal - Mart employ more people directly . </P> <P> See NHS Constitution for England </P> <P> The NHS has recently adopted a formal constitution which for the first time, in one document, lays down the objectives of the NHS, the rights and responsibilities of the various parties (patients, staff, trust boards) and the guiding principles which govern the service . </P> <P> A patient needing specialist care at a hospital or clinic, will be informed by the GP of the hospitals where they can get their treatment . This choice usually includes public and private hospitals . The NHS will pay for treatment in a private setting if the hospital meets the cost and service criteria that NHS hospitals adhere to . Otherwise opting for a private hospital makes the patient liable for private hospital fees . Because the private sector often has higher costs, most people choose to be treated for free in an NHS hospital . If the GP judges the case to be extremely urgent, the doctor may by - pass the normal booking system and arrange an emergency admission . The median wait time for a consultant led first appointment in English hospitals is a little over 3 weeks . Patients can be seen by the hospital as out - patients or in - patients, with the latter involving overnight stay . The speed of in - patient admission is based on medical need and time waiting with more urgent cases faster though all cases will be dealt with eventually . Only about one third of hospital admissions are from a waiting list . For those not admitted immediately, the median wait time for in - patient treatment in English hospitals is a little under 6 weeks . Trusts are working towards an 18 - week guarantee that means that the hospital must complete all tests and start treatment within 18 weeks of the date of the referral from the GP . Some hospitals are introducing just in time workflow analysis borrowed from manufacturing industry to speed up the processes within the system and improve efficiencies . </P>

When did free health care start in england