Overview of Healthcare in The UK

Received 2010 Sep 1; Accepted 2010 Sep 27; Issue date 2010 Dec.

. The National Health System in the UK has progressed to turn into one of the biggest healthcare systems on the planet. At the time of writing of this review (August 2010) the UK federal government in its 2010 White Paper "Equity and quality: Liberating the NHS" has revealed a technique on how it will "create a more responsive, patient-centred NHS which accomplishes outcomes that are amongst the very best in the world". This review post provides an overview of the UK health care system as it currently stands, with emphasis on Predictive, Preventive and Personalised Medicine components. It intends to work as the basis for future EPMA articles to broaden on and provide the modifications that will be implemented within the NHS in the upcoming months.

Keywords: UK, Healthcare system, National health system, NHS

Introduction

The UK healthcare system, National Health Service (NHS), originated in the consequences of the Second World War and became functional on the fifth July 1948. It was first proposed to the Parliament in the 1942 Beveridge Report on Social Insurance and Allied Services and it is the legacy of Aneurin Bevan, a former miner who ended up being a politician and the then Minister of Health. He established the NHS under the concepts of universality, complimentary at the point of shipment, equity, and spent for by central financing [1] Despite many political and organisational changes the NHS stays to date a service offered widely that cares for individuals on the basis of requirement and not ability to pay, and which is funded by taxes and nationwide insurance coverage contributions.

Health care and health policy for England is the duty of the central federal government, whereas in Scotland, Wales and Northern Ireland it is the duty of the respective devolved governments. In each of the UK countries the NHS has its own distinct structure and organisation, however overall, and not dissimilarly to other health systems, health care consists of two broad areas; one dealing with method, policy and management, and the other with actual medical/clinical care which is in turn divided into primary (neighborhood care, GPs, Dentists, Pharmacists etc), secondary (hospital-based care accessed through GP recommendation) and tertiary care (specialist healthcare facilities). Increasingly differences in between the 2 broad areas are becoming less clear. Particularly over the last years and guided by the "Shifting the Balance of Power: The Next Steps" (2002) and "Wanless" (2004) reports, gradual modifications in the NHS have led to a higher shift towards regional instead of main decision making, removal of barriers in between primary and secondary care and more powerful focus on patient option [2, 3] In 2008 the previous federal government strengthened this direction in its health method "NHS Next Stage Review: High Quality Look After All" (the Darzi Review), and in 2010 the existing government's health strategy, "Equity and quality: Liberating the NHS", remains helpful of the same concepts, albeit through perhaps various mechanisms [4, 5]

The UK federal government has actually simply announced plans that according to some will produce the most extreme modification in the NHS because its inception. In the 12th July 2010 White Paper "Equity and quality: Liberating the NHS", the present Conservative-Liberal Democrat union federal government outlined a technique on how it will "develop a more responsive, patient-centred NHS which attains results that are among the very best in the world" [5]

This evaluation article will therefore provide a summary of the UK healthcare system as it presently stands with the aim to act as the basis for future EPMA short articles to broaden and provide the modifications that will be carried out within the NHS in the upcoming months.

The NHS in 2010

The Health Act 2009 established the "NHS Constitution" which officially unites the purpose and concepts of the NHS in England, its values, as they have been established by patients, public and personnel and the rights, pledges and responsibilities of clients, public and personnel [6] Scotland, Northern Ireland and Wales have also accepted a high level declaration stating the principles of the NHS across the UK, despite the fact that services may be offered differently in the four countries, reflecting their various health requirements and scenarios.

The NHS is the biggest company in the UK with over 1.3 million staff and a budget of over ₤ 90 billion [7, 8] In 2008 the NHS in England alone employed 132,662 doctors, a 4% increase on the previous year, and 408,160 nursing personnel (Table 1). Interestingly the Kings Fund estimates that, while the total number of NHS staff increased by around 35% between 1999 and 2009, over the exact same period the number of managers increased by 82%. As a proportion of NHS staff, the number of supervisors rose from 2.7 per cent in 1999 to 3.6 per cent in 2009 (www.kingsfund.org.uk). In 2007/8, the UK health costs was 8.5% of Gdp (GDP)-with 7.3% accounting for public and 1.2% for private spending. The net NHS expenditure per head across the UK was lowest in England (₤ 1,676) and greatest in Scotland (₤ 1,919) with Wales and Northern Ireland at roughly the very same level (₤ 1,758 and ₤ 1,770, respectively) [8]

Table 1.

The distribution of NHS workforce according to main staff groups in the UK in 2008 (NHS Information Centre: www.ic.nhs.uk)

The general organisational structure of the NHS in England, Scotland, Wales and Northern Ireland in 2010 is displayed in Fig. 1. In England the Department of Health is accountable for the direction of the NHS, social care and public health and shipment of health care by establishing policies and strategies, securing resources, keeping track of performance and setting nationwide standards [9] Currently, 10 Strategic Health Authorities handle the NHS at a local level, and Primary Care Trusts (PCTs), which presently manage 80% of the NHS' spending plan, offer governance and commission services, in addition to make sure the schedule of services for public heath care, and arrangement of community services. Both, SHAs and PCTs will cease to exist once the plans outlined in the 2010 White Paper become implemented (see area listed below). NHS Trusts operate on a "payment by outcomes" basis and obtain the majority of their earnings by providing healthcare that has actually been commissioned by the practice-based commissioners (GPs, and so on) and PCTs. The primary kinds of Trusts consist of Acute, Care, Mental Health, Ambulance, Children's and Foundation Trusts. The latter were created as non-profit making entities, devoid of government control but likewise increased monetary responsibilities and are regulated by an independent Monitor. The Care Quality Commission manages separately health and adult social care in England in general. Other professional bodies offer monetary (e.g. Audit Commission, National Audit Office), treatment/services (e.g. National Patient Safety Agency, Medicines and Healthcare Products Regulatory Agency) and professional (e.g. British Medical Association) regulation. The National Institute for Health and Clinical Excellence (NICE) was established in 1999 as the body responsible for establishing nationwide guidelines and standards associated with, health promotion and prevention, evaluation of new and existing technology (consisting of medicines and treatments) and treatment and care clinical assistance, available across the NHS. The health research study technique of the NHS is being carried out through National Institute of Health Research (NIHR), the overall budget for which remained in 2009/10 near ₤ 1 billion (www.nihr.ac.uk) [10]

Fig. 1.

Organisation of the NHS in England, Scotland, Wales and Northern Ireland, in 2010

Section 242 of the NHS Act mentions that Trusts have a legal task to engage and involve clients and the general public. Patient experience information/feedback is officially gathered nationally by annual survey (by the Picker Institute) and belongs to the NHS Acute Trust efficiency structure. The Patient Advice Liaison Service (PALS) and Local Involvement Networks (LINks) support client feedback and participation. Overall, inpatients and outpatients surveys have actually revealed that clients rate the care they receive in the NHS high and around three-quarters indicate that care has actually been excellent or exceptional [11]

In Scotland, NHS Boards have changed Trusts and supply an integrated system for tactical direction, efficiency management and clinical governance, whereas in Wales, the National Delivery Group, with advice from the National Advisory Board, is the body performing these functions (www.show.scot.nhs.uk; www.wales.nhs.uk). Scottish NHS and Special Boards deliver services, with take care of specific conditions delivered through Managed Clinical Networks. Clinical standards are published by the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium (SMC) recommendations on the usage of brand-new drugs in the Scottish NHS. In Wales, Local Heath Boards (LHBs) plan, safe and secure and provide health care services in their areas and there are 3 NHS Trusts providing emergency, cancer care and public health services nationally. In Northern Ireland, a single body, the Health and Care Board is overseeing commissioning, performance and resource management and enhancement of health care in the country and six Health and Social Care Trusts deliver these services (www.hscni.net). A variety of health agencies support supplementary services and deal with a vast array of health and care concerns including cancer screening, blood transfusion, public health etc. In Wales Community Health Councils are statutory ordinary bodies promoting the interests of the general public in the health service in their district and in Northern Ireland the Patient and Client Council represent clients, customers and carers.

Predictive, Preventive and Personalised Medicine (PPPM) in the NHS

Like other national healthcare systems, predictive, preventive and/or customised medicine services within the NHS have traditionally been offered and are part of disease diagnosis and treatment. Preventive medicine, unlike predictive or personalised medication, is its own established entity and appropriate services are directed by Public Health and provided either via GP, neighborhood services or medical facilities. Patient-tailored treatment has actually always been common practice for great clinicians in the UK and any other healthcare system. The terms predictive and personalised medication though are evolving to describe a a lot more technically innovative way of detecting disease and forecasting reaction to the standard of care, in order to maximise the benefit for the client, the general public and the health system.

References to predictive and personalised medication are increasingly being introduced in NHS associated information. The NHS Choices website explains how clients can obtain customised suggestions in relation to their condition, and provides info on predictive blood test for illness such as TB or diabetes. The NIHR through NHS-supported research and together with scholastic and commercial collaborating networks is investing a considerable proportion of its spending plan in validating predictive and preventive therapeutic interventions [10] The previous government thought about the advancement of preventive, people-centred and more efficient healthcare services as the methods for the NHS to respond to the challenges that all modern-day health care systems are dealing with in the 21st century, particularly, high client expectation, aging populations, harnessing of details and technological improvement, altering labor force and developing nature of illness [12] Increased focus on quality (patient security, client experience and clinical efficiency) has also supported development in early medical diagnosis and PPPM-enabling innovations such as telemedicine.

A number of preventive services are delivered through the NHS either by means of GP surgeries, social work or hospitals depending on their nature and consist of:

The Cancer Screening programs in England are nationally coordinated and consist of Breast, Cervical and Bowel Cancer Screening. There is likewise a notified choice Prostate Cancer Risk Management programme (www.cancerscreening.nhs.uk).

The Child Health Promotion Programme is handling concerns from pregnancy and the very first 5 years of life and is delivered by community midwifery and health checking out groups [13]

Various immunisation programmes from infancy to adulthood, used to anyone in the UK totally free and normally delivered in GP surgeries.

The Darzi review set out 6 crucial scientific goals in relation to improving preventive care in the UK consisting of, 1) taking on weight problems, 2) reducing alcohol damage, 3) treating drug dependency, 4) lowering cigarette smoking rates, 5) enhancing sexual health and 6) improving psychological health. Preventive programmes to attend to these problems have been in place over the last decades in different forms and through different initiatives, and consist of:

Assessment of cardiovascular danger and recognition of individuals at higher risk of heart problem is typically preformed through GP surgeries.

Specific preventive programs (e.g. suicide, accident) in local schools and community

Family planning services and prevention of sexually sent illness programs, typically with an emphasis on young individuals

A variety of prevention and health promotion programs related to lifestyle choices are delivered though GPs and social work including, alcohol and smoking cessation programmes, promo of healthy consuming and physical activity. Some of these have a specific focus such as health promo for older individuals (e.g. Falls Prevention).

White paper 2010 - Equity and excellence: liberating the NHS

The current government's 2010 "Equity and excellence: Liberating the NHS" White Paper has set out the vision of the future of an NHS as an organisation that still remains real to its founding principle of, readily available to all, complimentary at the point of use and based on requirement and not capability to pay. It likewise continues to support the concepts and worths defined in the NHS Constitution. The future NHS becomes part of the Government's Big Society which is build on social solidarity and requires rights and obligations in accessing collective healthcare and making sure effective usage of resources hence providing much better health. It will provide healthcare outcomes that are among the finest worldwide. This vision will be carried out through care and organisation reforms focusing on four areas: a) putting patients and public first, b) enhancing on quality and health outcomes, c) autonomy, accountability and democratic legitimacy, and d) cut bureaucracy and improve performance [5] This technique makes references to issues that pertain to PPPM which indicates the increasing impact of PPPM concepts within the NHS.

According to the White Paper the principle of "shared decision-making" (no choice about me without me) will be at the centre of the "putting emphasis on client and public first" plans. In truth this consists of strategies stressing the collection and capability to gain access to by clinicians and patients all client- and treatment-related details. It likewise of higher attention to Patient-Reported Outcome Measures, greater choice of treatment and treatment-provider, and importantly customised care preparation (a "not one size fits all" method). A freshly created Public Health Service will unite existing services and location increased emphasis on research study analysis and examination. Health Watch England, a body within the Care Quality Commission, will supply a stronger client and public voice, through a network of local Health Watches (based upon the existing Local Involvement Networks - LINks).

The NHS Outcomes Framework sets out the top priorities for the NHS. Improving on quality and health results, according to the White Paper, will be attained through modifying objectives and healthcare top priorities and establishing targets that are based upon clinically trustworthy and evidence-based procedures. NICE have a central role in developing recommendations and standards and will be anticipated to produce 150 new standards over the next 5 years. The federal government prepares to establish a value-based pricing system for paying pharmaceutical business for providing drugs to the NHS. A Cancer Drug Fund will be created in the interim to cover client treatment.

The abolition of SHAs and PCTs, are being proposed as methods of supplying greater autonomy and accountability. GP Consortia supported by the NHS Commissioning Board will be accountable for commissioning healthcare services. The introduction of this kind of "health management organisations" has been somewhat questionable however perhaps not totally unanticipated [14, 15] The transfer of PCT health improvement function to regional authorities intends to supply increased democratic authenticity.

Challenges dealing with the UK healthcare system

Overall the health, along with ideological and organisational difficulties that the UK Healthcare system is dealing with are not different to those faced by numerous national health care systems throughout the world. Life expectancy has been steadily increasing throughout the world with occurring increases in persistent diseases such as cancer and neurological conditions. Negative environment and way of life impacts have developed a pandemic in weight problems and involved conditions such as diabetes and heart disease. In the UK, coronary heart problem, cancer, renal disease, mental health services for adults and diabetes cover around 16% of overall National Health Service (NHS) expenditure, 12% of morbidity and in between 40% and 70% of death [3] Across Western societies, health inequalities are disturbingly increasing, with minority and ethnic groups experiencing most major diseases, sudden death and special needs. Your Home of Commons Health Committee cautions that whilst the health of all groups in England is enhancing, over the last ten years health inequalities between the social classes have widened-the gap has increased by 4% for men, and by 11% for women-due to the truth that the health of the abundant is improving much quicker than that of the bad [16] The focus and practice of healthcare services is being changed from typically offering treatment and encouraging or palliative care to increasingly dealing with the management of chronic illness and rehabilitation regimes, and offering disease avoidance and health promo interventions. Pay-for-performance, modifications in guideline together with cost-effectiveness and spend for medicines concerns are becoming a vital consider brand-new interventions reaching scientific practice [17, 18]

Preventive medicine is solidly established within the UK Healthcare System, and predictive and customised methods are significantly becoming so. Implementation of PPPM interventions might be the solution however likewise the cause of the health and healthcare challenges and dilemmas that health systems such as the NHS are dealing with [19] The effective introduction of PPPM needs clinical understanding of illness and health, and technological improvement, together with comprehensive methods, evidence-based health policies and suitable policy. Critically, education of health care professionals, patients and the public is also paramount. There is little doubt however that harnessing PPPM appropriately can assist the NHS attain its vision of delivering healthcare outcomes that will be amongst the best on the planet.

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