댓글 0
등록된 댓글이 없습니다.
Overview of Healthcare in The UK > 자유게시판
Overview of Healthcare in The UK
작성일작성일: 2025-07-04 23:53
Received 2010 Sep 1; Accepted 2010 Sep 27; Issue date 2010 Dec.
. The National Health System in the UK has actually evolved to turn into one of the biggest healthcare systems worldwide. At the time of writing of this evaluation (August 2010) the UK federal government in its 2010 White Paper "Equity and excellence: Liberating the NHS" has actually revealed a method on how it will "develop a more responsive, patient-centred NHS which attains outcomes that are amongst the very best worldwide". This review short article provides an introduction of the UK healthcare system as it currently stands, with focus on Predictive, Preventive and Personalised Medicine components. It intends to work as the basis for future EPMA short articles to expand on and provide the modifications that will be implemented within the NHS in the forthcoming months.
Keywords: UK, Healthcare system, National health system, NHS
Introduction
The UK healthcare system, National Health Service (NHS), originated in the after-effects of the Second World War and ended up being operational on the 5th July 1948. It was first proposed to the Parliament in the 1942 Beveridge Report on Social Insurance and Allied Services and it is the tradition of Aneurin Bevan, a previous miner who became a political leader and the then Minister of Health. He founded the NHS under the concepts of universality, free at the point of shipment, equity, and paid for by central funding [1] Despite many political and organisational changes the NHS remains to date a service available universally that takes care of individuals on the basis of requirement and not capability to pay, and which is funded by taxes and nationwide insurance contributions.
Health care and health policy for England is the responsibility of the central federal government, whereas in Scotland, Wales and Northern Ireland it is the obligation of the particular devolved federal governments. In each of the UK countries the NHS has its own unique structure and organisation, however overall, and not dissimilarly to other health systems, health care consists of two broad areas; one handling strategy, 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 referral) and tertiary care (specialist hospitals). Increasingly differences in between the two broad areas are ending up being less clear. Particularly over the last years and assisted by the "Shifting the Balance of Power: The Next Steps" (2002) and "Wanless" (2004) reports, progressive changes in the NHS have actually caused a greater shift towards regional instead of central decision making, removal of barriers in between primary and secondary care and more powerful focus on patient option [2, 3] In 2008 the previous government enhanced this direction in its health strategy "NHS Next Stage Review: High Quality Care for All" (the Darzi Review), and in 2010 the existing government's health method, "Equity and quality: Liberating the NHS", remains helpful of the exact same ideas, albeit through perhaps various mechanisms [4, 5]
The UK government has simply announced plans that according to some will produce the most radical modification in the NHS because its inception. In the 12th July 2010 White Paper "Equity and excellence: Liberating the NHS", the existing Conservative-Liberal Democrat union federal government detailed a method on how it will "create a more responsive, patient-centred NHS which achieves results that are amongst the finest on the planet" [5]
This review post will therefore present an overview of the UK healthcare system as it currently stands with the goal to act as the basis for future EPMA articles to expand and present the modifications that will be implemented within the NHS in the upcoming months.
The NHS in 2010
The Health Act 2009 developed the "NHS Constitution" which officially combines the function and concepts of the NHS in England, its worths, as they have been established by patients, public and staff and the rights, promises and duties of clients, public and personnel [6] Scotland, Northern Ireland and Wales have likewise concurred to a high level statement stating the principles of the NHS across the UK, even though services may be offered in a different way in the 4 countries, reflecting their various health requirements and circumstances.
The NHS is the largest employer in the UK with over 1.3 million staff and a spending plan of over ₤ 90 billion [7, 8] In 2008 the NHS in England alone used 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 overall variety of NHS staff increased by around 35% between 1999 and 2009, over the exact same duration the variety of managers increased by 82%. As a proportion of NHS personnel, the variety of managers rose from 2.7 percent in 1999 to 3.6 per cent in 2009 (www.kingsfund.org.uk). In 2007/8, the UK health costs was 8.5% of Gross Domestic Product (GDP)-with 7.3% accounting for public and 1.2% for private costs. 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 approximately the exact same level (₤ 1,758 and ₤ 1,770, respectively) [8]
Table 1.
The distribution of NHS labor force according to main personnel groups in the UK in 2008 (NHS Information Centre: www.ic.nhs.uk)
The total 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 delivery of healthcare by developing policies and methods, protecting resources, keeping an eye on performance and setting nationwide requirements [9] Currently, 10 Strategic Health Authorities handle the NHS at a local level, and Primary Care Trusts (PCTs), which currently manage 80% of the NHS' spending plan, offer governance and commission services, as well as make sure the schedule of services for public heath care, and provision of community services. Both, SHAs and PCTs will disappear once the plans outlined in the 2010 White Paper become executed (see section listed below). NHS Trusts run on a "payment by results" basis and get the majority of their income by supplying health care that has actually been commissioned by the practice-based commissioners (GPs, and so on) and PCTs. The main kinds of Trusts consist of Acute, Care, Mental Health, Ambulance, Children's and Foundation Trusts. The latter were developed as non-profit making entities, devoid of government control but also increased monetary obligations and are controlled by an independent Monitor. The Care Quality Commission controls independently health and adult social care in England in general. Other professional bodies provide monetary (e.g. Audit Commission, National Audit Office), treatment/services (e.g. National Patient Safety Agency, Medicines and Healthcare Products Regulatory Agency) and expert (e.g. British Medical Association) policy. The National Institute for Health and Clinical Excellence (NICE) was established in 1999 as the body responsible for developing national standards and requirements connected to, health promo and prevention, assessment of brand-new and existing innovation (including medications and treatments) and treatment and care clinical guidance, readily available throughout the NHS. The health research method of the NHS is being carried out through National Institute of Health Research (NIHR), the overall spending plan for which remained in 2009/10 close to ₤ 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 patients and the public. Patient experience information/feedback is officially collected nationally by yearly study (by the Picker Institute) and is part of the NHS Acute Trust performance structure. The Patient Advice Liaison Service (PALS) and Local Involvement Networks (LINks) support client feedback and involvement. Overall, inpatients and outpatients studies have actually revealed that patients rate the care they receive in the NHS high and around three-quarters suggest that care has been very excellent or excellent [11]
In Scotland, NHS Boards have actually changed Trusts and supply an integrated system for tactical instructions, efficiency management and clinical governance, whereas in Wales, the National Delivery Group, with suggestions from the National Board Of Advisers, 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 particular conditions delivered through Managed Clinical Networks. Clinical standards are published by the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium (SMC) guidance on making use of new drugs in the Scottish NHS. In Wales, Local Heath Boards (LHBs) strategy, safe and secure and deliver health care services in their locations and there are 3 NHS Trusts providing emergency situation, cancer care and public health services nationally. In Northern Ireland, a single body, the Health and Care Board is supervising commissioning, performance and resource management and improvement of healthcare in the nation and six Health and Social Care Trusts deliver these services (www.hscni.net). A number of health firms support ancillary services and deal with a large range of health and care issues consisting of cancer screening, blood transfusion, public health etc. In Wales Community Health Councils are statutory ordinary bodies promoting the interests of the public in the health service in their district and in Northern Ireland the Patient and Client Council represent clients, clients and carers.
Predictive, Preventive and Personalised Medicine (PPPM) in the NHS
Like other nationwide healthcare systems, predictive, preventive and/or customised medication services within the NHS have generally been offered and are part of illness diagnosis and treatment. Preventive medication, unlike predictive or personalised medicine, is its own established entity and pertinent services are directed by Public Health and offered either by means of GP, social work or medical facilities. Patient-tailored treatment has always prevailed practice for good clinicians in the UK and any other healthcare system. The terms predictive and personalised medication though are evolving to describe a far more technically sophisticated method of diagnosing disease and predicting action to the standard of care, in order to maximise the benefit for the patient, the general public and the health system.
References to predictive and personalised medicine are progressively being presented in NHS related info. The NHS Choices site describes how clients can obtain customised recommendations in relation to their condition, and offers details on predictive blood test for disease such as TB or diabetes. The NIHR through NHS-supported research and together with academic and commercial teaming up networks is investing a considerable percentage of its budget in verifying predictive and preventive healing interventions [10] The previous government thought about the advancement of preventive, people-centred and more productive healthcare services as the ways for the NHS to react to the obstacles that all modern healthcare systems are dealing with in the 21st century, specifically, high client expectation, ageing populations, harnessing of info and technological advancement, altering workforce and progressing nature of illness [12] Increased focus on quality (patient security, client experience and scientific efficiency) has actually likewise supported development in early diagnosis and PPPM-enabling technologies such as telemedicine.
A variety of preventive services are delivered through the NHS either by means of GP surgeries, community services or health centers depending upon their nature and include:
The Cancer Screening programmes in England are nationally collaborated and consist of Breast, Cervical and Bowel Cancer Screening. There is likewise an informed option Prostate Cancer Risk Management program (www.cancerscreening.nhs.uk).
The Child Health Promotion Programme is handling issues from pregnancy and the first 5 years of life and is delivered by community midwifery and health visiting groups [13]
Various immunisation programs from infancy to their adult years, provided to anyone in the UK totally free and generally delivered in GP surgical treatments.
The Darzi evaluation set out 6 key clinical goals in relation to enhancing preventive care in the UK consisting of, 1) dealing with obesity, 2) reducing alcohol harm, 3) dealing with drug addiction, 4) reducing smoking rates, 5) improving sexual health and 6) enhancing psychological health. Preventive programs to attend to these concerns have actually remained in location over the last years in various types and through different efforts, and include:
Assessment of cardiovascular danger and recognition of people at greater risk of cardiovascular disease is generally preformed through GP surgical treatments.
Specific preventive programs (e.g. suicide, mishap) in regional schools and neighborhood
Family preparation services and avoidance of sexually transmitted disease programmes, often with a focus on youths
A range of prevention and health promo programmes associated with lifestyle options are delivered though GPs and community services consisting of, alcohol and smoking cessation programmes, promo of healthy consuming and physical activity. Some of these have a specific focus such as health promotion for older people (e.g. Falls Prevention).
White paper 2010 - Equity and quality: liberating the NHS
The 2010 "Equity and excellence: Liberating the NHS" White Paper has actually set out the vision of the future of an NHS as an organisation that still stays real to its founding concept of, offered to all, totally free at the point of usage and based on requirement and not ability to pay. It also continues to maintain the concepts and values specified in the NHS Constitution. The future NHS is part of the Government's Big Society which is build on social uniformity and involves rights and duties in accessing cumulative healthcare and ensuring reliable use of resources hence providing much better health. It will deliver healthcare results that are among the very best worldwide. This vision will be implemented through care and organisation reforms concentrating on 4 areas: a) putting patients and public initially, b) enhancing on quality and health outcomes, c) autonomy, accountability and democratic authenticity, and d) cut administration and improve effectiveness [5] This method refers to issues that relate to PPPM which suggests the increasing impact of PPPM concepts within the NHS.
According to the White Paper the concept of "shared decision-making" (no choice about me without me) will be at the centre of the "putting focus on client and public very first" plans. In truth this includes strategies emphasising the collection and ability to gain access to by clinicians and patients all patient- and treatment-related details. It also includes greater attention to Patient-Reported Outcome Measures, higher choice of treatment and treatment-provider, and notably customised care preparation (a "not one size fits all" method). A freshly produced Public Health Service will bring together existing services and place increased emphasis on research analysis and examination. Health Watch England, a body within the Care Quality Commission, will provide a stronger client and public voice, through a network of local Health Watches (based on 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 achieved through revising objectives and healthcare priorities and developing targets that are based upon scientifically trustworthy and evidence-based procedures. NICE have a main role in establishing recommendations and standards and will be anticipated to produce 150 brand-new standards over the next 5 years. The federal government plans to establish a value-based rates system for paying pharmaceutical companies for offering drugs to the NHS. A Cancer Drug Fund will be developed in the interim to cover patient treatment.
The abolition of SHAs and PCTs, are being proposed as ways of supplying higher autonomy and responsibility. GP Consortia supported by the NHS Commissioning Board will be accountable for commissioning healthcare services. The intro of this type of "health management organisations" has actually been rather questionable however potentially not completely unanticipated [14, 15] The transfer of PCT health improvement function to local authorities aims to provide increased democratic authenticity.
Challenges facing the UK health care system
Overall the health, as well as ideological and organisational obstacles that the UK Healthcare system is dealing with are not dissimilar to those dealt with by lots of nationwide health care systems throughout the world. Life span has actually been progressively increasing across the world with taking place increases in persistent illness such as cancer and neurological disorders. Negative environment and way of life influences have actually produced a pandemic in weight problems and associated conditions such as diabetes and heart disease. In the UK, coronary heart illness, cancer, renal disease, psychological health services for grownups and diabetes cover around 16% of total National Health Service (NHS) expenditure, 12% of morbidity and between 40% and 70% of mortality [3] Across Western societies, health inequalities are disturbingly increasing, with minority and ethnic groups experiencing most major health problems, sudden death and special needs. Your House of Commons Health Committee alerts 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 actually increased by 4% for guys, and by 11% for women-due to the reality that the health of the rich is enhancing much quicker than that of the bad [16] The focus and practice of healthcare services is being transformed from typically providing treatment and helpful or palliative care to progressively handling the management of chronic disease and rehabilitation routines, and using illness prevention and health promotion interventions. Pay-for-performance, changes in guideline together with cost-effectiveness and pay for medications concerns are becoming a crucial consider brand-new interventions reaching scientific practice [17, 18]
Preventive medicine is solidly developed within the UK Healthcare System, and predictive and customised approaches are increasingly becoming so. Implementation of PPPM interventions might be the solution however also the cause of the health and healthcare obstacles and dilemmas that health systems such as the NHS are facing [19] The efficient intro of PPPM needs scientific understanding of disease and health, and technological development, together with comprehensive strategies, evidence-based health policies and proper policy. Critically, education of health care experts, patients and the public is also paramount. There is little doubt nevertheless that utilizing PPPM appropriately can help the NHS attain its vision of delivering healthcare outcomes that will be among the very best in the world.
- 1. Delamothe T. NHS at 60: establishing principles. BMJ. 2008; 336:1216 -8. doi: 10.1136/ bmj.39582.501192.94. [DOI] [PMC free article] [PubMed] [Google Scholar]- 2. Shifting the Balance of Power: The Next Steps. Department of Health publications. 2002. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4008424
- 3. Wanless D. Securing health for the entire population: Final report-February 2004. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4074426
- 4. Professor the Lord Darzi of Denham KBE High quality take care of all: NHS Next Stage Review final report. Department of Health publications. 2008. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825
- 5. White paper Equity and excellence: Liberating the NHS. Department of Health publications. 2010. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353
- 6. The NHS Constitution for England. Department of Health publications. 2009. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093419
- 7. NHS Hospital and Community Health Services: Medical and Dental personnel England 1998-2008. The NHS Information Centre. 2009. www.ic.nhs.uk/webfiles/publications/nhsstaff2008/medandden/Medical%20and%20Dental%20bulletin%201998-2008.pdf
- 8. House of Commons Health Committee: Public Expenditure on Health and Personal Social Services. Your House of Commons. 2008. www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/cmhealth.htm
- 9. The DH Guide A guide to what we do and how we do it. Department of Health publications. 2007. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/index.htm
- 10. NIHR Annual Report 2009/10: Embedding Health Research. National Institute for Health Research. 2010. www.nihr.ac.uk/Pages/default.aspx
- 11. Leatherman S. and Sutherland K. Patient and Public Experience in the NHS. The Health Foundation. 2007. www.health.org.uk/publications/research_reports/patient_and_public.html
- 12. NHS 2010-2015: from great to fantastic. Preventative, people-centred, efficient. Department of Health publications. 2009. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_109876
- 13. Updated Child Health Promotion Programme. Department of Health publications. 2009. webarchive.nationalarchives.gov.uk/+/ www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_083645.
- 14. Klein R. What does the future hold for the NHS at 60? BMJ. 2008; 337: a549. doi: 10.1136/ bmj.a549. [DOI] [PMC free post] [PubMed] [Google Scholar]- 15. Ham C (2007) Clinically integrated systems: the next action in English health reform? Briefing paper. London Nuffield Trust.
- 16. Health Inequalities Third Report of Session 2008-09. House of Commons Health Committee. 2009; Volume I. www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/286/28602.htm.
- 17. Clinicians, services and commissioning in chronic disease management in the NHS The requirement for collaborated management programmes. Report of a joint working celebration of the Royal College of Physicians of London, the Royal College of General Practitioners and the NHS Alliance. 2004. www.rcgp.org.uk/PDF/Corp_chronic_disease_nhs.pdf.
- 18. Hughes DA. From NCE to NICE: the function of pharmacoeconomics. Br J Clin Pharmacol. 2010; 70( 3 ):317 -9. doi: 10.1111/ j.1365-2125.2010.03708. x. [DOI] [PMC complimentary article] [PubMed] [Google Scholar]- 19. Griggs JJ. Personalized medication: a perk of opportunity? Clin Pharmacol Ther.
