댓글 0
등록된 댓글이 없습니다.
Criticism of the National Health Service (England) > 자유게시판
Criticism of the National Health Service (England)
작성일작성일: 2025-07-05 00:03Criticism of the National Health Service (England) includes issues such as gain access to, waiting lists, healthcare protection, and various scandals. The National Health Service (NHS) is the publicly funded health care system of England, produced under the National Health Service Act 1946 by the post-war Labour government of Clement Attlee. It has come under much criticism, especially during the early 2000s, due to outbreaks of antibiotic resistant infections such as MRSA and Clostridioides difficile infection, waiting lists, and medical scandals such as the Alder Hey organs scandal. However, the involvement of the NHS in scandals extends back several years, consisting of over the provision of mental health care in the 1970s and 1980s (eventually part of the factor for the Mental Health Act 1983), and spends too much on medical facility newbuilds, consisting of Guy's Hospital Phase III in London in 1985, the cost of which soared from ₤ 29 million to ₤ 152 million. [1]
Access controls and waiting lists
In making healthcare a mainly "undetectable expense" to the patient, healthcare seems to be successfully free to its customers - there is no particular NHS tax or levy. To lower costs and guarantee that everyone is dealt with equitably, there are a variety of "gatekeepers." The family doctor (GP) operates as a primary gatekeeper - without a recommendation from a GP, it is often difficult to gain higher courses of treatment, such as a visit with a specialist. These are argued to be essential - Welshman Bevan noted in a 1948 speech in your home of Commons, "we shall never have all we need ... expectations will constantly surpass capability". [2] On the other hand, the national health insurance systems in other nations (e.g. Germany) have ignored the need for recommendation; direct access to a professional is possible there. [3]
There has been issue about opportunistic "health tourists" taking a trip to Britain (primarily London) and using the NHS while paying nothing. [4] British residents have been known to take a trip to other European nations to benefit from lower expenses, and since of a worry of hospital-acquired super bugs and long waiting lists. [5]
NHS gain access to is for that reason controlled by medical concern rather than rate mechanism, resulting in waiting lists for both assessments and surgery, as much as months long, although the Labour government of 1997-onwards made it among its essential targets to minimize waiting lists. In 1997, the waiting time for a non-urgent operation might be 2 years; there were ambitions to reduce it to 18 weeks despite opposition from doctors. [6] It is objected to that this system is fairer - if a medical grievance is severe and lethal, a client will reach the front of the line rapidly.
The NHS measures medical requirement in regards to quality-adjusted life years (QALYs), a technique of measuring the advantage of medical intervention. [7] It is argued that this technique of assigning healthcare implies some clients need to lose in order for others to get, and that QALY is a crude technique of making life and death decisions. [8]
Hospital got infections
There have actually been a number of fatal break outs of antibiotic resistant germs (" incredibly bugs") in NHS hospitals, such as Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus and Clostridioides difficile infection. [9] This has led to criticism of requirements of hygiene throughout the NHS, with some clients purchasing private medical insurance or taking a trip abroad to prevent the viewed risk of capturing a "very bug" while in health center. However, the department of health vowed ₤ 50 million for a "deep tidy" of all NHS England medical facilities in 2007. [10]
Coverage
The lack of accessibility of some treatments due to their viewed poor cost-effectiveness in some cases causes what some call a "postcode lottery". [11] [12] The National Institute for Health and Care Excellence (NICE) are the very first gatekeeper, and analyze the expense efficiency of all drugs. Until they have released assistance on the expense and efficiency of brand-new or pricey medicines, treatments and treatments, NHS services are unlikely to provide to money courses of treatment. The very same of real of the Scottish Medicines Consortium, NICE's equivalent in Scotland. [13]
There has actually been considerable controversy about the public health funding of pricey drugs, significantly Herceptin, due to its high cost and perceived restricted general survival. The campaign waged by cancer sufferers to get the government to pay for their treatment has gone to the highest levels in the courts and the Cabinet to get it certified. [14] [15] Your House of Commons Health Select Committee criticised some drug business for generating drugs that cost on and around the ₤ 30,000 limit that is considered the maximum worth of one QALY in the NHS.
Private Finance Initiative
Before the idea of private finance initiative (PFI) came to prominence, all brand-new healthcare facility structure was by convention moneyed from the Treasury, as it was thought it was best able to raise money and able to control public sector expense. In June 1994, the Capital Expense Manual (CIM) was published, setting out the regards to PFI contracts. The CIM made it clear that future capital tasks (structure of brand-new centers) needed to look at whether PFI was more suitable to utilizing public sector financing. By the end of 1995, 60 relatively small jobs had been prepared for, at a total cost of around ₤ 2 billion. Under PFI, buildings were developed and serviced by the personal sector, and after that leased back to the NHS. The Labour government chosen under Tony Blair in 1997 welcomed PFI projects, believing that public costs needed to be cut. [16]
Under the personal finance effort, an increasing variety of hospitals have actually been constructed (or rebuilt) by private sector consortia, although the federal government also motivated personal sector treatment centres, so called "surgicentres". [17] There has been substantial criticism of this, with a research study by a consultancy business which works for the Department of Health showing that for each ₤ 200 million invested in independently financed medical facilities the NHS loses 1000 doctors and nurses. The very first PFI hospitals contain some 28% less beds than the ones they replaced. [18] In addition to this, it has actually been noted that the return for building business on PFI agreements might be as high as 58%, and that in funding health centers from the personal rather than public sector cost the NHS almost half a billion pounds more every year. [19]
Scandals
Several high-profile medical scandals have actually occurred within the NHS throughout the years, such as the Alder Hey organs scandal and the scandal. At Alder Hey Children's Hospital, there was the unauthorised removal, retention, and disposal of human tissue, including kids's organs, between 1988 and 1995. The main report into the incident, the Redfern Report, revealed that Dick van Velzen, the Chair of Foetal and Infant Pathology at Alder Hey, had purchased the "dishonest and unlawful removing of every organ from every child who had had a postmortem." In response, it has actually been argued that the scandal brought the problem of organ and tissue contribution into the public domain, and highlighted the benefits to medical research that result. [20] The Gosport War Memorial Hospital scandal of the 1990s regarded opioid deaths. [21]
The Stafford Hospital scandal in Stafford, England in the late 2000s concerned abnormally high mortality rates amongst patients at the health center. [22] [23] As much as 1200 more clients passed away in between 2005 and 2008 than would be expected for the type and size of hospital [24] [25] based on figures from a mortality design, but the last Healthcare Commission report concluded it would be misleading to connect the insufficient care to a specific number or variety of numbers of deaths. [26] A public query later exposed several circumstances of overlook, incompetence and abuse of patients. [27]
" Lack of independence of inspecting for security and fitness for purpose"
Unlike in Scotland and Wales which have actually devolved healthcare, NHS England is worked on behalf of the taxpayer by the UK Parliament and the Department of Health, at the head of which is the Secretary of State for Health.
The group charged in England and Wales with inspecting if the care provided by the NHS is genuinely safe and fit for function is the Care Quality Commission, or CQC. Although the CQC explains itself as the "independent regulator of all health and social care services in England" [1], it is in truth "responsible to the general public, Parliament and the Secretary of State for Health." [2] Archived 31 August 2013 at the Wayback Machine and much of its financing comes from the taxpayer. At least one chairman, one chief executive [3] and a board member [4] of the CQC have been singled out for attention by a UK Secretary of State for Health.
There is therefore the potential for a conflict of interest, as both the NHS and the CQC have the very same management and both are highly prone to political disturbance.
In April 2024, Health Secretary Victoria Atkins prompted NHS England to focus on evidence and safety in gender dysphoria treatment following issues raised by the Cass Review. NHS required cooperation from adult clinics and started an evaluation, with Labour supporting evidence-based care. Momentum criticized constraints on gender-affirming care, while Stonewall invited the evaluation's concentrate on kids's wellness. [28] [29]
See also
National Health Service
List of medical facilities in England
Healthcare in the UK
Private Finance Initiative
Care Quality Commission
Notes
^ Rivett, Geoffrey (1998 ). From Cradle to Grave: 50 years of the NHS. Kings Fund. p. 437. ISBN 1-85717-148-9.
^ "TCSR 07 - Health: The Public Expects". theinformationdaily.com. 24 September 2007. Archived from the original on 22 August 2014. Retrieved 9 December 2007.
^ Schneider, Antonius; Donnachie, Ewan; Tauscher, Martin; Gerlach, Roman; Maier, Werner; Mielck, Andreas; Linde, Klaus; Mehring, Michael (9 June 2016). "Costs of coordinated versus uncoordinated care in Germany: results of a regular information analysis in Bavaria". BMJ Open. 6 (6 ): e011621. doi:10.1136/ bmjopen-2016-011621. PMC 4908874. PMID 27288386.
^ "Tougher rules to ensure that individuals do not abuse NHS services". Medical News Today. 26 April 2004. Archived from the initial on 8 December 2008. Retrieved 9 December 2007.
^ "Health travelers might get refund". BBC News Online. 7 December 2007. Retrieved 9 December 2007.
^ Jones, George (21 February 2007). "Doctors assault Blair's waiting list pledge". The Daily Telegraph. London. Archived from the original on 25 February 2007. Retrieved 9 December 2007.
^ "Quality Adjusted Life Years (QALYs)". National Library for Health. March 2006. Archived from the initial on 19 April 2013. Retrieved 9 December 2007.
^ "So what is a QALY?". Bandolier. Archived from the initial on 15 April 2008. Retrieved 9 December 2007.
^ "Do healthcare facilities make you ill?". BBC News. 31 January 2019.
^ "Hospital deep cleansing under fire". 14 January 2008.
^ "NHS 'postcode lottery game'". politics.co.uk. 9 August 2006. Archived from the original on 7 September 2007. Retrieved 9 December 2007.
^ "Why some drugs are not worth it". BBC News. 9 March 2005. Retrieved 4 December 2007.
^ "Cancer drug rejected for NHS use". BBC News Online. 9 July 2007. Retrieved 4 December 2007.
^ "Q&A: The Herceptin judgement". BBC News. 12 April 2006. Retrieved 15 September 2006.
^ "Update on Herceptin appraisal". National Institute for Health and Clinical Excellence. Archived from the original on 13 December 2006. Retrieved 1 December 2006.
^ Rivett, Geoffrey (1998 ). From Cradle to Grave: 50 years of the NHS. Kings Fund. p. 437. ISBN 1-85717-148-9.
^ "New generation surgery-centres to carry out thousands more NHS operations every year". Department of Health. 3 December 2002. Archived from the original on 5 March 2007. Retrieved 15 September 2006.
^ George Monbiot (10 March 2002). "Private Affluence, Public Rip-Off". The Spectator. Retrieved 7 September 2006.
^ PublicFinance.co.uk. "PFI hospitals 'costing NHS extra ₤ 480m a year'". Retrieved 3 December 2014.
^ Dixon, B. (19 March 2001). "Checks and balances needed for organ retention". Current Biology. 11 (5 ): R151 - R152. Bibcode:2001 CBio ... 11. R151D. doi:10.1016/ S0960-9822( 01 )00078-1. PMID 11267877.
^ "Gosport health center deaths: Police corruption probe flawed, guard dog says". BBC News. 14 October 2021. Retrieved 8 December 2024.
^ Nick Triggle (6 February 2013). "Stafford Hospital: Hiding errors 'need to be criminal offense'". BBC. Retrieved 9 February 2013.
^ Robert Francis QC (6 February 2013). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Report). House of Commons. ISBN 9780102981476. Retrieved 9 February 2013.
^ Smith, Rebecca (18 March 2009). "NHS targets 'may have caused 1,200 deaths' in Mid-Staffordshire". London: The Daily Telegraph. Archived from the initial on 21 March 2009. Retrieved 9 November 2010.
^ Emily Cook (18 March 2009). "Stafford healthcare facility scandal: Up to 1,200 may have passed away over "stunning" patient care". Daily Mirror. Retrieved 6 May 2009.
^ "How numerous people died "unnecessarily" at Mid Staffs". Full Fact. 7 March 2013. Retrieved 29 May 2015.
^ Sawer, Patrick; Donnelly, Laura (2 October 2011). "Boss of scandal-hit hospital leaves cross-examination". The Daily Telegraph. London. Archived from the initial on 3 October 2011.
^ "Minister informs NHS to 'end culture of secrecy' on gender care as focus shifts to adult clinics". Morning Star. 11 April 2024. Retrieved 15 April 2024.
^ "NHS England should end 'culture of secrecy' in children's gender care". The National. 11 April 2024. Retrieved 15 April 2024.
References
Rivett, Geoffrey (1998 ). From Cradle to Grave: 50 years of the NHS. Kings Fund. ISBN 1-85717-148-9.
External links
NHS.
Further reading
Pollock, Allyson (2004 ). NHS plc: the privatisation of our healthcare. Verso. ISBN 1-84467-539-4.
Mandelstam, Michael (2006 ). Betraying the NHS: Health Abandoned. Jessica Kingsley Publishing. ISBN 1-84310-482-2.
