댓글 0
등록된 댓글이 없습니다.
Overview of Healthcare in The UK > 자유게시판
Overview of Healthcare in The UK
작성일작성일: 2025-06-04 21:25Received 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 health care systems in the world. 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 actually announced a method on how it will "produce a more responsive, patient-centred NHS which attains outcomes that are amongst the very best worldwide". This review article presents a summary 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 present the changes 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), came into existence in the consequences of the Second World War and ended up being operational on the fifth July 1948. It was very 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 former miner who became a politician and the then Minister of Health. He founded the NHS under the principles of universality, free at the point of delivery, equity, and paid for by main funding [1] Despite many political and organisational changes the NHS stays to date a service available universally that takes care of people 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 obligation of the central federal government, whereas in Scotland, Wales and Northern Ireland it is the duty of the particular devolved federal governments. In each of the UK countries the NHS has its own unique structure and organisation, but in general, and not dissimilarly to other health systems, health care makes up of 2 broad sections; one handling method, policy and management, and the other with real medical/clinical care which is in turn divided into main (neighborhood care, GPs, Dentists, Pharmacists etc), secondary (hospital-based care accessed through GP referral) and tertiary care (professional health centers). Increasingly differences between the 2 broad sections are becoming 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 modifications in the NHS have resulted in a higher shift towards regional rather than main choice making, removal of barriers between primary and secondary care and stronger focus on patient choice [2, 3] In 2008 the previous government strengthened this direction in its health strategy "NHS Next Stage Review: High Quality Care for All" (the Darzi Review), and in 2010 the existing federal government's health method, "Equity and quality: Liberating the NHS", stays supportive of the very same concepts, albeit through perhaps various mechanisms [4, 5]
The UK federal government has actually just revealed strategies that according to some will produce the most radical modification in the NHS because its beginning. In the 12th July 2010 White Paper "Equity and excellence: Liberating the NHS", the existing Conservative-Liberal Democrat union federal government laid out a strategy on how it will "develop a more responsive, patient-centred NHS which attains outcomes that are among the very best on the planet" [5]
This evaluation short article will therefore present a summary of the UK health care system as it currently stands with the objective to function as the basis for future EPMA short articles to broaden and provide the modifications that will be carried out within the NHS in the forthcoming months.
The NHS in 2010
The Health Act 2009 established the "NHS Constitution" which officially unites the function and concepts of the NHS in England, its worths, as they have been developed by patients, public and personnel and the rights, pledges and duties of patients, public and staff [6] Scotland, Northern Ireland and Wales have likewise consented to a high level statement declaring the concepts of the NHS throughout the UK, even though services may be offered differently in the four countries, showing their different health needs and scenarios.
The NHS is the largest employer 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 used 132,662 medical professionals, a 4% boost 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 same period the variety of supervisors increased by 82%. As a percentage of NHS personnel, the variety of managers increased from 2.7 percent in 1999 to 3.6 per cent in 2009 (www.kingsfund.org.uk). In 2007/8, the UK health spending was 8.5% of Gdp (GDP)-with 7.3% accounting for public and 1.2% for private costs. The net NHS expense per head across the UK was lowest in England (₤ 1,676) and highest in Scotland (₤ 1,919) with Wales and Northern Ireland at around the very same level (₤ 1,758 and ₤ 1,770, respectively) [8]
Table 1.
The circulation of NHS labor force according to main staff 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 shipment of healthcare by developing policies and methods, protecting resources, keeping track of efficiency and setting national standards [9] Currently, 10 Strategic Health Authorities handle the NHS at a local level, and Medical care Trusts (PCTs), which presently manage 80% of the NHS' budget plan, supply governance and commission services, along with ensure the schedule of services for public heath care, and provision of social work. Both, SHAs and PCTs will disappear once the strategies outlined in the 2010 White Paper become carried out (see section listed below). NHS Trusts operate on a "payment by results" basis and get many of their earnings by supplying health care that has actually been commissioned by the practice-based commissioners (GPs, etc) and PCTs. The main 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 federal government control however also increased monetary responsibilities and are managed by an independent Monitor. The Care Quality Commission controls individually health and adult social care in England in general. Other specialist bodies offer financial (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) regulation. The National Institute for Health and Clinical Excellence (NICE) was established in 1999 as the body accountable for developing national standards and requirements associated with, health promo and avoidance, evaluation of brand-new and existing innovation (including medications and procedures) and treatment and care medical assistance, offered throughout the NHS. The health research study method of the NHS is being carried out through National Institute of Health Research (NIHR), the overall budget plan for which was 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 states that Trusts have a legal duty to engage and include patients and the public. Patient experience information/feedback is formally collected nationally by yearly study (by the Picker Institute) and becomes 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 exposed that patients rate the care they get in the NHS high and around three-quarters show that care has been great or exceptional [11]
In Scotland, NHS Boards have replaced Trusts and offer an integrated system for strategic instructions, efficiency management and clinical governance, whereas in Wales, the National Delivery Group, with advice 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 care for specific conditions delivered through Managed Clinical Networks. Clinical guidelines are released by the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium (SMC) recommendations on the usage of new drugs in the Scottish NHS. In Wales, Local Heath Boards (LHBs) strategy, secure and provide healthcare services in their locations and there are 3 NHS Trusts supplying emergency situation, cancer care and public health services nationally. In Northern Ireland, a single body, the Health and Care Board is managing commissioning, efficiency and resource management and enhancement of healthcare in the nation and six Health and Social Care Trusts provide these services (www.hscni.net). A variety of health companies support ancillary services and handle a vast array of health and care problems consisting of cancer screening, blood transfusion, public health etc. In Wales Community Health Councils are statutory lay 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 medication services within the NHS have actually traditionally been used and become part of disease medical diagnosis and treatment. Preventive medicine, unlike predictive or personalised medication, is its own established entity and relevant services are directed by Public Health and offered either by means of GP, community services or healthcare facilities. Patient-tailored treatment has actually constantly been common practice for great clinicians in the UK and any other healthcare system. The terms predictive and customised medication though are developing to describe a far more technologically advanced method of detecting illness and predicting reaction to the requirement of care, in order to maximise the benefit for the patient, the general public and the health system.
References to predictive and personalised medication are significantly being presented in NHS related information. The NHS Choices website describes how patients can get customised advice in relation to their condition, and provides info on predictive blood test for disease such as TB or diabetes. The NIHR through NHS-supported research and together with scholastic and commercial working together networks is investing a significant percentage of its spending plan in confirming predictive and preventive therapeutic interventions [10] The previous government considered the development of preventive, people-centred and more efficient healthcare services as the means for the NHS to react to the difficulties that all modern healthcare systems are facing in the 21st century, specifically, high patient expectation, aging populations, harnessing of info and technological advancement, changing labor force and progressing nature of illness [12] Increased emphasis on quality (patient security, patient experience and scientific efficiency) has also supported development in early diagnosis and PPPM-enabling technologies such as telemedicine.
A variety of preventive services are delivered through the NHS either through GP surgical treatments, community services or health centers depending on their nature and include:
The Cancer Screening programs in England are nationally coordinated and include Breast, Cervical and Bowel Cancer Screening. There is also an informed choice Prostate Cancer Risk Management program (www.cancerscreening.nhs.uk).
The Child Health Promotion Programme is handling concerns from pregnancy and the very first 5 years of life and is provided by neighborhood midwifery and health checking out teams [13]
Various immunisation programs from infancy to adulthood, used to anyone in the UK totally free and generally delivered in GP surgeries.
The Darzi review set out six crucial scientific objectives in relation to improving preventive care in the UK including, 1) tackling weight problems, 2) decreasing alcohol harm, 3) treating drug dependency, 4) lowering smoking cigarettes rates, 5) enhancing sexual health and 6) improving mental health. Preventive programs to address these concerns have been in location over the last years in different types and through different efforts, and include:
Assessment of cardiovascular threat and identification of people at higher risk of heart disease 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 disease programs, typically with an emphasis on youths
A variety of and health promo programs connected to lifestyle choices are delivered though GPs and neighborhood services including, alcohol and cigarette smoking cessation programs, promotion of healthy consuming and exercise. A few of these have a specific focus such as health promotion for older people (e.g. Falls Prevention).
White paper 2010 - Equity and excellence: liberating the NHS
The existing government's 2010 "Equity and quality: Liberating the NHS" White Paper has actually set out the vision of the future of an NHS as an organisation that still remains true to its starting concept of, offered to all, free at the point of usage and based on need and not ability to pay. It likewise continues to promote 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 entails rights and duties in accessing cumulative healthcare and ensuring efficient usage of resources thus providing better health. It will deliver healthcare outcomes that are among the best in the world. This vision will be executed through care and organisation reforms focusing on 4 locations: a) putting patients and public initially, b) improving on quality and health results, c) autonomy, accountability and democratic legitimacy, and d) cut administration and improve effectiveness [5] This method makes references to concerns that are appropriate to PPPM which suggests the increasing influence of PPPM principles within the NHS.
According to the White Paper the concept of "shared decision-making" (no decision about me without me) will be at the centre of the "putting focus on client and public first" strategies. In truth this includes strategies stressing the collection and capability to gain access to by clinicians and patients all patient- and treatment-related info. It also includes higher attention to Patient-Reported Outcome Measures, greater choice of treatment and treatment-provider, and significantly customised care planning (a "not one size fits all" technique). A newly developed Public Health Service will unite existing services and location increased focus on research analysis and evaluation. Health Watch England, a body within the Care Quality Commission, will offer a more powerful client and public voice, through a network of regional Health Watches (based on the existing Local Involvement Networks - LINks).
The NHS Outcomes Framework sets out the concerns for the NHS. Improving on quality and health results, according to the White Paper, will be attained through revising objectives and healthcare priorities and establishing targets that are based on clinically trustworthy and evidence-based steps. NICE have a main function in developing recommendations and standards and will be expected to produce 150 brand-new requirements over the next 5 years. The federal government plans to establish a value-based pricing system for paying pharmaceutical business for providing 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 greater autonomy and accountability. GP Consortia supported by the NHS Commissioning Board will be accountable for commissioning healthcare services. The introduction of this type of "health management organisations" has actually been rather questionable but perhaps not absolutely unanticipated [14, 15] The transfer of PCT health enhancement function to regional authorities intends to provide increased democratic authenticity.
Challenges facing the UK healthcare system
Overall the health, in addition to ideological and organisational difficulties that the UK Healthcare system is dealing with are not different to those dealt with by many nationwide health care systems across the world. Life span has been steadily increasing throughout the world with ensuing boosts in chronic diseases such as cancer and neurological disorders. Negative environment and way of life influences have actually created a pandemic in weight problems and associated conditions such as diabetes and cardiovascular disease. In the UK, coronary heart disease, cancer, kidney illness, psychological health services for grownups and diabetes cover around 16% of overall National Health Service (NHS) expense, 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 diseases, sudden death and special needs. Your Home of Commons Health Committee alerts that whilst the health of all groups in England is improving, over the last ten years health inequalities between the social classes have widened-the gap has increased by 4% for guys, and by 11% for women-due to the fact that the health of the abundant is enhancing much quicker than that of the bad [16] The focus and practice of health care services is being changed from traditionally providing treatment and helpful or palliative care to progressively dealing with the management of persistent illness and rehab regimes, and offering illness avoidance and health promotion interventions. Pay-for-performance, modifications in guideline together with cost-effectiveness and spend for medicines problems are ending up being a crucial consider new interventions reaching medical practice [17, 18]
Preventive medication is solidly developed within the UK Healthcare System, and predictive and customised approaches are increasingly becoming so. Implementation of PPPM interventions may be the solution but also the reason for the health and health care challenges and issues that health systems such as the NHS are facing [19] The efficient intro of PPPM needs scientific understanding of disease and health, and technological advancement, together with extensive techniques, evidence-based health policies and appropriate policy. Critically, education of health care experts, patients and the public is also critical. There is little doubt nevertheless that harnessing PPPM properly can help the NHS accomplish its vision of providing health care outcomes that will be amongst the finest on the planet.
- 1. Delamothe T. NHS at 60: establishing principles. BMJ. 2008; 336:1216 -8. doi: 10.1136/ bmj.39582.501192.94. [DOI] [PMC complimentary 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 great health for the whole 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 look after 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 quality: 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 terrific. Preventative, people-centred, productive. 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 complimentary short article] [PubMed] [Google Scholar]- 15. Ham C (2007) Clinically incorporated 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 coordinated management programmes. Report of a joint working party 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 role of pharmacoeconomics. Br J Clin Pharmacol. 2010; 70( 3 ):317 -9. doi: 10.1111/ j.1365-2125.2010.03708. x. [DOI] [PMC totally free short article] [PubMed] [Google Scholar]- 19. Griggs JJ. Personalized medicine: a perk of benefit? Clin Pharmacol Ther.