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Overview of Healthcare in The UK > 자유게시판
Overview of Healthcare in The UK
작성일작성일: 2025-06-11 05:27
Received 2010 Sep 1; Accepted 2010 Sep 27; Issue date 2010 Dec.
. The National Health System in the UK has developed to turn into one of the largest health care systems in the world. At the time of writing of this review (August 2010) the UK government in its 2010 White Paper "Equity and excellence: Liberating the NHS" has actually revealed a strategy on how it will "produce a more responsive, patient-centred NHS which attains results that are among the very best on the planet". This review post presents an overview of the UK healthcare system as it presently stands, with emphasis on Predictive, Preventive and Personalised Medicine elements. It intends to work as the basis for future EPMA short articles to broaden on and present the changes that will be executed within the NHS in the forthcoming months.
Keywords: UK, Healthcare system, National health system, NHS
Introduction
The UK health care system, National Health Service (NHS), originated in the after-effects of the Second World War and became functional 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 legacy of Aneurin Bevan, a former miner who became a political leader and the then Minister of Health. He founded the NHS under the principles of universality, totally free at the point of shipment, equity, and paid for by central funding [1] Despite various political and organisational modifications the NHS stays to date a service offered widely that takes care of individuals on the basis of need and not capability to pay, and which is moneyed by taxes and nationwide insurance contributions.
Healthcare and health policy for England is the duty of the main 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, but in general, and not dissimilarly to other health systems, healthcare consists of two broad sections; one dealing with technique, 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 healthcare facilities). Increasingly distinctions between the two broad areas are ending up being less clear. Particularly over the last years and directed by the "Shifting the Balance of Power: The Next Steps" (2002) and "Wanless" (2004) reports, gradual modifications in the NHS have actually led to a higher shift towards local rather than main choice making, removal of barriers between main and secondary care and stronger focus on patient choice [2, 3] In 2008 the previous federal government reinforced this instructions in its health method "NHS Next Stage Review: High Quality Care for All" (the Darzi Review), and in 2010 the current federal government's health method, "Equity and quality: Liberating the NHS", stays encouraging of the very same ideas, albeit through perhaps various systems [4, 5]
The UK federal government has actually just revealed plans that according to some will produce the most extreme modification in the NHS given that its inception. In the 12th July 2010 White Paper "Equity and excellence: Liberating the NHS", the present Conservative-Liberal Democrat union federal government outlined a strategy on how it will "produce a more responsive, patient-centred NHS which attains outcomes that are among the finest worldwide" [5]
This evaluation article will for that reason present a summary of the UK healthcare system as it presently stands with the objective to serve as the basis for future EPMA posts to expand and provide the modifications that will be carried out within the NHS in the forthcoming months.
The NHS in 2010
The Health Act 2009 developed the "NHS Constitution" which formally brings together the purpose and concepts of the NHS in England, its worths, as they have been established by clients, public and personnel and the rights, pledges and obligations of patients, public and staff [6] Scotland, Northern Ireland and Wales have also consented to a high level statement stating the principles of the NHS throughout the UK, even though services might be offered differently in the 4 countries, reflecting their different health requirements and situations.
The NHS is the largest company in the UK with over 1.3 million personnel and a budget of over ₤ 90 billion [7, 8] In 2008 the NHS in England alone utilized 132,662 medical professionals, a 4% boost on the previous year, and 408,160 nursing staff (Table 1). Interestingly the Kings Fund approximates that, while the total variety of NHS personnel increased by around 35% in between 1999 and 2009, over the same duration the number of supervisors increased by 82%. As a proportion of NHS personnel, the variety of supervisors rose from 2.7 percent in 1999 to 3.6 percent 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 personal costs. The net NHS expense per head across the UK was least expensive in England (₤ 1,676) and highest in Scotland (₤ 1,919) with Wales and Northern Ireland at around the exact same level (₤ 1,758 and ₤ 1,770, respectively) [8]
Table 1.
The distribution of NHS labor force according to primary 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 instructions of the NHS, social care and public health and shipment of healthcare by developing policies and methods, securing resources, monitoring efficiency 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' budget plan, supply governance and commission services, in addition to ensure the accessibility of services for public heath care, and arrangement of social work. Both, SHAs and PCTs will stop to exist as soon as the strategies described in the 2010 White Paper become executed (see section below). NHS Trusts operate on a "payment by results" basis and obtain the majority of their earnings by offering health care that has actually been commissioned by the practice-based commissioners (GPs, and so on) and PCTs. The main kinds of Trusts include Acute, Care, Mental Health, Ambulance, Children's and Foundation Trusts. The latter were produced as non-profit making entities, devoid of federal government control but likewise increased monetary commitments and are managed by an independent Monitor. The Care Quality Commission regulates individually health and care in England overall. Other specialist bodies supply 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) guideline. The National Institute for Health and Clinical Excellence (NICE) was developed in 1999 as the body accountable for establishing national standards and standards associated with, health promotion and prevention, evaluation of new and existing technology (including medications and treatments) and treatment and care clinical guidance, available across the NHS. The health research study strategy of the NHS is being executed through National Institute of Health Research (NIHR), the overall budget plan for which was in 2009/10 near 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 specifies that Trusts have a legal duty to engage and include clients and the public. Patient experience information/feedback is officially gathered nationally by yearly study (by the Picker Institute) and becomes part of the NHS Acute Trust performance framework. The Patient Advice Liaison Service (PALS) and Local Involvement Networks (LINks) support client feedback and participation. Overall, inpatients and outpatients surveys have actually exposed that patients rate the care they receive in the NHS high and around three-quarters show that care has actually been excellent or excellent [11]
In Scotland, NHS Boards have actually replaced Trusts and supply an integrated system for tactical instructions, efficiency management and medical governance, whereas in Wales, the National Delivery Group, with suggestions from the National Advisory Board, is the body carrying out these functions (www.show.scot.nhs.uk; www.wales.nhs.uk). Scottish NHS and Special Boards deliver services, with care for specific conditions provided through Managed Clinical Networks. Clinical guidelines are released by the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium (SMC) suggestions on using brand-new drugs in the Scottish NHS. In Wales, Local Heath Boards (LHBs) plan, safe and deliver healthcare 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 supervising commissioning, efficiency and resource management and enhancement of health care in the country and six Health and Social Care Trusts provide these services (www.hscni.net). A variety of health firms support supplementary services and deal with a wide variety 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 public in the health service in their district and in Northern Ireland the Patient and Client Council represent patients, customers and carers.
Predictive, Preventive and Personalised Medicine (PPPM) in the NHS
Like other nationwide health care systems, predictive, preventive and/or customised medication services within the NHS have traditionally been offered and become part of illness diagnosis and treatment. Preventive medication, unlike predictive or personalised medication, is its own established entity and appropriate services are directed by Public Health and provided either by means of GP, community services or health centers. Patient-tailored treatment has always prevailed practice for great clinicians in the UK and any other healthcare system. The terms predictive and customised medicine though are developing to describe a much more technically sophisticated method of diagnosing illness and predicting reaction to the requirement of care, in order to maximise the advantage for the patient, the public and the health system.
References to predictive and customised medication are significantly being presented in NHS related details. The NHS Choices website describes how patients can obtain customised recommendations in relation to their condition, and offers info on predictive blood test for disease such as TB or diabetes. The NIHR through NHS-supported research and together with scholastic and industrial working together networks is investing a significant percentage of its budget plan in verifying predictive and preventive restorative interventions [10] The previous federal government thought about the advancement of preventive, people-centred and more efficient health care services as the means for the NHS to react to the challenges that all modern healthcare systems are facing in the 21st century, namely, high patient expectation, aging populations, harnessing of information and technological development, changing workforce and progressing nature of disease [12] Increased focus on quality (client safety, patient experience and clinical effectiveness) has likewise supported innovation in early diagnosis and PPPM-enabling innovations such as telemedicine.
A number of preventive services are provided through the NHS either via GP surgeries, social work or hospitals depending upon their nature and consist of:
The Cancer Screening programmes in England are nationally collaborated and include Breast, Cervical and Bowel Cancer Screening. There is also a notified choice Prostate Cancer Risk Management program (www.cancerscreening.nhs.uk).
The Child Health Promotion Programme is dealing with concerns from pregnancy and the very first 5 years of life and is provided by community midwifery and health visiting teams [13]
Various immunisation programs from infancy to their adult years, provided to anybody in the UK for totally free and typically provided in GP surgeries.
The Darzi evaluation set out 6 crucial scientific goals in relation to enhancing preventive care in the UK including, 1) taking on weight problems, 2) lowering alcohol harm, 3) dealing with drug addiction, 4) lowering smoking cigarettes rates, 5) enhancing sexual health and 6) improving mental health. Preventive programmes to attend to these concerns have remained in place over the last years in different kinds and through different efforts, and consist of:
Assessment of cardiovascular danger and identification of individuals at greater risk of heart problem is generally preformed through GP surgeries.
Specific preventive programs (e.g. suicide, mishap) in local schools and community
Family preparation services and avoidance of sexually transferred illness programs, frequently with a focus on youths
A variety of avoidance and health promo programs connected to lifestyle choices are delivered though GPs and neighborhood services including, alcohol and smoking cigarettes cessation programs, promo of healthy consuming and exercise. A few of these have a specific focus such as health promo for older individuals (e.g. Falls Prevention).
White paper 2010 - Equity and quality: liberating the NHS
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