Healthcare in the United Kingdom
Encyclopedia
|
|-
Parts of this article are not updated

Healthcare in the United Kingdom is a devolved matter
Devolution
Devolution is the statutory granting of powers from the central government of a sovereign state to government at a subnational level, such as a regional, local, or state level. Devolution can be mainly financial, e.g. giving areas a budget which was formerly administered by central government...

, meaning England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...

, Northern Ireland
Northern Ireland
Northern Ireland is one of the four countries of the United Kingdom. Situated in the north-east of the island of Ireland, it shares a border with the Republic of Ireland to the south and west...

, Scotland
Scotland
Scotland is a country that is part of the United Kingdom. Occupying the northern third of the island of Great Britain, it shares a border with England to the south and is bounded by the North Sea to the east, the Atlantic Ocean to the north and west, and the North Channel and Irish Sea to the...

 and Wales
Wales
Wales is a country that is part of the United Kingdom and the island of Great Britain, bordered by England to its east and the Atlantic Ocean and Irish Sea to its west. It has a population of three million, and a total area of 20,779 km²...

 each have their own systems of private and publicly-funded healthcare, together with alternative
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

, holistic and complementary treatments. Each country having different policies and priorities has resulted in a variety of differences existing between the systems. That said, each country provides public healthcare to all UK permanent residents
British nationality law
British nationality law is the law of the United Kingdom that concerns citizenship and other categories of British nationality. The law is complex because of the United Kingdom's former status as an imperial power.-History:...

 that is free at the point of need, being paid for from general taxation. In addition, each also has a private healthcare sector which is considerably smaller than its public equivalent, with provision of private healthcare acquired by means of private health insurance, funded as part of an employer funded healthcare scheme or paid directly by the customer, though provision can be restricted for those with conditions such as AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...

/HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

.

Taken together, the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

, in 2000, ranked the provision of healthcare in the United Kingdom as fifteenth best in Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...

 and eighteenth in the world. Overall, around 8.4 per cent of the UK's gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....

 is spent on healthcare, which is 0.5% below the Organization for Economic Co-operation and Development average and about one percent below the average of the European Union
European Union
The European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...

.

Healthcare in England

Most healthcare in England
Healthcare in England
Healthcare in England is mainly provided by England's public health service, the National Health Service, that provides healthcare to all permanent residents of the United Kingdom that is free at the point of use and paid for from general taxation. Since health is a devolved matter, there are...

 is provided by the National Health Service
National Health Service (England)
The National Health Service or NHS is the publicly funded healthcare system in England. It is both the largest and oldest single-payer healthcare system in the world. It is able to function in the way that it does because it is primarily funded through the general taxation system, similar to how...

 (NHS), England's publicly funded healthcare system
Socialized medicine
Socialized medicine is a term used to describe a system for providing medical and hospital care for all at a nominal cost by means of government regulation of health services and subsidies derived from taxation. It is used primarily and usually pejoratively in United States political debates...

, which accounts for most of the Department of Health
Department of Health (United Kingdom)
The Department of Health is a department of the United Kingdom government with responsibility for government policy for health and social care matters and for the National Health Service in England along with a few elements of the same matters which are not otherwise devolved to the Scottish,...

's budget (£98.6 billion in 2008-9). The actual delivery of health care services is managed by ten Strategic Health Authorities
NHS Strategic Health Authority
NHS strategic health authorities are part of the structure of the National Health Service in England. Each SHA is responsible for enacting the directives and implementing fiscal policy as dictated by the Department of Health at a regional level. In turn each SHA area contains various NHS trusts...

 and, below this, locally accountable trusts and other bodies. Social care services are a shared responsibility with the local NHS and the local government Directors of Social Services under the guidance of the DH. From the birth of the NHS in 1948, private healthcare has continued to exist, paid for largely by private insurance. In recent years, despite some evidence that a large proportion of the public oppose such involvement, the private sector has been used to increase NHS capacity. In addition, there is some relatively minor sector crossover between public and private provision with it possible for some NHS patients to be treated in private healthcare facilities and some NHS facilities let out to the private sector for privately funded treatments or for pre- and post-operative care. However, since private hospitals tend to manage only routine operations and lack a level 3 critical care unit (or intensive therapy unit), unexpected emergencies may lead to the patient being transferred to an NHS hospital as very few private hospitals have a level 3 critical care unit (or intensive therapy unit), putting the patients at greater risk and costing the NHS money.

The two main kinds of trusts in the NHS, reflecting purchaser/provider roles, are commissioning trusts such as Primary Care Trusts
NHS Primary Care Trust
An NHS primary care trust is a type of NHS trust, part of the National Health Service in England. PCTs commission primary, community and secondary care from providers. Until 31 may2011 they also provided community services directly. Collectively PCT are responsible for spending around 80% of the...

 which examine local needs and negotiate with providers (that may be public or private entities) to provide health care services to the local population, and provider trusts which are NHS bodies delivering health care service. They will be involved in agreeing major capital and other health care spending projects in their region. Services commissioned include general practice physician services (most of whom are private businesses working under exclusive contract to the NHS), community nursing, local clinics and mental health service. For most people, the majority of health care is delivered in a primary health care setting. Provider trusts are care deliverers, the main examples being the hospital trusts and the ambulance trusts which spend the money allocated to them by the commissioning trusts. Hospitals, as they tend to provide more complex and specialized care, receive the lion's share of NHS funding. The hospital trusts own assets (such as hospitals and the equipment in them) purchased for the nation and held in trust for them. Commissioning has also been extended to the very lowest level enabling ordinary doctors who identify a need in their community to commission services to meet that need. Primary care is delivered by a wide range of independent contractors such as GPs, dentists, pharmacists and optometrists and is the first point of contact for most people. Secondary care (sometimes termed acute health care) can be either elective care or emergency care and providers may be in the public or private sector, though the majority of secondary care happens in NHS owned facilities.

The NHS Constitution
NHS Constitution for England
The NHS constitution for England is a formal constitution which, in one document, lays down the objectives of the National Health Service , the rights and responsibilities of the various parties involved in health care in England, and the guiding principles which govern the service...

 covers the rights and obligations of patients and staff, many of which are legally enforceable. The NHS has a high level of popular public support within the country: an independent survey conducted in 2004 found that users of the NHS often expressed very high levels satisfaction about their personal experience of the medical services they received: 92% of hospital in-patients, 87% of GP users, 87% of hospital outpatients, and 70% of Accident and Emergency department users. However, only 67% of those surveyed agreed with the statement "My local NHS is providing me with a good service”, and only 51% agreed with the statement “The NHS is providing a good service. Satisfaction in successive surveys has noted high satisfaction across all patient groups, especially recent inpatients, and user satisfaction is notably higher than that of the general public. The report found that most highly recalled sources of information on the
NHS are perceived to be the most critical. The national press was seen to be the most critical (64%), followed by local press (54%) and TV or radio (51%) compared to just 13% saying the national press is favourable). The national press was reported as being the least reliable source of information (50% reporting it to be not very or not at all reliable, compared to 36% believing the press was reliable). Newspapers were reported as being less favourable and also less reliable than the broadcast media. The most reliable sources of information were considered to be leaflets from GPs and information from friends (both 77% reported as reliable) and medical professionals (75% considered reliable).

Healthcare in Northern Ireland

The majority of healthcare in Northern Ireland is provided by Health and Social Care in Northern Ireland. Though this organisation does not use the term 'National Health Service', it is still sometimes referred to as the 'NHS'.

Healthcare in Scotland

The majority of healthcare in Scotland is provided by NHS Scotland
NHS Scotland
NHS Scotland is the publicly funded healthcare system of Scotland. Although they are separate bodies the organisational separation between NHS Scotland and the other three healthcare organisations each commonly called the National Health Service in the United Kingdom tends to be hidden from its...

; Scotland's current national system of publicly funded healthcare was created in 1948 at the same time as those in Northern Ireland and in England and Wales, incorporating and expanding upon services already provided by local and national authorities as well as private and charitable institutions. It remains a separate body from the other public health systems in the UK although this is often not realised by patients when "cross-border" or emergency care is involved due to the level of co-operation and co-ordination, occasionally becoming apparent in cases where patients are repatriated by the Scottish Ambulance Service
Scottish Ambulance Service
The Scottish Ambulance Service is part of NHS Scotland, and serves all of Scotland. It is a Special Health Board funded directly by the Scottish Government Health Department....

 to a hospital in their country of residence once essential treatment has been given but they are not yet fit to travel by non-ambulance transport.

Healthcare in Wales

The majority of healthcare in Wales is provided by NHS Wales. This body was originally formed as part of the same NHS structure
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

 for England and Wales
England and Wales
England and Wales is a jurisdiction within the United Kingdom. It consists of England and Wales, two of the four countries of the United Kingdom...

 created by the National Health Service Act 1946
National Health Service Act 1946
The National Health Service Act 1946 came into effect on 5 July 1948 and created the National Health Service in England and Wales. Though the title 'National Health Service' implies one health service for the United Kingdom, in reality a separate NHS was created for England and Wales accountable to...

 but powers over the NHS in Wales came under the Secretary of State for Wales in 1969 and, in turn, responsibility for NHS Wales was passed to the Welsh Assembly and the Welsh Assembly Government
Welsh Assembly Government
The Welsh Government is the devolved government of Wales. It is accountable to the National Assembly for Wales, the legislature which represents the interests of the people of Wales and makes laws for Wales...

 under devolution in 1999.

Comparisons between the public health systems in the UK

Common features

Each NHS system uses General Practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...

s (GPs) to provide primary healthcare and to make referrals to further services as necessary. Hospitals then provide more specialist services, including care for patients with psychiatric illnesses, as well as direct access to Accident and Emergency (A&E) departments. Pharmacies (other than those within hospitals) are privately owned but have contracts with the relevant health service to supply prescription drugs.

Each public healthcare system also provides free ambulance services for emergencies, when patients need the specialist transport only available from ambulance crews or when patients are not fit to travel home by public transport. These services are generally supplemented when necessary by the voluntary ambulance services (British Red Cross
British Red Cross
The British Red Cross Society is the United Kingdom branch of the worldwide impartial humanitarian organisation the International Red Cross and Red Crescent Movement. The society was formed in 1870, and is a registered charity with over 31,000 volunteers and 2,600 staff. At the heart of their work...

, St Andrews Ambulance Association and St John Ambulance). In addition, patient transport services by air are provided by the Scottish Ambulance Service
Scottish Ambulance Service
The Scottish Ambulance Service is part of NHS Scotland, and serves all of Scotland. It is a Special Health Board funded directly by the Scottish Government Health Department....

 in Scotland and elsewhere by county or regional air ambulance trusts (sometimes operated jointly with local police helicopter services) throughout England and Wales. In specific emergencies, emergency air transport is also provided by naval, military and air force aircraft of whatever type might be appropriate or available on each occasion.

Each NHS system also provides dental services through private dental practises and dentists can only charge NHS patients at the set rates for each country. Patients opting to be treated privately do not receive any NHS funding for the treatment. About half of the income of dentists in England comes from work sub-contracted from the NHS, however not all dentists choose to do NHS work.

Advice services

Each NHS system has its own 24-hour telephone advisory service: England has NHS Direct
NHS Direct
NHS Direct is the health advice and information service provided by the National Health Service for residents and visitors in England, with advice offered 24 hours a day, every day of the year through telephone contact on the national 0845 46 47 number, web based symptom checkers at and via...

, Wales has NHS Direct Wales
NHS Direct Wales
NHS Direct Wales is a 24-hour telephone and internet health advice service provided by NHS Wales to enable people to obtain advice when use of the national emergency telephone number does not seem to be appropriate but there is some degree of urgency; it also functions as a confidential advice...

/Galw Iechyd Cymru while Scotland has NHS24
NHS24
NHS 24 is the name of a confidential health advice and information service provided by NHS Scotland. It is the equivalent to the NHS Direct scheme in England and NHS Direct Wales, allowing people who feel unwell or those caring for them to obtain advice if it is not convenient or possible to wait...

.

Best practice and cost effectiveness

In England and Wales, the National Institute for Health and Clinical Excellence
National Institute for Health and Clinical Excellence
The National Institute for Health and Clinical Excellence is a special health authority of the English National Health Service , serving both English NHS and the Welsh NHS...

 (NICE) sets guidelines for medical practitioners as to how various conditions should be treated and whether or not a particular treatment should be funded. These guidelines are established by panels of medical experts who specialize in the area being reviewed.

In Scotland, the Scottish Medicines Consortium
Scottish Medicines Consortium
The Scottish Medicines Consortium has the role of providing advice to NHS Boards and their Area Drug and Therapeutics Committees about all newly licensed medicines....

 advises NHS Boards there about all newly licensed medicines and formulations of existing medicines as well as the use of antimicrobiotics but does not assess vaccines, branded generics, non-prescription-only medicines (POMs), blood products and substitutes or diagnostic drugs. Some new drugs are available for prescription more quickly than in the rest of the UK. At times this has led to complaints.

Cost control

The National Audit Office
National Audit Office (United Kingdom)
The National Audit Office is an independent Parliamentary body in the United Kingdom which is responsible for auditing central government departments, government agencies and non-departmental public bodies...

 reports annually on the summarised consolidated accounts of the NHS
National Health Service (England)
The National Health Service or NHS is the publicly funded healthcare system in England. It is both the largest and oldest single-payer healthcare system in the world. It is able to function in the way that it does because it is primarily funded through the general taxation system, similar to how...

, and Audit Scotland
Audit Scotland
Audit Scotland is an independent public body in Scotland which was established in 2000 and is responsible for auditing most of Scotland's public organisations. These include the Scottish Government, local councils and NHS Scotland....

 performs the same function for NHS Scotland
NHS Scotland
NHS Scotland is the publicly funded healthcare system of Scotland. Although they are separate bodies the organisational separation between NHS Scotland and the other three healthcare organisations each commonly called the National Health Service in the United Kingdom tends to be hidden from its...

.

Parking charges

Parking charges at hospitals have been abolished in Scotland (except for 3 PFI hospitals) but continue to be in place at many hospitals in England.

Prescription charges

Northern Ireland
Northern Ireland
Northern Ireland is one of the four countries of the United Kingdom. Situated in the north-east of the island of Ireland, it shares a border with the Republic of Ireland to the south and west...

, Scotland
Scotland
Scotland is a country that is part of the United Kingdom. Occupying the northern third of the island of Great Britain, it shares a border with England to the south and is bounded by the North Sea to the east, the Atlantic Ocean to the north and west, and the North Channel and Irish Sea to the...

 and Wales
Wales
Wales is a country that is part of the United Kingdom and the island of Great Britain, bordered by England to its east and the Atlantic Ocean and Irish Sea to its west. It has a population of three million, and a total area of 20,779 km²...

 no longer have prescription charges. However, in England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...

, a prescription charge of £7.40 is payable per item, though patients under 16 years old (19 years if still in full-time education) or over 59 years get prescribed drugs are exempt from paying as are people with certain medical conditions, those on low incomes and those prescribed drugs for contraception.

Polyclinics

Polyclinics are being trialled in England alone, in London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...

 and other suburban areas.

Role of private sector in public healthcare

Whereas the UK Government is expanding the role of the private sector within the NHS in England, the current Scottish government is actively reducing the role of the private sector within public healthcare in Scotland and planning legislation to prevent the possibility of private companies running GP practices in future.

Funding and performance of healthcare since devolution

In January 2010 the Nuffield Trust
Nuffield Trust
The Nuffield Trust is a charitable trust based in London, whose aim is to produce independent analysis and debate on UK healthcare policy.Its principal activities include:*Holding meetings, workshops and seminars for people interested in UK healthcare...

 published a comparative study of NHS performance in England and the devolved administrations since devolution
Devolution
Devolution is the statutory granting of powers from the central government of a sovereign state to government at a subnational level, such as a regional, local, or state level. Devolution can be mainly financial, e.g. giving areas a budget which was formerly administered by central government...

, concluding that while Scotland, Wales and Northern Ireland have had higher levels of funding per capita than England, with the latter having fewer doctors, nurses and managers per head of population, the English NHS is making better use of the resources by delivering relatively higher levels of activity, crude productivity of its staff, and lower waiting times. However, the Nuffield Trust quickly issued a clarifying statement in which they admitted that the figures they used to make comparisons between Scotland and the rest of the UK were inaccurate due to the figure for medical staff in Scotland being overestimated by 27 per cent. Using revised figures for medical staffing, Scotland's ranking relative to the other devolved nations on crude productivity for medical staff changes, but there is no change relative to England. The Nuffield Trust study was comprehensively criticised by the BMA which concluded "whilst the paper raises issues which are genuinely worth debating in the context of devolution, these issues do not tell the full story, nor are they unambiguously to the disadvantage of the devolved countries. The emphasis on policies which have been prioritised in England such as maximum waiting times will tend to reflect badly on countries which have prioritised spending increases in other areas including non-health ones.

Further reading

  • Alcock, P. (2003) Social Policy in Britain. Houndmills: McMillan
  • Allsop, J. (1995) Health Policy and the NHS towards 2000. London: Longman
  • Ham, C. (2004) Health Policy in Britain. London: McMillan
  • Klein, R. (2006) The New Politics of the NHS: from creation to reinvention. Oxford: Radcliff Publishing
  • Thane, P. (1982) The Foundations of the Welfare State. Harlow: Longman.
  • Webster, C. (2002) The National Health Service: a political history. Oxford: Oxford University Press.
The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
x
OK