업체명 : Overview of Healthcare in The UK

Received 2010 Sep 1; Accepted 2010 Sep 27; Issue date 2010 Dec.

. The National Health System in the UK has actually developed to end up being one of the biggest healthcare systems worldwide. At the time of writing of this review (August 2010) the UK federal government in its 2010 White Paper "Equity and excellence: Liberating the NHS" has actually announced a technique on how it will "develop a more responsive, patient-centred NHS which achieves outcomes that are amongst the finest in the world". This review short article presents an overview of the UK health care system as it currently stands, with emphasis on Predictive, Preventive and Personalised Medicine components. It intends to serve as the basis for future EPMA short articles to broaden on and present the modifications that will be carried out 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 aftermath of the Second World War and became functional on the 5th 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 legacy of Aneurin Bevan, a former miner who became a politician and the then Minister of Health. He established the NHS under the principles of universality, totally free at the point of shipment, equity, and paid for by central financing [1] Despite various political and organisational modifications the NHS remains to date a service readily available universally that looks after people on the basis of need and not capability to pay, and which is moneyed by taxes and national insurance contributions.

Healthcare and health policy for England is the responsibility of the main government, whereas in Scotland, Wales and Northern Ireland it is the obligation of the particular devolved 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, healthcare consists of 2 broad sections; one handling strategy, policy and management, and the other with real medical/clinical care which remains in turn divided into primary (community care, GPs, Dentists, Pharmacists etc), secondary (hospital-based care accessed through GP recommendation) and tertiary care (specialist medical facilities). Increasingly distinctions between the 2 broad sections 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 caused a greater shift towards local instead of central decision making, elimination of barriers in between primary and secondary care and more powerful emphasis on client choice [2, 3] In 2008 the previous federal government enhanced this instructions in its health strategy "NHS Next Stage Review: High Quality Care for All" (the Darzi Review), and in 2010 the present federal government's health technique, "Equity and quality: Liberating the NHS", remains supportive of the very same concepts, albeit through possibly different mechanisms [4, 5]

The UK federal government has actually just announced plans that according to some will produce the most extreme change in the NHS considering that its beginning. In the 12th July 2010 White Paper "Equity and quality: Liberating the NHS", the present Conservative-Liberal Democrat coalition government outlined a technique on how it will "create a more responsive, patient-centred NHS which achieves results that are among the very best in the world" [5]

This evaluation post will therefore present a summary of the UK healthcare system as it presently stands with the goal to serve as the basis for future EPMA articles to expand and provide the changes that will be implemented within the NHS in the forthcoming months.

The NHS in 2010

The Health Act 2009 established the "NHS Constitution" which formally combines the purpose and principles of the NHS in England, its worths, as they have actually been established by clients, public and staff and the rights, pledges and duties of patients, public and personnel [6] Scotland, Northern Ireland and Wales have also agreed to a high level statement declaring the concepts of the NHS throughout the UK, despite the fact that services might be supplied in a different way in the four countries, showing their various health requirements and scenarios.

The NHS is the largest employer 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 physicians, a 4% increase on the previous year, and 408,160 nursing personnel (Table 1). Interestingly the Kings Fund approximates that, while the overall number of NHS personnel increased by around 35% between 1999 and 2009, over the same duration the number of supervisors increased by 82%. As a proportion of NHS staff, the number of supervisors increased 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 personal costs. The net NHS expense per head across the UK was least expensive in England (₤ 1,676) and greatest in Scotland (₤ 1,919) with Wales and Northern Ireland at roughly the exact same level (₤ 1,758 and ₤ 1,770, respectively) [8]

Table 1.

The distribution of according to main 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 shown in Fig. 1. In England the Department of Health is responsible for the direction of the NHS, social care and public health and shipment of health care by establishing policies and techniques, securing resources, keeping track of performance and setting national requirements [9] Currently, 10 Strategic Health Authorities manage the NHS at a regional level, and Medical care Trusts (PCTs), which currently manage 80% of the NHS' budget, provide governance and commission services, along with make sure the availability of services for public heath care, and arrangement of community services. Both, SHAs and PCTs will stop to exist as soon as the plans laid out in the 2010 White Paper become carried out (see section below). NHS Trusts run on a "payment by results" basis and acquire the majority of their earnings by supplying health care that has been commissioned by the practice-based commissioners (GPs, etc) and PCTs. The main types of Trusts consist of Acute, Care, Mental Health, Ambulance, Children's and Foundation Trusts. The latter were created as non-profit making entities, totally free of government control however also increased financial obligations and are regulated by an independent Monitor. The Care Quality Commission controls separately health and adult social care in England overall. Other professional 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 nationwide guidelines and requirements connected to, health promotion and avoidance, assessment of new and existing technology (consisting of medications and treatments) and treatment and care clinical guidance, offered across the NHS. The health research study strategy of the NHS is being implemented through National Institute of Health Research (NIHR), the total spending plan for which was in 2009/10 near ₤ 1 billion (www.nihr.ac.uk) [10]

Fig. 1.