National Health Service (England)

National Health Service

Entrance to Richmond House in Whitehall.
Publicly funded health service overview
Formed	1948
Jurisdiction	England
Headquarters	Richmond House, 79 Whitehall, London, SW1A 2NS
Employees	1.4 million
Minister responsible	Jeremy Hunt, Secretary of State for Health
Publicly funded health service executive	Simon Stevens, Chief Executive of the National Health Service
Parent department	Department of Health
Child Publicly funded health service	211 Clinical commissioning groups

The National Health Service (NHS) is the publicly funded healthcare system for England. It is the largest and the oldest single-payer healthcare system in the world. Primarily funded through the general taxation system, the system provides healthcare to every legal resident in the United Kingdom, with most services free at the point of use. Some services, such as emergency treatment and treatment of infectious diseases are free for everyone, including visitors.^[1]

Free healthcare at the point of use comes from the core principles at the founding of the National Health Service by the United Kingdom Labour government in 1948. In practice, "free at the point of use" normally means that anyone legitimately fully registered with the system (i.e. in possession of an NHS number), including UK citizens and legal immigrants, can access the full breadth of critical and non-critical medical care without any out-of-pocket payment. Some specific NHS services do however require a financial contribution from the patient, for example eye tests, dental care, prescriptions, and aspects of long-term care. However, these charges are often free to vulnerable or low income groups, and when not free, often lower than equivalent services provided by a private health care provider.^[2][3]

The NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare, ophthalmology, and dentistry. The National Health Service Act 1946 came into effect on 5 July 1948. Private health care has continued parallel to the NHS, paid for largely by private insurance: it is used by about 8% of the population, generally as an add-on to NHS services. In the first decade of the 21st century, the private sector started to be increasingly used by the NHS to increase capacity. According to the BMA, a large proportion of the public opposed this move.^[4]

The NHS is largely funded from general taxation with a small amount being contributed by National Insurance payments^[5] and from fees levied in accordance with recent changes in the Immigration Act.^[6] The UK government department responsible for the NHS is the Department of Health, headed by the Secretary of State for Health. The Department of Health had a £110 billion budget in 2013-14, most of this being spent on the NHS.

Organization

There is no unified British NHS; the National Health Service in Scotland and Northern Ireland was always separate, and NHS Wales passed to the control of the devolved Welsh Government in 1999.^[7] In 2009 NHS England agreed a formal NHS constitution which sets out the legal rights and responsibilities of the NHS, its staff, and users of the service and makes additional non-binding pledges regarding many key aspects of its operations.^[8]

The Health and Social Care Act 2012 came into effect in April 2013, giving GP-led groups responsibility for commissioning most local NHS services. Starting in April 2013 Primary Care Trusts (PCTs) are being replaced by General Practitioner (GP) -led organisations called Clinical Commissioning Groups (CCGs). Under the new system, a new NHS Commissioning Board, called NHS England, oversees the NHS from the Department of Health.^[9] The Act has also become associated with the perception of increased private provision of NHS services. In reality, the provision of NHS services by private companies long precedes this legislation, but there are concerns that the new role of the healthcare regulator ('Monitor') could lead to increased use of private sector competition, balancing care options between private companies, charities, and NHS organisations.^[9] NHS Trusts are responding to the "Nicholson challenge" which involves making £20 billion in savings across the service by 2015.

History

A national health service was one of the fundamental assumptions in the Beveridge Report which Arthur Greenwood, Labour's Deputy Leader and wartime Cabinet Minister with responsibility for post-war reconstruction had successfully pressed the cabinet to commission from economist and social reformer William Beveridge.^[10] The government accepted this assumption in February 1943, and after a White Paper in 1944 it fell to Clement Attlee's Labour government to create the NHS as part of the "cradle to grave" welfare-state reforms in the aftermath of the Second World War. Aneurin Bevan, the newly appointed Minister of Health, was given the task of introducing the National Health Service.

Healthcare prior to the war had been an unsatisfactory mix of private, municipal and charity schemes. Bevan now decided that the way forward was a national system rather than a system operated by regional authorities, to prevent inequalities between different regions. He proposed that each resident of the UK would be signed up to a specific General Practice (GP) as the point of entry into the system, and would have access to any kind of treatment they needed without having to raise the money to pay for it.

Doctors were initially opposed to Bevan's plan, primarily on the stated grounds that it reduced their level of independence. Bevan had to get them onside, as, without doctors, there would be no health service. Being a shrewd political operator, Bevan managed to push through the radical health care reform measure by dividing and cajoling the opposition, as well as by offering lucrative payment structures for consultants. On this subject he stated, "I stuffed their mouths with gold". On 5 July 1948, at the Park Hospital (now known as Trafford General Hospital) in Manchester, Bevan unveiled the National Health Service and stated, "We now have the moral leadership of the world".

After the publication by the British Medical Journal on 24 December 1949 of University of Cambridge paediatrician Douglas Gairdner's landmark paper detailing the lack of medical benefit and the risks attached to non-therapeutic (routine) circumcision,^[11] the National Health Service decided that circumcision would not be performed unless there was a clear and present medical indication.^[12]

The cost of the new NHS soon took its toll on government finances. On 21 April 1951 the Chancellor of the Exchequer, Hugh Gaitskell, proposed that there should be a one shilling (5p) prescription charge and new charges for half the cost of dentures and spectacles. Bevan resigned from the Cabinet in protest. This led to a split in the party that contributed to the electoral defeat of the Labour government in 1951. The one shilling prescription charge was introduced in 1952 together with a £1 flat rate fee for ordinary dental treatment. Prescription charges were abolished in 1965, but re-introduced in June 1968.

Dr A. J. Cronin's highly controversial novel The Citadel, published in 1937, had fomented extensive dialogue about the severe inadequacies of health care. The author's innovative ideas were not only essential to the conception of the NHS, but in fact, his best-selling novels are even said to have greatly contributed to the Labour Party's victory in 1945.^[13]

On 13 November 2011 the government signed off on the 10-year contract to manage the debt-laden Hinchingbrooke Hospital in Huntingdon, Cambridgeshire by Circle Healthcare. It was the first time that an NHS hospital was to be taken over by a stock-market listed company.^[14]

There have been documented failures of some parts of the National Health Service to provide adequate care at a basic level. These failures were associated with bureaucratic fumbling as local institutions attempted to meet conflicting demands with inadequate resources.^[15] This notwithstanding, the NHS has received consistently strong approval and support from citizens.

Core principles

The principal NHS website states the following as core principles:^[16]

The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth. At its launch by the then minister of health, Aneurin Bevan, on 5 July 1948, it had at its heart three core principles:

• That it meet the needs of everyone
• That it be free at the point of delivery
• That it be based on clinical need, not ability to pay

These three principles have guided the development of the NHS over more than half a century and remain. However, in July 2000, a full-scale modernisation programme was launched and new principles added.

The main aims of the additional principles are that the NHS will:

• Provide a comprehensive range of services
• Shape its services around the needs and preferences of individual patients, their families and their carers
• Respond to the different needs of different populations
• Work continuously to improve the quality of services and to minimize errors
• Support and value its staff
• Use public funds for healthcare devoted solely to NHS patients
• Work with others to ensure a seamless service for patients
• Help to keep people healthy and work to reduce health inequalities
• Respect the confidentiality of individual patients and provide open access to information about services, treatment and performance

Structure

The English NHS is controlled by the UK government through the Department of Health (DH), which takes political responsibility for the service. Resource allocation and oversight was delegated to NHS England, an arms-length body, by the Health and Social Care Act 2012. NHS England commissions primary care services (including GPs) and some specialist services, and allocates funding to 211^[17] geographically-based Clinical Commissioning Groups (CCGS) across England. The CCGs commission most services in their areas, including hospital and community-based healthcare.^[18]

A number of types of organisation are commissioned to provide NHS services, including NHS trusts and private sector companies. Many NHS trusts have become NHS foundation trusts, giving them an independent legal status and greater financial freedoms. The following types of NHS trusts and foundation trusts provide NHS services in specific areas:^[19]

• NHS acute trusts administer hospitals, treatment centres and specialist care in around 1,600 NHS hospitals (some trusts run between 2 and 8 different hospital sites)
• NHS ambulance services trusts
• NHS care trusts, providing both health and social care services
• NHS mental health trusts, specialising in managing and treating mental illness, including by the use of involuntary commitment powers

Some services are provided at a national level, including:

• www.nhs.uk is the primary public-facing NHS website, providing comprehensive official information on services, treatments, conditions, healthy living and current health topics
• NHS special health authorities provide various types of services

Nearly all hospital doctors and nurses in England are employed by the NHS and work in NHS-run hospitals, with teams of more junior hospital doctors (most of whom are in training) being led by consultants, each of whom is trained to provide expert advice and treatment within a specific specialty. But General Practitioners, dentists, optometrists (opticians) and other providers of local health care are almost all self-employed, and contract their services back to the NHS. They may operate in partnership with other professionals, own and operate their own surgeries and clinics, and employ their own staff, including other doctors etc. However, the NHS does sometimes provide centrally employed health care professionals and facilities in areas where there is insufficient provision by self-employed professionals.

In 2009, the NHS Hospital & Community Health Service plus the General Practice service had a total workforce of a little under 1.18 million full-time equivalent of which 0.61 m were qualified clinical staff such as doctors (0.13 million), nurses (0.34 m), scientists, therapists and technical staff (0.13 m), and ambulance staff (0.02 m).^[20] It has been claimed that the NHS is the third or fifth largest workforce in the world, after the Chinese Army, Indian Railways and (as argued by Jon Hibbs, the NHS's head of news, in a press release from 22 March 2005) Wal-Mart and the United States Department of Defense.^[21][22] A recent analysis by the BBC placed the NHS fifth on the list of the world's largest employers (well above Indian Railways).^[23]

The NHS also plays a unique role in the training of new doctors in England, with approximately 8000 places for student doctors each year, all of which are attached to an NHS University Hospital trust. After completing medical school, these new doctors must go on to complete a two-year foundation training programme to become fully registered with the General Medical Council. Most go on to complete their foundation training years in an NHS hospital although some may opt for alternative employers such as the armed forces.^[24]

Most staff working for the NHS including non-clinical staff and GPs (most of whom [GP's] are self-employed) are eligible to join the NHS Pension Scheme which, from 1 April 2015, is an average-salary defined-benefit scheme.

2011 reforms

The coalition government's white paper on health reform, published on 12 July 2010, sets out the most significant reorganisation of the NHS in its history. The white paper, Equity and excellence: liberating the NHS,^[25] has implications for all health organisations in the NHS and very significant changes for PCTs and strategic health authorities. It aims to shift power from the centre to GPs and patients, moving somewhere between £60 to £80 billion into the hands of groups of GPs to commission services. The new commissioning system is expected to be in place by April 2013, by which time SHAs and PCTs will be abolished.

Following widespread criticism of the plans, on 4 April 2011, the Government announced a "pause" in the progress of the Health and Social Care Bill to allow the government to 'listen, reflect and improve' the proposals.^[26][27]

The bill became law on Tuesday 20 March 2012. After more than 1,000 amendments in the House of Commons and the House of Lords, MPs cast their final vote for the bill, with a government majority of 88.

Funding

The money to pay for the NHS comes directly from taxation. The 2008/9 budget roughly equates to a contribution of £1,980 for every man, woman and child in the UK.^[28]

When the NHS was launched in 1948 it had a budget of £437million (roughly £9billion at today’s value).^[29] In 2008/9 it received over 10 times that amount (more than £100billion).

This equates to an average rise in spending over the full 60-year period of about 4% a year once inflation has been taken into account. However, in recent years investment levels have been double that to fund a major modernisation programme.

Some 60% of the NHS budget is used to pay staff. A further 20% pays for drugs and other supplies, with the remaining 20% split between buildings, equipment and training costs on the one hand and medical equipment, catering and cleaning on the other. Nearly 80% of the total budget is distributed by local trusts in line with the particular health priorities in their areas.

The total budget of Department of Health in England in 2013/14 was £110bn.^[30] £13.8 Billion was spent on medicines.^[31] The National Audit Office reports annually on the summarised consolidated accounts of the NHS.^[32]

The commissioning system

From 2003 to 2013 the principal fundholders in the NHS system were the NHS Primary Care Trusts (PCTs), that commissioned healthcare from NHS trusts, GPs and private providers. PCTs disburse funds to them on an agreed tariff or contract basis, on guidelines set out by the Department of Health. The PCTs received a budget from the Department of Health on a formula basis relating to population and specific local needs. They were supposed to "break even" - that is, not show a deficit on their budgets at the end of the financial year. Failure to meet financial objectives can result in the dismissal and replacement of a Trust's Board of Directors, although such dismissals are enormously expensive for the NHS.^[33]

From April 2013 a new system was established as a result of the Health and Social Care Act 2012. The NHS budget is largely in the hands of a new body, NHS England. NHS England commission specialist services and primary care. Acute services and community care is commissioned by local Clinical Commissioning Groups which are led by GPs.

Free services and contributory services

Services free at the point of use

The vast majority of NHS services are free at the point of use.

This means that people generally do not pay anything for their doctor visits, nursing services, surgical procedures or appliances, consumables such as medications and bandages, plasters, medical tests, and investigations, x-rays, CT or MRI scans etc. Hospital inpatient and outpatient services are free, both medical and mental health services. Funding for these services is provided through general taxation and not a specific tax.

Because the NHS is not funded by contributory insurance scheme in the ordinary sense and most patients pay nothing for their treatment there is thus no billing to the treated person nor to any insurer or sickness fund as is common in many other countries. This saves hugely on administration costs which might otherwise involve complex consumable tracking and usage procedures at the patient level and concomitant invoicing, reconciliation and bad debt processing.

Eligibility for free NHS services is based on having "permanent residence status" (a birthright for some or granted by the Home Office for those who have immigrated). The person must be registered with a general practitioner and have an NHS card and number. This will include overseas students with a visa to study at a recognized institution for 6 months or more, but not visitors on a tourist visa for example. From April 2015 onwards there will be an immigration health surcharge applied to most visa applications, the proceeds of which will go directly to funding the NHS. The surcharge amount will either be £150 or £200 in respect of each year of the visa's duration, to be paid in full by the migrant when the visa application is submitted.^[34]

Citizens of the EU holding a valid European Health Insurance Card and persons from certain other countries with which the UK has reciprocal arrangements concerning health care can likewise get emergency treatment without charge.

In England, from 15 January 2007, anyone who is working outside the UK as a missionary for an organisation with its principal place of business in the UK is fully exempt from NHS charges for services that would normally be provided free of charge to those resident in the UK. This is regardless of whether they derive a salary or wage from the organisation, or receive any type of funding or assistance from the organisation for the purposes of working overseas. This is in recognition of the fact that most missionaries would be unable to afford private health care and those working in developing countries should not effectively be penalised for their contribution to development and other work.

Those who are not "ordinarily resident" who do not fall into the above category (including British citizens who may have paid National Insurance contributions in the past) are liable to charges for services.

There are some other categories of people who are exempt from the residence requirements such as specific government workers and those in the armed forces stationed overseas.

Prescription charges

As of April 2014 the NHS prescription charge in England was £8.05 for each quantity of medicine^[35] (which contrasts with Scotland, Wales and Northern Ireland^[36] where items prescribed on the NHS are free). People over sixty, children under sixteen (or under nineteen if in full-time education), patients with certain medical conditions, and those with low incomes, are exempt from paying. Those who require repeated prescriptions may purchase a single-charge pre-payment certificate which allows unlimited prescriptions during its period of validity. The charge is the same regardless of the actual cost of the medicine, but higher charges apply to medical appliances. For more details of prescription charges, see Prescription charges.

The high and rising costs of some medicines, especially some types of cancer treatment, means that prescriptions can present a heavy burden to the PCTs, whose limited budgets include responsibility for the difference between medicine costs and the fixed prescription charge. This has led to disputes whether some expensive drugs (e.g. Herceptin) should be prescribed by the NHS.^[37]

NHS dentistry

Main article NHS dentistry

Where available, NHS dentistry charges as of April 2015 were: £18.80 for an examination; £50.30 for a filling or extraction; and £222.50 for more complex procedures such as crowns, dentures or bridges.^[38] Less than 50% of the turnover of dentists comes from work contracted from the NHS.^[39]

NHS Optical Services

From 1 April 2007 the NHS Sight Test Fee (in England) was £19.32, and there were 13.1 million NHS sight tests carried out in the UK.

For those who qualify through need, the sight test is free, and a voucher system is employed to pay for or reduce the cost of lenses. There is a free spectacles frame and most opticians keep a selection of low-cost items. For those who already receive certain means-tested benefits, or who otherwise qualify, participating opticians use tables to find the amount of the subsidy.

Where vouchers do not cover the cost of the selected product, they reduce the cost at their face value. Although these voucher values are the maximum amounts that opticians can recover from the NHS, they might well make additional marketing offers of their own. See the external site Optical Voucher Values for a full NHS listing that includes varifocals, contact lenses, and essential coatings.

Injury cost recovery scheme

Under older legislation (mainly the Road Traffic Act 1930) a hospital treating the victims of a road traffic accident was entitled to limited compensation (under the 1930 Act before any amendment, up to £25 per person treated) from the insurers of driver(s) of the vehicle(s) involved, but were not compelled to do so and often did not do so; the charge was in turn covered by the then legally required element of those drivers' motor vehicle insurance (commonly known as Road Traffic Act insurance when a driver held only that amount of insurance). As the initial bill was sent to the driver rather than to his/her insurer, even when a charge was imposed it was often not passed on to the liable insurer; it was common for no further action to be taken in such cases as there was no practical financial incentive (and often a financial disincentive due to potential legal costs) for individual hospitals to do so.

The Road Traffic (NHS Charges) Act 1999 introduced a standard national scheme for recovery of costs using a tariff based on a single charge for out-patient treatment or a daily charge for in-patient treatment; these charges again ultimately fell upon insurers. This scheme did not however fully cover the costs of treatment in serious cases.

Since January 2007, the NHS has a duty to claim back the cost of treatment, and for ambulance services, for those who have been paid personal injury compensation.^[40] In the last year of the scheme immediately preceding 2007, over £128 million was reclaimed.^[41]

Car park charges

Car parking charges are a minor source of revenue for the NHS,^[42] with most hospitals deriving about 0.25% of their budget from them.^[43] The level of fees is controlled individually by each trust.^[42] In 2006 car park fees contributed £78 million towards hospital budgets.^[42][43] Patient groups are opposed to such charges.^[42] (This contrasts with Scotland where car park charges were mostly scrapped from the beginning of 2009^[44] and with Wales where car park charges were scrapped at the end of 2011.)^[45]

Charitable funds

There are over 300 official NHS charities in England and Wales. Collectively, they hold assets in excess of £2bn and have an annual income in excess of £300m.^[46] Some NHS charities have their own independent board of trustees whilst in other cases the relevant NHS Trust acts as a corporate Trustee. Charitable funds are typically used for medical research, larger items of medical equipment, aesthetic and environmental improvements, or services which increase patient comfort.

In addition to official NHS charities, many other charities raise funds which are spent through the NHS, particularly in connection with medical research and capital appeals.

Regional lotteries were also common for fundraising, and in 1988, a National Health Service Lottery was approved by the government, before being found to be illegal. The idea continued to become the National Lottery.^[47]

Financial outlook

As each division of the NHS is required to break even at the end of each financial year, the service should in theory never be in deficit. However in recent years overspends have meant that, on a 'going-concern' (normal trading) basis, these conditions have been consistently, and increasingly, breached. Former Secretary of State for Health Patricia Hewitt consistently asserted that the NHS would be in balance at the end of the financial year 2007-8;^[48] however, a study by Professor Nick Bosanquet for the Reform think tank predicts a true annual deficit of nearly £7bn in 2010.^[49]

NHS policies and programmes

Changes under the Thatcher government

The 1980s saw the introduction of modern management processes (General Management) in the NHS to replace the previous system of consensus management. This was outlined in the Griffiths Report of 1983.^[50] This recommended the appointment of general managers in the NHS with whom responsibility should lie. The report also recommended that clinicians be better involved in management. Financial pressures continued to place strain on the NHS. In 1987, an additional £101 million was provided by the government to the NHS. In 1988 Prime Minister Margaret Thatcher announced a review of the NHS. From this review in 1989 two white papers Working for Patients and Caring for People were produced. These outlined the introduction of what was termed the "internal market", which was to shape the structure and organisation of health services for most of the next decade.

In England, the National Health Service and Community Care Act 1990 defined this "internal market", whereby health authorities ceased to run hospitals but "purchased" care from their own or other authorities' hospitals. Certain GPs became "fund holders" and were able to purchase care for their patients. The "providers" became independent trusts, which encouraged competition but also increased local differences. Increasing competition may have been statistically associated with poor patient outcomes.^[51]

Changes under the Blair government

These innovations, especially the "fund holder" option, were condemned at the time by the Labour Party. Opposition to what was claimed to be the Conservative intention to privatise the NHS became a major feature of Labour's election campaigns.

Labour came to power in 1997 with the promise to remove the "internal market" and abolish fundholding. However in his second term Blair renounced this direction. He pursued measures to strengthen the internal market as part of his plan to "modernise" the NHS.

A number of factors drove these reforms. They include the rising costs of medical technology and medicines, the desire to improve standards and "patient choice", an ageing population, and a desire to contain government expenditure. (Since the National Health Services in Wales, Scotland and Northern Ireland are not controlled by the UK government, these reforms have increased the differences between the National Health Services in different parts of the United Kingdom. See NHS Wales and NHS Scotland for descriptions of their developments).

Reforms included (amongst other actions) the laying down of detailed service standards, strict financial budgeting, revised job specifications, reintroduction of "fundholding" (under the description "practice-based commissioning"), closure of surplus facilities and emphasis on rigorous clinical and corporate governance. Some new services were developed to help manage demand, including NHS Direct. The Agenda for Change agreement aimed to provide harmonised pay and career progression. These changes have, however, given rise to controversy within the medical professions, the news media and the public. The British Medical Association in 2009 in a document on Independent Sector Treatment Centres urged the Government to restore the NHS to a service based on public provision, not private ownership; co-operation, not competition; integration, not fragmentation; public service, not private profits.^[52]

The Blair Government, whilst leaving services free at point of use, encouraged outsourcing of medical services and support to the private sector. Under the Private Finance Initiative, an increasing number of hospitals were built (or rebuilt) by private sector consortia; hospitals may have both medical services such as independent Sector Treatment Centres (ISTCs)^[53] and non-medical services such as catering provided under long-term contracts by the private sector. A study by a consultancy company which works for the Department of Health shows that every £200 million spent on privately financed hospitals will result in the loss of 1000 doctors and nurses. The first PFI hospitals contain some 28 per cent fewer beds than the ones they replaced.^[54]

The NHS was also required to take on pro-active socially "directive" policies, for example, in respect of smoking and obesity.

Internet information service

In the 1980s and 90s, NHS IT spent money on several failed IT projects. The Wessex project, in the 1980s, attempted to standardise IT systems across a regional health authority. The London Ambulance Service was to be a computer-aided dispatch system. Read codes was an attempt to develop a new electronic language of health.^[55]

The NHS Information Authority (NHSIA) was established by an Act of Parliament in 1999 with the goal to bring together four NHS IT and Information bodies (NHS Telecoms, Family Health Service (FHS), NHS Centre for Coding and Classification (CCC) and NHS Information Management Group (IMG)) to work together to deliver IT infrastructure and information solutions to the NHS in England. A 2002 plan was for NHSIA to implement four national IT projects: Basic infrastructure, Electronic records, Electronic prescribing, and Electronic booking, modeled after the large NHS Direct tele-nurse and healthcare website program.^[55] The NHSIA functions were divided into other organizations by April 2005.

In 2002, the NHS National Programme for IT (NPfIT) was announced by the Department of Health.

Despite problems with internal IT programmes, the NHS has broken new ground in providing health information to the public via the internet. In June 2007 www.nhs.uk was relaunched under the banner "NHS Choices" as a comprehensive health information service for the public.

In a break with the norm for government sites, www.nhs.uk allows users to add public comments giving their views on individual hospitals and to add comments to the articles it carries. It also publishes blogs on a range of health topics written by patients, carers and clinicians and enables users to compare hospitals for treatment via a "scorecard".^[56] In April 2009 it became the first official site to publish hospital death rates (Hospital Standardised Mortality Rates) for the whole of England. Its Behind the Headlines daily health news analysis service, which critically appraises media stories and the science behind them, was declared Best Innovation in Medical Communication in the prestigious BMJ Group Awards 2009.^[57]

11 of the NHS hospitals in the West London Cancer Network have been linked using the IOCOM Grid System. The NHS has reported that the Grid has helped increase collaboration and meeting attendance and even improved clinical decisions.^[58]

Health screening for over 40s

From 1 April 2008, everyone over 40 years old will be offered health checks for heart disease, stroke, diabetes and kidney disease under new government plans. However, doctors currently reserve judgment on the effectiveness of the policy.^[59]

Public satisfaction and criticism

An independent survey conducted in 2004 found that users of the NHS often expressed very high levels of satisfaction about their personal experience of the medical services. Of hospital inpatients, 92% said they were satisfied with their treatment; 87% of GP users were satisfied with their GP; 87% of hospital outpatients were satisfied with the service they received; and 70% of Accident and Emergency department users reported being satisfied.^[60] When asked whether they agreed with the question "My local NHS is providing me with a good service” 67% of those surveyed agreed with it, and 51% agreed with the statement “The NHS is providing a good service." ^[60] The reason for this disparity between personal experience and overall perceptions is not clear, however researchers at King's College London found high profile media spectacles may function as part a wider 'blame business', in which the media, lawyers and regulators have vested interests.^[61][62] It is also apparent from the satisfaction survey that most people believe that the national press is generally critical of the service (64% reporting it as being critical compared to just 13% saying the national press is favourable), and also that the national press is 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) .^[60] 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).^[60]

Some examples of criticism include:

1. Some extremely expensive treatments may be available in some areas but not in others, the so-called postcode lottery.^[63]
2. The National Programme for IT which was designed to provide the infrastructure for electronic prescribing, booking appointments and elective surgery, and a national care records service. The programme ran into delays and overspends before it was finally abandoned.
3. In 2008 there was a decreasing availability of NHS dentistry following a new government contract^[64] and a trend towards dentists accepting private patients only,^[65] with 1 in 10 dentists having left the NHS totally. However, the number of NHS dental patients is now increasing.^[66]
4. There have been a number of high-profile scandals within the NHS. Most recently there have been scandals at acute hospitals such as at Alder Hey and at the Bristol Royal Infirmary. Stafford Hospital is currently under investigation for poor conditions and inadequacies that statistical analysis has shown caused excess deaths.
5. A 14 October 2008 article in The Daily Telegraph stated, "An NHS trust has spent more than £12,000 on private treatment for hospital staff because its own waiting times are too long." ^[67]
6. In January 2010, the NHS was accused of allocating £4 million annually on homeopathic medicines, which are unsupported by scientific research.^[68]
7. The absence of identity/residence checks on patients at clinics and hospitals allows people who ordinarily reside overseas to travel to the UK for the purpose of obtaining free treatment, at the expense of the UK taxpayer. A report published in 2007 estimates that the NHS bill for treatment of so-called ‘health tourists’ was £30m, 0.03% of the total cost.^[69]

NHS mental health services is one area that tends to receive regular criticism from service users and the public, for sometimes opposing reasons.^{[70][71][72][73][74]}

Quality of healthcare, and accreditation

There are many regulatory bodies with a role in the NHS, both government-based (e.g. Department of Health, General Medical Council, Nursing and Midwifery Council),and non-governmental-based (e.g. Royal Colleges). Independent accreditation groups exist within the UK, such as the public sector Trent Accreditation Scheme and the private sector CHKS.

With respect to assessing, maintaining and improving the quality of healthcare, in common with many other developed countries, the UK government has separated the roles of suppliers of healthcare and assessors of the quality of its delivery. Quality is assessed by independent bodies such as the Healthcare Commission according to standards set by the Department of Health and the National Institute for Health and Clinical Excellence. Responsibility for assessing quality transferred to the Care Quality Commission in April 2009.

A comparative analysis of health care systems in 2010 put the NHS second in a study of seven rich countries.^[75][76] The report put the UK health systems above those of Germany, Canada and the US; the NHS was deemed the most efficient among those health systems studied.

Performance

In 2014 the Nuffield Trust and the Health Foundation produced a report comparing the performance of the NHS in the four countries of the UK since devolution in 1999. They included data for the North East of England as an area more similar to the devolved areas than the rest of England. They found that there was little evidence that any one country was moving ahead of the others consistently across the available indicators of performance. There had been improvements in all four countries in life expectancy and in rates of mortality amenable to health care. Despite the hotly contested policy differences between the four countries there was little evidence, where there was comparable data, of any significant differences in outcomes. The authors also complained about the increasingly limited set of comparable data on the four health systems of the UK.^[77]

See also

• Emergency medical services in the United Kingdom
• Evidence-based medicine
• General Medical Council
• Genomics England
• Health
• Health and Social Care in Northern Ireland
• Health forecasting
• Health policy analysis
• Health Service Executive (Republic of Ireland)
• Healthcare in the United Kingdom
• Hospital accreditation
• Independent Sector Treatment Centre
• List of NHS Trusts
• NHS Constitution for England
• NHS England
• NHS Scotland
• NHS Wales
• Private hospital
• Publicly funded health care
• School health services
• Socialised medicine
• NHS Credit Union

References

External links

Look up bed blocker in Wiktionary, the free dictionary.

Wikiquote has quotations related to: National Health Service (England)

Wikimedia Commons has media related to National Health Service.

English NHS and related government sites

• NHS Choices - The UK's biggest health website and online 'front door' to the NHS
• NHS Bristol launches iPhone mobile app NHS Bristol's appointment reminder app
• NHS Direct - The NHS telephone advice service
• About the NHS: Overview - NHS Choices
• The NHS in England - NHS Choices
• NHS Services - NHS Choices
• NHS: Rights and pledges - NHS Choices
• NHS Professionals Special Health Authority
• Department of Health
• NHS Direct jobs and careers
• NHS local a range of digital services for NHS staff and the public in the West Midlands.

Shared with other UK health services

• NHS Confederation
• NHS Employers
• National Library for Health previously called the National Electronic Library for Health

Other sites

• NHS guide from the BBC - includes charts and statistics
• BBC coverage of NHS 50th anniversary
• Guardian Special Report - National Health Service
• History of the Tredegar Medical Aid Society
• From Cradle to Grave - the first 50 years of the NHS 1998 - 2007 the contemporary chapter dealing with the NHS in England
• NHS Optical Benefits in the UK A WikiBooks page
• 'The Origins of the NHS', by Professor Berridge, Gresham College, 14 April 2008 (available for video, audio and text download).
• Birth of the National Health Service - how the state of the nation's health became a political ideal, a BBC archive collection of programmes and documents.
• NHS Constitution(PDF)
• Text reminders could save NHS millions every year

Further reading

• Allyson M Pollock (2004), NHS plc: the privatisation of our healthcare. Verso. ISBN 1-84467-539-4 (Polemic against PFI and other new finance initiatives in the NHS)
• Rudolf Klein (2010), The New Politics of the NHS: From creation to reinvention. Radcliffe Publishing ISBN 978-1-84619-409-2 ( Authoritative analysis of policy making (political not clinical)in the NHS from its birth to the end of 2009)
• Geoffrey Rivett (1998) From Cradle to Grave, 50 years of the NHS. Kings Fund, 1998, Covers both clinical developments in the 50 years and financial/political/organisational ones. kept up to date at www.nhshistory.net

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