Healthcare in the United Kingdom
From Wikipedia, the free encyclopedia
Healthcare in the United Kingdom is mainly provided to all UK permanent residents (and overseas visitors for certain treatments[1]) by publicly-funded health care systems that are paid for from general taxation but provide healthcare to patients that is free at the point of need. Although commonly referred to as the "National Health Service" ("NHS") across the UK, the National Health Service just covers England with NHS Scotland covering Scotland, NHS Wales covering Wales and the Department of Health, Social Services and Public Safety providing healthcare in Northern Ireland. Since healthcare is a devolved matter, there are growing differences between the different systems.[2]
In addition to the public NHS systems (which dominate healthcare in the UK), private healthcare and a wide variety of alternative and complementary treatments are available.
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[edit] Healthcare in England
[edit] Public Healthcare
The National Health Service (NHS) is the publicly funded healthcare system in England. The NHS provides healthcare to anyone normally resident in the UK with most services free at the point of use for the patient though there are charges associated with eye tests, dental care, prescriptions, and many aspects of personal care. The National Health Service Act 1946 came into effect on 5 July 1948. The NHS is largely funded from general taxation (including a proportion from National Insurance payments)[3]. The UK government department responsible for the NHS is the Department of Health, headed by the Secretary of State for Health (Health Secretary), who sits in the British Cabinet. Most of the expenditure of The Department of Health (£98.6 billion in 2008-9[4]) is spent on the NHS. The NHS is the world's largest health service and the world's fourth-largest employer; only the Chinese People's Liberation Army, Indian Railways, and Wal-Mart employ more people directly.[5]
The NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare, ophthalmology and dentistry. A patient needing specialist care at a hospital or clinic, will be informed by the GP of the choice available and helped to decide. Since opting for a private hospital makes the patient liable for fees, most choose a free NHS hospital. GP's inform hospitals of their patient's conditions and the hospitals judge the urgency of each against other patients, with urgent need being met almost immediately and others getting appointments. The median wait time for a consultant led first appointment in English hospitals is a little over 3 weeks. [6] Patients can be seen by the hospital as out-patients or in-patients, with the latter involving overnight stay. The speed of in-patient admission is based on medical need and time waiting with more urgent cases faster though all cases will be dealt with eventually. Patient can ask for a private hospital referral at any time which may provide earlier treatment but at full cost to the patient. For those not admitted ímmediately, the median wait time for in-patient treatment in English hospitals is a little under 6 weeks Ibid. The government is introducing an 18 week guarantee that means that the hospital must complete all tests and start treatment within 18 weeks of the date of the referral from the GP. Trusts are now working towards achieving this target by December 2008. Some hospitals are introducing just in time workflow analysis borrowed from manufacturing industry to speed up the processes within the system and improve efficiencies. [7]
Almost all NHS hospital treatment is free of charge along with drugs administered in hospital, surgical consumables and appliances issued or loaned. However, if a patient has chosen to be treated in an NHS hospital as a private fee paying patient by arrangement with his consultant, the patient (or the insurance company) will be billed. This can happen because at the inception of the NHS, hospital consultants were allowed to continue doing private work in NHS hospitals and can enable private patients to "jump the NHS queue". This arrangement is nowadays quite rare as most consultants and patients choose to have private work done in private hospitals.
Emergency Department (traditionally known as Accident and Emergency) treatment is also free of charge. A triage nurse prioritises all patients on arrival. Waiting times can be up to 4 hours if a patient goes to the Emergency Department with a minor problem or may be referred to other agencies (e.g. pharmacy, GP, Walk in clinic). Emergency Departments try to treat patients within 4 hours as part of NHS targets for emergency care.[citation needed] The Emergency Department is always attached to an NHS general hospital. Private hospitals do not provide emergency care services.
The NHS also provides end of life palliative care in the form of Palliative Care Specialist Nurses. The NHS can also commission the expertise of organisations in the voluntary sector to compliment palliative care. Such organisations include Marie Curie Cancer Care, Sue Ryder Care and Macmillan Cancer Support. Despite their names, these services are designed for all palliative conditions, not exclusively cancer. All palliative care services provide support for both the patient and their relatives during and after the dying process. Again, these are all free of charge to the patient.
[edit] Private-sector medical care
England has an active private sector in health care providing similar treatments to the public healthcare systems. Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population, and generally as a top-up to NHS services. Recently the private sector has been increasingly used to increase NHS capacity despite a large proportion of the public opposing such involvement according to one survey by the BMA[8]. Private health care is sometimes funded by employers through medical insurance as part of a benefits package to employees though it is mostly the larger companies that do. Insurers also market policies directly to the public.
The private sector is now doing subcontracting work for the NHS [9]. Thus an NHS patient can be treated in the private sector as an NHS patient if the Health Services has subcontracted work to the hospital. This development is still in its infancy and quite rare.
Some private hospitals are business enterprises and some are non-profit-making trusts. Some hospital groups provide insurance plans (e.g. BUPA) and some insurance companies have deals with particular private hospital groups. Some private sector patients can be treated in NHS hospitals in which case the patient or his/her insurance company is billed.
[edit] Healthcare in Scotland
[edit] Public healthcare
Public healthcare in Scotland is provided by NHS Scotland. The National Health Service (NHS) in Scotland was created in 1948 at the same time as the NHS was created for England and Wales. 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. Healthcare policy and funding is the responsibility of the Scottish Government's Health and Wellbeing Directorate. The current Cabinet Secretary for Health and Wellbeing is Nicola Sturgeon and the Director-General (DG) Health and Chief Executive, NHS Scotland is Dr Kevin Woods.[10]
Accessing NHS Scotland comes initially through a primary care trust. This means registering with a local doctor, known as a general practitioner (GP), and dentist. Access to secondary care - provision in hospitals or clinics - is usually by referral from a GP. Both primary and secondary care trusts operate under 14 health board regions which together makes up NHS Scotland. In 2006, the NHS in Scotland had around 158,000 staff including more than 47,500 nurses, midwives and health visitors and over 3,800 consultants. In addition, there are also more than 12,000 doctors, family practitioners and allied health professionals, including dentists, opticians and community pharmacists, who operate as independent contractors providing a range of services within the NHS in return for fees and allowances.[11]
[edit] Similarities between systems
[edit] Advice services
Each NHS system runs 24 hour confidential advisory services. The English and Welsh NHSs run a service called NHS Direct which runs a telephone-based service staffed by professional nurses and health advisors, as well as an interactive digital TV service and a web site. Scotland has a similar system, called NHS24, which seeks to provide comprehensive up-to-date health information and self-care advice for the people of Scotland.[12]
[edit] Ambulance services
- Further information: Emergency medical services in England, Emergency medical services in Northern Ireland, Emergency medical services in Scotland, and Emergency medical services in Wales
Each public healthcare system provides ambulance services. Costs are not usually charged to the patient if the ambulance is called for a life-threatening emergency or is ordered by the hospital or GP because the patient needs the specialist transportation only available from an ambulance crew.
[edit] Cost recovery
Each NHS system reserves the right to claim compensation for work done as a result of the negligence of others. The main example of this is the Injury Costs Recovery Scheme, where compensation is received from motor insurance companies following the determination of fault in motor accidents. [13] The NHS in England currently recovers approximately £11 million per month (approx US$ 22 million) from the motor insurance industry. [14]
[edit] Dentistry
Each NHS system provides dental services through private dental practises and dentists can only charge NHS patients at set rates (though the rates vary between countries.) Patients opting to be treated privately do not receive any NHS funding for the treatment. About half of the income of dentists comes from work sub-contracted from the NHS[15]. Not all dentists choose to do NHS work and there is a trend of movement from the NHS to private dentistry.
[edit] General practitioners
General practitioners are qualified doctors, typically working in business practices that deal exclusively with NHS patients. The business practice receives fees from the NHS based on the number of patients and the different services provided under the GP contract. Doctors are not allowed to charge for services provided as part of the contract, which almost all care is. All people are eligible for registration with a GP, usually of the patient's choosing, though the GP must be local to the area in which the person lives. GPs can only reject patients in exceptional circumstances.
The role of the GP is to be the primary carer for the patient and to make referrals to other specialist NHS services as necessary, including for tests or treatments. This may mean the patient will have to go to a hospital or clinic for the investigation to take place, or, in the case of a simple blood test, the GP or a nurse at the GP surgery will take the sample and it will be posted to a hospital laboratory for analysis. The results of the test are returned to the referring doctor.
The GP will prescribe drugs and will follow the patient's progress treatment through to recovery. GPs do not usually follow their patients into hospital for elective treatment as is the practice in some countries, but they do get a comprehensive report from the hospital after discharge. In some cases the GP will be involved in the drawing up of a care plan for the patient before discharge if patient has special care needs. All treatments given at hospitals are reported back to the home GP, so there is a single record of a patient's medical history.
If patients are unable to get to the doctor or clinic because of illness or because the case is urgent and the surgery is closed, they may be seen at home by the GP or a doctor acting as locum for the GP. Home visits can be provided by District and Community Nurses as part of continuing care following discharge from hospital.
[edit] Pharmacies
In all countries of the UK, pharmacies are privately owned but have contracts with the relevant health service to supply prescription drugs. Pharmacists bill the relevant health service for the costs of prescriptions less any fees received from the patients.
[edit] Differences between systems
[edit] Cost control
In England and Wales, the National Institute for Health and Clinical Excellence (NICE) sets guidelines for medical practitioners as to how various conditions should be treated and whether or not a particular treatment should be funded. In Scotland, the Scottish Medicines Consortium performs a similar function. However, the Scottish system makes some new drugs available for prescription more quickly than in the rest of the UK which has led to complaints.[16]
The National Audit Office reports annually on the summarised consolidated accounts of the NHS, and Audit Scotland performs the same function for NHS Scotland [17].
[edit] Prescriptions
In England, patients under 16 years old (19 years if still in full-time education) or over 59 years will get the drug for free. There are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £7.10 is payable per item.
In Northern Ireland, patients under 16 years old (19 years if still in full-time education) or over 59 years will get the drug for free. There are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £6.85 is payable per item.
In Scotland, patients under 16 years old (19 years if still in full-time education) or over 59 years will get the drug for free. There are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £5 is payable per item with the intention is to phase out prescription charges before 2011.
In Wales, prescription charges have been abolished and all prescription drugs are now dispensed without charge.
[edit] Role of private sector in public healthcare
Whereas the UK government is expanding the role of the private sector within the NHS in England[18][19], the current Scottish government is moving in the opposite direction, actively reducing the role of the private sector within public healthcare in Scotland[20] and planning legislation to prevent the possibility of private companies running GP practices in future.[21]
[edit] See also
- National Health Service - England
- NHS Scotland - Scotland
- NHS Wales - Wales
- Health and Care NI - Northern Ireland
[edit] Footnotes and references
- ^ Eligibility for free hospital treatment under the NHS : Department of Health - Health care
- ^ NHS now four different systems BBC January 2, 2008
- ^ NHS Funding need not damage business health. Institute of Chartered Accountants of England & Wales (2008-03-14). Retrieved on 2008-03-31.
- ^ HM Treasury (2008-03-24). Budget 2008, Chapter C 23. Retrieved on 2008-03-24.
- ^ About the NHS
- ^ http://www.gnn.gov.uk/imagelibrary/downloadMedia.asp?MediaDetailsID=216856
- ^ http://www.nodelaysachiever.nhs.uk/Essentials/ The NHS No Delays performance improvement programme
- ^ Survey of the general public's views on NHS system reform in England (2007-06-01).
- ^ Choosing your hospital booklet
- ^ Strategic Board of the Scottish Government. Scottish Government. Retrieved on 2008-01-01.
- ^ About the NHS in Scotland NHS Scotland
- ^ NHS24, About Us
- ^ Road Traffic Act 1999 : Department of Health - Managing your organisation
- ^ http://www.dh.gov.uk/prod_consum_dh/idcplg?IdcService=GET_FILE&dID=145750&Rendition=Web
- ^ Call for dentists' NHS-work quota.
- ^ Call for quicker drug decisions BBC News, January 10, 2008
- ^ NAO report (HC 129-I 2007-08): Report on the NHS Summarised Accounts 2006-07: Achieving Financial Balance
- ^ Private firm to carry out surgery BBC News, August 5, 2007
- ^ £64bn NHS privatisation plan revealed guardian.co.uk, June 30, 2006
- ^ Plans to end private cash for NHS BBC News, 21 June, 2007
- ^ Sturgeon to end privatisation of GP practices Sunday Herald, June 8, 2008
[edit] External links
- Common questions about NHS services and Treatments(only applies to NHS in England)
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