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 progressed to turn into one of the biggest healthcare systems on the planet. At the time of writing of this evaluation (August 2010) the UK federal government in its 2010 White Paper “Equity and quality: Liberating the NHS” has announced a strategy on how it will “create a more responsive, patient-centred NHS which achieves outcomes that are among the very best in the world”. This evaluation article provides an introduction of the UK healthcare system as it currently stands, with emphasis on Predictive, Preventive and Personalised Medicine components. It intends to serve as the basis for future EPMA articles to broaden on and provide the changes that will be carried out within the NHS in the upcoming months.

Keywords: UK, Healthcare system, National health system, NHS

Introduction

The UK healthcare system, National Health Service (NHS), came into existence in the consequences of the Second World War and ended up being functional on the fifth July 1948. It was first proposed to the Parliament in the 1942 Beveridge Report on Social Insurance and Allied Services and it is the legacy of Aneurin Bevan, a previous miner who became a politician and the then Minister of Health. He founded the NHS under the concepts of universality, free at the point of shipment, equity, and paid for by central financing [1] Despite various political and organisational changes the NHS remains to date a service offered widely that looks after people on the basis of requirement and not ability to pay, and which is funded by taxes and national insurance contributions.

Health care and health policy for England is the duty of the central government, whereas in Scotland, Wales and Northern Ireland it is the obligation of the respective devolved federal governments. In each of the UK countries the NHS has its own distinct structure and organisation, but overall, and not dissimilarly to other health systems, health care consists of 2 broad sections; one dealing with method, policy and management, and the other with actual medical/clinical care which remains in turn divided into primary (community care, GPs, Dentists, Pharmacists and so on), secondary (hospital-based care accessed through GP referral) and tertiary care (professional hospitals). Increasingly distinctions between the 2 broad areas are ending up being less clear. Particularly over the last decade and assisted by the “Shifting the Balance of Power: The Next Steps” (2002) and “Wanless” (2004) reports, progressive modifications in the NHS have caused a greater shift towards local instead of main decision making, elimination of barriers in between primary and secondary care and more powerful emphasis on client choice [2, 3] In 2008 the previous government enhanced this instructions in its health technique “NHS Next Stage Review: High Quality Look After All” (the Darzi Review), and in 2010 the existing government’s health technique, “Equity and excellence: Liberating the NHS”, stays supportive of the exact same ideas, albeit through perhaps different systems [4, 5]

The UK government has simply revealed plans that according to some will produce the most radical modification in the NHS given that its beginning. In the 12th July 2010 White Paper “Equity and quality: Liberating the NHS”, the current Conservative-Liberal Democrat union government detailed a strategy on how it will “create a more responsive, patient-centred NHS which accomplishes outcomes that are amongst the best on the planet” [5]

This evaluation post will for that reason provide an introduction of the UK health care system as it currently stands with the objective to work as the basis for future EPMA posts to broaden and present the changes that will be executed within the NHS in the forthcoming months.

The NHS in 2010

The Health Act 2009 developed the “NHS Constitution” which officially brings together the function and principles of the NHS in England, its values, as they have been established by patients, public and staff and the rights, promises and responsibilities of patients, public and personnel [6] Scotland, Northern Ireland and Wales have also consented to a high level declaration declaring the principles of the NHS throughout the UK, even though services might be offered differently in the 4 countries, reflecting their different health requirements and situations.

The NHS is the biggest 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% boost on the previous year, and 408,160 nursing personnel (Table 1). Interestingly the Kings Fund approximates that, while the overall number of NHS staff increased by around 35% in between 1999 and 2009, over the same period the number of supervisors increased by 82%. As a percentage of NHS personnel, the number of managers increased from 2.7 per cent in 1999 to 3.6 percent in 2009 (www.kingsfund.org.uk). In 2007/8, the UK health spending was 8.5% of Gdp (GDP)-with 7.3% accounting for public and 1.2% for private spending. The net NHS expenditure per head throughout the UK was least expensive in England (₤ 1,676) and greatest in Scotland (₤ 1,919) with Wales and Northern Ireland at around the same level (₤ 1,758 and ₤ 1,770, respectively) [8]

Table 1.

The circulation of NHS workforce according to primary staff groups in the UK in 2008 (NHS Information Centre: www.ic.nhs.uk)

The total organisational structure of the NHS in England, Scotland, Wales and Northern Ireland in 2010 is displayed in Fig. 1. In England the Department of Health is accountable for the direction of the NHS, social care and public health and shipment of health care by developing policies and techniques, protecting resources, keeping track of performance and setting nationwide standards [9] Currently, 10 Strategic Health Authorities manage the NHS at a local level, and Medical care Trusts (PCTs), which presently control 80% of the NHS’ spending plan, supply governance and commission services, along with make sure the schedule of services for public heath care, and provision of neighborhood services. Both, SHAs and PCTs will stop to exist when the strategies detailed in the 2010 White Paper become executed (see area below). NHS Trusts operate on a “payment by outcomes” basis and get the majority of their income by offering healthcare that has actually been commissioned by the practice-based commissioners (GPs, and so on) and PCTs. The primary kinds of Trusts include Acute, Care, Mental Health, Ambulance, Children’s and Foundation Trusts. The latter were developed as non-profit making entities, without federal government control however also increased monetary obligations and are controlled by an independent Monitor. The Care Quality Commission regulates separately health and adult social care in England in general. Other specialist bodies supply financial (e.g. Audit Commission, National Audit Office), treatment/services (e.g. National Patient Safety Agency, Medicines and Healthcare Products Regulatory Agency) and expert (e.g. British Medical Association) policy. The National Institute for Health and Clinical Excellence (NICE) was in 1999 as the body responsible for developing nationwide standards and standards related to, health promo and avoidance, evaluation of brand-new and existing innovation (including medications and procedures) and treatment and care medical assistance, available throughout the NHS. The health research technique of the NHS is being executed through National Institute of Health Research (NIHR), the overall spending plan for which was in 2009/10 near to ₤ 1 billion (www.nihr.ac.uk) [10]

Fig. 1.

Organisation of the NHS in England, Scotland, Wales and Northern Ireland, in 2010

Section 242 of the NHS Act states that Trusts have a legal responsibility to engage and involve clients and the general public. Patient experience information/feedback is formally collected nationally by yearly survey (by the Picker Institute) and becomes part of the NHS Acute Trust performance framework. The Patient Advice Liaison Service (PALS) and Local Involvement Networks (LINks) support patient feedback and participation. Overall, inpatients and outpatients surveys have revealed that patients rate the care they get in the NHS high and around three-quarters indicate that care has actually been really good or excellent [11]

In Scotland, NHS Boards have actually replaced Trusts and provide an integrated system for strategic direction, performance management and medical governance, whereas in Wales, the National Delivery Group, with suggestions from the National Board Of Advisers, is the body carrying out these functions (www.show.scot.nhs.uk; www.wales.nhs.uk). Scottish NHS and Special Boards provide services, with care for particular conditions provided through Managed Clinical Networks. Clinical guidelines are released by the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium (SMC) suggestions on using brand-new drugs in the Scottish NHS. In Wales, Local Heath Boards (LHBs) strategy, safe and provide health care services in their locations and there are 3 NHS Trusts supplying emergency, cancer care and public health services nationally. In Northern Ireland, a single body, the Health and Care Board is overseeing commissioning, efficiency and resource management and enhancement of healthcare in the country and six Health and Social Care Trusts deliver these services (www.hscni.net). A variety of health firms support ancillary services and handle a wide variety of health and care problems including cancer screening, blood transfusion, public health etc. In Wales Community Health Councils are statutory lay bodies promoting the interests of the public in the health service in their district and in Northern Ireland the Patient and Client Council represent clients, customers and carers.

Predictive, Preventive and Personalised Medicine (PPPM) in the NHS

Like other national health care systems, predictive, preventive and/or customised medicine services within the NHS have traditionally been provided and are part of disease medical diagnosis and treatment. Preventive medication, unlike predictive or personalised medication, is its own recognized entity and pertinent services are directed by Public Health and used either via GP, social work or health centers. Patient-tailored treatment has always prevailed practice for excellent clinicians in the UK and any other health care system. The terms predictive and customised medication though are developing to explain a far more technologically innovative method of identifying disease and anticipating reaction to the standard of care, in order to maximise the advantage for the patient, the public and the health system.

References to predictive and customised medicine are progressively being introduced in NHS associated information. The NHS Choices website explains how clients can obtain personalised advice in relation to their condition, and offers information on predictive blood test for disease such as TB or diabetes. The NIHR through NHS-supported research study and together with scholastic and industrial teaming up networks is investing a substantial percentage of its spending plan in confirming predictive and preventive healing interventions [10] The previous government thought about the development of preventive, people-centred and more productive health care services as the means for the NHS to react to the difficulties that all contemporary health care systems are facing in the 21st century, namely, high patient expectation, aging populations, harnessing of details and technological development, altering labor force and progressing nature of disease [12] Increased emphasis on quality (client safety, client experience and medical effectiveness) has actually also supported development in early diagnosis and PPPM-enabling technologies such as telemedicine.

A number of preventive services are provided through the NHS either through GP surgeries, social work or medical facilities depending on their nature and include:

The Cancer Screening programmes in England are nationally coordinated and consist of Breast, Cervical and Bowel Cancer Screening. There is also a notified option Prostate Cancer Risk Management program (www.cancerscreening.nhs.uk).

The Child Health Promotion Programme is handling issues from pregnancy and the very first 5 years of life and is provided by neighborhood midwifery and health visiting teams [13]

Various immunisation programmes from infancy to the adult years, used to anybody in the UK for complimentary and typically delivered in GP surgical treatments.

The Darzi review set out 6 key scientific objectives in relation to enhancing preventive care in the UK including, 1) dealing with obesity, 2) minimizing alcohol harm, 3) dealing with drug addiction, 4) minimizing smoking cigarettes rates, 5) improving sexual health and 6) enhancing psychological health. Preventive programmes to deal with these problems have been in place over the last years in various kinds and through different initiatives, and consist of:

Assessment of cardiovascular risk and recognition of people at greater threat of cardiovascular disease is usually preformed through GP surgical treatments.

Specific preventive programmes (e.g. suicide, accident) in local schools and community

Family planning services and avoidance of sexually transferred illness programmes, typically with a focus on young people

A range of prevention and health promotion programs related to way of life choices are delivered though GPs and social work including, alcohol and smoking cessation programs, promo of healthy eating and physical activity. A few of these have a particular focus such as health promotion for older people (e.g. Falls Prevention).

White paper 2010 – Equity and quality: liberating the NHS

The current government’s 2010 “Equity and quality: Liberating the NHS” White Paper has set out the vision of the future of an NHS as an organisation that still remains real to its founding concept of, readily available to all, free at the point of usage and based upon need and not capability to pay. It likewise continues to promote the concepts and values specified in the NHS Constitution. The future NHS becomes part of the Government’s Big Society which is build on social uniformity and entails rights and responsibilities in accessing cumulative health care and making sure effective use of resources thus providing better health. It will deliver health care results that are amongst the best in the world. This vision will be carried out through care and organisation reforms concentrating on 4 areas: a) putting clients and public first, b) improving on quality and health outcomes, c) autonomy, responsibility and democratic legitimacy, and d) cut bureaucracy and enhance efficiency [5] This method refers to issues that are appropriate to PPPM which shows the increasing impact of PPPM principles within the NHS.

According to the White Paper the concept of “shared decision-making” (no decision about me without me) will be at the centre of the “putting focus on client and public first” strategies. In truth this includes plans stressing the collection and capability to gain access to by clinicians and clients all patient- and treatment-related info. It also consists of higher attention to Patient-Reported Outcome Measures, higher choice of treatment and treatment-provider, and notably personalised care planning (a “not one size fits all” technique). A newly created Public Health Service will bring together existing services and place increased emphasis on research analysis and evaluation. Health Watch England, a body within the Care Quality Commission, will provide a stronger patient and public voice, through a network of local Health Watches (based upon the existing Local Involvement Networks – LINks).

The NHS Outcomes Framework sets out the concerns for the NHS. Improving on quality and health outcomes, according to the White Paper, will be achieved through modifying objectives and health care concerns and establishing targets that are based upon clinically reliable and evidence-based steps. NICE have a main function in developing recommendations and standards and will be anticipated to produce 150 new standards over the next 5 years. The federal government prepares to develop a value-based pricing system for paying pharmaceutical business for offering drugs to the NHS. A Cancer Drug Fund will be produced in the interim to cover client treatment.

The abolition of SHAs and PCTs, are being proposed as means of providing greater autonomy and accountability. GP Consortia supported by the NHS Commissioning Board will be accountable for commissioning healthcare services. The introduction of this type of “health management organisations” has been rather questionable but possibly not absolutely unexpected [14, 15] The transfer of PCT health enhancement function to regional authorities aims to offer increased democratic legitimacy.

Challenges dealing with the UK health care system

Overall the health, in addition to ideological and organisational challenges that the UK Healthcare system is dealing with are not dissimilar to those faced by many nationwide healthcare systems across the world. Life span has been steadily increasing across the world with taking place boosts in chronic illness such as cancer and neurological conditions. Negative environment and way of life influences have actually created a pandemic in weight problems and involved conditions such as diabetes and cardiovascular illness. In the UK, coronary heart problem, cancer, kidney disease, mental health services for adults and diabetes cover around 16% of overall National Health Service (NHS) expenditure, 12% of morbidity and between 40% and 70% of mortality [3] Across Western societies, health inequalities are disturbingly increasing, with minority and ethnic groups experiencing most serious illnesses, sudden death and disability. Your Home of Commons Health Committee warns that whilst the health of all groups in England is enhancing, over the last 10 years health inequalities in between the social classes have widened-the gap has increased by 4% for males, and by 11% for women-due to the truth that the health of the rich is improving much quicker than that of the poor [16] The focus and practice of health care services is being transformed from traditionally offering treatment and encouraging or palliative care to increasingly dealing with the management of persistent illness and rehabilitation routines, and offering disease avoidance and health promotion interventions. Pay-for-performance, modifications in guideline together with cost-effectiveness and pay for medicines concerns are ending up being an important factor in brand-new interventions reaching medical practice [17, 18]

Preventive medication is solidly established within the UK Healthcare System, and predictive and personalised approaches are progressively ending up being so. Implementation of PPPM interventions may be the solution but also the cause of the health and healthcare challenges and predicaments that health systems such as the NHS are facing [19] The effective introduction of PPPM requires scientific understanding of disease and health, and technological development, together with extensive strategies, evidence-based health policies and proper guideline. Critically, education of health care specialists, patients and the public is likewise paramount. There is little doubt nevertheless that utilizing PPPM properly can assist the NHS achieve its vision of providing healthcare outcomes that will be amongst the finest in the world.

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