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 developed to turn into one of the largest health care systems in the world. At the time of writing of this evaluation (August 2010) the UK government in its 2010 White Paper “Equity and excellence: Liberating the NHS” has actually announced a method on how it will “produce a more responsive, patient-centred NHS which achieves results that are amongst the very best in the world”. This evaluation article provides a summary of the UK health care system as it currently stands, with focus on Predictive, Preventive and Personalised Medicine components. It aims to act as the basis for future EPMA articles to expand on and provide the changes that will be executed within the NHS in the forthcoming months.

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

Introduction

The UK health care system, National Health Service (NHS), came into existence in the aftermath of the Second World War and ended up being operational 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 tradition of Aneurin Bevan, a former miner who became a political leader and the then Minister of Health. He founded the NHS under the concepts of universality, complimentary at the point of shipment, equity, and paid for by main financing [1] Despite various political and organisational changes the NHS remains to date a service available universally that cares for individuals on the basis of requirement and not ability to pay, and which is funded by taxes and national insurance coverage contributions.

Health care and health policy for England is the obligation of the central federal government, whereas in Scotland, Wales and Northern Ireland it is the obligation of the respective devolved federal governments. In each of the UK nations the NHS has its own unique structure and organisation, but overall, and not dissimilarly to other health systems, health care makes up of two broad areas; one handling strategy, policy and management, and the other with actual medical/clinical care which remains in turn divided into main (community care, GPs, Dentists, Pharmacists etc), secondary (hospital-based care accessed through GP recommendation) and tertiary care (expert medical facilities). Increasingly distinctions between the two broad sections are becoming less clear. Particularly over the last years and guided 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 rather than main choice making, elimination of barriers between primary and secondary care and stronger focus on client option [2, 3] In 2008 the previous government reinforced this instructions in its health method “NHS Next Stage Review: High Quality Take Care Of All” (the Darzi Review), and in 2010 the existing government’s health technique, “Equity and quality: Liberating the NHS”, stays encouraging of the same concepts, albeit through potentially different systems [4, 5]

The UK government has actually simply announced strategies that according to some will produce the most extreme modification in the NHS given that its inception. In the 12th July 2010 White Paper “Equity and quality: Liberating the NHS”, the current Conservative-Liberal Democrat union federal government laid out a technique on how it will “develop a more responsive, patient-centred NHS which attains outcomes that are among the best on the planet” [5]

This review post will therefore provide an introduction of the UK healthcare system as it presently stands with the goal to work as the basis for future EPMA posts to broaden and present the changes that will be implemented within the NHS in the forthcoming months.

The NHS in 2010

The Health Act 2009 developed the “NHS Constitution” which formally brings together the function and concepts of the NHS in England, its values, as they have actually been developed by patients, public and personnel and the rights, promises and duties of patients, public and staff [6] Scotland, Northern Ireland and Wales have likewise concurred to a high level declaration declaring the concepts of the NHS throughout the UK, despite the fact that services might be provided in a different way in the 4 countries, showing their different health needs and situations.

The NHS is the biggest company 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 medical professionals, a 4% increase on the previous year, and 408,160 nursing personnel (Table 1). the Kings Fund approximates that, while the total variety of NHS staff increased by around 35% in between 1999 and 2009, over the same duration the variety of supervisors increased by 82%. As a percentage of NHS personnel, the variety of managers rose 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 personal spending. 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 around the same level (₤ 1,758 and ₤ 1,770, respectively) [8]

Table 1.

The distribution of NHS workforce 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 displayed in Fig. 1. In England the Department of Health is accountable for the instructions of the NHS, social care and public health and delivery of health care by establishing policies and techniques, protecting resources, keeping an eye on efficiency and setting nationwide standards [9] Currently, 10 Strategic Health Authorities manage the NHS at a regional level, and Primary Care Trusts (PCTs), which presently control 80% of the NHS’ budget plan, offer governance and commission services, along with ensure the availability of services for public heath care, and provision of social work. Both, SHAs and PCTs will disappear as soon as the plans detailed in the 2010 White Paper end up being carried out (see area listed below). NHS Trusts run on a “payment by results” basis and obtain most of their earnings by supplying health care that has actually been commissioned by the practice-based commissioners (GPs, and so on) and PCTs. The primary types of Trusts include Acute, Care, Mental Health, Ambulance, Children’s and Foundation Trusts. The latter were created as non-profit making entities, without government control however also increased monetary commitments and are regulated by an independent Monitor. The Care Quality Commission controls individually health and adult social care in England in general. Other professional 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 developed in 1999 as the body accountable for developing national standards and standards related to, health promotion and avoidance, assessment of new and existing technology (consisting of medicines and treatments) and treatment and care medical assistance, readily available throughout the NHS. The health research method of the NHS is being carried out through National Institute of Health Research (NIHR), the overall budget for which remained in 2009/10 near ₤ 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 duty to engage and include clients and the general public. Patient experience information/feedback is formally collected nationally by yearly study (by the Picker Institute) and belongs to the NHS Acute Trust performance framework. The Patient Advice Liaison Service (PALS) and Local Involvement Networks (LINks) support patient feedback and involvement. Overall, inpatients and outpatients surveys have actually revealed that clients rate the care they receive in the NHS high and around three-quarters suggest that care has actually been excellent or outstanding [11]

In Scotland, NHS Boards have replaced Trusts and provide an integrated system for strategic direction, efficiency management and scientific governance, whereas in Wales, the National Delivery Group, with advice from the National Board Of Advisers, is the body performing these functions (www.show.scot.nhs.uk; www.wales.nhs.uk). Scottish NHS and Special Boards deliver services, with take care of specific conditions delivered through Managed Clinical Networks. Clinical standards are published by the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium (SMC) guidance on making use of 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 supervising commissioning, performance and resource management and enhancement of health care in the nation and six Health and Social Care Trusts provide these services (www.hscni.net). A variety of health firms support secondary services and handle a large range of health and care problems consisting of 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, clients 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 actually typically been offered and are part of disease medical diagnosis and treatment. Preventive medicine, unlike predictive or personalised medication, is its own recognized entity and appropriate services are directed by Public Health and provided either through GP, social work or healthcare facilities. Patient-tailored treatment has constantly been typical practice for great clinicians in the UK and any other healthcare system. The terms predictive and customised medicine though are evolving to describe a far more technically advanced method of identifying illness and forecasting action to the requirement of care, in order to increase the benefit for the patient, the general public and the health system.

References to predictive and customised medicine are progressively being presented in NHS associated information. The NHS Choices site explains how clients can acquire personalised advice in relation to their condition, and provides information on predictive blood test for disease such as TB or diabetes. The NIHR through NHS-supported research and together with academic and industrial collaborating networks is investing a considerable proportion of its spending plan in verifying predictive and preventive healing interventions [10] The previous federal government considered the development of preventive, people-centred and more efficient health care services as the ways for the NHS to react to the challenges that all contemporary healthcare systems are dealing with in the 21st century, particularly, high patient expectation, aging populations, harnessing of details and technological development, changing labor force and progressing nature of illness [12] Increased emphasis on quality (client safety, patient experience and scientific effectiveness) has actually likewise supported innovation in early diagnosis and PPPM-enabling innovations such as telemedicine.

A number of preventive services are delivered through the NHS either by means of GP surgeries, neighborhood services or medical facilities depending upon their nature and consist of:

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

The Child Health Promotion Programme is dealing with issues from pregnancy and the first 5 years of life and is delivered by neighborhood midwifery and health checking out groups [13]

Various immunisation programmes from infancy to the adult years, provided to anybody in the UK free of charge and generally provided in GP surgeries.

The Darzi review set out six essential clinical goals in relation to enhancing preventive care in the UK including, 1) tackling obesity, 2) decreasing alcohol harm, 3) treating drug addiction, 4) decreasing smoking cigarettes rates, 5) improving sexual health and 6) enhancing mental health. Preventive programs to address these problems have been in place over the last decades in different forms and through various efforts, and include:

Assessment of cardiovascular risk and identification of individuals at greater danger of heart illness is generally preformed through GP surgical treatments.

Specific preventive programs (e.g. suicide, accident) in regional schools and neighborhood

Family planning services and prevention of sexually sent illness programmes, frequently with a focus on youths

A range of prevention and health promo programmes associated with lifestyle options are delivered though GPs and neighborhood services including, alcohol and smoking cessation programs, promotion of healthy eating and physical activity. A few of these have a specific focus such as health promo for older individuals (e.g. Falls Prevention).

White paper 2010 – Equity and excellence: liberating the NHS

The present 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 starting principle of, readily available to all, totally free at the point of usage and based on requirement and not capability to pay. It likewise continues to maintain the concepts and worths defined in the NHS Constitution. The future NHS is part of the Government’s Big Society which is build on social uniformity and involves rights and obligations in accessing collective health care and guaranteeing reliable use of resources therefore delivering better health. It will deliver health care results that are among the best worldwide. This vision will be executed through care and organisation reforms concentrating on four areas: a) putting patients and public initially, b) improving on quality and health results, c) autonomy, responsibility and democratic authenticity, and d) cut administration and enhance performance [5] This strategy refers to concerns that relate to PPPM which indicates the increasing influence of PPPM principles within the NHS.

According to the White Paper the principle of “shared decision-making” (no choice about me without me) will be at the centre of the “putting emphasis on patient and public first” plans. In reality this consists of strategies stressing the collection and ability to access by clinicians and patients all patient- and treatment-related details. It also consists of greater attention to Patient-Reported Outcome Measures, higher choice of treatment and treatment-provider, and significantly customised care preparation (a “not one size fits all” method). A freshly created Public Health Service will combine existing services and location increased emphasis on research analysis and assessment. Health Watch England, a body within the Care Quality Commission, will offer a more powerful client and public voice, through a network of local Health Watches (based on the existing Local Involvement Networks – LINks).

The NHS Outcomes Framework sets out the priorities for the NHS. Improving on quality and health outcomes, according to the White Paper, will be attained through modifying objectives and healthcare top priorities and establishing targets that are based on scientifically credible and evidence-based measures. NICE have a central role in establishing recommendations and requirements and will be expected to produce 150 new standards over the next 5 years. The government prepares to establish a value-based rates system for paying pharmaceutical companies for supplying 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 ways of providing greater autonomy and responsibility. GP Consortia supported by the NHS Commissioning Board will be accountable for commissioning healthcare services. The intro of this kind of “health management organisations” has actually been rather questionable however potentially not completely unexpected [14, 15] The transfer of PCT health enhancement function to regional authorities aims to supply increased democratic authenticity.

Challenges dealing with the UK healthcare system

Overall the health, along with ideological and organisational challenges that the UK Healthcare system is facing are not different to those dealt with by lots of nationwide health care systems throughout the world. Life span has been gradually increasing throughout the world with occurring boosts in persistent diseases such as cancer and neurological disorders. Negative environment and way of life influences have actually produced a pandemic in obesity and associated conditions such as diabetes and heart disease. In the UK, coronary heart problem, cancer, renal illness, mental health services for adults and diabetes cover around 16% of overall National Health Service (NHS) expense, 12% of morbidity and in between 40% and 70% of death [3] Across Western societies, health inequalities are disturbingly increasing, with minority and ethnic groups experiencing most severe diseases, premature death and special needs. Your House of Commons Health Committee warns that whilst the health of all groups in England is enhancing, over the last ten years health inequalities between the social classes have widened-the space has actually increased by 4% for men, 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 healthcare services is being changed from typically providing treatment and encouraging or palliative care to progressively dealing with the management of persistent disease and rehab regimes, and providing disease prevention and health promo interventions. Pay-for-performance, changes in regulation together with cost-effectiveness and spend for medications problems are becoming a critical factor in brand-new interventions reaching medical practice [17, 18]

Preventive medication is sturdily established within the UK Healthcare System, and predictive and customised techniques are increasingly becoming so. Implementation of PPPM interventions might be the service but also the reason for the health and healthcare challenges and predicaments that health systems such as the NHS are dealing with [19] The efficient introduction of PPPM requires scientific understanding of disease and health, and technological development, together with detailed methods, evidence-based health policies and suitable guideline. Critically, education of healthcare experts, patients and the general public is also paramount. There is little doubt however that utilizing PPPM appropriately can help the NHS accomplish its vision of providing healthcare results that will be among the best on the planet.

– 1. Delamothe T. NHS at 60: founding principles. BMJ. 2008; 336:1216 -8. doi: 10.1136/ bmj.39582.501192.94. [DOI] [PMC totally free post] [PubMed] [Google Scholar]- 2. Shifting the Balance of Power: The Next Steps. Department of Health publications. 2002. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4008424
– 3. Wanless D. Securing health for the entire population: Final report-February 2004. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4074426
– 4. Professor the Lord Darzi of Denham KBE High quality look after all: NHS Next Stage Review last report. Department of Health publications. 2008. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825
– 5. White paper Equity and quality: Liberating the NHS. Department of Health publications. 2010. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353
– 6. The NHS Constitution for England. Department of Health publications. 2009. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093419
– 7. NHS Hospital and Community Health Services: Medical and Dental personnel England 1998-2008. The NHS Information Centre. 2009. www.ic.nhs.uk/webfiles/publications/nhsstaff2008/medandden/Medical%20and%20Dental%20bulletin%201998-2008.pdf
– 8. House of Commons Health Committee: Public Expenditure on Health and Personal Social Services. The House of Commons. 2008. www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/cmhealth.htm
– 9. The DH Guide A guide to what we do and how we do it. Department of Health publications. 2007. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/index.htm
– 10. NIHR Annual Report 2009/10: Embedding Health Research. National Institute for Health Research. 2010. www.nihr.ac.uk/Pages/default.aspx
– 11. Leatherman S. and Sutherland K. Patient and Public Experience in the NHS. The Health Foundation. 2007. www.health.org.uk/publications/research_reports/patient_and_public.html
– 12. NHS 2010-2015: from great to terrific. Preventative, people-centred, efficient. Department of Health publications. 2009. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_109876
– 13. Updated Child Health Promotion Programme. Department of Health publications. 2009. webarchive.nationalarchives.gov.uk/+/ www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_083645.
– 14. Klein R. What does the future hold for the NHS at 60? BMJ. 2008; 337: a549. doi: 10.1136/ bmj.a549. [DOI] [PMC totally free article] [PubMed] [Google Scholar]- 15. Ham C (2007) Clinically integrated systems: the next step in English health reform? Briefing paper. London Nuffield Trust.
– 16. Health Inequalities Third Report of Session 2008-09. House of Commons Health Committee. 2009; Volume I. www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/286/28602.htm.
– 17. Clinicians, services and commissioning in chronic disease management in the NHS The need for coordinated management programmes. Report of a joint working celebration of the Royal College of Physicians of London, the Royal College of General Practitioners and the NHS Alliance. 2004. www.rcgp.org.uk/PDF/Corp_chronic_disease_nhs.pdf.
– 18. Hughes DA. From NCE to NICE: the function of pharmacoeconomics. Br J Clin Pharmacol. 2010; 70( 3 ):317 -9. doi: 10.1111/ j.1365-2125.2010.03708. x. [DOI] [PMC complimentary short article] [PubMed] [Google Scholar]- 19. Griggs JJ. Personalized medicine: a perk of advantage? Clin Pharmacol Ther.