Overview of Healthcare in The UK

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

. The National Health System in the UK has actually evolved to turn into one of the largest health care systems worldwide. 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 actually announced a method on how it will “create a more responsive, patient-centred NHS which accomplishes results that are amongst the finest in the world”. This evaluation post provides an overview of the UK healthcare system as it presently stands, with focus on Predictive, Preventive and Personalised Medicine components. It intends to function as the basis for future EPMA articles to broaden on and provide the modifications 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), originated in the consequences 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 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, complimentary at the point of delivery, equity, and paid for by main financing [1] Despite many political and organisational modifications the NHS remains to date a service readily available universally that takes care of people on the basis of need and not ability to pay, and which is moneyed by taxes and national insurance contributions.

Healthcare and health policy for England is the responsibility of the central federal government, whereas in Scotland, Wales and Northern Ireland it is the responsibility of the respective devolved federal governments. In each of the UK countries the NHS has its own distinct structure and organisation, but in general, and not dissimilarly to other health systems, health care consists of two broad sections; one handling technique, policy and management, and the other with actual medical/clinical care which is in turn divided into main (community care, GPs, Dentists, Pharmacists etc), secondary (hospital-based care accessed through GP referral) and tertiary care (expert health centers). Increasingly distinctions between the two broad areas are ending up being less clear. Particularly over the last decade and directed by the “Shifting the Balance of Power: The Next Steps” (2002) and “Wanless” (2004) reports, steady modifications in the NHS have actually caused a higher shift towards local instead of main decision making, removal of barriers in between primary and secondary care and stronger emphasis on patient choice [2, 3] In 2008 the previous government enhanced this direction in its health strategy “NHS Next Stage Review: High Quality Look After All” (the Darzi Review), and in 2010 the current government’s health technique, “Equity and excellence: Liberating the NHS”, stays helpful of the exact same ideas, albeit through perhaps different mechanisms [4, 5]

The UK federal government has simply revealed plans that according to some will the most extreme change in the NHS given that its inception. In the 12th July 2010 White Paper “Equity and excellence: Liberating the NHS”, the existing Conservative-Liberal Democrat coalition government laid out a technique on how it will “develop a more responsive, patient-centred NHS which attains results that are amongst the very best on the planet” [5]

This evaluation article will for that reason provide an introduction of the UK health care system as it presently stands with the goal to serve as the basis for future EPMA articles to broaden and provide the changes that will be executed within the NHS in the upcoming months.

The NHS in 2010

The Health Act 2009 developed the “NHS Constitution” which officially combines the function and concepts of the NHS in England, its values, as they have actually been developed by clients, public and staff and the rights, promises and obligations 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 across the UK, despite the fact that services might be offered differently in the 4 nations, reflecting their various health needs and situations.

The NHS is the biggest company in the UK with over 1.3 million personnel and a spending plan of over ₤ 90 billion [7, 8] In 2008 the NHS in England alone employed 132,662 physicians, a 4% boost on the previous year, and 408,160 nursing personnel (Table 1). Interestingly the Kings Fund estimates that, while the total variety of NHS staff increased by around 35% in between 1999 and 2009, over the very same period the variety of managers increased by 82%. As a proportion of NHS personnel, the variety of managers increased from 2.7 percent in 1999 to 3.6 per cent in 2009 (www.kingsfund.org.uk). In 2007/8, the UK health costs was 8.5% of Gdp (GDP)-with 7.3% accounting for public and 1.2% for personal spending. The net NHS expenditure 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 very same level (₤ 1,758 and ₤ 1,770, respectively) [8]

Table 1.

The circulation of NHS workforce according to main personnel 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 revealed 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 strategies, protecting resources, keeping track of efficiency and setting nationwide requirements [9] Currently, 10 Strategic Health Authorities handle the NHS at a local level, and Medical care Trusts (PCTs), which currently manage 80% of the NHS’ spending plan, supply governance and commission services, as well as make sure the schedule of services for public heath care, and provision of social work. Both, SHAs and PCTs will stop to exist when the plans described in the 2010 White Paper become executed (see section below). NHS Trusts run on a “payment by outcomes” basis and acquire many of their income by providing healthcare that has been commissioned by the practice-based commissioners (GPs, and so on) and PCTs. The main types of Trusts include Acute, Care, Mental Health, Ambulance, Children’s and Foundation Trusts. The latter were created as non-profit making entities, totally free of federal government control but also increased monetary responsibilities and are managed by an independent Monitor. The Care Quality Commission regulates independently health and adult social care in England in general. Other expert bodies offer monetary (e.g. Audit Commission, National Audit Office), treatment/services (e.g. National Patient Safety Agency, Medicines and Healthcare Products Regulatory Agency) and professional (e.g. British Medical Association) policy. The National Institute for Health and Clinical Excellence (NICE) was established in 1999 as the body accountable for developing national standards and standards connected to, health promotion and prevention, evaluation of new and existing innovation (including medicines and treatments) and treatment and care medical guidance, readily available throughout the NHS. The health research study technique of the NHS is being executed through National Institute of Health Research (NIHR), the total budget for which was in 2009/10 close 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 duty to engage and include patients and the general public. Patient experience information/feedback is formally gathered nationally by yearly study (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 involvement. Overall, inpatients and outpatients surveys have revealed that patients rate the care they get in the NHS high and around three-quarters suggest that care has been very excellent or excellent [11]

In Scotland, NHS Boards have actually replaced Trusts and provide an integrated system for tactical direction, efficiency management and medical governance, whereas in Wales, the National Delivery Group, with recommendations from the National Advisory Board, is the body performing these functions (www.show.scot.nhs.uk; www.wales.nhs.uk). Scottish NHS and Special Boards provide services, with care for specific conditions provided through Managed Clinical Networks. Clinical guidelines are released by the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium (SMC) guidance on the usage of new drugs in the Scottish NHS. In Wales, Local Heath Boards (LHBs) plan, protected and provide healthcare services in their locations and there are 3 NHS Trusts offering emergency situation, cancer care and public health services nationally. In Northern Ireland, a single body, the Health and Care Board is managing commissioning, efficiency and resource management and improvement of health care in the country and 6 Health and Social Care Trusts provide these services (www.hscni.net). A variety of health agencies support secondary services and deal with 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 advocating 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 medication services within the NHS have generally been provided and become part of illness diagnosis and treatment. Preventive medication, unlike predictive or personalised medication, is its own recognized entity and relevant services are directed by Public Health and used either by means of GP, community services or hospitals. Patient-tailored treatment has actually constantly been typical practice for great clinicians in the UK and any other health care system. The terms predictive and customised medicine though are evolving to describe a far more technically innovative method of diagnosing disease and predicting reaction to the requirement of care, in order to maximise the advantage for the client, the general public and the health system.

References to predictive and personalised medication are significantly being introduced in NHS related info. The NHS Choices website describes how clients can get personalised recommendations in relation to their condition, and uses information on predictive blood test for illness such as TB or diabetes. The NIHR through NHS-supported research and together with academic and business collaborating networks is investing a significant percentage of its spending plan in confirming predictive and preventive therapeutic interventions [10] The previous federal government considered the advancement of preventive, people-centred and more efficient healthcare services as the means for the NHS to react to the challenges that all modern health care systems are dealing with in the 21st century, specifically, high client expectation, aging populations, harnessing of details and technological advancement, changing labor force and developing nature of illness [12] Increased emphasis on quality (client security, client experience and clinical effectiveness) has also supported innovation in early medical diagnosis and PPPM-enabling innovations such as telemedicine.

A number of preventive services are delivered 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 collaborated 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 dealing with concerns from pregnancy and the very first 5 years of life and is delivered by neighborhood midwifery and health going to groups [13]

Various immunisation programs from infancy to their adult years, used to anyone in the UK for complimentary and normally delivered in GP surgeries.

The Darzi review set out six essential medical goals in relation to improving preventive care in the UK including, 1) tackling obesity, 2) decreasing alcohol damage, 3) treating drug dependency, 4) minimizing smoking rates, 5) improving sexual health and 6) enhancing psychological health. Preventive programs to resolve these problems have actually remained in place over the last decades in various types and through various efforts, and include:

Assessment of cardiovascular danger and recognition of people at higher threat of heart problem is generally preformed through GP surgeries.

Specific preventive programs (e.g. suicide, mishap) in local schools and neighborhood

Family planning services and prevention of sexually sent illness programmes, typically with an emphasis on young people

A variety of avoidance and health promotion programs associated with way of life options are provided though GPs and community services including, alcohol and smoking cigarettes cessation programs, promo of healthy eating and physical activity. Some of these have a particular focus such as health promo for older individuals (e.g. Falls Prevention).

White paper 2010 – Equity and quality: 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 stays real to its founding concept of, available to all, free at the point of use and based on requirement and not ability to pay. It also continues to maintain the concepts and worths specified 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 responsibilities in accessing collective health care and making sure reliable usage of resources therefore delivering better health. It will deliver healthcare results that are amongst the finest worldwide. This vision will be executed through care and organisation reforms concentrating on 4 areas: a) putting patients and public initially, b) enhancing on quality and health outcomes, c) autonomy, responsibility and democratic authenticity, and d) cut administration and enhance performance [5] This strategy refers to problems that are relevant to PPPM which suggests the increasing impact 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 focus on patient and public very first” plans. In reality this consists of strategies stressing the collection and capability to access by clinicians and clients all client- and treatment-related information. It likewise includes higher attention to Patient-Reported Outcome Measures, greater choice of treatment and treatment-provider, and importantly customised care preparation (a “not one size fits all” method). A newly produced Public Health Service will bring together existing services and place increased emphasis on research analysis and examination. Health Watch England, a body within the Care Quality Commission, will supply 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 accomplished through modifying goals and health care concerns and developing targets that are based upon scientifically credible and evidence-based steps. NICE have a central function in establishing suggestions and requirements and will be expected to produce 150 brand-new requirements over the next 5 years. The federal government plans to develop a value-based pricing system for paying pharmaceutical business for providing drugs to the NHS. A Cancer Drug Fund will be created in the interim to cover patient treatment.

The abolition of SHAs and PCTs, are being proposed as methods of offering 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 controversial but perhaps not totally unanticipated [14, 15] The transfer of PCT health enhancement function to regional authorities aims to provide increased democratic authenticity.

Challenges dealing with the UK healthcare system

Overall the health, in addition to ideological and organisational difficulties that the UK Healthcare system is dealing with are not dissimilar to those faced by lots of nationwide healthcare systems throughout the world. Life expectancy has been progressively increasing throughout the world with occurring boosts in chronic illness such as cancer and neurological disorders. Negative environment and lifestyle impacts have actually produced a pandemic in obesity and associated conditions such as diabetes and cardiovascular illness. In the UK, coronary heart disease, cancer, renal illness, mental health services for grownups and diabetes cover around 16% of total National Health Service (NHS) expenditure, 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 major diseases, sudden death and impairment. Your Home of Commons Health Committee alerts that whilst the health of all groups in England is enhancing, over the last ten years health inequalities in between the social classes have widened-the gap 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 bad [16] The focus and practice of health care services is being transformed from traditionally providing treatment and helpful or palliative care to significantly handling the management of chronic disease and rehab programs, and providing disease prevention and health promotion interventions. Pay-for-performance, modifications in guideline together with cost-effectiveness and pay for medications concerns are becoming a crucial consider new interventions reaching clinical practice [17, 18]

Preventive medicine is sturdily developed within the UK Healthcare System, and predictive and personalised approaches are increasingly ending up being so. Implementation of PPPM interventions may be the option however also the reason for the health and healthcare challenges and issues that health systems such as the NHS are facing [19] The efficient introduction of PPPM requires clinical understanding of disease and health, and technological development, together with thorough methods, evidence-based health policies and proper regulation. Critically, education of healthcare professionals, patients and the general public is likewise critical. There is little doubt nevertheless that utilizing PPPM properly can help the NHS accomplish its vision of providing health care outcomes that will be among the finest worldwide.

– 1. Delamothe T. NHS at 60: establishing principles. BMJ. 2008; 336:1216 -8. doi: 10.1136/ bmj.39582.501192.94. [DOI] [PMC free short article] [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 take care of 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 excellence: 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. Your 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 excellent to terrific. Preventative, people-centred, productive. 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 free post] [PubMed] [Google Scholar]- 15. Ham C (2007) Clinically incorporated systems: the next action 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 illness 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 role of pharmacoeconomics. Br J Clin Pharmacol. 2010; 70( 3 ):317 -9. doi: 10.1111/ j.1365-2125.2010.03708. x. [DOI] [PMC totally free short article] [PubMed] [Google Scholar]- 19. Griggs JJ. Personalized medicine: a perk of opportunity? Clin Pharmacol Ther.