The National Health ServiceHealthcare in the United Kingdom

By Vruti DattaniUniversity of Cambridge

• NHS = National Health Service

• 1948

• Good healthcare should be available to all

• primary care

• in-patient care

• long-term healthcare

• ophthalmology

• dentistry

3 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

New principles…(2000)• Provide a comprehensive range of services • Shape its services around the needs and preferences of individual

patients, their families and their careers • 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

• 60 million served

• Employs over 1.7 million

• 120,000 hospital doctors, 40,000 general practitioners (GPs), 400,000 nurses and 25,000 ambulance staff.

Funding

• National taxation• 2008/09 budget = £98.6 billion

= £1980 per person (Rs 138600)• 60% - pay staff• 20% - drugs and supplies• 20%- buildings, equipment, training, catering,

cleaning

Organization

• Funded centrally• However, England, Wales, Scotland and

Northern Ireland managed separately

• England…..• Department of Health, headed by Secretary of

State for Health: Andrew Lansley

• Management divided between 10 ‘Strategic Health Authorities’ (SHA’s)– Developing plans for improving health services in their

local area– Making sure local health services are of a high quality and

are performing well– Increasing the capacity of local health services so they can

provide more services– Making sure national priorities (for example, programmes

for improving cancer services) are integrated into local health service plans

• Further divided into:

- Primary Care Trusts (PCTs)primary care and public health

- Hospital Trusts and Foundations trustshospitals, treatment centres, specialist care

- Ambulance services trusts

- Care trustshealth and social services

- Mental Health services trusts

PCTs

• Provide primary care• Oversee General Practitioners and dentists• Hold 80% of budget• Commission services from other trusts and

private and voluntary sectors• Oversee primary and secondary prevention,

vaccination administration and control epidemics

General Practitioners (GPs)

- First point of contact- Make appointment- 10 minute consultation-‘Family doctor’- Free- Can refer to higher level services- Patient:GP ratio varies widely from 680 in the Western Isles to 3428 in Greater Derby!- Each GP sees on average 140 patients per week

Pharmacies

• Prescription charge for medicines = £7.20 (England) (approx Rs 500)

• Patients over 60, under 16 (or 19 if in education) or with certain medical conditions are exempt from paying

• NHS walk in centres

• NHS Direct

• Dentists

• Opticians

Acute Hospital Trusts• Oversee hospitals and specialist care centres.

• Acute trusts employ nurses, doctors, pharmacists, midwives and health visitors.

• Also employ physiotherapists, radiographers, podiatrists, speech and language therapists, counsellors, occupational therapists, psychologists and healthcare scientists.

• Non-medical staff employed by acute trusts, include receptionists, porters, cleaners, specialists in information technology, managers, engineers, caterers and domestic and security staff.

• May be a national centre for specialist care or attached to a university

Foundation Trusts

• New type of hospital trust run by local managers

• Tailored to local population• More financial and operational freedom• Decentralization of public services• 129 established since 2004

Patient Involvement• Patient Advice and Liaison Service (PALS)- Patient involvement in the NHS- Officers in all hospitals- Advice, support and information on health matters to patients,

family and carers- Can mediate complaints to NHS

• LINks- Local Involvement Networks- Any member of the community can become a member of a LINk- Can promote neglected issues, influence decisions, help community

view be represented and help provide a better standard of service

Private healthcare

• Paid for largely by private insurance• Used by 8% of population as an add-on to NHS

healthcare• NHS is beginning to used the private sector to

increase capacity

Problems in the NHS

• Drugs approved by NICE (National Institute for Health and Clinical Excellence)

• Waiting Lists• Superbugs• Computerization• Hospital debt• Staffing problems

The White Paper• ‘Equity and Excellence: Liberating the NHS ’• Launched on 12th July 2010• Proposes radical changes to the NHS• SHAs and PCTs to be phased out and GPs to be

made responsible for health budget by joining commissioning consortia

• Management costs will be reduced so more resources to frontline services

• Changes should be complete by 2013• Big changes so keep an eye out!

Thank you for listening!