The National Health Service ( NHS ) is a publicly funded national health care system for the UK and one of the four National Health Services for each constituent country of the United Kingdom. It is the single largest paying healthcare system in the world. Funded by a common taxation system and overseen by the Department of Health, NHS England provides healthcare to all legitimate UK residents, with most free services when in use. Some services, such as emergency care and infectious disease treatment, are free for everyone, including visitors.
The free health care at the point of use stems from the core principles on the establishment of the National Health Service by the Labor government in 1948. In practice, "free at point of use" usually means that everyone is legally registered with the system (ie in possession of the NHS number ), available to legitimate British citizens regardless of citizenship (but not non-resident British citizens), may access all critical and uncritical medical care, without payment except for certain NHS services, for example eye tests, dental care, prescriptions and long-term care aspects. These allegations are usually lower than the equivalent services provided by private providers, and many are free for vulnerable or low-income patients.
The NHS provides the majority of health care in the UK, including primary care, inpatient care, long-term health care, ophthalmologists and dentistry. The 1946 National Health Service Act came into force on 5 July 1948. Private health care continues to parallel with the NHS, paid for largely by private insurance: used by about 8% of the population, generally in addition to the NHS. services.
NHS is largely funded from general taxation with small amounts donated by National Insurance payments and from fees charged in accordance with recent changes in the Immigration Act 2014. The UK government department responsible for the NHS is the Department of Health, headed by the Secretary of State for Health. The Department of Health has a budget of 110 billion pounds in 2013-14, mostly spent on the NHS.
In 2017, the British media reported that the Quality Care Commission (CQC) said that the NHS "strives" with a "precarious" future. Sources do not always explain if they refer to the entire NHS or just to the UK.
Video National Health Service (England)
Organization
The NHS was established in different countries of the UK through different laws, and as such there has never been a single British health system; rather, there are 4 health services in the UK; NHS England, NHS Scotland, HSC Northern Ireland and NHS Wales, run by each UK Government ministry for each country of origin before falling under the control of the devolved government in 1999. In 2009 the NHS UK approved a formal NHS constitution establishing rights and the legal responsibilities of the NHS, its staff, and the users of the service and make no additional binding promise on many key aspects of its operations.
The 2012 Health and Social Care Act came into force in April 2013, assigning responsibility to GP-led groups to deploy most of the local NHS services. Beginning in April 2013, Primary Care Trusts (PCTs) are being replaced by an organization headed by the General Practitioner (GP) called Clinical Commissioning Groups (CCGs). Under the new system, the new NHS Steering Board, called the NHS UK, oversees the NHS from the Department of Health. The law also became associated with an increased perception of the provision of private NHS services. In fact, the provision of NHS services by private companies precedes this law, but there are concerns that the new role of health regulators ('monitors') could lead to increased use of private sector competition, balancing the choice of care between private companies, charities and NHS organizations. The NHS Trust responds to Nicholson's "challenge" which involves savings of £ 20 billion across services by 2015.
Some NHS organizations use a referral management center to help reduce inappropriate reference in an effort to save NHS money. Millions of pounds have been spent on this service, 32% of which is provided by private companies, since 2013. Of the 211 clinical commissioning groups (CCG) surveyed by the British Medical Journal in 2016, 184 answered and 72 of them said using such schemes. Of CCGs using this service, 14% can show savings, 12% did not show overall savings and 74% can not indicate whether money has been saved. Because this service can prevent doctors referring patients to the hospital, there are some concerns they may delay the diagnosis and endanger the patient's safety.
GP left the profession because they felt the government was underestimating them and they felt the government was pushing too hard on them. GP is doing all the work necessary to ensure the safety of patients fearing too much work endangers their own health. There were 33,302 GPs in the UK in October 2017, and 34,495 the year before.
Maps National Health Service (England)
History
The controversial novel of Dr A. J. Cronin The Citadel , published in 1937, has sparked widespread debate about severe inadequacies of health. The author's innovative ideas are not only important for the NHS concept, but in fact, his best-selling novel is said to have contributed greatly to the Labor Party's victory in 1945.
The national health service is one of the fundamental assumptions in the Beveridge Report. The Emergency Hospital Service, established in 1939, gives the impression of what the National Health Service is all about.
Pre-war health care has become an unsatisfactory mixture of personal schemes, cities and charities. Bevan decided that the way forward was a national system rather than a system operated by local authorities. He proposed that every resident of the United Kingdom would register for a particular General Practice (GP) as a point of entry into the system, establishing a foundation laid in 1912 by the introduction of National Insurance and listing system for general practice. Patients will have access to all the medical, dental and nursing care they need without having to pay for it at that time.
In the 1980s, Thatcherism represented the systematic refusal and reversal of the postwar Consensus, in which major political parties largely agreed on the central themes of Keynesianism, the welfare state, nationalized industries, public housing and strict economic regulations. There is one major exception: National Health Service, which is very popular and gained widespread support within the Conservative Party. Prime Minister Margaret Thatcher promised Britons in 1982, the NHS "safe in our hands."
In 2011 the government signed a 10-year contract to manage the debt-laden Hinchingbrooke Hospital in Huntingdon, Cambridgeshire by Circle Healthcare. This is the first time that NHS hospital management has been taken over by a listed company on the stock exchange.
There have been several documented failures of some parts of the National Health Service to provide adequate care at the basic level. This failure is attributed to a groping bureaucracy as local institutions seek to meet conflicting demands with inadequate resources. Nevertheless, the NHS has received consistent consent and strong support from citizens.
The core principles
The main NHS website states the following as core principles:
NHS is born from long-held ideals that good health care must be available to everyone, regardless of wealth. At the launch by then health minister Aneurin Bevan, on July 5, 1948, there were essentially three core principles:
- That it meets everyone's needs
- Free at the delivery point
- It's based on clinical needs, not paying ability
These three principles have guided the development of the NHS for over half a century and remain. However, in July 2000, a full-scale modernization program was launched and new principles were added.
The main purpose of the additional principle is that the NHS will:
- Provides comprehensive services
- Form services around the needs and preferences of each patient, their family, and their caregiver
- Responding to the different needs of different populations
- Keep working to improve service quality and minimize errors
- Support and appreciate his staff
- Use public funding for health care that is specific to NHS patients
- Working with others to ensure unlimited services for patients
- Help to keep people healthy and work to reduce health disparities
- Respect the confidentiality of each patient and provide open access to information about services, treatment, and performance
Structure
The NHS UK is controlled by the British government through the Ministry of Health (DH), which takes political responsibility for the service. The allocation of resources and oversight is delegated to the NHS UK, an equal body, by the Health and Social Care Act 2012. NHS UK commissions primary care services (including general practitioners) and some specialist services, and allocates funds to 211 Geographic-based Clinical Commissions Group (CCG) throughout the UK. CCGs provide most services in their area, including hospitals and community-based health care.
A number of different types of organizations are assigned to provide NHS services, including NHS trusts and private sector companies. Many NHS trusts have become the trust of the NHS foundation, giving them an independent legal status and greater financial freedom. The types of NHS trusts and trusts of the following foundations provide NHS services in certain areas:
- The NHS acute care administers hospitals, care centers, and specialist care in about 1,600 NHS hospitals (multiple trusts are run between 2 and 8 different hospital sites)
- NHS ambulance service trust
- NHS treatments trust, provide health care and social care
- NHS mental health trust, specializing in managing and treating mental illness, including by using the power of unconscious commitment
Some services are provided at the national level, including:
- www.nhs.uk is the front-facing NHS website, providing complete official information on services, treatments, conditions, healthy living, and health topics
- NHS special health authorities provide various types of services
Staffing
In the year ending March 2017, there were 1.187 million staff in the NHS UK, 1.9% more than in March 2016. There were 34,260 unfilled nurses and midwifery posts in the UK in September 2017, this was the highest level since records began. 23% of women giving birth are left alone part of the time causing anxiety in women and possible harm to them and their baby. This is because there are too few midwives. The neonatal mortality rate increased from 2.6 deaths per 1,000 births in 2015 to 2.7 deaths per 1,000 births by 2016. Infant mortality (deaths during the first year of life) increased from 3.7 to 3.8 per 1,000 live births during the same period. Attacks on NHS staff have increased, accounting for 56,435 physical attacks on staff in 2016-2017, 9.7% more than 51,447 the previous year. Low staff levels and delays in treated patients are blamed for this.
Almost all hospital doctors and nurses in the UK are employed by the NHS and work in NHS-managed hospitals, with teams of more junior doctors (mostly in training) led by consultants, each of whom is trained to advise experts and care in specialization. Starting in 2017 the NHS doctors must disclose how much money they generate from private practice.
General doctors, dentists, optometrists (optometrists) and other local health care providers almost all work independently, and contract their services back to the NHS. They can operate in partnership with other professionals, own and operate their own operations and clinics, and hire their own staff, including other doctors etc. However, the NHS sometimes provides professional personnel and health care facilities employed in areas where there is no sufficient provision. by entrepreneurial professionals.
Note that due to methodological change, the 1978 figure is not directly proportional to the later figure.
The 2012 analysis by the BBC estimates that the NHS across the UK has 1.7 million staff, making it the fifth in the list of the world's largest entrepreneurs (well above the Indian Railway). In 2015 the Journal of Health Services reported that there were 587,647 non-clinical staff in the NHS UK. 17% work in support of clinical staff. 2% in cleaning and 14% administrative. 16.211 is a financial staff.
The NHS plays a unique role in training new doctors in the UK, with approximately 8,000 venues for student physicians each year, all of which are inherent in the NHS University Hospital's trust. After completing medical school, the new physician must continue to complete a two-year basic training program to be fully registered with the General Medical Council. Most continue to complete their base year of training in NHS hospitals although some may choose alternative employers such as the armed forces.
Most of the staff working for the NHS include non-clinical staff and general practitioners (many of whom are [GP] are self-employed) eligible to join the NHS Pension Scheme which, from April 1, 2015, is the average benefit scheme- salary.
Nurses who are citizens of other EU countries leave the NHS in large numbers because of their ability to live and work in the UK after Brexit has not been secured and there is concern that doctors may also leave.
33,000 nurses leave the NHS every year. Working pressures and low wages are blamed. Wage increases are limited to 1% per year even though inflation is higher than that. The NHS providers claim this makes hiring and maintaining staff difficult and endangering patient safety. Chris Hopson of the NHS Providers said, "The increasing problem of recruitment and retention makes it increasingly difficult to trust to ensure patient safety." Unsustainable staff gaps are rapidly opening. " The stoppage of seven years' salary along with stressful work has a devastating effect on the workforce. Hopson said further, "Pay becomes uncompetitive.Many significant trusts say that lower paid staff will leave piles of shelves in the supermarket rather than continue working on the NHS." Uncertainty over Brexit suggests that "important recruitment from EU countries is declining rapidly" The termination of salaries should be terminated and politicians should therefore be clear about when during the next parliamentary period will occur and how. " Hopson repeated the request of the NHS Provider for £ 25 billion in additional funds and staff who were warned would also leave because of exhaustion due to a steady job to meet an unprecedented treatment demands. The trainee doctor is 'sustaining' the hospital for lack of consultants. Disadvantages of family doctors are feared in areas such as Kent, Medway and Somerset where many doctors are over 55 and therefore tend to retire. No job vacancies have reached record levels and increased by 12% in the year to 2017. There are certain shortages of nurses and midwives. More GPs are leaving the profession than entering despite the government's encouragement to recruit GP. The number of both doctors and nurses in the NHS both fell even though it was more needed and despite the government's efforts to recruit more. The Guardian states. "The Health Foundation found a decrease in the number of nurses and GPs, and doubted the government's ability to meet staff targets." High staff turnover damages the NHS financially and impairs continuity of care. A 1% pay cut on the NHS payroll is blamed for this. In 2016-17 the number of GPs working on the NHS in the UK fell by 1,190. Staff shortages are in some areas so poor patient safety is risky. Patients are sometimes either dead or permanently disabled due to lack of specialist staff who can prevent this.
In January 2018 the hospital was under unprecedented pressure. The patient waits in the corridor because there is not enough beds for them. There is a delay before the patient is seen. Dr Nick Scriven of the Society for Acute Medicine stated, "The position [on the opposite side of the NHS] is as bad as I know." The big problem right now is the level of nursing staff, with extra beds being opened around the hospital to cope with winter spurs and not enough nurses to get around This is the same for doctors and therapists.The hospital's diagnostic facility will be flooded - a vicious cycle requiring an increase causes longer delays throughout the system. "Surgery such as knee and hip replacements is delayed to free the bed.
Commentators are increasingly arguing that staff shortages jeopardize the viability of the NHS. There are too few health workers, nurses and midwives, doctors are also in short supply. Hospital, Community Trust, and Mental Health Trust all the flaws in the face. NHS UK nearly 100,000 lack of qualified staff it needs. Some GPs lose sleep because they are worried that work pressure can cause them to lose something that puts patients at risk. In hospitals junior doctors are sometimes forced to do work beyond what has been trained for them. It stresses the doctor and puts the patient at risk. Overworked consultants do not have the time to make proper supervision of less qualified doctors. In a survey by The Observer and The Guardian newspapers, the majority of NHS staff feared that the lack of key staff had sacrificed the quality of patient care and patient safety.
In addition, due to the greater number in winter, the NHS has declared a black warning (official recognition that they can not cope with demand) over the past few years. In 2018, this was done on January 2, when appointments and non-emergency operations had to be canceled due to high demand, deteriorating due to limited staff.
2012 reform
The coalition government's white paper on health reform, published in July 2010, sets a significant reorganization of the NHS. White paper, Equality and excellence: liberating the NHS , with implications for all health organizations in the NHS abolishing PCT and strategic health authorities. It is claimed to divert power from the center to doctors and patients, moving somewhere between Ã, Â £ 60 to Ã, Â £ 80 billion into the hands of the Clinical Communist Group for commission services. The bill becomes law in March 2012 with a majority of 88 governments and follows more than 1,000 amendments in the House of Commons and the House of Lords.
Funding
The total budget of the Department of Health in the UK in 2017/18 was  £ 124.7 billion. Ã,  £ 13.8 billion was spent on drugs. The National Audit Office reports annually on the NHS compound summary accounts. Health spending in the UK will increase from Ã,  £ 112 billion in 2009/10 to Ã,  £ 127 billion in 2019/20 (in real terms), and per capita spending will increase by 3.5%. However, according to the Institute for Fiscal Studies (IFS), compared with the increase needed to keep up with an aging population growth, spending will fall 1.3% from 2009-10-2019-20.
George Stoye, senior IFS research economist, said the annual increase since 2009-10 was "the lowest level of growth during the same period since the mid-1950s, since when the annual growth rate was 4.1%." The NHS has been accused of drastic cuts to some services while keeping the public in the dark over what is going on. In 2017, funding increased by 1.3% while demand rose 5% and there are concerns about how the NHS will manage in the winter of 2017-2018. Ted Baker, Chief Hospital Inspector said that the NHS is still running the model it owned in the 1960s and 1970s and has not been modernized due to lack of investment.
The BMA has called for Ã, Â £ 10 billion more per year for the NHS to keep pace with what other advanced European countries spend on health. The BMA believes this could pay at least 35,000 hospital beds per day and thousands of other doctors. Dr Mark Porter of BMA, writes, "Our members report that service is truly on the cusp, with unprecedented patient requests only met with financial restraints and direction for the NHS and social concerns to make big savings that can not be achieved through plans for sustainability and transformation (STP) throughout the UK. "Porter stressed that he did not ask for more from comparable countries, only for the spending of other leading European countries to be matched. The increase, said Porter is needed.
Commissioning system
From 2003 to 2013, the primary fund holders in the NHS system were the NHS Primary Care Trust (PCT), which assigned health care from NHS trusts, GPs and private providers. PCT disbursed funds to them on an agreed tariff or contract, based on guidelines set by the Ministry of Health. The PCT budget of the Ministry of Health is calculated based on formulas relating to specific population and specific needs. They should "break even" - that is, not showing a deficit on their budget at the end of the financial year. Failure to meet financial objectives may result in the dismissal and replacement of the Board of Trustees, although such dismissals are very expensive for the NHS.
From April 2013 a new system was established as a result of the Health and Social Care Act 2012. The NHS budget is largely in the hands of a new body, the NHS UK. Specialist NHS England primary commission and care services. Acute care and community care are assigned by a local Clinical Commission Group headed by a physician.
Free services and contributing services
Free service at point of use
Most NHS services are free at the point of use.
This means that people generally pay nothing for doctor visits, nursing services, surgical procedures or equipment, consumables such as medicines and bandages, plasters, medical tests, and investigations, X-ray, CT scan or MRI or other diagnostic services. Free inpatient and outpatient hospital services, both medical and mental health services. Funding for these services is provided through general taxation and not special taxes.
Because the NHS is not funded by a contribution insurance scheme in the usual sense and most patients pay nothing for their care there is no bill to the person being treated or to the insurance or disease fund as is common in many other countries. This greatly reduces administrative costs that may involve complex tracking and consumption use procedures at the patient level and along with poor invoicing, reconciliation and debt processing processes.
Feasibility
Eligibility for NHS services is based on having the status of ordinary citizens. See National Health Service # Eligibility for treatment.
Recipe charge
By April 2015 the cost of prescribing the NHS in the UK was Ã, Â £ 8.20 for each amount of drug (which differs from Scotland, Wales and Northern Ireland where goods are determined on the NHS free of charge). People over the age of sixty, children under the age of sixteen (or under nineteen if in full-time education), patients with certain medical conditions, and those with low incomes, are exempt from payment. Those who need recipes can purchase a single pre-payment certificate that allows unlimited recipes during their validity period. It costs the same regardless of actual drug costs, but higher costs apply to medical equipment. For more details on prescription costs, see Prescription fees.
The high and rising costs of some drugs, especially some types of cancer treatments, mean that prescriptions can present a heavy burden for PCT, whose limited budget includes the responsibility for the difference between drug costs and fixed prescription costs. This causes a dispute whether some expensive drugs (eg Herceptin) should be prescribed by the NHS.
NHS Dentistry
If available, the cost of NHS dentistry as of April 2017 is: Ã, Â £ 20.60 for examination; Ã, Â £ 56.30 for charging or extraction; and Ã, Â £ 244.30 for more complex procedures such as dental crowns, dentures or bridges. In 2007, less than half of the dentist's income came from patients treated under NHS coverage; about 52% of the dentist's income is from treating private patients. Some people who need NHS dental care can not get it.
NHS Optical Services
Beginning April 1, 2007, the NHS Sight Test Fees (in the UK) are Ã, £ 19.32, and there are 13.1 million NHS tests conducted in the UK.
For those who qualify through needs, free vision tests, and voucher systems are used to pay or reduce the cost of the lens. There are free sunglasses frames and most optical experts keep a selection of low-cost items. For those who have received certain proven benefits, or otherwise eligible, participating optical experts use the table to find the number of subsidies.
Injury cost recovery scheme
Under the older law (especially the 1930 Road Traffic Act), hospitals treating road traffic accidents are entitled to limited compensation (based on the 1930 Act prior to any change, up to £ 25 per person being treated) of the insurance company driver (s) of the vehicles involved, but not forced to do so and often do not do so; the cost is in turn covered by elements that are legally required from the driver's motor vehicle insurance (commonly known as the Road Traffic Insurance when a driver only has the insurance). Since the initial bill is sent to the driver rather than to the insurer, even when the indictment is imposed, it is often not forwarded to the responsible firm; it is common that no further action should be taken in such cases as there are no practical financial incentives (and often financial disincentives due to potential legal costs) for each hospital to do so.
The Road Traffic (NHS Charges) Act 1999 introduced a standard national scheme for cost recovery using tariffs based on a single fee for outpatient care or a daily fee for inpatient care; these costs again eventually fall on the insurance company. However this scheme does not fully cover the cost of treatment in serious cases.
Since January 2007, the NHS has an obligation to reclaim medical expenses, and for ambulance services, for those who have paid personal injury compensation. In the final year of the scheme shortly before 2007, over Ã, £ 128 million has been reclaimed.
Car parking fee
The cost of car parking is a small revenue source for the NHS, with most hospitals getting about 0.25% of their budget from them. The cost level is controlled individually by each trust. In 2006 the cost of parking the car contributed Ã, Â £ 78 million towards the hospital budget. The patient group opposes such allegations. (This contrasts with Scotland where the cost of parking a car is largely removed from early 2009 and with Wales where parking fees are canceled by the end of 2011.)
The charity
There are more than 300 official NHS charities in England and Wales. Collectively, they have assets of over  £ 2 billion and have annual revenues in excess of £ 300 million. Some NHS charities have their own independent board of commissioners while in other cases, the relevant NHS Trust acts as Trustee of the company. Charity funds are usually used for medical research, larger medical equipment, aesthetic and environmental improvements, or services that enhance patient comfort.
In addition to the official NHS charity, many other charities accumulate funds that are spent on the NHS, mainly in relation to medical research and capital applications.
Regional lotteries were also common for fundraising, and in 1988, the National Health Service Lottery was approved by the government, before it was found illegal. The idea continues to be the National Lottery.
Outsourcing and privatization
Although the NHS routinely outsources its equipment and products and dentistry, eye care, pharmaceuticals and most GP practices are provided by the private sector, outsourcing hospital health care has always been controversial.
Outsourcing and privatization continued to rise in the NHS UK, and the UK NHS spending going into the private sector rose from Ã, Â £ 4.1 billion in 2009-10 to Ã, Â £ 8.7 billion in 2015-16. Private companies provide services in areas such as community services, general practice, and mental health care. Denis Campbell, Guardian health policy editor stated there was concerns the quality of private-sector care might be under what the NHS gave. Dr Louise Irvine, of the National Health Action Party, who campaigns against the use of private companies in the NHS, argues that private companies tend to do easier jobs by leaving complicated drugs to the NHS. An article in the Independent states that the private sector chooses an easier case because they are more profitable, also because the private sector does not have an intensive care facility if something goes wrong. Professor Allyson Pollock considers privatization to be monitored to ensure the poor, the elderly and the sick are not inferior.
According to the BMA survey more than two-thirds of doctors are quite uncomfortable or very uncomfortable about the independent sector that provides NHS services. The BMA believes that it is important for the independent sector to have the same standards as the NHS when providing NHS care. BMA recommends: data collection, comprehensive impact analysis before independent providers are accepted to ensure the existing NHS services are not compromised, risk assessment to know the likely outcomes if NHS staff is unwilling to transfer to the private sector, transparent reporting by the private sector from patient safety and performance, independent providers should be regulated like NHS providers, patients should be protected if independent providers terminate contracts early, transfers from independent providers to the NHS should be reviewed periodically to establish how much these NHS costs, private sector contracts should be changed so that private sector providers contribute to training costs staff financially or by providing training opportunities. According to the BMA, most communities are opposed to increased privatization.
The NHS organization provides approximately Ã, Â £ 600 million jobs in private patient units by 2017 and is expected to increase by 6 or 7% per annum. Jobs funded by the NHS by independent hospitals as part of their income increased from 15.7% in 2007/8 to 29.9% by 2015/6.
There are many problems with NHS jobs being outsourced to Capita, patients may be at risk. See NHS Service for more.
Capacity
NHS is very stretched in the winter of 2016-17 and the situation is worse in 2017-18. England, Wales and Northern Ireland miss every three of their top targets (cancer, surgery and A & E care) for 18 months. Patients wait longer for treatment. 6,932 patients waited more than 3 hours at A & amp; E in October 2010, but this increased to 45,532 patients by October 2017. Between late November 2017 and December 24 58,845 patients waited 30 minutes or more in the ambulance and they, 12,188 waited for over an hour. A waiting ambulance crew with a patient who can not be handed over to a hard-pressed hospital staff can not respond to further emergencies in the community. Patients with serious illness sometimes have to wait for hours for ambulances (waiting time should not exceed 8 minutes) and this can lead to death. Intensive care units send patients to other hospitals due to lack of beds. 79% of intensive care consutants fear the care of patients can suffer because of staff shortage. Just under 600,000 ambulances have to wait more than 15 minutes before they can hand patients to A & amp; E in the three months to April 2018. Senior people responsible for acute, urgent and emergency care in NHS regulators write to all NHS trusts explaining clearly delayed hazards of handover. They emphasize, "Acute guardianship should always accept patient submission within 15 minutes from an ambulance arriving in the emergency department (ED) leaving abandoned patients waiting in ambulances or in corridors overseen by ambulance personnel is not appropriate Delays in handover of patients from ambulance services for ED outcomes in: increased risk for patients on site due to late diagnosis and treatment [and] increased risk in the community due to fewer ambulances available to respond Patients in the urgent care line at highest risk are preventable, the losses are those who receive emergency call 999 high priority, but no ambulance source available for delivery. "
There are plans to stop waiting time targets in the coming year. The patient group is afraid that the patient should wait for longer pain before getting treatment. Despite unprecedented demand for hospital beds and unprecedented pressure on the Health Service in September 2017 there were 82 wards closed and 1429 empty beds because the NHS has no funds or staff to keep them open.
The NHS is much more stretched in 2017-18 than in previous winters though the British Red Cross declared the state of British hospitals in 2016-17 humanitarian crises. Serious incidents including death when patients are under care of ambulance services have risen sharply. Underfunding is blamed. About 30 health charities, including the Teen Cancer Trust, the National AIDS Trust and the Neurone Motor Disease Association, expressed concerns over the UK NHS "limiting and rationing care" due to underfunding, especially for patients with rare and complex conditions. Groups from the Special Health Alliance maintain that there is not enough public scrutiny. Cancer, diabetes, and asthma patients may lose new affordability criteria, meaning medicines that deplete the NHS of more than £ 20 million in total annually may be limited. The survival rate of lung cancer is a postcode lottery and patients in the worst-performing areas are dying unnecessarily.
NHS hospitals are under more pressure in winter 2017-18 than in winter 2016-17. At least one hospital patient had to sleep on the floor due to lack of beds and trolleys. The larger number of operations canceled 3,351 per week on average during 2017-18, compared to 1948 the previous year. The patient waited so long in an ambulance outside the hospital that the hospital staff went out to take care of them. Long waiting in the ambulance is dangerous for the patient and preventing the ambulance crew from handling the next 999 call. There is no room in the resuscitation unit for patients who need to be there. The beds are in short supply such as various essential medical equipment and even ordinary items such as pillows and mask buffers to prevent the spread of infection in short supply.
From 2011 to 2018, the UK population increased by about 6%. The number of hospitalized patients in emergencies rose 15%. Half of them are over 65.
The NHS UK has 166 too few cancer specialist nurses, 158 too few chemotherapy nurses, 44 palliative care nurses too few caring for cancer patients, and 61 very few cancer support workers, 429 posts in total. Nurse stress and cancer therapy may be delayed through this, or chemotherapy may be restricted.
In the first quarter of 2018 the number of canceled operations at 25,475 was the highest since records began in 1994. This is psychologically very stressful for patients and delays can make their condition worse. The Royal College of Surgeons places cancellations to "extreme pressure" at A & amp; E departments and patients are running out late.
From January to March 2018 an average of 92.6% of hospital beds are occupied by the Royal College of Surgeons found. Occupancy 85% is the upper limit of where the patient's management regularly reaches crisis points and infections become more frequent. 92% occupancy capacity is the level maintained by the Ministry of Health should not exceed the hospital. Critics claimed the pressure was worse because of government austerity measures since 2010. The number of patients received back to hospital within thirty days of debit increased by 19.2% from 1.16 million in 2010-11 to 1.38 million in 2016-17 Nuffield Trust and Health Foundation reported. It is feared that some patients may be discharged too soon, that overworked hospital staff may ignore warning signs, other patients may be hospitalized for too long due to lack of resources for community care if they are discharged. Only fewer than 200,000 patients a year are admitted back to the hospital due to blood clots, pneumonia or press injuries that can all be prevented with proper care at a hospital or community.
Sustainability and transformation plan
The sustainability and transformation plan is generated during 2016 as a method to address the financial problems of the service. This plan seems to involve a loss of service and is highly controversial. The plan may be the most far-reaching change in healthcare over the decades and the plan should contribute to redesigning treatments to manage increased patient demand. Some units of A & amp; E will be closed and hospital care is concentrated in fewer places. Nearly two-thirds of senior doctors fear the plan will worsen patient care.
Consultations will range from cost savings, downsizing and some service reductions at the National Health Service. Downsizing will lead to closure of the ward including the closure of the psychiatric ward and the reduction of the number of beds in many areas among other changes. There is concern that hospital beds are closed without an increase in community provision.
The think tank Nuffield Trust claims many suggestions will fail to implement government financial targets and involve "enormous implementation tasks". Sally Gainsbury of Nuffield Trust says many current plans involve removal or closing services. Gainsbury adds, "Our study found that, in many types of this reconfiguration, you do not save a lot of money - everything that happens is that patients have to go to the next hospital down the street. They are more uncomfortable... but rarely keep the money it needs. There will be a shift from inpatient outpatient care, but critics fear that there will be life-threatening pruning that the plan unravels healthcare rather than protect it, further that an untested plan makes patients vulnerable to harm, less mobile. In contrast, NHS England claims that plans bring combined care closer to home. John Lister of Keep Our NHS Public says there are too many assumptions, and managers who are desperate to cut the deficit move to an untried plan. The NHS manager has struggled to keep the service running, handling increased volume and juggling for hospital beds. Finding extra time to develop a workable sustainability and transformation plan is itself problematic.
Critics fear that the plan will involve cuts but supporters insist some services will be cut while others will be upgraded. Democratic Liberal Democrat MP Norman Lamb accepted that the review made sense in principle but stated: "It would be embarrassing if the government only hopes to use this plan as an excuse to cut the NHS services and hunger from much-needed funding. that the NHS is becoming more efficient and sustainable for future generations, the redesign of the model of care will only take us so far - and no expert believes the Conservative doctrine that an extra fund of £ 8 billion by 2020 will be close enough. "Norman Lamb also said The NHS is sliding toward "catastrophe (...) With so rapidly increasing demand, more funding is needed.It will be inexcusable for governments not to act in the light of this warning." The NHS's superiors have kept plans to bypass secrets, also preventing NHS staff and the public from getting feedback. This led to allegations of cover-up and stealth cuts. Undisclosed plans include closing A & amp; Ice and one hospital even though full details remain hidden. One of the local managers described keeping the secret plan as 'ridiculous' and the other saying 'wrong judgment call' has been made. Others talk about being in a meeting where 'real people' like patients and the community are not involved. Complex jargon can confuse people who try and follow what happens. The King's Fund reports the public and most patients are absent from plans that may involve the closure of large-scale services. Chris Ham of the King's Fund describes suggesting out-of-hospital service and GP can take over the work now performed by hospitals as a "heroic assumption" because both out-of-hospital services and general practitioners are under too much pressure. Some councils that disagree with the secrecy have published plans on their website. Funds that should be used to help move services after closure go instead to include other NHS deficits.
NHS policies and programs
Changes under Thatcher rule
The 1980s saw the introduction of the modern management process ( General Management ) in the NHS to replace the previous consensus management system. This is outlined in the 1983 Griffiths Report. It recommends the appointment of general managers in the NHS with whom responsibility should lie. The report also recommends that doctors engage better in management. Financial pressures continue to put strain on the NHS. In 1987, an additional Ã, Â £ 101 million was provided by the government to the NHS. In 1988, Prime Minister Margaret Thatcher announced the NHS review. From this review in 1989 two white papers Working for Patients and Concern for People were produced. It outlines the introduction of so-called "internal markets", which make up the structure and organization of health services for much of the next decade.
In the UK, the National Health Service and the Community Care Act 1990 define this "internal market", in which health authorities stop running hospitals but "buy" care from their own hospitals or other authorities. Certain doctors become "holders of funds" and can purchase care for their patients. "Providers" become independent trusts, which encourage competition but also increase local differences. Increasing competition may be statistically associated with poor patient outcomes.
Changes under Blair rule
These innovations, especially the "moneyholder" option, were denounced at that time by the Labor Party. Opposition to what is claimed as a Conservative intention to privatize the NHS is a key feature of the Labor Party election campaign.
Labor came to power in 1997 with a pledge to abolish "internal markets" and abolish fundholding. However, in his second term, Blair broke free of this direction. He is pursuing steps to strengthen the internal market as part of his plan to "modernize" the NHS.
A number of factors push for this reform; they include an increase in the cost of medical technology and medicine, a desire to raise standards and "patient choice", an aging population, and a desire to withhold government spending. (Since the National Health Services in Wales, Scotland and Northern Ireland are not controlled by the British government, these reforms have increased the distinction between the National Health Service in different parts of the UK. See NHS Wales and NHS Scotland for a description of their development).
Reforms include (among other measures) the laying of detailed service standards, rigorous budgetary financing, revised job specifications, the reintroduction of "fundholding" (under the description of "practice-based commissioning"), the closure of surplus facilities and the careful clinical emphasis and corporate governance. Several new services are developed to help manage demand, including NHS Direct. The agenda for the Change agreement aims to provide harmonized payments and career advancement. These changes have caused controversy in the medical profession, the news media and the public. The British Medical Association in a 2009 document at the Independent Sector Treatment Center (ISTC) urged the government to return the NHS to the service under public provisions, not private property; cooperation, not competition; integration, not fragmentation; and public services, not personal gain.
The Blair government, while abandoning free services at the point of use, encourages the outsourcing of medical services and support to the private sector. Under the Private Finance Initiative, more and more hospitals are built (or rebuilt) by private sector consortiums; hospitals may have both medical services such as ISTC and non-medical services such as catering provided under long-term contracts by the private sector. A study by a consulting firm working for the Department of Health shows that every Ã, Â £ 200 million spent on private-funded hospitals will result in the loss of 1000 doctors and nurses. The first PFI hospital contains about 28 percent less than they replace.
The NHS is also required to take a proactive "social directive" policy, for example, in terms of smoking and obesity.
Internet information service
In the 1980s and 90s, NHS IT spent money on several failed IT projects. The Wessex project, in the 1980s, attempted to standardize IT systems across regional health authorities. London Ambulance Service is a computer-assisted delivery system. Read the code is an attempt to develop new electronic health language, then scheduled to be replaced by CT SNOMED.
The NHS Information Authority (NHSIA) was established by the Parliament Act in 1999 with the aim of bringing together four NHS IT and Information agencies (NHS Telecoms, Family Health Services (FHS), NHS Center for Coding and Classification (CCC) and NHS Information Management Group (IMG)) to work together to deliver IT infrastructure and information solutions to the NHS in the UK. The 2002 plan was for NHSIA to implement four national IT projects: basic infrastructure, electronic records, electronic recipes, and electronic ordering, modeled after NHS Direct's large nurse program and health website. The NHSIA function was divided into other organizations in April 2005.
In 2002, the NHS National Program for IT (NPfIT) was announced by the Ministry of Health.
Despite problems with internal IT programs, the NHS has breached a new ground in providing health information to the public via the internet. In June 2007, www.nhs.uk was relaunched under the "NHS Choice" banner as a comprehensive health information service for the community.
In a break with the norm for government sites, www.nhs.uk allows users to add public comments giving their views on each hospital and adding comments on the articles it carries. It also allows users to compare hospitals for care through "score cards". In April 2009 became the first official website to publish hospital mortality rates (Hospital Standard Death Rate) for the entire UK. Its Behind Headlines daily health news analysis service, critically assessing the media and science stories behind them, was declared the Best Innovation in Medical Communications in the prestigious BMJ Group 2009 Awards and in case studies 2015 is found to provide very accurate and detailed information when compared to other sources. In 2012, NHS UK launched the NHS mobile app library that has been reviewed by doctors.
Eleven NHS hospitals in West London Cancer Network have been linked using the IOCOM Grid System. The NHS has reported that Grid has helped improve collaboration and attendance meetings and even improve clinical decisions.
Smoking cess
One in four hospital patients smokes and it is higher than the proportion in the general population (just under one in five). Public Health England (PHE) wants all hospitals to help smokers quit. One in thirteen smoked patients are referred to hospitals or community-based cessation programs. More than a quarter of patients were not asked if they smoked and nearly three quarters of smokers were not asked if they wanted to quit. Half of the frontline hospital staff were not offered training to quit smoking. Patients who smoke should be given special assistance to stop and replace nicotine. There must be a dedicated staff that helps the patient to stop. Seven-tenths of smokers say they want to quit and those who offer help are four times more likely to quit permanently. PHE claims smoking causes 96,000 deaths per year in the UK and twenty times the number of smoking-related diseases. Dr. Frank Ryan, a psychologist said, "It's really about refocusing our efforts and motivating users of our services and staff to quit." And of course, whatever investment we do in smoking cessation programs, there are many returns in terms of health benefits and even factors such as attendance at work, because workers who smoke tend to have more absent mantra than work. "
See Smoking in England
Public satisfaction and criticism
A 2016 survey by Ipsos MORI found that the NHS topped the list of "things that make us most proud to be British" by 48%. An independent survey conducted in 2004 found that NHS users often reveal very high levels of satisfaction about their personal experience about medical services. Of hospitalized patients, 92% said they were satisfied with their care; 87% of GP users are satisfied with their GP; 87% of hospital outpatients are satisfied with the services they receive; and 70% of Accident and Emergency Department users reported satisfaction. When asked if they agree with the question "my local NHS gives me good service" 67% of those surveyed agreed with it, and 51% agreed with the statement "NHS provides good service." The reason for this difference between personal experience and overall perception is unclear; However, researchers at King's College London found that famous media goggles can serve as part of a broader 'blame business', in which media, lawyers and regulators have personal interests. It is also evident from the satisfaction survey that most people believe that the national press is generally critical of service (64% reporting it as critical compared to just 13% saying the national press is profitable), and also that the national press is the most unreliable source of information 50% reported not fully or unreliable, compared to 36% who believed the press was reliable). Newspapers are reportedly less profitable and less reliable than broadcast media. The most reliable sources of information are considered as leaflets from general practitioners and information from friends (both 77% reported as reliable) and medical professionals (75% considered reliable).
Professor Sir Michael Adrian Richards says more money should be spent on the NHS. Richards maintains nurses need a raise to encourage them to stay. Richards also said the NHS needs to spend money more effectively and some hospitals have improved by focusing on providing patient needs.
Some examples of criticism include:
- Some very expensive treatments may be available in some areas but not elsewhere, called the postcode lottery.
- National Program for IT designed to provide infrastructure for electronic prescriptions, appointment orders and elective operations, and national care record services. The program is experiencing delays and overspends before it is finally abandoned.
- In 2008 there was a decrease in the availability of NHS dentistry after new government contracts and dentists' tendency to accept private patients only, with 1 in 10 dentists leaving the NHS completely. However, by 2014 the number of NHS dental patients is reported to increase.
- There are a number of high profile scandals in the NHS. Recently there was a scandal in an acute hospital like Alder Hey and Bristol Royal Infirmary. Stafford Hospital is currently being investigated for poor conditions and inadequate statistical analysis that led to excessive mortality.
- The October 14, 2008 article in The Daily Telegraph states, "The NHS trust has spent more than Ã, Â £ 12,000 on personal care for hospital staff because the waiting time itself is too long."
- In January 2010, the NHS was accused of allocating Ã, Â £ 4 million per year for homoeopathic medicine, which is not supported by scientific research.
- The absence of identity/dwelling checks on patients in clinics and hospitals allows people normally living abroad to travel to the UK for the purpose of obtaining free care, at the expense of British taxpayers. A report published in 2007 estimated that the NHS bill for treatments called 'health tourists' was  £ 30 million, 0.03% of the total cost.
- Long waiting for treatments such as cancer treatment, cataracts, knees and hip replacement cause people who are vulnerable to paying for this treatment in person. Patients use savings or take out a loan. It is widely perceived that the NHS should provide free health care to those who need it and patients should not be under pressure to pay.
- According to Tessa Jowell, cancer survival rates in the UK are the worst in Western Europe and the blame lies in the slow diagnosis.
NHS mental health services is one area that tends to receive routine criticism from service users and the public, for sometimes conflicting reasons. Women are not getting gender-specific help and in most guardians are not routinely asked if they have experienced domestic violence even though NICE recommends asking this. Some psychiatric patients are difficult to manage. Police are increasingly being called in to deal with mental health crises because of the lack of trained mental health staff in the NHS. The police are less suited for this role. The number of psychiatrists working with children and teenagers fell from 1,015 post equivalent full-time in 2013 to 948 in 2017 despite the growing need for psychiatry among children. Many troubled young people have to wait long before treatment begins or is rejected altogether. There is also a shortage of psychiatrists who care for elderly patients. Two thirds of children referred by their general practitioner for psychiatric care do not get it. Because the patient lacks a bed more pain when entering the unit and there are fewer staff to manage it. Attacks on staff have increased from 33,620 in 2012-3 to 42692 in 2016-7. There are also more than 17,000 attacks by patients in other patients. Patients with eating disorders are sometimes denied treatment or are made to wait too long for a treatment that reduces their chances of making a good recovery. There is a preventable death among psychiatric patients and the lack of staff to provide adequate care is cited as an excuse.
Long waiting for surgery increased three times in four years.
Because of the shortage of nurses in the hospital, drugs for sepsis, Parkinson's and diabetes are given late, the pain is not treated because the nurses are too busy, the children go without food because care must be prioritized, the patient is not moved at risk of injury, the patient remains in the corridor because there are no empty beds, the community staff complain that they can not do all the work required of them. The number of hospital beds has decreased even though demand for beds has increased.
Record the number of GP practices closed, The Royal College of GPs says doctors can no longer manage the increase in patient demand unless there is higher funding.
Quality of health care, and accreditation
There are many regulatory bodies that play a role in the NHS, both government-based (eg Ministry of Health, General Medical Board, Nursing and Midwifery Board), and non-governmental organizations (eg Royal Colleges). Independent accreditation groups exist in the UK, such as the Public Sector Accreditation Scheme and the private sector CHKS.
In relation to the assessment, maintenance and improvement of the quality of health services, as with many other developed countries, the UK government has separated the role of health care suppliers and their quality delivery reviewers. Quality is assessed by an independent body such as the Health Commission in accordance with standards established by the Ministry of Health and the National Institute for Clinical Health and Excellence (NICE). The responsibility for assessing quality was transferred to the Quality Care Commission in April 2009.
The comparative analysis of health care systems in 2010 put the second NHS in the study of seven rich countries. The report placed the British health system on top of Germany, Canada and the United States; NHS is considered the most efficient among health systems studied.
Performance
In 2014, the Nuffield Trust and Health Foundation produced a report comparing the performance of the NHS in four British countries since devolution in 1999. They incorporate data for Northeast England as an area more akin to the devolution area than the rest of England. They found that there is little evidence that any country moves ahead of others consistently across all available performance indicators. There is an increase in all four countries in life expectancy and in mortality rates that can be handled by health care. Despite warmly contested policy differences between the four countries there is little evidence, where there is comparable data, of any significant difference in outcomes. The authors also complained about the limited number of comparable data on four health systems in the UK. The place of medical school will increase 25% from 2018.
A report from the UK Public Health Neurology Intelligence Network based on hospital outpatient data for 2012-13 indicates that there are significant variations
Source of the article : Wikipedia
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