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The National Health ServiceHealthcare in the United Kingdom
By Vruti DattaniUniversity of Cambridge
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• NHS = National Health Service
• 1948
• Good healthcare should be available to all
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• primary care
• in-patient care
• long-term healthcare
• ophthalmology
• dentistry
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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
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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
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• 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.
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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
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Organization
• Funded centrally• However, England, Wales, Scotland and
Northern Ireland managed separately
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• England…..• Department of Health, headed by Secretary of
State for Health: Andrew Lansley
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• 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
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• 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
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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
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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
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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
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• NHS walk in centres
• NHS Direct
• Dentists
• Opticians
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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
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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
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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
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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
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Problems in the NHS
• Drugs approved by NICE (National Institute for Health and Clinical Excellence)
• Waiting Lists• Superbugs• Computerization• Hospital debt• Staffing problems
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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!
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Thank you for listening!