Healthcare in the United Kingdom

From Wikipedia, the free encyclopedia

Healthcare in the United Kingdom is a devolved matter and England, Northern Ireland, Scotland and Wales each has its own system of publicly-funded health care together with private healthcare and a wide variety of alternative and complementary treatments. Public healthcare is provided to all UK permanent residents and is free at the point of need being paid for from general taxation. Taken together, the World Health Organisation, in 2000, ranked the provision of healthcare in the United Kingdom as fifteenth best in Europe and eighteenth in the world.^[1][2]

The responsibility of healthcare in the United Kingdom lies with four executives; healthcare in England is the responsibility of Her Majesty's Government; healthcare in Northern Ireland is the responsibility of the Northern Ireland Executive; healthcare in Scotland is the responsibility of the Scottish Government; and healthcare in Wales is the responsibility of the Welsh Assembly Government. Each asserts governmental influence upon a National Health Service; due to each of these health systems having different policies and priorities, a variety of differences exist between the systems.^[3][4]

Contents 1 Healthcare in England 1.1 Experiences, perceptions and reporting of the NHS in England 2 Healthcare in Northern Ireland 3 Healthcare in Scotland 4 Healthcare in Wales 5 Comparisons between the public health systems in the UK 5.1 Common features 5.1.1 Advice services 5.1.2 Ambulance services 5.1.3 Cost recovery in exceptional circumstances 5.1.4 Dentistry 5.1.5 General practitioners and hospitals 5.1.6 Pharmacies 5.2 Differences 5.2.1 Best practice and cost effectiveness 5.2.2 Cost control 5.2.3 Parking charges 5.2.4 Prescription charges 5.2.5 Polyclinics 5.2.6 Role of private sector in public healthcare 6 Private health care 7 See also 8 References

[edit] Healthcare in England

Th majority of healthcare in England is provided by the publicly funded healthcare system, the National Health Service (NHS), which provides healthcare to anyone normally resident in the UK with most services free at the point of use for the patient though there are charges associated with eye tests, dental care, prescriptions, and many aspects of personal care.

The National Health Service Act 1946 came into effect on 5 July 1948 and today the NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare, ophthalmology and dentistry. Though private health care has continued parallel to the NHS, paid for largely by private insurance, it is used by less than 8% of the population. Recently the private sector has been increasingly used to increase NHS capacity despite a large proportion of the public opposing such involvement according to one survey by the BMA^[5].

The UK government department responsible for the NHS is the Department of Health, and most of the Department of Health's budget (£98.6 billion in 2008-9^[6]) is spent on the NHS.

[edit] Experiences, perceptions and reporting of the NHS in England

Although the NHS has a high level of popular public support within the country, the national press is often highly critical of it. An independent survey conducted in 2004 found that users of the NHS often expressed very high levels satisfaction about their personal experience of the medical services they received: 92% of hospital in-patients said they were satisfied with their treatment; 87% of GP users were satisfied with their GP; 87% of hospital outpatients were satisfied with the service they received; and 70% of Accident and Emergency department users reported being satisfied. ^[7] However, only 67% of those surveyed agreed with the statement "My local NHS is providing me with a good service”, and only 51% agreed with the statement “The NHS is providing a good service.^[8] Satisfaction in successive surveys has noted high satisfaction across all patient groups, especially recent inpatients, and user satisfaction is notably higher than that of the general public. The reason for this disparity between personal experience and overall perceptions, and the difference in perceptions between recent users of the health service and the public at large is not clear. It is also apparent from the survey that most people realize that the national press is generally critical of the service (64% reporting it as being critical compared to just 13% saying the national press is favourable), and also that the national press is the least reliable source of information (50% reporting it to be not very or not at all reliable, compared to 36% believing the press was reliable). ^[8] Newspapers were reported as being less favorable and also less reliable than the broadcast media. The most reliable sources of information were considered to be leaflets from GPs and information from friends (both 77% reported as reliable) and medical professionals (75% considered reliable).^[8]

[edit] Healthcare in Northern Ireland

The majority of healthcare in Northern Ireland is provided by Health and Social Care in Northern Ireland. Though this organisation does not use the term 'National Health Service', it is still commonly referred to as the 'NHS'.^[9]

[edit] Healthcare in Scotland

The majority of healthcare in Scotland is provided by NHS Scotland, Scotland's system of publically funded healthcare that was created in 1948 at the same time as the NHS south of the border. It remains a separate body from the other public health systems in the UK although this is often not realised by patients when "cross-border" or emergency care is involved due to the level of co-operation and co-ordination.

[edit] Healthcare in Wales

The majority of healthcare in Wales is provided by NHS Wales. This body was originally formed as part of the same NHS structure for England and Wales created by the National Health Service Act 1946 but powers over the NHS in Wales came under the Secretary of State for Wales in 1969^[10]. and, in turn, responsibility for NHS Wales was passed to the Welsh Assembly and the Welsh Assembly Government under devolution in 1999.

[edit] Comparisons between the public health systems in the UK

[edit] Common features

[edit] Advice services

Each NHS system runs 24-hour confidential advisory services: NHS Direct ^[11] provides a telephone-based service for England, NHS Direct Wales/Galw Iechyd Cymru ^[12] provides a similar service in Wales while Scotland has NHS24^[13].

[edit] Ambulance services

Each public healthcare system provides free ambulance services for emergencies, when patients need the specialist transport only available from ambulance crews or when patienets are not fit to be travel home by public transport. These services are generally supplemented when necessary by the voluntary ambulance services (British Red Cross, St John Ambulance and the St Andrews Ambulance Association). In addition, patient transport services by air are provided by the Scottish Ambulance Service and by county or regional air ambulance trusts (sometimes operated jointly with local police helicopter services^[14]) throughout England and Wales[1]. In specific emergencies, emergency air transport is also provided by naval, military and air force aircraft of whatever type might be appropriate or available on each occasion. On more than one occasion this has led to new-born babies needing special care being flown long distances in Hercules transport aircraft ^[15] or similar.

[edit] Cost recovery in exceptional circumstances

Being paid for from general taxation, the public health services do not bill for services rendered. Each NHS system, however, reserves the right to claim compensation for treatment required as a result of the negligence of others such as from insurance companies through the Injury Costs Recovery Scheme following the determination of fault in motor accidents.

[edit] Dentistry

Each NHS system provides dental services through private dental practises and dentists can only charge NHS patients at set rates (though the rates vary between countries). Patients opting to be treated privately do not receive any NHS funding for the treatment. About half of the income of dentists in England comes from work sub-contracted from the NHS^[16], however not all dentists choose to do NHS work.

[edit] General practitioners and hospitals

Each NHS system uses General Practitioners (GPs) to provide primary healthcare for patients and to make referrals to further services as necessary. GP Practices often operate from Health Centres which typically provide care that is considered more routine and less invasive than the type of surgeries and procedures that take place in the hospital, including ophthalmology, dentistry, wound dressings and re-dressing, infant check-ups and vaccinations. Hospitals provide more specialist services including diagnostic and surgical and specialist mental hospitals exist to care for patients with psychiatric illnesses. Access to hospital services is usually via referral from a general practitioner though access to Accident and Emergency (A&E) departments is an obvious exception.

[edit] Pharmacies

Each NHS system uses pharmacies to supply prescription drugs. Pharmacies (other than those within hospitals) are privately owned but have contracts with the relevant health service.

[edit] Differences

[edit] Best practice and cost effectiveness

In England and Wales, the National Institute for Health and Clinical Excellence (NICE) sets guidelines for medical practitioners as to how various conditions should be treated and whether or not a particular treatment should be funded. These guidelines are established by panels of medica experts who specialize in the area being reviewed.

In Scotland, the Scottish Medicines Consortium advises NHS Boards there about all newly licensed medicines and formulations of existing medicines as well as the use of antimicrobiotics but does not assess vaccines, branded generics, non-prescription-only medicines (POMs), blood products and substitutes or diagnostic drugs. Some new drugs available for prescription more quickly than in the rest of the UK. At times this has led to complaints.^[17]

[edit] Cost control

The National Audit Office reports annually on the summarised consolidated accounts of the NHS, and Audit Scotland performs the same function for NHS Scotland ^[18].

[edit] Parking charges

Parking charges at hospitals have been abolished in Scotland (except for 3 PFI hospitals)^[19] but continue to be in place at many hospitals England.

[edit] Prescription charges

In England, patients under 16 years old (19 years if still in full-time education) or over 59 years will get the drug for free. There are also exemptions for people with certain medical conditions, including cancer, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2009, a fixed charge of £7.20 is payable per item.

In Northern Ireland, prescription charges will be abolished by April 2010.^[20] At present, patients under 16 years old (19 years if still in full-time education) or over 59 years get free prescriptions and there are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £6.85 is payable per item.

In Scotland, prescription charges will be abolished before 2011.^[21] At present, patients under 16 years old (19 years if still in full-time education) or over 59 years get free prescriptions and there are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2009, a fixed charge of £4 is payable per item.^[22]

In Wales, prescription charges were abolished in 2007 and all prescription drugs are now dispensed without charge.

[edit] Polyclinics

Polyclinics are being trialled in London and in other suburban areas and, if successful, may be rolled out across England.

[edit] Role of private sector in public healthcare

Whereas the UK government is expanding the role of the private sector within the NHS in England^[23][24], the current Scottish government is moving in the opposite direction, actively reducing the role of the private sector within public healthcare in Scotland^[25] and planning legislation to prevent the possibility of private companies running GP practices in future.^[26]

[edit] Private health care

Each country of the United Kingdom has a private healthcare sector which is considerably smaller than its public equivalent. Provision of private healthcare is acquired by means of private health insurance, funding as part of an employer funded health care scheme or paid directly by the customer.

There are certain treatments that the private sector does not provide. For example BUPA, one of the largest 'private' health care providers in the UK, excludes AIDS/HIV treatment from its insurance plans, whilst full treatment is freely available through the NHS. ^[27]

There is some relatively minor overlap between public and private provision in some places. For instance it is possible for some NHS patients to be treated in private health care facilitities and some NHS facilities are let out to the private sector for privately funded treatments or for pre- and post-operative care. This depends on policy and contractual arrangements in each local area.

[edit] See also

• National Health Service (England's national health service)
• NHS Scotland
• NHS Wales
• Health and Social Care in Northern Ireland (Northern Ireland's national health service)

• Emergency medical services in the United Kingdom
• Euthanasia in the United Kingdom

[edit] References

v • d • e Healthcare in Europe Sovereign states Albania · Andorra · Armenia1 · Austria · Azerbaijan2 · Belarus · Belgium · Bosnia and Herzegovina · Bulgaria · Croatia · Cyprus1 · Czech Republic · Denmark · Estonia · Finland · France · Georgia2 · Germany · Greece · Hungary · Iceland · Ireland · Italy · Kazakhstan3 · Latvia · Liechtenstein · Lithuania · Luxembourg · Macedonia · Malta · Moldova · Monaco · Montenegro · Netherlands · Norway · Poland · Portugal · Romania · Russia3 · San Marino · Serbia · Slovakia · Slovenia · Spain · Sweden · Switzerland · Turkey3 · Ukraine · United Kingdom (England • Northern Ireland • Scotland • Wales) Other entities European Union · Sovereign Military Order of Malta Dependencies, autonomies, other territories Abkhazia 2 · Adjara1 · Adygea · Akrotiri and Dhekelia · Åland · Azores · Bashkortostan · Catalonia · Chechnya · Chuvashia · Crimea · Dagestan · Faroe Islands · Gagauzia · Gibraltar · Guernsey · Ingushetia · Jan Mayen · Jersey · Kabardino-Balkaria · Kalmykia · Karachay-Cherkessia · Republic of Karelia · Komi Republic · Kosovo · Madeira · Isle of Man · Mari El · Mordovia · Nagorno-Karabakh1 · Nakhchivan1 · North Ossetia-Alania · Northern Cyprus1 · South Ossetia 2 · Svalbard · Tatarstan · Transnistria · Udmurtia · Vojvodina Italics indicates an unrecognised or partially recognised country.  1 Entirely in Asia, but historically considered European.  2 Partially or entirely in Asia, depending on the border definitions.  3 Transcontinental country.