Criticism of the National Health Service (England)

The logo of the NHS for England. The colour, "NHS Blue" (Pantone 300, coincidentally the same as the blue of the Flag of Scotland), is used on signs and leaflets throughout the NHS in England.

The National Health Service (NHS) is the publicly funded health care system of England, created under the National Health Service Act 1946 by the post-war Labour government of Clement Attlee. It has come under much criticism, especially during the early 2000s, due to outbreaks of antibiotic-resistant infections such as MRSA and C.diff, waiting lists, and medical scandals such as the Alder Hey organs scandal. However, the involvement of the NHS in scandals extends back many years, including over the provision of mental health care in the 1970s and 1980s (ultimately part of the reason for the Mental Health Act 1983, and overspends on hospital newbuilds, including Guy's Hospital Phase III in London in 1985.

Access controls

Simple economics states that the cheaper a good or service is, the greater the demand for it. By making health care a largely invisible cost to the patient (there is no special NHS tax or levy) health care seems to be effectively free to its consumers. To prevent gratuitous demand NHS treatments are available only according to preset rules which doctors must adhere to. Denial of service can cause distress to both patient and doctor. Those falling just outside the rules must then seek and pay for private treatment or go without.

Supporters of the NHS would argue that the rules are there to ensure that everyone gets treated by the same rules, and that in any case, health is not a consumable commodity like ice-cream. People do not get more sprained ankles or heart attacks just because health care is free at the point of use.

Politicisation

Over time, increased demand leads to continual political pressures to increase spending and widen the range of treatments available. The politicisation of health care which it is centrally funded and free at the point of use may be one reason why so few countries have adopted this model.

Supporters of the NHS would point out that the NHS has wide public support and the UK population has as good a health outcome as many other similar countries, and often at much lower cost. Political pressure could work both ways, but the Blair government was elected in 1997 largely on a promise to invest more taxpayers money in health to bring spending closer to the European average. Most people would prefer to see gradual improvements within the current framework and be able to hold politicians to account for the service. This is the position of all the political parties, none of which has an agenda to replace or make a wholesale reform to the system. The Conservative Party says its policies are aimed at "Protecting and improving our health service by putting patients back at the heart of the NHS, and trusting the professionals to ensure that they are able to use their skills to make the fullest possible contribution to patient care". The far-right but economically left-of-centre British National Party says that "socialised medicine is not just a hallmark of a decent society, but economically rational as well. If one leaves behind capitalist-romantic theories about private-sector efficiency and looks at real-world privatised medicine, which may be observed in America, it is an obvious disaster. It is vastly more expensive and delivers mediocre results outside of luxury care. Britain spends about 1/3 the money per person and we have public health statistics roughly equivalent to America. Except for the fact that the bottom 1/4 of our population is vastly healthier."

"Paying twice"

Those who can afford it sometimes opt for private health care, usually to get treated more quickly. When this occurs, these patients are opting to pay twice for their health care, once for the NHS through taxes, which they are not using, and again for the private care they are using.

Supporters of the NHS would argue that these people usually do get value from the NHS because most people use their NHS GP and other health services such as screening, vaccinations etc. and that their opting out from time-to-time is effectively queue jumping because they are utilizing a resource ahead of someone in greater need and that their double payment is the penalty for queue jumping. The concept is well recognized and accepted in the field of public services such as libraries and state-funded schools — that it is a civic responsibility for every citizen capable of paying legally applicable levels of tax, to do so, regardless of service use. Therefore, the public services can be subsidised for those who wish to use them -- economically, the more people who pay taxes, the less cost to each individual concerned.

Waiting lists

Because NHS access is controlled by medical priority rather than a price mechanism, there are sometimes waiting lists for certain consultations and surgical procedures. These can be months long.

NHS supporters would counter that the access to services is fair to everyone and if the need is urgent it will bring that patient to the front of the queue. Those in the queue are those with less acute need. Patients dissatisfied with the queue can always choose to seek care in the private sector, albeit at their expense. Supporters might also point out that even in free market medicine paid for out-of-pocket or from insurance, there are also many people who are waiting or go untreated because they have to save for their care because their insurance is insufficient or they cannot afford to pay it. They would argue that in the NHS everyone needing treatment will get it eventually, but not everyone in a free market health care system will get what they need.

"Superbugs"

See also: Maidstone and Tunbridge Wells NHS Trust

Fatal outbreaks of antibiotic-resistant bacteria ("superbugs"), such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, in NHS hospitals has led to criticism of standards of hygiene across the NHS.

Supporters would point out that there is not much evidence to support the argument that this is a problem peculiar to the NHS. Both C. difficile and MRSA are problems in British private hospitals, as well as other western healthcare systems. It is theorised that the increased use of strong antibiotics and disinfectants in modern society may account for the resistance of such a "superbug". Some in the UK argue that the introduction of private cleaning contractors into the NHS has been partly to blame as contractors try to cut costs and hygiene levels may have suffered because of this. There is not much evidence to prove the case either way.

Coverage

The lack of availability of some treatments due to their perceived poor cost-effectiveness sometimes leads to what some call a "postcode lottery". NICE, thne National Institute for Clinical Excellence, are the first gatekeeper, and examine the cost effectiveness of drugs. Until they have issued guidance on the cost and effectivenss of new medicines, treatments and procedures, NHS Primary Care Trusts are unlikely to offer to fund courses of treatment. The same of true of the Scottish Medicines Consortium, NICE's counterpart in Scotland.

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There has been controversy the UK about public health funding of drugs, most notably Herceptin due to its high cost and perceived limited overall survival. The campaign waged by cancer victims to get the government to pay for their treatment has gone to the highest levels in the courts and the cabinet to get it licensed against the judgement of the regulator.

Private Finance Initiative

See also: Private Finance Initiative and Public-Private Partnership

Before the idea of PFI came to prominence, all new hospital building was by convention funded from the Treasury,as it was believed it was best able to raise money and able to control public sector expenditure. In June 1994, the Capital Investment Manual (CIM) was published, setting out the terms of PFI contracts. The CIM made it clear that future capital projects (i.e. building of new facilities) had to look at whether PFI was preferable to using public sector funding. By the end of 1995, 60 relatively small projects had been planned for, at a total cost of around £2billion. Under PFI, buildings were built and serviced by the private sector, and then leased back to the NHS. The Labour government elected under Tony Blair in 1997 embraced PFI projects, recognising that public spending needed to be curtailed.

Under the Private Finance Initiative, an increasing number of hospitals have been built (or rebuilt) by private sector consortia, an example being Barnet General Hospital, although the government also encouraged private sector treatment centres, so called "surgicentres". There has been significant criticism of this, with a study by a consultancy company which works for the Department of Health showing that for every £200 million spent on privately financed hospitals the NHS looses 1000 doctors and nurses. The first PFI hospitals contain some 28% fewer beds than the ones they replaced. As well as this, it has been noted that the return for construction companies on PFI contracts could be as high as 58%, and that in funding hospitals from the private rather than public sector cost the NHS almost half a billion pounds more every year.

Scandals

Main article: Scandals in the NHS

Several high-profile scandals have occurred within the NHS over the years such as the Alder Hey organs scandal and the Bristol heart scandal. It involved the unauthorised removal, retention, and disposal of human tissue, including children’s organs 1988 and 1995. At this time, organs were retained in more than 2,000 pots, from around 850 infants. It first came to light in 1996, when the mother of a infant girl that had died during cardiac surgery read a pathology report, which noted that her daughter's heart had been retained. The official report into the incident, the Redfern Report, revealed that Dick van Velzen, the Chair of Fetal and Infant Pathology at Alder Hey had ordered the "unethical and illegal stripping of every organ from every child who had had a postmortem." In response, it has been argued that the scandal brought the issue of organ and tissue donation into the public domain, and highlighted the benefits to medical research that result.

See also

• NHS
• List of NHS Hospitals
• Scandals in the NHS
• waiting list
• Healthcare in the United Kingdom
• Private Finance Initiative

External links

• [www.nhs.uk NHS]