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"NHS" redirects here. For other uses, see NHS (disambiguation).
"Health in England" redirects here. For health in Elizabethan England, see Health and diet in Elizabethan England.
NHS hospital in England.
Aug2005.jpg/58px-NorfolkAndNorwichUniversityHospital(KatyAppleton)Aug2005.jpg)
Example of an NHS hospital.
The National Health Service (NHS) is the publicly funded healthcare system in England. The NHS provides healthcare to everyone normally resident in the UK, is funded exclusively through income tax, and whilst many services are free of charge to the patient there are significant charges associated with eye tests, prescriptions, and many aspects of personal care. Furthermore there is very little NHS provision of dental care.
The NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare, ophthalmology and dentistry. The National Health Service Act 1946 came into effect on 5 July 1948. Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population, and generally as a top-up to NHS services, although recently the private sector has been increasingly used to increase NHS capacity despite a large proportion of the British public opposing such involvementSurvey of the general public\'s views on NHS system reform in England (2007-06-01)..
The costs of running the NHS (est. £104 billion in 2007-8HM Treasury (2007-03-21). Budget 2007 21. Retrieved on 2007-05-11.) are met directly from general taxation.
The UK government department responsible for the NHS is the Department of Health, headed by a Secretary of State for Health (Health Secretary), who sits in the British Cabinet.
The NHS is the world\'s largest health service, and the world\'s third largest employer Times Online (2004-03-20). NHS is world\'s biggest employer after Indian rail and Chinese Army. Retrieved on 2008-02-13. after the Chinese army and the Indian railways.
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In the aftermath of World War II, Clement Attlee\'s Labour government created the NHS as part of the "cradle to grave" welfare-state reforms, based on the proposals of the Beveridge Report, prepared in 1942 by the economist and social reformer William Beveridge.
The idea was that if Britain could work towards full employment and spend huge sums of money during the wartime effort, then in a time of peace equitable measures of social solidarity and financial resources could be redirected towards fostering public goods. This sentiment was widely shared, as the wartime hero Winston Churchill was decisively voted out in a landslide defeat in the 1945 elections. Although most of the British felt that Churchill\'s leadership during the war was commendable, there were a number of reasons which led to Conservative defeat in the elections following the war. One reason was that the public favoured a push for sweeping social changes that Churchill\'s Conservative Party vehemently opposed. The driving force behind this reformist agenda was popular enough, that eventually it constituted a \'Postwar Consensus\' which continued virtually unchallenged until the early 1970\'s, no matter which party controlled the government.
The first problem for Labour\'s reform agenda began when the U.S. war with Japan ended, and the United States subsequently withdrew the funding that had sustained Britain during the war. At this point, Attlee realised that his plans for the rebuilding of postwar Britain and enacting widespread reform were in serious financial trouble. It wasn\'t until the Cold War began to escalate that the Americans initiated the Marshall Plan which helped rebuild Western Europe from physical and economic ruin. This allowed Attlee to continue moving forward with the "cradle to grave" reforms outlined in the Beveridge Report that his government had promised the British public.
Aneurin Bevan, the newly appointed Health Minister, was given the task of introducing the National Health Service. Bevan based his plan for the NHS on the Tredegar Medical Aid Society which was set up in his place of birth, and in fact, had been a member and later chairman of the Cottage Hospital Management Committee in the late 1920s. Doctors were initially opposed to the reform measure and even organized to try to fight against it. Bevan had to get them onside, as, without doctors, there would be no health service. Being a shrewd political operator, Bevan managed to push through the radical health care reform measure by dividing and cajoling opposition, as well as by offering lucrative payment structures for consultants. On this subject he stated, "I stuffed their mouths with gold." On July 5, 1948, at the Park Hospital in Manchester, Bevan unveiled the National Health Service and stated, "We now have the moral leadership of the world."
Dr. A. J. Cronin\'s highly controversial novel, The Citadel, published in 1937, had fomented extensive dialogue about the severe inadequacies of health care. The author\'s innovative ideas were not only essential to the conception of the NHS, but in fact, his best-selling novels are even said to have greatly contributed to the Labour Party\'s victory in 1945.R. Samuel, "North and South," London Review of Books 17.12 (22 June 1995): 3-6. Millions of citizens had been unable to afford the privatized system and were disenfranchised from access to health care before the NHS. Now, every single person has access to quality health care that is financed through progressive taxation, that is, from each according to his ability to pay, to each according to his needs as a patient.
The NHS in England is controlled by the UK government through the Department of Health, which takes political responsibility for the service. The DoH controls ten Strategic Health Authorities (SHAs), which oversee all NHS operations, particularly the Primary Care Trusts, in their area. These are coterminous the nine Government Office Regions for the most part, with the South East region split into South East Coast and South Central SHAs.
In addition, several Special Health Authorities provide services to the devolved NHS administrations. These include The Information Centre for health and social care, NHS Blood and Transplant, NHS Direct, NHS Professionals, NHS Business Services Authority, National Patient Safety Agency, NHS Connecting for Health, National Treatment Agency, the Scottish Intercollegiate Guidelines Network and the National Institute for Health and Clinical Excellence (NICE).
There are several types of NHS trust:
A feature of the NHS, distinguishing it from other public healthcare systems in Continental Europe, is that not only does it pay directly for health expenses, it also employs a large number of the doctors and nurses that provide them. In particular, nearly all hospital doctors and nurses in England are employed by the NHS and work in NHS-run hospitals.
In contrast General Practitioners, dentists, optometrists (opticians) and other providers of local healthcare, are almost all self-employed, and contract their services back to the NHS. They may operate in partnership with other professionals, own and operate their own surgeries and clinics, and employ their own staff, including other doctors etc. However, the NHS does sometimes provide centrally employed healthcare professionals and facilities in areas where there is insufficient provision by self-employed professionals.
As of March 2005, the NHS has 1.3 million workers, and is variously the third or fifth largest workforce in the world, after the Chinese Army, Indian Railways and (as argued by Jon Hibbs, the NHS\'s head of news, in a press release from March 22, 2005) Wal-Mart and the United States Department of Defense.Trefgarne, George (2005-03-23). NHS reaches 1.4m employees. The Daily Telegraph. Retrieved on 2006-09-15.Carvel, John (2005-03-23). Record rise in NHS consultants and midwives. The Guardian. Retrieved on 2006-09-15. The BBC quotes an alternative workforce of 1.33 million people in 2004.see discussion - dated reference has 1.46M in 2004BBC "State of the NHS" - Staff Numbers
It should be noted that NHS workforce figures provided by the Department of Health include not only employees of NHS divisions but also local authority social services workers.Department of Health - Statistical work area: workforce (retrieved 29 Jul 2007) The full-time equivalent figure for 2005 was about 980,000 staff.
The total budget for the NHS in 2007/8 is £104bn http://budget2007.treasury.gov.uk/page_09.htm. The cost is largely met from National Insurance contributions received from employers, employees and the self-employed but is held separately from the National Insurance Fund which receives contributions mostly net of the NHS allocation.http://www.opsi.gov.uk/acts/acts1992/ukpga_19920005_en_17#pt12-l1g161 Social Security Administration Act 1992 The National Audit Office reports annually on the summarised consolidated accounts of the NHS http://www.nao.org.uk/publications/nao_reports/07-08/0708129_I.pdf.
The principal fundholders in the NHS system are the NHS Primary Care Trusts (PCTs), who commission healthcare from hospitals, GPs and others. PCTs disburse funds to them on an agreed tariff or contract basis, on guidelines set out by the Department of Health. The PCTs receive a budget from the Department of Health on a formula basis relating to population and specific local needs. They are required to "break even" - that is, they must not show a deficit on their budgets at the end of the financial year, although in recent years cost and demand pressures have made this objective impossible for some Trusts. Failure to meet financial objectives can result in the dismissal and replacement of a Trust\'s Board of Directors, although such dismissals are enormously expensive for the NHSAnger over C difficile payoff. Health Service Journal (2008-01-25)..
Except for set charges applying to most adults for prescriptions, optician services and dentistry, the NHS is free for all patients "ordinarily resident" in the UK at the point of use irrespective of whether any National Insurance contributions have been paid.
Those who are not "ordinarily resident" (including British citizens who have paid National Insurance contributions in the past) are liable to charges for services other than that given in Accident and Emergency departments or "walk-in" centres.
NHS costs are met, via the PCTs, from UK government taxation, thus all UK taxpayers contribute to its funding.
In England, from 15 January 2007, anyone who is working outside the UK as a missionary for an organisation with its principal place of business in the UK will be fully exempt from NHS charges for services that would normally be provided free of charge to those resident in the UK. This is regardless of whether they derive a salary or wage from the organisation, or receive any type of funding or assistance from the organisation for the purposes of working overseas. This is in recognition of the fact that most missionaries would be unable to afford private health care and those working in developing countries should not effectively be penalised for their contribution to development/other work.
There are some other categories of people who are exempt from the residence requirements such as specific government workers and those in the armed forces stationed overseas.
As of April 2008 the prescription charge for medicines in England is set at £7.10 (which contrasts with Scotland at £5 and Wales where they are free.) People over sixty, children under sixteen (or under nineteen if the child is still in full time education), patients with certain medical conditions, and those with low incomes, are exempt from paying. Those who require repeated prescriptions may purchase a single-charge pre-payment certificate which allows unlimited prescriptions during the period of validity. The charge is the same regardless of the actual cost of the medicine but higher charges apply to medical appliances. For more details of prescription charges, see Prescription drugs.
However, the rising costs of some medicines, especially some types of cancer treatment, means that prescriptions can present a heavy burden to the PCTs whose limited budgets include responsibility for the difference between medicine costs and the fixed prescription charge. This has led to disputes in certain cases (e.g. over Herceptin), as to whether such drugs should be prescribed.Q&A: The Herceptin judgement. BBC News (2006-04-12). Retrieved on 2006-09-15.
Following the government\'s introduction of a new contract in April 2006, NHS dentistry is not as widely available as it once wasDentist shortage hits \'millions\'. BBC (2008-01-16). Retrieved on 2008-02-28., forcing many patients to pay much higher sums for private treatmentNHS dentistry \'set back 20 years\'. BBC (2008-02-19). Retrieved on 2008-02-28.. Where available, NHS dentistry charges from 1 April 2007 are: £15.90 for an examination; £43.60 if a filling is needed; and £194 for more complex procedures such as crowns, dentures or bridges.FAQ - What are the patient charges?. NHS England. Retrieved on 2006-09-15.. About 50% of the income of dentists comes from work sub-contracted from the NHS.Call for dentists\' NHS-work quota.
Since January 2007, the NHS have been able to claim back the cost of treatment, and for ambulance services, for those who have been paid personal injury compensation.NHS Injury Cost Recovery scheme. NHS. Retrieved on 2008-03-10. Prior to 2007, the NHS were only able to claim back their costs for those who received personal injury compensation as a result of a motor vehicle crash.NHS Cost Recovery Scheme. Scottish Executive. Retrieved on 2008-03-10. In the last year of the old scheme, over £128 million was reclaimed.Totals for England, Scotland and Wales – 1 April 2006 to 31 March 2007. NHS. Retrieved on 2008-03-10.
Car parking charges are an important source of revenue for the NHS, Nick Triggle. "NHS car park charges - a necessary evil?", BBC News, BBC, 2008-03-03. Retrieved on 2008-03-10. with some hospitals deriving more than 1 per cent of their budget from them. The level of fees is controlled individually by each trust. In 2006, car park fees contributed £78 million towards hospital budgets, with individual hospitals netting up to £1.5 million."Hospitals making £78m a year from car park charges", The Times, Times Newspapers, 2006-07-18. Retrieved on 2008-03-10. Patient groups are opposed to such charges. Car park charges in Welsh hospitals are due to be scrapped by the end of 2011.David Rose. "Welsh NHS scraps car park charges", The Times, Times Newspapers, 2008-03-03. Retrieved on 2008-02-10.
As each division of the NHS is required to break even at the financial year-end, the service should in theory never be in deficit. However in recent years overspends have meant that, on a \'going-concern\' (normal trading) basis, these conditions have been consistently, and increasingly, breached. Former Secretary of State for Health Patricia Hewitt consistently asserted that the NHS will be in balance at the end of the financial year 2007-8;I\'ll carry the can for NHS, says Hewitt (2006-03-09). Retrieved on 2007-02-28. however, a study by Professor Nick Bosanquet for the Reform think tank predicts a true annual deficit of nearly £7bn in 2010.YouGov (2006-03-09). NHS: How Well Is Our Money Being Spent?. Retrieved on 2006-09-01.
The 1980s saw the introduction of modern management processes (General Management) in the NHS to replace the previous system of consensus management. This was outlined in the Griffiths Report of 1983.Manfred Davidmann (1985). Reorganising the National Health Service: An Evaluation of the Griffiths Report, Second edition. ISBN 0-85192-046-2. This recommended the appointment of general managers in the NHS with whom responsibility should lie. The report also recommended that clinicians be better involved in management. Financial pressures continued to place strain on the NHS. In 1987, an additional £101 million was provided by the government to the NHS. In 1988 the then Prime Minister, Margaret Thatcher, announced a review of the NHS. From this review and in 1989, two white papers Working for Patients and Caring for People were produced. These outlined the introduction of what was termed the "internal market", which was to shape the structure and organisation of health services for most of the next decade.
In 1990, the National Health Service & Community Care Act (in England) defined this "internal market", whereby Health Authorities ceased to run hospitals but "purchased" care from their own or other authorities\' hospitals. Certain GPs became "fund holders" and were able to purchase care for their patients. The "providers" became independent trusts, which encouraged competition but also increased local differences.
These innovations, especially the "fund holder" option were condemned at the time by the Labour Party; opposition to what was claimed to be the Conservative intention to privatise the NHS became a major feature of Labour campaigning in the 1997 and subsequent British elections. Although the incoming government of Tony Blair (1997) stated its intention to remove the "internal market" and abolished fundholding, in effect the market was strengthened and fundholding reintroduced as part of Blair\'s ongoing reforms to "modernise" the NHS.
Driving these reforms have been a number of factors. They include the rising costs of medical technology and medicines, the desire to increase standards and "patient choice", an ageing population, and a desire to contain government expenditure. Since the National Health Services in Wales, Scotland and Northern Ireland are not controlled by the UK government, these reforms have increased the differences between the National Health Services in different parts of the United Kingdom. (See NHS Wales and NHS Scotland for descriptions of their developments).
Reforms have included (amongst other actions) the laying down of detailed service standards, strict financial budgeting, revised job specifications, reintroduction of "fundholding" (under the description "practice-based commissioning"), closure of surplus facilities and emphasis on rigorous clinical and corporate governance. In addition medical training has undergone an unsuccessful restructuring which was so badly managed that the Secretary of State for Health was forced to apologise publicly. MMC is now being revised but its flawed implementation has left the NHS with significant medical staffing problems which are unlikely to be resolved before 2009. Some new services have been developed to help manage demand, including NHS Direct. A new emphasis has been given to staff reforms, with the Agenda for Change agreement providing harmonised pay and career progression. These changes have, however, given rise to controversy within the medical professions, the media and the public.
The Blair Government, whilst leaving services free at point of use, has encouraged outsourcing of medical services and support to the private sector. Under the Private Finance Initiative, an increasing number of hospitals have been built (or rebuilt) by private sector consortia; hospitals may have both medical services (such as "surgicentres"),New generation surgery-centres to carry out thousands more NHS operations every year. Department of Health (2002-12-03). Retrieved on 2006-09-15. and non-medical services (such as catering) provided under long-term contracts by the private sector. A study by a consultancy company which works for the Department of Health shows that every £200 million spent on privately financed hospitals will result in the loss of 1000 doctors and nurses. The first PFI hospitals contain some 28 per cent fewer beds than the ones they replaced.George Monbiot (2002-03-10). Private Affluence, Public Rip-Off. The Spectator. Retrieved on 2006-09-07.
In 2005, surgicentres (ISTCs) treated around 3% of NHS patients (in England) having routine surgery. By 2008 this is expected to be around 10%.Hewitt, Patricia (2005-07-02). Even Nye Bevan\'s NHS saw a role for the private sector. The Guardian. Retrieved on 2006-09-15. NHS Primary Care Trusts have been given the target of sourcing at least 15% of primary care from the private or voluntary sectors over the medium term.
As a corollary to these intitiatives, the NHS has been required to take on pro-active socially "directive" policies, for example, in respect of smoking and obesity.
The NHS has also encountered significant problems with the IT innovations accompanying the Blair reforms. The NHS\'s National Programme for IT (NPfIT), believed to be the largest IT project in the world, is running significantly behind schedule and above budget, with friction between the Government and the programme contractors. Originally budgeted at £2.3 billion, present estimates are £20-30 billion and rising.Wearden, Graeme (2004-10-12). NHS IT project costs soar. ZDNet. Retrieved on 2006-09-15. There has also been criticism of a lack of patient information security.Wearden, Graeme (2004-11-15). NHS dismisses claim of IT security glitch. ZDNet. Retrieved on 2006-09-15. The ability to deliver integrated high quality services will require care professionals to use sensitive medical data. This must be controlled and in the NPfIT model it is, sometimes too tightly to allow the best care to be delivered. One concern is that GPs and hospital doctors have given the project a lukewarm reception, citing a lack of consultation and complexity.Collins, Tony (2005-02-07). Is it too late for NHS national programme to win support of doctors for new systems?. Computer Weekly. Retrieved on 2006-09-15. Key "front-end" parts of the programme include Choose and Book, intended to assist patient choice of location for treatment, which has missed numerous deadlines for going "live", substantially overrun its original budget, and is still (May 2006) available in only a few locations. The programme to computerise all NHS patient records is also experiencing great difficulties. Furthermore there are unresolved financial and managerial issues on training NHS staff to introduce and maintain these systems once they are operative.
The NHS has frequently been the target of criticism over the years. Examples of such criticism include:
Treatments determined by NICE to be ineffective (e.g. homeopathy) or relatively cost-ineffective (i.e. drugs that have only minor effect at great cost) are simply not offered by the NHS though may be available privately. The media are apt to label these controls as "rationing" though they are seen more as being a sensible cost control mechanism by the medical profesion and the public generally.
GP referrals are needed to access specialist care. It has been argued that a nominal charge for an appointment with a GP could be introduced to prevent patients consulting their GP with minor real or imaginary complaints. To date this has never been introduced to avoid the danger of patients avoiding consultations (for financial reasons) for conditions which might be potentially serious.
Over time, increased demand leads to continual political pressures to increase spending and widen the range of treatments available.
Supporters of the NHS would point out that the NHS has wide public support and the English 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[citation needed] 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."Stand Up Speak Up - The Conservative Party.
Taxpayers who choose to pay for private healthcare must nonetheless still contribute to the NHS via taxation, and in effect "pay twice", although the vast majority of emergency medical treatment is carried out by the NHS. This is not an effect specific to the NHS, and occurs whenever a choice between a publicly-funded and privately-funded service exists - for instance in private education.
Some patients with complex illnesses pay for some medical services privately, while turning to the NHS for the rest of their care. In one recent case a cancer patient was told that if she paid privately for a drug that was not covered by the NHS she would have to pay for the rest of her care. NHS officials argue that allowing the practice would give wealthy patients an unfair advantage and undermine the philosophy of the system.Sarah Lyall, "Paying Patients Test British Health Care System," The New York Times, February 21, 2008
Rationing is a part of all health care systems because resources are necessarily finite. In purely private systems, health care is rationed via the price mechanism, with those being able to pay for care getting it immediately and those not able waiting indefinitely (until they can afford it, which may be never). In the NHS, which aims to give a broad coverage of care to all without charging, health care is rationed on the grounds of clinical need, meaning that emergency cases (e.g. heart attacks) get instant access where those with less urgent needs (e.g. cataract surgery) are given lower priority and so wait longer. This means that waiting times for some conditions and surgical procedures can be months longWaiting list concerns highlighted. BBC (2006-11-12)..
Although there are obvious arguments in favour of prioritising by clinical need rather than ability to paye.g. as set out in In Place of Fear, Aneurin Bevan, it can mean that waiting lists vary widely between regions. Patients waiting can choose to have a procedure done outside their local NHS district in order to be seen more quickly, and if the waiting time is long can often get private treatment at public expense, either in the UK or abroad. A major programme is underway in the NHS to reduce all wait times to 18 weeks by December 200818 Weeks Delivery Programme. This new target starts at the point the time the patient\'s own doctor writes to the hospital specialist and ends when treatment begins. It therefore includes the time to make the first appointment, and the time for all diagnostic tests to be completed, evaluated, and discussed with the patient, which were not in the previous target. It has been widely criticised by doctors, healthcare professionals, and think-tanks as diverting resources from more serious conditions to achieve politically-motivated goalsNick Triggle (2005-08-15). Patient target \'could harm NHS\'. BBC., and doubts persist over its achievability18-week waiting times target – an update. King\'s Fund (2007-08-03)..
Fatal outbreaks of antibiotic-resistant bacteria ("superbugs"), such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, in NHS hospitalsLabour hails fall in MRSA cases. BBC news (2005-03-07). Retrieved on 2008-02-28. has led to criticism of standards of hygiene across the NHS.
Both C. difficile and MRSA are, however, not exclusive to the NHS, existing in British private hospitals and throughout other western healthcare systems; for instance, cases doubled in the USA\'s private healthcare system between 1999 and 2005Klein E, Smith DL, Laxminarayan R (2007). "Hospitalizations and Deaths Caused by Methicillin-Resistant Staphylococcus aureus, United States, 1999–2005". Emerg Infect Dis 13 (12): 1840–6. , and the UK\'s death rate is half that of the USA\'sUK Office for National Statistics Online (February 22, 2007), "MRSA Deaths continue to rise in 2005". The introduction of Private Finance Initiative cleaning contractors into the NHS and the associated "cutting corners on cleaning"NHS trust warned over hygiene breaches. The Telegraph (2008-02-07). have been blamed for the problem, as has increased drug resistance due to inappropriate prescribing of antibiotics and patients failing to complete courses of antibiotics.
The NHS has been criticised over the implementation of its National Programme for IT which is designed to provide the infrastructure for electronic prescribing, booking appointments and elective surgery, and a national care records service. The programme has run into delays and overspends, with the initial budget of £2.3 billion over three years officially revised to £12.4bn over 10 yearsThe Cost of the National Programme for IT is spiralling and some sources putting it as high as £20bnThe Daily Telegraph Bill for hi-tech NHS soars to £20 billion. Critics including the House of Commons Public Accounts Committee and the National Audit Office claim the project is falling behind scheduleDaily Telegraph Patients \'won\'t benefit from £12bn IT project\'Twentieth Report of Session 2006–07. In addition, 93% of doctors within the NHS are not confident their patients\' data will be secureDoctors have no confidence in NHS database, says BMA News poll. British Medical Association (2008-02-01)., some GP practices have begun to advise all their patients to opt-out of the schemeThe Oaklands Practice. Opting out of the NHS Database., and privacy campaigners have claimed the national care records system breaches patients\' privacy rightsThe NHS confidentiality campaign.
The Government and NHS national leadership have consistently argued that major capital investment in IT is necessary to transform services[citation needed]. Fragmented information systems, as in the US, prevent health services providing consistent data[citation needed] and can damage patient care[citation needed] where doctors may not have an overview of patients records held by another NHS body.
There has been a decreasing availability of NHS dentistry following the new government contract and a trend towards dentists accepting private patients onlyNHS Dentist shortage. GMTV (2006-04-26). Retrieved on 2008-02-28., with 10% of dentists having rejected the contract offeredOverseas dentists boost NHS ranks. BBC (2006-08-23). Retrieved on 2008-02-28..
The lack of availability of some treatments due to their perceived poor cost-effectiveness sometimes leads to what some call a "postcode lottery".BBC NEWS | Health | Why some drugs are not worth it
NHS supporters would argue that the NHS has a duty to ensure that taxpayers money is used wisely and such denials are effective controls. People can always choose to go private, if they can afford it, if the treatment is legally available in the UK or elsewhere.
Some hospitals and trusts were running a financial deficit and getting into debt.NHS hospitals sink into debt to pay off PFI | Politics | The Observer
Supporters would argue that this problem has been controlled without the taxpayer having to fund the shortfall.
Several high-profile scandals have occurred within the NHS over the years such as the Alder Hey organs scandal, Harold Shipman and the Bristol heart scandal.
Supporters would argue that there is nothing endemic about such issues which might equally have occurred in other types of health care establishments. They might also point out that the detection of such issues leads to better controls being established throughout the NHS for the benefit of all.
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This section does not cite any references or sources. (January 2008) Please improve this section by adding citations to reliable sources. Unverifiable material may be challenged and removed. |
There are various regulatory bodies in the UK, both government-based (e.g. Department of Health, General Medical Council, Nursing and Midwifery Council) and non-governmental-based (e.g. Royal Colleges). Some of these organisations have high world-widestanding.
With respect to assessing, maintaining and improving the quality of healthcare, unlike in the USA and many other developed countries where hospital accreditation groups independent of central government are utilised, the UK government take on both the role of suppliers of healthcare and assessors of the quality of its delivery through groups organised directly by government departments, such as NICE and CHI.
This lack of separation of government from healthcare delivery is often seen as weakness and has the potential to over-politicise healthcare, especially over issues of funding and geographical distribution of services. The fact that the body who are underwriting the bills (ie. the government) have a political stake in how the NHS runs is potentially divisive. Scandals and other difficulties, such as hospital "superbugs", often become political issues simply as a result of media coverage, and the response is often driven by political considerations rather than by science and by evidence-based medicine. In addition, the problems of ensuring quality and improvement in the growing private sector in British healthcare have not yet been solved.
To try to solve this problem, an independent hospital accreditation group, or groups, responsible for surveying hospitals and other healthcare facilities, similar to the role of the Joint Commission in the USA and the Trent Accreditation Scheme in Hong Kong, may be a viable alternative for solving some of these problems and concerns.
The traditional ambulance, as pictured in London and the one which is sometimes referred to as "The Big White Taxi"
The ambulances used by the NHS are sometimes referred to by their staff as the "Big White Taxi Service". This slang term is used to express the frustration felt when members of the public dial 999 for minor ailments and injuries.Meetings with destiny. The Guardian. Retrieved on 2007-12-29. The term is becoming obsolete as ambulances are no longer painted white and the term "Blue Light Taxi" is now more widely used.
"The Big White Taxi Service" is also the name of an online community established by ambulance staff from the London Ambulance Service during 1999. The forum provided peer support in the aftermath of the 7 July 2005 London bombings.
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