Criticism of the National Health Service (England) > 자유게시판

Criticism of the National Health Service (England) consists of concerns such as access, waiting lists, health care coverage, and numerous scandals. The National Health Service (NHS) is the publicly financed health care system of England, developed under the National Health Service Act 1946 by the post-war Labour federal government of Clement Attlee. It has come under much criticism, specifically throughout the early 2000s, due to break outs of antibiotic resistant infections such as MRSA and Clostridioides difficile infection, waiting lists, and medical scandals such as the Alder Hey organs scandal. However, the involvement of the NHS in scandals extends back several years, including over the arrangement of mental healthcare in the 1970s and 1980s (ultimately part of the factor for the Mental Health Act 1983), and spends too much on medical facility newbuilds, consisting of Guy's Hospital Phase III in London in 1985, the expense of which shot up from ₤ 29 million to ₤ 152 million. [1]

Access controls and waiting lists

In making healthcare a mostly "undetectable cost" to the patient, healthcare seems to be efficiently complimentary to its customers - there is no particular NHS tax or levy. To reduce costs and ensure that everybody is dealt with equitably, there are a variety of "gatekeepers." The family doctor (GP) operates as a primary gatekeeper - without a recommendation from a GP, it is typically difficult to acquire higher courses of treatment, such as a visit with a consultant. These are argued to be necessary - Welshman Bevan kept in mind in a 1948 speech in the House of Commons, "we will never have all we require ... expectations will constantly surpass capacity". [2] On the other hand, the national health insurance systems in other countries (e.g. Germany) have actually ignored the need for referral; direct access to a professional is possible there. [3]

There has actually been concern about opportunistic "health travelers" taking a trip to Britain (mainly London) and utilizing the NHS while paying nothing. [4] British citizens have been understood to travel to other European nations to take benefit of lower costs, and due to the fact that of a fear of hospital-acquired very bugs and long waiting lists. [5]

NHS access is therefore controlled by medical priority rather than rate mechanism, resulting in waiting lists for both consultations and surgical treatment, up to months long, although the Labour government of 1997-onwards made it among its essential targets to decrease waiting lists. In 1997, the waiting time for a non-urgent operation might be 2 years; there were ambitions to minimize it to 18 weeks regardless of opposition from physicians. [6] It is contested that this system is fairer - if a medical problem is severe and deadly, a patient will reach the front of the queue quickly.

The NHS measures medical need in regards to quality-adjusted life years (QALYs), a method of quantifying the benefit of medical intervention. [7] It is argued that this technique of designating healthcare means some clients should lose out in order for others to get, and that QALY is a crude approach of making life and death decisions. [8]

Hospital acquired infections

There have been several fatal outbreaks of antibiotic resistant germs (" incredibly bugs") in NHS medical facilities, such as Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus and Clostridioides difficile infection. [9] This has actually caused criticism of requirements of hygiene across the NHS, with some patients buying personal medical insurance or taking a trip abroad to avoid the perceived hazard of catching a "very bug" while in medical facility. However, the department of health vowed ₤ 50 million for a "deep clean" of all NHS England health centers in 2007. [10]

Coverage

The lack of schedule of some treatments due to their perceived poor cost-effectiveness often leads to what some call a "postcode lottery". [11] [12] The National Institute for Health and Care Excellence (NICE) are the very first gatekeeper, and examine the expense effectiveness of all drugs. Until they have actually issued guidance on the expense and efficiency of brand-new or pricey medications, treatments and procedures, NHS services are unlikely to provide to money courses of treatment. The same of true of the Scottish Medicines Consortium, NICE's counterpart in Scotland. [13]

There has actually been substantial debate about the public health funding of pricey drugs, especially Herceptin, due to its high expense and viewed limited general survival. The project waged by cancer sufferers to get the government to pay for their treatment has gone to the greatest levels in the courts and the Cabinet to get it certified. [14] [15] Your House of Commons Health Select Committee criticised some drug business for generating drugs that cost on and around the ₤ 30,000 limit that is considered the maximum worth of one QALY in the NHS.

Private Finance Initiative

Before the concept of personal finance effort (PFI) came to prominence, all new health center structure was by convention moneyed from the Treasury, as it was believed it was best able to raise cash and able to control public sector expense. In June 1994, the Capital Expense Manual (CIM) was released, setting out the regards to PFI contracts. The CIM made it clear that future capital jobs (building of new facilities) needed to look at whether PFI was more suitable to using public sector financing. By the end of 1995, 60 relatively little jobs had been prepared for, at a total expense of around ₤ 2 billion. Under PFI, structures were developed and serviced by the economic sector, and after that leased back to the NHS. The Labour federal government elected under Tony Blair in 1997 embraced PFI tasks, thinking that public costs required to be curtailed. [16]

Under the personal finance effort, an increasing variety of medical facilities have been constructed (or rebuilt) by personal sector consortia, although the government likewise motivated economic sector treatment centres, so called "surgicentres". [17] There has been significant criticism of this, with a research study by a consultancy business which works for the Department of Health revealing that for every single ₤ 200 million invested in independently funded medical facilities the NHS loses 1000 doctors and nurses. The very first PFI health centers contain some 28% fewer beds than the ones they changed. [18] In addition to this, it has actually been noted that the return for building and construction companies on PFI agreements could be as high as 58%, and that in financing hospitals from the private rather than public sector cost the NHS almost half a billion pounds more every year. [19]

Scandals

Several high-profile medical scandals have actually occurred within the NHS over the years, such as the Alder Hey organs scandal and the Bristol heart scandal. At Alder Hey Children's Hospital, there was the unauthorised elimination, retention, and disposal of human tissue, including kids's organs, in between 1988 and 1995. The official report into the incident, the Redfern Report, that Dick van Velzen, the Chair of Foetal and Infant Pathology at Alder Hey, had ordered the "unethical and unlawful removing of every organ from every child who had actually had a postmortem." In reaction, it has actually been argued that the scandal brought the concern of organ and tissue donation into the public domain, and highlighted the benefits to medical research that result. [20] The Gosport War Memorial Hospital scandal of the 1990s related to opioid deaths. [21]

The Stafford Hospital scandal in Stafford, England in the late 2000s worried abnormally high death rates amongst clients at the healthcare facility. [22] [23] Approximately 1200 more patients passed away between 2005 and 2008 than would be expected for the type and size of medical facility [24] [25] based upon figures from a death design, but the final Healthcare Commission report concluded it would be deceiving to connect the insufficient care to a particular number or series of varieties of deaths. [26] A public query later on exposed multiple instances of overlook, incompetence and abuse of patients. [27]

" Lack of self-reliance of inspecting for safety and physical fitness for function"

Unlike in Scotland and Wales which have actually devolved healthcare, NHS England is worked on behalf of the taxpayer by the UK Parliament and the Department of Health, at the head of which is the Secretary of State for Health.

The group charged in England and Wales with inspecting if the care provided by the NHS is really safe and in shape for purpose is the Care Quality Commission, or CQC. Although the CQC describes itself as the "independent regulator of all health and social care services in England" [1], it remains in truth "responsible to the general public, Parliament and the Secretary of State for Health." [2] Archived 31 August 2013 at the Wayback Machine and much of its funding originates from the taxpayer. A minimum of one chairman, one president [3] and a board member [4] of the CQC have actually been singled out for attention by a UK Secretary of State for Health.

There is therefore the potential for a dispute of interest, as both the NHS and the CQC have the very same management and both are extremely susceptible to political interference.

In April 2024, Health Secretary Victoria Atkins advised NHS England to focus on proof and security in gender dysphoria treatment following issues raised by the Cass Review. NHS demanded cooperation from adult centers and started a review, with Labour supporting evidence-based care. Momentum criticized limitations on gender-affirming care, while Stonewall invited the review's focus on children's wellness. [28] [29]

See also

National Health Service
List of hospitals in England
Healthcare in the United Kingdom
Private Finance Initiative
Care Quality Commission


Notes

^ Rivett, Geoffrey (1998 ). From Cradle to Grave: 50 years of the NHS. Kings Fund. p. 437. ISBN 1-85717-148-9.
^ "TCSR 07 - Health: The General Public Expects". theinformationdaily.com. 24 September 2007. Archived from the original on 22 August 2014. Retrieved 9 December 2007.
^ Schneider, Antonius; Donnachie, Ewan; Tauscher, Martin; Gerlach, Roman; Maier, Werner; Mielck, Andreas; Linde, Klaus; Mehring, Michael (9 June 2016). "Costs of collaborated versus uncoordinated care in Germany: outcomes of a routine information analysis in Bavaria". BMJ Open. 6 (6 ): e011621. doi:10.1136/ bmjopen-2016-011621. PMC 4908874. PMID 27288386.
^ "Tougher rules to ensure that people do not abuse NHS services". Medical News Today. 26 April 2004. Archived from the original on 8 December 2008. Retrieved 9 December 2007.
^ "Health tourists might get refund". BBC News Online. 7 December 2007. Retrieved 9 December 2007.
^ Jones, George (21 February 2007). "Doctors attack Blair's waiting list pledge". The Daily Telegraph. London. Archived from the initial on 25 February 2007. Retrieved 9 December 2007.
^ "Quality Adjusted Life Years (QALYs)". National Library for Health. March 2006. Archived from the original on 19 April 2013. Retrieved 9 December 2007.
^ "So what is a QALY?". Bandolier. Archived from the original on 15 April 2008. Retrieved 9 December 2007.
^ "Do health centers make you ill?". BBC News. 31 January 2019.
^ "Hospital deep cleaning under fire". 14 January 2008.
^ "NHS 'postcode lottery game'". politics.co.uk. 9 August 2006. Archived from the original on 7 September 2007. Retrieved 9 December 2007.
^ "Why some drugs are not worth it". BBC News. 9 March 2005. Retrieved 4 December 2007.
^ "Cancer drug rejected for NHS usage". BBC News Online. 9 July 2007. Retrieved 4 December 2007.
^ "Q&A: The Herceptin judgement". BBC News. 12 April 2006. Retrieved 15 September 2006.
^ "Update on Herceptin appraisal". National Institute for Health and Clinical Excellence. Archived from the original on 13 December 2006. Retrieved 1 December 2006.
^ Rivett, Geoffrey (1998 ). From Cradle to Grave: 50 years of the NHS. Kings Fund. p. 437. ISBN 1-85717-148-9.
^ "New generation surgery-centres to perform thousands more NHS operations every year". Department of Health. 3 December 2002. Archived from the original on 5 March 2007. Retrieved 15 September 2006.
^ George Monbiot (10 March 2002). "Private Affluence, Public Rip-Off". The Spectator. Retrieved 7 September 2006.
^ PublicFinance.co.uk. "PFI hospitals 'costing NHS extra ₤ 480m a year'". Retrieved 3 December 2014.
^ Dixon, B. (19 March 2001). "Checks and balances needed for organ retention". Current Biology. 11 (5 ): R151 - R152. Bibcode:2001 CBio ... 11. R151D. doi:10.1016/ S0960-9822( 01 )00078-1. PMID 11267877.
^ "Gosport health center deaths: Police corruption probe flawed, watchdog says". BBC News. 14 October 2021. Retrieved 8 December 2024.
^ Nick Triggle (6 February 2013). "Stafford Hospital: Hiding errors 'must be criminal offence'". BBC. Retrieved 9 February 2013.
^ Robert Francis QC (6 February 2013). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Report). House of Commons. ISBN 9780102981476. Retrieved 9 February 2013.
^ Smith, Rebecca (18 March 2009). "NHS targets 'may have led to 1,200 deaths' in Mid-Staffordshire". London: The Daily Telegraph. Archived from the original on 21 March 2009. Retrieved 9 November 2010.
^ Emily Cook (18 March 2009). "Stafford health center scandal: Up to 1,200 may have died over "stunning" client care". Daily Mirror. Retrieved 6 May 2009.
^ "How many individuals died "needlessly" at Mid Staffs". Full Fact. 7 March 2013. Retrieved 29 May 2015.
^ Sawer, Patrick; Donnelly, Laura (2 October 2011). "Boss of scandal-hit healthcare facility gets away interrogation". The Daily Telegraph. London. Archived from the initial on 3 October 2011.
^ "Minister tells NHS to 'end culture of secrecy' on gender care as focus shifts to adult centers". Morning Star. 11 April 2024. Retrieved 15 April 2024.
^ "NHS England must end 'culture of secrecy' in kids's gender care". The National. 11 April 2024. Retrieved 15 April 2024.
References

Rivett, Geoffrey (1998 ). From Cradle to Grave: 50 years of the NHS. Kings Fund. ISBN 1-85717-148-9.


External links

NHS.


Further reading

Pollock, Allyson (2004 ). NHS plc: the privatisation of our healthcare. Verso. ISBN 1-84467-539-4.
Mandelstam, Michael (2006 ). Betraying the NHS: Health Abandoned. Jessica Kingsley Publishing. ISBN 1-84310-482-2.