Criticism of the National Health Service (England) > 상담신청

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Criticism of the National Health Service (England) includes concerns such as gain access to, waiting lists, healthcare coverage, and various scandals. The National Health Service (NHS) is the publicly funded healthcare system of England, produced under the National Health Service Act 1946 by the post-war Labour federal government of Clement Attlee. It has actually come under much criticism, particularly during the early 2000s, due to outbreaks 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 lots of years, consisting of over the arrangement of psychological health care in the 1970s and 1980s (eventually part of the factor for the Mental Health Act 1983), and overspends on healthcare facility newbuilds, including Guy's Hospital Phase III in London in 1985, the cost of which soared from ₤ 29 million to ₤ 152 million. [1]

Access controls and waiting lists

In making healthcare a largely "invisible cost" to the client, health care seems to be efficiently free to its consumers - there is no particular NHS tax or levy. To lower costs and guarantee that everyone is treated equitably, there are a range of "gatekeepers." The family doctor (GP) works as a primary gatekeeper - without a referral from a GP, it is frequently difficult to get higher courses of treatment, such as an appointment with a specialist. These are argued to be required - Welshman Bevan noted 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 nationwide health insurance coverage systems in other nations (e.g. Germany) have dispensed with the requirement for recommendation; direct access to an expert is possible there. [3]

There has actually been issue about opportunistic "health tourists" travelling to Britain (mainly London) and using the NHS while paying nothing. [4] British citizens have actually been understood to travel to other European nations to benefit from lower costs, and because of a worry of hospital-acquired incredibly bugs and long waiting lists. [5]

NHS gain access to is for that reason managed by medical top priority instead of price system, leading to waiting lists for both consultations and surgery, approximately months long, although the Labour federal government of 1997-onwards made it one of its essential targets to reduce waiting lists. In 1997, the waiting time for a non-urgent operation could be two years; there were ambitions to decrease it to 18 weeks in spite of opposition from medical professionals. [6] It is objected to that this system is fairer - if a medical problem is acute and life-threatening, a patient will reach the front of the line rapidly.

The NHS determines medical requirement in regards to quality-adjusted life years (QALYs), a technique of measuring the benefit of medical intervention. [7] It is argued that this technique of assigning health care indicates some clients need to lose in order for others to get, which QALY is a crude approach of making life and death choices. [8]

Hospital obtained infections

There have actually been several fatal break outs of antibiotic resistant bacteria (" super bugs") in NHS medical facilities, such as Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus and Clostridioides difficile infection. [9] This has led to criticism of standards of health throughout the NHS, with some patients purchasing private health insurance coverage or taking a trip abroad to avoid the perceived danger of catching a "incredibly bug" while in hospital. However, the department of health promised ₤ 50 million for a "deep tidy" of all NHS England hospitals in 2007. [10]

Coverage

The lack of schedule of some treatments due to their perceived bad in some cases leads to what some call a "postcode lotto". [11] [12] The National Institute for Health and Care Excellence (NICE) are the very first gatekeeper, and take a look at the expense efficiency of all drugs. Until they have released assistance on the expense and effectiveness of brand-new or pricey medicines, treatments and treatments, NHS services are unlikely to use to money courses of treatment. The exact same of real of the Scottish Medicines Consortium, NICE's counterpart in Scotland. [13]

There has been significant debate about the public health funding of expensive drugs, notably Herceptin, due to its high expense and perceived minimal overall survival. The project waged by cancer patients to get the federal government to spend for their treatment has gone to the greatest levels in the courts and the Cabinet to get it licensed. [14] [15] The House of Commons Health Select Committee criticised some drug companies for bringing in drugs that cost on and around the ₤ 30,000 limit that is thought about the optimum worth of one QALY in the NHS.

Private Finance Initiative

Before the concept of private financing effort (PFI) came to prominence, all brand-new healthcare facility building was by convention moneyed from the Treasury, as it was thought it was best able to raise cash and able to control public sector expense. In June 1994, the Capital Expense Manual (CIM) was published, setting out the regards to PFI contracts. The CIM made it clear that future capital tasks (structure of new facilities) had to look at whether PFI was preferable to utilizing public sector financing. By the end of 1995, 60 relatively little projects had been planned for, at an overall expense of around ₤ 2 billion. 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 welcomed PFI jobs, believing that public spending required to be curtailed. [16]

Under the personal finance initiative, an increasing variety of healthcare facilities have actually been built (or rebuilt) by economic sector consortia, although the government likewise encouraged economic sector treatment centres, so called "surgicentres". [17] There has been significant criticism of this, with a study by a consultancy company which works for the Department of Health revealing that for each ₤ 200 million invested in independently financed health centers the NHS loses 1000 doctors and nurses. The very first PFI medical facilities include some 28% fewer beds than the ones they changed. [18] As well as this, it has been kept in mind that the return for construction business on PFI contracts might be as high as 58%, which in financing medical facilities from the personal 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, consisting of kids's organs, in between 1988 and 1995. The main report into the event, the Redfern Report, exposed that Dick van Velzen, the Chair of Foetal and Infant Pathology at Alder Hey, had ordered the "dishonest and illegal stripping of every organ from every child who had had a postmortem." In reaction, it has actually been argued that the scandal brought the issue of organ and tissue donation into the general public domain, and highlighted the advantages 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 concerned abnormally high mortality rates amongst patients at the healthcare facility. [22] [23] Approximately 1200 more patients passed away in between 2005 and 2008 than would be expected for the type and size of healthcare facility [24] [25] based on figures from a death design, however the final Healthcare Commission report concluded it would be misguiding to link the insufficient care to a particular number or variety of varieties of deaths. [26] A public query later exposed several circumstances of overlook, incompetence and abuse of patients. [27]

" Lack of self-reliance of looking for security and fitness for purpose"

Unlike in Scotland and Wales which have actually degenerated healthcare, NHS England is run 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 delivered by the NHS is truly safe and healthy for function 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 "accountable to the 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. At least 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 for that reason the capacity for a conflict of interest, as both the NHS and the CQC have the same leadership and both are extremely susceptible to political interference.

In April 2024, Health Secretary Victoria Atkins advised NHS England to focus on proof and safety in gender dysphoria treatment following concerns raised by the Cass Review. NHS demanded cooperation from adult centers and initiated a review, with Labour supporting evidence-based care. Momentum slammed constraints on gender-affirming care, while Stonewall welcomed the evaluation's focus on children's well-being. [28] [29]

See likewise

National Health Service
List of medical facilities 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 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: results of a routine data analysis in Bavaria". BMJ Open. 6 (6 ): e011621. doi:10.1136/ bmjopen-2016-011621. PMC 4908874. PMID 27288386.
^ "Tougher rules to make sure that individuals do not abuse NHS services". Medical News Today. 26 April 2004. Archived from the initial on 8 December 2008. Retrieved 9 December 2007.
^ "Health travelers 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 original on 25 February 2007. Retrieved 9 December 2007.
^ "Quality Adjusted Life Years (QALYs)". National Library for Health. March 2006. Archived from the initial on 19 April 2013. Retrieved 9 December 2007.
^ "So what is a QALY?". Bandolier. Archived from the initial on 15 April 2008. Retrieved 9 December 2007.
^ "Do medical facilities 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 initial 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 bring out thousands more NHS operations every year". Department of Health. 3 December 2002. Archived from the initial 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 health centers 'costing NHS additional ₤ 480m a year'". Retrieved 3 December 2014.
^ Dixon, B. (19 March 2001). "Checks and balances required 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 'need to 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 'might have caused 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 might have passed away over "shocking" client care". Daily Mirror. Retrieved 6 May 2009.
^ "How numerous individuals passed away "needlessly" at Mid Staffs". Full Fact. 7 March 2013. Retrieved 29 May 2015.
^ Sawer, Patrick; Donnelly, Laura (2 October 2011). "Boss of scandal-hit medical facility leaves 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 health care. Verso. ISBN 1-84467-539-4.
Mandelstam, Michael (2006 ). Betraying the NHS: Health Abandoned. Jessica Kingsley Publishing. ISBN 1-84310-482-2.