Criticism of the National Health Service (England) > 상담신청

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Criticism of the National Health Service (England) consists of problems such as access, waiting lists, health care protection, and different scandals. The National Health Service (NHS) is the publicly financed healthcare 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, especially 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 participation of the NHS in scandals extends back numerous 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 spends beyond your means on hospital newbuilds, consisting of 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, healthcare seems to be efficiently complimentary to its customers - there is no specific NHS tax or levy. To minimize costs and ensure that everybody is dealt with equitably, there are a variety of "gatekeepers." The family doctor (GP) works as a primary gatekeeper - without a referral from a GP, it is frequently impossible to get higher courses of treatment, such as a visit with a consultant. These are argued to be needed - Welshman Bevan kept in mind in a 1948 speech in your home of Commons, "we shall never ever have all we need ... expectations will always surpass capability". [2] On the other hand, the nationwide health insurance coverage systems in other countries (e.g. Germany) have done without the requirement for recommendation; direct access to an expert is possible there. [3]

There has been concern about opportunistic "health travelers" travelling to Britain (primarily London) and utilizing the NHS while paying absolutely nothing. [4] British people have been known to travel to other European countries to make the most of lower costs, and since of a worry of hospital-acquired extremely bugs and long waiting lists. [5]

NHS access is for that reason managed by medical priority instead of price system, resulting in waiting lists for both consultations and surgery, as much as months long, although the Labour government of 1997-onwards made it one of its key targets to decrease waiting lists. In 1997, the waiting time for a non-urgent operation might be 2 years; there were aspirations to lower it to 18 weeks despite opposition from medical professionals. [6] It is objected to that this system is fairer - if a medical complaint is severe and life-threatening, a patient will reach the front of the queue quickly.

The NHS measures medical requirement in terms of quality-adjusted life years (QALYs), a technique of measuring the advantage of medical intervention. [7] It is argued that this technique of assigning health care indicates some clients must lose in order for others to gain, which QALY is a crude method of making life and death decisions. [8]

Hospital obtained infections

There have been numerous deadly break outs of antibiotic resistant germs (" extremely bugs") in NHS hospitals, such as Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus and Clostridioides difficile infection. [9] This has actually caused criticism of standards of health throughout the NHS, with some clients purchasing private medical insurance or travelling abroad to prevent the perceived risk of capturing a "incredibly bug" while in medical facility. 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 cost-effectiveness in some cases causes what some call a "postcode lottery". [11] [12] The National Institute for Health and Care Excellence (NICE) are the first gatekeeper, and analyze the expense effectiveness of all drugs. Until they have issued assistance on the expense and effectiveness of new or expensive medications, treatments and treatments, NHS services are unlikely to offer to money courses of treatment. The very same of true of the Scottish Medicines Consortium, NICE's counterpart in Scotland. [13]

There has actually been significant controversy about the public health funding of expensive drugs, significantly Herceptin, due to its high expense and viewed limited total survival. The project waged by cancer sufferers to get the government to spend for their treatment has gone to the greatest levels in the courts and the Cabinet to get it accredited. [14] [15] Your Home of Commons Health Select Committee criticised some drug business 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 idea of personal finance initiative (PFI) pertained to prominence, all new health center structure was by convention funded from the Treasury, as it was believed it was best able to raise money and able to manage public sector expenditure. In June 1994, the Capital Investment Manual (CIM) was published, setting out the terms of PFI agreements. The CIM made it clear that future capital tasks (building of new facilities) needed to take a look at whether PFI was more effective to utilizing public sector financing. By the end of 1995, 60 reasonably small tasks had actually been planned for, at an overall cost of around ₤ 2 billion. Under PFI, structures were built and serviced by the private sector, and then leased back to the NHS. The Labour federal government elected under Tony Blair in 1997 accepted PFI projects, thinking that public spending required to be reduced. [16]

Under the private financing initiative, an increasing variety of healthcare facilities have actually been developed (or rebuilt) by economic sector consortia, although the government also motivated private sector treatment centres, so called "surgicentres". [17] There has been considerable criticism of this, with a research study by a consultancy company which works for the Department of Health revealing that for every ₤ 200 million invested on privately financed medical facilities the NHS loses 1000 physicians and nurses. The very first PFI health centers include some 28% fewer beds than the ones they replaced. [18] In addition to this, it has been noted that the return for building business on PFI agreements could be as high as 58%, and that in funding health centers from the personal instead of public sector cost the NHS practically half a billion pounds more every year. [19]

Scandals

Several high-profile medical have taken place 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 occurrence, the Redfern Report, exposed that Dick van Velzen, the Chair of Foetal and Infant Pathology at Alder Hey, had actually purchased the "unethical and prohibited stripping of every organ from every child who had had a postmortem." In response, it has actually been argued that the scandal brought the problem of organ and tissue contribution 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 worried unusually high death rates amongst clients at the hospital. [22] [23] As much as 1200 more clients passed away between 2005 and 2008 than would be anticipated for the type and size of medical facility [24] [25] based on figures from a mortality model, but the final Healthcare Commission report concluded it would be misinforming to link the inadequate care to a specific number or variety of varieties of deaths. [26] A public inquiry later on exposed multiple instances of overlook, incompetence and abuse of patients. [27]

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

Unlike in Scotland and Wales which have actually degenerated health care, 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 examining if the care provided by the NHS is genuinely safe and suitable for purpose is the Care Quality Commission, or CQC. Although the CQC explains itself as the "independent regulator of all health and social care services in England" [1], it remains in truth "liable 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 financing comes 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 therefore the capacity for a dispute of interest, as both the NHS and the CQC have the same leadership and both are extremely vulnerable to political disturbance.

In April 2024, Health Secretary Victoria Atkins prompted NHS England to focus on evidence and safety in gender dysphoria treatment following concerns raised by the Cass Review. NHS demanded cooperation from adult clinics and started an evaluation, with Labour supporting evidence-based care. Momentum slammed limitations on gender-affirming care, while Stonewall invited the evaluation's focus on kids's well-being. [28] [29]

See also

National Health Service
List of hospitals in England
Healthcare in the UK
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 initial 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 coordinated versus uncoordinated care in Germany: outcomes of a regular data 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 travelers could get refund". BBC News Online. 7 December 2007. Retrieved 9 December 2007.
^ Jones, George (21 February 2007). "Doctors assault 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 hospitals make you sick?". BBC News. 31 January 2019.
^ "Hospital deep cleaning under fire". 14 January 2008.
^ "NHS 'postcode lotto'". 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 turned down 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 carry 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 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, guard dog states". 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 resulted in 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 medical facility scandal: Up to 1,200 might have passed away over "stunning" patient care". Daily Mirror. Retrieved 6 May 2009.
^ "How many individuals passed away "unnecessarily" at Mid Staffs". Full Fact. 7 March 2013. Retrieved 29 May 2015.
^ Sawer, Patrick; Donnelly, Laura (2 October 2011). "Boss of scandal-hit health center escapes 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 need to 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.