Criticism of the National Health Service (England) > 상담신청

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Criticism of the National Health Service (England) includes concerns such as access, waiting lists, healthcare protection, and various scandals. The National Health Service (NHS) is the publicly funded healthcare system of England, created under the National Health Service Act 1946 by the post-war Labour federal government of Clement Attlee. It has actually come under much criticism, especially throughout 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 several years, including over the provision of psychological health care in the 1970s and 1980s (ultimately part of the reason for the Mental Health Act 1983), and spends beyond your means 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 health care a mainly "undetectable cost" to the client, health care appears to be effectively totally free to its consumers - there is no particular NHS tax or levy. To lower expenses and ensure that everybody is dealt with equitably, there are a variety of "gatekeepers." The basic practitioner (GP) operates as a primary gatekeeper - without a referral from a GP, it is typically difficult to get greater courses of treatment, such as an appointment with a specialist. These are argued to be essential - Welshman Bevan noted in a 1948 speech in the House of Commons, "we shall never ever have all we need ... expectations will always surpass capacity". [2] On the other hand, the nationwide medical insurance systems in other nations (e.g. Germany) have actually 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 (mainly London) and utilizing the NHS while paying absolutely nothing. [4] British people have actually been known to take a trip to other European countries to make the most of lower expenses, and due to the fact that of a worry of hospital-acquired super bugs and long waiting lists. [5]

NHS gain access to is for that reason controlled by medical priority instead of cost system, causing waiting lists for both assessments and surgery, approximately months long, although the Labour government of 1997-onwards made it one of its key targets to reduce waiting lists. In 1997, the waiting time for a non-urgent operation could be two years; there were ambitions to lower it to 18 weeks despite opposition from physicians. [6] It is objected to that this system is fairer - if a medical grievance is acute and lethal, 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 advantage of medical intervention. [7] It is argued that this method of allocating health care suggests some patients should lose in order for others to gain, and that QALY is a crude method of making life and death choices. [8]

Hospital got infections

There have been a number of deadly outbreaks of antibiotic resistant germs (" incredibly bugs") in NHS health centers, such as Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus and Clostridioides difficile infection. [9] This has caused criticism of standards of hygiene across the NHS, with some clients purchasing private medical insurance or taking a trip abroad to avoid the viewed hazard of capturing a "super 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 absence of schedule of some treatments due to their viewed poor cost-effectiveness in some cases results in what some call a "postcode lotto". [11] [12] The National Institute for Health and Care Excellence (NICE) are the first gatekeeper, and analyze the cost efficiency of all drugs. Until they have actually released guidance on the expense and efficiency of new or pricey medicines, treatments and procedures, NHS services are not likely to use to money courses of treatment. The exact same of true of the Scottish Medicines Consortium, NICE's equivalent in Scotland. [13]

There has actually been significant debate about the public health financing of costly drugs, significantly Herceptin, due to its high expense and viewed limited overall survival. The campaign waged by cancer patients to get the government to spend for their treatment has actually gone to the highest levels in the courts and the Cabinet to get it licensed. [14] [15] Your House of Commons Health Select Committee criticised some drug business for generating drugs that cost on and around the ₤ 30,000 limitation that is thought about the maximum worth of one QALY in the NHS.

Private Finance Initiative

Before the concept of private financing initiative (PFI) came to prominence, all new medical facility structure 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 agreements. The CIM made it clear that future capital tasks (building of brand-new centers) had to take a look at whether PFI was more effective to using public sector funding. By the end of 1995, 60 fairly small tasks had been prepared for, at an overall expense of around ₤ 2 billion. Under PFI, structures were built and serviced by the personal sector, and then rented back to the NHS. The Labour federal government chosen under Tony Blair in 1997 welcomed PFI tasks, thinking that public spending needed to be curtailed. [16]

Under the private finance initiative, an increasing number of medical facilities have actually been constructed (or rebuilt) by economic sector consortia, although the government likewise encouraged private sector treatment centres, so called "surgicentres". [17] There has actually been substantial criticism of this, with a study by a consultancy company which works for the Department of Health revealing that for every single ₤ 200 million invested in independently financed hospitals the NHS loses 1000 doctors and nurses. The very first PFI health centers consist of some 28% fewer beds than the ones they changed. [18] Along with this, it has actually been kept in mind that the return for construction companies on PFI contracts might be as high as 58%, and that in financing health centers from the private instead of public sector cost the NHS almost half a billion pounds more every year. [19]

Scandals

Several high-profile medical scandals have happened 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 removal, retention, and disposal of human tissue, consisting of kids's organs, in between 1988 and 1995. The official report into the event, the Redfern Report, revealed that Dick van Velzen, the Chair of Foetal and Infant Pathology at Alder Hey, had actually bought the "unethical and unlawful removing of every organ from every child who had had a postmortem." In reaction, it has been argued that the scandal brought the concern of organ and tissue contribution into the public domain, and highlighted the advantages to medical research study that result. [20] The Gosport War Memorial Hospital scandal of the 1990s concerned opioid deaths. [21]

The Stafford Hospital scandal in Stafford, England in the late 2000s worried unusually high death rates amongst patients at the healthcare facility. [22] [23] As much as 1200 more clients died in between 2005 and 2008 than would be anticipated for the type and size of [24] [25] based on figures from a death model, however the final Healthcare Commission report concluded it would be deceiving to link the inadequate care to a particular number or series of numbers of deaths. [26] A public questions later exposed numerous instances of disregard, incompetence and abuse of patients. [27]

" Lack of independence of looking for security and fitness for function"

Unlike in Scotland and Wales which have actually devolved healthcare, NHS England is operated 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 in shape 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 is in fact "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 funding comes from the taxpayer. A minimum of one chairman, one chief executive [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 potential for a conflict of interest, as both the NHS and the CQC have the very same management and both are extremely prone to political disturbance.

In April 2024, Health Secretary Victoria Atkins advised NHS England to prioritize evidence and security 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 restrictions on gender-affirming care, while Stonewall welcomed the review's focus on children's wellness. [28] [29]

See likewise

National Health Service
List of health centers 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 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: results of a routine information analysis in Bavaria". BMJ Open. 6 (6 ): e011621. doi:10.1136/ bmjopen-2016-011621. PMC 4908874. PMID 27288386.
^ "Tougher guidelines to guarantee that individuals 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 promise". 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 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 hospitals make you sick?". BBC News. 31 January 2019.
^ "Hospital deep cleansing under fire". 14 January 2008.
^ "NHS 'postcode lottery'". politics.co.uk. 9 August 2006. Archived from the initial 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 declined 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 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 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 medical facility 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 offense'". 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: Approximately 1,200 might have died over "shocking" 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 medical facility leaves cross-examination". The Daily Telegraph. London. Archived from the original on 3 October 2011.
^ "Minister informs NHS to 'end culture of secrecy' on gender care as focus shifts to adult clinics". 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.