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| In addition to the public NHS systems (which dominate healthcare in the UK), private healthcare and a wide variety of alternative and complementary treatments are available. | In addition to the public NHS systems (which dominate healthcare in the UK), private healthcare and a wide variety of alternative and complementary treatments are available. | ||
| ==Information== | |||
| The ] granted all workers of 16 years or over free medical coverage as well as unemployment benefits. <ref>http://www.rcgp.org.uk/services__contacts/history_heritage__archives/history__chronology/history_essay.aspx Royal College of General Practitioners</ref> In 1948 the system was extended to the entire population and a new service, the ] or NHS was established. Today it is the world's largest publicly funded health service. <ref></ref> It was set up on July 5 1948 to "provide healthcare for all citizens, based on need, not the ability to pay." It is funded by the taxpayer and in England it is managed by a government department, the Department of Health, which sets overall policy on health issues. | |||
| <ref>http://www.nhs.uk/aboutnhs/nhshistory/Pages/NHSHistorySummary.aspx</ref> There are four separate health services for each of the three constituent nations (England, Scotland, and Wales) and one for Northern Ireland. In practice, they work closely together and provide a seamless service based on the same core principles. | |||
| <blockquote> | |||
| "The NHS is committed to providing quality care that meets the needs of everyone, is free at the point of need, and is based on a patient's clinical need, not their ability to pay." ''(Source: NHS website)'' <ref name="autogenerated4"></ref> | |||
| </blockquote> | |||
| '''Funding''': The estimated cost of the ] NHS in 2008 is £98.6 billion<ref name="budget2008">{{cite web | author=HM Treasury| title=Budget 2008, Chapter C |date=2008-03-24 | url=http://www.hm-treasury.gov.uk/media/7/3/bud08_chapterc.pdf| accessdate = 2008-03-24 | pages=23|format=PDF}}</ref> or about US$243 per person per month. Funding for the NHS is met from ] and ] contributions paid by all persons over the age of 18 and employers in the UK. There is no direct correlation between National Insurance payments and health care costs because UK National insurance is part of much wider plan for ], funding health care, retirement pensions and other social security benefits such as Jobseeker’s Allowance, Incapacity Benefit, Bereavement Benefits, and Maternity Allowance. Unlike other benefits paid from National Insurance, health care entitlement is not dependent on a person's National Insurance contribution history but is instead dependent on a person's right to be permanently resident. Temporary residents such as tourists are only entitled to free emergency care. | |||
| '''Primary care''': At the core of the service are the General Practitioners (GPs or family doctors) who are responsible for the care of patients registered with them. GPs are mostly private doctors that choose to contract with the NHS to provide services to patients paid for by the government and not the patient. They are paid a capitation fee and certain performance related payments. Patients are free to register with any GP of their choice in their locality. NHS prescribed drugs are often 100% subsidized by the taxpayer, for example if the person is being treated in medical setting or at home by an NHS medical professional, or if the person is under 18 or over retirement age, or if the patient lives in an area such as Scotland where the local NHS has decided to meet the cost of all drugs. In England, people of working age usually pay a fixed price of ]7.10 (or about US$11) for each prescribed drug collected from a retail pharmacy. The pharmacy invoices the cost of the drugs (less any fixed price patient contribution) to the NHS. | |||
| '''Hospitals''': Only GPs (NHS or private) can refer their patients to a hospital (NHS or private) for more specialized services and for surgery. Most patients choose to be treated in NHS run hospitals. The quality is comparable to private hospitals and the services obtained (medicines, surgeons and other care workers, and even meals) are free of charge to the patient, whereas private hospitals bill for these. Ambulance services, mental health, and ancillary services such as physical and occupational therapy, in-home and in-clinic nursing, and certain care for the sick elderly in nursing homes are met from the NHS budget. GPs do not follow their patients into hospital but each patient is referred to a specialist employed by the hospital. On discharge, the home GP receives a report back of the treatment(s) given and the results with recommendations for any follow up actions to be taken. | |||
| '''Electronic records''': Most doctors and hospitals already keep electronic patient records, but a wide ranging IT upgrade programme is in progress to integrate these systems. Patients in England already can book their own hospital appointments electronically (either aided at the GP office or elsewhere via the internet), choosing a hospital and time to suit their needs. The English NHS was the first G8 country to fully implement a digital Picture Archiving Communications System (PACS) to store and retrieve x-ray and other scans in all of its hospitals nationally. <ref>http://www.connectingforhealth.nhs.uk/about/benefits</ref> Future IT developments are primarily about integration synergies, such as data sharing, such as electronic prescriptions (direct to the pharmacy) and quality management recording. Patients can choose to have their personal GP and hospital medical records mirrored centrally. In this way their complete medical history will be fully available at any hospital or doctor's office in the country at any time. <ref>http://information.connectingforhealth.nhs.uk/prod_images/pdfs/31556.pdf</ref> | |||
| '''Wait times''': | |||
| - '''GP appointments''' 41 per cent of UK patients reported being able to get a same day appointment with their GP, with 13 per cent reporting having to wait 6 days or more (''2004 data'' <ref>http://www.commonwealthfund.org/usr_doc/ihp_2004_survey_charts.pdf?section=4039</ref>). | |||
| - '''Hospital treatments''' For hospital treatment, a timer for Referal to Treatment (RTT) starts running when a GP first agrees to refer a patient to the hospital. A number of steps them typically follow. The first hospital appointment must be booked; all tests completed; a diagnosis made; a follow up appointment (if necessary); an appointment made for inpatient treatment (if appropriate); or the patient prioritized to a waiting list (if there is waiting list for that procedure - about one third of hospital admissions are from a waiting list). At some point, hospital treatment will commence at which point the clock stops. The hospitals are targeted to complete these steps within 18 weeks.<ref>http://www.18weeks.nhs.uk/Content.aspx?path=/What-is-18-weeks/About-the-programme</ref> The 18 week RTT targets is met for 90% of patients in England found to need admission (and 95% for those for whom outpatient treatment was sufficient). Two thirds of patients needing a hospital admission experience RTTs of under 12 weeks. <ref>http://www.18weeks.nhs.uk/Asset.ashx?path=/RTT/October%202008%20statistical%20press%20notice.pdf</ref> | |||
| '''Other statistics:'''NHS hospitals in England carried out almost 13 million inpatient admissions in the NHS reporting year 2006/7. Of these admissions 36% were emergencies, 13% had been deferred for medical or social reasons and 35% were admitted from a waiting list. 15% were admitted for other reasons (such as maternity care or childbirth) <ref>http://www.hesonline.nhs.uk/Ease/servlet/AttachmentRetriever?site_id=1937&file_name=d:\efmfiles\1937\Accessing\DataTables\Headline\Headline_0607.pdf&short_name=Headline_0607.pdf&u_id=7922 Department of Health: Hospital episode statistcs</ref>. 99.6% of hospital admissions took place on time as planned. <ref>http://www.performance.doh.gov.uk/hospitalactivity/data_requests/cancelled_operations.htm Department of Health: Inpatient cancellations</ref>. Only 0.02% of all planned admissions were cancelled and not subsequently admitted within the following 28 days. Performance data for all hospitals for all common procedures (such as number of similar operations per year, clinical and patient ratings, wait times, re-admission rate) are publicly available on-line at the main NHS web site. | |||
| There is popular support for the NHS in the UK <ref></ref>. The Health Care Commission also undertakes regular surveys of patients' opinions of the NHS. In its most recent survey (2007), the experience of hospitals in England was rated by inpatients as follows: “excellent” (42%), “very good (35%)”, “good”(14%), “fair” (6%) and “poor” (2%). <ref>http://www.healthcarecommission.org.uk/_db/_documents/Full_2007_results_with_historical_comparisons_-_tables.doc</ref> | |||
| == Services common to the whole of the United Kingdom == | == Services common to the whole of the United Kingdom == | ||
Revision as of 02:37, 26 January 2009
Healthcare in the United Kingdom is mainly provided by four publicly-funded health care systems to all UK permanent residents that is free at the point of need and paid for from general taxation in the United Kingdom. Healthcare is a devolved matter and so England, Northern Ireland, Scotland and Wales each has its own system with different policies and priorities though the degree of co-operation usually conceals the difference from cross-border users of the services. Although commonly referred to as the "National Health Service" ("NHS") across the UK, the National Health Service covers England with NHS Scotland covering Scotland, NHS Wales covering Wales and the Department of Health, Social Services and Public Safety providing healthcare in Northern Ireland in the guise of Health and Social Care in Northern Ireland.
In addition to the public NHS systems (which dominate healthcare in the UK), private healthcare and a wide variety of alternative and complementary treatments are available.
Services common to the whole of the United Kingdom
General practitioners
Each NHS system uses General Practitioners (GPs) to provide primary healthcare for patients and to make referrals to services as necessary, whether for tests or treatments. GPs are qualified doctors, typically working in business practices that deal exclusively with NHS patients and receive fees based on the number of patients and the different services provided by the practice under the GP contract. Doctors are not allowed to charge for services provided as part of the contract, which almost all care is. All people are eligible for registration with a GP, usually of the patient's choosing, though the GP must be local to the area in which the person lives. GPs can only reject patients in exceptional circumstances.
There are no fees payable for the services of a general practitioner.
Health Centres and Clinics
Health Centres close to residential areas are provided as part of the free public health service. They typically provide care that is considered more routine and less invasive than the type of surgeries and procedures that take place in the hospital. Ophthalmology, dentistry, wound dressings re-dressing, infant check-ups and vaccinations, are typical areas of practice to be found in such places. Medical services are typically provided by nurse practitioners and visiting specialist doctors.
Health centres do not make a charge for their services.
Hospitals
Hospitals have specialist diagnostic equipment that is not generally available in GP surgeries or in health centres. They also perform surgical procedures. Mental hospitals care for those with psychiatric illnesses although many general hospitals may merely have separate psychiatric units. Access to hospital services is via referral from a general practitioner. Some hospitals have Accident and Emergency departments providing trauma care and no referral is needed to access A&E services.
All services in UK hospitals are free of charge to the patient.
Advice services
Each NHS system runs 24 hour confidential advisory services: NHS Direct provides a telephone-based service for England, NHS Direct Wales/Galw Iechyd Cymru provides a similar service in Wales while Scotland has NHS24.
Ambulance services
Each public healthcare system provides free ambulance services for patients facing life-threatening emergencies or if ordered by hospitals or GPs when patients need the specialist transport only available from ambulance crews or are not fit to be sent home by car or public transport. In some areas these services are supplemented when necessary by the voluntary ambulance services (British Red Cross, St John Ambulance and the St Andrews Ambulance Association). Where needed, patient transport services by air are provided by the Scottish Ambulance Service, various ambulance trusts in England and Wales (some jointly operated with police helicopter services) with emergency air transport also provided by naval, military and air force aircraft of whatever type might be appropriate or available on each occasion; on more than one occasion this has led to new-born babies needing special care being flown long distances in Hercules transport aircraft or similar.
Cost recovery in exceptional circumstances
In general, the cost of NHS health care is met from taxation and the NHS does not bill for its services. Each NHS system, however, reserves the right to claim compensation for treatment required as a result of the negligence of others. For example, when compensation is received from motor insurance companies through the Injury Costs Recovery Scheme following the determination of fault in motor accidents. Foreign visitors to the UK are not charged for emergency NHS treatment to stabilize a health problem that has started in the UK during their visit but cannot receive any other NHS services. If it becomes clear that a patient has received services who was not in fact eligible to receive free treatment, the NHS will recover costs from the patient.
Dentistry
Each NHS system provides dental services through private dental practises and dentists can only charge NHS patients at set rates (though the rates vary between countries). Patients opting to be treated privately do not receive any NHS funding for the treatment. About half of the income of dentists comes from work sub-contracted from the NHS. Not all dentists choose to do NHS work and there is a trend of movement from the NHS to private dentistry.
Services which differ between the countries of the United Kingdom
Pharmacies & Prescription charges
Each NHS system uses pharmacies to supply prescription drugs. Pharmacies (other than those within hospitals) are privately owned but have contracts with the relevant health service
In England, patients under 16 years old (19 years if still in full-time education) or over 59 years will get the drug for free. There are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £7.10 is payable per item.
In Northern Ireland, prescription charges will be abolished by April 2010. At present, patients under 16 years old (19 years if still in full-time education) or over 59 years get free prescriptions and there are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £6.85 is payable per item.
In Scotland, prescription charges will be abolished before 2011. At present, patients under 16 years old (19 years if still in full-time education) or over 59 years get free prescriptions and there are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £5 is payable per item.
In Wales, prescription charges were abolished in 2007 and all prescription drugs are now dispensed without charge.
Parking charges
Parking charges at hospitals have been abolished in Scotland (except for 3 PFI hospitals) but continue in England.
Polyclinics
Polyclinics are being trialled in London and in other suburban areas and, if successful, may be rolled out across England.
Role of private sector in public healthcare
Whereas the UK government is expanding the role of the private sector within the NHS in England, the current Scottish government is moving in the opposite direction, actively reducing the role of the private sector within public healthcare in Scotland and planning legislation to prevent the possibility of private companies running GP practices in future.
Cost control
Each constituent part of the NHS (e.g. a trust or GP practice) is responsible for overall control of costs within its area of operation.
The National Audit Office reports annually on the summarised consolidated accounts of the NHS, and Audit Scotland performs the same function for NHS Scotland .
In England and Wales, the National Institute for Health and Clinical Excellence (NICE) sets guidelines for medical practitioners as to how various conditions should be treated and whether or not a particular treatment should be funded. In Scotland, the Scottish Medicines Consortium performs a similar function. However, the Scottish system makes some new drugs available for prescription more quickly than in the rest of the UK which has led to complaints.
Private health care
The United Kingdom also has private health care which is mainly paid for by insurance or funding as part of an employer funded health care scheme. It is considerably smaller than the public NHS sector given the comprehensive nature of NHS healthcare and the fact that NHS care is mostly free of charge at the point of use.
There are many treatments that the private sector does not provide. For example, one of the largest health care providers in the UK is BUPA and it excludes many treatments from its insurance plans , nearly all which are available as NHS treatments. The list contains many forms of treatment and care that most people will need during their lifetime. The BUPA exclusion list includes
- ageing, menopause and puberty
- AIDS/HIV†
- allergies or allergic disorders
- birth control, conception, sexual problems and sex changes†
- chronic conditions†
- complications from excluded or restricted conditions/ treatment
- convalescence, rehabilitation and general nursing care†
- cosmetic, reconstructive or weight loss treatment†
- deafness
- dental/oral treatment (such as fillings, gum disease, jaw shrinkage, etc)†
- dialysis†
- drugs and dressings for out-patient or take-home use†
- experimental drugs and treatment†
- eyesight†
- HRT and bone densitometry†
- learning difficulties, behavioural and developmental problems
- overseas treatment and repatriation
- physical aids and devices†
- pre-existing or special conditions
- pregnancy and childbirth†
- screening and preventive treatment
- sleep problems and disorders
- speech disorders†
- temporary relief of symptoms†
- treatment in a hospital that is not a Bupa Heartbeat hospital
† (except in exceptional circumstances)
See also
- Emergency medical services in England
- Emergency medical services in Northern Ireland
- Emergency medical services in Scotland
- Emergency medical services in Wales
References
- 'Huge contrasts' in devolved NHS BBC News, 28 August 2008
- NHS now four different systems BBC 2 January 2008
- Health and Social Care in Northern Ireland
- NHS Direct (England)
- NHS Direct Wales/Galw Iechyd Cymru
- NHS 24 (Scotland)
- Wiltshire Air Ambulance
- BBC News-RAF flight 'saved couple's baby'
- "Call for dentists' NHS-work quota".
{{cite web}}: Text "BBC" ignored (help) - NI to scrap prescription charges BBC News, 29 September, 2008
- Vow to scrap prescription charges BBC News, 22 October 2008
- NHS car parking charges abolished BBC News, 2 September 2008
- Private firm to carry out surgery BBC News, 5 August 2007
- £64bn NHS privatisation plan revealed guardian.co.uk, 30 June 2006
- Plans to end private cash for NHS BBC News, 21 June 2007
- Sturgeon to end privatisation of GP practices Sunday Herald, 8 June 2008
- NAO report (HC 129-I 2007-08): Report on the NHS Summarised Accounts 2006-07: Achieving Financial Balance
- Call for quicker drug decisions BBC News, 10 January 2008
- http://www.bupa.co.uk/heartbeat/html/not_covered.html BUPA exclusions
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