최고위과정(ACE)

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Criticism of the National Health Service (England) consists of issues such as access, waiting lists, health care protection, and different 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, 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 participation of the NHS in scandals extends back several years, consisting of over the provision of mental healthcare in the 1970s and 1980s (ultimately part of the factor for the Mental Health Act 1983), and spends too much on healthcare facility newbuilds, including 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 health care a largely "undetectable expense" to the patient, health care seems to be effectively totally free to its customers - there is no specific NHS tax or levy. To reduce costs and guarantee that everyone is treated equitably, there are a range of "gatekeepers." The basic professional (GP) works as a primary gatekeeper - without a recommendation from a GP, it is typically impossible to gain higher courses of treatment, such as a visit with a consultant. These are argued to be necessary - Welshman Bevan noted in a 1948 speech in the House of Commons, "we shall never have all we require ... expectations will always exceed capacity". [2] On the other hand, the national health insurance coverage systems in other countries (e.g. Germany) have done without the requirement for referral; direct access to a professional is possible there. [3]

There has actually been issue about opportunistic "health tourists" taking a trip to Britain (primarily London) and using the NHS while paying nothing. [4] British people have actually been known to travel to other European nations to benefit from lower expenses, and because of a fear of hospital-acquired super bugs and long waiting lists. [5]

NHS access is therefore managed by medical priority rather than rate mechanism, causing waiting lists for both consultations and surgical treatment, as much as months long, although the Labour government of 1997-onwards made it among its essential targets to reduce waiting lists. In 1997, the waiting time for a non-urgent operation might be two years; there were ambitions to decrease it to 18 weeks despite opposition from doctors. [6] It is objected to that this system is fairer - if a medical problem is intense and lethal, a patient will reach the front of the queue quickly.

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

Hospital acquired infections

There have actually been numerous fatal break outs of antibiotic resistant germs (" incredibly bugs") in NHS healthcare facilities, such as Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus and Clostridioides difficile infection. [9] This has resulted in criticism of requirements of health across the NHS, with some patients purchasing private health insurance or travelling abroad to avoid the viewed hazard of capturing a "super bug" while in medical facility. However, the department of health pledged ₤ 50 million for a "deep clean" of all NHS England health centers in 2007. [10]

Coverage

The absence of availability of some treatments due to their perceived bad cost-effectiveness often leads to what some call a "postcode lotto". [11] [12] The National Institute for Health and Care Excellence (NICE) are the first gatekeeper, and take a look at the cost efficiency of all drugs. Until they have actually provided guidance on the expense and effectiveness of brand-new or pricey medicines, treatments and treatments, NHS services are not likely to use to money courses of treatment. The very same of real of the Scottish Medicines Consortium, NICE's counterpart in Scotland. [13]

There has been substantial controversy about the public health funding of pricey drugs, significantly Herceptin, due to its high expense and viewed minimal overall survival. The campaign waged by cancer victims to get the government to spend 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 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 personal finance initiative (PFI) concerned prominence, all new hospital building was by convention moneyed from the Treasury, as it was believed it was best able to raise money and able to control public sector expense. In June 1994, the Capital Expense Manual (CIM) was released, setting out the terms of PFI agreements. The CIM made it clear that future capital projects (building of new facilities) had to look at whether PFI was more suitable to using public sector funding. By the end of 1995, 60 relatively little tasks had been prepared for, at a total cost of around ₤ 2 billion. Under PFI, buildings were developed and serviced by the economic sector, and then leased back to the NHS. The Labour federal government elected under Tony Blair in 1997 embraced PFI jobs, believing that public costs required to be curtailed. [16]

Under the personal financing initiative, an increasing number of healthcare facilities have actually been developed (or rebuilt) by economic sector consortia, although the federal government likewise motivated economic sector treatment centres, so called "surgicentres". [17] There has been significant criticism of this, with a study by a consultancy business which works for the Department of Health revealing that for every ₤ 200 million invested in independently financed health centers the NHS loses 1000 physicians and nurses. The first PFI healthcare facilities include some 28% fewer beds than the ones they replaced. [18] As well as this, it has actually been noted that the return for building business on PFI agreements might be as high as 58%, which in financing medical facilities 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 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 elimination, retention, and disposal of human tissue, consisting of children's organs, between 1988 and 1995. The official report into the incident, the Redfern Report, revealed that Dick van Velzen, the Chair of Foetal and Infant Pathology at Alder Hey, had actually purchased the "dishonest and prohibited stripping of every organ from every child who had had a postmortem." In action, it has actually been argued that the scandal brought the concern 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, in the late 2000s concerned unusually high mortality rates among patients at the health center. [22] [23] Up to 1200 more patients died between 2005 and 2008 than would be anticipated for the type and size of healthcare facility [24] [25] based upon figures from a mortality model, however the last Healthcare Commission report concluded it would be misinforming to connect the insufficient care to a specific number or variety of varieties of deaths. [26] A public inquiry later exposed several circumstances of neglect, incompetence and abuse of clients. [27]

" Lack of independence of examining for security and fitness for purpose"

Unlike in Scotland and Wales which have devolved health care, 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 checking if the care delivered by the NHS is genuinely safe and fit 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 reality "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 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 dispute of interest, as both the NHS and the CQC have the very same leadership and both are extremely prone to political disturbance.

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

See also

National Health Service
List of healthcare facilities 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 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: results of a regular 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 initial on 8 December 2008. Retrieved 9 December 2007.
^ "Health tourists could 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 original on 15 April 2008. Retrieved 9 December 2007.
^ "Do medical facilities 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 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 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 perform 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 extra ₤ 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 healthcare facility deaths: Police corruption probe flawed, guard dog says". BBC News. 14 October 2021. Retrieved 8 December 2024.
^ Nick Triggle (6 February 2013). "Stafford Hospital: Hiding mistakes '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 hospital scandal: Up to 1,200 may have died over "stunning" patient care". Daily Mirror. Retrieved 6 May 2009.
^ "How numerous 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 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 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.