Criticism of the National Health Service (England) > 자유게시판

• 목록
• 답변
• 글쓰기
• 게시판 리스트 옵션
  • 수정
  • 삭제

Criticism of the National Health Service (England) includes problems such as access, waiting lists, healthcare coverage, and various scandals. The National Health Service (NHS) is the publicly financed health care system of England, produced 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 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 involvement of the NHS in scandals extends back lots of years, consisting of over the provision of mental healthcare in the 1970s and 1980s (ultimately part of the reason 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 expense of which soared from ₤ 29 million to ₤ 152 million. [1]

Access controls and waiting lists

In making healthcare a mostly "undetectable cost" to the patient, healthcare appears to be efficiently complimentary to its consumers - there is no particular NHS tax or levy. To minimize expenses and ensure that everybody is dealt with equitably, there are a variety of "gatekeepers." The general specialist (GP) works as a primary gatekeeper - without a recommendation from a GP, it is often impossible to gain higher courses of treatment, such as a consultation with an expert. These are argued to be necessary - Welshman Bevan kept in mind in a 1948 speech in the House of Commons, "we shall never ever have all we need ... expectations will always exceed capability". [2] On the other hand, the nationwide health insurance systems in other countries (e.g. Germany) have actually ignored the requirement for recommendation; direct access to a specialist is possible there. [3]

There has actually been issue about opportunistic "health tourists" taking a trip to Britain (mostly London) and using the NHS while paying nothing. [4] British citizens have been understood to take a trip to other European countries to take benefit 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 rather than cost system, leading to waiting lists for both assessments and surgery, up to months long, although the Labour federal government of 1997-onwards made it among its essential targets to decrease waiting lists. In 1997, the waiting time for a non-urgent operation could be 2 years; there were aspirations 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 intense and dangerous, a client will reach the front of the line quickly.

The NHS measures medical need in regards to quality-adjusted life years (QALYs), a technique of quantifying the benefit of medical intervention. [7] It is argued that this approach of allocating healthcare implies some clients should lose out in order for others to get, which QALY is a crude approach of making life and death decisions. [8]

Hospital obtained infections

There have been several 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 resulted in criticism of requirements of hygiene throughout the NHS, with some patients purchasing private health insurance or travelling abroad to prevent the perceived hazard of capturing 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 accessibility of some treatments due to their perceived bad cost-effectiveness in some cases results in what some call a "postcode lottery game". [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 actually released guidance on the expense and efficiency of new or costly medications, treatments and procedures, NHS services are not likely to provide to fund courses of treatment. The very same of real of the Scottish Medicines Consortium, NICE's counterpart in Scotland. [13]

There has actually been significant debate about the public health funding of pricey drugs, notably Herceptin, due to its high expense and perceived minimal general survival. The project waged by cancer patients 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 companies for bringing in drugs that cost on and around the ₤ 30,000 limit that is thought about the maximum worth of one QALY in the NHS.

Private Finance Initiative

Before the concept of personal finance effort (PFI) pertained to prominence, all brand-new hospital building was by convention moneyed from the Treasury, as it was believed 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 projects (structure of new facilities) had to look at whether PFI was more effective to utilizing public sector funding. By the end of 1995, 60 fairly small jobs had been prepared for, at a total cost of around ₤ 2 billion. Under PFI, structures were constructed and serviced by the economic sector, and then leased back to the NHS. The Labour government elected under Tony Blair in 1997 welcomed PFI projects, thinking that public spending needed to be cut. [16]

Under the private financing effort, an increasing variety of health centers have been built (or rebuilt) by economic sector consortia, although the government likewise encouraged economic sector treatment centres, so called "surgicentres". [17] There has been considerable criticism of this, with a research study by a consultancy business which works for the Department of Health showing that for every single ₤ 200 million spent on privately financed healthcare facilities the NHS loses 1000 physicians and nurses. The very first PFI hospitals include some 28% less beds than the ones they replaced. [18] As well as this, it has actually been kept in mind that the return for building and construction companies on PFI agreements might be as high as 58%, which in financing medical facilities from the personal instead of public sector cost the NHS nearly half a billion pounds more every year. [19]

Scandals

Several high-profile medical scandals have occurred within the NHS for many years, such as the organs scandal and the Bristol heart scandal. At Alder Hey Children's Hospital, there was the unauthorised elimination, retention, and disposal of human tissue, including kids's organs, in between 1988 and 1995. The main 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 "unethical and unlawful stripping of every organ from every child who had had a postmortem." In reaction, it has actually been argued that the scandal brought the concern of organ and tissue contribution into the general public domain, and highlighted the benefits 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 abnormally high death rates amongst patients at the medical facility. [22] [23] Up to 1200 more clients died in between 2005 and 2008 than would be expected for the type and size of hospital [24] [25] based upon figures from a mortality design, but the last Healthcare Commission report concluded it would be deceiving to connect the inadequate care to a specific number or variety of numbers of deaths. [26] A public query later on revealed numerous circumstances of neglect, incompetence and abuse of patients. [27]

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

Unlike in Scotland and Wales which have actually degenerated 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 inspecting if the care delivered by the NHS is genuinely safe and suitable for function 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 reality "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 financing 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 potential for a conflict of interest, as both the NHS and the CQC have the very same management and both are extremely susceptible to political interference.

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

See also

National Health Service
List of medical 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 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 initial 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 attack Blair's waiting list pledge". The Daily Telegraph. London. Archived from the initial 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 initial on 15 April 2008. Retrieved 9 December 2007.
^ "Do medical facilities make you sick?". BBC News. 31 January 2019.
^ "Hospital deep cleansing 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 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 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 health centers 'costing NHS extra ₤ 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, guard dog states". 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 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 healthcare facility scandal: As much as 1,200 might have passed away over "stunning" client care". Daily Mirror. Retrieved 6 May 2009.
^ "How many people 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 health center gets away cross-examination". The Daily Telegraph. London. Archived from the original 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.