Criticism of the National Health Service (England) > 상담신청

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Criticism of the National Health Service (England) consists of concerns such as access, waiting lists, health care protection, and different scandals. The National Health Service (NHS) is the openly funded healthcare system of England, created under the National Health Service Act 1946 by the post-war Labour government of Clement Attlee. It has actually come under much criticism, especially 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 lots of years, including over the provision of psychological health care in the 1970s and 1980s (eventually 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 healthcare a largely "invisible cost" to the client, health care appears to be effectively free to its customers - there is no particular NHS tax or levy. To reduce costs and make sure that everybody is dealt with equitably, there are a range of "gatekeepers." The basic professional (GP) works as a main gatekeeper - without a referral from a GP, it is typically impossible to acquire greater courses of treatment, such as a consultation with an expert. These are argued to be needed - Welshman Bevan kept in mind in a 1948 speech in your house of Commons, "we will never have all we need ... expectations will constantly exceed capacity". [2] On the other hand, the national medical insurance systems in other nations (e.g. Germany) have actually given with the need for recommendation; direct access to an expert is possible there. [3]

There has been issue about opportunistic "health tourists" taking a trip to Britain (mainly London) and using the NHS while paying absolutely nothing. [4] British people have actually been known to travel to other European countries to take benefit of lower expenses, and due to the fact that of a worry of hospital-acquired very bugs and long waiting lists. [5]

NHS access is therefore controlled by medical concern instead of price mechanism, leading to waiting lists for both consultations and surgical treatment, up to months long, although the Labour federal government of 1997-onwards made it one of its key targets to minimize waiting lists. In 1997, the waiting time for a non-urgent operation might be 2 years; there were ambitions to minimize it to 18 weeks despite opposition from medical professionals. [6] It is contested that this system is fairer - if a medical grievance is intense and dangerous, a client will reach the front of the queue quickly.

The NHS measures medical need in terms of quality-adjusted life years (QALYs), a method of quantifying the advantage of medical intervention. [7] It is argued that this approach of assigning health care means some patients must lose out in order for others to acquire, and that QALY is a crude technique 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 health centers, such as Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus and Clostridioides difficile infection. [9] This has led to criticism of standards of hygiene throughout the NHS, with some clients buying personal health insurance or taking a trip abroad to avoid the viewed danger of capturing a "extremely bug" while in medical facility. However, the department of health vowed ₤ 50 million for a "deep clean" of all NHS England hospitals in 2007. [10]

Coverage

The lack of schedule of some treatments due to their perceived poor cost-effectiveness in some cases causes what some call a "postcode lottery game". [11] [12] The National Institute for Health and Care Excellence (NICE) are the very first gatekeeper, and analyze the cost effectiveness of all drugs. Until they have released guidance on the cost and effectiveness of new or costly medications, treatments and treatments, NHS services are unlikely to offer to money courses of treatment. The same of real of the Scottish Medicines Consortium, NICE's counterpart in Scotland. [13]

There has actually been considerable debate about the public health financing of expensive drugs, especially Herceptin, due to its high expense and viewed restricted general survival. The project waged by cancer patients to get the federal government to pay for their treatment has gone to the greatest levels in the courts and the Cabinet to get it certified. [14] [15] The House 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 optimum worth of one QALY in the NHS.

Private Finance Initiative

Before the concept of personal financing effort (PFI) pertained to prominence, all brand-new health center building was by convention funded from the Treasury, as it was believed it was best able to raise money and able to manage public sector expense. In June 1994, the Capital Investment Manual (CIM) was released, setting out the terms of PFI contracts. The CIM made it clear that future capital projects (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 prepared for, at an overall expense of around ₤ 2 billion. Under PFI, structures were built and serviced by the economic sector, and after that rented back to the NHS. The Labour government elected under Tony Blair in 1997 embraced PFI tasks, thinking that public costs needed to be reduced. [16]

Under the personal finance effort, an increasing variety of healthcare facilities have been constructed (or rebuilt) by private sector consortia, although the government also encouraged personal sector treatment centres, so called "surgicentres". [17] There has been considerable criticism of this, with a study by a consultancy company which works for the Department of Health showing that for every ₤ 200 million spent on privately financed hospitals the NHS loses 1000 doctors and nurses. The first PFI hospitals contain some 28% fewer beds than the ones they changed. [18] As well as this, it has been noted that the return for construction companies on PFI contracts could be as high as 58%, and that in funding healthcare facilities from the private rather than public sector cost the NHS practically half a billion pounds more every year. [19]

Scandals

Several high-profile medical scandals have actually happened within the NHS for many 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, between 1988 and 1995. The official report into the occurrence, the Redfern Report, revealed that Dick van Velzen, the Chair of Foetal and Infant Pathology at Alder Hey, had bought the "dishonest and prohibited removing of every organ from every kid who had actually had a postmortem." In response, it has actually been argued that the scandal brought the concern of organ and tissue donation 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 regarded opioid deaths. [21]

The Stafford Hospital scandal in Stafford, England in the late 2000s worried unusually high death rates amongst clients at the medical facility. [22] [23] Up to 1200 more patients died between 2005 and 2008 than would be expected for the type and size of medical facility [24] [25] based on figures from a mortality design, however the last Healthcare Commission report concluded it would be misguiding to link the inadequate care to a particular number or series of varieties of deaths. [26] A public inquiry later on exposed several instances of disregard, incompetence and abuse of clients. [27]

" Lack of independence of looking for safety and fitness for purpose"

Unlike in Scotland and Wales which have devolved healthcare, 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 provided by the NHS is genuinely safe and in shape for function is the Care Quality Commission, or CQC. Although the itself as the "independent regulator of all health and social care services in England" [1], it remains in reality "responsible 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. At least one chairman, one president [3] and a board member [4] of the CQC have been singled out for attention by a UK Secretary of State for Health.

There is therefore the capacity for a conflict of interest, as both the NHS and the CQC have the same management and both are highly susceptible to political interference.

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 required cooperation from adult centers and initiated a review, with Labour supporting evidence-based care. Momentum criticized limitations on gender-affirming care, while Stonewall invited the review's focus on kids's wellness. [28] [29]

See also

National Health Service
List of medical facilities in England
Healthcare in the United Kingdom
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 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 guidelines to make sure 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 might 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 health centers make you sick?". BBC News. 31 January 2019.
^ "Hospital deep cleaning under fire". 14 January 2008.
^ "NHS 'postcode lottery game'". 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 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 hospitals '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 healthcare facility deaths: Police corruption probe flawed, watchdog states". BBC News. 14 October 2021. Retrieved 8 December 2024.
^ Nick Triggle (6 February 2013). "Stafford Hospital: Hiding errors 'should 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 'may 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 healthcare facility scandal: Up to 1,200 may have passed away over "stunning" client care". Daily Mirror. Retrieved 6 May 2009.
^ "How lots of individuals 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 hospital leaves cross-examination". 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 clinics". Morning Star. 11 April 2024. Retrieved 15 April 2024.
^ "NHS England must end 'culture of secrecy' in children'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.