Criticism of the National Health Service (England) > 자유게시판

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

Criticism of the National Health Service (England) consists of problems such as gain access to, waiting lists, healthcare coverage, and various scandals. The National Health Service (NHS) is the openly financed healthcare system of England, created under the National Health Service Act 1946 by the post-war Labour government of Clement Attlee. It has come under much criticism, specifically 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 several years, including over the arrangement of psychological health care in the 1970s and 1980s (eventually part of the reason for the Mental Health Act 1983), and spends too much on health center newbuilds, including Guy's Hospital Phase III in London in 1985, the cost of which shot up from ₤ 29 million to ₤ 152 million. [1]

Access controls and waiting lists

In making healthcare a mostly "unnoticeable expense" to the patient, health care appears to be successfully free to its customers - there is no specific NHS tax or levy. To reduce expenses and ensure that everybody is dealt with equitably, there are a range of "gatekeepers." The family doctor (GP) operates as a main gatekeeper - without a recommendation from a GP, it is typically impossible to gain higher courses of treatment, such as a consultation with a consultant. These are argued to be needed - Welshman Bevan noted in a 1948 speech in the House of Commons, "we will never have all we require ... expectations will always go beyond capacity". [2] On the other hand, the national health insurance systems in other countries (e.g. Germany) have actually dispensed with the requirement for referral; direct access to a specialist is possible there. [3]

There has actually been concern about opportunistic "health travelers" travelling to Britain (mostly 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 costs, and due to the fact that of a worry of hospital-acquired incredibly bugs and long waiting lists. [5]

NHS access is for that reason controlled by medical concern instead of cost system, leading to waiting lists for both consultations and surgery, up to months long, although the Labour government of 1997-onwards made it among its crucial targets to minimize waiting lists. In 1997, the waiting time for a non-urgent operation might be two years; there were ambitions to reduce it to 18 weeks in spite of opposition from doctors. [6] It is objected to that this system is fairer - if a medical complaint is acute and lethal, a client will reach the front of the queue rapidly.

The NHS measures medical requirement in terms of quality-adjusted life years (QALYs), a technique of measuring the benefit of medical intervention. [7] It is argued that this technique of allocating health care indicates some patients need to lose out in order for others to gain, which QALY is a crude technique of making life and death choices. [8]

Hospital obtained infections

There have actually been several deadly outbreaks of antibiotic resistant bacteria (" very bugs") in NHS healthcare facilities, such as Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus and Clostridioides difficile infection. [9] This has actually caused criticism of standards of hygiene throughout 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 vowed ₤ 50 million for a "deep clean" of all NHS England healthcare facilities in 2007. [10]

Coverage

The lack of availability of some treatments due to their perceived bad cost-effectiveness sometimes results in what some call a "postcode lotto". [11] [12] The National Institute for Health and Care Excellence (NICE) are the very first gatekeeper, and examine the cost efficiency of all drugs. Until they have released guidance on the expense and efficiency of brand-new or expensive medicines, treatments and treatments, NHS services are unlikely to offer to money courses of treatment. The very same of true of the Scottish Medicines Consortium, NICE's equivalent in Scotland. [13]

There has actually been significant controversy about the general public health funding of expensive drugs, significantly Herceptin, due to its high cost and viewed limited total survival. The project 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 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 idea of personal financing initiative (PFI) concerned prominence, all brand-new medical facility structure was by convention funded from the Treasury, as it was believed it was best able to raise cash and able to manage public sector expense. In June 1994, the Capital Investment Manual (CIM) was published, setting out the terms of . The CIM made it clear that future capital tasks (building of brand-new centers) needed to take a look at whether PFI was preferable to using public sector financing. By the end of 1995, 60 relatively little tasks had been prepared for, at a total expense of around ₤ 2 billion. Under PFI, buildings were constructed and serviced by the economic sector, and then leased back to the NHS. The Labour government elected under Tony Blair in 1997 accepted PFI jobs, thinking that public costs needed to be curtailed. [16]

Under the personal financing effort, an increasing number of medical facilities have been developed (or rebuilt) by economic sector consortia, although the government likewise motivated private sector treatment centres, so called "surgicentres". [17] There has been significant criticism of this, with a research study by a consultancy company which works for the Department of Health showing that for each ₤ 200 million invested on privately financed hospitals the NHS loses 1000 physicians and nurses. The very first PFI healthcare facilities include some 28% fewer beds than the ones they changed. [18] Along with this, it has been noted that the return for building companies on PFI agreements could be as high as 58%, which in financing health centers from the private rather than public sector cost the NHS practically half a billion pounds more every year. [19]

Scandals

Several prominent 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, including children's organs, between 1988 and 1995. The official report into the event, the Redfern Report, exposed that Dick van Velzen, the Chair of Foetal and Infant Pathology at Alder Hey, had ordered the "dishonest and illegal stripping of every organ from every kid who had had a postmortem." In action, it has 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 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 clients at the medical facility. [22] [23] As much as 1200 more clients died between 2005 and 2008 than would be expected for the type and size of medical facility [24] [25] based upon figures from a death design, however the final Healthcare Commission report concluded it would be misinforming to connect the insufficient care to a particular number or range of numbers of deaths. [26] A public inquiry later on revealed multiple circumstances of disregard, incompetence and abuse of patients. [27]

" Lack of independence of examining 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 really 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 is in reality "liable 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 comes from the taxpayer. At least 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 capacity for a conflict of interest, as both the NHS and the CQC have the very same leadership and both are highly vulnerable to political disturbance.

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

See likewise

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 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: outcomes 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 make sure that individuals 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 hospitals 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 rejected for NHS use". 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 healthcare facilities '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 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 'ought to 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 'might have resulted in 1,200 deaths' in Mid-Staffordshire". London: The Daily Telegraph. Archived from the initial on 21 March 2009. Retrieved 9 November 2010.
^ Emily Cook (18 March 2009). "Stafford hospital scandal: As much as 1,200 might have passed away over "stunning" client care". Daily Mirror. Retrieved 6 May 2009.
^ "The number of 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 escapes 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 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 healthcare. Verso. ISBN 1-84467-539-4.
Mandelstam, Michael (2006 ). Betraying the NHS: Health Abandoned. Jessica Kingsley Publishing. ISBN 1-84310-482-2.