The United Kingdom Healthcare System - Essay Example

Essay #

THE UK HEALTHCARE SYSTEM

Introduction

The United Kingdom is comprised of four different countries, namely; England, Scotland Wales and Northern Ireland. Understanding the UK health care system thus involves an examination of the health care systems across these four countries. The UK is a vast geographical area with a population of more than 64 million across these four countries. According to a report by Deloitte (2015), the National Health Service (NHS), which is the UK’s healthcare system, has been identified as one of the best throughout the world. This system is among the few in the world that offer services free of charge at the point of access. Although operating in four different jurisdictions, the health care system in the UK aims at promoting public health, offering quality services and providing an integrated system of health care (Cylus et al. 14). The efforts by the NHS have led to better health outcomes in the UK, and this is evidenced by the increasing life expectancy. This report aims at offering a deep insight into the UK’s healthcare system, with emphasis on organization, financing and service delivery.

Methods

To successfully undertake a review of the UK’s health care system, the internet was used as the primary source of material. The main search term used was “the United Kingdom Healthcare system.” In undertaking the internet search, only materials published in reputable journals and those authored by reputable bodies were used. A total of six publications were found to be relevant to the current research topic. The first article by Richardson Cylus et al. (2015) published in the Health Systems in Transition series offers a comprehensive review of the UK health care system, including the sources of funding, organization and the delivery of services. An article published by the Deloitte Touche Tohmatsu Limited (2015) offers a brief overview of the current state of the UK healthcare system and the challenges that need to be addressed. Another article by Donald Light (2003) published in the American Journal of Public Health gives a brief history of the NHS and its mandate and responsibilities. An overview of the UK health care system is also provided in the article by Anne Gulland (2011) published in the British Medical Journal was also included in the review. Articles by Stepehen Peckham (2014) and Konstantina Grosios (2010) were also used as additional materials.

Organization of the UK health cares system

The running of the health care system in the UK is done by the National Health Service (NHS), and this body was set up in 1948 (Cylus et al. 14). The aim of this body is to ensure that health care services are delivered through a single national system. The majority of the funding for the UK health care system comes from taxes. Through the National Health Service, legal residents of the UK can access free health care services. Also, they have the option of buying private insurance if they wish to. Given that the UK is comprised of four different countries, the health care system is devolved. Each of these countries makes its own decisions about the running and organization of health care services. Scotland, Wales, and Northern Ireland receive block grants from the UK government to take care of their health care systems (Light: 26). For England, the UK government allocates a budget for this purpose.

In order to understand the overall organization and running of health care in the UK, each of these four countries is analyzed separately. The first part of this analysis focuses on England. The UK Department of Health is tasked with the responsibility of overseeing the running of the health care system in England and is also involved in deciding certain regulatory matters throughout the UK and also at international level (Cylus et al.: 20). In England, the NHS is under the governance of the Secretary of State who oversees its performance and service delivery. The NHS England is responsible for the NHS services. NHS England is a non-departmental body that is directly accountable to the Secretary of State as well as the general public. This body is responsible for the contracting and purchasing of health care services, and also oversees national functions that were previously handled by the Department of Health. In England, there are more than 200 clinical commissioning groups that are led by general practitioners (Cylus et al. 23). Because GPs interact with patients on a regular basis, it is desired that they should have a say in the decisions about spending. The protection of public health in England is done by the Public Health England, an executive agency under the Department of Health. It advises the government on matters relating to health care in England, and also works to support the public in improving their health through research. The Care Quality Commission is responsible for regulating of health in England and also regulates the adult social care providers. It has the mandate to protect the rights of vulnerable populations, including those people with mental illnesses. In England, the economic regulation of health sector is done by the Monitor, a non-departmental body that sets the regulatory framework for providers as well as commissioners. Finally, in 2012, the Health and Wellbeing Boards were formed which provide a forum for improving the health of the citizens (Cylus et al. 33).

In Scotland, the Scottish Parliament is responsible for setting the required legislative framework for NHS. The government decides on the resources to be given to the NHS. The NHS is run by the Scottish Cabinet Secretary for Health and Wellbeing. In Scotland, there are 14 regional NHS Boards that are responsible for the planning and delivering of health services (Cylus et al. 26). There are also an additional seven national NHS boards that provide national services. The Healthcare Improvement Scotland has the responsibility of providing the scrutiny of public health services in order to ensure that the public is well protected. There are local NHS boards that help involve local authorities, the patients and the general public in the running of the health care system. In Scotland, health and social care are integrated, and this demands that health boards and local authorities come up with the required partnership arrangements. Through the Integrated Joint Boards, planning and delivery of health and social services in Scotland is done in almost uniform manner.

In Wales, the Welsh government funds the NHS through the Department of Health and Social Services. Through this department, policy and strategy for healthcare systems in the country are undertaken. The overall responsibility for health and social services in Wales is under the Minister for Health and Social Services. The minister works with the Director General, Health & Social Services in formulating policy and the overall management of NHS. There are seven Local Health Boards (LHBs) whose responsibility is to plan and deliver health care services. Furthermore, there are also NHS Trusts that provide emergency and specialized services in the treatment for cancer. There are also Community Health Councils that promote the interests of patients and the general public. Finally, the NHS Wales Shared Services Partnership supports the NHS Wales and is responsible for offering support to bodies such as the NHS Trusts and the LHBs (Cylus et al. 28).

Finally, in Northern Ireland, the running of health service is under the management of the Minister of Health (Cylus et al. 32). Through local commissioning groups, the Health and Social Care Board is responsible for the commissioning and delivery of care through Northern Ireland.

In addition to the specific bodies described for the various countries, there are also bodies that cover the entire of the UK. For example, the Medicines and Healthcare Products Regulatory Agency (MHRA) regulates all medicines and medical services in the region by ensuring they are safe and work as intended. Trade Unions also cut across these four countries. For instance, the British Medical Association (BMA) represents doctors, and currently, more than two-thirds of participating doctors in the UK are members (Cylus et al. 35). Finally, charities are also common throughout the UK, and they are mainly involved in the provision of palliative care services. Most of the funding for these charities comes from the NHS. Nursing care for older people is provided by private companies.

Financing of health services in the UK

As earlier noted, the financing of health services in the UK is through taxation, and the rest collected from private insurance and personal out-of-pocket payments. As noted by Anne (2011), over the years, the health care spending in the UK has gradually been increasing. Currently, the health care spending in the UK accounts for more than 9% of the GDP (Cylus et al. 42). When healthcare allocation is offered, the administrators give the money to the commissioners or providers (Peckham: 156). This allocation is also given to public health organization. Each of the four countries has its own formula for making these allocations. In the UK, most of the health services are free at the point of use, but in some cases, cost-sharing or direct payments may be needed.

In the UK, private insurance can be purchased by individuals or by employers for their employees. Private insurance is used to cover for services that are not given by the NHS, or such payments can be used to access NHS services quickly (Grosios et al. 530). Cost sharing payments are done for services such as dental care and outpatient prescription fees. Due to budgetary constraints, local authorities make a determination of the services that will be provided to the public. This approach has been criticized because some regions will offer certain services that are not offered in neighboring regions.

The collection of health care finances is done by Her Majesty’s Revenue and Customs (HMRC) (Cylus et al. 43). In addition, the HMRC also collects insurance contributions from employees, employers and the self-employed. Charitable contributions offer an additional source of financing. For instance, NHS trusts and boards may run registered charities and take donations from the public. After the funds have been collected, they are pooled at the UK level. Because Scotland, Wales, and Northern Ireland receive block grants, the Barnett formula is used in making these allocations. This formula was developed in 1978. This formula has however been criticized because it does not reflect the needs of the population throughout the UK. For example, there are those who claim that the formula allocates too much money to Scotland when in fact England deserves the largest share.

An important aspect of health care financing relates to the paying off health workers. Throughout the UK, the NHS Employers undertakes the responsibility of negotiating pay and working conditions for NHS employees (Grosios et al. 531). GPs are covered by the General Medical Services (GMS) Contract.

Provision of Health Services in the UK

The NHS is one of the largest employers throughout the UK, with a workforce of more than 1.5 million people. Over the years, the NHS workforce has been on the increase, at an average annual rate of about 3% (Cylus et al. 78). In the UK, the number of physicians has been on a steady increase as well. For instance, in 1990, 162 physicians were responsible for 100000 people. This figure has increased to 278 as of 2013 (Cylus et al.: 78). Similarly, the number of nurses throughout the UK is impressive, currently above the EIU average. This, however, does not mean that the UK does not suffer from shortages. Over the years, the number of patients for every nurse has been on a steady increase, and this is a major concern for the healthcare system in the UK (Light: 28).

The public health in the UK is centered on three major elements: programs for health protection, health improvement and reducing health inequalities (Cylus et al. 80). In the UK, primary care serves three major purposes. First, it is the initial point of contact when an individual has a health problem. Secondly, it is used to offer ongoing care for injuries and common conditions. Finally, it used as a gatekeeper for specialized care which is offered in hospitals (Peckham: 158). Public health services throughout the UK are offered through the NHS, although local authorities and similar groups assist in providing these services. The main public health priorities throughout the UK include childhood obesity, infant mortality, sexual health, alcohol harm reduction and tobacco control among others (Cylus, et al. 81). In order to work on these priorities, there are several interventions that have been introduced throughout the UK. For example, smoking is generally banned in public places as a way of safeguarding the public against the harms associated with tobacco use. Through the National Screening Committee, the UK can identify the potential diseases to the general public.

As noted by Gulland Anne (2011), in order to boost primary care, efforts have been put in place to have equitable distribution of GPs. Currently, the number of GP consultants per person stands at about 5.5. Despite these efforts, some parts of the UK have a lower ratio of doctors, and this is a common problem in rural areas. In order to boost access to primary care services, people in England and Scotland can dial 111 to get information during any time of the day. Similar strategies are also used in Wales and Northern Ireland where both telephone and the internet are being used to provide information to patients. In addition, in 2000, the NHS introduced NHS walk-in centers as a way of accessing primary care without having to get an appointment. These centers are normally led by nurses and operate during the regular office hours.

Specialized care is mainly provided by specialist doctors or consultants (Grosios et al. 532). Patients can only receive care from a specialist if they have been referred by a GP or if they have been admitted to a hospital as a case of emergency. In certain parts of the UK that have large rural areas, specialized care is also offered in specialized clinics.

When it comes to emergency care, this is provided by GPs, minor injuries units, NHS 111 and local mental health teams among others (Cylus et al. 84). In the UK, emergency care is offered free of charge. In hospitals, the Accident and Emergency departments operate 24 hours a day throughout the year. There are also eleven ambulance services in England with Scotland, Wales and Northern Ireland having one each. Emergency services in the UK are boosted by the availability of air ambulance services.

Rehabilitation care is also part of the services offered by the health care system. These services are offered by rapid response teams, residential rehabilitation units, hospital-at-home services and day-care rehabilitation centers (Cylus et al. 87). Through this type of care, the UK aims at help patients stay at home instead of visiting a hospital. However, in the recent past, there has been less emphasis on this type of care, especially in England. This has led to a high number of delayed discharges in England. In Scotland however, efforts are in place to promote rehabilitation care as a way of preventing delayed discharges and premature admissions.

When it comes go long term care, most of these services are provided by the private sector. However, only a small percentage of these services are provided by the NHS. This type of care is mainly offered to the elderly, persons with disabilities, persons misusing substances, persons with learning disabilities and people with mental health issues (Cylus et al.: 90). It is the responsibility of local authorities to determine those people who might need this type of care, and access whether they qualify for support. Unfortunately, there is no specific criterion throughout the UK, and this determination is mainly anchored on the availability of funds.

Mental health care is taken seriously in the UK. These services are offered by the NHS, voluntary organizations and local authorities (Grosios et al. 532). If accessed through the NHS, these services are free. However, services offered by local authorities are often charged. Psychiatric hospitals in acute hospitals provide inpatient services for persons with mental problems (Cylus et al. 92). Throughout the UK, there are also community-based accommodation options for persons with mental illnesses, and these include group homes and supported housing. These services are also extended to criminal offenders with mental health issues. Such services are offered in secure hospitals and prisons. Also, the UK has developed programs to deal with the stigma associated with mental illnesses.

Finally, in the area of dental services, a three-part system is used in the UK: general services in the community, dental services at acute hospitals and community services and nursing homes (Cylus et al. 95). Dental health services are offered under NHS as well as private settings. Although these services were initially offered for free during the early days of NHS, charges have now been introduced. Dental professionals in the UK are regulated by the General Dental Council. This body also offers guidelines on the best practices for good clinic care.

Challenges facing the UK health care system

Like many other countries throughout the world, the increase in life expectancy has resulted in an increase in chronic diseases. Furthermore, poor lifestyles have led to an increase in diseases such as obesity and diabetes. This is, in turn, putting pressure on the available facilities throughout the UK. Cancer, renal diseases, coronary heart disease and diabetes account for more than 16% of the total budget by the NHS (Grosios et al. 533). Secondly, inequalities in the health sector are also increasing throughout the UK. Minority populations, especially those in rural areas, are often left out of health care programs. Thirdly, equity in the financing of health care in the UK is a major challenge. The Barnett formula that is currently used is seen to be ineffective, but it has not been replaced by a better alternative yet. England, for instance, is seen to receive a relative smaller funding than what it actually deserves, and this affects services delivery in the country. Finally, the UK is yet to fully guarantee access to modern equipment and medicines by all groups in the region. With the recent advances in the field of medicine, some populations are still left behind in the adoption of these new methods.

Conclusion

Through the NHS, the UK health care system is one of the most effective systems in the world. Operating in four different countries, the services offered by the NHS are almost similar, although minor differences are witnessed when each of the four countries is considered separately. It also remains to be one of the most complex health care systems since it spans across four different jurisdictions. The primary objective of the NHS remains to provide high-quality health services to the people of the UK. More importantly, most of these services are offered free at the point of access. The main source of funding is through taxes, and the Barnett formula is then applied in distributing the funds to the different countries. The UK health care system has placed greater emphasis on the protection of public health through proper prevention and protection measures. Also, investments are being made in community health care programs so as to reduce the number of people visiting hospitals and reduce the delayed discharge rates. Furthermore, over the years, the NHS has focused on increasing the workforce to enhance service delivery. Although the UK has a high number of personnel in the health care system, there is the need to continue improving on these figures to further promote service delivery. The challenges faced by this system are not unique but are replicated across many developed countries in the world. These challenges are stemming from the improved life expectancy and the poor lifestyles adopted today. With an increase in chronic ailments, a significant proportion of the NHS budget is directed towards their treatment and management. This has put pressure on the existing facilities. Furthermore, there is need to improve on the current formula used in the distribution of funds to promote equity.