National Healthcare Provision in the UK: Current and Future Trends - Essay Example

?National Healthcare Provision in the UK: Current & Future Trends Healthcare in the UK is a devolved system whereby the constituent countries possess distinct health care systems i.e. privately and/or publicly funded. Each country provides free public health care services to all permanent residents. Each constituent country provides free public health care services to all permanent residents. Public health service in the UK is offered by the National Health Service (NHS). The NHS provides a wide range of health care services ranging from primary care, in-patient care, ophthalmology, long-term healthcare and dentistry. NHS delivers health care services at different levels such as primary, secondary, home and community care, quaternary care, tertiary care and long-term care. Some of the challenges facing National Health Service include changing disease profiles, health inequalities, changing lifestyles, population ageing and high demand. Effective health care delivery requires excellent management staff, with impeccable skills in planning, organization and communication. The prominent areas that the UK health care industry should focus on include improvement of processes, reduction in cost, improvement of quality, increased service innovation, increase in patient satisfaction and global expansion. Table of Contents National Healthcare Provision in the UK: Current & Future Trends 1 Abstract 1 Table of Contents 2 1.Introduction 4 2.National Healthcare Provision in the UK 5 3.National Health Service 5 3.1Primary Care 6 3.2Secondary Care 7 3.3Tertiary Care 7 3.4.1Quaternary Care 7 3.4.2Home and Community Care 7 3.4.3In-Patient Care 8 3.4.4Long-Term Care 8 4.Population Expectations 8 5.Health Care Financing In the UK 9 6.Technological Uptake 12 7.Management Approach 13 8.Challenges Facing NHS 13 8.1High Demand 13 8.2Population Ageing 15 8.3Changing Lifestyles 16 8.4Health Inequalities 17 8.5Changing Disease Profiles 17 8.6Trends 19 8.6.1Education 19 9.Recommendations 20 10.Conclusion 20 References 22 Department Of Health Strategy Unit (2007) Key Influences on future trends in healthcare: Changing disease profiles. 22 National Healthcare Provision in the UK: Current & Future Trends 1. Introduction Health care describes diagnosis, treatment and prevention of human health complications such as physical injuries and mental impairments. Access to health care is largely determined by socio-economic factors as well as health policies existing in the concerned country. A health system is the organization of institutions, people and resources that collaborate in the delivery of health services to meet the population expectations. The health care industry is made up of several sectors that offer health care services e.g. hospitals, medical and dental facilities. The primary methods of global health care financing are taxation, national health insurance, private or voluntary health insurance, out-of-pocket payments and donations remitted to health charities. The operation of health care institutions and the conduct of health care professionals are regulated by national or state regulatory frameworks in collaboration with various regulatory bodies involved in quality assurance. Global health care industries endeavour to offer excellent health care services. These services are characterized by reduced medical errors, better medication management, and accurate dissemination of information technology for credible management of medical services. Enhanced medical processes reduces duplication of services, improves decision making skills, diagnosis and treatment, and enhances continuity for care. Healthcare systems are also enacting methods of transforming care delivery to curtail health care costs and ensure future health stability at both societal and individual levels. Healthcare can be viewed as merit good because its consumption is beneficial to an individual consumer as well as others. For instance, inoculation against diseases is beneficial to the infected and affected. Health care provision is the biggest service-based global sector as evidenced by the expansive annual Gross Domestic Product (GDP) in healthcare spending, especially in the developed countries such as the United States (US) and United Kingdom (UK). The paper below discusses the current and projected changes in health care provision in the UK. 2. National Healthcare Provision in the UK Healthcare in the UK is a devolved system whereby the constituent countries possess distinct health care systems i.e. privately and/or publicly funded. Each constituent country provides free public health care services to all permanent residents. Public health care is taxpayer funded i.e. funds are outsourced from general government funds, or through social insurance. The employees and employers remit compulsory health care contributions towards the health care system. Each country has an additional private health care program that provides private care services in form of private health insurance and funded through direct customer payments or private insurance. Most private schemes are restricted to people possessing chronic conditions such as HIV/AIDS and cancer. In the private insurance arrangement, individuals remit premiums to private companies which they claim during treatment requirements. The program may also involve patients making direct compensation for treatments they receive. According to the UK Department of Health (2007), private health care program is only used by less that 8% of the UK population. Intervention of the government through publicly funded schemes may contribute to moral hazard i.e. individuals knowing that they will receive free health care may fail to take the necessary preventive measures aimed at curbing increased risks to health e.g. smoking and drug abuse. Privately-funded schemes can be used to frustrate moral hazards. 3. National Health Service Public health service in the UK is offered by NHS (NHS, 2000). The NHS provides a wide range of health care services ranging from primary care, in-patient care, ophthalmology, long-term healthcare and dentistry. The establishment of NHS in 1948 was geared towards provision of comprehensive, free and universal health care. The program requires huge investment in terms of financial resources. For instance, the 2011 statistics indicates that the UK government spending on NHS amounted to 20% of the annual government expenditures. Each person is estimated to be spending ?2 000 annually, portraying the significance of the sector in the UK budget. NHS offers jobs to more than 1.3 million people. However, the cost of health care has rose to unsustainable levels e.g. a course of treatment has rose up to ?300,000.The NHS’s ability to supply health care has been enhanced by the recent application of new technology, enhanced treatments and new drugs. This has led to subsequent rise in demand that exceeds the supply. The imbalance in demand and supply causes shortage for hospital beds and increase in complaints arising from long waiting lists. Additionally, the true cost of supply will be reflected through rise in health care services in private health care arrangements. Extra funding from the public money may not be sufficient to keep in pace with the projected health care demand increase due to the aging population and increased expectations. For instance, the 2015 projected statistics indicates that 25% of the population will be above 65 years. NHS delivers health care services at different levels such as primary and secondary care among others. 3.1 Primary Care The primary health care is offered by health care providers. The provider acts as the prime consultant for the patients enrolled in the health care system and coordinates extra-specialist services that the patient may require (Lewis, Eskeland, Traa-Valerezo, 2004, 303–325). Such specialists include physicians and their assistants, pharmacists, nurses or clinical officers. The professionals may also be Ayurvedic or traditional medicine practitioners depending on the patient’s discretion, culture or locality. Primary care is the widest scope of health care offered by the UK health care industry covering patients from all ages, geographic origins and socioeconomic orientation. Primary care arrangement covers patients with all forms of chronic and acute physical, mental and social problems. The key characteristic distinguishing primary care from secondary or tertiary care is continuity. This is because patients enrolled in primary care consult the same practitioner when faced with health problems. The nature of the condition determines whether the patient will be referred to secondary or tertiary care. 3.2 Secondary Care Secondary care is provided by medical specialists and health care professionals without the necessity for direct contact with the patients e.g. the case of dermatologists. Secondary care includes medical processes such as acute care e.g. handling emergency cases for injuries or serious illnesses, and skilled attendance during intensive care or childbirth. In the United Kingdom, self-referral to secondary specialist is rare because prior referral from other physicians is encouraged regardless of whether funding is emanating from NHS or private insurance schemes. 3.3 Tertiary Care This is a specialized consultative health provision arrangement. It is mostly offered to inpatients on referral from primary or secondary care professionals. Tertiary care facilities and personnel offer advanced medical investigations and treatments e.g. neurosurgery and cardiac surgery. 3.4 Other health care services offered include; 3.4.1 Quaternary Care This is an extension to tertiary services that is highly specialized and rarely accessed e.g. experimental medicine. 3.4.2 Home and Community Care These are health care interventions delivered outside the health care facilities. Such services include food safety surveillance and needle exchange programs to curtail the spread of transmissible ailments. Home community care services are eminent in the UK because it is grappling with the increased numbers of aging populations and obesity of children. 3.4.3 In-Patient Care In-patient care is only required for those patients whose health conditions are severe. Most patients prefer outpatient care that enables them to be close to their families. 3.4.4 Long-Term Care The health care system also incorporates a variety of services that assists in catering for both medical and non-medical needs for the victims of chronic illnesses or disability incapable of caring for themselves for long periods. The long-term care program provides the custodial and non-skilled care that assist in normal daily tasks such as bathing. The long-term care program largely requires the involvement of skilled practitioners capable of handling the complications related to chronic conditions in older populations. Long-term care is provided at home, nursing homes and assisted living facilities. 4. Population Expectations People expect the NHS to provide comprehensive health care services to all citizens irrespective of their gender, age or sexual orientation. Their access to health care services should be based on health needs and not their ability to pay for the services. The population also expects to receive quality care that is safe and effective. This implies that the NHS is obligated to commit to the highest standards of professionalism and excellence. The program should collaborate and work in unity with other health organizations to ensure that patients receive quality health services (Smith, Newhouse and Freeland, 2009, 1276–84). The patients expects to be granted rights, and not non-binding pledges, on access to health care that should be free of charge, non-discriminatory, approved of the attainment of the required standards, never denied on unreasonable or unsatisfactory ground and obtainable from the UK NHS provider. The treatment offered should uphold the aspect of quality care and environmental safety. According to NHS (2000) drugs, treatments and health care programs offered should be approved by National Institute for Health and Clinical Excellence (NICE). The NHS is expected to uphold the rights respect, confidentiality and consent. The public feels that they have a right to be involved in their own health care and in NHS through discussions and decision making or through representatives. 5. Health Care Financing In the UK The entire UK population is eligible for health care services, with the services and health care being regulated by the national government. The system is a two-tier health care model where the basic government-provided health care caters for basic health care needs (Campbell et al, 2009: 368–378). The secondary tier care is present whereby those who can afford better and faster services can purchase. Private health care represents the secondary tier model whose popularity among the public arose in a bid to avoid the long waiting lists. Table 1: Investment in General Practice in England, Wales, Northern Ireland and Scotland 2007/08 to 2011/12 2007/08 2008/09 2009/10 2010/11 2011/12 England Total Investment (?m) ?7,867.211 ?7,957.431 ?8,321.014 ?8,349.368 ?8,397.042 Annual %age change 1.15% 4.57% 0.34% 0.57% Wales Total Investment (?m) ?442.689 ?453.998 ?460.189 ?463.628 ?466.255 Annual %age change 2.55% 1.36% 0.75% 0.57% Northern Ireland Total Investment (?m) ?217.478 ?234.929 ?238.296 ?234.747 ?236.241 Annual %age change 8.02% 1.43% 1.49% 0.64% Scotland Total Investment (?m) ?698.442 ?704.786 ?729.184 ?741.622 ?747.939 Annual %age change 0.91% 3.46% 1.71% 0.85% United Kingdom Total Investment (?m) ?9,225.820 ?9,351.144 ?9,748.683 ?9,789.365 ?9,847.477 Annual %age change 1.36% 4.25% 0.42% 0.59% Graph 1: Investment in General Practice in England, Wales, Northern Ireland and Scotland 2007/08 to 2011/12 As illustrated in Table 1, the budget allocated for General Practice in England, Wales, Northern Ireland and Scotland increases yearly with the changes in the health conditions of the population. The increase is more pronounced in the UK as illustrated in the graphical representation of the information. 6. Technological Uptake The current competitive environment in health care delivery requires the industry players to incorporate IT in health care delivery i.e. health information technology (HIT). This improves the quality of service while maintaining the core values. This involves the use of computers and communication channels that can be networked to form systems for dissemination of health information. The UK health care is applying the IT technology to improve service delivery. The primary strategy being applied to incorporate IT in the health care delivery is through combination of information technology and knowledge management. This records and analyzes information on health care in the form of electronic records. Flow of information within the healthcare system is also enhanced, a strategy crucial in professional management of health care system. Electronic health records are efficient in coping with the frequency in which people are changing physicians. People movements are also making efficient delivery of health care difficult because health complications can occur in flight. Focus on technological application in the UK health care system has seen the implementation of GP computer systems operation policy to promote the use of electronic health records (Pearson and Connah, 1991). The government’s reliance on electronic health records has seen the implementation of Electronic Record Development and Implementation Programme (ERDIP). This initiative is mandated to research and compile satisfactory information on electronic health records. The original obligation of the ERDIP was to compile information related to the lessons learnt and apply this information to implement the necessary organizational changes for prolonged success. The UK has spent massive resources in a bid to reform the electronic health care. The efforts have paid off with 87% of the physicians and health practitioners often applying the technology in their daily activities. 7. Management Approach The NHS applies strict rules to curb the menace of waiting lists. Allocation of better funding for hospitals has also minimized delays to service delivery. Currently, most patients are not admitted from a waiting list and if they do, they do not wait for long i.e. less than 8 weeks. This has enabled the NHS to re-arrest the customer confidence with the private sector only counting on the surplus capacity from NHS to sell. Dentistry is the only field that the private practice has banked on for constant provision of service as the dentistry services offered by NHS are relatively patchy. 8. Challenges Facing NHS 8.1 High Demand NHS is largely over-stretched due to the excess demand emanating from its free nature. The system has always been blamed of being unwieldy and bureaucratic. The huge financial investment directed in the health care industry makes many people to have high expectations of service delivery. This leads to disappointment every time their health needs are not adequately addressed. Being a merit good, health care is normally provided free at the point of consumption. This implies that the price mechanism strategy cannot be applied in the rationing of the scarce resource as is the case with private goods (Campbell et al, 2009: 368–378). Lack of price value implies that there will be shortage because the demand will expand to its maximum. This is what led to the advent of waiting lists as the health resources have to be regulated through other means. Diagram 1: Rationing phenomenon of health care system in the UK < http://economicsonline.co.uk/Market_failures/Healthcare.html> The demand for health services is at its maximum when it is offered free. As Diagram 1 illustrates, the demand will be higher than the supply, with the increase in waiting list and bed shortages. Waiting lists is the regulatory factors in this case. 8.2 Population Ageing The UK is currently experiencing a shift in population (as shown in Table 2) with an imbalance in the number of young generation compared to the increased number of aging generation. The shift in the balance between the young and older generation has been aggravated by the overall decrease in the family sizes that decreases the number of new generation in the population (Saltman, Dubois and Chawla, 2006, 719-746). According to the WAG Chronic Conditions Management Framework (WAG 2007), 2014 will experience a 12 percent increase in the number of adults and a 20 per cent rise in the older generation i.e. over 65. Table 2 - Projected population by age, United Kingdom, 2010-2035 2010 2015 2020 2025 2030 2035 Ages 0-14 10,872 11,497 12,231 12,455 12,279 12,117 15-29 12,471 12,619 12,168 12,192 12,809 13,543 30-44 12,725 12,545 13,185 14,037 14,108 13,664 45-59 12,126 13,018 13,161 12,514 12,338 12,986 60-74 9,163 9,709 10,335 10,925 11,807 11,981 75 and over 4,905 5,388 6,093 7,279 8,051 8,918 Graph 2 - Projected population by age, United Kingdom, 2010-2035 The Y-axis represents the population while the x-axis the year. Table 2 and Graph 2 represent changes from 2010 to 2035. The information has been outsourced from ONS 2010-based population projection www.parliament.uk/briefing-papers/SN03228.pdf The UK state pension is currently funded through pay as you go basis whereby the funds are outsourced from the contributions of the current employees rather than the accumulated reserve of the former contributions of the current beneficiaries. The state pension has become a predominant issue due to the imbalance in the ratio of workers to pensioners. 8.3 Changing Lifestyles The future demand for health care is likely to implode due to the increased engagement of the population in behaviours that endanger lives e.g. smoking, sedentary lifestyles and unhealthy eating (Simmons, 2009). The behaviours have aggravated the prevalence of disorders such as heart disease diabetes and chronic kidney disease. 8.4 Health Inequalities Despite the current application of effective efforts aimed at curbing the health care delivery inequalities, the issue is still prevalent within UK health care system. Inadequate awareness on health issues among the deprived socio-economic groups makes them assume ineffective lifestyles that lead to deterioration of health conditions (Simmons, 2009). This frustrates the failure channels of the efforts geared towards administration of preventive strategies as well as transmission of the health complications from one generation to another. Illiteracy on health issues leads to degradation of health status, enhanced risk of hospitalization, increase in the treatment and medication errors and increase in the rate of emergency cases. 8.5 Changing Disease Profiles The advancement in health technology has increased the profile of age related ailments as illustrated in Table 3. This implies that most elder members of the society are living with multiple conditions characterized by long term illnesses. European Commission, (2010) ‘Contributing to Universal Coverage of Health Services through Development Policy’ Staff Working Document to Accompany COM (2010)128, The EU Role in Global Health (Brussels). Lewis, M., Eskeland, G., & Traa-Valerezo, X. (2004) ‘Primary health care in practice: is it effective?’ Health Policy, vol. 70, pp. 303–325. NHS (2000) “Quality and performance in the NHS: NHS performance indicators NHS Executive” Performance Analysis Branch Book, Published [Leeds]: NHS Executive. NHS (2012). “Investment in General Practice 2007/08 to 2011/12 England, Wales, Northern Ireland and Scotland, viewed 24 November 2012 . Pearson, R. & Connah, B. (1991) National Association of Health Authorities and Trusts, Published London, Macmillan Press. Rossiter A (2007) The Future of Healthcare Social Market Foundation, Accessed on line January 2008 Rutherford T. (2012) Population ageing: statistics, Saltman, R.B., Dubois, H.F.W. & Chawla, M. (2006) ‘The impact of aging on long-term care in Europe and some potential policy responses’ International Journal of Health Services, vol. 36, no. 4, pp. 719-746. Simmons, J. (2009) Primary care needs new innovations to meet growing demands. HealthLeaders Media. Smith, S., Newhouse J. & Freeland. M. (2009) ‘Income, Insurance, and Technology: Why Does Health Spending Outpace Economic Growth?’ Health Affairs, vol. 28, no. 5, pp. 1276–84. Read More