Differences in Health Policy between England and Wales - Essay Example

?Devolution is leading to significant differences in health policy between England and Wales. To what extent do you agree with this ment and howcan we evaluate the impact of any differences that exist? In the United Kingdom, power is devolved from the Parliament of the United Kingdom to the Scottish Parliament, the National Assembly for Wales, and the Northern Irish assembly. This has meant that many services in these areas are different from that in England, and they are different again from each other. Some has argued that these differences are negligible and are only in line with the needs of that area, and some feel that the differences are leading to big levels of inequality. One of the main focuses of the debate is health policy, something which affects people of all ages, education levels and incomes. Additionally, different areas of one country may have very different disease rates, and so it makes sense to have separate healthcare policies for each of these areas to benefit the patients involved. There are several differences between the services provided in England and Wales, and the purpose of this essay is to explore these, including the different pricing ranges. It will also explore the differences in the results of the healthcare in England and Wales, by showing some of the main disease rates which may be a direct result of the different healthcare policies in the two countries. It will then look into these policies to show that they are significant differences that may have an effect on people’s lives, and then see what the impact of these differences in policy may have. Analysis of these differences is very important to creating good policies that are of benefit to everyone (Wennberg et al, 1987), so there are several different analysis tools that are discussed below which can help readers to understand why the differences between England and Wales and their NHS services are so important. Differences in Health Policy It is obvious that and devolution will have an effect on the health policies of each of the areas. In the case of the United Kingdom, each area has ‘great power over health services and public health’ and ‘are highly autonomous and not subject to any law of shared standards or values’ (Greer, 2009, p10). This means that each area of the National Health Service (NHS) can put money where it is most needed, which does tend to be different between each area of the U.K. For example, lung cancer is higher in Scotland than England (HFII, 2011), so having more centres, treatments and scanning places in Scotland makes more sense. It has been suggested that Wales has made the most changes in NHS policy since devolution in 1997 (Greer, 2009). Some of these changes include getting rid of car parking fees in hospitals, and getting rid of prescription. This means that the NHS costs less to people using it in Wales than England. England still charges ?7.40 for a prescription (Bevan & Hood, 2006), and car parking charges are decided by the hospital itself, meaning that any trip to the doctor or hospital is unlikely to be free. One of the main aims of the NHS is to provide service that is free at the point of use, so these hidden charges can often be seen as a negative aspect of the English NHS. Interestingly, Scotland has followed Wales in getting rid of prescription charges (Greer, 2009) whilst the price in England keeps rising. This again suggests that those in Wales and Scotland can benefit from cost-free medications when this would not be available to them in England, something which could cause migration to border areas. These are not the only differences between healthcare services in England and Wales. Dental care is one of the areas where the two countries are very different, with dental care being free until the age of 26 in Wales and almost 50% cheaper than England (Webb et al, 2010). NHS dental costs have been rising in England for a while, but have been frozen in Wales for five years (NHS Wales, 2006). NHS dental care has been widely talked about in recent years, especially in England where NHS dental care is becoming harder and harder to find (Bevan & Hood, 2006). Providing more NHS services at a lower cost surely sets NHS Wales apart, further showing that parliamentary devolution is leading to changes in the NHS. The effect of these changes is found below. Health Policy Effects It is really obvious that bad healthcare can cause unnecessary death. This fact seems to get ignored when those in power are trying to work out ways of making the NHS (or any healthcare system) more economic, but it remains true. In America, for example, the government spends more on healthcare than any other developed nation , but has one of the lowest life expectancies from these same countries (Weinstein et al, 2010). Life expectancy isn’t the only way of measuring how good a healthcare system is, but it does show that there must be some flaw in the system . One of the most interesting things about healthcare in America is that it is not paid for by the central government like it is in the U.K. but is generally covered by insurance premiums . This has generally meant that the poorest people there can’t afford healthcare , probably one of the reasons why the life expectancy is so low. It may not seem fair that money can buy you extra years of life. This is one of the main reasons that the NHS was founded, and since then life expectancy in the U.K. has risen (HFII, 2011). There are problems. If the cost of prescription is ?7.40 in England (Bevan & Hood, 2006) but free in Scotland and Wales, it will eventually lead to some sort of inequality, as it has in other areas (Pollock, 2004). This can be seen in the difference between America (very little free healthcare) and Canada (free healthcare); Canadians live longer and more healthily than their neighbours (Squires, 2011). ?7.40 might not seem a lot in an individual case, and can be waivered if the patient is on benefits (Pollock, 2004, Bevan & Hood, 2006), but there are many cases where a patient who cannot afford this charge is forced to pay it. This means that there are inequality between those living in Wales and England in all areas (Birch & Gafni, 2002); sometimes even only one mile apart. Another consequence could be related to the dental care. As previously mentioned, dental care in Wales is much cheaper than in England (Constable, 2011), and to some this might seem unimportant. Dental care is still a part of healthcare, although some may feel it is less important than heart surgery. Bad oral health can cause infections which may be systemic, or impact on mental health. This means that it is important to make sure that the NHS is providing good dental care to everyone in the U.K., although many feel that this is not happening (Zalmanovitch & Vashdi, 2010). It is becoming increasingly hard for people in England to find an NHS dentist (Zalmanovitch & Vashdi, 2010), and many are turning to private services that they may not afford. This means that there is an extra strain on the very poorest people and they will be negatively impacted by any reduction in dental services. This widens the gap between the rich and poor again and therefore we may see unnecessary deaths in the very poorest that could have been avoided if healthcare was provided more better. The effects of these different healthcares have been shown already. Life expectancy for women is very similar (around 81) but men live almost a year longer in Wales (HFII, 2011). This suggests that providing free prescriptions has not caused the services to get worse. It also means that free prescriptions might be helping some people live for longer. Interestingly, the rates of the major diseases seem to be higher in Wales than in England, suggesting that it could be better healthcare providing that is causing this increase in life expectancy than all-round good health. Wales does have a smaller focus on prevention and advertising than England, but this can’t be 100% negative as it does not seem to be impacting the people that live there and perhaps means that there are more money available for actual treatments. This information is backed up by the fact that Wales has a much higher 5-year survival rate for all cancers than England (HFII, 2011). Slightly more people get cancer but if they do the treatment is there and may mean that they can live longer than their English friends. The uptake for breast cancer screening is almost 5% higher in Wales (Bennett et al, 2011, HFII, 2011), suggesting that these people are better informed than English about the benefits of screening. It is not all good news for the Welsh as their rates of mortality for heart disease are higher by almost 10% in women and 15% in men (HFII, 2011); this is an area that needs to be improved on. From this we can say that there are differences that come from the healthcare services in both countries; Wales is spending more on cancer prevention and treatment than England but less on heart disease. This is having a clear effect on the health. Evaluating Impact of Differences in Healthcare Policy Earlier in this essay we saw that there are clear differences between the NHS of England and Wales as would be expected from a devolved government. These have seemingly caused differences in mortality rates between people and even between different types of diseases. This is evident from facts and figures published by the various authorities that are involved. Looking at these figures may not give us an accurate vision of the impact of the differences in the healthcare policies of these two countries, and it is easy to assume that a higher life expectancy means better healthcare but this is not always the case. The purpose of this section is to look at how we can evaluate this impact in more detail. One of the most important things about healthcare that is paid for by a central body like that of the NHS is how cost-effective the treatments and things being offered are. One way of doing this is to form a reference case analysis (Russel et al, 1996) which looks at cost effectiveness from a societal perspective and gives information about the benefits and costs to all the people involved. This is interesting as it does not just focus on economic cost effectiveness but actually shows how certain areas of healthcare (or the lack of them) actually harm or benefit the patients who are receiving the treatments. By forming a reference case analysis (or multiple) for England and Wales using all the information available it would be possible to get a general overview of the cost effectiveness of each of the systems and how the differences outlined above are actually effecting the people involved. Another way of evaluating the differences between England and Wales would be to see the inequality found within and between the two nations. England has a history of not being able to provide equal healthcare to everyone in the country despite the development of the NHS (Mackenbach, 2010). For example, the difference in life expectancy of the 10% poorest men and the 10% richest men is almost 6 years (HFII, 2011). The way that this data was collected was by statistically analysing income data and life expectancy data from men in the United Kingdom. It would be possible to collect this data for England and for Wales to see if there is a difference in equality. If Wales had a smaller difference in the life expectancies of these two groups it could be suggested that the cheaper cost to the patient of NHS Wales was having a good effect on reducing the differences in this case. It is also possible for the life expectancy data to be collected for England and Wales as a whole (as analysed earlier) and the different areas of England and Wales to see how differences in healthcare policy are affecting different areas. The impact of these differences can also be analysed by looking at the types of facility available. For example, many studies look at the number of primary care physicians or GPs in the area. Collecting and analysing this data for England and Wales (as well as more information about clinics) would show where the money was being spent. This is a direct economic impact of a difference in healthcare policy (Wennberg et al, 1987). Numbers could also be collected on waiting times and also patient survival rates from each of these different areas to see how quality of services is being affected by these differences in healthcare policy (Wennberg et al, 1987). Taking this information together could give information as to why cancer survival rates in Wales are so much lower than in England (HFII, 2011) for example. Information here could show not only how differences are affecting the services by why and by how much. Another important aspect of evaluating the impact of these different healthcare policies does not involve facts and figures like those seen above. Case studies could be conducted involving those who have lived in both England and Wales, and qualitative data could be collected about their experiences of each of the systems. This gives a new level of information about NHS and NHS Wales from someone who has really experienced it. Additionally, surveys could be conducted about how people feel about the differences in healthcare. Interesting questions to consider would be whether an individual from England would consider moving to Wales to benefit from the cheaper parking and prescriptions or whether these costs were not important. Another question could be if someone from Wales would be put off moving to England because of these additional costs that they had previously not given. Another way of evaluating the effects of the differences is to try and understand why there are these differences. If there are higher rates of a specific disease in Wales it would be sensible to direct money into treatment and other things for that disease to help reduce the numbers. Longitudinal studies can be used to check if this is working (see Roos & Shapiro, 1981), and again this is an aspect of how the differences between England and Wales are affecting. For example if numbers of heart disease drop in Wales because of a change in policy, analysis of this could give ways of improving aspects of this disease in England and the reverse. Longitudinal studies are often used for seeing the differences in healthcare provisions between areas because they show how people are affected in the long term (Webb et al, 2010), and are a good analysis tool. Conclusions There is a lot of evidence suggesting that healthcare in Wales is different to that found in England. It is quite easy to argue that the healthcare in Wales is better for many patients because of the pricing structure that allows those on a low income better access to healthcare services. These differences in healthcare services could lead to many moving to Wales to gain access to free prescriptions and free dental care up until the age of 26, things that many families feel are necessary particularly during this recession. It could also lead to England and Wales having very different life expectancies, as well as different waiting list times. The healthcare systems themselves do not seem to be too different in quality, with many areas being very similar, which again shows that Wales is offering better value for money. It is particularly interesting that NHS Wales does not receive a very different funding per capita, so again seems to be offering better value. There appear to be a number of ways that we can examine the effects of the healthcare policy. The most obvious and perhaps the most used is to check the differences in life expectancy in different areas. Another way is to see the rates of different key diseases in the area and see how the rates differ between comparison services. There are also a number of available frameworks for getting and analysing information about health services, which all have various positives and negatives. There seems to be no one way which is the best but each can be used in different ways to try and work out how differences in services are affecting the people that really matter. From the information gathered from this paper, it appears that there are definite differences between England and Wales and we can make predictions on how these will affect the population, but it cannot be guaranteed. References Bennett, R., Sellars, S. & Moss, S., 2011. Interval cancers in the NHS breast cancer screening programme in England, Wales and Northern Ireland. British journal of cancer, 104(4), pp.571–577. Bevan, G. & Hood, C., 2006. Health Policy: Have targets improved performance in the English NHS? BMJ: British Medical Journal, 332(7538), p.419. Birch, S. & Gafni, A., 2002. On being NICE in the UK: guidelines for technology appraisal for the NHS in England and Wales. Health Economics, 11(3), pp.185–191. Constable, C., 2011. Key agencies. Stroke. Greer, S.L., 2008. Devolution and divergence in UK health policies. BMJ, 337(dec15 1), p.a2616-a2616. HFII, 2011. Quality of healthcare in England, Scotland, Wales and Northern Ireland: an intra-UK chartbook - Health Foundation. Health Foundation. Available at: http://www.health.org.uk/publications/quality-of-healthcare-in-england-scotland-wales-and-northern-ireland-an-intra-uk-chartbook [Accessed December 29, 2011]. NHS Wales, W.A., 2006. NHS Wales | NHS dental charges in Wales frozen for fifth year running. Available at: http://www.wales.nhs.uk/news/18289 [Accessed December 29, 2011]. Pollock, A.M., 2004. NHS plc: the privatisation of our health care. BMJ, 329, p.862. Rees, E., 2011. NHS Wales keeps a difference in the valleys. the Guardian. Available at: http://www.guardian.co.uk/healthcare-network/2011/apr/12/nhs-wales-difference-valleys-assembly-government [Accessed December 29, 2011]. Roos, N.P. & Shapiro, E., 1981. The Manitoba longitudinal study on aging: Preliminary findings on health care utilization by the elderly. Medical Care, pp.644–657. Russell, L.B. et al., 1996. The Role of Cost-effectiveness Analysis in Health and Medicine. JAMA: The Journal of the American Medical Association, 276(14), pp.1172 -1177. Squires, D., 2011. The US health system in perspective: a comparison of twelve industrialized nations. Issue brief (Commonwealth Fund), 16, p.1. Webb, M. et al., 2010. Healthcare Service Improvement Team Public health evidence-based summary internal fixation of fracture of the tibial shaft. Weinstein, M.C. & Skinner, J.A., 2010. Comparative effectiveness and health care spending—implications for reform. New England Journal of Medicine, 362(5), pp.460–465. Wennberg, J.E. et al., 1987. Use of claims data systems to evaluate health care outcomes. JAMA: The Journal of the American Medical Association, 257(7), p.933. Zalmanovitch, Y. & Vashdi, D.R., 2010. Shrinking budgets, improving care: Trade-offs are unavoidable. BMJ, 340. Read More