National Health Care Today - United Kingdom

United Kingdom

Britain’s public provider of health care is known as the National Health Services (NHS). Services provided by the NHS include hospitals, family doctors, specialists, dentists, chemists, opticians and the ambulance service.

Not all services provided by the NHS are free of charge. Unless exempt, patients pay

  1. (subsidised) fixed costs for prescriptions
  2. Sight tests
  3. NHS glasses
  4. Dental treatment.

Hospital treatment, the ambulance service and medical consultations remain free.

The UK’s NHS was the first state organisation in the world to provide free universal healthcare. Today, it is an organisation with some severe structural problems, which means that waiting lists for treatments even for urgent operations have grown and the standard of treatment in some hospitals has deteriorated. Many Britons in the higher income bracket purchase private health insurance and there is a growing number of employers providing private cover as standard to their employees.[1]

Private Health Care

Private medical treatment in Britain is amongst the best in the world, with London having some of world’s most skilled specialists. Within the country, most people go private to avoid NHS waiting lists for non-emergency specialist appointments and non-urgent treatment. Around a quarter of all operations are performed privately.

There is almost always no difference in quality between private and NHS doctors. Indeed, you will often end up seeing the same specialist privately as you would have seen through the NHS. The difference will be  when you get the appointment and how quickly you are treated, i.e. a heart bypass operation may be diagnosed for and completed in a couple of weeks with private treatment, but through the NHS this could take two or three months. Many employers also provide their workers with private health insurance, which is definitely worth finding out about if interviewing for different positions or negotiating a package.[2]

NHS to allow ‘private’ drugs for cancer

Patients may soon be allowed to pay for “top up” drugs on top of their NHS care under a major reform to Britain’s healthcare system expected next month.

Approval of top-up payments for cancer and certain other treatments is being widely anticipated from the review being conducted by Professor Mike Richards, the Government’s national cancer adviser, despite fears that it could introduce a two-tier NHS.

Medical organisations have accepted that the change is inevitable in a health service that champions patient choice and is increasingly driven by consumer demand. But there is little enthusiasm for the move, which is seen as difficult to implement and would pose a long-term threat to a comprehensive NHS.

The review was ordered by Alan Johnson, the Health Secretary, in June after protests from NHS cancer patients who were told they could not pay privately for cancer drugs that had been rejected, or not yet assessed, by the National Institute for Clinical Excellence.[3]

Life prolonging cancer drugs to be banned because they cost too much

Thousands of patients with terminal cancer were dealt a blow last night after a decision was made to deny them life prolonging drugs. The Government’s rationing body said two drugs for advanced breast cancer and a rare form of stomach cancer were too expensive for the NHS.

The National Institute for Health and Clinical Excellence is expected to confirm guidance in the next few weeks that will effectively ban their use. The move comes despite a pledge by Nice to be more flexible in giving life-extending drugs to terminally-ill cancer patients after a public outcry last year over ‘death sentence’ decisions. Leading campaigners last night said Nice had failed the ‘acid test’ of whether it really intended to give new priority to people with just a few months to live. [4]

Cost Containment has created problems in the NHS

FILTHY hospitals in Kent have led to the death of 90 patients – and now you can find out if your local hospital has been affected too.

Appalling hygiene at Kent and Sussex Hospital, Pembury Hospital and Maidstone Hospital saw the killer Clostridium difficile bug C.diff directly linked to 90 deaths.

Almost every hospital in England has suffered C.diff outbreaks and MRSA scares.[5]

Find out how your hospital has been affected by using our interactive map. Just click on the link below.[6]

Hard-up hospital orders staff: Don’t wash sheets – turn them over

Cleaners at an NHS hospital with a poor record on superbugs have been told to turn over dirty sheets instead of using fresh ones between patients to save money. Housekeeping staff at Good Hope Hospital in Sutton Coldfield, have been asked to re-use sheets and pillowcases wherever possible to cut a £500,000 laundry bill.

Posters in the hospital’s linen cupboards and on doors into the A&E department remind workers that each item costs 0.275 pence to wash. Good Hope reported a deficit of £6million last year and was subject to a report by the Audit Commission because of its poor financial standing.

It recorded 36 cases of MRSA from April last year to January, while cases of clostridium difficile have more than doubled in less than a year to 327. A Government hit squad was drafted in to solve the infection problems last year but the trust is still failing to hit MRSA targets.

Tony Field, chairman of Birmingham-based MRSA Support, said: ‘Is that all the safety of a patient’s life is worth? 0.275 pence? ‘It is utterly disgraceful and tantamount to murder because hygiene like changing sheets is essential to protect patients.

“It proves beyond all doubt that cost- cutting is directly contributing to hospital acquired infections.” The scheme is one of many ways that cash- strapped trusts are trying to save money.

Staff at West Hertfordshire NHS Trust were amazed to receive a memo urging them to save £2.50 a day by:

  1. Prescribing cheaper medicines
  2. Reducing the number of sterile packs used
  3. Cutting hospital tests
  4. Asking patients to bring drugs in from home
  5. Epsom and St Helier Trust in South London has removed every third light bulb from corridors.[7]

The NHS cost containment can be deadly

Dying woman refused chemotherapy by the NHS Tuesday 3rd June 2008

A widower has demanded a change in the law after his wife was denied chemotherapy for bowel cancer on the NHS because she paid privately for life-extending drugs.

Linda O’Boyle, 64, and husband Brian, 74, both retired NHS workers, decided to pay for drug cetuximab in addition to NHS treatment after her consultant said it might prolong her life.

The decision meant she was considered a private patient and had to pay for her NHS treatment as well, because the Government has banned patients mixing public and private care. Mrs O’Boyle died on March 26 this year. Mr. O’Boyle, who was a health manager for 30 years before his retirement, blames the Government and South West Essex Primary Care trust for the system which saw them paying out £11,000 for private treatment, including cetuximab and chemotherapy.

Mr O’Boyle said he and Linda, who was an assistant occupational therapist, were angry at the decision.

He blames Health Secretary Alan Johnson, who last year issued guidance to NHS trusts telling them not to permit patients to pay or additional medicines. Mr. Johnson claims co-payment would create a two-tier NHS, with preferential treatment for patients who buy extra drugs.

“Linda told me they just did not think she was worth helping and had put her on the dump and sent her to die. “That was her initial reaction. It was a huge shock.”

He added: “I still think it extended her life by three months, so don’t regret doing it, but the system needs to be changed.”

Comments on the page:

Mrs. K., Southend on Sea says…
8:36am Tue 3 Jun 08

In 1997 when it was discovered that my Dad had lung cancer, he wasn’t offered any sort of chemotherapy or radiotherapy at all.
Maybe it was because it was too far gone to do anything, or maybe it was because he was 80 years old, although he only looked about 65 and was still full of life. He died six months later.

Tony Winchester, Wos says…
1:15pm Tue 3 Jun 08

Atragic decission from the PCT but then again they wont even give school kids the TB vaccine (not British ones anyway)so therefore this case don’t surprise me unfortunately. My heartfelt wishes go out to her family.[8]

Cost Containment – waiting times

Friday 8 June 2007 – One in eight NHS hospital patients still has to wait more than a year for treatment, the government acknowledged yesterday in its first attempt to tell the full truth about health service queues in England.

A Department of Health analysis of 208,000 people admitted to hospital in March showed 48% were wheeled into the operating theatre within 18 weeks of a GP sending them for hospital diagnosis. But 30% waited more than 30 weeks and 12.4% more than a year.

The inpatient clock started when the consultant decided hospital treatment was needed and stopped when the patient was treated. The maximum inpatient delay is six months. Until now, the NHS did not measure the time patients waited after the first outpatient appointment before going on the inpatient list. This “hidden” delay could last months.

Some primary care trusts ordered hospitals to go slow in March to avoid overspending. The analysis measured the waits of people who were treated during the month without estimating the extra waiting experienced by those still in the queue.

Norman Lamb, the Liberal Democrat health spokesman, said: “Behind the statistics, thousands of sick people are still waiting more than a year for hospital treatment. This is a daily tragedy.”[9]

Operations cancelled as NHS runs out of money – January 4, 2007

Patients are being denied basic operations, including treatments for varicose veins, wisdom teeth and bad backs, as hospitals try frantically to balance the books by the end of the financial year.

NHS trusts throughout the country are making sweeping cuts to services and delaying appointments in an attempt to address their debts before the end of March. Family doctors have been told to send fewer patients to hospital, A&E departments have been instructed to turn people away, and a wide range of routine procedures has been suspended.

In one example of the cash-saving strategies, seen by The Times, a primary care trust in Yorkshire has told hospitals that they will not be paid for some non-essential operations, while patients will not be given a hospital appointment in under eight weeks. Similar tactics have emerged at hospitals in Norfolk and Surrey, while dozens of trusts have resorted to closing beds and offering voluntary redundancy in recent months. Devon Primary Care Trust has offered voluntary redundancy to all 5,000 staff.

The cuts are widespread, although there are no central records to provide definitive figures. Among the most comprehensive plans are those from North Yorkshire and York Primary Care Trust, which faces a deficit of £24 million this year.

A letter from its chief executive, Janet Soo-Chung, says that all non-urgent admissions must be approved by an assessment team or they will not be paid for. A&E departments in Harrogate, Scarborough, South Tees and York have been told that they will not be paid for treating patients with minor ailments who could go elsewhere.

No patients will be given a hospital appointment in less than eight weeks, and none admitted for elective surgery unless they have waited a minimum of 12 to 16 weeks. Those treated quicker will not be paid for.

The trust also announced the immediate suspension of treatments for varicose veins, wisdom teeth, X-rays of the back, operations for carpal tunnel syndrome, bunions, arthroscopy of the knee, and grommets for the ear, among others. “We fully appreciate the difficulties that the introduction of these measures entail,” Dr Soo-Chung’s letter says. “However, the financial position of the PCT is such that there is absolutely no alternative to this programme if we are to avoid even more difficult decisions in the near future.”

Norfolk PCT has issued similar instructions, telling hospitals not to treat patients who have waited less than 17 weeks — expected to rise to 18 weeks by February. Hilary Daniels, the interim chief executive, told hospitals to work out how many patients could be deferred until next financial year, and said that the trust would not pay for elective operations on smokers until they had attended smoking clinics.

In a report published this week, the think-tank Reform said that NHS deficits were deepening. It called for a one-off repayment of debt followed by a more rigorous financial regime and immediate administration for failing trusts. But the idea was rejected by the Department of Health.

Last year the NHS returned a net deficit of £512 million, a fraction of the total budget. But the scale of the problems was concealed by strategic health authorities saving large amounts of money largely by cutting education and training budgets.[10]

[4] http://www.dailymail.co.uk/health/article-1159506/Life-prolonging-cancer-drugs-banned-cost-much.html Life prolonging cancer drugs to be banned because they cost too much