Healthcare in the United Kingdom

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Healthcare in the United Kingdom is a devolved matter and England, Northern Ireland, Scotland and Wales each has its own arrangement: Healthcare in England is the responsibility of the UK Government, Healthcare in Northern Ireland is the responsibilty of the Northern Ireland Executive, Healthcare in Scotland is the responsibilty of the Scottish Government and Healthcare in Wales is the responsibilty of the Welsh Assembly Government. Each country uses publicly-funded health care to meet the majority of healthcare needs, sitting alongside private healthcare and a wide variety of alternative and complementary treatments. Public healthcare is provided to all UK permanent residents and is free at the point of need being paid for from general taxation, though due to each of these health systems having different policies and priorities, a variety of differences exist between the systems.^[1][2] Taken together, the World Health Organisation, in 2000, ranked the provision of healthcare in the United Kingdom as fifteenth best in Europe and eighteenth in the world.^[3][4]

Contents 1 Common features in the public health systems in the UK 1.1 General practitioners 1.2 Hospitals 1.3 Advice services 1.4 Ambulance services 1.5 Cost recovery in exceptional circumstances 1.6 Dentistry 2 Contrasts between the public health systems in the UK 2.1 Pharmacies & Prescription charges 2.2 Parking charges 2.3 Polyclinics 2.4 Role of private sector in public healthcare 2.5 Cost control 3 Private health care 4 Experiences, Perceptions and Reporting of the NHS in England 5 See also 6 References

[edit] Common features in the public health systems in the UK

[edit] General practitioners

Each NHS system uses General Practitioners (GPs) to provide primary healthcare for patients and to make referrals to further services as necessary. GP Practices often operate from Health Centres which typically provide care that is considered more routine and less invasive than the type of surgeries and procedures that take place in the hospital, including ophthalmology, dentistry, wound dressings and re-dressing, infant check-ups and vaccinations.

[edit] Hospitals

Hospitals provide more specialist services including diagnostic and surgical and specialist mental hospitals exist to care for patients with psychiatric illnesses. Access to hospital services is usually via referral from a general practitioner though access to Accident and Emergency (A&E) departments is an obvious exception.

[edit] Advice services

Each NHS system runs 24 hour confidential advisory services: NHS Direct ^[5] provides a telephone-based service for England, NHS Direct Wales/Galw Iechyd Cymru ^[6] provides a similar service in Wales while Scotland has NHS24^[7].

[edit] Ambulance services

Each public healthcare system provides free ambulance services for emergencies, when patients need the specialist transport only available from ambulance crews or when patienets are not fit to be travel home by public transport. These services are generally supplemented when necessary by the voluntary ambulance services (British Red Cross, St John Ambulance and the St Andrews Ambulance Association). In addition, patient transport services by air are provided by the Scottish Ambulance Service and by county or regional air ambulance trusts (sometimes operated jointly with local police helicopter services^[8]) throughout England and Wales[1]. In specific emergencies, emergency air transport is also provided by naval, military and air force aircraft of whatever type might be appropriate or available on each occasion. On more than one occasion this has led to new-born babies needing special care being flown long distances in Hercules transport aircraft ^[9] or similar.

[edit] Cost recovery in exceptional circumstances

Being paid for from general taxation, the public health services do not bill for services rendered. Each NHS system, however, reserves the right to claim compensation for treatment required as a result of the negligence of others such as from insurance companies through the Injury Costs Recovery Scheme following the determination of fault in motor accidents.

[edit] Dentistry

Each NHS system provides dental services through private dental practises and dentists can only charge NHS patients at set rates (though the rates vary between countries). Patients opting to be treated privately do not receive any NHS funding for the treatment. About half of the income of dentists comes from work sub-contracted from the NHS^[10], however not all dentists choose to do NHS work.

[edit] Contrasts between the public health systems in the UK

[edit] Pharmacies & Prescription charges

Each NHS system uses pharmacies to supply prescription drugs. Pharmacies (other than those within hospitals) are privately owned but have contracts with the relevant health service

In England, patients under 16 years old (19 years if still in full-time education) or over 59 years will get the drug for free. There are also exemptions for people with certain medical conditions, including cancer, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2009, a fixed charge of £7.20 is payable per item.

In Northern Ireland, prescription charges will be abolished by April 2010.^[11] At present, patients under 16 years old (19 years if still in full-time education) or over 59 years get free prescriptions and there are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £6.85 is payable per item.

In Scotland, prescription charges will be abolished before 2011.^[12] At present, patients under 16 years old (19 years if still in full-time education) or over 59 years get free prescriptions and there are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2009, a fixed charge of £4 is payable per item.^[13]

In Wales, prescription charges were abolished in 2007 and all prescription drugs are now dispensed without charge.

[edit] Parking charges

Parking charges at hospitals have been abolished in Scotland (except for 3 PFI hospitals)^[14] but continue to be in place at many hospitals England.

[edit] Polyclinics

Polyclinics are being trialled in London and in other suburban areas and, if successful, may be rolled out across England.

[edit] Role of private sector in public healthcare

Whereas the UK government is expanding the role of the private sector within the NHS in England^[15][16], the current Scottish government is moving in the opposite direction, actively reducing the role of the private sector within public healthcare in Scotland^[17] and planning legislation to prevent the possibility of private companies running GP practices in future.^[18]

[edit] Cost control

The National Audit Office reports annually on the summarised consolidated accounts of the NHS, and Audit Scotland performs the same function for NHS Scotland ^[19].

In England and Wales, the National Institute for Health and Clinical Excellence (NICE) sets guidelines for medical practitioners as to how various conditions should be treated and whether or not a particular treatment should be funded. In Scotland, the Scottish Medicines Consortium performs a similar function. However, the Scottish system makes some new drugs available for prescription more quickly than in the rest of the UK which has led to complaints.^[20]

[edit] Private health care

Each country of the United Kingdom has private healthcare sector which is considerably smaller than its public equivalent. Provision of private healthcare is acquired by means of private health insurance, funding as part of an employer funded health care scheme or paid directly by the customer.

There are certain treatments that the private sector does not provide. For example BUPA, one of the largest 'private' health care providers in the UK, excludes AIDS/HIV treatment from its insurance plans, whilst full treatment is freely available through the NHS. ^[21]

[edit] Experiences, Perceptions and Reporting of the NHS in England

Although the NHS has a high level of popular public support within the country the national press is often highly critical of it. This may have affect perceptions of the service within the country as a whole and outside.^{[citation needed][original research?]} An independent survey conducted in 2004 found that users of the NHS often expressed very high levels satisfaction about their personal experience of the medical services they received. Of hospital inpatients, 92% said they were satisfied with their treatment; 87% of GP users were satisfied with their GP; 87% of hospital outpatients were satisfied with the service they received; and 70% of Accident and Emergency department users reported being satisfied. ^[22] But when asked whether they agreed with the question "My local NHS is providing me with a good service” only 67% of those surveyed agreed with it, and only 51% agreed with the statement “The NHS is providing a good service. ^[23] The reason for this disparity between personal experience and overall perceptions is not clear. It does seems to be the case that people who are not using the service are the ones most likely to be critical of it and that therefore their opinion must be obtained from somewhere other than their own experience. It is also apparent from the survey that most people realize that the national press is generally critical of the service (64% reporting it as being critical compared to just 13% saying the national press is favourable), and also that the national press is the least reliable source of information (50% reporting it to be not very or not at all reliable, compared to 36% believing the press was reliable). ^[23] Newspapers were reported as being less favorable and also less reliable than the broadcast media. The most reliable sources of information were considered to be leaflets from GPs and information from friends (both 77% reported as reliable) and medical professionals (75% considered reliable).^[23]

Many people, politicians and news organizations outside the United Kingdom seem to fail to recognize that the UK media, and particularly the printed press, is regarded as being an unreliable source of information about the NHS.^{[citation needed]} This seems to be particularly true in the United States of America where the NHS is often vilified, using the term of abuse "socialized medicine".^{[citation needed][neutrality disputed]} Garish UK press stories often figure highly in their denigration of the NHS.^{[neutrality disputed]} These stories are rarely representative of the service as a whole and are sometimes false or misrepresent the real picture.^{[citation needed]} The American news media, politicians and politically active bloggers in the United States fail to understand that the NHS is in fact highly regarded and trusted by the British people and that most people there don't give much credence to these stories.^{[citation needed]}

[edit] See also

• National Health Service (England's national health service)
• NHS Scotland
• NHS Wales
• Health and Social Care in Northern Ireland (Northern Ireland's national health service)

• Emergency medical services in the United Kingdom
• Euthanasia in the United Kingdom

[edit] References

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