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Q: Health ( Answered,   0 Comments )
Question  
Subject: Health
Category: Health
Asked by: princess2003-ga
List Price: $2.00
Posted: 15 Jan 2003 05:03 PST
Expires: 14 Feb 2003 05:03 PST
Question ID: 142944
What are the strengths and weaknesses of the NHS

Request for Question Clarification by kevinmd-ga on 15 Jan 2003 06:22 PST
Hello,
I presume you referring to the National Health Service in the UK?

Kevin, M.D.
Answer  
Subject: Re: Health
Answered By: jumpingjoe-ga on 15 Jan 2003 09:17 PST
 
Thanks for asking this interesting question, which strikes to the
heart of politics in the UK today.

Here is an excerpt from the Department of Health's NHS Plan:

" 2.1 Britain is committed to the National Health Service. Everyone –
no matter how much they earn, who they are, how old they are, where
they come from or where they live – should have the health care they
need from themselves and for their families. Four-fifths of people
today say the NHS is critical to British society and the country must
do everything it can to maintain it.

2.2 The NHS has delivered major improvements in the health of our
nation. Free at the point of use, the NHS has freed millions of
individuals from worry about the costs of falling ill. In the five
decades since the NHS was formed quality of life has improved, with
people living healthier as well as longer lives. A baby girl born in
1948 could expect to live for 71 years, a boy for 66 years. Today it
is 80 years and 75 years. In the years since 1948, the death rates for
babies under a year old have fallen from 34 out of every 1,000 births
to six per 1,000 today.

2.3 The NHS has been at the centre of a range of pioneering medical
and technological breakthroughs. NHS doctors developed the technique
on which the modern approach to hip replacement was based. Cataract
surgery is an NHS innovation. Hospitals like Papworth, Great Ormond
Street, the Freeman Hospital in Newcastle, Addenbrooke's, St James’,
Leeds and the Royal Marsden are internationally renowned and
respected. Today the NHS is still home to
international pioneers in the fields of vaccine development, imaging
and gene therapy and many other fields of endeavour. The British
system of primary care is envied and copied throughout the world.

2.4 The NHS continues to work at the cutting edge of new forms of
health services, inventing new ways of meeting patients’ needs, with
pioneering developments such as NHS Direct, the Commission for Health
Improvement and the National Institute for Clinical Excellence.

2.5 The NHS remains one of the fairest health care systems by
international standards. The World Health Organisation recently
reported that the NHS was performing better than Germany, the United
States and Australia. In surveys, Americans, Canadians and Australians
are 50% more worried than British people about affording medical care
if they became seriously ill. The NHS is effective and efficient at
meeting its goals. The NHS gets more and fairer health care for every
pound invested than most other health care systems.


The NHS now: a snapshot

On a typical day in the NHS:

• almost a million people visit their family doctor
• 130,000 go to the dentist for a check up
• 33,000 people get the care they need in accident and emergency
• 8,000 people are carried by NHS ambulances
• 1.5 million prescriptions are dispensed
• 2,000 babies are delivered
• 25,000 operations are carried out including 320 heart operations and
125 kidney operations
• 30,000 people receive a free eye test
• District nurses make 100,000 visits 

On a typical day in the NHS, there are:

• 90,000 doctors
• 300,000 nurses
• 150,000 healthcare assistants
• 22,000 midwives
• 13,500 radiographers
• 15,000 occupational therapists
• 7,500 opticians
• 10,000 health visitors
• 6,500 paramedics
• 90,000 porters, cleaners and other support staff
• 11,000 pharmacists
• 19,000 physiotherapists
• 24,000 managers
• 105,000 practice staff in GP surgeries"

From here you can see the breadth and scale of the NHS. The report
also lists some of the current perceived weaknesses:

"An under-invested system

The NHS has suffered from decades of under investment. In the 1940s
some even
thought the costs of the NHS would fall as the health of the nation
improved. Spending has risen over the years – but not by enough to
deliver the sort of modern health services our country needs.

UK spending on healthcare has consistently lagged behind other
developed countries. Since 1960 Organisation for Economic Co-operation
and Development (OECD) countries have on average increased health
spending per capita by 5.5% in real terms compared with only 3.6% in
the UK.


Between 1979-1997 the average annual increase in Government spending
on health was even less – just 2.9%. And real terms funding in England
has veered between under 0% and over 6% a year. This erratic pattern
of spending has impeded planning for the shorter, medium and
long-term.


As a consequence the NHS has been left with insufficient capacity to
provide the
services the public expect. England has too few hospital beds per head
of population compared with most other health systems. The NHS lacks
sufficient doctors, nurses and other skilled staff. There are 1.8
practising doctors per 1,000 people compared with an European Union
average of 3.1 per 1,000 population. One third of the buildings used
by the NHS today were built before the NHS was even created. The
backlog of maintenance in the NHS now stands at 3.1 billion."

You can read the full report here:

- http://www.doh.gov.uk/nhsplan/nhsplan.htm


This is backed up by the BBC's Medicine Through Time site, which says
the following:

"In July 1945, the new Labour government began the implementation of
the welfare state, with free healthcare for all. the NHS came into
operation in 1948. the majority of doctors and the British Medical
Association (BMA) were initially opposed to the NHS, but its
architect, Aneurin Bevan, was persuasive and by the end of 1948, 90%
of doctors backed the NHS.

The benefits of the NHS are clear. GPs offered a wide range of
services to local communities such as vaccinations, cancer screening,
family planning, etc. However, as medical care becomes more advanced,
the costs of running the NHS are increasing. This poses a problem for
all governments and some compromises have had to be taken; patients
now have to pay for prescriptions and many older hospitals have been
closed."

- http://www.bbc.co.uk/education/medicine/nonint/modern/ph/mophcs2.shtml

That sums up the problem nicely. The basic principle of the NHS is
that all healthcare should be free, funded by taxes. This does and has
worked extremely well both in terms of social welfare and value for
money, and the UK system continues to provide absolutely free quality
healthcare at less of a cost to the taxpayer than the USA. A Labour
Member of Parliament restates this here:

"Listening to the debate, I wondered whether Conservative Members even
understand why we have public services. I urge them to look at page 7
of a handy little Treasury document called "Budget 2002: a summary
leaflet", which gives a breakdown of how taxpayers' money is spent.
Having done a few sums, I discovered that the national health service
costs about 1,200 a year per person—in other words, 100 a month. Do
Conservative Members believe that a private or social insurance system
could provide the benefits of the NHS for 100 a month? We have public
services because they leverage in benefits of scale, of fairness and
of innovation, and that gives us more bang for our buck. They enable
us to deliver services to the people who need them, as they need them.
It is time that Conservative Members learned that lesson."

- http://www.parliament.the-stationery-office.co.uk/pa/cm200102/cmhansrd/cm020422/debtext/20422-16.htm

The problem we face now however is that the march of medical science,
and the growth of large pharmaceutical companies producing drugs on a
commercial basis has led to the NHS becoming more and more expensive.
What's more, the current policies that exist in the West of
private/public ownership of assets and provision of services lean far
more towards the private sector providing healthcare services.
Business often regards the NHS as an unfair state monopoly, that they
should be able to compete in a market environment for healthcare
provision rather than one provider giving it away for free.

The Guardian newspaper contains an interesting story containing many
of the arguments for the NHS here:

- http://www.guardian.co.uk/business/story/0,3604,608066,00.html

And finally here is a discussion of the 'third way' of Foundation
Hospitals as currently seen in Sweden:

- http://news.bbc.co.uk/1/hi/health/2291869.stm

If you have further queries do please ask.

jumpingjoe-ga
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