British Health System
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British Health System






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British Health System British Health System Presentation Transcript

  • Overview of the British Health System Grzegorz Chodkowski (MD) Riga, Radisson SAS 2009
  • A famous TV star ? A popular writer ? A top model ? NO ! He is … Your Future BOSS ! Andy Burnham – Secretary of State for Health
  • Key Players
  • Secretary of State for Health • Andrew Burnham, 5-th June 2009 – • Alan Johnson, 28-th June 2007 – 5-th June 2009
  • NHS is…
  • … modern
  • British Health System Public Private - NHS (Independent)
  • Private Sector • Consists of (for profit) organisations as well as individual practitioners working partly or wholly in a private capacity • The sector provides 19% of hospital and nursing home services • 1% maternity care, 13% for elective surgery, 50% terminations • 80% of long term nursing an residential care for the elderly • 3% of general practitioners • 38% of dental service contributions • There has been a growth in ‘for-profit’ health care provision • In the private acute sector, the majority of beds are now in ‘for-profit’ • Voluntary providers now operate in a much more ‘commercial’ environment, they have to compete to win business and contracts • Consequently the differences between for-profit and not-for-profit providers have been eroded considerably
  • Private Hospitals in th UK
  • A typical private hospital • Mainly elective surgery • No A & E • Small number of medical admissions • Can range from 20 – 100 Beds
  • …is a brand name
  • "The best way to find yourself is to lose yourself in the service of others." Mahatma Gandhi (1869-1948)
  • NHS Structure & Funding
  • Key Figures • Founded in 1948 • Employment 1.5 mln people ( 2007) - 90 000 hospitals doctors - 35 000 GP’s - 400 000 nurses - 16 000 ambulance staff + almost a million of other staff Only the Chinese People’s Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ more people. • Budget – over 93 billion pounds ( 2007)
  • Where does the money go? Some 60% of the NHS budget is used to pay staff. A further 20% pays for drugs and other supplies, with the remaining 20% split between buildings, equipment and training costs on the one hand and medical equipment, catering and cleaning on the other. Nearly 80% of the total budget is distributed by local trusts in line with the particular health priorities in their areas.
  • NHS Outcome
  • Statistics On average, it deals with 1m patients every 36 hours - that’s 463 people a minute or almost 8 a second. Each week, 700,000 will visit an NHS dentist, while a further 3,000 will have a heart operation. Each GP in the nation’s 10,000-plus practices sees an average of 140 patients a week.
  • What people want from the NHS • A good hospital close to home • Continuity of care from their GP who should be within walking distance • To be treated sensitively, listened to and their views taken into account • To be treated within a reasonable time • 84% said they were happy with their doctors opening hours in a huge survey in 2007 Source: Wendy Savage MBBCh(Cantab) FRCOG MSc (Public Health) Hon DSc Co-Chair of Keep Our NHS Public steering group
  • Under the 1990 NHS and Community Care Act, hospitals became self-governing trusts: • Now able to buy, own and sell land and services • Develop their own management systems • Employ their own staff • Raise money through developing private patient services, renting out shops in the hospital, car park charges etc…
  • Primary Care Trusts (PCT) The role of the PCTs is to assess the health needs of the population, and commission the services to meet them: • Child protection staff • Tissue viability nurses • District nurses • Health visitors • Occupational therapists
  • • Podiatrists • Rehabilitation care • School nurses professionals • Speech and language • Palliative care professionals specialists • Wheelchair/equipment • Infection control nurse provision • Smoking cessation co- • Health promotion ordinators practitioners • Physiotherapist • Dieticians • Continence nurse • Specialist nurses
  • The PCTs are now at the centre of the NHS and control 80% of the total NHS budget. They: • Assess the health needs of people in the community • Commission the right services, GP practices, hospitals and dentists, to meet these needs • Improve the overall health of their local community • Ensure these services can be assessed by everyone who needs them • Listen to patients views on services and act on them • Ensure that the organisations providing these services, including social care organisations, are working effectively together Each year the PCT receives a sum of money from the government, with which it purchases all the healthcare provisions for the registered patients in its catchment area. This budget is divided up, on an agreed basis, between the different areas of healthcare services that are necessary to meet the needs of its population
  • The Performance Assessment Framework The Blair government introduced performance indicators for each Trust, which included things such as waiting times. However they also proposed a new Performance Assessment Framework. It put greater emphasis on assess to care, and the quality of care provided. It identified six key areas: • Health improvement • Fair access • Health outcomes of NHS care • Patient and care experience • Effective delivery of appropriate health care • Efficiency Performances tables were published, so that the best and worst performers could be identified
  • GP Funding and the Triage System • Many GPs have now become fund-holding practices • They can bargain aggressively with hospital providers by forming a consortia • If five or six practices join together, they become a substantial force • No hospital can afford to lose the custom of these GPs • Subsequently hospitals and consultants have become more sensitive to the demands of GPs and their patients • Other changes include GPs using a triage system, to prioritise patients for hospital treatment • Three categories include urgent, soon and routine • They affect the patients position on the waiting list
  • Waiting lists are highly visible representations of a rationed resource, but what features make them appear to be a sign of failure or underfunding? • The growing number of people on NHS waiting lists • The long time that some people have to wait
  • Walk-in-Centre
  • NHS Walk-in Centres • Introduced as a means of improving access to primary care • Based in high streets, shopping centres, near railways stations, bus stations and airports • Quick access to services, including assessment, treatment for minor injuries, advice and information • No appointment necessary • Centres are open outside normal surgery hours • Led by nurses, working within protocols, where appropriate • The centres refer patients to other services, including general practice, social services, and accident and emergency Walk-in centres were criticised for several reasons: • They failed to assess patients properly • Undermined general practice, disrupting the continuity of care and the gate- keeper role of GPs • They raise costs, as referrals increase and services are duplicated
  • What are the opening times for NHS walk-in centres NHS WiCs providing services throughout the whole year. Most centres are open seven days a week some even open 24 hours a day. The opening times may vary to fit local circumstances. • General opening times: 7am – 10pm Monday - Friday 9 am – 10pm Saturday - Sunday
  • What can I expect from my NHS walk-in centre? • NHS WiCs give you fast access to health advice and treatment. There are now around 93 NHS WiCs throughout England that offer: • treatment for minor illnesses and injuries, • assessment by an experienced NHS nurse, • advice on how to stay healthy, • information on out-of-hours GP and dental services, • information on local pharmacy services, and • information on other local health services.
  • NHS Direct
  • NHS Direct • It is a nurse healthcare information and advisory service • It is a telephone service, providing 24 hour cover 7 days a week • It can also be accessed via the internet: NHS direct • NhS direct is heavily used, 6 million calls in 2005 However it has been criticised for: • Inconsistent advice • Ability of service to deal with rare conditions • Expensive, consultations cost £18 • Consultation with GP costs £14 • Accessed more by those sections of the population who generally enjoy better health
  • NHS Direct
  • NSF (National Service Framework)
  • National Service Framework (NSFs) These cover some of the highest priority conditions such as the UKs biggest killers-cancer and coronary heart disease. There are also NSFs for some o the key patient groups including children and older people. NSFs have two main roles: • Set clear quality requirements for care based on the best available evidence of what treatments and services work most effectively for patients • Offer strategies and support to help organisations achieve these. • One of the main strengths of each NSF is that they are inclusive- developed in partnership with health professionals; patients, carers, health services managers; voluntary agencies and other experts.
  • There are currently NSFs for: • Cancer • Coronary Heart Disease • Diabetes • Long term Conditions • Mental Health • Older people • Renal services
  • PALS (Patient Advise and Liason Service)
  • New Patient Advice and Advocacy Services • The NHS Plan announced the creation of a Patient Advocacy and Liason Service (PALS) in every trust by 2002. There core functions were as follows: • To be identifiable and accessible to patients, carers, friends and families • To provide on-the-spot help • To provide relevant information or support • To act as a gateway to independent advice and advocacy support • To act as a catalyst for improving services, linking closely with clinical governance systems • To support staff in developing a culture more responsive to patients and their families • To promote a seamless service, with PCT and PALS leading on issues cutting across primary, secondary and social care • The government acknowledged that PALS would not provide independent advocacy. • Consequently the Health and Social Act 2001, introduced an independent complaints advocacy service (ICAS). ICAS provide independent support for those wishing to complain about services.
  • PASA (Purchasing & Supply Agency)
  • Purchasing and Supply Agency
  • SCR (Summary Care Record)
  • SCR Summary Care Record (SCR) is an electronic summary of key health information. It will hold limited essential information derived initially from the patient’s GP record. This will include medication, adverse reactions and allergies and a patient’s significant medical history . The NHS Care Records Service (CRS) ia a secure service that links patient information from different parts of the NHS locally so that authorised staff and patients have the information they need to make care decisions. There are two elements to NHS CRS: 1) Detailed receords (held locally) 2) SCR – held nationally
  • Thank You! Any Questions?