Received 2010 Sep 1; Accepted 2010 Sep 27; Issue date 2010 Dec.

. The National Health System in the UK has actually developed to become one of the largest health care systems on the planet. At the time of writing of this evaluation (August 2010) the UK government in its 2010 White Paper "Equity and excellence: Liberating the NHS" has actually announced a method on how it will "create a more responsive, patient-centred NHS which accomplishes results that are among the very best on the planet". This evaluation article provides an introduction of the UK health care system as it presently stands, with emphasis on Predictive, Preventive and Personalised Medicine components. It intends to serve as the basis for future EPMA posts to expand on and present the modifications that will be executed within the NHS in the upcoming months.

Keywords: UK, Healthcare system, National health system, NHS

Introduction

The UK health care system, National Health Service (NHS), came into presence in the consequences of the Second World War and became functional on the 5th July 1948. It was very first proposed to the Parliament in the 1942 Beveridge Report on Social Insurance and Allied Services and it is the legacy of Aneurin Bevan, a former miner who became a political leader and the then Minister of Health. He founded the NHS under the principles of universality, totally free at the point of shipment, equity, and paid for by central financing [1] Despite various political and organisational changes the NHS stays to date a service readily available generally that looks after people on the basis of need and not capability to pay, and which is moneyed by taxes and nationwide insurance contributions.

Healthcare and health policy for England is the responsibility of the central federal government, whereas in Scotland, Wales and Northern Ireland it is the obligation of the respective devolved governments. In each of the UK nations the NHS has its own unique structure and organisation, however in general, and not dissimilarly to other health systems, health care comprises of 2 broad sections; one handling strategy, policy and management, and the other with actual medical/clinical care which is in turn divided into primary (community care, GPs, Dentists, Pharmacists and so on), secondary (hospital-based care accessed through GP recommendation) and tertiary care (specialist healthcare facilities). Increasingly differences in between the 2 broad sections are becoming less clear. Particularly over the last decade and directed by the "Shifting the Balance of Power: The Next Steps" (2002) and "Wanless" (2004) reports, steady modifications in the NHS have actually led to a greater shift towards regional instead of central choice making, elimination of barriers between main and secondary care and stronger focus on patient option [2, 3] In 2008 the previous federal government strengthened this direction in its health technique "NHS Next Stage Review: High Quality Look After All" (the Darzi Review), and in 2010 the current government's health technique, "Equity and quality: Liberating the NHS", stays supportive of the very same ideas, albeit through potentially different mechanisms [4, 5]

The UK government has actually just revealed strategies that according to some will produce the most extreme change in the NHS since its creation. In the 12th July 2010 White Paper "Equity and excellence: Liberating the NHS", the current Conservative-Liberal Democrat union government laid out a method on how it will "produce a more responsive, patient-centred NHS which achieves results that are among the very best on the planet" [5]

This evaluation article will for that reason present an overview of the UK health care system as it presently stands with the aim to serve as the basis for future EPMA posts to broaden and provide the changes that will be executed within the NHS in the forthcoming months.

The NHS in 2010

The Health Act 2009 established the "NHS Constitution" which formally combines the function and principles of the NHS in England, its worths, as they have been developed by patients, public and personnel and the rights, promises and obligations of patients, public and staff [6] Scotland, Northern Ireland and Wales have actually likewise concurred to a high level declaration declaring the concepts of the NHS across the UK, despite the fact that services may be provided differently in the four countries, reflecting their different health needs and scenarios.

The NHS is the biggest company in the UK with over 1.3 million staff and a budget plan of over ₤ 90 billion [7, 8] In 2008 the NHS in England alone employed 132,662 physicians, a 4% boost on the previous year, and 408,160 nursing staff (Table 1). Interestingly the Kings Fund approximates that, while the total number of NHS staff increased by around 35% in between 1999 and 2009, over the same duration the number of managers increased by 82%. As a percentage of NHS staff, the variety of managers rose from 2.7 percent in 1999 to 3.6 percent in 2009 (www.kingsfund.org.uk). In 2007/8, the UK health spending was 8.5% of Gross Domestic Product (GDP)-with 7.3% accounting for public and 1.2% for personal spending. The net NHS expense per head across the UK was lowest in England (₤ 1,676) and greatest in Scotland (₤ 1,919) with Wales and Northern Ireland at around the exact same level (₤ 1,758 and ₤ 1,770, respectively) [8]

Table 1.

The circulation of NHS workforce according to primary personnel groups in the UK in 2008 (NHS Information Centre: www.ic.nhs.uk)

The general organisational structure of the NHS in England, Scotland, Wales and Northern Ireland in 2010 is shown in Fig. 1. In England the Department of Health is accountable for the direction of the NHS, social care and public health and delivery of health care by developing policies and methods, securing resources, monitoring performance and setting national standards [9] Currently, 10 Strategic Health Authorities handle the NHS at a regional level, and Primary Care Trusts (PCTs), which currently manage 80% of the NHS' spending plan, offer governance and commission services, along with ensure the accessibility of services for public heath care, and provision of social work. Both, SHAs and PCTs will disappear once the plans outlined in the 2010 White Paper become carried out (see section listed below). NHS Trusts run on a "payment by outcomes" basis and get most of their income by providing health care that has actually been commissioned by the practice-based commissioners (GPs, and so on) and PCTs. The main kinds of Trusts consist of Acute, Care, Mental Health, Ambulance, Children's and Foundation Trusts. The latter were produced as non-profit making entities, without federal government control however also increased financial commitments and are managed by an independent Monitor. The Care Quality Commission regulates separately health and adult social care in England in general. Other specialist bodies supply financial (e.g. Audit Commission, National Audit Office), treatment/services (e.g. National Patient Safety Agency, Medicines and Healthcare Products Regulatory Agency) and expert (e.g. British Medical Association) policy. The National Institute for Health and Clinical Excellence (NICE) was established in 1999 as the body responsible for establishing nationwide standards and requirements connected to, health promo and avoidance, evaluation of brand-new and existing innovation (consisting of medicines and treatments) and treatment and care clinical assistance, offered across the NHS. The health research method of the NHS is being implemented through National Institute of Health Research (NIHR), the total budget plan for which was in 2009/10 close to ₤ 1 billion (www.nihr.ac.uk) [10]

Fig. 1.

Organisation of the NHS in England, Scotland, Wales and Northern Ireland, in 2010

Section 242 of the NHS Act mentions that Trusts have a legal responsibility to engage and include clients and the public. Patient experience information/feedback is officially collected nationally by annual study (by the Picker Institute) and belongs to the NHS Acute Trust performance framework. The Patient Advice Liaison Service (PALS) and Local Involvement Networks (LINks) support client feedback and participation. Overall, inpatients and outpatients studies have exposed that patients rate the care they get in the NHS high and around three-quarters show that care has been really great or exceptional [11]

In Scotland, NHS Boards have actually changed Trusts and supply an integrated system for strategic instructions, performance management and medical governance, whereas in Wales, the National Delivery Group, with guidance from the National Board Of Advisers, is the body performing these functions (www.show.scot.nhs.uk; www.wales.nhs.uk). Scottish NHS and Special Boards deliver services, with look after particular conditions delivered through Managed Clinical Networks. Clinical guidelines are released by the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium (SMC) recommendations on using new drugs in the Scottish NHS. In Wales, Local Heath Boards (LHBs) strategy, safe and provide healthcare services in their areas and there are 3 NHS Trusts supplying emergency, cancer care and public health services nationally. In Northern Ireland, a single body, the Health and Care Board is overseeing commissioning, performance and resource management and enhancement of health care in the country and six Health and Social Care Trusts provide these services (www.hscni.net). A number of health companies support secondary services and deal with a large variety of health and care issues consisting of cancer screening, blood transfusion, public health etc. In Wales Community Health Councils are statutory lay bodies advocating the interests of the general public in the health service in their district and in Northern Ireland the Patient and Client Council represent clients, customers and carers.

Predictive, Preventive and Personalised Medicine (PPPM) in the NHS