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HEALTH CARE DELIVERY IN UK

Moderator-----Dr B.S.GargPresenter-------Dr Rashmi

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FRAMEWORK

Introduction History Trends And development Health care In four areas of UK Understanding NHS High quality care for all Current Health Issues in UK Challenges for India References

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INTRODUCTION

Total Population – 64.596m--- (July 1 2014*) 0.88% of the total world population. Female-32.803m Male-31.793m Ranks 22nd in the list of countries by population Decentralised Government in Wales(4.8%),Scotland (8.4%),England (84%) and

Northern Ireland (2.9%) Each having Publicly Funded health Care Private sector is in smaller stage Healthcare has 18 % of citizen’s income tax i.e.4.5 % of average citizen’s Income

*Source-www.worldometers.info/world-population/uk-population/)

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FIGURE 1: LIFE EXPECTANCY AT BIRTH, UNITED KINGDOM, 1980-1982 TO 2011-2013

Soource-National Life Tables, United Kingdom, 2011-2013, Statistical Bulletin

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HISTORY

1911- David Lloyd George Introduced National Insurance Act– small amount was deducted from employee’s wage in return of free healthcare.

But it was restricted to individual worker only Health care was restricted to wealthy, or free treatment seekers through

charity or teaching hospitals After 1945-a public health care system was launch- services were provided

at the point of need, financed from central taxation and with equity. 1946-48The National Health service(NHS) was founded-Responsible for

Public healthcare sector of UK 1970-74 System was splitted into three areas of care –1. Hospital services,2. Primary care and3. Community services.

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HISTORY……CONTINUED

1974—Reorganization to support all three areas of care 1990- The National Health Services and community care act---independent trusts

managing hospital care. Over sixty years- NHS Aim—Improve healthcare standards ,Lower costs and Waiting

times 1999- National Institute for Health and Clinical Excellence(NICE)-develops national

guidelines and standards for NHS 2010-NHS Vision-”Equity and excellence, Liberating the NHS.” 2012-Health and Social care act 2013 April - Clinical commissions group after legislative changes from the act 2014-dissolved current government management structure 80% budget turned to doctors –to encourage on going privatization since 2002

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TRENDS AND DEVELOPMENT Figure2:Total healthcare expenditure in the UK, 1997 to 2013

Source-Expenditure on Healthcare in the UK, 2013Author Name(s): James Lewis and James Cooper,office for National statitics

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FIGURE 3: TOTAL HEALTHCARE EXPENDITURE PER PERSON, 1997 TO 2013

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FIGURE 4: TOTAL HEALTHCARE EXPENDITURE AS A PERCENTAGE OF GDP, 1997 TO 2013

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FIGURE 5: PUBLIC AND PRIVATE SECTOR HEALTHCARE EXPENDITURE IN THE UK, 1997 TO 2013

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FIGURE 6: PUBLIC SECTOR HEALTHCARE EXPENDITURE AS A SHARE OF TOTAL HEALTHCARE EXPENDITURE IN THE G7 COUNTRIES

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FIGURE-7: HOUSEHOLD FINAL CONSUMPTION EXPENDITURE

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NHS IN FOUR AREAS OF UK Northern Ireland- - Health and Social Care Health and Social care Board-- five professional groups Medical and Allied Services Social Services Inspectorate Nursing and Midwifery Advisory Group Dental Services, Pharmaceutical Advice and Services○ No providers competition ○ Primary care – 350 GP Practices2010- Abolished prescription and hospital Parking charges

Wales--- NHS Wales 1946- Created by National Health Service

Act 1969-Came under the Secretary of wales 1999-NHS Wales was passed to the Welsh

Assembly and the Government due to decentralization

Three NHS trusts- Emergency, cancer care and Public health services

use of performance targets2007- Abolished prescription and Hospital parking charges

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Scotland---NHS Boards Provision of a paramedic-led accident and

emergency service in respond to 999 call free social care for 65so Scottish Ambulance Service -o The patient non-emergency transport service & o to physically or medically unfit to travel to

hospital out-patient appointments by any other means

o Transport vehicles - handled by Ambulance Care Assistant trained in Basic Emergency Services

Air ambulance division-to & fro of patients from remote areas of scotland

2011- prescription and hospital parking charges abolished

use of performance targets and applied sanctions for poor performance from 2006

England ( NHS England) England's publicly funded healthcare

system Accounts for most of the Department of

Health’s budget (£110 billion in 2013-14) Deals 1 million patients every 36 hours

(NHS,England May 2013) Made up of Number of organisations

specialising different types of patients services ,Eg Clinical commissioning Group

90 % of prescriptions are dispensed free charge per item paid £8.05 Paid Hospital parking charges. uses performance targets and applied

sanctions for poor performance

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NATIONAL HEALTH SERVICES (NHS-1948) 1942-first parliamentary proposal in Beveridge Report on social Insurance and allied services Operational on 5Th July 1948 Largest employer In UK(1.3m staff) World’s largest publicly-funded health service. Aims—Good health care should be available to all citizens, regardless of their income. Objective–To improve outcomes for people, and in all indicators Focus-Diagnosis and treatment of disease, preventing ill health and improving the

physical and mental health of the population.Rehabilitaion & Palliative care. Responsibilities and shared values of NHS are mentioned in NHS constitution. Operationally independent from Dept. Of the Health with The secretary of state Health Dept.– Develops policies ,strategies ,monitors performance and sets national stds. Web site-www.nhs.uk

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HOW IT FLOWS

Respect And dignity Improving Lives Commitment to quality of careWorking together for patients compassion everyone counts

Prioritise patients in every decision listen and learn Evidence basedOpen and Transparent Inclusive strive for Improvement

Create culture and Conditions for Health and care services and staff to deliver the highest standard of care and ensure that valuable public resources are used

effectively to get the best outcomes for individuals, communities and society for now and for future generation

Everyone has greater control of their wellbeing, supported to live longer,healtheir lives by high quality health and care services that are

compassionate, inclusive and constantly improving

High Quality care for all now, and for future Generations

values

Behaviours

Purpose

Vision

Mission

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NHS CONSTITUTION (DEPT. OF HEALTH-2011)

It comprises of THE RIGHTS which the Citizens are entitled and THE PLEDGES the NHS is committed to achieve.

It belongs to people, Provides a comprehensive Service available all Irrespective of gender,race,disability, age, sexual orientation, religion or Belief, gender reassignment, pregnancy and maternity or marital or civil partnership status.

Responsibility Of NHS and staff- Good medical outcome, safe care and good patient experience

Gives protection to the NHS against political change

http://www.nhs.uk/Constitution

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PROVIDING CARE Primary care- First contact for physical mental health and wellbeing of patient Include– 36000 GPs all over England , Non urgent cases --dentists, opticians and pharmacists. Urgent care Providers -accident and emergency Dept. Patients have rights to choose the service providers. Community based care -Increasingly preferred Long term care-Community Care Act

1990 reduced government role to only covering nursing services Most LTC takes place in private sector State Equity Release Scheme-1st October 2001 permanent resident in a care home in England need not sell their own home to fund

their long term care fees. NHS Funding NHS providers Organizations ,Charities ,Private Organizations and Social enterprises.

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NHS TRUSTS Primary Care Trusts (PCT's) >300 PCTs covering all parts of England since April 2002,

which report directly to their local Strategic Health Authority,80% of NHS budgetResponsibility- Assessing the health needs of the local community. Commissioning the right services, for instance from GP practices, hospitals and

dentists. Improving the overall health of their local communities

Mental health NHS trusts (60) -oversee 1,600 NHS hospitals and specialist care centres, and Mental health care

NHS Foundation trusts (115) -Highest performing NHS hospital., Run by local managers ,staff and members of public

NHS Ambulance services trusts.(12)-- provides Emergency vehicles. NHS care trusts -provide care in both health and social fields. Agencies under the umbrella of the NHS.- National Institute for Health and Clinical

Excellence (NICE) and National Institute of Health Research( NIHR)

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COMMISSIONING CARE Organisation 0f Clinical commissioning group ( CCG), 2012 Act replaced PCTs in England with 211 CCG AIM-Improve health outcomes and deliver high quality care for people Responsibilities –Assessing and providing needs of population Primary care—All GP’s members of CCG Specialised healthcare services -NHS trusts and foundation hospitals Accounts for around 10% of the total NHS budget Health services for serving personnel and families in the armed forces Health services for people of prison or other secure accommodation, and for victims of sexual assault (adults and children ) Single organisation with 27 Area team across England serving 250,000 people/team

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PREDICTIVE, PREVENTIVE AND PERSONALISED MEDICINE (PPPM) IN NHS

Directed by Public health-offered by GP,Community services or Hospitals Predictive and personalised medicine -NHS choices website, Quality emphasis for early diagnosis eg Telemedicine Preventive services- Cancer Screening Programmes Child health promotion Programme-Community midwifery &visiting teams Immunisation programmes Specific preventive programmes in local schools and community Family planning services,STI prevention Healthy eating and Physical activities Health promotion for older people

LOCAL AUTHORITIES

Local council– Responsibilities in Public and social care They can report directly to State Health Secretory if Unsatisfied with

services or any feedback Work as a Health and wellbeing board Members –Directors of Public health, Adult social services and of

children’s services and CCGs representatives. Assessment of health and social care needs of local community is

done through –Joint strategic Needs assessments(JSNAs) JSNAs Principle -Analysing the available evidence on local community's

health and social care.

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PUBLIC HEALTH –Public health England (PHE) April2013 Independent executive agency of health department Supports local authority to improve public health Main functions 1. Health Protection2. Health improvement3. Knowledge and information4. Operations. SOCIAL CARE- Care and support Helps people to maintain their independence and wellbeing. Enabling them to play fuller part in society Protecting vulnerable people.

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Source-Guide for everyone working and training within the NHS

83% taxes 13% Employer-employee contributions4% users Fees

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HIGH–QUALITY CARE FOR ALL Quality- Excellence in patient safety, clinical effectiveness and patients experience

Domain 1 Domain 2 Domain 3

Preventing people from dying prematurely

Enhancing quality of life for people with long term conditions

Helping people to recover from episodes of ill health or following injury

Domain 4 Ensuring people have a positive experience of care

Domain5Treating and caring people in a safe environment and protecting them from avoidable harm

Effectiveness

Experience

Safety

KEY CONCEPTS OF UK HEALTH SYSTEM UK system has realized that it is more efficient to spend money on 1o care rather

than 2o careFocus on health promotion, disease prevention and managementWhen you focus on 1o care, you eliminate much of the demand on 2o care – with

the resultant cost savings being used to fund further 1o care developmentPatients can see a primary healthcare provider within 24hrs of requesting an

appointment (48hr to see their GP) Increased workplace satisfaction for all involved healthcare professionalsPatients receive care from the most appropriate health care professionalAdaptable option for physician payment especially in rural areaso Quality assurance By-o High Quality Care for All’ (since 2007)

The Care Quality Commission( 2009)28

CURRENT ISSUES IN THE UK

Aging population High cost of advanced technology and its impact on tight budgets Increased incidence of serious patients ( Cancer, Neurological

disorders) Obesity,CVD and diabetes burden increasing Expensive to treat chronic diseases(16% total NHS expenditure) On-going problems with long queues and waiting periods e.g. Wales

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CHALLENGES FOR INDIA Health care provider attitude Patient attitudes Funding Lack of resources,(human& financing) Rigidity towards change Mutual Respect Lack of trust Fear of failure No focus on small continual change Lack of IT system India is Improving though slow implementation of policies

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REFERENCES Expenditure on Healthcare in the UK, 2013 Author Name(s): James Lewis

and James Cooper, office for national statistics The UK Health Care System, Josh Chang, Felix Peysakhovich, Weimin Wang,

Jin Zhu The four UK health systems Learning from each other, Nicholas Timmins United Kingdom (England) Health system review,vol13 no.1 2011 NHS: U.K. Health care System Information in England,2013 NHS funding and expenditure -Standard Note: SN/SG/724 Last updated: 03

April 2012 ,Author: Rachael Harker, Social and General Statistics . UNDERSTANDING THE NEW NHS,A guide for everyone working and training

within the NHS, 26 June 2014, Author NHS England.

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“If you don’t take change by the hand, it will grab you by the throat”

-Winston Churchill

THANK YOU

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