OverviewOverview ofof thethe

BritishBritish HealthHealth SystemSystem

Grzegorz Chodkowski (MD)Grzegorz Chodkowski (MD)

Riga, Radisson SAS

2009

A famous TV star ?

A popular writer ?A top model ?

Your Future BOSS !

NO !

Andy Burnham – Secretary of State for Health

He is …

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

- NHS

Private

(Independent)

• 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 Sector

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 paystaff. A further 20% pays for drugs and othersupplies, with the remaining 20% split betweenbuildings, equipment and training costs on theone hand and medical equipment, catering andcleaning on the other.

Nearly 80% of the total budget is distributed by local trusts in line with the particular healthpriorities 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

• School nurses

• Speech and language specialists

• Infection control nurse

• Smoking cessation co-ordinators

• Physiotherapist

• Continence nurse

• Rehabilitation care professionals

• Palliative care professionals

• Wheelchair/equipment provision

• Health promotion practitioners

• Dieticians

• Specialist nurses

The PCTs are now at the centre of the NHS and control

80%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 UKsbiggest killers-cancer and coronary heart disease. There are also NSFsfor 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 LiasonService (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

ThankThank YouYou!!

AnyAny QuestionsQuestions??