Health in The United Kingdom - Healthcare in England

Healthcare in England

Most healthcare in England is provided by the National Health Service (NHS), England's publicly funded healthcare system, which accounts for most of the Department of Health's budget (£98.6 billion in 2008-9). The actual delivery of health care services is managed by ten Strategic Health Authorities and, below this, locally accountable trusts and other bodies. Social care services are a shared responsibility with the local NHS and the local government Directors of Social Services under the guidance of the DH. From the birth of the NHS in 1948, private healthcare has continued to exist, paid for largely by private insurance. In recent years, despite some evidence that a large proportion of the public oppose such involvement, the private sector has been used to increase NHS capacity. In addition, there is some relatively minor sector crossover between public and private provision with it possible for some NHS patients to be treated in private healthcare facilities and some NHS facilities let out to the private sector for privately funded treatments or for pre- and post-operative care. However, since private hospitals tend to manage only routine operations and lack a level 3 critical care unit (or intensive therapy unit), unexpected emergencies may lead to the patient being transferred to an NHS hospital as very few private hospitals have a level 3 critical care unit (or intensive therapy unit), putting the patients at greater risk and costing the NHS money.

The two main kinds of trusts in the NHS, reflecting purchaser/provider roles, are commissioning trusts such as Primary Care Trusts which examine local needs and negotiate with providers (that may be public or private entities) to provide health care services to the local population, and provider trusts which are NHS bodies delivering health care service. They will be involved in agreeing major capital and other health care spending projects in their region. Services commissioned include general practice physician services (most of whom are private businesses working under exclusive contract to the NHS), community nursing, local clinics and mental health service. For most people, the majority of health care is delivered in a primary health care setting. Provider trusts are care deliverers, the main examples being the hospital trusts and the ambulance trusts which spend the money allocated to them by the commissioning trusts. Hospitals, as they tend to provide more complex and specialized care, receive the lion's share of NHS funding. The hospital trusts own assets (such as hospitals and the equipment in them) purchased for the nation and held in trust for them. Commissioning has also been extended to the very lowest level enabling ordinary doctors who identify a need in their community to commission services to meet that need. Primary care is delivered by a wide range of independent contractors such as GPs, dentists, pharmacists and optometrists and is the first point of contact for most people. Secondary care (sometimes termed acute health care) can be either elective care or emergency care and providers may be in the public or private sector, though the majority of secondary care happens in NHS owned facilities.There are also (as of 2009) 246 Memory clinics in the United Kingdom.

The NHS Constitution covers the rights and obligations of patients and staff, many of which are legally enforceable. The NHS has a high level of popular public support within the country: an independent survey conducted in 2004 found that users of the NHS often expressed very high levels satisfaction about their personal experience of the medical services they received: 92% of hospital in-patients, 87% of GP users, 87% of hospital outpatients, and 70% of Accident and Emergency department users. However, only 67% of those surveyed agreed with the statement "My local NHS is providing me with a good service”, and only 51% agreed with the statement “The NHS is providing a good service. Satisfaction in successive surveys has noted high satisfaction across all patient groups, especially recent inpatients, and user satisfaction is notably higher than that of the general public. The report found that most highly recalled sources of information on the NHS are perceived to be the most critical. The national press was seen to be the most critical (64%), followed by local press (54%) and TV or radio (51%) compared to just 13% saying the national press is favourable). The national press was reported as being the least reliable source of information (50% reporting it to be not very or not at all reliable, compared to 36% believing the press was reliable). Newspapers were reported as being less favourable and also less reliable than the broadcast media. The most reliable sources of information were considered to be leaflets from GPs and information from friends (both 77% reported as reliable) and medical professionals (75% considered reliable).