English Medicine
GELB, NORMAN
Lessons of the National Health Service English Medicine By Norman Gelb London A Notice from Britain’s National Health Service (NHS) recently mailed to everyone in the London borough where I...
...A spokesman for the pressure group Health Emergency chided, “You can have all the constitutions, charters, warm words, and PR stunts that you like, but until we get more beds and staff in place...
...Prescribed medication is free for children under 16, people receiving unemployment benefits and seniors...
...Yet from its creation in 1948, the NHS has made available to all Britons health care that in America is denied to millions and forces countless others to dig deep into their pockets...
...How, it is asked, can the NHS go on doing business as usual when the International Monetary Fund recently forecast that, among the world’s advanced economies, Britain will be hit hardest by the current international recession...
...Questions are being asked about whether patients will actually be able to exercise their specified rights...
...A London doctor once briskly told me it was none of my business when I asked how a medication he prescribed worked...
...This amounts to partial privatization of the system, a description the Labor government shies away from...
...Some goals were met...
...Today, according to Dr...
...It has been argued that, if outsourcing some tasks to private enterprises seems the best way for the NHS to do its job as fully as possible, clearly people with related government and business experience are qualified to be involved...
...Successive British leaders here have sought in vain to correct the situation through reforms and restructurings...
...Still a practicing NHS surgeon, the Iraqborn Darzi maintains that patients are now genuinely being afforded the greater options and flexibility they want...
...IN VIEW OF the less than expected effectiveness of previous NHS reforms, the new constitution has not been greeted with universal acclaim...
...For nonurgent cases the maximum specialist waiting time is 18 weeks...
...At present the current government is trying its hand at doing the job...
...The Department of Health has just issued an NHS “constitution...
...Since the Labor Party rose to power 12 years ago, the government has significantly increased NHS funding...
...The King’s Fund, a charitable foundation that monitors public health matters here, says that “for the first time . . . hospitals will be held to account for the quality and outcomes of the care they provide...
...Consisting of private hospitals and some GP practices, the ISTCs handle diagnostic matters, surgery, psychiatric care, and nursing home management...
...To cut waiting times, for instance, the NHS has been outsourcing some of its tasks to Independent Sector Treatment Centers (ISTCs...
...Such disquiet is compounded by the disclosure that several former government figures who were instrumental in fashioning recent NHS changes have become associated with private companies in the health care industry...
...It further stipulates their right to choose the local medical group they want to join for regular care (neighborhood word-ofmouth tends to rank them) and to indicate the particular doctor in it that they prefer...
...But its opponents fear it is expanding stealthily, and the concentration on profit that drives commercial enterprises could in time introduce the profit motive into the basic NHS ethic...
...But once they gain British nursing credentials many of them move on quickly to better-paying jobs in the U.S...
...Aneurin Bevan, the creator of the NHS as Minister of Health in the Labor government that took power from Winston Churchill after World War II, would be enraged...
...What will happen, for example, if a highly touted oncologist or urologist attracts more patients than he can handle within the prescribed time frame...
...Each is authorized to decide how to offer the best care for the funding it receives from the government...
...But Deputy Health Minister Lord Darzi, one of the most active campaigners for improving patient choice, is optimistic...
...As the team assigned by President Barack Obama begins exploring the possibilities for creating a new, comprehensive American health care system, a close look by its members at where the NHS has succeeded, where it has failed, and the questions being asked about it would be instructive...
...It is meant to reassure Britons that the NHS will meet their needs better than it has in the past, and details how they can legally demand it to do so...
...Cancer and cardiac care were improved and waiting lists for nonacute treatment were substantially reduced...
...The rest pay a modest charge for each prescription (currently the equivalent of about $11), regardless of its cost...
...Perhaps the toughest challenge facing the British health system today, though, is coping with demands for a fundamental restructuring...
...THE COUNTRY’S current economic woes have heightened those concerns...
...One of them, exLabor Health Secretary Patricia Hewitt, is now an adviser to a private hospital and health care outf it...
...The British Medical Association, representingthe country’s doctors, insists, “ We need more than a ‘feel-good’ document...
...But the price of those successes, partly achieved by increasing doctors’ pay (excessively, many complain) for working longer hours, and expanding managerial staffs, devoured much of the additional funding and greatly limited the expected benefits for the system as a whole...
...Every Briton has free access to GPs, specialists, an ambulance when needed, hospitalization, and several forms of therapy...
...Britain has to recruit nurses from Third World countries to make up for its domestic shortfall...
...Hence the new constitution...
...Nevertheless, the expansion of market forces into the medical system here is being increasingly accepted as essential if it is to fulfill its originally intended role...
...Those found to have urgent conditions, such as cancer or heart disease, are to come under the care of a specialist within two weeks...
...They are part of a program designed not only to expand the availability of free medical care at all levels, but also to convince Britons that the government is determined to overcome stubbornly persistent shortcomings in the national health system...
...Simon Griffiths, coauthor of Assertive Citizens: New Relationships in the Public Services, patients can tell their general practitioner that they Googled what they think their ailments are and the treatment they want...
...With people living longer and the cost of medical equipment and drugs constantly soaring, however, it has been virtually impossible for the NHS to fully meet all the challenges it faces...
...It is doubtful that the . . . constitution will be any match for the large corporate interests currently looking to run NHS services...
...and Canada...
...The reaction of GPs to patients invoking their new constitutionally enshrined rights remains to be seen...
...The inroads privatization has made are still small compared to the range and depth of NHS services...
...The government hopes the new NHS innovations will eventually put an end to troubling tales of lengthy waiting lists for elective surgery, dissatisfaction with the treatment administered, reluctance to prescribe high cost medications, sharp variations in the quality of service in different areas of the country, the questionable state of some hospitals, and the limited hours of local GP practices...
...All patients are to receive any appropriate medication approved by the National Institute for Health and Clinical Excellence (NICE), which determines the medicines to be made available in the NHS...
...Yet perhaps inevitably, given its vast undertaking, it has been plagued by problems despite massive injections of taxpayer money and the employment of more people than any other organization in the world, except the Chinese People’s Liberation Army and the Indian Railways...
...How can a patient’s right to “dignity and respect” be assured when a chronic shortage of nurses sometimes strains the care in hospital wards...
...The director of the NHS Support Foundation, an independent organization, has said: “The government is placing commercial values at the heart of the NHS...
...Some practices had been withholding more expensive medications for budgetary reasons, despite their NICE approval...
...Some alternative medicine procedures, including acupuncture, are available too...
...The same is said to hold true for doctors and is claimed to herald an uprooting of the “doctor always knows best” culture...
...patient choice will remain a sick joke...
...The grandly named charter sets out an updated statement of what patients and staff may expect from their health service...
...Lessons of the National Health Service English Medicine By Norman Gelb London A Notice from Britain’s National Health Service (NHS) recently mailed to everyone in the London borough where I live announced: “We are making it easier to see your doctor and get the services you need...
...Similar improvements are being introduced throughout the country...
...In addition, it said more “surgeries”—as doctors’ offices are called here—would be opened at two local hospitals to supplement their hard-pressed Accident and Emergency clinics and provide urgent care 24/7...
...Trust administrators, responsible for fulfilling the ambitious objectives set for them, insist they are better positioned to do so by using and paying for “extra capacity in the private sector...
...Nevertheless, profit-oriented commercial enterprises may be well positioned to expand their influence on the direction the NHS will be taking in troubled economic times...
...It tells Britons they have the legal right to be treated “by appropriately qualified and experienced staff ” that “meets required levels of safety and quality” and “to be treated with dignity and respect...
...Norman Gelb reports regularly for The New Leader on British affairs...
...For administrative purposes, the NHS is divided into 152 geographically defined “trusts...
...After being diagnosed as requiring hospitalization, they have the right to select the one judged best for their condition...
...It went on to list the medical groups, including mine, that would be staying open evenings and weekends...
...The NHS has been in existence for over 60 years and is deeply ingrained in the British way of life...
...Another is Simon Stevens, a health care adviser to former Prime Minister Tony Blair and now a senior executive of the American UnitedHealth group, which has substantial interests in Britain...
...Individuals can discover online which hospitals, across the country, specialize in the treatment of particular ailments and how each is rated by experts and by patients...
Vol. 92 • January 2009 • No. 1
