There is a crisis in the National Health Service (NHS). The publication of the
Health and Social Care Bill last week heralds dramatic changes for the NHS, which will affect the way public health and social care are provided in the UK. Those changes alone will have huge impact, but it is the formation of an NHS Commissioning Board, and commissioning consortia, that will once and for all remove the word “national” from the health service in England. The result, due to come into force in 2013, will be the catastrophic break up of the NHS.
Maintaining the status quo in the NHS is not an option. The NHS is not delivering the care that patients need. Patients with cancer, for example, are less likely to survive in the UK than in Australia, Canada, Sweden, or Norway. Michel Coleman and colleagues' Lancet Article, published last month, reports that the survival of patients with primary colorectal, lung, breast, or ovarian cancer is lower in the UK than in other countries with similar wealth, universal access to health care, and good cancer registration data. Survival is, they argue, “the key index of the overall effectiveness of health services in the management of patients with cancer”.
Despite the huge sums of money pumped into the NHS over the past few years—particularly into the salary budget for staff—translation into benefits for patients is hard to identify. Moreover, the unyielding mountain of bureaucracy that is integral to the NHS stifles innovation, such that it is difficult to design the services needed for local populations.
Will the changes outlined in the Health and Social Care Bill solve these problems within the NHS and improve care for patients? The truth is that we do not know. What we do know is that putting general practitioners (GPs) in charge of commissioning health services for their patients is similar, in some respects, to the fundholding experiment in the 1990s. The principle then was that GPs controlled the budgets to buy the specialist care their patients needed. Fundholding took years to implement, but evidence on short-term or long-term benefits for patients is lacking. In the current Bill, health outcomes, including prevention of premature death, will be the responsibility of the NHS Commissioning Board, which has been asked to publish a business plan and annual reports on progress. That business plan is urgently needed to allow transparent appraisal of how the Board plans to monitor patients' outcomes.
The UK coalition Government has now been in power for about 8 months. Neither the Conservatives nor the Liberal Democrats included the formation of an NHS Commissioning Board, or GPs' commissioning consortia, in their health manifestos on which the electorate voted. The speed of the introduction of the Health and Social Care Bill is surprising, especially given the absence of relevant detail in the health manifestos. The Conservatives promised, if elected, to scrap “politically motivated targets that have no clinical justification” and called themselves the “party of the NHS”—a commitment that seems particularly hollow now.
Since its establishment in July, 1948, the aim of the NHS has been to offer a comprehensive service to improve health and prevent illness, available to all in England and Wales (and then extended throughout the UK), which is largely free of charge. Health care for all, for free, has been the common ethos and philosophy throughout the NHS. On July 3, 1948, in an editorial entitled “Our Service”, The Lancet commented: “Now that everyone is entitled to full medical care, the doctor can provide that care without thinking of his own profit or his patient's loss, and can allocate his efforts more according to medical priority. The money barrier has of course protected him against people who do not really require help, but it has also separated him from people who really do.” Now, GPs will return to the market place and will decide what care they can afford to provide for their patients, and who will be the provider. The emphasis will move from clinical need (GPs' forte) back to cost (not what GPs were trained to evaluate). The ethos will become that of the individual providers, and will differ accordingly throughout England, replacing the philosophy of a genuinely national health service.
Health professionals cannot say that no change is needed—it most certainly is. But there is sufficient uncertainty and concern about the changes outlined in the Health and Social Care Bill to pause, to learn from the past, and to consider what the changes mean for patients' outcomes. As it stands, the UK Government's new Bill spells the end of the NHS.
댓글 목록
도키
부가 정보
관리 메뉴
본문
글에서 지적한 바처럼 선거 때 NHS의 이런 개정을 공약으로 내세운 바가 없는데 진행되는 속도를 보면 기가 막힐 정도입니다. 이걸 어떻게 막을 수 있을까 생각해보면, 'nobody'가 답일 정도. 영국의사협회에서 반대하고 나서서 3월 중순에 회원 총회를 소집한다는데, GP가 반대를 해도 이 정책이 달라질 것 같지는 않아요.핵심은, 이윤을 추구하는 영리민간기업이 의료서비스를 제공하는 데 어떤 제한도 두지 않는다는 점인데, 이를 위해 지난 노동당 정부에서 이미 길을 닦아 놓았기 때문에 걸릴 게 아무 것도 없죠. 게다가 노동당 정부에서 NHS 내부의 '지나친 관료화'를 남겼다는 평가에 대해서 부정할 수가 없기 때문에 보수/자민 연정의 논리에 대항할 게 없습니다.
결론적으로 nhs의 '정신'은 사라졌는가, 라고 물으면, yes라고 말할 수밖에 없을 듯해요. 이게 단지 잉글랜드에 한정된 일이라서 그나마 다행이라고나 할까. 어쩌면 이미 잉글랜드 인민 아니 중산층의 영혼은 진작 다 투기자본의 노예가 되어 버렸는지도.
비관적인 견해지만 국경 너머 이를 바라보고 있는 제 심정은 이렇습니다.