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  1. Unlike in Scotland and Wales which have devolved healthcare, NHS England is run on behalf of the taxpayer by the UK Parliament and the Department of Health, at the head of which is the Secretary of State for Health. The group charged in England and Wales with checking if the care delivered by the NHS is genuinely safe and fit for purpose is the Care Quality Commission, or CQC. Although the CQC describes itself as the "independent regulator of all health and social care services in England", it is in fact "accountable to the public, Parliament and the Secretary of State for Health." and much of its funding comes from the taxpayer. At least one chairman, one chief executive and a board member of the CQC have been singled out for attention by a UK Secretary of State for Health. There is therefore the potential for a conflict of interest, as both the NHS and the CQC have the same leadership and both are highly susceptible to political interference. wikipedia.org
  2. Those who can afford it sometimes opt for private healthcare, usually to get treated more quickly in private facilities (i.e. facilities not provided by, or using, NHS staff or services). When this occurs, these patients are opting to pay twice for their health care, once for the NHS through taxes, and again for the private care they are using. Critics argue that these people do use NHS services, such as their General Practitioner, screening, and vaccination services, and that their opting out from time-to-time is effectively queue jumping because they are utilising a resource ahead of someone in greater need and that their double payment is the penalty for queue jumping. It is argued that it is a civic responsibility for every citizen capable of paying legally applicable levels of tax, to do so, regardless of service use. Therefore, the public services can be subsidised for those who wish to use them - economically, the more people who pay taxes, the less cost to each individual concerned. wikipedia.org
  3. Several high-profile medical scandals have occurred within the NHS over the years such as the Alder Hey organs scandal and the Bristol heart scandal. At Alder Hey, there was the unauthorised removal, retention, and disposal of human tissue, including children’s organs, between 1988 and 1995. The official report into the incident, the Redfern Report, revealed that Dick van Velzen, the Chair of Foetal and Infant Pathology at Alder Hey had ordered the "unethical and illegal stripping of every organ from every child who had had a postmortem." In response, it has been argued that the scandal brought the issue of organ and tissue donation into the public domain, and highlighted the benefits to medical research that result. The Stafford Hospital scandal in Stafford, England in the late 2000s concerned abnormally high mortality rates amongst patients at the hospital. Up to 1200 more patients died between 2005 and 2008 than would be expected for the type and size of hospital based on figures from a mortality model, but the final Healthcare Commission report concluded it would be misleading to link the inadequate care to a specific number or range of numbers of deaths. A public inquiry later revealed multiple instances of neglect, incompetence and abuse of patients. wikipedia.org
  4. Before the idea of ( Private Finance Initiative ) PFI came to prominence, all new hospital building was by convention funded from the Treasury, as it was believed it was best able to raise money and able to control public sector expenditure. In June 1994, the Capital Investment Manual (CIM) was published, setting out the terms of PFI contracts. The CIM made it clear that future capital projects (building of new facilities) had to look at whether PFI was preferable to using public sector funding. By the end of 1995, 60 relatively small projects had been planned for, at a total cost of around £2 billion. Under PFI, buildings were built and serviced by the private sector, and then leased back to the NHS. The Labour government elected under Tony Blair in 1997 embraced PFI projects, recognising that public spending needed to be curtailed. Under the Private Finance Initiative, an increasing number of hospitals have been built (or rebuilt) by private sector consortia, although the government also encouraged private sector treatment centres, so called "surgicentres". There has been significant criticism of this, with a study by a consultancy company which works for the Department of Health showing that for every £200 million spent on privately financed hospitals the NHS loses 1000 doctors and nurses. The first PFI hospitals contain some 28% fewer beds than the ones they replaced. As well as this, it has been noted that the return for construction companies on PFI contracts could be as high as 58%, and that in funding hospitals from the private rather than public sector cost the NHS almost half a billion pounds more every year. wikipedia.org
  5. The lack of availability of some treatments due to their perceived poor cost-effectiveness sometimes leads to what some call a "postcode lottery". NICE, the National Institute for Health and Care Excellence, are the first gatekeeper, and examine the cost effectiveness of all drugs. Until they have issued guidance on the cost and effectiveness of new or expensive medicines, treatments and procedures, NHS services are unlikely to offer to fund courses of treatment. The same of true of the Scottish Medicines Consortium, NICE's counterpart in Scotland. There has been considerable controversy about the public health funding of expensive drugs, notably Herceptin, due to its high cost and perceived limited overall survival. The campaign waged by cancer victims to get the government to pay for their treatment has gone to the highest levels in the courts and the Cabinet to get it licensed. The House of Commons Health Select Committee criticised some drug companies for bringing in drugs that cost on and around the £30,000 limit that is considered the maximum worth of one QALY (Quality-Adjusted Life Years) in the NHS. wikipedia.org
  6. There have been several fatal outbreaks of antibiotic resistant bacteria ("superbugs") in NHS hospitals, such as Methicillin-resistant Staphylococcus aureus (MRSA) Vancomycin Resistant Enterococci (V.R.E.) and Clostridium difficile. This has led to criticism of standards of hygiene across the NHS, with some patients buying private health insurance or travelling abroad to avoid the perceived threat of catching a "superbug" while in hospital. However, the department of health pledged £50 million for a "deep clean" of all NHS England hospitals in 2007. wikipedia.org
  7. In making health care a largely "invisible cost" to the patient, health care seems to be effectively free to its consumers - there is no specific NHS tax or levy. To reduce cost and ensure that everyone is treated equitably there are a variety of "gatekeepers." The GP ( General Practitioners ) functions as a primary gatekeeper - without referral from a GP, it is often impossible to gain higher courses of treatment, such as an appointment with a consultant. These are argued to be necessary - Welshman Bevan noted in a 1948 speech in the House of Commons, "we shall never have all we need... expectations will always exceed capacity". On the other hand, the national health insurance systems in other countries (e.g. Germany) have dispensed with the need for referral; direct access to a specialist is possible there. There has been concern about opportunistic "health tourists" travelling to Britain (mostly London) and using the NHS while paying nothing. British citizens have been known to travel to other European countries to take advantage of lower costs, and because of a fear of hospital-acquired superbugs and long waiting lists. NHS access is therefore controlled by medical priority rather than price mechanism, leading to waiting lists for both consultations and surgery, up to months long, although the Labour government of 1997-onwards made it one of its key targets to reduce waiting lists. In 1997, the waiting time for a non-urgent operation could be two years, there were ambitions to reduce it to 18 weeks despite opposition from doctors. It is contested that this system is fairer - if a medical complaint is acute and life-threatening, a patient will reach the front of the queue quickly. The NHS measures medical need in terms of quality-adjusted life years (QALYs), a method of quantifying the benefit of medical intervention. It is argued that this method of allocating healthcare means some patients must lose out in order for others to gain, and that QALY is a crude method of making life and death decisions. wikipedia.org
  8. Criticism of the National Health Service includes issues such as access, waiting lists, healthcare coverage, and various scandals. The National Health Service (NHS) is the publicly funded health care system of England, created under the National Health Service Act 1946 by the post-war Labour government of Clement Attlee. It has come under much criticism, especially during the early 2000s, due to outbreaks of antibiotic-resistant infections such as MRSA and Clostridium difficile, waiting lists, and medical scandals such as the Alder Hey organs scandal (The Alder Hey organs scandal involved the unauthorised removal, retention, and disposal of human tissue, including children’s organs, during the period 1988 to 1995). However, the involvement of the NHS in scandals extends back many years, including over the provision of mental health care in the 1970s and 1980s (ultimately part of the reason for the Mental Health Act 1983), and overspends on hospital newbuilds, including Guy's Hospital Phase III in London in 1985, the cost of which shot up from £29 million to £152 million. wikipedia.org
  9. Each NHS (National Health Service) system uses General Practitioners (GPs) to provide primary healthcare and to make referrals to further services as necessary. Hospitals then provide more specialist services, including care for patients with psychiatric illnesses, as well as direct access to Accident and Emergency (A&E) departments. Community pharmacies are privately owned but have contracts with the relevant health service to supply prescription drugs. The public healthcare system also provides free (at the point of service) ambulance services for emergencies, when patients need the specialist transport only available from ambulance crews or when patients are not fit to travel home by public transport. These services are generally supplemented when necessary by the voluntary ambulance services (British Red Cross, St Andrews Ambulance Association and St John Ambulance). In addition, patient transport services by air are provided by the Scottish Ambulance Service in Scotland and elsewhere by county or regional air ambulance trusts (sometimes operated jointly with local police helicopter services) throughout England and Wales. In specific emergencies, emergency air transport is also provided by naval, military and air force aircraft of whatever type might be appropriate or available on each occasion, and dentists can only charge NHS patients at the set rates for each country. Patients opting to be treated privately do not receive any NHS funding for the treatment. About half of the income of dentists in England comes from work sub-contracted from the NHS, however not all dentists choose to do NHS work. When purchasing drugs, the NHS has significant market power that, based on its own assessment of the fair value of the drugs, influences the global price, typically keeping prices lower. Several other countries either copy the U.K.'s model or directly rely on Britain’s assessments for their own decisions on state-financed drug reimbursements. Private medicine Private medicine, where patients, or their insurers, pay for treatment in the UK is a niche market. Some is provided by NHS hospitals. Private providers also contract with the NHS, especially in England, to provide treatment for NHS patients, particularly in mental health and planned surgery. Patients also go abroad for treatment. In 2014 about 48,000 went abroad for treatment and about 144,000 in 2016. This may be driven by increasing waiting times for NHS treatment, but will also include migrants who may return to their home country for treatment, especially childbirth. It also includes fertility services, dentistry and cosmetic surgery which may not be available on the NHS. See Medical tourism. wikipedia.org
  10. Health care in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together with smaller private sector and voluntary provision. As a result of each country having different policies and priorities, a variety of differences now exist between these systems. Despite there being separate health services for each country, the performance of the National Health Service (NHS) across the UK can be measured for the purpose of making international comparisons. In a 2017 report by the Commonwealth Fund ranking developed-country healthcare systems, the United Kingdom was ranked the best healthcare system in the world overall and was ranked the best in the following categories: Care Process (i.e. effective, safe, coordinated, patient-oriented) and Equity. The UK system was ranked the best in the world overall in the previous three reports by the Commonwealth Fund in 2007, 2010 and 2014. The UK's palliative care has also been ranked as the best in the world by the Economist Intelligence Unit. On the other hand, in 2005-09 cancer survival rates lagged ten years behind the rest of Europe, although survival rates continue to increase. In 2015, the UK was 14th (out of 35) in the annual Euro health consumer index. It was criticised for its poor accessibility and "an autocratic top-down management culture". The index has in turn been criticized by academics, however. The total expenditure on healthcare as a proportion of GDP in 2013 was 8.5%, below the OECD average of 8.9% and considerably less than comparable economies such as France (10.9%), Germany (11.0%), Netherlands (11.1%), Switzerland (11.1%) and the USA (16.4%). The percentage of healthcare provided directly by the state is higher than most European countries, which have insurance-based healthcare with the state providing for those who cannot afford insurance. In 2017 the UK spent £2,989 per person on healthcare, the second lowest of the Group of Seven, but around the median for members of the Organisation for Economic Co-operation and Development. The NHS has a reasonable claim to be the most efficient healthcare system in the world. The 2018 OECD data, which incorporates in health a chunk of what in the UK is classified as social care, has the UK spending £3121 per head, France £3471, Australia £3892, Germany £4057 and Sweden £4877. The exit of the United Kingdom from the European Union could make an impact on the healthcare industry if there is a "no deal" Brexit. There are speculations that the supply of medicines to the UK will be hit. As a precautionary measure, the government has asked the drug companies to stock up a six-week supply of medicines and make arrangements for their storage. wikipedia.org
  11. In 2015, the Conservative Party called for the referendum. Most of the pro-Brexit voters were older, working-class residents of England's countryside. They were afraid of the free movement of immigrants and refugees. They claimed citizens of poorer countries were taking jobs and benefits. Small businesses were frustrated by EU fees. Others felt leaving the EU would create jobs. Many felt the U.K. paid more into the EU that it received. Those who wanted to stay lived in London, Scotland, and Northern Ireland. They liked the free trade with the EU. They claimed most EU immigrants were young and eager to work. Most felt that leaving the EU would damage the U.K.’s global status. thebalance.com
  12. Brexit is a vote against globalization. It takes the United Kingdom off the main stage of the financial world. It creates uncertainty throughout the U.K. as The City seeks to keep its international clients. The day after the Brexit vote, the currency markets were in turmoil. The euro fell 2% to $1.11. The pound fell 8% to $1.36. Both increased the value of the dollar. That strength is not good for U.S. stock markets. It makes American shares more expensive for foreign investors. A weak pound also makes U.S. exports to the U.K. more expensive. The United States has a $18.9 billion trade surplus with the U.K. In 2018, it exported $141 billion while importing $122 billion. Brexit could turn this surplus into a deficit if a weak pound makes U.K. imports more competitive. Brexit dampens business growth for companies that operate in Europe. U.S. companies invested $758 billion in the U.K. in 2018. Most of this was the finance sector with some manufacturing. These companies use the U.K. as the gateway to free trade with the EU nations. U.K. businesses invested $561 billion in the United States. Brexit puts at risk jobs in both countries. In addition, there were 716,000 U.K. immigrants in the United States and 215,000 U.S. immigrants in the U.K. in 2019. thebalance.com
  13. The Brexit vote has strengthened anti-immigration parties throughout Europe. If these parties gain enough ground in France and Germany, they could force an anti-EU vote. If either of those countries left, the EU would lose its most robust economies and would dissolve. On the other hand, new polls show that the majority of EU citizens still strongly support the Union. Almost 75% say the EU promotes peace, and 55% believe it supports prosperity. More than a third see the role of the U.K. as diminishing. thebalance.com
  14. London Brexit has already depressed growth in The City, the U.K.'s financial center. Growth was only 1.4% in 2018, and was close to zero in 2019. Brexit has diminished business investment by 11%. International companies would no longer use London as an English-speaking entry into the EU economy. Goldman Sachs, JP Morgan, and Morgan Stanly have already switched 10% of their clients. Bank of America has transferred 100 bankers to its Dublin office and 400 to Paris. Scotland Scotland voted against Brexit. The Scottish government believes that staying in the EU is the best for Scotland and the U.K. It has been pushing the U.K. government to allow for a second referendum. To leave the U.K., Scotland would have to call a referendum on independence. It could then apply for EU membership on its own. thebalance.com
  15. Northern Ireland would remain with the United Kingdom. The Republic of Ireland, with which it shares a border, would stay a part of the EU. Johnson's plan avoided a customs border between the two Irish countries. A customs border could have reignited The Troubles. It was a 30-year conflict in Northern Ireland between mainly Catholic Irish nationalists and pro-British Protestants. In 1998, it ended with the promise of no border between Northern Ireland and Ireland. A customs border would have forced 9,500 commuters to go through customs on their way to and from work and school. Brexit would also affect the 2,100 workers who commute to Great Britain. thebalance.com
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