Received 2010 Sep 1; Accepted 2010 Sep 27; Issue date 2010 Dec.

. The National Health System in the UK has actually progressed to turn into one of the biggest health care systems in the world. At the time of writing of this review (August 2010) the UK federal government in its 2010 White Paper "Equity and excellence: Liberating the NHS" has actually announced a method on how it will "create a more responsive, patient-centred NHS which attains outcomes that are amongst the best on the planet". This review article presents an introduction of the UK healthcare system as it currently stands, with emphasis on Predictive, Preventive and Personalised Medicine components. It aims to work as the basis for future EPMA posts to broaden on and present the modifications that will be executed within the NHS in the forthcoming months.

Keywords: UK, Healthcare system, National health system, NHS

Introduction

The UK healthcare system, National Health Service (NHS), originated in the aftermath of the Second World War and ended up being functional on the 5th July 1948. It was first proposed to the Parliament in the 1942 Beveridge Report on Social Insurance and Allied Services and it is the legacy of Aneurin Bevan, a former miner who ended up being a politician and the then Minister of Health. He established the NHS under the concepts of universality, totally free at the point of delivery, equity, and spent for by main funding [1] Despite various political and organisational modifications the NHS remains to date a service available generally that looks after individuals on the basis of requirement and not ability to pay, and which is moneyed by taxes and nationwide insurance coverage contributions.

Health care and health policy for England is the obligation of the central federal government, whereas in Scotland, Wales and Northern Ireland it is the responsibility of the respective devolved federal governments. In each of the UK countries the NHS has its own unique structure and organisation, but in general, and not dissimilarly to other health systems, health care makes up of two broad sections; one dealing with method, policy and management, and the other with actual medical/clinical care which remains in turn divided into main (neighborhood care, GPs, Dentists, Pharmacists and so on), secondary (hospital-based care accessed through GP referral) and tertiary care (expert hospitals). Increasingly differences between the two broad sections are becoming less clear. Particularly over the last years and directed by the "Shifting the Balance of Power: The Next Steps" (2002) and "Wanless" (2004) reports, steady changes in the NHS have resulted in a greater shift towards local instead of main choice making, elimination of barriers between primary and secondary care and stronger emphasis on patient choice [2, 3] In 2008 the previous federal government reinforced this instructions in its health strategy "NHS Next Stage Review: High Quality Care for All" (the Darzi Review), and in 2010 the current government's health technique, "Equity and quality: Liberating the NHS", stays encouraging of the exact same ideas, albeit through perhaps various systems [4, 5]

The UK government has just revealed plans that according to some will produce the most transformation in the NHS considering that its creation. In the 12th July 2010 White Paper "Equity and quality: Liberating the NHS", the existing Conservative-Liberal Democrat coalition government described a strategy on how it will "create a more responsive, patient-centred NHS which accomplishes outcomes that are amongst the very best on the planet" [5]

This review short article will for that reason present a summary of the UK healthcare system as it currently stands with the objective to serve as the basis for future EPMA short articles to broaden and present the modifications that will be carried out within the NHS in the upcoming months.

The NHS in 2010

The Health Act 2009 developed the "NHS Constitution" which formally unites the function and concepts of the NHS in England, its worths, as they have actually been established by clients, public and personnel and the rights, promises and obligations of patients, public and staff [6] Scotland, Northern Ireland and Wales have also accepted a high level statement declaring the principles of the NHS throughout the UK, despite the fact that services may be supplied differently in the 4 countries, reflecting their various health needs and circumstances.

The NHS is the largest employer in the UK with over 1.3 million staff and a budget plan of over ₤ 90 billion [7, 8] In 2008 the NHS in England alone used 132,662 medical professionals, a 4% increase on the previous year, and 408,160 nursing staff (Table 1). Interestingly the Kings Fund estimates that, while the overall variety of NHS staff increased by around 35% between 1999 and 2009, over the same duration the variety of managers increased by 82%. As a percentage of NHS staff, the variety of supervisors rose from 2.7 per cent in 1999 to 3.6 per cent in 2009 (www.kingsfund.org.uk). In 2007/8, the UK health spending was 8.5% of Gdp (GDP)-with 7.3% accounting for public and 1.2% for private spending. The net NHS expenditure per head across the UK was least expensive in England (₤ 1,676) and highest in Scotland (₤ 1,919) with Wales and Northern Ireland at roughly the exact same level (₤ 1,758 and ₤ 1,770, respectively) [8]

Table 1.

The distribution of NHS labor force according to primary personnel groups in the UK in 2008 (NHS Information Centre: www.ic.nhs.uk)

The overall organisational structure of the NHS in England, Scotland, Wales and Northern Ireland in 2010 is revealed in Fig. 1. In England the Department of Health is accountable for the instructions of the NHS, social care and public health and delivery of health care by establishing policies and methods, securing resources, keeping an eye on efficiency and setting nationwide requirements [9] Currently, 10 Strategic Health Authorities manage the NHS at a local level, and Primary Care Trusts (PCTs), which currently control 80% of the NHS' budget, supply governance and commission services, as well as guarantee the schedule of services for public heath care, and arrangement of neighborhood services. Both, SHAs and PCTs will disappear as soon as the strategies outlined in the 2010 White Paper end up being executed (see section below). NHS Trusts operate on a "payment by results" basis and acquire many of their earnings by supplying healthcare that has actually been commissioned by the practice-based commissioners (GPs, etc) and PCTs. The main types of Trusts consist of Acute, Care, Mental Health, Ambulance, Children's and Foundation Trusts. The latter were developed as non-profit making entities, devoid of federal government control but likewise increased monetary obligations and are controlled by an independent Monitor. The Care Quality Commission regulates independently health and adult social care in England in general. Other specialist bodies supply monetary (e.g. Audit Commission, National Audit Office), treatment/services (e.g. National Patient Safety Agency, Medicines and Healthcare Products Agency) and expert (e.g. British Medical Association) regulation. The National Institute for Health and Clinical Excellence (NICE) was established in 1999 as the body accountable for developing nationwide standards and requirements related to, health promo and avoidance, evaluation of new and existing innovation (consisting of medicines and procedures) and treatment and care medical guidance, offered throughout the NHS. The health research technique of the NHS is being carried out through National Institute of Health Research (NIHR), the overall spending plan for which remained in 2009/10 near to ₤ 1 billion (www.nihr.ac.uk) [10]

Fig. 1.

Organisation of the NHS in England, Scotland, Wales and Northern Ireland, in 2010

Section 242 of the NHS Act mentions that Trusts have a legal duty to engage and include patients and the general public. Patient experience information/feedback is formally collected nationally by annual study (by the Picker Institute) and belongs to the NHS Acute Trust performance structure. The Patient Advice Liaison Service (PALS) and Local Involvement Networks (LINks) support patient feedback and participation. Overall, inpatients and outpatients surveys have exposed that clients rate the care they get in the NHS high and around three-quarters indicate that care has actually been extremely good or excellent [11]

In Scotland, NHS Boards have changed Trusts and provide an integrated system for strategic direction, efficiency management and medical governance, whereas in Wales, the National Delivery Group, with recommendations from the National Board Of Advisers, is the body performing these functions (www.show.scot.nhs.uk; www.wales.nhs.uk). Scottish NHS and Special Boards deliver services, with look after particular conditions delivered through Managed Clinical Networks. Clinical standards are released by the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium (SMC) suggestions on the usage of brand-new drugs in the Scottish NHS. In Wales, Local Heath Boards (LHBs) plan, protected and deliver healthcare services in their locations and there are 3 NHS Trusts supplying emergency situation, cancer care and public health services nationally. In Northern Ireland, a single body, the Health and Care Board is overseeing commissioning, performance and resource management and enhancement of healthcare in the country and 6 Health and Social Care Trusts deliver these services (www.hscni.net). A number of health agencies support secondary services and deal with a wide variety of health and care problems including cancer screening, blood transfusion, public health etc. In Wales Community Health Councils are statutory lay bodies advocating the interests of the general public in the health service in their district and in Northern Ireland the Patient and Client Council represent patients, customers and carers.

Predictive, Preventive and Personalised Medicine (PPPM) in the NHS

Like other nationwide healthcare systems, predictive, preventive and/or personalised medication services within the NHS have actually typically been provided and belong to disease medical diagnosis and treatment. Preventive medication, unlike predictive or customised medicine, is its own established entity and appropriate services are directed by Public Health and provided either by means of GP, social work or health centers. Patient-tailored treatment has constantly prevailed practice for great clinicians in the UK and any other healthcare system. The terms predictive and personalised medication though are progressing to describe a much more technically advanced method of diagnosing illness and anticipating action to the standard of care, in order to maximise the advantage for the client, the general public and the health system.

References to predictive and personalised medication are progressively being introduced in NHS related info. The NHS Choices site explains how patients can obtain personalised suggestions in relation to their condition, and uses info on predictive blood test for illness such as TB or diabetes. The NIHR through NHS-supported research and together with academic and commercial teaming up networks is investing a substantial proportion of its spending plan in verifying predictive and preventive restorative interventions [10] The previous federal government thought about the advancement of preventive, people-centred and more productive health care services as the ways for the NHS to respond to the challenges that all contemporary health care systems are facing in the 21st century, specifically, high patient expectation, ageing populations, harnessing of info and technological improvement, changing workforce and evolving nature of illness [12] Increased focus on quality (client safety, client experience and medical efficiency) has likewise supported development in early medical diagnosis and PPPM-enabling technologies such as telemedicine.

A variety of preventive services are delivered through the NHS either by means of GP surgical treatments, social work or health centers depending on their nature and consist of:

The Cancer Screening programmes in England are nationally collaborated and include Breast, Cervical and Bowel Cancer Screening. There is likewise a notified choice Prostate Cancer Risk Management programme (www.cancerscreening.nhs.uk).

The Child Health Promotion Programme is handling concerns from pregnancy and the first 5 years of life and is provided by neighborhood midwifery and health checking out teams [13]

Various immunisation programs from infancy to adulthood, provided to anyone in the UK for free and typically provided in GP surgical treatments.

The Darzi review set out 6 crucial clinical objectives in relation to improving preventive care in the UK including, 1) taking on obesity, 2) reducing alcohol harm, 3) dealing with drug dependency, 4) reducing cigarette smoking rates, 5) enhancing sexual health and 6) improving psychological health. Preventive programmes to deal with these concerns have remained in location over the last years in different forms and through different initiatives, and consist of:

Assessment of cardiovascular danger and recognition of people at higher risk of heart problem is usually preformed through GP surgeries.

Specific preventive programmes (e.g. suicide, accident) in regional schools and community

Family planning services and avoidance of sexually sent disease programs, frequently with a focus on young people