Overview of the National Health Service (NHS)
Discuss about the Sustainability of the United Kingdom Health system-NHS.
All healthcare systems worldwide be it they are tax-funded, social insurance-based or market based are struggling towards sustainability issues (Thomson, Foubister & Mossialos, 2009). Due to the diverse challenges facing the healthcare system, attention has been drawn to looking at how well the system can cope with the impending challenges. The United Kingdom healthcare system, the National Health Service (NHS) is one of the systems that has been faced with problems that question its sustainability. Notably, this is the reason for the commission of research for the future of the NHS by the chief executive of the NHS which led to a publication of the report findings in 2014 which highlighted the “Five Year Forward View” strategic plan (Alderwick, Dunn, McKenna, Walsh & Ham, 2016). Some of the way forwards provided in the report is the empowerment of the patients and communities to lessen the burden on the system, focusing on public welfare and ill-health prevention strategies, strengthening the primary care and improving its service efficiency (Alderwick et al., 2016). Further, an independent member of the House of Lords; Nigel Crisp, argues that the sustainability of the system relies not only on financial sustainability, effectiveness and efficiency but also it is dependent on some factors from without the healthcare industry (Crisp, 2017, p.358). Adopting the seven sustainability factors from a recent report by a commission on the Portuguese health system, Crisp proposed for emphasis on a cross-sectoral partnership for creating a healthcare system that adequately meets the healthcare needs of its people and contributes to the economy of the country (Crisp, 2015, pp.98-106). In this report, the results of an analysis of the seven factors of sustaining the NHS against various performance indicators will be discussed.
After World II, the healthcare system of England-the NHS became functional in 1948 as an implementation of the recommendations of the Beveridge Report which guided by the Minister of Health then, Aneurin Bevan (Grosios, Gahan & Burnbridge, 2010, pp.529-534). The system was based on the following principles; universality, equity, free service at any point of delivery and being financed by central funding (Russell & Greenhalgh, 2012, pp.2463-2471). The NHS has undergone significant political and organization modifications. The service is to date available to all people with health care needs regardless of their ability to pay since it is funded by the English taxes and national insurance contributions (Mossialos, Wenzl, Osborn & Sarnak, 2016). The medical care is categorized into primary, secondary and tertiary healthcare. However, there have been gradual developments to eliminating the demarcations among these types of care to enhance the care that emphasizes on the choice of the customer (Rodin & de Ferranti, 2012, pp.861-862).
Challenges Facing the NHS and Need for Sustainability Strategies
The UK healthcare system offers free services to over 60 million people across its states. The NHS is one of the largest employers in the world, providing jobs to about two million people. Among these employees, about 120,000 are hospital doctors, 40, 000 are general practitioners, 400, 000 are nurses and 25, 000 are the ambulance staff (Meyer, 2013). Information from the Organization for Economic Cooperation and Development, the UK government spends about $4, 192 of every individual citizen to cater for their healthcare needs (Yuen, 2014, pp.1-14).
However, there have been experienced protests as a result of an inefficient and less effective strained system (Senthilingam, 2018). The funding of the NHS and its sustainability is a hotly contested issue in the British politics because of the many uncertainties engulfing the system which brings about the demonstrations. In critical health crisis times, the system has failed to love up to the expectations. For example, a flu outbreak exposed the deficiencies of the system which saw the cancellation of some routine procedures to free up hospital beds. The emergency rooms were overwhelmed by the large number of patients whereby 15% of these patients had to wait for longer than four hours before seeing a healthcare professional, surpassing the less than 5% NHS goal of patients that can see a doctor in a less than four-hour wait (Senthilingam, 2018). The challenges facing this system validates the consideration of the seven sustainability strategies. Which include; effectiveness and efficiency of health and care provision, availability of well-trained healthcare workers, costs, and economic benefits, health and resilience of population. Also, the contributions of healthcare providers and informal network care, the integration of policy and practice with other sectors, and the public and political acceptability as well as supporting of the healthcare sector and reforms as proposed by Nigel Crisp (Crisp, 2017, p.358). These factors were assessed using various available literature materials along with health system performance indicators for sustainability to ascertain how they impact on the flexibility of the system to changes.
The performance indicators adopted for this NHS are the responsiveness of the system, health outcomes after treatment, financial protection of the customers by the system, its productivity, and equity. The factors as mentioned earlier qualify as performance indicators for they achieve statistical validity, it is possible to collect related information using these indicators. They can be evaluated internationally, and their usage can result to the provision of recommendations that can be used to enhance appropriate changes to the healthcare system to improve it (Soyiri & Redipath, 2013, p.1). Several performance indicators have been devised (Papanicolas, 2013, pp.31), however, in this report the signs employed succinctly bring out the fundamental goals of the health system. A health system encompasses the resources, institutions and other stakeholders that finance, regulate and contribute to health outcomes or ‘health action’ (Murray & Frenk, n.d). The performance indicators for a health system that were used in are discussed below.
Seven Sustainability Strategies Proposed by Nigel Crisp
Responsiveness of a healthcare system entails two components in which one of them is ‘respect for persons’ whereby the interaction of individuals with the system promotes important ethical dimensions. The respect for dignity, individual autonomy and confidentially enhance the ‘respect for persons’ within the system. There is a possibility that a health system to achieve high levels of health for a population by isolating persons with communicable diseases or eliminating them through sterilizing them with a genetic disorder. However, this would amount to a violation of a basic human right hence not respecting human dignity (Perez-Rodriguez & de la Fuente, 2017, pp.36-47). Therefore for a responsive system, there is always respect for human dignity through interactions of individuals with the healthcare providers while being sensitive to potentially embarrassing instances during the process of delivering the services such as during physical examination (Plomer, 2013). The other aspect fostering the respect of persons is the respect for individual autonomy whereby the client’s choice regarding his or her preferred medical intervention is considered and respected (Grady, 2015, pp.855-862). However, the patient has a right to information on the available responses to enhance choice of an appropriate option. The third component for respect for the customers, respect for confidentiality, highlights the necessity of a sustainable health system that preserves the privacy of the personal information of its customers (Suckling, Shickle & Wallace, 2016, p.265). Respect for patient confidentiality within the healthcare system builds trust among the users within the system.
Response to client health needs is another important factor that determines the sustainability of a system. The system is always put in place to cater for customer needs, if this objective is not met then the system requires reforms to survive past any crisis. Periodical patient surveys on their satisfaction from the services are appropriate to enable the system keep up the pace with the dynamic client needs for it to survive for a long time. For the comfort of the patients, there is a need for promptness in attending to patient needs for they believe that such attention will lead to better healthcare outcomes (Aiken et al., 2012, pp.1717). Moreover, the system should connect the patients to social networks which enhances their recovery promoting its sustainability (Fenton, Jerant, Bertakis & Franks, 2012). In this report regarding the responsiveness of the system, both the average level of responsiveness and its distributions across individuals were assessed to evaluate the factors affecting the sustainability of the NHS.
Performance Indicators Used to Assess NHS Sustainability
A health system should facilitate the access to healthcare services among its clients regardless of their socioeconomic status. More importantly, the system should be affordable to prevent impoverishing of the households whereby it protects the customers from paying an excess of their income to obtain the services. A patient financial protective system ensures the fair contribution of the diversely capable patients. The poor households can even contribute nothing to the healthcare system to maintain the fair contribution for people without jobs or sources of income. The payment tax funding of the system is or should be based on the income of every household to maintain the fair share of contribution as opposed on the frequency for the use of the type of services an individual seeks within the system. Taxation of individuals to contribute to the universal health system should not be a burden to the taxpayers. The financial fairness of the system among the economically different people was used as an indicator basing on the tax every household contributes to the system compared to the income of these households.
The fundamental objective of any health system is to offer quality healthcare services as a way of achieving a healthy population by paying an essential role in the health of this people. To ascertain the effectivity of its functions the system has to formulate and put in place mechanisms of obtaining a patient response to the services offered and their effectiveness. The after treatment results need to be captured by the system and be evaluated for an appropriate actions. Typically, the success and sustainability of a healthcare system is measured by checking on the survival rates of patients after treatment. The ability to capture the after treatment data is crucial to the system and it is dependent on the available infrastructure for measuring, monitoring and reporting them (Bennett, Jensen, Basch, 2012, pp.336-347). The sustainability of a system also depends on the quality of services it offers which also can be improved upon assessing the post treatment information. Therefore, patient information will always be a critical factor in exposing the issues affecting the sustainability of a healthcare system. Another important aspect is the proper use of the information collected from the patient-reported survey. The patients are determined to ensure the care provided is medically useful, safe and one that gives attention to their health needs, so the system should provide mechanisms to collect their views.
Responsiveness of the Healthcare System
Health productivity is a measure of the proportion of total output to a certain amount of inputs (Walker, 2008). The amount and quality of resources channeled towards the health system should be reflected in the variety of services the system offers to its customers. Moreover, it involves the efficient utilization of the available resources to improve the performance of the system. In this case, the number of healthcare practitioners available for this healthcare system and the health status of a population should be marrying. For example, the availability of a good proportion of doctors to the country’s population should translate to the performance of the NHS. Underperformance from the service providers reduce the performance and sustainability of the system. The productivity of this system goes beyond just the material resources as it encompasses the emotional or psychological status of those working within the system which is also determined by the working environment. The amount of resources available to support the productivity process is usually strained when the population and demand for the services increases and changes. Also, the productivity of a system can be assessed in relation to how the system is adjusting to changes for example technological changes and advances. Such changes demand a flexible system that can incorporate the associated increases in technology into the system. Failure to use advanced production techniques will undoubtedly hinder the survival of the system in the contemporary world. In the healthcare system there have been tremendous advances in the therapeutic techniques and methods. So, in the event a system does not adjust from the traditional forms of services by adopting the new technologies there are some health needs that cannot be met, a good example is radiotherapy.
For sustainability and acceptability of a health system, the aspect of fairness has to be incorporated in it. The system should allow access to every individual regardless of his or her socioeconomic status of political stance. Equity forms part of the dimensions of the quality of the services delivered through a specific system. Most reforms in the healthcare sector have factored in cost-effectiveness and safety as equity is sidelined hence continued exhibition of variations among various classes of people within a country (Doran, Fullwood, Kontopantelis & Reeves, 2008). According to Cookson et al. (2018), the challenge towards attaining equity in the healthcare system is that it proves difficult to provide quality services to the socially disadvantaged people. Also, the existence of quality frameworks that penalize the healthcare system providers worsens the variations among the various social classes regarding quality care (Delgadillo, Asaria, Ali & Gilbody, 2016). Therefore, as quality service is a critical factor that affects the sustainability of a healthcare system so is equity. Any discrimination of the system in service delivery thwarts its sustainability. The contemporary healthcare frameworks aim at providing quality services to its customers as well as reduces any social disparities that already exist. Therefore, to generally improve the productivity of a system all the people need to have equal access to the services.
Health Outcomes After Treatment
In the contemporary society, there is a shift of focus from the traditional sustainability factors, for example, the financial sustainability to factors outside the control of the healthcare sector. Moreover, the durability of the system is currently being assessed concerning the contributions to the economy (Crisp, 2017, p.358). In this report the findings of a literature analysis of the factors as mentioned above that if tackled they will enhance the sustainability of the NHS. The elements are categorized into three types namely the internal, external and public and political acceptability.
The internal sustainability factors, in this case, will refer to the factors related to the organization and implementation of the NHS, elements with the capability to initiate reforms or changes within the system (LaFond, 2013). These factors include the effectiveness and efficiency of the system in service provision, availability of qualified healthcare practitioners and the costs and economic benefits of NHS.
The sustainability of the NHS depends to a great extent on the availability of well trained and qualified staff to propagate the implementation of the objectives of the UK healthcare system. Globally, there is a deficit of well-trained healthcare professionals which strains the healthcare system since there is a high demand for the services from the ever-increasing population (Crisp & Chen, 2014, pp.950-957). In the UK the, an already strained system about the available healthcare experts as compared to its population especially the aging people with chronic health conditions requires maximum healthcare attention; the Brexit is predicted to worsen the situation. The chairperson of the Royal College of General Practitioners, Dr. Stokes-Lampard, asserts that the NHS will face more challenges since 11% of the healthcare experts in the country are from the EU hence the Brexit compounds the risks of the system (Senthilingam, 2018). As earlier noted, the incapability of the system to sustain its-self has been exposed during the flu outbreak when many people suffered, and some died in the queues before they could be attended to because of the mass influx of patients. Moreover in a recent report by the select committee on the long-term sustainability of the NHS, highlighted the impending dangers to the NHS if more healthcare professionals were not trained (Cooper, 2017, pp.99-105). The inadequacy of skilled healthcare personnel hinders the system’s equity and productivity which also reduce the quality of services offered. Therefore, the insufficiency of well-trained health care workforce has been exhibited with the current NHS system which mentions at the incapability of the system to sustain itself in the coming years.
Financial Protection of Customers
NHS is the best health system in the world and the least spending, about 50% less than the other countries in the G7 countries (Davis, Stremikis, Schoen & Squires, 2014, pp.1-31). This information implies that the cost-benefit analysis of the system hints that the system can sustain itself even in the future. Furthermore, the NHS is facilitating economic growth of the country by contributing about $71 billion to the government revenues each year through the biomedical companies (Crisp et al., 2016, pp.24-27). There is, therefore, no need to increase taxes on English people since they system is already financially viable and offers financial protection to its customers. Further, the system promotes a health workforce through education and skill development in the healthcare industry which contributes to the well-being of the society and generally to the growth of the economy hence fosters productivity, customer financial protection as well as equity.
The healthcare outcomes, especially after treatment, show the efficiency and effectiveness of the system. The UK population enjoys good health with high life experience. The method further has effectively managed preventable diseases. However, the challenge is with the lifestyle diseases that are evident among its citizens. In the healthcare budgetary allocation, 70% of the share is for handling chronic diseases (Henderson eta l., 2013, p.1035). For sustainability of the system, there is a need to increase the efficiency of the system in the areas that are currently thwarting the effectiveness of the system. However, the NHS has made significant achievements on its ability since about 70% UK citizens are satisfied with the healthcare services (James & Moseley, 2014, pp.493-511).
These are factors that are associated or relate to the beneficiaries of the healthcare system services. They include; health resilience of the population, the contributions of the carers and the informal healthcare network, and the integration of policies and practices with the other sectors for a healthy people.
Good healthcare empowers its customers with healthy life which enables it to live a quality life. Such a characteristic has got socio and financial benefits to the country and consequently on the sustainability of the system. The NHS has performed well in this area as the health status of the UK people compares well regarding life expectancy and quality among another good healthcare system in the world. The available children’s health care programs have promoted long life expectancy through significant reduction of child mortality and morbidity. So, the system economically empowers its population besides its contribution to the national economy through supporting a healthy nation.
Productivity of the Healthcare System
For example, the Greater Manchester healthcare services form a connection with other areas such as social care to provide holistic healthcare to its people (Goodwin, 2013). A sustainable health system has the ability to strong link and integrates various policies to improve its services as well as the health of its people.
A sustainable healthcare system is one that allows for the participation of every stakeholder though in a regulated manner to maintain the quality of the services. In the UK the informal sector through the community organization and volunteers spending about £2 billion less than the regular services to provide healthcare services to the English people in the year 2015 (Crisp & Chen, 2014, pp.950-957). The appreciation of the contributions of the informal sector to the health of the population enhances system sustainability by relieving pressure on NHS. The informal sector relieves some pressure on the formal healthcare sector increasing the efficiency, productivity, equity and financial protection of patients.
Besides the external and internal factors for the sustainability of a health system, public acceptability and political support enhance the durability of NHS.
The NHS depends on the support of both the people and the politicians to survive and implement necessary reforms. Also, the media platforms have to support and be in the forefront to inform the public of the changes and appropriately guide them. The NHS has achieved tremendous success due to a substantial audience and political support implicating its sustainability (Crisp, 2011).
Conclusions
The sustainability of the NHS depends on factors that go beyond the economic feasibility of the system. For a health people and efficiency of the NHS, every individual has a role to play. Such a consorted effort will facilitate the formulation and implementation of healthcare reforms to ensure quality services on the population. The NHS is one of the best healthcare systems in the world since it undergoes almost continues assessment against healthcare indicators hence it is one of the methods that are on the right path to sustainability.
There is a need to review the education system for the healthcare practitioners to promote well-trained professionals as well as assess whether the multidisciplinary education will be beneficial in alleviating the current and the impending shortages.
The informal sector of the healthcare system requires the continued support of the NHS as well as the government. A regulatory body to control the practices in this sectors, as well as offer further education to the informal healthcare practitioner for competency, should be instituted.
Equity in Healthcare Services
Chronic and lifestyle disease are straining the NHS as the UK population is composed of many aged people that require continues healthcare attention. Further research on this area to help formulate strategies to reduce the impending burden on the NHS will be appropriate
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