- Healthcare in England
Healthcare in England is mainly provided by England's public health service, the National Health Service, that provides healthcare to all UK permanent residents that is free at the point of need and paid for from general taxation. Since 'Health' is a matter that has been devolved to the Parliaments and Assemblies in Scotland, Wales and Northern Ireland, considerable differences are now developing between the public healthcare systems in the different countries of the United Kingdom. [ [http://news.bbc.co.uk/1/hi/health/7149423.stm NHS now four different systems]
BBC January 2 2008] Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing to pay.
The [http://www.nhs.uk/ National Health Service] (NHS) is the publicly funded healthcare system in
England. The NHS provides healthcare to anyone normally resident in the UK with most services free at the point of use for the patient though there are charges associated with eye tests, dental care, prescriptions, and many aspects of personal care.
The NHS provides the majority of healthcare in England, including
primary care, in-patient care, long-term healthcare, ophthalmologyand dentistry. The National Health Service Act 1946came into effect on 5 July 1948. Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population, and generally as a top-up to NHS services. Recently the private sector has been increasingly used to increase NHS capacity despite a large proportion of the public opposing such involvement according to one survey by the BMAcite web | url=http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/PDFnhssystreform2007/$FILE/48751Surveynhsreform.pdf | pulisher=BMA | date=2007-06-01 | title=Survey of the general public's views on NHS system reform in England] .
The NHS is largely funded from general taxation (including a proportion from
National Insurancepayments) [cite web |url=http://www.icaew.com/index.cfm?route=100799 |title=NHS Funding need not damage business health |accessdate=2008-03-31 |date=2008-03-14 |publisher=Institute of Chartered Accountants of England & Wales |format= |work=] . The UK government department responsible for the NHS is the Department of Health, headed by the Secretary of State for Health(Health Secretary), who sits in the British Cabinet. Most of the expenditure of The Department of Health (£98.6 billion in 2008-9cite web | author=HM Treasury| title=Budget 2008, Chapter C |date=2008-03-24 | url=http://www.hm-treasury.gov.uk/media/7/3/bud08_chapterc.pdf| accessdate = 2008-03-24 | pages=23] ) is spent on the NHS.
The NHS is the world's largest health service and the world's fourth-largest employer; only the Chinese
People's Liberation Army, Indian Railways, and Wal-Martemploy more people directly. [ [http://www.nhs.uk/aboutnhs/pages/about.aspx About the NHS ] ]
A patient needing specialist care at a hospital or clinic, will be informed by the GP of the choice available and helped to decide. Since opting for a private hospital makes the patient liable for fees, most choose a free NHS hospital. GP's inform hospitals of their patient's conditions and the hospitals judge the urgency of each against other patients, with urgent need being met almost immediately and others getting appointments. The median wait time for a consultant led first appointment in English hospitals is a little over 3 weeks. [http://www.gnn.gov.uk/imagelibrary/downloadMedia.asp?MediaDetailsID=216856] Patients can be seen by the hospital as out-patients or in-patients, with the latter involving overnight stay. The speed of in-patient admission is based on medical need and time waiting with more urgent cases faster though all cases will be dealt with eventually. Patient can ask for a private hospital referral at any time which may provide earlier treatment but at full cost to the patient. For those not admitted ímmediately, the median wait time for in-patient treatment in English hospitals is a little under 6 weeks Ibid. Trusts are working towards an 18 week guarantee that means that the hospital must complete all tests and start treatment within 18 weeks of the date of the referral from the GP. Some hospitals are introducing
just in timeworkflow analysis borrowed from manufacturing industry to speed up the processes within the system and improve efficiencies. [ http://www.nodelaysachiever.nhs.uk/Essentials/ The NHS No Delays performance improvement programme ]
Almost all NHS hospital treatment is free of charge along with drugs administered in hospital, surgical consumables and appliances issued or loaned. However, if a patient has chosen to be treated in an NHS hospital as a private fee paying patient by arrangement with his consultant, the patient (or the insurance company) will be billed. This can happen because at the inception of the NHS, hospital consultants were allowed to continue doing private work in NHS hospitals and can enable private patients to "jump the NHS queue". This arrangement is nowadays quite rare as most consultants and patients choose to have private work done in private hospitals.
Emergency Department (traditionally known as Accident and Emergency) treatment is also free of charge. A triage nurse prioritises all patients on arrival. Waiting times can be up to 4 hours if a patient goes to the Emergency Department with a minor problem or may be referred to other agencies (e.g. pharmacy, GP, Walk in clinic). Emergency Departments try to treat patients within 4 hours as part of NHS targets for emergency care.Fact|date=April 2008 The Emergency Department is always attached to an NHS general hospital. Private hospitals do not provide emergency care services.
The NHS also provides end of life palliative care in the form of Palliative Care Specialist Nurses. The NHS can also commission the expertise of organisations in the voluntary sector to compliment palliative care. Such organisations include
Marie Curie Cancer Care, Sue Ryder Careand Macmillan Cancer Support. Despite their names, these services are designed for all palliative conditions, not exclusively cancer. All palliative care services provide support for both the patient and their relatives during and after the dying process. Again, these are all free of charge to the patient.
Private-sector medical care
England has an active private sector in health care providing similar treatments to the public healthcare systems. Private health care is sometimes funded by employers through
medical insuranceas part of a benefits package to employees though it is mostly the larger companies that do. Insurers also market policies directly to the public.
The private sector is now doing subcontracting work for the NHS [ [http://www.nhs.uk/choices/Pages/Alternativeformatversions.aspx Choosing your hospital booklet ] ] . Thus an NHS patient can be treated in the private sector as an NHS patient if the Health Services has subcontracted work to the hospital. This development is still in its infancy and quite rare.
Some private hospitals are business enterprises and some are non-profit-making trusts. Some hospital groups provide insurance plans (e.g. BUPA) and some insurance companies have deals with particular private hospital groups. Some private sector patients can be treated in NHS hospitals in which case the patient or his/her insurance company is billed.
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