Increasing Patient Charges in the National Health Service: A Method of Privatizing Primary Care

1986 ◽  
Vol 15 (2) ◽  
pp. 163-184 ◽  
Author(s):  
S. Birch

ABSTRACTFrequent increases in the real value of National Health Service (NHS) patient charges have been made since the Conservative Party's return to office in 1979. For those patients subject to these charges the increases have led to a substantial reduction in the level of subsidization of the cost of the service. The rationale for the subsidization of health care is shown to be unrelated to ‘ability to pay’ considerations. Consequently the ‘backdoor privatization’ of these services is inconsistent with the objectives of the NHS even though the Government has continually committed itself to these objectives. Alternative policies to increasing patient charges are suggested which would encourage the efficient use of NHS resources without compromising NHS objectives.

2018 ◽  
Author(s):  
Matthew Willis ◽  
Paul Duckworth ◽  
Angela Coulter ◽  
Eric T Meyer ◽  
Michael Osborne

BACKGROUND Recent advances in technology have reopened an old debate on which sectors will be most affected by automation. This debate is ill served by the current lack of detailed data on the exact capabilities of new machines and how they are influencing work. Although recent debates about the future of jobs have focused on whether they are at risk of automation, our research focuses on a more fine-grained and transparent method to model task automation and specifically focus on the domain of primary health care. OBJECTIVE This protocol describes a new wave of intelligent automation, focusing on the specific pressures faced by primary care within the National Health Service (NHS) in England. These pressures include staff shortages, increased service demand, and reduced budgets. A critical part of the problem we propose to address is a formal framework for measuring automation, which is lacking in the literature. The health care domain offers a further challenge in measuring automation because of a general lack of detailed, health care–specific occupation and task observational data to provide good insights on this misunderstood topic. METHODS This project utilizes a multimethod research design comprising two phases: a qualitative observational phase and a quantitative data analysis phase; each phase addresses one of the two project aims. Our first aim is to address the lack of task data by collecting high-quality, detailed task-specific data from UK primary health care practices. This phase employs ethnography, observation, interviews, document collection, and focus groups. The second aim is to propose a formal machine learning approach for probabilistic inference of task- and occupation-level automation to gain valuable insights. Sensitivity analysis is then used to present the occupational attributes that increase/decrease automatability most, which is vital for establishing effective training and staffing policy. RESULTS Our detailed fieldwork includes observing and documenting 16 unique occupations and performing over 130 tasks across six primary care centers. Preliminary results on the current state of automation and the potential for further automation in primary care are discussed. Our initial findings are that tasks are often shared amongst staff and can include convoluted workflows that often vary between practices. The single most used technology in primary health care is the desktop computer. In addition, we have conducted a large-scale survey of over 156 machine learning and robotics experts to assess what tasks are susceptible to automation, given the state-of-the-art technology available today. Further results and detailed analysis will be published toward the end of the project in early 2019. CONCLUSIONS We believe our analysis will identify many tasks currently performed manually within primary care that can be automated using currently available technology. Given the proper implementation of such automating technologies, we expect considerable staff resources to be saved, alleviating some pressures on the NHS primary care staff. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11232


2005 ◽  
Vol 35 (3) ◽  
pp. 479-483 ◽  
Author(s):  
Richard Lewis

A new political consensus has emerged over the benefits of new rights for patients to choose their provider of elective health care in the English National Health Service. From December 2005, patients will be able to select from a number of alternative providers at the time they are referred for treatment. In the longer term, patients will be able to access care at any public or private provider that meets national quality and cost standards. The government intends that this policy will lead to improvements in the quality and efficiency of health care and will reduce levels of inequity among patients. Pilot schemes have shown that a majority of patients will exercise a choice of provider when this is offered. However, the policy of patient choice may involve significant costs to the NHS and may be more difficult to implement outside urban areas. Further, the information needed to support patients' choices is not yet available. Whether such a policy will increase or decrease levels of equity in the English NHS remains open to debate.


2018 ◽  
Vol 48 (3) ◽  
pp. 461-481 ◽  
Author(s):  
David I Benbow

The English National Health Service (NHS) has suffered from a democratic deficit since its inception. Democratic accountability was to be through ministers to Parliament, but ministerial control over and responsibility for the NHS were regarded as myths. Reorganizations and management and market reforms, in the neoliberal era, have centralized power within the NHS. However, successive governments have sought to reduce their responsibility for health care through institutional depoliticization, to shift blame, facilitated through legal changes. New Labour’s creation of the National Institute for Clinical Excellence (NICE) and Monitor were somewhat successful in reducing ministerial culpability regarding health technology regulation and foundation trusts, respectively. The Conservative-Liberal Democrat coalition created NHS England to reduce ministerial culpability for health care more generally. This is pertinent as the NHS is currently being undermined by inadequate funding and privatization. However, the public has not shifted from blaming the government to blaming NHS England. This indicates limits to the capacity of law to legitimize changes to social relations. While market reforms were justified on the basis of empowering patients, I argue that addressing the democratic deficit is a preferable means of achieving this goal.


2014 ◽  
Vol 16 (03) ◽  
pp. 289-303 ◽  
Author(s):  
Christina Petsoulas ◽  
Stephen Peckham ◽  
Jane Smiddy ◽  
Patricia Wilson

BackgroundPatient and Public involvement (PPI) in health care occupies a central place in Western democracies. In England, this theme has been continuously prominent since the introduction of market reforms in the early 1990s. The health care reforms implemented by the current Coalition Government are making primary care practitioners the main commissioners of health care services in the National Health Service, and a duty is placed on them to involve the public in commissioning decisions and strategies. Since implementation of PPI initiatives in primary care commissioning is not new, we asked how likely it is that the new reforms will make a difference. We scanned the main literature related to primary care-led commissioning and found little evidence of effective PPI thus far. We suggest that unless the scope and intended objectives of PPI are clarified and appropriate resources are devoted to it, PPI will continue to remain empty rhetoric and box ticking.AimTo examine the effect of previous PPI initiatives on health care commissioning and draw lessons for future development.MethodWe scanned the literature reporting on previous PPI initiatives in primary care-led commissioning since the introduction of the internal market in 1991. In particular, we looked for specific contexts, methods and outcomes of such initiatives.Findings1. PPI in commissioning has been constantly encouraged by policy makers in England. 2. Research shows limited evidence of effective methods and outcomes so far. 3. Constant reconfiguration of health care structures has had a negative impact on PPI. 4. The new structures look hardly better poised to bring about effective public and patient involvement.


1979 ◽  
Vol 8 (2) ◽  
pp. 157-176 ◽  
Author(s):  
Alan Maynard

ABSTRACTSince the birth of the National Health Service in 1948 there have been periodic discussions of the potential role of pricing and insurance in the United Kingdom health care system. This article is concerned with discussing the problems inherent in these mechanisms and it advocates more careful articulation of the cost and benefits of such policies. The first section gives a description of some quite recent proposals to extend the role of the pricing and insurance mechanisms which have been made by the British Medical Association and the McKinsey consultancy company. The second section uses economic analysis to show that both the pricing and the insurance mechanisms have inherent problems which may vitiate their efficiency in many western health care markets. The third section is concerned with the mechanisms by which the efficiency of the health care system can be improved, and radical experimentation is advocated. Without radical experimentation and the implementation of suitable incentive systems, inefficiency and inequality will continue in the National Health Service.


2021 ◽  
pp. 1-15
Author(s):  
Jo Samanta ◽  
Ash Samanta

This chapter provides an overview of the contemporary health-care environment, with particular reference to the National Health Service (NHS) and its core principles, as well as its constitution. Access to health services, as set out in section 3(1) of the National Health Service Act 2006, is also discussed, together with the quality of care provided for individuals. In addition, the chapter looks at the findings of the Francis Report, which conducted a public inquiry into acknowledged failings in the Mid Staffordshire NHS Foundation Trust, the government response to the report, and the future of the NHS. In addition, there is a section on public health and the COVID-19 pandemic.


BMJ ◽  
1980 ◽  
Vol 280 (6229) ◽  
pp. 1449-1449
Author(s):  
A. Smith

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