The British Liberal Democratic Party is launching a website, NHS Watch, to monitor whether the British National Health Service is "not working as it should be."
Examples of items this website is seeking include:
The British government now needs to broaden its focus from driving down waiting times to ensuring that the British National Health Service (NHS) delivers equal treatment for patients in equal need of it, according to a new report from the King's Fund.
The report, " War on Waiting for Hospital Treatment: What has Labour achieved and what challenges remain?", by Anthony Harrison and John Appleby, is available priced �15 from King�s Fund publications on 020 7307 2591 or by visiting www.kingsfund.org.uk/publications.
The report argues the government has reasons to feel optimistic that no patient will wait more than 18 weeks from GP appointment to hospital treatment by 2008, although it warns there are many constraints that could still mean the target is missed. It also suggests the government will need to monitor carefully the impact of potentially destabilising policies, such as payment by results and the extension of patient choice.
However, it says that even if the 18-week target is met, it will not be the 'end of waiting' that Ministers have claimed. The government should look carefully at the potential costs and benefits of reducing waits even further, it says, and develop policies to remove variations in access to services and unacceptable differences in the quality of clinical practices.
Report author Anthony Harrison said: "The government is moving in the right direction on waiting times but should use the next two to three years to prepare to go further. Waiting time targets are based on assumptions that are rarely made explicit: namely that the right people are being identified and referred for the right treatment at the right time.
"Yet we know that access to some non-emergency surgical treatments is lower for people from poorer communities compared to those who are better off, and that the clinical criteria by which patients are treated vary from area to area and even doctor to doctor. More work is needed to determine the scale of the current variations, the reasons for them and the policies likely to be effective in tackling them. But as the 18-week target is approached, the government should put much more emphasis on doing just that."
The government inherited a waiting list of 1.3 million people and a maximum waiting time of 18 months when it came to power in 1997. The War on Waiting for Hospital Treatment , by Anthony Harrison and John Appleby, analyses how the government has reduced this by waging a three-phase campaign against waiting lists and times, and says its policies have become more important and effective at each stage:
* First phase - lasting from 1997 to 2000, the government focused on reducing the number of people waiting through a combination of funds for specific initiatives and advice for NHS trusts
* Second phase - lasting from 2000 to 2004, Ministers set targets in terms of maximum waiting times and introduced a much wider range of policies designed to increase the supply of elective care
* Third phase - starting in 2005, the government set an 18 week 'total' waiting target, including waiting for diagnostic tests, to be met by 2008. Ministers argue that if this is met, waiting for elective treatment will cease to be a major concern for the NHS, and it will be able to turn its attention to other priorities.
King's Fund chief executive Niall Dickson said: "The government has waged a war on hospital waiting that has achieved a degree of success few believed was possible at the start. While they may not be perfect, targets can deliver real improvements and Ministers may well feel confident they will meet the ambitious 18-week target. Waiting lists continue to fall and extra capacity purchased from the private sector is starting to come on stream. But nothing should be taken for granted. The sheer number of patients to treat, the worsening financial climate, the uncertain impact of payment by results and choice, and shortages of staff in key areas all present real challenges for the government and the NHS."
Finally, the report argues that government will need to manage both supply and demand to secure its gains. On the supply side, choice and payment by results could shift work between hospitals and between elective and emergency services, without increasing overall NHS capacity. The government will need to monitor their impact. On the demand side, shorter waiting times could encourage doctors and patients to refer more people into the system. The report says the government needs to look carefully at treatment 'thresholds' to stop this happening and to ensure treatment is clinically appropriate.
Canada spends more on health care than any other industrialized country providing universal access save Iceland and Switzerland, yet ranks low in measures of access to care, according to How Good is Canadian Health Care? An International Comparison of Health Care Systems (2005 Report) released Thursday by The Fraser Institute.
�Canadians are being short-changed under our current health care system. Despite spending more than almost every other developed nation on health care, Canadians are experiencing inferior access to physicians and technology and suffering very long waits for treatment. Canada is also less successful in reducing deaths from preventable causes than other developed nations,� said Nadeem Esmail, co-author and senior health policy analyst at the Institute.
The study compares Canada to other OECD countries that guarantee access to health care regardless of ability to pay. Twelve indicators of access to health care and outcomes from the health care process are examined including access to physicians, access to high-tech medical equipment, and key health outcomes.
Many of the countries examined produce superior outcomes in health care and at a lower cost than Canada. Other industrialized countries with universal access programs, such as Sweden, Japan, and Australia, allow user fees, some form of private insurance, and private hospitals that compete for patient demand. These three countries consistently outperform Canada on health outcomes but spend less.
�This evidence supports the Supreme Court�s recent conclusion that private health insurance does not need to be outlawed in order to �protect� Medicare. It is striking to note that amongst industrialized countries, only Canada outlaws a private parallel health care system for its citizens,� noted Esmail.
Health Care Spending
The average age of a country�s population is a major determinant of the amount of money it will have to spend in order to provide adequate health care. In Canada, those aged 65 and over consume more than 44 percent of health care expenditures yet make up only 12.7 percent of the population.
After adjusting for the age of the population, Canada spends 10.7 percent of GDP on health care, the third highest among developed nations with universal access health care programs.
Comparing Health Outcomes
In this study, seven outcome measures have been used to rank the performance of the OECD countries.
Canada ranks twenty-second in the percentage of total life expectancy that will be lived in full health; twentieth in infant mortality; twelfth in perinatal mortality; fourth in medically avoidable deaths; eighth in potential years of life lost to disease; tenth in the incidence of breast cancer mortality, and second in the incidence of mortality from colorectal cancer.
The evidence presented in this study suggests that health care expenditures can be significantly reduced if consumers of care help to pay for the care they demand. In banning user fees, Canada is very much in the minority. More than three-quarters of the countries in the OECD that provide universal access also charge user fees for access to hospitals, general practitioners, or specialists and, in many cases, to all three. In most cases, low-income citizens are exempted from paying user fees.
The Number of Doctors
On an age-adjusted basis, Canada has among the fewest number of physicians in the OECD. Canada ranks twenty fourth out of twenty-seven countries with 2.3 doctors per 1,000 people for a total of 66,289 doctors. To be comparable to first-placed Iceland, Canada would need 53,663 more doctors, an 81 percent increase over the current level.
In 1970, when public insurance first fully applied to physician services, Canada placed second among the countries that could be ranked in that year.
Access to Technology
In terms of age-adjusted access to high-tech machinery, Canada performs dismally. Canada ranks thirteenth out of twenty-two countries in access to MRIs; seventeenth of twenty-one in access to CT scanners; seventh of twelve in access to mammographs, and is tied for last in access to lithotriptors. Lack of access to machines has also meant longer waiting times for diagnostic assessment, and mirrors the longer waiting times for access to specialists and to treatment found in other comparative studies.
�It is astounding that Canadians continue to commit themselves to the status quo for Medicare, when other nations manage to deliver so much more for less money. We should be looking at incorporating successful policies from other countries, such as cost sharing and competition, in order to fix our ailing health care system,� Esmail pointed out. �Canada should emulate these more successful models.�
Click here for the related figures.
Established in 1974, The Fraser Institute is an independent public policy
organization with offices in Vancouver, Calgary, and Toronto.
The Australian Health Care Association says a proposed change in the Australian healthcare system to establish "fundholding", a capitation payment system for doctors, could lead to rationing of healthcare, according to the Sydney Morning Herald .
That would make Australia's health care system more like the British, which reportedly suffers from medical rationing.
While Australia's health care payment system also is government run, it currently has a fee-for-service payment structure.
In capitation, a doctor gets paid a fixed amount for each patient, regardless of how much treatment that patient receives. In fee-for-service, the doctor gets paid a fixed amount for each item of service.
The Scottish arm of the British National Health Service (NHS) has published a pamphlet entitled 'The NHS and You', which provides an introduction to its services.
Perhaps of greatest interest are the standard waiting times for treatment in Scotland. They are as follows:
The Health Department has set targets for the whole of Scotland which set out how quickly you should be able to get certain kinds of appointment, test or treatment. These targets are as follows:
Contacting your GP surgery
*When you contact your GP surgery, you should be able to see or speak to someone for advice within two working days. The surgery team will decide who they think is best suited to deal with your problem. This could be a GP, a practice nurse, or someone else.
*By the end of 2005, you should not have to wait more than 26 weeks from a GP referral for a hospital outpatient appointment.
* By the end of 2007, you should not have to wait longer than 18 weeks from a GP referral for a hospital outpatient appointment.
Hospital inpatient and day case treatment
*You should not have to wait more than nine months for inpatient or day case treatment.
*By the end of 2005, you should not have to wait more than six months for inpatient or day case treatment.
*By the end of 2007, you should not have to wait more than 18 weeks for inpatient or day case treatment.
Accident and Emergency department
*By the end of 2007, when you arrive at an Accident and Emergency (A&E;) department, the longest you will wait is four hours before being admitted to a ward, discharged or transferred to another hospital.
*By the end of 2007, if you are referred by your GP or optometrist for cataract surgery, you will not have to wait more than 18 weeks.
*By the end of 2007, if you fracture your hip and are admitted to a specialist orthopaedic unit for surgery, your operation will be carried out within 24 hours.
*If you see a specialist and they refer you for angiography, you will not have to wait for more than eight weeks to have this done.
* If you have angiography done and you then need a heart bypass operation or angioplasty, you will not have to wait more than 18 weeks after the angiography for this.
*By the end of 2007, if you are being referred by your GP for treatment through the rapid access chest pain clinic, you will not have to wait formore than 16 weeks.
* By the end of 2007, if you are being referred by a heart specialist for treatment, you will wait no more than 16 weeks.
*By the end of 2005, if you are referred urgently to hospital by your GP for investigation and then found to have cancer, you should not have to wait for more than two months for the treatment to start.
*If investigation has shown that you have breast cancer, you should start the treatment within one month of doctors telling you that you have cancer.
*If you are referred urgently to hospital by your GP for investigation and then found to have acute leukaemia, you should not have to wait for more than one month for the treatment to start.
*If your child is referred urgently to hospital by your GP for investigation and is then found to have cancer, treatment should start within one month.
Sometimes, hospital services in your local area might be so busy that it will not be possible for you to get an appointment, a test or treatment within the national target times. If this is the case, you will be given the opportunity to travel to somewhere else in Scotland to get the appointment, test or treatment within the target time. If you want to find out about this, speak to a member of NHS staff involved in your care.
The British Commission for Healthcare Audit and Inspection, known as the Healthcare Commission, today told the British NHS, it must do more to help people with the greatest need for healthcare. In its first report into the state of British healthcare the independent inspectorate said there are many positive indicators that healthcare provided by the NHS is improving. But it also said the pace of the improvement is not enough for the people who need help most.
Examples of improvement include patients typically waiting less time for treatment in hospital and GP surgeries, falling mortality rates from cancer and many more hospitals having dedicated units for stroke patients, which can greatly improve their chances of recovery. However, the report also found wide variations in healthcare and health between different parts of the country and different groups of the population. For instance, the death rate from cancer is 60% higher in Liverpool than in east Dorset and long term illness or disability is more common among people with lower incomes.
The State of Healthcare Report 2004 examines many aspects of the NHS� provision of healthcare, including care in hospitals and in the community, public health, mental health, care of children and of the elderly.
Sir Ian Kennedy, Chairman of the Healthcare Commission said: �The NHS is highly complex, ranging from GPs� surgeries to intensive care units and from clinics treating those with drug addiction to care for those who need mental healthcare. Some parts of the system are performing better than others.
�It also serves a huge range of people, from pregnant mothers to newborn babies, the chronically ill, those with acute illnesses and those at the end of their lives. It must serve the whole nation, not just those who live in certain areas, or those best able to demand healthcare of good quality.
�My concern, and that of the Healthcare Commission, is that those most in need may still be getting the worst deal.�
The Healthcare Commission today pledged to put inequalities in healthcare and health at the top of its agenda. The Commission will be vigilant in checking that every citizen receives healthcare according to their needs regardless of their circumstances and background. Part of its future work will be dedicated to ensuring that the NHS identifies why the experience of healthcare varies and what it intends to do to address the clear inconsistencies in the provision of services. For example, it appears that a disproportionately high proportion of those compulsorily admitted to mental health units are from black and minority ethnic groups, and the proportion of older people in the population receiving flu vaccinations varies from 49% to 78% across England.
The Healthcare Commission also found variations between England and Wales. For instance, patients are more likely to wait longer for hospital appointments in Wales than in England. In March 2004, fewer than 50 people were waiting more than nine months for an operation in England. In Wales at the end of the same month, 8,457 patients had been waiting longer than 12 months, of which 1,401 had been waiting longer than 18 months.
The Government�s spending on healthcare is increasing. However, the Healthcare Commission is concerned about how those funds are allocated across the country. On historical grounds, some communities receive more money than others. The Government has a formula to address anomalies and to determine how much each community should get, based on the needs of its population, including age, deprivation and amount of ill-health. But many deprived communities, who have the greatest health needs, are not getting as much as they should according to the formula. For instance, Easington in County Durham should be receiving an additional �26.5 million a year while Kensington and Chelsea is receiving �30.3 million a year more than the formula requires.
Sir Ian Kennedy said: �We recognise the Government has a system that, by 2010, will move communities away from their historical funding towards the funding that they should receive. Eventually, more money will go to the communities that most need it. However, 2010 is far away and the Healthcare Commission would like to see more money going to those who need it, more urgently. We believe this is important if the Government is going to achieve its targets for health and healthcare.�
Sir Ian Kennedy also said that solving inequalities in healthcare will also require action to improve the health of people in those communities. This will require partnership between local authorities, schools, healthcare organizations and others. The Healthcare Commission will work with the Audit Commission and other bodies to ensure that all those concerned work towards improving the health of the population.
Following the June 9 Canadian Supreme Court decision that Quebec cannot prohibit individuals from privately seeking health care, Alberta will permit patients to pay extra for speical hip replacements or for private hospital rooms, according to 940News.
Reportedly, Alberta Premier Ralph Klein denies these changes will lead to a two-tier medical system for Alberta; while Liberal opposition Leader Kevin Taft says it will do just that.
The Canadian Supreme Court has ruled today that Quebec cannot prohibit individuals from privately paying for medical treatment that the public system also covers.
Presently, in Canada, while patients may privately pay for services not generally offered under Canada's medicare system, they are barred from paying for those services that it does offer.
This ban was challenged by a patient who had to wait a year for a hip replacement operation and by a doctor who wanted to charge for services in a private hospital.
The ruling directly applies only to Quebec's plan and not to Canada's as a whole. However, because other provinces have plans that resemble Quebec's, the ruling probably will have widespread impact.