Health care in the United Kingdom

Private medicine, where patients, or their insurers, pay for treatment in the UK is a niche market. Some is provided by NHS hospitals. Private providers also contract with the NHS, especially in England, to provide treatment for NHS patients, particularly in mental health and planned surgery.

Patients also go abroad for treatment. In 2014 about 48,000 went abroad for treatment and about 144,000 in 2016. This may be driven by increasing waiting times for NHS treatment, but will also include migrants who may return to their home country for treatment, especially childbirth. It also includes fertility services, dentistry and cosmetic surgery which may not be available on the NHS.[24] See Medical tourism.

In April 2013, under the terms of the Health and Social Care Act 2012, a reorganisation of the NHS took place regarding the administration of the NHS. Primary care trusts (PCTs) and strategic health authorities (SHAs) were abolished, and replaced by clinical commissioning groups (CCGs).[26] CCGs now commission most of the hospital and community NHS services in the local areas for which they are responsible.[27] Commissioning involves deciding what services a population is likely to need, and ensuring that there is provision of these services.[28]

The CCGs are overseen by NHS England, formally known as the NHS Commissioning Board (NHS CB) which was established on 1 October 2012 as an executive non-departmental public body.[28] NHS England also has the responsibility for commissioning primary care services - General Practitioners, opticians and NHS dentistry, as well as some specialised hospital services. Services commissioned include general practice physician services (most of whom are private businesses working under contract to the NHS), community nursing, local clinics and mental health services.

Provider trusts are NHS bodies delivering health care service. They are involved in agreeing major capital and other health care spending projects in their region.[26] NHS trusts are care deliverers which spend money allocated to them by CCG's.[29] Secondary care (sometimes termed acute health care) can be either elective care or emergency care and providers may be in the public or private sector.[30]

Each NHS system has developed ways of offering access to non-emergency medical advice. People in England[33] and Scotland can access these services by dialling the free-to-call 111 number. Scotland's service is run by NHS24.[34] The telephone number for NHS Direct Wales/Galw Iechyd Cymru[35] is 0845 4647, but this service intends to offer access through the 111 number from some point in 2015.[36]

In England and Wales, the National Institute for Health and Clinical Excellence (NICE) sets guidelines for medical practitioners as to how various conditions should be treated and whether or not a particular treatment should be funded. These guidelines are established by panels of medical experts who specialise in the area being reviewed.

In Scotland, the Scottish Medicines Consortium advises NHS Boards there about all newly licensed medicines and formulations of existing medicines as well as the use of antimicrobiotics but does not assess vaccines, branded generics, non-prescription-only medicines (POMs), blood products and substitutes or diagnostic drugs. Some new drugs are available for prescription more quickly than in the rest of the United Kingdom. At times this has led to complaints.[37]

The National Audit Office reports annually on the summarised consolidated accounts of the NHS, and Audit Scotland performs the same function for NHS Scotland.[38]

Since January 2007, the NHS have been able to claim back the cost of treatment, and for ambulance services, for those who have been paid personal injury compensation.[39]

Parking charges at hospitals have been abolished in Scotland (except at three PFI hospitals)[40] and have also been abolished in Wales.[41] Parking charges continue to be in place at many hospitals in England,[42] however, since April 2020, disabled people, frequent outpatient attenders, parents of sick children staying overnight and staff working night shifts have had access to free parking.[43]

In a sample of 13 developed countries, the UK was 9th in its population-weighted usage of medication in 14 classes in both 2009 and 2013. The drugs studied were selected on the basis that the conditions treated had high incidence, prevalence and/or mortality, caused significant long-term morbidity and incurred high levels of expenditure and significant developments in prevention or treatment had been made in the last 10 years. The study noted considerable difficulties in cross border comparison of medication use.[44]

Northern Ireland, Scotland and Wales no longer have Prescription charges. However, in England, a prescription charge of £9.00 is payable per item as of April 2019,[45] though patients under 16 years old (16–18 years if still in full-time education) or over 60 years getting prescribed drugs are exempt from paying as are people with certain medical conditions, those on low incomes or in receipt of certain benefits, and those prescribed drugs for contraception.[46]

UK permanent residents in England do not pay the real cost of the medicines and so for some prescribed medicines that can be bought over the counter without a prescription, for example aspirin, it can be much cheaper to purchase these without a prescription. UK permanent residents in England who must pay can (instead of paying for each medical item individually) purchase a three-month Prescription Prepayment Certificate (PPC) costing £29.10. This saves the patient money where the patient needs three or more items in three months. There is also a 12-month PPC certificate costing £104.00 which saves patient's money if 12 or more items are needed in 12 months. There are no prescription charges anywhere in the UK for medicines administered at a hospital, by a doctor or at an NHS walk-in centre.[46]

From the birth of the NHS in 1948, private medicine has continued to exist, paid for partly by private insurance. Provision of private healthcare acquired by means of private health insurance, funded as part of an employer funded healthcare scheme or paid directly by the customer, though provision can be restricted for those with conditions such as AIDS/HIV.[47] In recent years, despite some evidence that a large proportion of the public oppose such involvement,[48] the private sector has been used to increase NHS capacity. In addition, there is some relatively minor sector crossover between public and private provision with it possible for some NHS patients to be treated in private healthcare facilities[49] and some NHS facilities let out to the private sector for privately funded treatments or for pre- and post-operative care.[50] However, since private hospitals tend to manage only routine operations and lack a level 3 critical care unit (or intensive therapy unit), unexpected emergencies may lead to the patient being transferred to an NHS hospital.[51]

When the Blair government expanded the role of the private sector within the NHS in England,[52][53] the Scottish government reduced the role of the private sector within public healthcare in Scotland[54] and planned legislation to prevent the possibility of private companies running GP practices in future.[55] Later, however in an attempt to comply with the Scottish Treatment Time Guarantee, a 12-week target for inpatient or day-case patients waiting for treatment, NHS Lothian spent £11.3 million on private hospital treatment for NHS patients in 2013-14.[56]

In January 2010 the Nuffield Trust published a comparative study of NHS performance in England and the devolved administrations since devolution, concluding that while Scotland, Wales and Northern Ireland have had higher levels of funding per capita than England, with the latter having fewer doctors, nurses and managers per head of population, the English NHS is making better use of the resources by delivering relatively higher levels of activity, crude productivity of its staff, and lower waiting times.[57] However, the Nuffield Trust quickly issued a clarifying statement in which they admitted that the figures they used to make comparisons between Scotland and the rest of the United Kingdom were inaccurate due to the figure for medical staff in Scotland being overestimated by 27 per cent.[58]

Using revised figures for medical staffing, Scotland's ranking relative to the other devolved nations on crude productivity for medical staff changes, but there is no change relative to England.[59] The Nuffield Trust study was comprehensively criticised by the BMA which concluded "whilst the paper raises issues which are genuinely worth debating in the context of devolution, these issues do not tell the full story, nor are they unambiguously to the disadvantage of the devolved countries. The emphasis on policies which have been prioritised in England such as maximum waiting times will tend to reflect badly on countries which have prioritised spending increases in other areas including non-health ones."[60]

In April 2014 the Nuffield Trust produced a further comparative report "The four health systems of the UK: How do they compare?" which concluded that despite the widely publicised policy differences there was little sign that any one country was moving ahead of the others consistently across the available indicators of performance. It also complained that there was an increasingly limited set of comparable data on the four health systems of the UK which made comparison difficult.

In February 2016 the Organisation for Economic Co-operation and Development published a review which concluded that performance of the NHS in Wales was little different from that in the rest of the UK. They described performance across the UK as "fairly mediocre" saying that great policies were not being translated into great practices. They suggested that GPs should be more involved in health boards and that resources should be shifted out of hospitals.[61]