275:
66:
300:. In June 1994, the Capital Investment Manual (CIM) was published, setting out the terms of PFI contracts. The CIM made it clear that future capital projects (building of new facilities) had to look at whether PFI was preferable to using public sector funding. By the end of 1995, 60 relatively small projects had been planned for, at a total cost of around £2 billion. Under PFI, buildings were built and serviced by the private sector, and then leased back to the NHS. The Labour government elected under
181:, leading to waiting lists for both consultations and surgery, up to months long, although the Labour government of 1997-onwards made it one of its key targets to reduce waiting lists. In 1997, the waiting time for a non-urgent operation could be two years; there were ambitions to reduce it to 18 weeks despite opposition from doctors. It is contested that this system is fairer - if a medical complaint is acute and life-threatening, a patient will reach the front of the queue quickly.
312:. There has been significant criticism of this, with a study by a consultancy company which works for the Department of Health showing that for every £200 million spent on privately financed hospitals the NHS loses 1000 doctors and nurses. The first PFI hospitals contain some 28% fewer beds than the ones they replaced. As well as this, it has been noted that the return for construction companies on PFI contracts could be as high as 58%, and that in funding hospitals from the
24:
363:
in
Stafford, England in the late 2000s concerned abnormally high mortality rates amongst patients at the hospital. Up to 1200 more patients died between 2005 and 2008 than would be expected for the type and size of hospital based on figures from a mortality model, but the final Healthcare Commission
211:
infection. This has led to criticism of standards of hygiene across the NHS, with some patients buying private health insurance or travelling abroad to avoid the perceived threat of catching a "super bug" while in hospital. However, the department of health pledged £50 million for a "deep clean" of
412:
urged NHS England to prioritize evidence and safety in gender dysphoria treatment following concerns raised by the Cass Review. NHS demanded cooperation from adult clinics and initiated a review, with Labour supporting evidence-based care. Momentum criticized limitations on gender-affirming care,
232:(NICE) are the first gatekeeper, and examine the cost effectiveness of all drugs. Until they have issued guidance on the cost and effectiveness of new or expensive medicines, treatments and procedures, NHS services are unlikely to offer to fund courses of treatment. The same of true of the
146:
In making health care a largely "invisible cost" to the patient, health care seems to be effectively free to its consumers - there is no specific NHS tax or levy. To reduce cost and ensure that everyone is treated equitably, there are a variety of "gatekeepers." The
174:" travelling to Britain (mostly London) and using the NHS while paying nothing. British citizens have been known to travel to other European countries to take advantage of lower costs, and because of a fear of hospital-acquired super bugs and long waiting lists.
188:(QALYs), a method of quantifying the benefit of medical intervention. It is argued that this method of allocating healthcare means some patients must lose out in order for others to gain, and that QALY is a crude method of making life and death decisions.
364:
report concluded it would be misleading to link the inadequate care to a specific number or range of numbers of deaths. A public inquiry later revealed multiple instances of neglect, incompetence and abuse of patients.
307:
Under the private finance initiative, an increasing number of hospitals have been built (or rebuilt) by private sector consortia, although the government also encouraged private sector treatment centres, so called
151:(GP) functions as a primary gatekeeper - without referral from a GP, it is often impossible to gain higher courses of treatment, such as an appointment with a consultant. These are argued to be necessary -
901:
1089:
1170:
247:, due to its high cost and perceived limited overall survival. The campaign waged by cancer sufferers to get the government to pay for their treatment has gone to the highest levels in the
122:. However, the involvement of the NHS in scandals extends back many years, including over the provision of mental health care in the 1970s and 1980s (ultimately part of the reason for the
372:
Unlike in
Scotland and Wales which have devolved healthcare, NHS England is run on behalf of the taxpayer by the UK Parliament and the Department of Health, at the head of which is the
356:." In response, it has been argued that the scandal brought the issue of organ and tissue donation into the public domain, and highlighted the benefits to medical research that result.
400:
1116:
742:
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There is therefore the potential for a conflict of interest, as both the NHS and the CQC have the same leadership and both are highly susceptible to political interference.
229:
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Schneider, Antonius; Donnachie, Ewan; Tauscher, Martin; Gerlach, Roman; Maier, Werner; Mielck, Andreas; Linde, Klaus; Mehring, Michael (9 June 2016).
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45:
32:
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There have been several fatal outbreaks of antibiotic resistant bacteria ("super bugs") in NHS hospitals, such as
Methicillin-resistant
112:
1313:
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885:
470:
292:
Before the idea of private finance initiative (PFI) came to prominence, all new hospital building was by convention funded from the
201:
77:
379:
The group charged in
England and Wales with checking if the care delivered by the NHS is genuinely safe and fit for purpose is the
750:
1332:
682:
432:
337:
89:
563:
383:, or CQC. Although the CQC describes itself as the "independent regulator of all health and social care services in England"
266:
for bringing in drugs that cost on and around the £30,000 limit that is considered the maximum worth of one QALY in the NHS.
252:
233:
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427:
850:
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221:
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37:
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159:, "we shall never have all we need... expectations will always exceed capacity". On the other hand, the national
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at Alder Hey, had ordered the "unethical and illegal stripping of every organ from every child who had had a
442:
422:
380:
259:
65:
514:"Costs of coordinated versus uncoordinated care in Germany: results of a routine data analysis in Bavaria"
123:
333:
164:
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148:
104:
345:
625:
297:
593:
387:
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344:, including children's organs, between 1988 and 1995. The official report into the incident, the
93:
1193:"Minister tells NHS to 'end culture of secrecy' on gender care as focus shifts to adult clinics"
328:
Several high-profile medical scandals have occurred within the NHS over the years, such as the
1309:
1290:
1252:
1061:
1015:
881:
545:
466:
386:, it is in fact "accountable to the public, Parliament and the Secretary of State for Health."
167:) have dispensed with the need for referral; direct access to a specialist is possible there.
127:
96:
76:
includes issues such as access, waiting lists, healthcare coverage, and various scandals. The
396:
and much of its funding comes from the taxpayer. At least one chairman, one chief executive
1005:
535:
527:
225:
160:
103:. It has come under much criticism, especially during the early 2000s, due to outbreaks of
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100:
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902:"New generation surgery-centres to carry out thousands more NHS operations every year"
686:
402:
of the CQC have been singled out for attention by a UK Secretary of State for Health.
304:
in 1997 embraced PFI projects, believing that public spending needed to be curtailed.
1326:
939:
317:
239:
There has been considerable controversy about the public health funding of expensive
571:
1120:
1117:"Stafford hospital scandal: Up to 1,200 may have died over "shocking" patient care"
341:
152:
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23:
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296:, as it was believed it was best able to raise money and able to control
384:
220:
The lack of availability of some treatments due to their perceived poor
853:. National Institute for Health and Clinical Excellence. Archived from
353:
85:
413:
while
Stonewall welcomed the review's focus on children's well-being.
1219:"NHS England must end 'culture of secrecy' in children's gender care"
368:"Lack of independence of checking for safety and fitness for purpose"
131:
1058:
Report of the Mid
Staffordshire NHS Foundation Trust Public Inquiry
177:
NHS access is therefore controlled by medical priority rather than
273:
240:
64:
1090:"NHS targets 'may have led to 1,200 deaths' in Mid-Staffordshire"
1035:"Stafford Hospital: Hiding mistakes 'should be criminal offence'"
340:, there was the unauthorised removal, retention, and disposal of
348:, revealed that Dick van Velzen, the Chair of Foetal and Infant
564:"Tougher rules to ensure that people do not abuse NHS services"
135:
17:
489:. theinformationdaily.com. 24 September 2007. Archived from
320:
cost the NHS almost half a billion pounds more every year.
1171:"Boss of scandal-hit hospital escapes cross-examination"
1272:
1142:"How many people died "unnecessarily" at Mid Staffs"
126:), and overspends on hospital newbuilds, including
1169:Sawer, Patrick; Donnelly, Laura (2 October 2011).
118:, waiting lists, and medical scandals such as the
74:Criticism of the National Health Service (England)
230:National Institute for Health and Care Excellence
984:"Checks and balances needed for organ retention"
962:"PFI hospitals 'costing NHS extra £480m a year'"
1092:. London: The Daily Telegraph. Archived from
8:
1287:NHS plc: the privatisation of our healthcare
621:"Doctors attack Blair's waiting list pledge"
170:There has been concern about opportunistic "
184:The NHS measures medical need in terms of
1249:From Cradle to Grave: 50 years of the NHS
1009:
878:From Cradle to Grave: 50 years of the NHS
539:
463:From Cradle to Grave: 50 years of the NHS
134:in 1985, the cost of which shot up from
48:of all important aspects of the article.
453:
1348:Medical scandals in the United Kingdom
487:"TCSR 07 - Health: The Public Expects"
44:Please consider expanding the lead to
1056:Robert Francis QC (6 February 2013).
653:"Quality Adjusted Life Years (QALYs)"
224:sometimes leads to what some call a "
7:
155:Bevan noted in a 1948 speech in the
1306:Betraying the NHS: Health Abandoned
936:"Private Affluence, Public Rip-Off"
729:"Hospital deep cleaning under fire"
278:University College Hospital, London
212:all NHS England hospitals in 2007.
825:"Q&A: The Herceptin judgement"
799:"Cancer drug rejected for NHS use"
619:Jones, George (21 February 2007).
594:"Health tourists could get refund"
236:, NICE's counterpart in Scotland.
14:
908:. 3 December 2002. Archived from
773:"Why some drugs are not worth it"
163:systems in other countries (e.g.
142:Access controls and waiting lists
1088:Smith, Rebecca (18 March 2009).
1033:Nick Triggle (6 February 2013).
433:Healthcare in the United Kingdom
408:In April 2024, Health Secretary
90:National Health Service Act 1946
69:The logo of the NHS for England.
22:
1308:. Jessica Kingsley Publishing.
851:"Update on Herceptin appraisal"
749:. 9 August 2006. Archived from
570:. 26 April 2004. Archived from
36:may be too short to adequately
1343:Politics of the United Kingdom
46:provide an accessible overview
1:
1011:10.1016/S0960-9822(01)00078-1
709:"Do hospitals make you sick?"
374:Secretary of State for Health
338:Alder Hey Children's Hospital
234:Scottish Medicines Consortium
1304:Mandelstam, Michael (2006).
1115:Emily Cook (18 March 2009).
1060:(Report). House of Commons.
659:. March 2006. Archived from
428:List of hospitals in England
192:Hospital acquired infections
138:29 million to £152 million.
982:Dixon, B. (19 March 2001).
880:. Kings Fund. p. 437.
685:. Bandolier. Archived from
657:National Library for Health
532:10.1136/bmjopen-2016-011621
465:. Kings Fund. p. 437.
186:quality-adjusted life years
82:publicly funded health care
1364:
1338:Criticism of organizations
438:Private Finance Initiative
288:Public-Private Partnership
284:Private Finance Initiative
281:
270:Private Finance Initiative
1285:Pollock, Allyson (2004).
1247:Rivett, Geoffrey (1998).
876:Rivett, Geoffrey (1998).
461:Rivett, Geoffrey (1998).
361:Stafford Hospital scandal
298:public sector expenditure
1177:. London. Archived from
743:"NHS 'postcode lottery'"
629:. London. Archived from
330:Alder Hey organs scandal
255:to get it licensed. The
120:Alder Hey organs scandal
1333:National Health Service
443:Care Quality Commission
423:National Health Service
381:Care Quality Commission
260:Health Select Committee
78:National Health Service
392:31 August 2013 at the
279:
124:Mental Health Act 1983
70:
960:PublicFinance.co.uk.
334:Bristol heart scandal
277:
209:Clostridium difficile
202:vancomycin-resistant
198:Staphylococcus aureus
114:Clostridium difficile
68:
906:Department of Health
683:"So what is a QALY?"
149:general practitioner
105:antibiotic resistant
88:, created under the
1175:The Daily Telegraph
1002:2001CBio...11.R151D
857:on 13 December 2006
753:on 7 September 2007
633:on 25 February 2007
626:The Daily Telegraph
399:and a board member
107:infections such as
1181:on 3 October 2011.
731:. 14 January 2008.
717:. 31 January 2019.
574:on 8 December 2008
568:Medical News Today
280:
222:cost-effectiveness
71:
934:(10 March 2002).
600:. 7 December 2007
493:on 22 August 2014
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262:criticised some
257:House of Commons
226:postcode lottery
161:health insurance
157:House of Commons
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54:September 2016
40:the key points
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1227:. Retrieved
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1201:. Retrieved
1197:Morning Star
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1179:the original
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1098:. Retrieved
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910:the original
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855:the original
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342:human tissue
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33:lead section
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945:7 September
1327:Categories
1241:References
1100:9 November
1073:9 February
1041:9 February
967:3 December
861:1 December
809:4 December
783:4 December
757:9 December
693:9 December
667:9 December
637:9 December
604:9 December
578:9 December
497:9 December
354:postmortem
302:Tony Blair
282:See also:
243:, notably
84:system of
1289:. Verso.
1147:Full Fact
350:Pathology
245:Herceptin
116:infection
38:summarize
1229:15 April
1203:15 April
1020:11267877
829:BBC News
777:BBC News
714:BBC News
550:27288386
519:BMJ Open
417:See also
390:Archived
332:and the
324:Scandals
294:Treasury
251:and the
228:". The
216:Coverage
200:(MRSA),
153:Welshman
94:post-war
998:Bibcode
541:4908874
314:private
253:Cabinet
165:Germany
92:by the
86:England
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1154:29 May
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249:courts
132:London
97:Labour
1126:6 May
1037:. BBC
449:Notes
336:. At
241:drugs
1310:ISBN
1291:ISBN
1253:ISBN
1231:2024
1205:2024
1156:2015
1128:2009
1102:2010
1075:2013
1062:ISBN
1043:2013
1016:PMID
969:2014
947:2006
918:2006
882:ISBN
863:2006
837:2006
811:2007
785:2007
759:2007
695:2007
669:2007
639:2007
606:2007
580:2007
546:PMID
499:2007
467:ISBN
359:The
286:and
207:and
111:and
109:MRSA
1273:NHS
1006:doi
536:PMC
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