NHS e as eleições

The NHS: what are the UK’s political parties promising?

The UK's National Health Service is a top priority for voters ahead of the general election in May. What are the key political parties pledging for the health service? Emma Wilkinson reports.

The UK National Health Service (NHS) is always a political hot potato, but with patient satisfaction at a record high in 2010, it was not top of the agenda ahead of the last general election. Fast forward 5 years and the continued fall out from the Coalition Government's Health and Social Care Act, rising pressures, falling staff morale, and growing financial problems mean that health and the NHS are likely to dominate in political debates in the run up to the UK general election on May 7.

The Conservative–Liberal Democrat Coalition is defending a tough record. Although the NHS purse has largely been protected, at least in relation to other parts of the public sector, the health service has in essence had to manage on a frozen budget. In his politically astute Five Year Forward View for the health service, NHS chief executive Simon Stevens said although the NHS has managed to deal with a larger, sicker, older population with flat funding, “service pressures are building”.

And the cracks are starting to show. The past year in particular has seen patients unable to get appointments, emergency departments struggling to cope with demand, and an increasing number of trusts failing to balance the books.

There remains a great deal of anger over the NHS Health and Social Care Act, passed in 2012 with a majority of 88, bringing in its wake a change in structure so large it was “visible from space”, as the then NHS chief executive David Nicholson famously described it.

The Act paved the way for a greater role for competition and the private sector, an issue that politicians will be at loggerheads over in the coming weeks. Not least as it is the first general election to involve the National Health Action (NHA) Party—founded 3 years ago to campaign against privatisation of the NHS and cuts in funding.

Yet, unless they work in the NHS, the electorate might largely be unaware of these mostly behind-the-scenes organisational issues. The topics they will of course care about are access, quality of care, safety, and funding.

Several polls have pointed to the NHS being a top issue, including one BBC survey of more than 4000 adults, which placed it higher up the agenda than the economy or immigration.

Lancet 21.03.15  link

Labour’s 10-year plan for health and care  link

NHS FIVE YEAR FORWARD VIEW link

Liz Kendall believes Labour has to show voters it can reform public services when finances are tight. link

THE ANDREW MARR SHOW INTERVIEW: JEREMY HUNT, MP HEALTH SECRETARY APRIL 27th 2014  link

Our priorities for the next government   link

How is the NHS performing?  link

NHS, value for money, value for many

The National Health System (NHS) is one of the proudest achievements of the UK. Established in 1948, the NHS has not only played an important part in improving the health of the nation, but has provided to citizens and residents of the UK financial protection during illness and sickness. The NHS provides value for money and value for many.

The British public appreciates the NHS and its equity ethos—a defining and enduring characteristic that ensures all those who need care get it when they need it, free at the point of delivery. In the 2014 British Social Attitudes Survey, 89% of the public agreed that the government should support a tax-funded national health system, free at the point of use, that provided comprehensive care for all citizens, and 65% of the British public was satisfied with the NHS (compared with only 37% in 1997). Notwithstanding major limitations of comparative health-system analysis, cross-country studies rank the NHS favourably relative to the health systems of other high-income countries in relation to health outcomes achieved per person, amount of health expenditure, financial protection, and equity. Yet other studies identify opportunities for improving the efficiency of the overall health sector compared with what is achieved in other countries of the Organisation for Economic Cooperation and Development (OECD) and the health outcomes the NHS achieves, particularly mortality from diseases that are amenable to treatment.

In looking to the future, however, the NHS is confronted by four transitions for which it is ill prepared: a demographic transition to an ageing population with a high dependency ratio; an epidemiological transition to chronic illness, disability, and multimorbidity; an economic transition with widening income and wealth inequalities; and a social transition to a public that expects responsive and personalised health services. The ageing population of the UK currently bears the brunt of a high burden of chronic disease, mental illness, and disability, where the rates of standardised years of life lost for ischaemic heart disease, chronic obstructive pulmonary disease, other cardiovascular and circulatory disorders, and breast cancer are significantly higher than in other western European countries, such as France, the Netherlands, Norway, and Sweden.9 The population of the UK faces major risk factors for ill health: tobacco use, hypertension, obesity, and physical inactivity.

But there is an asymmetry between the design of the NHS and the UK's health and social care needs. Three decades of repeated, and mostly unproductive, organisational restructuring and ill-conceived financial allocation regimes have produced a hospital-centric NHS in which treating acute episodic illness is rewarded disproportionately more than disease prevention and maintenance of good health. Spending for hospital-dominated secondary care increased each year in real terms from £49·1 billion in 2003–04 to reach £68·8 billion in 2011–12 (a 40% increase), whereas that for primary care rose only 19·2% from £17·7 billion to £21·6 billion, respectively.10 Much of the increase in primary care was for medicines, but from 2007–08 general practice spending by primary care trusts fell each year, on average, by 0·2% in real terms.

The consequences of underinvestment in public health, primary care, community services, and social care are all too apparent, with pressure on emergency services and acute hospitals, as primary and community services struggle to cope with rising demand. Meanwhile, some NHS hospital trusts face the risk of financial insolvency. Failures in safety and quality are also eroding confidence in the NHS. But there is an opportunity: chronic illness and disability can be managed effectively in primary, community, and social care settings; well-proven public health interventions can mitigate and manage health risks.

The Five Year Forward View provides a glimpse of future possibilities. There are five considerations for the next UK Government to address if the asymmetry between the country's needs and the NHS's organisation is to be rectified. The first is system design. Bringing together general practice with nurses, community health services, mental health services, social care, and hospital specialists to create integrated out-of-hospital services holds much promise, especially if the—now orphan—public health function and emergency services are incorporated within the new institutional design: a person-centred health system. Conversely, transition to integrated primary and acute care dominated by hospitals would be a retrograde step, since it would reinforce the dominance of acute hospitals and starve primary care of funding. The changes, however, should emerge organically through local innovations that produce context-sensitive system design by drawing on the strengths of NHS organisations, not-for-profit institutions, and the private sector.

The second consideration is stability for the NHS. Hard though it may be, the next UK Government needs to provide a period of stability for the NHS, without top-down reorganisation, while fostering local creativity and continuity in local NHS leadership. Creativity and innovation does not thrive in an environment of rigid regulation and risk aversion, however. The period of stability should be used to reduce the onerous regulation faced by NHS organisations, by rationalising the excessive number of regulatory agencies whose functions clearly overlap. The third is financing. The next UK Government should maintain per-person NHS funding in real terms, funding which takes into account population growth and ageing, both of which will increase demand on services. Increase in funding should be combined with up-front investments in primary care and community services to enable the creation of local solutions that draw on the social sector, as well as new technologies. A fourth consideration is empowerment of service users and local citizens by involving them in decisions on their care and the design of local health systems. The fifth, and undoubtedly the most important consideration, is the health workforce, which should be entrusted by the authorising environment to create local solutions and bring about change. Leadership development at all levels is an urgent priority.

The NHS has stood the test of time, but it faces major threats. In 2012, the health expenditure in the UK was 9·3% of GDP, the average for the OECD, but far less than Canada (10·9%), Germany (11·3%), France (11·6%), and the USA (16·9%). Its achievements make a strong case for any responsible government to nurture the NHS by continued investment to generate greater value for money through improved efficiency, effectiveness, and responsiveness, and to create value for many by upholding equity. Not doing so would have untold consequences for the British public and the social cohesion the UK enjoys. 

Lancet 14.03.15 link

NHS, a rebentar pelas costuras

Na primeira semana dez 2014, 35.373 pacientes esperaram mais de quatro horas para serem atendidos nos serviços de emergência hospitalar  (type 1 departments - Major A&E), o valor mais elevado desde que há registos (final de 2010). O maior valor anterior era de 34.595 utentes em espera >a quatro horas, registado  em abril de 2013. link

Este valor (35.373 utentes), representa um crescimento de  50% (utentes em esperara superior a quatro horas) em relação ao valor registado na  semana homónima de 2013 (21.276 utentes). link

Nota: Tentei apurar o movimento das urgências dos nossos hospitais, registado no mesmo período, sem resultado. Informação sobre tempos de espera de atendimentos de urgência continuam a ser ficção cientifica no nosso país.

clara gomes

High quality care for all in the UK

A report published by the UK Centre for Health and the Public Interest (CHPI) last week raised concerns about the quality of care in some private hospitals and highlighted the effect on the National Health Service (NHS) of these failings in care. The review describes inadequate reporting, both of patient safety incidents and of hospitals’ performance, preventing proper assessment of risk, problems with staffing, a lax safety culture, and inadequate record-keeping. Clinical governance, widely recognised as essential for the delivery of high quality care, has no statutory basis in private hospitals, and the overseeing committees have no legal duties, no power to enforce good practice, and potential conflicts of interest. Patients treated in private hospitals have little protection from direct and serious threats to their safety.

There are knock-on effects for the NHS too. 25% of patients treated in private hospitals are funded by the NHS, often referred by hospitals otherwise unable to meet the government's waiting-time targets. Many private hospitals lack the facilities to care for patients when things go wrong—leaving the NHS to pick up the pieces. 6000 patients per year are admitted to the NHS from private hospitals, but there are no data to explain why.

Poor quality care is not confined to private practice. Recent reports such as the Berwick Report, the Keogh Review, and investigations by the Care Quality Commission into East Kent University NHS Foundation Trust and Alder Hey Children's Hospital, highlight patient safety problems throughout the NHS. Incorrect priorities, lack of accountability, poor leadership, and failings in communication have led to a culture that accepts inadequate care.

Alarmingly, many of the recommendations made by the CHPI echo those of previous inquiries. Indeed, some reiterate recommendations made by the House of Commons Health Committee in 1999. Without a Minister for Health who makes quality of care for patients a main priority, the time and money spent on such reports and reviews is wasted. The UK Government must put learning, improvement, and patient safety at the heart of health-care delivery nationwide.

The Lancet, Volume 384, Issue 9945, Page 716, 30 August 2014

NHS, the best

MIRROR, MIRROR ON THE WALL - How the Performance of the U.S. Health Care System Compares Internationally link

The Spirit of '45

The Loach '45 spirit may be mocked – yet it seems preferable to the 21st-century spirit of austerity and paradox in which we found money to nationalise failing banks, maintaining the spirit of what Milton Friedman called socialism for the rich, free enterprise for the poor. link  link

NHS

O NHS, "vai durar enquanto houver gente com a fé para lutar por ele" (Bevan).

England is not alone in its assault on universal health care. Many European countries  are cutting health service budgets in order to get help in dealing with the banking  crisis. In 2012, Portugal raised user charges for health care by €150 million. In 2013, charges will be raised by another €50 million. Between 2011-12, Greece increased user fees and cut the country’s health budget by €1.4 billion. The Czech Republic cut their budget by 30%. At the end of last year Spain used the extraordinary device of a royal decree to repeal overnight its universal health care law and major reductions in health spending have been agreed in Ireland, Ukraine, Latvia, Romania, Hungary and Iceland, the Czech Republic, France, Netherlands and Austria. In all these cases, as in England, households are being forced to take on more of the financial risks of illness, rehabilitation and nursing care.

Meanwhile, in the low and middle-income countries of the world, international aid is increasingly aligned with policies that rely on households continuing to pay for health care. These policies set aside the World Health Organisation’s long-standing commitment to elimination of co-payments: an era of safety nets in which tax financed care is limited to the impoverished has replaced the era of universal access.

The results can only be diminished services for the poor and not-so-poor in a climate of growing injustice. Proponents of the argument that tax-financed or ‘free’ health care is a privilege we can no longer afford are unable to explain why universal health care was instituted when the world’s economy was very much smaller than it is today. If the UK could create an NHS when the country was literally bankrupt, why in England (but not in Scotland or Wales) can the government not sustain the NHS today?

The answer of course is political not financial. These changes are the culmination of a transition from public to private responsibility and control as market dogma spread by large global corporations and financial institutions has penetrated only to abolish an institution that has defined us in our own eyes and internationally. By repealing the government's mandate to provide a health service, the Health and Social Care Act 2012 marks another backward step in this long recessional from universality.

Bevan link said of the NHS it “will last as long as there are folk left with the faith to fight for it”. Many millions of people fought over a century to establish it, millions of us are still fighting for it today; on the streets, in our hospitals, in our campaign groups, in our trade unions, in the corridors of the BMA and the RCN, in the Royal Colleges, in local government and in our parliament. This wanton destruction of the legacy of two world wars and more than a century of activism and commitment to universal public health care is a public health catastrophe. It is an act of tyranny. The NHS in England must be re-established. Our response must be political too.

Allyson Pollock and David Price - Duty to care: In defence of universal health care link

Facilitar a vida dos utentes

On the way towards the 2018 goal, the Health Secretary wants to see: link 

By March 2015 – everyone who wishes will be able to get online access to their own health records held by their GP.
Adoption of paperless referrals – instead of sending a letter to the hospital when referring a patient to hospital, the GP can send an email instead.
Clear plans in place to enable secure linking of these electronic health and care records wherever they are held, so there is as complete a record as possible of the care someone receives.
Clear plans in place for those records to be able to follow individuals, with their consent, to any part of the NHS or social care system.
By April 2018 – digital information to be fully available across NHS and social care services, barring any individual opt outs.

NHS Constitution

NHS Constitution maximum waiting time treatment poster available link 

The average (median) time waited for patients completing an RTT pathway in August 2012 was 8.3 weeks for admitted patients and 4.3 weeks for non-admitted patients. For patients waiting to start treatment at the end of August 2012 the median waiting time was 5.9 weeks. link link

No Satisfaction

Satisfaction with the NHS

The latest results for 2011, however, show a marked drop in overall satisfaction – from 70 per cent to 58 per cent. While this level of satisfaction remains the third highest since 1983, this fall is the largest drop in satisfaction in one year since the British Social Attitudes survey started. The results also show rises in dissatisfaction – from an all-time low of around 18 per cent in 2010 to 24 per cent, and a rise in more equivocal attitudes (from 12 per cent to 18 per cent). link

Respondents to the survey may be reacting to actual deteriorations in aspects of the NHS which they value and so express less satisfaction. Alternatively, and for whatever reason, respondents may perceive a reduction in the performance and quality of the NHS – for example, through negative media stories and reporting – and express this as a reduction in satisfaction.

the king´s fund

Andrew Lansley secretary of state for health link

Privatização da Saúde

Hospitals taken out of public ownership
The NHS white paper says (section 4.21): link

Our ambition is to create the largest and most vibrant social enterprise sector in the world. ... As all NHS trusts become foundation trusts, staff will have an opportunity to transform their organisations into employee-led social enterprises that they themselves control, freeing them to use their front-line experience to structure services around what works best for patients.

A social enterprise is not a public body, it is not owned by the state and hence is not owned by the public. The white paper suggests that a narrow section of the public will own the social enterprises (employee-led) but this can no more be described as "public ownership" than a de-mutualised building society. Indeed, social enterprises are exempt from Freedom of Information requests, showing that they are not public bodies. If a social enterprise hospital is not a public body then it can only be described as a private business. At best, the mechanism of changing hospitals into social enterprise can be called de-nationalising, but the most accurate term is privatisation.

...Lá como cá o objectivo fundamental é a privatização da Saúde.

Clara

A mesma política

Esta súbdita de sua majestade dava-nos jeito para organizarmos umas esperas ao ministro da saúde, Paulo Macedo em S.Bento, quando começar o encerramento das urgências e dos hospitais públicos em favor das Misericórdias e dos serviços privados de saúde.link

Lá como cá!

Desvalorizar o NHS para justificar as políticas

NHS productivity has "almost certainly" risen in the past decade, with taxpayers getting more out of the health service for every pound spent – undermining one of the government's key arguments for its reforms, according a new paper. link

In a paper published in the Lancet, Nick Black, professor of health services research at the London School of Hygiene and Tropical Medicine, said that although the health secretary, Andrew Lansley, claimed NHS productivity had fallen 15%, the opposite was almost certainly the case.
...
Andy Burnham, the shadow health secretary, said: "This analysis is hugely embarrassing for the prime minister. It demolishes an anti-NHS argument that Cameron and his ministers have repeatedly trotted out. Far from falling, NHS productivity increased in the last decade at the same time as the NHS was achieving record patient satisfaction. It is this successful NHS that, inexplicably, is being turned upside down by the Tory-led coalition.

"But, as well as destroying their arguments, this analysis exposes the prime minister's duplicity on the NHS. Professor Black explicitly criticises the Tories for propagating a myth that NHS productivity was declining to create a false justification for their health and social care bill."link

Guardian 13.02.12

How the Health and Social Care Bill 2011 Would end

entitlement to comprehensive health care in England

Allyson M Pollock, David Price, Peter Roderick, Tim Treuherz, David McCoy, Martin McKee , Lucy Reynolds link

The National Health Service (NHS) in England has been a leading international model of tax-financed, universal health care. Legal analysis shows that the Health and Social Care Bill currently making its way through the UK Parliament1 would abolish that model2 and pave the way for the introduction of a US-style health system by eroding entitlement to equality of health-care provision. The Bill severs the duty of the Secretary of State for Health to secure comprehensive health care throughout England and introduces competitive markets and structures consistent with greater inequality of provision, mixed funding, and widespread provision by private health corporations. The Bill has had a turbulent passage. Unusually, the legislative process was suspended for more than 2 months in 2011 because of the weight of public concern.3 It was recommitted to Parliament largely unaltered after a “listening exercise”. These and more recent amendments to the Bill do not sufficiently address major concerns that continue to be raised by Peers and a Constitution Committee of the House of Lords,4, 5 where the Bill now faces one of its last parliamentary hurdles before becoming law.

The Lancet, Volume 379, Issue 9814, Pages 387 - 389, 4 February 201

The end of our National Health Service

There is a crisis in the National Health Service (NHS). The publication of the Health and Social Care Bill link last week heralds dramatic changes for the NHS, which will affect the way public health and social care are provided in the UK. Those changes alone will have huge impact, but it is the formation of an NHS Commissioning Board, and commissioning consortia, that will once and for all remove the word “national” from the health service in England. The result, due to come into force in 2013, will be the catastrophic break up of the NHS. link

The Lancet, Volume 377, Issue 9763, Page 353, 29 January 2011

Esperem pela camarilha do Passos ...

drfeelgood

NHS e neoliberais de pacotilha

Andrew Lansley, foto guardian

Ora aí está uma forma inteligente de apresentação do pensamento neoliberal face ao que continua a considerar-se um modelo estatizante e esquerdista de prestação de cuidados sociais. link

A diferença para os neoliberais de pacotilha cá do burgo, é a assunção do NHS como um pilar essencial da sociedade moderna: "We believe that the NHS is an integral part of a Big Society, reflecting the social solidarity of shared access to collective healthcare, and a shared responsibility to use resources effectively to deliver better health", assumindo ainda os princípios que estiveram na sua génese ("We are committed to an NHS that is available to all, free at the point of use, and based on need, not the ability to pay. We will increase health spending in real terms in each year of this Parliament"). Serão meras palavras? Talvez, mas não deixam de assentar nos pilares essenciais do NHS.

Tratando-se da visão de um governo liberal, obviamente estamos perante uma abertura (ou cedência?) ao privado. É interessante a livre associação de clínicos gerais, ou seja, a liberalização nos cuidados primários. No entanto, parece-me mais relevante a descentralização da "governance", atribuindo ao poder local responsabilidades na gestão dos cuidados de saúde. Talvez fosse bom os presidentes de câmara gerirem os centros de saúde. Certamente em muitos casos fariam muito melhor do que as ARS.

Infelizmente, a tradução para o nosso SNS de uma visão desta natureza, será a já habitual cedência aos interesses corporativos e privados. Será como passar do Tony Blair para o Guterres - muita conversa e pouca acção.

Seria interessante analisar em que medida as asneiradas da "esquerda" na gestão do SNS não vieram permitir à "direita" defender de forma tão descarada a privatização da saúde em Portugal:
• Depois das reformas do CC e das tentativas de resgatar o SNS dos interesses corporativos (ANF, sindicatos, ordens), não estará tudo na mesma, ou ainda pior?
• E a gestão dos hospitais? Como se passou de uma situação financeira controlada, para o descalabro nas contas? E de equipas de gestão "debaixo de olho", para "para-quedistas" do aparelho que nada nem ninguém parece conter nem controlar?
• A reforma do CSP? De velocidade de cruzeiro para a estagnação?

É que os portugueses só darão real valor ao SNS quando o perderem. No entanto, até lá, toda a gestão nebulosa, feita à vista, sem estratégia e sem rumo que esta MS tem seguido, só beneficia quem defende um SNS publico para indigentes e um SNS privado para quem puder pagar.

cipião

Power for patients (1)

Preparemo-nos para coisas semelhantes, promovidas por um qualquer desconhecido ministro da saúde laranja. Ainda vamos ter saudades da nossa abelhinha Maia...

Healthcare Survey, fieldwork : June 11th-13th 2010 link

Table 1 - Q.1 The new Government wants to give every patient the option to choose their own healthcare provider. This means that you could use a service outside the NHS, as long as it meets NHS standards and the NHS would still pay for your care. To what extent do you support or oppose these plans?
Base: All respondents

Table 2 - Q.2 The new Government plans to give every patient the freedom to choose which GP they register with, regardless of where they live. To what extent do you support or oppose these plans?
Base: All respondents

Table 3 - Q.3 The new Government wants to allow public sector workers to form employee-owned co-operatives and take over the services they deliver, including health services. This could, for example, lead to doctors and nurses running the hospitals and healthcare trusts they work in. To what extent do you support or oppose these plans?
Base: All respondents

Table 4 - Q.4 At present the Government gives some patients control over the money that is spent on their care. The new Government wants to expand this service. To what extent do you support or oppose this?
Base: All respondents

Table 5 - Q.5 The Government is proposing to publish detailed data about the performance of healthcare providers online, to show how well or how poorly local healthcare providers are performing. To what extent do you support or oppose this?
Base: All respondents

Table 6 - Q.6 Which of the following treatments, would you would be happy for a private supplier to provide, while the NHS pays for it. Please say Yes or No for each of the following treatments...?
Base: All respondents

Nota : (1) "Power for patients", o mesmo é dizer: "poder para os privados". A eng.ª Isabel Vaz, com estas novidades todas, nem vontade deve ter de ir de férias.

drfeelgood

NHS, debaixo de fogo

A nova coligação do governo de sua majestade anunciou recentemente a reforma mais radical do NHS - não extensível ao País de Gales, Escócia e Irlanda do Norte - dos últimos 40 anos. Que prevê, entre outras coisas, a transformação dos hospitais públicos em organizações privadas de fins não lucrativos. Alterações profundas da gestão da rede primária com o encerramento de 150 PCT (fundações de cuidados primários) e de 10 estruturas regionais e a entrega da sua gestão directa aos médicos de família e médicos hospitalares que trabalharão em conjunto nos serviços de saúde locais, passando a dispor, para o efeito, de um orçamento de cerca de 80.000 milhões libras até agora gerido pelas PCT.

Prevê ainda (como não podia deixar de ser) a atribuição de mais poder de escolha aos utentes do NHS (lá mais para diante não sei se mudará também de designação) através da melhoria do acesso à informação sobre a qualidade das prestações de cuidados.

O NHS, fundado em 1948, goza do consenso quase geral da sociedade britãnica, e, apesar de reconhecidamente prestar cuidados de elevada qualidade a preços baixos, num mercado onde os preços e a procura não param de subir, o novo governo de coligação entendeu que era chegada a hora de promover nova arremetida dos interesses privados.

Docs:
1.º - Equity and excellence: Liberating the NHS link
2.º - Liberating the NHS: Regulating healthcare providers link
3.º - Liberating the NHS: commissioning for patients link
4.º - Department of Health Draft Structural Reform Plan link
5.º - Analytical strategy for the White Paper and associated documents link

6.º - Initial Equality Impact Assessment (EqIA) July 2010 link
7.º - Transparency in outcomes - a framework for the NHS link
8.º - Local Democratic Legitimacy in Health link

Nota: Os nossos liberais de pacotilha (O irmão Dupond dos fatinhos inclusivé. Não é o Cameron lusitano, mas vai fazendo por isso) não vão querer perder pitada desta reforma anunciada .

Costa do Castelo

Top-ups in the NHS

Já aqui fizémos referência ao debate que tem lugar no Reino Unido sobre o acesso aos novos medicamentos, não aprovados pelo NICE (não comparticipados, portanto).
Actualmente os doentes do NHS que queiram ter acesso a estes medicamentos (pagos do seu bolso) perdem o direito aos cuidados (tendencialmente) gratuitos do NHS.
Recentemente, foi solicitado ao "King’s Fund" um parecer sobre esta matéria pelo "Department of Health (DH)". The King’s Fund response (11.09.08) to the Department of Health’s review of the consequences of additional private drugs for NHS care link
Anna Dixon gives The King's Fund position on top-ups.

Reforma Darzi

Foi hoje (30.06.08), publicado o relatório do ministro da Saúde, Lord Ara Darzi, “High Quality Care for All”, link com o plano de reforma do NHS, para os próximos dez anos.
Pedra de toque deste plano a definição de um núcleo de direitos e deveres dos doentes: direito à dignidade, privacidade, confidencialidade, oportunidade de obter uma segunda opinião de outro médico e do direito dos doentes escolherem o médico de família ou o hospital onde querem ser tratados. O que implica a criação, por partes das entidades prestadoras, de um novo conjunto de indicadores, como a taxa de mortalidade por cirúrgião e a avaliação do estado de recuperação dos doentes pós-cirurgia ou tratamento, por exemplo, de forma a estes poderem identificar as melhores práticas de cuidados primários e hospitalares. link
Com vista à melhoria da qualidade está prevista a criação de um conjunto de incentivos financeiros para os hospitais e médicos de família.

Todos sabemos o que significa promover a livre escolha dos utentes num mercado como o da saúde. Em vésperas de completar 60 anos de existência vamos ver como o NHS resistirá a mais este solavanco liberalizador.