Continuing our series of blogs on integrating care, today we explore Healthcare to establish what it is and how it fits into Westcott's integrated care model.
Of our three areas of care (Healthcare, Social Care and Well-being) Healthcare is arguably the best understood, although it is often confused for "care" in general. In short, Healthcare is the organised provision of medical care to an individual or community. In the UK, healthcare is free at the point of service through the NHS. Private provision - funded through health insurance or by an individual - is also available. For most of us, our entry into the healthcare system is typically through our GP. They act as a gate-keeper, dealing with minor conditions and referring us to other medical specialists as appropriate.
The NHS Explained
The NHS was formally founded on 5th July 1948 when the then Health Secretary, Aneurin Bevan, opened the Park Hospital in Manchester. It was created out of the ideal that good healthcare should be available to all regardless of wealth. It's three founding princples remain at the core of the NHS today and have guided its development:
Of our three areas of care (Healthcare, Social Care and Well-being) Healthcare is arguably the best understood, although it is often confused for "care" in general. In short, Healthcare is the organised provision of medical care to an individual or community. In the UK, healthcare is free at the point of service through the NHS. Private provision - funded through health insurance or by an individual - is also available. For most of us, our entry into the healthcare system is typically through our GP. They act as a gate-keeper, dealing with minor conditions and referring us to other medical specialists as appropriate.
The NHS Explained
The NHS was formally founded on 5th July 1948 when the then Health Secretary, Aneurin Bevan, opened the Park Hospital in Manchester. It was created out of the ideal that good healthcare should be available to all regardless of wealth. It's three founding princples remain at the core of the NHS today and have guided its development:
- meet the needs of everyone;
- free at the point of service;
- based on clinical need, not the ability to pay.
Funding for the NHS comes directly from taxation and is granted to the Department of Health by Parliament. In 2012/13 the NHS budget was around £109 Bn.
In April 2013, a new structure for the NHS was put into place (see below).
In April 2013, a new structure for the NHS was put into place (see below).
The new structure is based on the principle that competition for services from "any willing provider" will lead to chocie, efficiency and the intorduction of niche and specialist services. It is also intended to encourage cooperation and the integration of care, especially between Local Authorities (who look after social care) and healthcare providers. In essence, the NHS has become a commissioner ("buyer") of care services, rather than a provider - albeit the NHS can continue to buy its own provision. "Any willing provider" means that services can provided by independent, private and voluntary/charitable organisations as well as NHS trusts (who effectively operate as independent commercial entities) provided they meet and maintain appropriate quality and safety criteria.
From a care consumer's perspective, very little has changed. GPs remain the gate-keepers and health services remain free at the point of service. However, GPs now participate directly in local Clinical Commissioning Groups (CCGs), which effectively "buy" the health services of "any willing provider." This means that GPs are closer to, and have new responsibility for, the cost of care but they also have the power to influence commissioning decisions for their patients.
NHS vs. Private Healthcare
Despite healthcare being available to all, free at the point of service, the private healthcare sector continues to grow and remains a strong force within the British Healthcare system. Many people have health insurance, either inividually or through their employers. This has generally given them the opportunity to arrange for elective procedures to be carried out more quickly, or to fit in with their requirements, rather than waiting for NHS slots to become available. However, there are very few, if any, private health insurers or providers who deal with acute care: this remains the domain of the NHS.
There are clear opportunites for both to work alongside each other. Indeed, many private hospitals, for example, are often a "willing provider" for NHS patients seeking elective surgery. Instead of being paid for by an individual or insurance company, a CCG pays for the service on behalf of the patient. For example, a hip replacement may improve quality of life, but not carrying it out immediately isn't usually life threatening. Whereas, a heart attack or stroke could be fatal if not dealt with urgently. Rather than wait, an individual may choose to "go private" in order to get their hip replaced sooner and quality of life improved sooner. However, were they to have a heart attack or stroke, an acute hospital would be their only option, regardless of their ability to pay.
How does Healthcare Fit into an Integrated Care System?
Throughout our lives we are likely to have episodes where we need medical care. Sometimes we may self-medicate, e.g. taking over-the-counter remedies for cold and flu symptioms, or we may enter the health system through our GP or an admission to hospital, e.g. through A&E. The role of Healthcare is to re-establish a level of Well-being as rapidly as possible. This may, of course, involve on-going medical support, for example through continuing care, follow-up consultations or chronic medication. However, healthcare is likely to remain an area of the integrated model that we dip in and out of over the course of our life in response to our changing circumstances.
As with all aspects of care, the key is knowing when and how to use these services efficiently and effectively. Receiving the right care, at the right time, from the right provider can help improve quality of life and reduce the overall cost of care.