Healthcare Systems Notes

The NHS as a System

• Founded in 1948 by Aneurin Bevan.
• Principles:
  • Meets the needs of everyone.
  • Free at the point of delivery.
  • Based on clinical need, not ability to pay.
• Delivers care to 1 million people every 36 hours.
• Political football.
• An economy.
• Delivers healthcare, public health, social care.
• Regulatory bodies (NICE, CQC).
• An educational establishment (HEE).
• A car dealership (metaphorical).
• Budget of $116$ billion compared to $437$ million (equivalent to $15$ billion) in 1948.
• $1.5$ million employees (5th largest worldwide).
• Fiendishly complicated with unclear hierarchies.
• Deeply political.
• Moving towards personalised, sustainable, and joined-up care.
• Dependent on politics, people, and unclear hierarchies.
• Secondary care + treatment >> expensive >> primary care and prevention but still gets the spotlight.
• Poor health literacy in our society – many don’t know how to use the system properly or take responsibility for their own health.

Implications of an Ageing Population

• Older people are more likely to use all types of healthcare services.
• Medication use and cost are substantially higher.
• Condition-specific service use (stroke, IHD, dementia) increases.
• More likely to require coordination with other services (e.g., social care).

Where Does Healthcare Take Place?

• Hierarchy of urgency: self-care, primary care, secondary care.
• GPs as gatekeepers.
• Healthcare service use differs between younger and older people.
• Case study: Mrs. Watson, a 72-year-old retired teacher with a cough.
  • She initially visits the local pharmacist who advises her to see her GP if the cough persists.
  • She then sees her GP, who books her a chest X-ray and blood tests.
  • Mrs. Watson finds she is breathless and is reviewed at home by her GP, who decides she needs urgent assessment.
  • She is taken to A&E by ambulance and given oxygen.
  • She is admitted for treatment.

What is 'Good' Care?

• Mrs. Watson had contact with a pharmacist, her GP, and the A&E team.
• All regulated healthcare professions have their own standards of care.
• Individualised care – giving patients what they want.
• The question of whether you can have too much investigation.
• Whether getting a diagnosis is good care, and what if you can't get one.
• Getting a medication.
• Patient education.
• Being sent somewhere else.
• Time of appointment and wait times.

Preparation for Seminar

• Aims: To discuss healthcare services in more depth and consider older people’s needs.
• Format: Synchronous online.
• Seminar Topics:
  • Pharmacy
  • General practice
  • A&E
  • Acute care in hospitals
  • Rehabilitation
• Preparatory videos:
  • Health talk online (improving care for people with multi-morbidities).
  • Joined up care: Sam’s story.

Summary

• The NHS is a complicated system.
• The patterns of NHS services use differ by age-group.
• Demand on the NHS is increasing.
• Healthcare for older people is delivered in a range of contexts depending on needs.
• “Good” care for older people varies by context but is founded on key principles.