Lessons learned from the NHS - Christoph Rochlitz
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Lessons learned from the NHS
Christoph Rochlitz
Lessons learned from the RMH
?
Christoph Rochlitz
Lehr- und Wanderjahre (1. September 2017 bis 1. Januar 2018)
SABBATICAL
After discovering the difficulties the poor had in obtaining medical treatment, Marsden sought to establish a free hospital in London for which "poverty and sickness are the only passports".
Foundation Trusts • have the freedom to decide how to organise their services to best meet local needs • independent from the Department of Health • run on a not-for-profit basis • still an NHS hospital, more flexible, fast and effective • high-quality cancer care for free, not based on the patient's ability to pay • can raise capital investment for new buildings and services faster • can retain financial surpluses made during a financial year to plough back into our services
AKA Prince William
The Royal Marsden
The Marsden was the first hospital in the world to
be dedicated to cancer, founded in 1851 by a doctor
who watched his own wife die from the disease
It is the country's only designated Biomedical
Research Centre for Cancer, with a £10 million
annual grant, and remains one of the most
important cancer hospitals in the world.
Annual Business Report 2017/18
In 2017/18 the overall income was £428.3 million
(£370.7 million in 2016/17)
24% PPI
(target 2022: 40%)
2017 £ 22.7m
Breast Team Royal Marsden
• Outpatient Clinic over 9000 referrals per year • Tumor Boards 30-50 patients • Ward Rounds different teams and responsibilities • Educational and Scientific Meetings
National Health Service (NHS) United Kingdom (UK)
NHS England NHS Scottland NHS Wales HSC
in Northern Ireland
(Health and Social Care)“NHS, the institution which more than any other unites our nation"
• Aus dem allgemeinen Steueraufkommen (und nicht wie in vielen Ländern über Sozialversicherungsbeiträge) finanziert • Bietet jeder in Großbritannien wohnhaften Person medizinische Versorgung im primären (Hausarzt) und sekundären Bereich (Krankenhäuser) • Reisende aus der EU bzw. dem EWR haben im Notfall ebenfalls Anspruch auf gebührenfreie medizinische Versorgung • Wenn Briten gefragt werden, welche Institutionen sie hochschätzen, erzielt der NHS regelmässig die besten Werte, noch vor Streitkräften und Monarchie
History of the NHS
• 1934
• S. Hastings, President of the Socialist Medical Association, successfully proposed a resolution at the
Labour Party Conference to establish a State Health Service
• 1944
• H. Willink, Conservative MP and Health Minister, publication of the “White Paper”
• cross party support
• 1946/47
• Legislation for England & Wales/Scotland & Northern Ireland
• 1948
• Founding of the NHS by PM Clement Attllee
• One of the major social reforms following the Second World War
• Founding principles: services should be comprehensive, universal and free at
the point of deliveryHistory of the NHS
At its launch by Bevan on 5 July 1948 it had at its heart three core
principles: That it meet the needs of everyone, that it be free at
the point of delivery, and that it be based on clinical need, not
ability to pay
Three years after the founding of the NHS, Bevan resigned from
the Labour government in opposition to the introduction of
charges for the provision of dentures and glasses
The following year, Winston Churchill's Conservative government
introduced prescription charges. These charges were the first of
many controversies over reforms to the NHS throughout its
history
From its earliest days, the cultural history of the NHS has shown its
place in British society reflected and debated in film, TV,
cartoons and literature
Aneurin Bevan, who built on Sir Henry
Willink's vision of a National Health
Service with the establishment of the NHSHistory of the NHS
2500 2143
• International, vor allem im deutschsprachigen Raum, eher 2000
negativer Ruf 1522
1500
1000 629
• Lange Wartezeiten für Krankenhausbehandlungen
500 264
39 62 86
0
• Ärztemangel
• Deutsche Presse: Auswanderungsland für deutsche Ärzte
Quelle: Bundesärztekammer Deutschland 2015History of the NHS
2500 2143
• International, vor allem im deutschsprachigen Raum, eher 2000
negativer Ruf 1522
1500
1000 629
• Lange Wartezeiten für Krankenhausbehandlungen
500 264
39 62 86
0
• Ärztemangel
• Deutsche Presse: Auswanderungsland für deutsche Ärzte
• In England Kritik an Ausbildungssystem
• Programm „Modernising Medical Careers“ (MMC)
• Aufruhr innerhalb der Ärzteschaft
• 2007 Remedy UK, Massenproteste in London und
GlasgowUK health services - Funding
• Four National Health Services (2015–16 )
• combined budget £136.7 billion
• Total health sector workforce across the UK: 2,165,043
• 1,789,586 in England
• 198,368 in Scotland
• 110,292 in Wales
• 66,797 in Northern Ireland
• 98.8% funded from general taxation and
National insurance contributions, plus small amounts
from patient charges for some services
• The 2008/9 budget roughly equates to a contribution of
£1,980 per person in the UKMay 24th 2018
Health Care Cost (% of GDP)
Health Care Cost (% of GDP)
11.5% 9.8%Health Care Cost (per capita)
$ 7.919
$ 4.192NHS: social or socialist? The King‘s Fund Report 2018
NHS: social or socialist? The King‘s Fund Report 2018
Wartezeiten The King‘s Fund Report 2018
Sep. 16th, 2018
Wartezeit auf Tumordiagnose oft > 1 Monat26,171 procedures (last week of March 2018)
3,724 (14%) called off
(experience at 90% of NHS hospitals across the UK)
Cancellations caused by
33% medical issues
66% non-clinical reasons
31% lack of beds,
13% shortage of operating theatre capacity
2% equipment problems
2% no staff
18% other non-clinical reasons
Sep. 2018, British Journal of Anaesthesia1990 2015
2015
Infant mortality in England and Wales 30% over the median EU15+ rate (15 EU nations, together with Australia, Canada and Norway) If trend continues the difference will increase The Royal College of Paediatrics and Child Health
Brexit Mug
Brexit Lies 2016
• Brexit will deliver “the exact same benefits” as membership in the EU with “no downside”…
David Davis
• The UK holds most of the cards
Michael Gove
• 'A post-Brexit free-trade deal with the EU will be ‘one of the easiest things in human history‘
Liam Fox
• Post Brexit, a UK-German deal will include free access for their cars and industrial goods, in
exchange for a deal on everything else
David Davis
• The money saved from leaving the EU will result in the NHS getting £350m a week
Boris JohnsonBrexit Lies
18.2b : 52w = 350m £
50% of voters believed the claim!Brexit-Dividende • 350 Millionen £/Woche = 18.2 Milliarden £/Jahr • Übertrieben und nur Bruttozahlen (1/3 fliesst in Form von Subventionen und Forschungsgeldern zurück) • britische Nettozahlung höchstens 9 Milliarden £/Jahr • Bleibt bis 2020 bestehen, vermutlich länger (transition period) • Brexit-Rechnung von 39 Milliarden £ („divorce settlement“, grösstenteils in den ersten Jahren fällig) • Durch Brexit verursachter Wachstumsrückgang (derzeit 1,5 Prozent des Bruttosozialprodukts) • Laut IFS (Institute for Fiscal Studies) fiskalische Verluste von bis zu 15 Milliarden £/Jahr
Wie die Kosten auffangen?
• Steuererleichterungen verschieben
• Mehrverschuldung
• Steuererhöhungen
Jahresbudget derzeit 125 Milliarden Pfund
Geplant: zusätzlich 4 Milliarden/J x 5 J.23.2.2017
June 5th, 2018 1,500 doctors have been denied tier 2 visas to come and work in the NHS in the past four months. This is despite the fact that there are reportedly 10,000 vacant posts for doctors. EU nurses registering to work in the UK are down 96% since the Brexit vote aggravating shortages of nurses. 3,962 nurses and midwives from the European Economic Area (EEA) left in 2017 and 2018. Quelle: NHS Digital 2018
Sep. 18th, 2018
Nov. 26th, 2018
• data from 82 hospital trusts and 116 universities
• a 22% increase in the number of EU nationals leaving their jobs
Nov. 15th, 2018
The NHS in England – Shortness of Staff
• Now (official figures)
• over 100,000 staff (10,000 doctors, 40,000 nurses)
• Then (three leading English health thinktanks)
• 250,000 by 2020
• 350.000 by 2030Brexit and Research
Li Ka Shing Centre, Cambridge Carlos Caldos Group
The Strengths and Weaknesses of NHS
The King’s Fund Study
The main weakness of the NHS was health care outcomes.
Mortality for cancer, heart attacks and stroke, was higher than
average among comparable countries. The UK appears to
perform less well than similar countries on the overall rate
at which people die when successful medical care could have
saved their lives.
The NHS does well at protecting people from heavy
financial costs when they are ill.
Waiting times are about the same and the management of
longterm illness is better than in other comparable countries.
Efficiency is good, with low administrative costs and high use
of cheaper generic medicines.Bye Bey London
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