The Government's National Health Service reforms are designed to increase cost effectiveness, widen consumer choice and improve the quality of care. In making the case for these reforms, the White Paper Working for Patients (CM 555) pointed to the wide variations in performance throughout the health service.
The objective of medical care is to make people as healthy as possible. Over the past 40 years, since the National Health Service was established in Britain, medical progress - including particularly pharmacological advances - has greatly extended the scope for the health services to achieve this objective. However, this success has also led to steadily rising expenditure on the Health Service. As a result, there has been a very proper concern to ensure that this expenditure is as effective as possible. The latest Health Service Review (HMSO.
Since the first identification of the AIDS syndrome in Los Angeles in 1981 (and the description of the virus responsible- now termed HIV 1 -in 1983) health care professionals and policy makers across the globe have had to face the reality that the human community is facing a transmissible disease epidemic of a potential severity not experienced in living memory. Already many millions of people in sub-Saharan Africa are infected and at risk of premature death, as are considerable (if uncertain) numbers of individuals in the rest of the developing and developed world.
There has always been a problem in making sure that patients take the medicines which doctors prescribe for them in accordance with their instructions. The problem varies from the patients who forget the occasional tablet, or take rather too large a dose of the mixture, to those who never even bother to get their prescription dispensed. Other patients, for example, 'feel better' half-way through their course of treatment, and leave the remainder in the bathroom cupboard.
People pay for some health care themselves out of income and savings. In Britain, out of a total expenditure on health care of all kinds of £ 13,700 million in 1981 it is estimated that some 3.0 per cent was paid for in this way, partly for non-prescription medicines. They also claim health care insurance. In 1981, BUPA and other health insurance agencies paid out almost £205 million, or 1.5 per cent of the total expenditure.
There have been substantial increases in all categories of professional manpower in the National Health Service since it was first established in 1949. This Briefing examines and discusses the trends for doctors, nurses and midwives. The data it presents relate mainly to England, but similar trends apply to Great Britain as a whole. The discussion draws attention to the balance in professional manpower between hospitals and the domiciliary services.
During the last 30 years the proportion of deaths occurring in childhood caused by accidents has risen from 21 to 30 per cent. This development is not, however, as disturbing as it might initially appear for it is more a reflection of the elimination of infectious diseases from childhood mortality patterns than an indication of trends in accidental fatalities. Over this period the latter have fallen, both in volume terms and as rates per million population aged 1-14 years, by between 40 and 50 per cent.