In January 1989 the Government announced its proposals for reforming the National Health Service in the White Paper ‘Working for Patients’ (CM555). The two main objectives of the reforms, as outlined in the White Paper, are ‘to give patients, wherever they live in the UK, better health care and greater choice of the services available; and greater satisfaction and rewards for those working in the NHS who successfully respond to local needs and preferences’.
Outcomes, it is commonly said by general practitioners, are more difficult to measure in our discipline than those in hospital based specialties. This is true but it should not be used as an excuse for continuing sloppy work, for sufficient measures of outcome do exist to keep practices busy with audit for some time to come. We have good data - arguably the best in the world - about the incidence and prevalence of common disease in the community and where these can be linked to effective treatments we have a very valuable tool indeed.
The objective of medical care is to improve people's health. This includes avoiding illness whenever possible, alleviating suffering and disability when illness does occur, and prolonging life, particularly through the prevention of premature deaths.
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 late John Vaizey posed a challenging question about the 'explosion' of health care costs in the Western World. 'Why was it seen as a problem'. he asked, 'when even more rapid growth for example in home entertainment and electronics was seen as an economic achievement?' Clearly, the answer does not depend only on the fact that Health Services in Europe are generally financed out of collective funds. In the United States, where much of medical care is still privately financed, 'cost containment' is an even more fashionable issue than in Europe.
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.
Despite much of the current discussion, Britain's National Health Service has been an outstanding success during its 40 years of existence. Its present problems stem primarily from the way in which the scope for medical care within the service has been extended so dramatically since 1948.
In this report our visiting scholar. Yinong Shao, has produced a fascinating picture of the health services in China in 1988. It is particularly remarkable because even a few years ago the wealth of statistics which it contains could not have been published. First and foremost Shao's Report is an indication of the new enlightened approach by the Chinese in allowing international discussion of their internal affairs.
In purely quantitative terms, acquired immune deficiency syndrome (AIDS) might not appear to have warranted the remarkable amount of attention it has attracted since 1982. By the end of October 1986 a total of just 548 cases of AIDS in the UK had been reported to the Communicable Disease Surveillance Centre. This sum pales in comparison with the contemporary incidence of respiratory tuberculosis - equally a scourge of mankind that is now, and for some time has been, 'under control'.