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From care to prevention in the NHS
Published in Kathy Knox, Krzysztof Kubacki, Sharyn Rundle-Thiele, Stakeholder Involvement in Social Marketing, 2020
Because of its scale and complexity, the search for the optimum way to organise and control healthcare services in the United Kingdom efficiently and effectively has been a major issue over the years and has been subject to changes in structure and style of working. In the present structure, at the national level, links are primarily between the Department of Health and Social Care (DoHSC) with responsibility for the overall direction of strategy and policy, NHS England (NHSE) which implements those strategies, and Public Health England which is responsible for improving the health of the population and reduced inequalities in health across the country. At a local level, clinical commissioning groups (CCGs) work in the planning and purchasing of healthcare services, providing mental healthcare, ambulance services, hospital, and community services (NHS England, 2019). CCGs are led by clinicians and are responsible for approximately 60% of the NHS budget nationally. Such services may be purchased from any one or more organisations. The CCGs receive funding directly from NHSE.
Organisational ethics
Published in Therese Feiler, Joshua Hordern, Andrew Papanikitas, Marketisation, Ethics and Healthcare, 2018
The idea of the market as the ideal regulator culminated in the passage of the Health and Social Care Act in 2012. The Act changed how healthcare is commissioned (bought). It established clinical commissioning groups (CCGs) (overseen by NHS England) – who have responsibility for commissioning services for their local populations replacing Primary Care Trusts and Strategic Health Authorities. The ‘any qualified provider’ initiative, (NHS Confederation, 2011) enabled patients to choose from a range of providers from different sectors: commercial, third sector and the NHS. This built on previous initiatives to encourage non-NHS organisations to bid for services previously offered by the NHS. Section 75 of the 2012 Act, described as the ‘engine of privatisation’ (Chand, 2013), ensures that NHS contracts are opened up to the market. The regulations state that CCGs must put all services out to tender unless they can prove the service could only be provided by one particular provider. As one commentator notes: ‘This reform represents the completion of the roll-out of competition throughout NHS-funded provision’ (Reynolds, 2011).
Health systems
Published in Liam J. Donaldson, Paul D. Rutter, Donaldsons' Essential Public Health, 2017
Liam J. Donaldson, Paul D. Rutter
NHS England is the main strategic centre for healthcare services in England. It performs a headquarters function and funds local clinical commissioning groups (CCGs) to commission services. It directly commissions certain specialist services itself, as well as commissioning primary care services; increasingly, this is either in partnership with clinical commissioning groups or by delegating fully to the latter. NHS England has taken over many responsibilities that historically belonged to the Department of Health.
The effect of smoking on outcomes following primary total hip and knee arthroplasty: a population-based cohort study of 117,024 patients
Published in Acta Orthopaedica, 2019
Gulraj S Matharu, Sofia Mouchti, Sarah Twigg, Antonella Delmestri, David W Murray, Andrew Judge, Hemant G Pandit
The UK National Health Service is currently under unprecedented financial pressures (Daily Telegraph 2018). In the UK, 197 clinical commissioning groups (CCGs) have the authority and funding to commission healthcare services for their communities. In recent years over half of CCGs have rationed THA and TKA to reduce healthcare expenditure; therefore patients with certain perceived risk factors (like smokers, or those with a high BMI) have been denied access to arthroplasty (Daily Telegraph 2018). A recent report highlighted the severity of the problem with almost 1,700 requests for THA and TKA rejected by CCGs between 2017 and 2018, which represented a 45% increase from the previous year with some CCGs rejecting almost all requests received (Iacobucci 2018a). These actions leave many patients in considerable pain for prolonged periods despite a clinically effective intervention being available, and it appears patients are increasingly accessing arthroplasty in the private sector (Iacobucci 2018a). Thus, the longstanding problem of health inequalities between socioeconomic groups is perpetuated.
Austerity on the frontline- a preliminary study of physiotherapists working in the National Health Service in the UK
Published in Physiotherapy Theory and Practice, 2022
Rachael Tucker, Fiona Moffatt, Stephen Timmons
Much like other professional groups, physiotherapists have faced challenges as a result of rising neoliberalism, managerialism, corporatization, and the requirement for increased productivity; for example, physiotherapists have faced encroachment from other occupations (such as exercise technicians and generic rehabilitation assistants) (Jones, 2006; Rolfe et al., 1999; Stanmore, Ormrod, and Waterman, 2006) and decommissioning of services (McMillan, 2013; Walumbe, Swinglehurst, and Shaw, 2016). The term decommissioning is used to describe the removal or replacement of healthcare services, often incorporating a reconfiguration of such services, resulting in ‘organizational downgrading or closure’ (Harlock et al., 2018). Examples of decommissioning include closure of organizations or departments, replacement with cheaper alternatives and removal of medicines or interventions from funded use (Harlock et al., 2018). Following the publication of the Health and Social Care Act (Department of Health and Social Care, 2012), Primary Care Trusts and Strategic Health Authorities were abolished and Clinical Commissioning Groups (CCGs) were formed, mainly made up of local General Practitioners (GPs) (National Health Service, 2013). These groups take on the responsibility for making decisions for the funding and procuring of health services in their local area (Department of Health and Social Care, 2012; Harlock et al., 2018). It is suggested that decommissioning decisions are made not solely on cost-effectiveness, but on evidence-based medicine, quality, and clinical appropriateness (Harlock et al., 2018). Nonetheless, a national survey of commissioners suggested that cost-effectiveness was the most common intended outcome of decommissioning (Harlock et al., 2018).
Use of in vitro fertilization—ethical issues
Published in Upsala Journal of Medical Sciences, 2020
In most countries, there are no national age limits for IVF, and practices vary. In the UK, for instance, public funding is decided locally by Clinical Commissioning Groups (CCGs), with different practices across the country. There are, however, healthcare professionals’ guidelines that recommend that women up to the age of 40 should be offered three cycles of IVF and women up to the age of 42 one cycle of IVF (6).