Transformational Change in Action

  • Botting L
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EvEry major industrialised country treats health care as a unique and important sector. It is valued by society, as well as by individuals, who think that access to good health care is a right. Despite its status as an essential social good, health care provision imposes 'trade offs' like every other service. In essence, resources are scarce, so decisions about priorities have to be made on the basis of consumer needs. Every country must therefore have mechanisms, explicit or implicit, market based or regulatory, to determine how much and what type of health care to provide, how to provide it and how to do so across the population. The NHS in England employs more than 1.3 million people and has a budget of more than £100 billion a year. When it was founded, the UK population was 49 million, which in the intervening years has grown to about 61 million. In 2008, there were more people in England over the state pension age than aged under 16 (office for National Statistics (oNS) 2009, Department of Health (DH) 2010a) and, by 2025, most people will be aged 50 years or more (NHS Institute for Innovation and Improvement (NHSI) 2010). If current trends continue, the number of people over 75 will almost double from 4.7 to 8.2 million by 2031 (oNS 2009). However, although life expectancy is rising and people are living longer, health and wellbeing have yet to catch up. There are 15 million people living with long-term conditions in the UK, 60 per cent of whom are aged over 65 (DH 2010b). The King's Fund (2010) estimates the cost of caring for long-term illness at £69 billion a year, and the growing number of older people is likely to place an increasing strain on healthcare expenditure. over the past ten years, healthcare systems have come under pressure to improve performance and manage productivity better. Between 1995 and 2008, productivity in health care fell by 3.3 per cent in the UK (oNS 2009), even though investment had increased, particularly between 2000 and 2001. This investment included staff pay awards, increased recruitment, partly to satisfy the European working time directive, and greater investment in equipment and buildings. Equally, the significant growth in population (King's Fund 2010) and expensive, sophisticated diagnostic techniques and treatments may have further compounded this fall in productivity. In the current economic climate, the coalition government has proposed structural changes to public services. It plans to introduce GP Summary

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  • Lucy Botting

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