C ommo nwe a l t h memb e r c o u n t r i e s supported by a number of agencies and partner organisations, including the Care Quality Commission, NHS Blood and Transplant, the Human Tissue Authority and Public Health England. The Health and Social Care Act 2012 introduced changes to NHS England, allowing hospitals and GP surgeries to commission any relevant health-care services directly through clinical commissioning groups where this was previously done by regional primary care trusts. The NHS budget for 2015–16 is £115.4 billion. In addition to the NHS, there is a thriving private health care system offering a range of services, sometimes funded by employersponsored medical insurance. Health insurance providers also market directly to the public. More than 12 per cent of the population is covered by private medical insurance (2011). Most private care is for specialist referrals, after utilising the primary care services of the NHS. The pharmaceutical industry is highly advanced and is a major contributor to the GDP of the UK. Its pharmaceutical exports account for 7.4 of total global pharmaceutical exports (2011). The sector is the investor in research and development. The Mental Health Act was introduced to the UK in 1959 and most recently revised, for England and Wales, in 2007. Scotland has the Mental Health (Care and Treatment) Act 2003 and Northern Ireland the Mental Health NI Order 1986. Much mental health treatment is provided through care in the community, a system run by local authorities that provides residential or at-home care for those suffering both physical and mental disabilities. Main health concerns and plans for remedial action: The UK has a life expectancy of 81 years, showing a sustained increase, up from 76 years in 1990 and 78 years in 2000. Gains have been primarily due to reduced child and maternal mortality, and improved longevity for other age groups, particularly for older people with chronic diseases. Levels of alcohol consumption and alcohol-related deaths, and the sharp increases in adult and child obesity are among the most pressing public health concerns. Levels of smoking are steadily decreasing, with 20 per cent of over-16s classified as smokers (2012). By comparison, in 1974, 45 per cent of over-16s smoked. The government is investing funds in services to help people stop smoking. In 2011–12 the government collected £12.1 billion in total from tobacco tax, and spent £88.2 million on services to help people stop smoking and £66.4 million on medication to help smokers quit. A high level of alcohol consumption is a long-standing problem in the UK, but it is slowly decreasing, having hit a peak in the early 2000s. More than one in five adults in Britain thought of themselves as teetotal in 2013, with the proportion of non-drinking young adults (aged 16–24) increasing by more than 40 per cent between 2005 and 2013. In 2010, 65 per cent of alcohol-related deaths in men and 63 per cent of alcohol-related deaths in women were attributed to alcoholic liver disease. In 2012 the government released an alcohol strategy primarily aimed at reducing binge drinking. Measures included plans to make cheap alcohol less accessible and reduce the number of outlets licensed to sell alcohol. Between 1993 and 2011 there was a notable increase in the proportion of both men and women in the UK who were classified as clinically obese. By 2004 the UK had one of the highest levels of obesity in Europe at 22.7 per cent, almost twice the European Union average of 13.4 per cent. Childhood obesity is also a growing concern. In the period 2011–12, 9.5 per cent of four- and five-year-olds were obese. Obesity can lead to a number of further health complications, such as increased risk of developing type two diabetes, heart disease and some cancers. In 2011 the government released its action plan Healthy Lives, Healthy People: A Call to Action on Obesity in England, outlining a commitment to achieving an overall decrease in the level of excess weight averaged across all adults and children by 2020. For definitions and sources see page 314. Universal health coverage Less than a fifth of health care in the UK (17 per cent) was paid for by patients or funded by other non-governmental entities – such as private insurers, charities or employers – in 2012. Total health expenditure constitutes 9.4 per cent of GDP, of which 83 per cent (US$3,009 per capita) was covered by the government. The NHS, launched in 1948, was set up with the philosophy that good quality health care should be available to all, regardless of wealth – it is free at the point of use for anyone who is a UK resident. In the decades since the NHS was first established, some, usually low, charges have been introduced, such as for prescriptions, dental care and eye tests, with variations between England, Scotland, Wales and Northern Ireland. But people on the lowest incomes usually pay lower, or no, charges. A Commonwealth Fund survey of health care systems in 11 countries found that Britain’s NHS ranked highest over all, beating Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the USA. The NHS was rated as the most impressive system for efficiency, effective care, safe care, co-ordinated care, patient-centred care and cost-related problems. It was also rated second for equity. Since 2011, some immigrants, depending on their visa status, have been charged for certain NHS services that would be free for British nationals. This includes antenatal and maternity care, which has led to a rise in the number of unattended home births as families strive to avoid charges that can run to several thousand pounds. The UK has signed up to and ratified the International Covenant on Economic, Social and Cultural Rights, which includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination. Care of the elderly: In 2013, 17 per cent of the population was over 65 years of age, with people aged 60 expected to live for an additional 24 years, on average. Five per cent of pensions were paid out of public funds in 2009, with monthly pension credits (called the Guarantee Credit) paid by the state at a rate of US$949 per person (2007–12) on a means-tested basis. Pensions were first introduced in the UK in 1909. The government committed £300 million for dementia research in February 2015, which will be used to establish an international 290 Commonwealth Health Partnerships 2015
Commonwealth Health Partnerships 2015
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