Survival of England's national health service questioned

(HealthDay)—Recent criticism of England's National Health Service (NHS) has called its survival into question, according to a perspective piece published online June 19 in the New England Journal of Medicine.

Noting that the NHS has never faced such intense and prolonged criticism as it has in recent months, Nicholas Black, M.D., from the London School of Hygiene and Tropical Medicine, discusses the implications for the future of the NHS.

The author notes that public-sector financial austerity, administrative reorganization, and publication of a recent report into shortcomings in one hospital combined to create turmoil within the NHS. Given a lack of funding increase over a prolonged period, to meet the rising demand, the NHS has to increase its productivity by 4 percent per year. The government is convinced that this is feasible with fundamental changes, including replacing nonclinical managers of the organizations which purchase hospital and community services with groups led by primary care doctors, as well as increasing competition among providers of these services. For the NHS to survive, four challenges need to be addressed: financial constraint, opposition to attempts to improve productivity; lack of managerial capacity; and concern about NHS reorganization impeding integration of services across health care.

"Although some of the challenges in England are unique, the underlying problem of meeting rising demand for care with steady or diminishing resources is faced by many countries," Black writes. "Just as we can learn from other health care systems, our experiences over the next few years in redesigning the organization and delivery of services will undoubtedly provide lessons for others."

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