May 10, 2022
Introduction to UK Health and Social Care
Today our lectures were all about the United Kingdom’s free National Health Service called the NHS. It was established in 1948 by Nye Bevan of the labour (socialist) government which aims to provide “health care from the cradle to the grave.” The organization is overseen by the Department of Health and funded by taxes. In contrast, there is a private sector which can provide quicker access to services, however, it is not an affordable option for most.
In recent years, the power has shifted from the hospital towards community general practitioners (GPs). GPs are the first medical professional you will see that act as gatekeepers to specialized care. They form regional groups called clinical commissioning groups (CCGs) that purchase services, make connections with hospitals, and decide which medicines or treatments are subsidized by NHS funding. This is very different from the US where insurance companies hold the power and make the decisions about what is or isn’t covered. What is the same between the two is the inequities they contribute to. In the UK, treatments such as hormone replacement therapy or gender affirming surgery may be funded in one region, but not another. It is the same way with US insurance where different companies decide what they will cover.
The 3 major aspects of the NHS are primary care which is the level of general practice and community nursing, secondary care which includes hospital interventions, and social care that encompasses the aid in daily living tasks. In the past, these aspects have been lacking proper communication leading to duplicate services and patient dissatisfaction. To aid in this discontinuity, the health system is moving towards an integrated model using electronic health records. This new model is similar to the one that UPMC uses in Pittsburgh. The electronic health records are shared between all of your care providers so that whenever you go to a UPMC facility, you do not have to waste time going over the same information over and over again.
Nursing Roles
We had the wonderful opportunity to have discussions with the many unique roles nurses play in the UK. Although the terminology is different, there are so many similarities in duties. My favourite part about this lecture was discovering that an operating room is called a theater here.
To begin, Dee shared with us her experiences as an operating department practitioner (ODP). The training to become this is a 3 year Bachelor’s degree. Her roles include assessments of individual risk (airway, comorbidities, medication, mental health) as well as supporting the surgical and anesthetic teams during surgery by knowing equipment and medications, performing surgical checks, and understanding all the emergency protocols. Overall, this job is very broad and encompasses a combination of what an operating nurse, resident doctor, and nurse anesthetist would do in the US. The most important similarity that she discussed is the importance of consent and advocacy across all members of the multidisciplinary teams in the UK and the US. A patient that is under general anesthesia cannot make decisions so it is the responsibility of an ODP or resident doctor or nurse anesthetist to advocate for the patient wishes.
Then, Sue spoke to us about primary care general practice nursing. This is very similar to the role of a family doctor or nurse practitioner in the United States. In both the UK and US, there has been major growth in advanced practitioner roles that are able to independently prescribe medicine, work with long-term condition management, and research. A general practice nurse and nurse practitioner both treat a large spectrum of patients from cradle to grave and from every kinds of socioeconomic or ethnic backgrounds. It seems like the main difference between the two is the access to healthcare for people of low socioeconomic background or ethnic minorities. Due to the universal healthcare in the UK, anyone living there, including refugees, can get help. The wait times to see a practitioner are much longer in the UK than the US, but overall, people are able to get the care they need.
The next role we learned about from Rachel was community nursing. Community nursing is at the level of household. It is a very personal job where you are welcomed into someone’s home with the goal to improve their quality of life. Some common tasks performed are continence assessments, diagnoses of diseases, and treatments such as antibiotic therapy, mobilizations, wound care, or even chemotherapy. This job sounds very similar to what an occupational therapist would do in the US. Interestingly, there are occupational therapists in the UK, however, hardly any of them work in community nursing.
Finally, Lisa introduced the role of midwifery. The qualifications to call oneself a midwife began in 1902 with the Midwifery Act. It was so shocking to me that a profession as old as time was only regulated starting 120 years ago. It just goes to show how privileged we are to live in a time where we have access to great birth and maternal care. Now, you would think that the advancements in medicine and research would mean that everywhere has a great birth rate, right? Well, the UK is significantly better that the US to give birth in. The introduction of standardized protocols set forth by the NHS in addition to comprehensive prenatal care contribute to their low maternal death rate of 7 per 100,000 live births whereas the US is over twice that amount at 19 per 100,000 live births (CIA). Not only are the rates overall significantly different, but also the disparities between ethnic groups. In the US, women who are poor, African American, or live in a rural area are more likely to die during and after pregnancy. This disparity is much smaller in the UK where all British women have equal access to NHS medical services (Propublica). The US has a lot of stepping up to do when it comes to maternal mortality rate.
Sources:
https://www.cia.gov/the-world-factbook/field/maternal-mortality-ratio/country-comparison
https://www.propublica.org/article/why-giving-birth-is-safer-in-britain-than-in-the-u-s
Special Education
SEND which stands for special education needs and disabilities is an umbrella term for people with any physical, learning, language, or mental disabilities. In schools in the UK, both the NHS school nurses and SEND coordinators have a role in the initial assessment of children, referrals, management of day to day needs of children in classrooms, and implementing education health care plans in schools.
Education health care plans in the UK take a holistic approach designed to make education accessible to all and to improved the outcomes for children identified with SEND. Funds to create these plans must be approved by the local authority, but this process can take a minimum of 30 weeks to years. Once a plan is set in place, it is reevaluated as needed and good up until age 25. The program with the same goal as this in the US is called the individualized education program (IEP). The differences include that the children are tested before starting school so that the program is implemented within 30 school days, it is reevaluated every 3 years, and it only covers up to age 21.
Botanical Garden
In between lectures, we took a relaxing walk through the Birmingham Botanical Garden. It was a brilliant day and the flowers were incredible.
