National Health Service NHS

The advent of novel atypical antipsychotic drugs has sharpened the debate in the UK about the cost burden of schizophrenia to the National Health Service (NHS) and the relative cost-effectiveness of these drugs. Schizophrenia has a prevalence of about 0.5% and a lifetime risk of 1%. Because the disease affects adolescents and has a lifetime course associated with a high degree of hospital and social... 

In this book I will share with you the process by which I came to this conclusion and the scientific evidence on which it is based. This includes evidence that was known to the pharmaceutical companies and to regulatory agencies, but that was intentionally withheld from prescribing physicians, their patients and even from the National Institute for Health and Clinical Excellence (NICE) when it was drawing up treatment guidelines for the National Health Service (NHS) in the UK. 

Our empirical evaluation of competition between pharmaceuticals was based on information on prescription drug consumption by non-hospital patients in the National Health Service (NHS) in England in 19% and the Sistema Nacional de Salud or SNS (National Health System) in Spain in 1997. The authors wish to thank Statistics Division IE of the UK Department of Health and the Directorate-General of Pharmacy and Health Products of the Spanish Ministry of Health and Consumer Affairs for supplying us with these data. As can be seen from Table 4.1, public consumption of pharmaceuticals... 

Since 1990, responsibility for containing the public pharmaceutical bill in Spain has fallen to a variety of instruments, none of which has proved particularly effective at cost containment, as can be seen from Table 6.1. These instruments have included stricter control over the National Health Service (NHS) (Sistema Nacional de Salud or SNS) budget for pharmaceuticals, modifications to the co-payment rates for certain drugs for chronic diseases, the exclusion of certain drugs from public financing (negative lists) and agreements with laboratories and pharmacies.1... 

The ABPI is the trade association that represents the manufacturers of prescription medicines. Formed in 1930, it now represents some 80 companies, which produce over 80% of the medicines supplied to the National Health Service (NHS). The ABPI has had a code of practice since 1958, the Code of Practice for the Pharmaceutical Industry, which governs the promotion of medicines to health professionals, and has operated a system whereby complaints made about the advertising of prescription medicines are taken up and considered under the Code. It is a condition of membership of the ABPI to abide by the Code of Practice. In addition, some 70 companies that are not members of the ABPI have given their formal agreement to abide by the Code and to accept the jurisdiction of the PMCPA over complaints made under the Code. Thus, the Code... 

In the United Kingdom, annual expenditure on the National Health Service (NHS) is... 

In the United Kingdom, prescriptions are required for all medicines supplied under the National Health Service (NHS) and for all prescription-only medicines. Prescriptions may only be written by a doctor or dentist registered in the United Kingdom. 

Approximately a third of stroke survivors are functionally dependent at one year and stroke is the commonest cause of neurological disability in the developed world (Murray and Lopez 1996 MacDonald et al. 2000). Stroke also causes secondary medical problems, including dementia, depression, epilepsy, falls and fractures. In the UK, the costs of stroke are estimated to be nearly twice those of coronary heart disease (British Heart Foundation Statistics Database 1998 Rothwell 2001), accounting for about 6% of total National Health Service (NHS) and Social Services expenditure (Rothwell 2001). As the population ages over the coming two decades, the total stroke rate will probably increase unless there are substantial decreases in age- and sex-specific incidence (Rothwell et al. 2004a). Stroke deaths are projected to increase from 4.5 million worldwide in 1990 to 7.7 million in 2020, when stroke will account for 6.2% of the total burden of illness (Bonita 1992 Sudlow and Warlow 1997 Menken et al. 2000). 

The UK National Health Service (NHS) spending on drugs has been 9-11% per year (of the total cost) over nearly 50 years. 

In 1996, total health care expenditure in the United Kingdom was approximately 7.0% of the GDP. Public expenditure by the National Health Service (NHS) accounts for most of the health care costs. The NHS was set up after World War II, with the aim of unifying health care services by voluntary and local hospitals. The NHS offers free health services to all U.K. residents, funded through general taxation. 

Funded by the government, the National Institute for Clinical Excellence (NICE) was set up as a Special Health Authority in the United Kingdom in 1999 and, as such, it is a part of the National Health Service (NHS). It was set up to provide the NHS (patients, health professionals, and the public) with authoritative, robust and reliable guidance on current best practice. Its key functions are to appraise the clinical benefits and the costs of those (health care) interventions and to make recommendations. Guidance is issued from each appraisal based on the clinical benefits,... 

This introduces medicines supply in the community and covers the background details. National Health Service (NHS) prescription forms and the restrictions placed on different NHS prescribers in the community, including the role of the UK Drug Tariffs, are discussed. 

The material in this chapter will follow on from Chapter 2 by covering the supply of prescription items via the National Health Service (NHS) in the community. The following topics are covered ... 

This chapter will cover the supply of medicines via the National Health Service (NHS) within hospitals. Throughout this chapter, the term hospital is used, but the types of supply described may also apply to other residential style care establishments, for example, some care homes and hospices. It should be noted that the procedures discussed in this chapter for... 

The Canadian Institute for Health Information (CIHI) is actively working on developing drug performance indicators for uptake and application by the Canadian Council on Health Services Accreditation (CCHSA). In Great Britain, the National Health Service (NHS) has established a National Performance Framework that has... 

In the UK, annual expenditure on the National Health Service (NHS) is largely determined by government during public expenditure negotiations. Until recently, there has tended to be an implicit belief that this money (or the resources that this money could command) should be used to meet all health needs. Words such as rationing were avoided at all costs in official documents. 

Part of the UK National Health Service (NHS). Provides guidelines and technology assessments to health care practitioners (http //nice.org.uk). 

In the United Kingdom, the government controls the cost of pharmaceuticals not by limiting individual product prices, but by setting a cap on the profit that individual pharmaceutical companies can enjoy from their business with the National Health Service. Each company negotiates with the Secretariat of Pharmaceutical Price Regulation Scheme (PPRS) a total rate of return on the capital employed in generating its sales to the British National Health Service (NHS). 

In the United Kingdom, for example, all residents are covered by the National Health Service (NHS) and access to drugs is subsidised directly, leaving only a minor role for private health insurance and a nominal charge to be borne by the patient. In the United States, at the other extreme, health insurance is voluntary and in the hands of proht-driven private insurance companies, leaving only a residual role... 

Clinical research in the UK is governed by statutory requirements in the form of the EU Directive (2001/20/EC) on Good Clinical Practice (GCP), ethical principles (Declaration of Helsinki), the Research Governance Eramework for Health and Social Care (Department of Health, 2005) and the duty of care in the National Health Service (NHS), the high professional and ethical standards that most care professionals and researchers uphold. 

The UK has one of the largest medical device markets in the world. The market is dominated by the National Health Service (NHS), which accounts for approximately 80% of the healthcare expenditure, even though there are fewer private sectors. 

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