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Dealing with the Austerity Challenge
Abstract
This chapter describes the difficult financial position the National Health Service (NHS) faces and how this directly affects the ambulance service. It discusses the changing demographics and attitude of the UK and the impact of these on the ambulance service. The authors go on to discuss the innovative ideas and changes ambulance services have had to make to meet the ever-increasing demand placed upon them. Finally, the question is raised regarding the possible need for changes in commissioning.
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Although Cuba has limited economic resources, its health care system has solved some problems that the U.S. system has not yet managed to address. Everyone has a family physician, everything is free, the system is tightly organized, and the first priority is prevention.
Out-of-hours primary care services continues to change with the growth of general practitioner (GP) co-operatives and the more recent development of NHS Direct. While older people are more likely to have increased needs for such services, evidence suggests that they are reluctant users of GP out-of-hours services.
To explore older people's experiences and perceptions of different models of general practice out-of-hours services.
Focus group methodology, with qualitative data analysis undertaken using a grounded theory (Framework) approach.
Thirty people aged between 65 and 81 years old from community groups based in south east London.
Four focus groups were held, each with between five and 12 participants. Each focus group session lasted 90 minutes and was audiotape-recorded with the permission of the participants. The tapes were transcribed verbatim.
Two related themes were identified. First, attitudes to health and healthcare professionals with reference to the use of health services prior to the establishment of the NHS, a stoical attitude towards health, and not wanting to make excessive demands on health services. Second, the experience of out-of-hours care and the perceived barriers to its use, including the use of the telephone and travelling at night. Participants preferred contact with a familiar doctor and were distrustful of telephone advice, particularly from nurses.
Older people appear reluctant to make use of out-of-hours services and are critical of the trend away from out-of-hours care being delivered by a familiar GP. With increasing numbers of older people in the population it is important to consider steps to address their reluctance to use out-of-hours and telephone advice services, particularly those based around less personal models of care.
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