Healthcare under pressure ..and needs to change

Healthcare under pressure. ..and needs to change

In my introduction to healthcare I mentioned that in recent years it has become clear that healthcare systems around the world as under major pressure.

Wherever we look we see that healthcare systems of all types are under going major change. The pressure to change seems a constant regardless of the underpinning approach to healthcare delivery.

In recent years my work has been based in the NHS, the National Health Service in the UK. The NHS is one of the largest employers of the world, was set up after the second world war, and is a key institution within the UK. In the late 1990s, the New Labour government launched the “NHS plan”, aiming to address “the lack of standards”, “lack of incentives and levers to improve performance” across the system via “investment and reform”.

One of the key ambitions that was declared was a 98% 4hour standard, from arrival to discharge in Emergency Departments. Those of us at the frontline thought it could not be done, but it has happened and it has transformed the care of patients in Emergency Departments in the UK, largely for the better.

While several of those measures were very successful, others were less so. Overall the NHS changed for the better, but the challenge to change remains. With the global downturn, the focus 10 years later once again is to “do more with less”. So the pressure continues to mount with the need for innovation and improvement been given a higher profile every successive year.

Elsewhere in the world, the pressure of healthcare systems to change has also been mounting.

In the US, on the other side of the Atlantic, the healthcare system is both a subject of envy in some respects and in others it is seen as broken and deeply inefficient. In a country that spends 16% of its GDP on health, the outcomes they get are very mixed, by some accounts they are poorer than other systems that spend less (such as the NHS in the UK).

Time after time the cry for healthcare reform has been raised in the US, to address the many millions of those uninsured people which has been one of the key drivers behind the Obama led Healthcare reform effort. On the other hand, many of the international centres of excellence in healthcare are based in the US. Largely privately funded there are pioneers in their field with global reputations.

The dichotomy between the successes and failures of the US healthcare system has been difficult to explain in recent decades, so there remains a significant amount of work to be done to foster a healthcare system that delivers Value for Money in the US.

Many other countries have been examining ways to transform their healthcare systems in recent years.

In Ireland, in recent years  the Department of Health has overseen the establishment of the Health Service Executive as the delivery arm and the Health Information and Quality Authority as the regulatory arm of a health system attempting major change.

In Australia, there has been a tussle between the federal government and the regional states over the funding of healthcare and varying suggestions as to the means to tackle the increasingly pressing need for healthcare reform..

Many other examples of healthcare systems under pressure to change can be seen in New Zealand, Canada, South Africa, not to mention the many developing countries also working to improve their healthcare systems.

So wherever you look across healthcare system (be they public or privately funded, tax or insurance based), it is evident that healthcare is under pressure to change across the world, and many countries are actively pursuing programmes of significant change and reform across their healthcare systems to address these pressures.

Most recently given the global economic downturn, it is also safe to say that the option to spend ones way to healthcare reform is now not an option for most healthcare systems. So the pressure will mount.. to work harder.. or work smarter.. and deliver better value for money.

In trying to tackle the challenges ahead for healthcare in the 21st century, where should one start?

In attempting to answer that we will now look at healthcare from a number of perspectives

  • At the patient-physician encounter
  • At the healthcare department trying to improve
  • Exploring links between healthcare delivery and research that are needed
  • Exploring the pursuit of Value for Money across healthcare systems.

In each of those we will identify common themes and particularly expect to identify that amidst the complexity there are some simple key principles that must be now tackled by all those attempting healthcare reform.


Cohn J (2007) “Sick: The Untold Story of America’s Health Care Crisis—and the People Who Pay the Price”

Equity and excellence: Liberating the NHS

Healthcare Reform in the US

Healthcare Reform in Australia

Irish Health Service Executive Transformation Programme

O’Connor M (2007) “Emergency: Irish Hospitals in Chaos” Gill & McMillan, Dublin


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