There is currently an ongoing debate in the USA about whether the US government should expand health coverage to include some groups that have limited access to health care. In the UK, we have had universal health coverage since 1948, when the NHS was introduced. The US health system has some stark disparities between ethnic groups. A recent article from Imperial College published in the Journal of Public Health examined change in the quality of care for people with diabetes over a 10 year period from 1997-2006. We found that although Although ethnic disparities persist in diabetes management, these are starting to be addressed, particularly in the South Asian group. It appears therefore that all ethnic groups have benefited from recent quality improvement initiatives in the UK.
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...
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