Erin P. Fraher, PhD, MPP, and Thomas C. Ricketts III, PhD, MPH, of the American College of Surgeons (ACS) Health Policy Research Institute (HPRI), were guests of Sir Bernard F. Ribeiro, KtCBE, FACS(Hon), FRCSEng, FRCPEng, May 22–23 at the United Kingdom’s House of Lords. Several doctoral students from the University of North Carolina (UNC), Chapel Hill, accompanied Drs. Fraher and Ricketts on the trip, where they witnessed firsthand the art of legislative compromise.
Lord Ribeiro was appointed in 2010 to the House of Lords as a Life Peer. During a distinguished career, Lord Ribeiro has contributed significantly to the surgical profession in the U.K., where he has worked to modernize surgical training and introduced a new surgical curriculum. He served as president of the Royal College of Surgeons of England from 2005 to 2008.
In 2008, he joined the ACS leadership in presenting testimony on resident work hours and work schedules to the Institute of Medicine of the National Academy of Sciences panel on resident hours and work schedules. “He helped panel members understand the ramifications of restricting resident hours,” said Dr. Ricketts.
The HPRI, established in 2008 at the UNC under the direction of ACS Past-President George F. Sheldon, MD, FACS, conducts research on surgical issues, including the geographic distribution of general surgeons in the U.S. Dr. Sheldon presented Dr. Ribeiro for Honorary Fellowship in the ACS in 2008.
At the time of the visit, “The British Parliament had just gone through a very long process of reforming the English health and social care systems (the Health and Social Care Act 2012, which passed on March 27). It was a serious overhaul of the National Health Service (NHS) and a very difficult one,” explained Dr. Ricketts. “The actual bill was longer than the Affordable Care Act, and observers described the changes as the English health system’s most extensive reorganization. Lord Ribeiro was really one of the key people who negotiated the process and compromise that was finally reached.” The newly created public body that will manage the health service, the NHS Commissioning Board, will officially begin its work on April 1, 2013.*
The new plan restructures health service in England, giving groups of general practitioners (GPs—the equivalent of family physicians in the U.S.) and other health care professionals 60 percent control of the health service’s annual budget. “Basically, what it does is give family doctors the purse strings to care for patients,” explained Dr. Fraher. “Clinicians will make the decisions on whether, for example, a patient needs a hip replacement.”
“The legislation also introduces competition into the health services,” Dr. Fraher continued. As in the U.S., the goal is to reduce administrative costs and the rising costs of caring for an aging population, she said.
“Even though our systems are different, it was striking to me how similar the challenges are,” said Dr. Fraher. One of England’s major health care issues, she said, centers on the evolving standards of quality health care and how quality can be measured and reported. “These are the same concerns that the ACS addresses today.
“The English parliament is looking to their professional groups for input in a process that has engaged clinicians in helping to transform the NHS,” she added.
The U.S. visitors also met with Baroness Judith Jolly, co-chair of the Liberal Democrat Party Committee on Health and Social Care in England, who was instrumental in passing England’s health service bill, and Earl Howe, Parliamentary Under Secretary of Sate at the Department of Health.
“The whole experience was very useful in helping us understand health reform in the U.S.,” said Dr. Ricketts. “Lord Ribeiro said he wants to continue to share information and communicate regularly with us. He asked that we keep him informed about what we’re working on here.”
*Triggle N. BBC News. Analysis: What next for the NHS? Available at http://www.bbc.co.uk/news/health-17448838. Accessed June 22, 2012.