
由于儿童和成人对诊断的需求激增,英国国家医疗服务体系(NHS)的ADHD和自闭症服务部门正面临大量员工离职,转而加入私营诊所。
is facing an exodus of staff quitting its ADHD and autism services to join private clinics amid huge demand from children and adults to get a diagnosis.
专科人员流失至私营部门,已迫使英格兰的一家NHS信托机构将其神经发育服务限制在最紧急的病例范围内。
The loss of specialist personnel to the private sector has already forced one NHS trust in England to limit access to its neurodevelopmental service to only the most urgent cases.
心理学家、精神科医生、护士及其他医护人员的“人才外流”,正使NHS“实力减弱”,并增加民众被迫寻求私人医疗服务的可能性。
The brain drain of psychologists, psychiatrists, nurses and other staff is leaving the NHS "weaker" and making it more likely that people will be forced to seek private healthcare.
NHS护理监管机构周五宣布,将开始对提供ADHD和自闭症诊断评估的私营诊所进行审查,而这些诊所目前尚无监管。护理质量委员会(CQC)此举是在政府委托的心理健康与神经多样性审查报告发布之后。该报告敦促部长们确保所有服务提供者都受到适当监管,以应对私营机构提供诊断测试领域被形容为“西部狂野地带”的乱象。
The NHS care watchdog announced on Friday it will start inspecting private clinics that offer diagnostic assessments for ADHD and autism, which are currently unregulated. The Care Quality Commission's move follows the publication of the government-commissioned review of mental health and neurodiversity urging ministers to ensure all service providers are properly regulated amid claims of a "wild west" of private firms offering diagnostic tests.
近年来,大量私营诊所成立,提供ADHD和自闭症的评估与治疗。这些诊所利用了因神经多样性诊断需求激增而服务不堪重负、无法获得NHS护理的庞大人群,导致求助等待时间漫长且积压严重。
Scores of private clinics have been set up in recent years offering assessments and treatment for ADHD and autism. They have capitalised on the large number of people who have been unable to access NHS care because services have been overwhelmed by an explosion in demand for diagnoses of neurodiversity, creating long waits for help and massive backlogs.
CQC心理健康护理临时检查官阿德里安·詹姆斯表示:“这项新职责将……填补我们监管中的一个重大空白,这意味着接受这些诊断的人们可以对自己所获得的服务更有信心。”彼得·福纳吉教授的报告——据信是全球同类调查中规模最大的一次——表达了对私营机构可能受“经济激励”诱惑,错误诊断和治疗那些症状不符合诊断标准的患者的担忧。
Adrian James, the CQC's interim inspector of mental health care, said: "This new responsibility will … close a significant gap in our oversight, meaning that people receiving these diagnoses can have far greater confidence in the service they are receiving." Prof Peter Fonagy's report – thought to be the biggest inquiry of its kind in the world to date – voiced concern that private firms face the temptation of "financial incentives" to wrongly diagnose and treat patients whose symptoms mean they should not qualify for either.
CQC 已经对提供诊断和治疗的服务进行了监管。但这项新规意味着,未来仅提供诊断评估的非 NHS 诊所也将必须接受监管。
The CQC already regulates services offering diagnosis and treatment. But the change means non-NHS clinics offering only diagnostic assessments will in future have to with them.
卫生部长伊维特·库珀表示,更严格的监管意味着“民众可以确信,这些评估是高质量的,而且 NHS 不会被独立或私营机构过度收费”。目前,英格兰约有 81 万名儿童和成人正在等待评估。
Yvette Cooper, the health secretary, said the tighter regulation means "people can be confident that assessments are high quality and that the NHS is not being overcharged by independent or private providers". About 810,000 children and adults in England are waiting for an assessment.
上周,《卫生服务期刊》披露,赫里福德郡和伍斯特郡卫生与护理 NHS 信托机构因员工流失至私营部门,被迫限制儿童和青少年使用其神经发育服务,这一事件凸显了 NHS 面临的风险。
The risks to the NHS of losing staff to the private sector was highlighted last week when the Health Service Journal revealed that the Herefordshire and Worcestershire health and care NHS trust had been forced to restrict children and young people's access to its neurodevelopmental service for that reason.
提交给该信托机构董事会的一份报告指出:“神经发育领域的 staffing 大幅减少,大多数离职员工选择加入 ISP(私营机构)和 RtC(‘选择权’计划)的神经多样性(ND)服务提供者。”“选择权”计划允许 NHS 患者通过私营机构接受由 NHS 资助的 ADHD 或自闭症评估,以便更快地获得治疗。
A paper presented to the trust's board reported: "Neurodevelopmental staffing is reduced significantly, with the majority of leavers choosing to take up employment with ISP [independent sector providers] and RtC [Right to Choose] providers for ND [neurodiversity]." Right to Choose gives NHS patients the right to have an NHS-funded ADHD or autism assessment with a private provider to help them receive care more quickly.
上个月,该信托机构为应对员工大规模流失,将 18 岁以下人群的就诊资格限制为仅适用于症状最严重的患者。该限制将于周一解除,恢复正常服务。目前已有总计 1298 人等待该信托机构提供 ADHD 或自闭症评估超过两年。
The trust responded to the exodus last month by limiting access by under-18s to only those with the most serious symptoms. It will revert to a normal service on Monday. A total of 1,298 people have already waited at least two years for an ADHD or autism assessment with the trust.
纳菲尔德信托机构首席执行官、政府 ADHD 特别工作组成员西娅·斯坦表示,当员工加入私营机构时,NHS 的服务会受到损害,物理治疗以及儿童和青少年心理健康服务领域也存在类似情况。
Thea Stein, the chief executive of the Nuffield Trust and a member of the government's ADHD taskforce, said NHS services suffered when staff joined private operators, as also happens in physiotherapy and child and adolescent mental health services.
她说:“有些员工在获得私营部门工作后仍会兼职留在 NHS,但许多人会完全离开,导致卫生服务体系实力减弱、压力增大。”
She said: "Some staff stay with the NHS part-time when they get a private-sector job, but many will walk away entirely, leaving the health service in a weaker position and under greater pressure.
如果英国国家医疗服务体系(NHS)无法维持充足的团队人员,或无法扩大团队以满足日益增长的注意力缺陷多动障碍(ADHD)支持需求,那么严重的资源不平等现象将进一步加剧。斯坦补充道:“如果这些服务持续流失员工,那么那些有能力支付私人护理费用的人将能更快地获得支持。”
"Concerning inequalities will widen further if the NHS can't keep fully staffed teams or expand them to meet increasing demand for ADHD support. If these services continue to haemorrhage staff, some people will get much quicker support if they can afford to pay for private care," Stein added.
代表各医疗信托机构的NHS联盟证实了员工持续流失的情况。该联盟心理健康网络主管丽贝卡·格雷表示:“我们正越来越多地面临这样的情况:同一批ADHD专业人员分散在NHS和私营部门的不同服务提供者中。”
The NHS Alliance, which represents trusts, confirmed the continuing exodus of staff. "We're increasingly dealing with one ADHD workforce spread across different providers both in the NHS and private sector," Rebecca Gray, the director of the alliance's mental health network, said.
“私营部门市场正在显著增长,而在此获得服务的人往往比在资源紧张的NHS服务中等待得更短,这将使独立部门的工作对部分员工更具吸引力。”代表众多非NHS企业的行业组织——独立医疗服务提供者网络(IHPN)对英国临床质量与安全委员会(CQC)加强后的新角色表示欢迎。
"The significant growth in the private sector market, where people accessing services can often be seen more quickly than in stretched NHS services, will make working in the independent sector attractive to some staff." The Independent Healthcare Providers Network (IHPN), a trade body that represents many non-NHS firms, welcomed the CQC's enhanced new role.
IHPN政策主管肖恩·菲利普斯表示:“IHPN所有提供ADHD和自闭症评估的成员机构均已接受CQC的评估,其中83%的机构被评为‘良好’或‘卓越’。但我们长期以来一直呼吁对神经发育相关服务进行更全面的‘端到端’监管,因此很高兴看到CQC已确认将开始对所有提供ADHD和自闭症评估的机构进行监管。”
Sean Phillips, the IHPN's head of policy, said: "While all of IHPN members who deliver ADHD and autism assessments are CQCed – with 83% rated good or outstanding – we have long called for greater 'end to end' oversight of neurodevelopmental provision and it's welcome to see that the CQC have confirmed they will now be regulating all providers of ADHD and autism assessments."