来源：《经济学人》
原文见刊日期：2023年1月14日
Britons used to see the National Health Service (NHS) as a source of pride. It is now a source of danger. Data suggest that, in the course of December, over 50,000 sick people in England waited more than 12 hours to be admitted to hospital from accident-and-emergency (A&E) departments. Emergency doctors warn: around one in four excess deaths in recent months is attributable to delays in emergency care.
英国人过去把国家医疗服务体系（NHS）视为骄傲的源泉。它现在是危险的来源。数据显示，在12月期间，英国有超过50000名患者等待了超过12个小时才从急症科入院。急诊医生警告说：近几个月来，约有四分之一的超额死亡是由于急救延误造成的。
The scenes in A&E are just the most alarming symptoms of a health-care system that is failing. Downstream, one in seven patients is ready to leave the wards, which would free up beds for those clamouring to get in, but they would have no one to look after them if they were released from hospital. The government’s proposed solution—an extra £200m to block-book places in private care homes—seems sensible. But it will take more than that to deal with the deeper problem: a chronic shortage of staff.
急诊科的场景只是医疗保健系统正在失灵的最令人担忧的症状。下游，七分之一的病人准备离开病房，这将为那些吵着要进来的人腾出床位，但如果出院了，就没有人照顾他们了。政府提出的解决方案——增加2亿英镑预算在私人护理中心批量预定床位——似乎是合理的。但要解决更深层次的问题：严重的人员短缺，还需要更多努力。
Upstream, the same issue bedevils general practice, the network of family doctors where many of the pressures on the NHS first build. General practitioners (GPs) are conventionally a patient’s first and most frequent point of contact with Britain’s health-care professionals. But the system is buckling. Demand is rising—owing partly to a backlog in cases from the pandemic and partly to an increase in patients with complex, chronic diseases. And the number of doctors is dwindling, as GPs retire early, emigrate or reduce their hours. There are 15% more junior doctors in hospitals than there were in 2019, but 2% fewer full-time family doctors. As a result, millions are not getting the care they need. Many turn directly to the hospitals. Polling shows that one in five people who cannot see their family doctor goes to A&E instead. Many simply get sicker.
在上游，同样的问题困扰着全科诊所，这个家庭医生网络是NHS首先承受压力的地方。一般来说，全科医生是病人与英国医疗保健专业人员接触的第一个也是最频繁的点。但这个系统正在崩溃。需求正在上升，部分原因是新冠大流行导致病例积压，部分原因是患有复杂慢性病的患者增加。由于全科医生提前退休、移民或缩短工作时间，医生的数量正在减少。医院的初级医生比2019年增加了15%，但全职家庭医生减少了2%。结果，数以百万计的人得不到他们所需的医疗服务。许多人直接求助于医院。民意调查显示，五分之一不能去看家庭医生的人会去急诊室。许多人因此病情加重了。
To slow the stampede of older GPs retiring early, the government should exempt doctors from pension-tax rules that penalise high-earners. More advanced technology, including automated telephone services and online consultations, would calm the 8am panic to book an appointment.
为了减缓老年全科医生蜂拥提前退休的现象，政府应该免除医生的养老金税规定，这些规定对高收入者不利。更先进的技术，包括自动电话服务和在线咨询，将缓解早上8点预约的恐慌。
More profound changes are needed to make this foundation of the NHS sturdy again. General practices are businesses, most commonly owned by GP partners. The building will collapse if partners continue to quit. One option is to make all GPs salaried NHS employees. The Labour Party is considering this approach, along with other reforms such as allowing self-referrals to certain specialists.
要使NHS的基础再次稳固，还需要进行更深刻的改革。全科诊所是企业，通常由全科医生合伙人拥有。如果合伙人继续退出，NHS就会崩溃。一种选择是让所有全科医生都成为NHS的受薪员工。工党正在考虑这种方法，还有其他改革，如允许自行转诊给某些专家。
Buying out GP partners and their premises would be costly. It would also be risky to abandon a model that, for all its faults, remains the envy of other countries. Primary care provides most of the NHS’s patient contacts for just 9% of its budget. Specialists, meanwhile, have seen their hospital waiting lists spiral to over 7m: self-referrals would make the problem worse.
收购全科医生合伙人及其经营场所的成本很高。抛弃一个尽管存在种种缺陷，但仍令其他国家羡慕不已的模式也是有风险的。初级保健为NHS提供了大部分的病人接触，而其预算仅占9%。与此同时，专家们发现他们的医院候诊名单已经上升到700多万人：自我转诊会让问题变得更糟。
It would be better to make changes from within. The NHS should abolish the Quality and Outcomes Framework, a pointless pay-for-performance scheme which means that GPs spend hours filling out forms instead of seeing patients.
从内部做出改变会更好。NHS应该废除“质量和结果框架”，这是一个毫无意义的绩效薪酬计划，意味着全科医生要花几个小时填写表格，而不是去看病人。
The NHS’s most urgent problem lies in its hospitals. But the health service will not be fixed unless general practice is, too.
NHS最紧迫的问题在于医院。但是，除非全科诊所的问题也得到解决，否则医疗服务的问题就不能解决。