The Ethox Centre and The Wellcome Trust Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
PLoS One. 2019 Feb 13;14(2):e0212314. doi: 10.1371/journal.pone.0212314. eCollection 2019.
In 2010, the UK embarked on a self-imposed programme of contractionary measures signalling the beginning of a so-called "age of austerity" for the country. It was argued that budgetary cuts were the most appropriate means of eliminating deficits and decreasing national debt as percentage of General Domestic Product (GDP). Although the budget for the National Health Service (NHS) was not reduced, a below-the-average increase in funding, and cuts in other areas of public spending, particularly in social care and welfare spending, impacted significantly on the NHS. One of the areas where the impact of austerity was most dramatically felt was in Accidents and Emergency Departments (A&E). A number of economic and statistical reports and quantitative studies have explored and documented the effects of austerity in healthcare in the UK, but there is a paucity of research looking at the effects of austerity from the standpoint of the healthcare professionals. In this paper, we report findings from a qualitative study with healthcare professionals working in A&E departments in England. The study findings are presented thematically in three sections. The main theme that runs through all three sections is the perceptions of austerity as shaping the functioning of A&E departments, of healthcare professions and of professionals themselves. The first section discusses the rising demand for services and resources, and the changed demographic of A&E patients-altering the meaning of A&E from 'Accidents and Emergencies' to the Department for 'Anything and Everything'. The second section in this study's findings, explores how austerity policies are perceived to affect the character of healthcare in A&E. It discusses how an increased focus on the procedures, time-keeping and the operationalisation of healthcare is considered to detract from values such as empathy in interactions with patients. In the third section, the effects of austerity on the morale and motivations of healthcare professionals themselves are presented. Here, the concepts of moral distress and burnout are used in the analysis of the experiences and feelings of being devalued. From these accounts and insights, we analyse austerity as a catalyst or mechanism for a significant shift in the practice and function of the NHS-in particular, a shift in what is counted, measured and valued at departmental, professional and personal levels in A&E.
2010 年，英国开始实行紧缩措施，标志着该国进入所谓的“紧缩时代”。有人认为，削减预算是消除赤字和降低国民债务占国内生产总值（GDP）比例的最恰当手段。尽管国家卫生服务体系（NHS）的预算没有减少，但资金增长低于平均水平，公共支出的其他领域，特别是社会护理和福利支出的削减，对 NHS 产生了重大影响。紧缩政策影响最明显的领域之一是急症室（A&E）。一些经济和统计报告和定量研究已经探讨和记录了紧缩政策对英国医疗保健的影响，但很少有研究从医疗保健专业人员的角度来看待紧缩政策的影响。在本文中，我们报告了一项针对英格兰急症室工作的医疗保健专业人员的定性研究的结果。研究结果以三个部分的主题形式呈现。贯穿所有三个部分的主题是对紧缩政策的看法，认为它塑造了急症室部门、医疗保健职业和专业人员自身的运作。第一节讨论了对服务和资源的需求不断增加，以及急症室患者的人口结构变化——将急症室的含义从“意外和紧急情况”转变为“任何事情和一切”的部门。本研究结果的第二节探讨了紧缩政策如何被认为影响急症室的医疗保健特征。它讨论了如何更加关注程序、时间管理和医疗保健的运作，认为这会削弱与患者互动中的同理心等价值观。在第三节中，提出了紧缩政策对医疗保健专业人员自身士气和动机的影响。在这里，道德困境和倦怠的概念被用于分析被贬低的经历和感受。从这些描述和见解中，我们将紧缩政策分析为 NHS 实践和功能发生重大转变的催化剂或机制——特别是在急症室部门、专业和个人层面上，对计数、衡量和重视的内容发生转变。
