Part A: Reading Comprehension

Text 2

When it was established, the National Health Service (NHS) was visionary: offering high-quality, timely care to meet the dominant needs of the population it served. Nearly 75 years on, with the UK facing very different health challenges, it is clear that the model is out of date.

From life expectancy to cancer and infant mortality rates, we are lagging behind many of our peers. With more than 6.8 million on waitlists, healthcare is becoming increasingly inaccessible for those who cannot opt to pay for private treatment; and the cost of providing healthcare is increasingly squeezing our investment in other public services. As demand for healthcare continues to grow, pressures on the workforce—which is already near breaking point—will only become more acute.

Many of the answers to the crisis in health and care are well rehearsed. We need to be much better at reducing and diverting demand on health services, rather than simply managing it. Much more needs to be invested in communities and primary care to reduce our reliance on hospitals. And capacity in social care needs to be greater, to support the growing number of people living with longterm conditions.

Yet despite two decades of strategies and a number of major health reforms, we have failed to make meaningful progress on any of these aims. That is why the Reform think tank is launching a new programme of work entitled “Reimagining health”, supported by ten former health ministers. Together, we are calling for a much more open and honest conversation about the future of health in the UK, and an “urgent rethink” of the hospital-centric model we retain.

This must begin with the question of how we maximise the health of the nation, rather than “fix” the NHS. It is estimated, for example, that healthcare accounts for only about 20% of health outcomes. Much more important are the places we live, work and socialise—yet there is no clear cross-government strategy for improving these social determinants of health. Worse, when policies like the national obesity strategy are scrapped, taxpayers are left with the hefty price tag of treating the illnesses, like diabetes, that result.

Reform wants to ask how power and resources should be distributed in our health system. What health functions should remain at the centre, and what should be given to local leaders, often responsible for services that create health, and with a much better understanding of the needs of their populations?

26. According to the first two paragraphs, the NHS

[A]

is troubled by funding deficiencies. 

[B]

can hardly satisfy people’s needs. 

[C]

can barely retain its current employees. 

[D]

is rivalled by private medical services. 

27. One answer to the crisis in health and care is to

[A]

boost the efficiency of hospitals. 

[B]

lighten the burden on social care. 

[C]

increase resources for primary care. 

[D]

reduce the pressure on communities. 

28. “Reimagining health” is aimed to

[A]

reinforce hospital management. 

[B]

readjust healthcare regulations. 

[C]

restructure the health system. 

[D]

resume suspended health reforms. 

29. To maximise the nation’s health, the author suggests

[A]

introducing relevant taxation policies. 

[B]

paying due attention to social factors. 

[C]

reevaluating major health outcomes. 

[D]

enhancing the quality of healthcare. 

30. It can be inferred that local leaders should

[A]

exercise their power more reasonably. 

[B]

develop a stronger sense of responsibility. 

[C]

play a bigger role in the health system. 

[D]

understand people’s health needs better. 

答案解析 (Answers & Explanations)

26. [B] can hardly satisfy people’s needs.
解析：细节推理题。第一、二段指出，NHS在建立之初是为了满足人口的主要需求，但75年后的今天，这个模式已经“过时（out of date）”。第二段列举了各项指标落后、候补名单超过680万人、医疗服务变得越来越难以获得（inaccessible）等现象，说明当前的NHS已经“几乎无法满足人们的需求（can hardly satisfy people's needs）”，故选 [B]。

27. [C] increase resources for primary care.
解析：细节题。第三段第二句明确给出了解决危机的答案之一：“需要在社区和基层医疗（primary care）方面投入更多（Much more needs to be invested in...），以减少我们对医院的依赖”。“投入更多”完美对应选项 [C] 中的“增加对基层医疗的资源（increase resources for primary care）”。

28. [C] restructure the health system.
解析：细节推理题。第四段指出 Reform 智库发起了名为“Reimagining health”的项目，其目的是呼吁就健康未来进行公开对话，并要求对目前我们保留的以医院为中心的模式进行“紧急反思（an “urgent rethink” of the hospital-centric model）”。打破旧有的医院中心模式，本质上就是要求“重组医疗体系（restructure the health system）”，选 [C]。

29. [B] paying due attention to social factors.
解析：细节题。第五段讨论如何最大化国民健康，作者指出医疗保健仅占健康结果的20%，而“更重要的是我们生活、工作和社交的地方（Much more important are the places we live, work and socialise）”，也就是必须重视这些“健康的社会决定因素（social determinants of health）”。这就等同于选项 [B] 中的“给予社会因素应有的关注（paying due attention to social factors）”。

30. [C] play a bigger role in the health system.
解析：推理题。最后一段中，Reform 智库质问权力应当如何分配，并指出：“哪些职能应保留在中央，哪些应该交给地方领导人（what should be given to local leaders）？他们通常负责创造健康的服务，并且对当地民众的需求有更好的理解”。既然地方领导人更了解需求，作者的言下之意就是应当下放权力，让他们“在医疗体系中发挥更大的作用（play a bigger role in the health system）”，选 [C]。（注意：D选项是前提而不是推论出的建议，正是因为他们更了解，所以才要给他们更多权力发挥更大作用）。

核心长难句精解 (High-Light)

1. with 引导的独立主格结构作状语：
"Nearly 75 years on, with the UK facing very different health challenges, it is clear that the model is out of date."
【解析】`with + 宾语(the UK) + 宾补(facing...)` 构成了独立主格结构，作为全句的背景状语。主句使用了 `it` 作为形式主语，真正的真正主语是 `that` 引导的从句（即：这个模式已经过时，这件事是很清楚的）。

2. As 引导时间状语从句与双破折号插入语：
"As demand for healthcare continues to grow, pressures on the workforce—which is already near breaking point—will only become more acute."
【解析】`As` 在这里意为“随着”。主句的骨干是 `pressures... will only become more acute`。在主语 `workforce` 后面，使用了双破折号插入了一个由 `which` 引导的非限制性定语从句，补充说明当前的劳动力（医护人员）已经处于崩溃的边缘。

3. 倒装句与并列的地点状语：
"Much more important are the places we live, work and socialise—yet there is no clear cross-government strategy for improving these social determinants of health."
【解析】破折号前面是一个完全倒装句。正常的语序应该是 `The places (that) we live, work and socialise are much more important`。为了强调“更重要”，将表语 `Much more important` 提到了句首。`we live, work and socialise` 则是省略了关系副词 `where` 的定语从句，修饰 `the places`。