The National Health Service (NHS)

The National Health Service (NHS)
The National Health Service (NHS)

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The National Health Service (NHS)

Introduction

 The National Health Service (NHS) is identified as one of the best healthcare system. This is attributable to the National Health Service April 2013 health reforms; which aimed at improving care delivery with fewer resources. These reforms have made improvements in a number of   areas in healthcare including funding of the system and patient satisfaction, making the NHS to be more efficient.

Patient choices have been extended to primary care, community care and in mental health services (NHS England, 2014). There has been increased transparency on patient outcomes and data. However, several studies have reported less positive information on National Health Service reforms. According to critics, the benefits and savings being reaped from the reforms is only short term, and that it is not sustainable. 

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The progress of the reforms are  somewhat disappointing  towards establishing a sustainable integrative healthcare services which impeded the establishment of greater use of A&E alternatives, high level completion or greater capacity for outpatient care (Tian, et al., 2012).

 For this reason, this article will explore how the NHS reforms introduced in April 2013 have brought changes in the healthcare services. The main reasons behind the introduction of these reforms will also be evaluated.  This will facilitate the understanding of development of healthcare systems in the UK, and the State’s roles in changing of the system (Murray et al., 2014).  

Additionally, the reasons for recent changes to National Health Service will be evaluated through the analysis of healthcare policies and political perspective in the contemporary health issues in the UK. This facilitates understanding of the various debates and concepts of health promotion, public health, and management of the health services.  This paper is planned as follows (Trust Development Authority, 2014);

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 Development of healthcare in the UK and Changing of the States roles

 The healthcare system in the UK was established after World War II, and began its operations on 5th July 1948. The National Health Service was proposed in the UK parliament in 1942 in the Beveridge report on Social Insurance (BSI) and other health services allied. The NHS is a bequest of Aneurin Bevan, a previous mineworker who turn out to be the then Minister of Health. NHS was established under the doctrines of impartiality, universality and easy access and delivery of services. The principles were facilitated by a central funding from the government (Alexander, 2013).

            In England, the health policy and healthcare is the accountability of the central government. In Scotland, Northern Ireland and Wales, the health care and health policy is the concern of the decentralized governments. In every of the United Kingdom nations, the National Health Service system has its unique structure as well as organization, but has a general organization structure.

Generally, the healthcare consists of two major categories, one section deals with strategy and policy management, whereas the other deals with actual clinical care and medical interventions, which is in turn subdivided into primary care ( General physicians, pharmacists, dentists etcetera), secondary care ( consists of  hospice-centred care) and  tertiary maintenance (expertise hospitals) (Woringer et al., 2015).

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 Recently, the distinction amid the two sections has become less clear. This is attributable to the fact that the last few years have been guided by shifting balance of authority. The other phase and Walness reports have described the gradual changes within the NHS that has resulted into shift towards the local or devolved rather than the centralised decision making process.

The emphasis has been on identification of barriers to effective delivery of the primary and secondary care.  This was reinforced by the previous government on 2008 in the strategy dubbed “NHS Next Stage Review: High Quality Care for all” (Cornock, 2016), and “Equity and excellence: Liberating the NHS” 2010 strategy that has remained focus of the current government (Cornock, 2016).

 The government has remained supportive of the initial National Health Service principles but possibly through different mechanisms. Recent past, the United Kingdom`s government announced plans to develop strategies that will produce most radical changes in the NHS. The white paper proposed on July 12th, 2010 “Equity and excellence: Liberating the NHS” aimed at outlining strategies that creates a patient centred and more responsive NHS (Trust Development Authority, 2014).

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Reasons for reforming NHS

The NHS reforms introduced in April 2013 aimed at bringing positive change to the services. Learning from the past mistakes in UK and elsewhere, it was just right time to bring about the fundamental shift to reform the National Health Service.  Previously, the UK politics and policy only established short-term political initiatives which were the main hindrances of long-term policy achievements and establishing a sustainable and transformational change.  The previous government’s structural reforms were large-scale which acted as major distractions rather than facilitators (NHS England, 2014).

The NHS reforms ensured that such distractions are avoided in the future. Previously, the National Health Service reforms relied on external stimuli such as performance management, targets, quality inspection and regulation, choice and competition.  These were too little to offer for improvement from within the health care. This called for a new settlement where the strategic role of a politician could be demarcated clearly. This helped minimize the frequent shift in directions which hindered transformational change (Trust Development Authority, 2014).

 Unlike in the past, April 2013 National Health Service reforms did not dwell on bold strokes or politician big gestures, but rather engaged the primary care, secondary care and tertiary care providers. It focused mainly on healthcare staff improvements. The complementary approaches used by these reforms pursued national leadership in combination with devolution, competition and innovative standardization (NHS England, 2014).

The April 2013 reforms focused on transparency, devolution and performance in a systematic manner. The reforms ensured that the improvement in the NH was based on commitment instead of compliance by investing in staff improvement to empower them to achieve sustainable quality improvement. The reforms envisioned a high performing healthcare organization, which indicated continuity in leadership, organization stability and clear goals for improvement in delivery of healthcare services (Woringer et al., 2015).

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Underlying concepts of funding in healthcare

             The overall organizational structure of NHS in the National Health Service fiscal support is obtained from taxation. Approximately, 60% of the funds are used for staff salary, whereas additional 20% is used for medical appliances such as drugs, buildings, training costs, and equipment. The principle founders of the NHS system were the NHS primary Care Trusts (PCTs).

They disburse funds to the commissioned healthcare providers such as the National Health Service trusts, General Providers and Private providers according to the agreed contract basis. In public healthcare medical cover, vast of the National Health Service services are free. This implies that UK citizens need not pay anything for doctor visits, nursing services and consumable charges such as medications and laboratory services (Iacobucci, 2015).

 The Department of Health have the responsibility for direction of National Health Service, public health and social care and the delivery of care. This includes developing policies and strategic interventions and ensures that they secure healthcare resources. Previously, there are about 10 strategic Health authorities manages NHS at local level, and the PCTs control approximately eighty percent of the NHS budget to provide the commission services and governance, and to ensure  resource availability  within the public health.

The NHS trusts operate on basis of paying by results (NHS England, 2014).  Examples of National Health Service trusts include the Mental Health, Acute care, Ambulance, Foundation Trust and Children’s Trust. The foundation Trusts was developed to increase financial obligations and are monitored by an independent body. These include the Care Quality Commission, National Audit Office, Audit commission, Medicines and Healthcare Products Regulatory Agency, British Medical association, and the National Institute for Health and Clinical Excellence (NICE) (Frisina Doetter & Götze, 2011).

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Evaluation of health policies as well as political thoughts in contemporary health issues

            The government has embarked on widespread reform programme which aims at introducing substantial changes in the National Health Service structure and management, and to improve the quality of care delivery.  For instance, a number of new changes in NHS was introduced by the April 1st NHS reforms in England. One of the main changes done by these reforms includes shifting of responsibilities that originally were in the Department of Health, to the politically independent entity- the National Health Service commissioning Board. 

The reforms will also establish a health specific economic monitor whose aim is to guard the healthcare delivery from ‘anti-competitive practices.  The reforms ensure that all NHS trusts are shifted to foundation trust status (Le Grand, 2013).

 The reforms are expected to fill some gaps in the UK healthcare system.  According to the April 2013 reforms, the government supports the idea of GP commissioning. This implies that the key decisions of patient’s treatment should be made by GP in partnership with the service user rather than the managerial organisations.

The Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs). Under the new reform, GPs are integrated in the consortium that controls commission’s services and budgets. However, the NHS commissioning Board is expected to reduce health inequalities so as to access healthcare (Edkins, Cairns & Hultman, 2014).

 The government white paper calls for a healthcare system that moves away from the centrally-driven healthcare system to one which focuses on the patient outcomes and the quality of care delivered (Mead, 2013). This devolution of healthcare system implies the five main domains used to assess the effectiveness of the program success are realized.

These includes reduction of premature death, improving the life of people living with chronic diseases,  helping people recover from preventable injuries, ensure people easily access better care services equitably and  ensuring a safe environment and protecting people from harm (Mead, 2013).

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            The reform has been highly criticized warning that the move is creeping towards privatisation of commissioners. The opponents argue that the profit oriented firms could oust GPs from their role of   making decision on effective treatments due to the creeping privatisation of primary care.

According British Medical Association (BMA), the reforms would make the relationship between physician and patients will suffer irreparable damages, and the negative impacts will damage NHS irreversibly. According to the BMA, health and social care bill is incoherent, complex and unfit for its purpose. They argue that to sustain the implemented reforms will be difficult (Sussex, n.d.).

  The privatisation of commissioning will cause massive effects  on public  health, as it will is likely to exacerbate health inequalities  and loss of accountability.  Most of the areas affected by the reforms are about the issue of how money is spent and who makes the decisions. This is because new organizations are being established and others being abolished. The legal responsibility for management of NHS budget will be shifted to new organisations. Local councils are also given higher mandate in matters that influence health services.  The suggested performance reforms and finance performance is somewhat daunting (Milburn & Flowerday, 2012).

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 For instance, on autonomy, many people believe that the policy landscape is clear. This implies that the NHS Trusts autonomy would be progressively replaced by the independent foundation trusts. According to Cornock (2016), the rising new relationship between commissioners and providers will help bring primary and secondary care closely, which will help merge the transformation and sustainability plans to sustain effective delivery of services (Triggle, 2014).

However, this would imply deterioration of performance and finance as the central control of healthcare budget is extended to include other aspects of healthcare such as operational management and workforce (Murray et al., 2014). As the issue of finance recedes, NHS is expected to invent new approach to sustain the earned autonomy for NHS providers. This is a challenge because the foundation trust model may fail to ultimately protect the local organizations autonomy. Therefore, to reinvent autonomy, the NHS governance and structure will need to be restructured (Woringer et al., 2015).

Conclusion

 Despite the fact that the reforms were established to reduce health inequalities, the reforms issues are highly debateable. The government believed that the NHS reforms were the best approach to improve the public health. Clearly, many things as highlighted by BMA have been overlooked.  In this context, the NHS needs to make more honest assessment of what can be achieved and ensure that the strategic plans designed are comprehensive and realized.

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References

Alexander, J. (2013). The Tavistock and Portman NHS Trust short course Holding the Baby and Toddler Mind: An individual family and community perspective April 2013. Infant Observation, 16(2), 200-204. http://dx.doi.org/10.1080/13698036.2013.818362

Cornock, M. (2016). Removing rancour in examining mistakes would be new for the NHS. Nursing Standard, 30(30), 30-31. http://dx.doi.org/10.7748/ns.30.30.30.s38

Edkins, R., Cairns, B., & Hultman, C. (2014). A Systematic Review of Advance Practice Providers in Acute Care. Annals of Plastic Surgery, 1. http://dx.doi.org/10.1097/sap.0000000000000106

Frisina Doetter, L., & Gatze, R. (2011). Health Care Policy for Better or for Worse? Examining NHS Reforms during Times of Economic Crisis versus Relative Stability. Social Policy & Administration, 45(4), 488-505. http://dx.doi.org/10.1111/j.1467-9515.2011.00786.x

Iacobucci, G. (2015). Privatisation of cancer and end of life care services in Staffordshire could threaten NHS providers, warn critics. BMJ, 350(mar19 9), h1557-h1557. http://dx.doi.org/10.1136/bmj.h1557

Le Grand, J. (2013). Will 1 April mark the beginning of the end of England’s NHS? No. BMJ, 346(mar26 4), f1975-f1975. http://dx.doi.org/10.1136/bmj.f1975

Mead, J. (2013). Orthopaedics – Allegation of obsolete procedure dismissed: Ecclestone v Medway NHS Foundation Trust (High Court, 12 April 2013 – Judge Reddihough). Clinical Risk, 19(3), 83-84. http://dx.doi.org/10.1177/1356262213497684

Milburn, S., & Flowerday, A. (2012). Delivering scalable Telehealth: What is Scale? With case studies from NHS providers, a perspective on the challenges, constraints and issues associated with scalability. Int J Integr Care, 12(4). http://dx.doi.org/10.5334/ijic.931

Murray, R. et al., (2014). Financial failure in the NHS: What causes it and how best to manage it, The King’s Fund. Retrieved from http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/financial-failure-in-the-nhs-kingsfund-oct14.pdf

NHS England. (2014), Examining new options and opportunities for providers of NHS        care: the Dalton Review. NHS England (2014), Five. Retrieved from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/384126/Dalton_Review.pdf.

Sussex, J. (n.d.). How Fair? Competition between Independent and NHS Providers to Supply Non-Emergency Hospital Care to NHS Patients in England. SSRN Electronic Journal. http://dx.doi.org/10.2139/ssrn.2640148

Tian, Y. et al. (2012). “Data briefing: Emergency hospitals admissions for ambulatoryCare-sensitive conditions”, The King’s Fund. Retrieved from http://www.kingsfund.org.uk/publications/data-briefing-emergency-hospital-admissions-ambulatory-care-sensitive-conditions

Trust Development Authority. (2014). Annual report and accounts for the period 1 April 2013-31 March 2014. Retrieved from http://www.ntda.nhs.uk/wp-content/uploads/2014/07/NHS-TDA-Annual-Reports-and-Accounts-201314.pdf.

Triggle, N. (2014). Five-year plan to transform NHS focuses on teamwork. Nursing Management, 21(8), 10-11. http://dx.doi.org/10.7748/nm.21.8.10.s12

Woringer, M., Cecil, E., Watt, H., Chang, K., Hamid, F., & Khunti, K. (2015). Community Providers of the NHS Health Check CVD Prevention Programme Target Younger and More Deprived People. Int J Integr Care, 15(5). http://dx.doi.org/10.5334/ijic.2185

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