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The development of the National Health Service (NHS)

Discuss about the Introduction to National Health Service.

Healthcare services are vital in every nation. The development of NHS with the aim to improve the health care outcomes has enhanced the quality of care services for the patient largely. It radically changed the dissemination of the information related to the patient’s health care (Waterson 2014).

The paper is an information booklet, which concerns the National Health Service (NHS) guide and intends to provide insight into its history and status. The paper provides the details of NHS objectives and explains its role and structure. It describes the structure and role of the Department of Work and Pension (DWP) and highlights the structure and role within the hospital as well as the responsibilities of the key hospital personnel. The structure and role within a general practice will be discussed and describe the role played by the three personnel within general practise. Further, the author will discuss the aim and vision of the NHS and information on the current issues related to the NHS.

NHS was launched in the year 1948 and is currently known to be the world’s largest health service that is publicly funded (Reynolds and McKee 2012). It was born to make healthcare services “free for everyone” depending upon the citizenship. This service came into effect after the release of “The Beveridge report” in the year 1942 named as “Social Insurance and Allied services”. It was during the period of World War II, that William Beveridge composed this report. The aim of the report was to end the Five Giants these are Disease, Want, Ignorance, Idleness and squalor (Waterson 2014).

The development of NHS is evident in increase of its budget 10 times more than what it was in 1948 (£ 437 million). In today’s value it can be say £9 billion. NHS received 10 fold higher amount than this in the year 2008-2009 (Ocloo and Fulop 2012).

The biggest part of the NHS is in England, which serves around population of 51 million and has employed more than 1.3 million people. NHS is financed by central taxation system by which government receives tax revenues to purchase health services for the population. However, these services are separately managed in Wales, Scotland and England (England, N.H.S. and Care Quality Commission, 2014).

Originally the structure of the NHS was called as the “Tripartie System” which contains the three parts, which are- primary care, hospital services, and community services (Choices, N.H.S. 2013). These services are provided by the “same doctors and the same hospitals”. NHS has a hierarchical system. Major structural changes occurred after the “Health and Social Care Act”, 2013.

Structure and role of NHS

: new structure of NHS

Figure: new structure of NHS

(Source: Hjortdahl et al. 2014)

The “Secretary of State for Health” takes entire responsibility of the department of health. The later provides strategic leadership in England for NHS, public health and Social care. NHS England plays a role by setting priorities and goals for NHS. It is the commissioner for the services of GPs, dentists, pharmacists and manages the overall budget. On the other hand the “Clinical Commissioning Groups” plans and commissions the health care services for the local area. The secondary care services include rehabilitive care and emergency care. The health and well being boards works to strengthen relationship between social care and health. The public health England supports local public health based on evidence (Hjortdahl et al. 2014).

DWP is a welfare system that effectively assists and guides people to gain financial independence by employment. DWP is known to be responsible for pensions, welfare, and child maintenance policy. This system is fair and affordable and it improves and increases the “life chances of children”. It is the UK’s biggest department related to public service. It administers the “State Pension” as well as disability and ill health benefits to over 20 million customers (Hughes and Stewart 2013). Ten agencies and other public bodies anchor this ministerial department.

This department consists of the two executive agencies, which are: “The Pension Service and the Disability and Carers Service”. The public bodies of the department are as follow:

  • The Pensions Regulator
  • The Health and Safety Executive
  • The Pensions Ombudsman (Nakatudde et al. 2014)

The Pension Service and the Disability and Carers Service along with the job centres operate under the network of “contact centres, benefit processing centres and 1,000 Jobcentres, across the UK” (Hughes and Stewart 2013).

The “secretary of state” for work and pensions undertakes responsibility related to “benefit entitlement” in delegation with decision makers. The Ministry of justice runs the appeal system with help of tribunal services. The “HM revenue and Customs” makes decision related to child benefit, tax credits and guardian’s allowance. The decision makers make decision related to social fund (Nakatudde et al. 2014).

 According to Hughes and Stewart (2013), DWP deals with poverty issues. It encourages people with disability to work and be independent. It provides the people of “pension age” with decent income and promotes their retirement savings. Its role is to reduce error and fraud by giving value for money. Its role is to reduce work place injuries and death via “Health and safety executive”. The pension services is dedicated towards “current and future pensioners” and it administers the winter fuel payments, pension credit, (Waterson 2014).

Structure and role of DWP in relation to health and social care

The Disability and Carers service offers benefits such as:

  • Attendance Allowance
  • Carer’s Allowance
  • Vaccine Damage Payment
  • Disability Living Allowance
  • Personal Independence Payment (Hughes and Stewart 2013)

DWP requires the Healthcare Professionals to provide clinical information in case it is difficult to make a decision regarding the award of benefit. DWP can obtain this information by sending “form BI205 (to GPs) or BI127A (to hospitals)”.

The “Secretary of State for Health” takes entire responsibility of the department of health. The later provides strategic leadership in England for NHS, public health and Social care. NHS England plays a role by setting priorities and goals for NHS. It is the commissioner for the services of GPs, dentists, pharmacists and manages the overall budget. On the other hand the “Clinical Commissioning Groups” plans and commissions the health care services for the local area. The secondary care services include rehabilitive care and emergency care. The health and well being boards works to strengthen relationship between social care and health. The public health England supports local public health based on evidence (Hjortdahl et al. 2014).

The human resource staffs handle the employment issues of medical and non-medical staff. They can recruit or fire employees and make new laws. The hospital managers perform activities such as data centered activities, bringing improvement in culture, promoting quality care, developing measures for quality improvement and mandate policy systems. General practitioners treat common medical conditions. They refer patients to clinics and medical services for emergency and special treatment. They focus on patient’s health considering the social, physical, and psychological aspects of care. Nurses provide care to the patients by timely administration of medicines and emergency services in absence of the GP (Ocloo and Fulop 2012).

The changes focused to have the GP’s control on most of the budget of NHS. The government accepted the proposal and created the “clinical commissioning groups” which consists of General Practioners (GP), nurses and doctors (Canivet et al. 2013). If this proposal is accepted then the doctors will be able to purchase care from providers including the private companies and willing voluntary groups. According to Bellamy et al. (2014) the government believes that this plan would favour the NHS to overcome challenges such as a growing elderly population.

The NHS services were developed to meet the patient’s needs by effective delivery of the health care services. These services includes varying responsibilities including

  • assessment of population needs
  • To prioritise the health outcomes
  • Procurement of products and services
  • Service providers management (Higgins et al. 2014)

The role played by NHS includes addressing the local health issues by patient concordance and providing treatment as per the standards of NICE commissioning boards to meet the health targets (England, N.H.S. and Care Quality Commission, 2014). NHS provides patient centered care and engages patients in decision making. NHS is playing an effective role by providing the patients with additional options and giving them control over the services and information. NHS tries to be in the best interest of the client. Without the patient consent, the NHS does not make any decision.

The structure within the Hospital

General practitioners treat common medical conditions. They refer patients to clinics and medical services for emergency and special treatment. They focus on patient’s health considering the social, physical, and psychological aspects of care (de Bono 2014).

GPs are “primary care doctors” who firstly contact NHS for their community people. They help patients by identifying and addressing the early stage problems that may be cancer, infectious disease. They treat conditions such as hypertension, asthma, diabetes, and psychiatric illness. Intervention process includes prescribing medication, one-to-one sessions, protecting vulnerable children, carrying out audits to improve the health outcomes (Choices, N.H.S. 2013). Nurses provide care to the patients by timely administration of medicines and emergency services in absence of the GP (). The policy regulators regulate the existing policies and make new policies if required.

Lord Darzi has proposed the modernisation of the NHS services. The vision of NHS is provision of “quality of care rather than quantity of care”. It aims to provide patient centered care. The “NHS outcome framework” addresses the treatment effectiveness, patient safety and experience (Loveday et al. 2014).

NHS has currently predesigned its services to improve the health outcomes and expects to fit the patients in these services instead of adjusting the services according to the patients. Currently, it is planning to remodel the management layers and improve its clinical staff. In future, it will be accountable for every “evidence-based outcome measures” but not the process targets. The NHS commissioning board will be responsible to eliminate any inequalities in the health outcomes (Higgins et al., 2014).

NHS plans to establish “GP consortia” as well as “transfer of responsibilities from the Primary care trusts”. Therefore, providing GPs with more to prioritise the health issues and accordingly allocate the funds within the population. This ensures efficient utilisation of the taxpayer’s money. The new system of NHS requires the providers to manage the data related to healthcare with contractual obligations (Hjortdahl et al. 2014).

Currently, it aims to provide education and training for medical professionals to positively influence their work performance and enhance knowledge. According to (Ocloo and Fulop (2012) the “NHS pay and staffing” is subjected to the health employers. Presently, it also aims to make the system decentralised, which appears to be difficult as the ministers make the decisions related to staffing and affordability.

According to Sunderland et al. (2013) NHS has achieved poor health outcomes in the areas of respiratory difficulties, cancer, cardiovascular diseases. The NHS system of providing the incentives based on the number of patients registered has restricted the population in rural areas from GP surgeries due to insufficient money. In addition, the consideration of prices and payments are on the basis of high quality and efficient services. It is also dependent on the treatment of the local population. Hence, the population with healthy and rich life style may exhibit better outcomes with little intervention from GP whereas; the deprived communities with excess health issues may show poor health outcomes.

Role of key hospital personnel

As per the new system of “Equity and Excellence”, patients are allowed to choose a consultant according to their medical condition. It in turn makes difficult for the GP while deciding for any particular treatment process for the patient. Moreover, the chosen GP might charge higher than preferred by other GP thus, leading to the overspending of the budget. Additionally, if too many patients choose particular GP, it will increase the waiting time affecting the health care outcomes. There are agreement issues between Monitor system and GP once the patient decision is considered. The other disadvantage includes the long waiting time for “non-emergency services” such as dental services, ambulance services etc. as well as increased cost modernised treatment facilities and technology (Reynolds and McKee 2012).

The GPs are given the responsibility of co-ordinating patient care, which consumes extra time in negotiating with the other care providers for patient referrals. This financial negotiation hampers the primary responsibility of treating patients of care providers (Waterson 2014).

References

Banks, J., Blundell, R. and Emmerson, C., 2015. Disability benefit receipt and reform: reconciling trends in the United Kingdom. The Journal of Economic Perspectives, 29(2), pp.173-190.

Bellamy, J., Paleologos, Z., Kemp, B., Carter, S. and King, S., 2014. Caring into Old Age: The wellbeing and support needs of parent carers of people with disabilities. Anglicare Diocese of Sydney, Social Policy and Research Unit, Sydney.

Canivet, C., Choi, B., Karasek, R., Moghaddassi, M., Staland-Nyman, C. and Östergren, P.O., 2013. Can high psychological job demands, low decision latitude, and high job strain predict disability pensions? A 12-year follow-up of middle-aged Swedish workers. International archives of occupational and environmental health, 86(3), pp.307-319.

Choices, N.H.S., 2013. The NHS in England. NHS choices website. Available at: www. nhs. uk/NHSEngland/thenhs/about/Pages/overview. aspx (accessed on 20 May 2013).

de Bono, A.M., 2014. The implications of the Francis report for occupational health in the NHS. Occupational Medicine, 64(7), pp.478-480.

England, N.H.S. and Care Quality Commission, 2014. NHS five year forward view. London: NHS England, pp.16-16.

Higgins, A., Porter, S. and O'Halloran, P., 2014. General practitioners' management of the long-term sick role. Social Science & Medicine, 107, pp.52-60.

Hjortdahl, M., Zakariassen, E. and Wisborg, T., 2014. The role of general practitioners in the pre hospital setting, as experienced by emergency medicine technicians: a qualitative study. Scandinavian journal of trauma, resuscitation and emergency medicine, 22(1), p.1.

Hughes, G. and Stewart, J. eds., 2013. The role of the state in pension provision: employer, regulator, provider. Springer Science & Business Media.

Loveday, H.P., Wilson, J., Pratt, R.J., Golsorkhi, M., Tingle, A., Bak, A., Browne, J., Prieto, J. and Wilcox, M., 2014. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection, 86, pp.S1-S70.

Nakatudde, R., Ige, T., Ibn Seddik, A. and El-Shahat, K., 2014. THE ROLE OF HEALTH MANAGERS IN PROMOTING MEDICAL PHYSICISTS IN AFRICA. MEDICAL PHYSICS INTERNATIONAL, 2(1), p.27.

Ocloo, J.E. and Fulop, N.J., 2012. Developing a ‘critical’approach to patient and public involvement in patient safety in the NHS: learning lessons from other parts of the public sector?. Health Expectations, 15(4), pp.424-432.

Pickard, L., King, D., Brimblecombe, N. and Knapp, M., 2015. The effectiveness of paid services in supporting unpaid carers’ employment in England. Journal of social policy, 44(03), pp.567-590.

Reynolds, L. and McKee, M., 2012. Opening the oyster: the 2010–11 NHS reforms in England. Clinical medicine, 12(2), pp.128-132.

Sunderland, M., Newby, J.M. and Andrews, G., 2013. Health anxiety in Australia: prevalence, comorbidity, disability and service use. The British Journal of Psychiatry, 202(1), pp.56-61.

Waterson, P., 2014. Health information technology and sociotechnical systems: A progress report on recent developments within the UK National Health Service (NHS). Applied Ergonomics, 45(2), pp.150-161.

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