National Health Care System
Preferred language style: English (U.S.); The bureaucratic issues surrounding the development of a National Health Care System and needs to include description, an analysis and personal evaluation of the issue.
The National Health Service is a largest publicly funded health scheme in any part of the world. It was founded during the early portion of the 20th century, more than 60 years back, and it has grown and the quality of the services have slowly improved. The system has become more and more efficient and comprehensive. The basic justification for providing this service was to provide quality healthcare services to all people irrespective of their ability to pay for the service. This remains to be the justification for their service even today. Most of the services under the NHS are free of cost, except for a few dental services and outpatient prescription medications. More than 60 million people benefit from the NHS Service. Several services such as prenatal tests, open heart surgeries, emergency and critical care, etc, are covered under the NHS. The services of various portions of the United Kingdom including England, Scotland, Northern Ireland and Wales, are managed independently. There may be only a few minor differences in the services between these four regions (NHS, 2008).
Many people are considering having a larger unified system under the NHS. More than 1.5 million people are employed by the NHS, which includes 90, 000 doctors, 35, 000 GP’s, 400, 000 nurses and 16, 000 paramedics. It is one of the largest employers in the World. The NHS England itself, employs more than 1.3 million staff and caters to the needs of 50 million people. NHS Scotland employs 158, 000 people, whereas NHS Wales employs 70, 000 staff. A general practitioner would be seeing about 140 patients on an average every week. In the first year of its inception, the NHS received a funding of about 437 million pounds, which has grown to 90 billion today. Over the years, the rise in spending has been about 3 % every year. There may be a need to modernize several facilities, and as such there would also be a need to double their budget. More than 60 % of the budget is utilized to pay for the human resources and about 20 % is utilized to pay for the medications. 20 % is utilized to pay for the infrastructure and the equipment purchased. A huge portion of the budget is distributed in various areas depending on the local need of the population. The King’s fund, a public benefit fund, is mainly utilized to fund the NHS, and over the years it has been seen as an effective means of using the money obtained from taxation. In the year 2007/08, every man, woman or child would have roughly contributed about 1500 pounds to the NHS fund (NHS, 2008).
The NHS is overall managed by the Department of Health, with the health minister reporting directly regarding the functioning of this scheme to the prime minister. About 10 Strategic health authorities are managed by the NHS. In each area, a strategic health authority would be supervising the healthcare activities. The way the NHS is managed in England, and in Wales, Scotland or Northern Ireland may be slightly different. However, the NHS is finding it very difficult to maintain the efficiency of the services. It may be very difficult to monitor the status of the patient’s health. The organization is considering improving the health of the patients, and hence it may be difficult to determine how an increase in the spending would help improve the health of the patients further. One measure that has been utilized frequently is the increase in the life expectancy and the decrease in the infant mortality rates. These rates have been improving and it suggests the nature of the quality of the services provided under the NHS scheme. People, who utilize the services under the NHS, also report of high satisfaction levels. Some of the services that are available to the people under the NHS include:-
· Outpatient medical services
· Dental services
· Opticians services
· Hospitalization and critical care
· Diagnostic tests
· Social health services
· Mental health services
· Pharmacy services
The NHS has proved to be a social health system. There is a strong relationship between the users and these staff. The staff would be providing medical care to the users. Potential solutions would be developed. This type of relationship is present, rather than any international relationship in the NHS. Sylvia Diggory considered the NHS system to be an incredible structure that has not been present in any other part of the world (1998). This is basically due to the hierarchy and the bureaucracy issues which are existent in the NHS. Two strong devices that influence the functioning of the NHS include the executive/legislation and the clinical community. A central system influences the command of the NHS. This central system would be having several authorities under it in particular regions of the UK which provides healthcare facilities (Stanton, 2008).
The Bureaucratic hierarchy of the NHS can be compared to be an instrument which controls the entire bureaucratic apparatus. The NHS Bureaucracy system is said to be a ‘caring bureaucracy’ consisting of users and staff member. In 2007, Hewitt said that although the interests of the users were given importance, the interests of the staff members began to hold much more importance. Besides, the NHS had monopoly over the healthcare services provision in the UK. This meant any alternative system was not available for the users. Several competitive developments such as innovation, improvements in efficiency, ideas, etc, were disenabled in the system. Hence strong reforms are suggested in the NHS structure. Some of these suggested include:-
· Vertical segmentation of the department of health
· Appropriate policies
· Developing regulations
· Structural reorganization
· De-bureaucratization
· Depoliticisation
· Having greater amount of local responsibilities (handing over management and policy-making powers to the local authorities which control the NHS) (Stanton, 2008).
One of the studies was conducted by Sir John Tooke to examine the government system under which junior physicians were trained to work for the NHS. This was following the issue of the previous year, in which 30000 physicians were trained to fill up 20000 posts in the NHS. The review by Tooke demonstrated gross incompetencies and inconsistencies from the NHS officials and bureaucrats. This issue was in addition to the previous year’s understandings that the NHS was filled with bureaucratic burdens that seriously troubled the effectiveness of the organizations. The NHS work did not even have short-term planning from the officials and administrators of the NHS. The physicians training plan was also inappropriate and did not provide any solution to the problem existing at the frontline organizations. The UK especially is considering improving the healthcare organizations, and the bureaucratic burdens seem to seriously affect the functioning of the NHS (Letterhead Matters, 2008).
Several other bureaucratic burdens and issues existed in the NHS system. These include:-
Long waits for surgery, as physicians are doing services that can be performed by other healthcare professionals including nurses. The waiting period is especially high.
Rural patients who require specialized care often have to travel to the urban areas to get advanced treatment done. This is mainly because the spending of the NHS is focused on the cities
The services of the NHS are very good, but the administrative system is very poor, often affecting patient’s health issues
Diagnostic tests are unnecessary conducted which is using up the resources. Frequently, diagnostic tests are conducted multiple times.
Poor stress on preventive issues and wellness management (Yorkshire Post, 2008).
In recent years, there has been an effort in order to reduce the bureaucratic burdens on the NHS. This has been an effort also initiated by the Department of Health (DH). They are constantly working with several other government departments including the Cabinet Office to help reduce the red tape issues in the NHS services. Clinicians and managers of the NHS are also affected by this red tape issues. The DH is trying its best to help clinicians to treat patients better and managers to effectively manage the show. Bureaucracy is affected the NHS services to the people, especially the quality and the effectiveness. The Prime Minister of Great Britain has also headed the campaign of reducing the bureaucratic burden on the NHS, and also across the other public services by the government. Several reports have been conducted across the UK to determine the bureaucratic issues that are existing in the public health system. Two reports have found that the bureaucratic burden is rather heavy and also suggested strong measures to free the general practitioners. The Front line staff has besides laid down more than 100 modifications that are required to help restore the quality of services. For instance, the GP’s earlier had to sign passports and driving licenses for leaves even less than 6 days. Today this measure has been removed, and it has a drastic improvement in the quality of healthcare (NATPACT, 2008).
With the changes in the bureaucracy, nurses are given an even greater role in comparison to yester years. Now nurses can share the burden of patient care with the physician, by actually administering certain drugs in the NHS. This has ensured that physicians are free and can attend to more complex cases including surgeries. In the past, the NHS had awfully long waiting periods for surgery, and several patients were left in a lurch. Several organizations which provide care in the NHS, has utilized the changes in the bureaucracy to help improve the clinical-decision-making system, and provision of care under a healthcare team (consisting of physicians, nurses, surgeons, etc) (NATPACT, 2008).
In the past the bureaucratic system under the NHS was such that data was collected repeated times, often wasting the resources available. The new system has ensured that data collection for the DH is overall reduced by 20 % as on March 2005. A more coordinated system is required so that information gathered from one source can be shared profitably by other parties. The DH has also planned to pass on more of the funds devoted to the NHS to the frontline healthcare organizations that would be directly involved in providing services to the patient. The planning system under the old bureaucratic system was extremely rigid and top-down. However, with the new proposed system, the planning would be bottom-up. Besides, the manner in which the budgets would be spend at the healthcare organization, would be decided by the healthcare organization itself and not by the bureaucrats. All limitations on resource allocation and management processes would be lifted. This would ensure that the organization would be getting what it needs depending on the patient requirements. The NHS is also developing several foundation trusts that would provide patient care and would also develop techniques for better self-management. These organizations could be the model for other NHS organizations (NATPACT, 2008).
In the past, the NHS was known to receive surplus number of guidance, circulars and directives from the DH and other authorities. However, with the proposed changes to the NHS, the number of circulars given to the NHS has dropped from 245 in 1999 to 12 in 2003. This would ensure that the patient workflow would not be affected (NATPACT, 2008).
The DH is also proposing several other changes in the basic functioning of the NHS. One of the measures that have been proposed includes visiting the frontline healthcare and interacting with them of how the bureaucratic burdens can be solved. They are also hosting seminars in close coordination with the NHS association to help understand the hassles faced by the NHS Staff members due to the unnecessary and excessive bureaucratic burdens. The NHS staff members are also free to write to the DH and the higher authorities regarding these issues. However, the frontline staff is also made to understand local issues and develop mechanisms to solve them. For instance, local economies can be identified and local solutions can be provided, rather than depending on red tape formalities. The strategic health authorities are given the power and the resources in order to challenge any bureaucratic policy that may be existing in the NHS and would be causing unnecessary hassle to the patient care. Managers and supervisors at various levels in the NHS should be open to listen to the bureaucratic burdens the frontend staff are having. Once their problems are understood, solutions can be developed. The senior managers and the supervisors are also warned of not having any bureaucratic policy within the organization that unnecessary obstructs patient care. The frontend organizations are also warned of keeping unnecessary and excessive records. This would not only mean unnecessary wastage of resources, but also exhaustion of the clinicians time (NATPACT, 2008).
References:
Letter Head Matters (2008). The NHS – A Tale of Bureaucratic Incompetence, Retrieved on September 19, 2008, from Letter Head Matters Web site: http://leatherheadblog.com/2008/01/09/the-nhs-a-tale-of-bureaucratic-incompetence/
NATPACT (2008). Reducing bureaucratic burdens – what PEC members can do. Retrieved on September 19, 2008, from NATPACT Web site: http://www.natpact.nhs.uk/uploads/PEC6ReducingBureaucraticBurdens.pdf
NHS (2008). About NHS services, Retrieved on September 19, 2008, from NHS Web site: http://www.nhs.uk/AboutNHSservices/Pages/About.aspx
NHS (2008). About NHS services, Retrieved on September 19, 2008, from NHS Web site: http://www.nhs.uk/aboutnhs/Pages/About.aspx
Stanton, P. (2008). The NHS Paradox, Retrieved on September 19, 2008, from Social Health Web site: http://www.sochealth.co.uk/confs/stanton.pdf
Yorkshire Post (November 20, 2007). NHS case studies: Bureaucrats blamed for problems, Retrieved on September 19, 2008, from Yorkshire Web site: http://www.yorkshirepost.co.uk/6547/NHS-case-studies-Bureaucrats-blamed.3503213.jp