National Health Service
National health service is one of the cost effective institution. It is used to come up with health outcome that can be comparable to health services like those of other countries. National Health Service is funded publically. It provides health care to all residents of United Kingdom and most of the services are free to patients but there are other extra charges which are associated with other special tests such as dental, eye check, prescriptions and personal aspect care.
Most of National Health Service provides health care in many countries. Some of health care provided include: Primary care, Opthalmology, dentistry, in and out Patient care and also long term health care[1]. National Health Service gets its funds from the general taxation and the government of United Kingdom has established a department of health which deals with all issues related to health. The department is headed by secretary who is the head of state for health. Most of the expenditure from their department is used to fund National Health Service. The world’s largest health service is National Health Service.
For the last 30 years, there have been quite a number of initiative for change in National Health Service which are quite different for different governments[2]. The core principles of National Health Service is that it is dedicated to meet everyone’s health needs and they usually provide it free at a needy patient’s needs but not on their capability to pay for the service that are offered. National Health Service does not exclude people from giving them the required services bared on their status or the way they can afford the services which are rendered to them[3]. There main aims include the following:
To provide services which are universal to everyone in regard to one’s clinical needs.
They give a range of comprehensive services to all those who are in need of them.
They work with patients, families and carers so that they can shape their services based on their needs and preference.
They respond to different population’s needs.
They ensure that their work is perfect so that they can reduce error and also increase quality of services that they offer to the patients.
They also support the value of their staffs.
They ensure that public funds are utilized for the value of health needs of citizen.
They also ensure confidentiality of patient is maintained all the time and they provide them with access to services, treatment and other health aspects.
They work with other organizations so that they can ensure that patients get their best.
Reform of health services is quite an emotive issue. In past years, National Health Service was spared much of reform which ended up affecting other public sectors since conservative government which was in power by then had fear that adverse reaction will occur which can result to electro damages. Some changes were introduced which dealt with these aspects such as private financial initiative (PFI) which were meant private sector companies to deliver hospitals[4]. Within this time, GP fundholding was also introduced together with mechanism which was meant for passing part of budget in National Health Service to the lower level this was dine so that competitive market can be established which could boost health provision which will cater for a range of providers[5].
This time when the conservative government initiated these change, the labour party was greatly opposed to GP fundholding and they were arguing against the market reform. From 1997, labour party has tried to push through some changes to National Health Service such as introduction for proposal which was based on practice commissioning which was alike with conservatives original ideas. Labour administration did not drop down the Private financial Initiative but rather it has continued to use it and getting involved with other private partnerships despite the fact that there was resistance from some of the trade unions and also from other bodies such as medical professional bodies.
There have been a number of complains which are based on the pace at which the reform is taking for the last few years. There are some large scale reforms which have been initiated primary care trust (PCT). Since there is a lot of money needed to finance the reform, financial difficulties have outstipped the pace of reform PCTs have undergone all the processes of and they have finished reorganizing them which have been matched with strategic changes at the level of health, authority. This will help to enhance efficiency and also to improve services that are offered by National Health Service[6]. Commissioning which is based on practice can be used to assist in targeting services that are provided which are based on local requirements and thee is less emphasis on specification which is driven.
Recently pace of reform has been quite rapid and therefore, some of the bodies of National Health Service will need to be assisted so that they can be able to respond and to cope effectively with the reform in regard to delivery of services in National Health Service. This is evidenced by the PTCs which have been in existence for quite a short time have been able to hold large responsibilities such as managing National Health Service budget. Management skills need to be supported which should lay its emphasis on financial and planning service and therefore management should ensure that there are well linked.
Private financial initiative is a reform which was established to deal with financial issues of National Health Service it has increased the total cost of hospital building investments which have been made under PFI are higher than those of procurement of public sector. The charges that they charge annually for faculty use is 9.1% and 18% calculated based on initial construction cost[7].
Health initiative change in National Health Service. This help in reducing waiting list, waiting list has grown drastically due to a lot of demand in health services on hospitals and pressure which is mounted to make efficiency savings. Conservative government introduced charter mark and this helps hospital to be within waiting lists limit. The labour party has promised to reduce waiting list below the level that conservative government had promised to reduce it. This lead to rapid growth of budget which has enabled the hospital to develop it.
Money was also concentrated on waiting list in effort to evaluate budgets. This has been viewed as part of the emergency crisis[8]. Most of hospital branches are emphasizing on allocation of more money in hospital which will enable to reduce waiting list and when their importance are stressed, other areas have been affected such as emergency beds. Many hospitals have gained big budget deficit within the last few years. This resulted to cut back and other areas were consequently
more affected due to lack of fund to finance those areas.
Aspect which are meant to achieve various changes are familiar to most people who utilizes services of National Health Service. Legislative framework which can lead to equality and diversity of health services within National Health Service.
There has been a major change in clinical work and their implications have not been known yet. Introduction of information technology has enhanced these changes by use of electronic patient record instead of using the general cards. This was implemented in National Health Service in 2005 to all its branches. Electronic document is meant to be shared between patient, hospital general practice and other services which require to view patients data[9]. In this care, records will still be under the direct control of the National Health Service and patient can have access of them by reading on the screen only.
For example, a person who is staying in a nursing home his data can be shared with those carers who looks after him but this has been viewed as a problem by the government since there will be a problem of shared multidisciplinary health which can interfere with the social statures of an individual. Since nursing home is a private sector, there is great need to be linked with National Health Service and other private sectors. This can reduce the effects of scandals which mainly occur due to use of shared health information with the relevant data. Therefore, establishment of these electronic data will reduce the effect of scandal. Plans have not been put in place to established strategies of sharing data with other social services, private sector and other organizations which need to be linked with National Health Service.
In appropriate use of professional data should be guarded especially when electronic data transmission is used and it should be enhanced that information is shared only to relevant individuals those who are close to patient patient and have a direct interest on the patient[10]. Successful implementation of this electrical record depends greatly on major changes which will take place in field of clinical practices. When data is being shared, there must be total trust between clinicians and other individuals who are liable to handling patients data. Clinicians should take a lot of caution when they are using other clinicians data and they should not rely on data generated by others entirely.
Electronic records can portray clear and coherent health information. This can reduce manpower and increase the effectivity of health records and also reliability is enhanced since the records can be accessed at all time when they are needed.
Fundamental reforms in National Health Service were meant to free DHAs from their funding responsibilities and those of managing hospital services and other units which were located within different areas of the creation of new role. This was meant for purchasing and caring of local population in regard to their health needs[11]. Districts were given authority to look for field for provision of services. The main interest of the government in initiating reform was to increase compensation in National Health Service. This could be enhanced by encouraging large GP xxx so that they could become fundholders which could hold responsibilities in commissioning.
Standards for better health were established in 2004 which had an outline of plans which were meant to improve the living standards of patient and also those of health care workers. There plans to continue modernizing National Health Service were to be enhanced up to 2008. There plans were 24 core standards which were basically established so that they can describe the level of services which need to be acceptable by all and this should be the same for all patient who accesing the National Health Service so that equality can be achieved for all despite of their social political or financial background. Services should be allowed to all at all ages which elusive that total care is taken for all people with different ages.
Patient led National Health Service was introduced by the labour government which will be self improving and its meant to be sustained for quite a long time this was only meant to be applicable if the reforms were initiated[12]. They tried to step up the pace of reform so that the services can be improved and overall satisfaction of patient can be achieved.
National Health Service is undergoing fundamental reform and great dynamic transformation and those changes are meant to improve the efficiency and effectiveness of services of National Health Service.
Back in 1930s, the two government i.e concentrative government and the labour government had different ideologies in regard to changes that needed to be implemented in National Health Service[13]. Each government had conflicting ideas since they did not value the effectiveness of health services the same and this resulted to their difference in the way they presented their ideas in regard to the National Health Service.
Concentrative government ensured that National Health Service was free to all the citizens of United Kingdom and the services were offered to everyone equally without valuing the financial status or health status of an individual. The scrapped the use of patient passports which enabled transfer of patient from public to a private hospital. The same way the labour party ensured that there was availability of public money which in their ideologies stated that it could be used for public spending and this could enable the National Health Service to have it share of public spending. This could help them to have cheap and efficient services which could hence be used by all people. Therefore, the two government ideologies were quite similar since they took interest of both the rich and the common man who could not afford expensive medical services.
The labour party ensured that it was not under direct control of health strategies of National Health Service since it stated that the funds which were available were only for public spending and therefore, they did not want to be engaged in any strategies of National Health Service. The concentrative government on the other hand, had great plans of initiating changes in National Health Service so that their services can be efficient and affordable by all people[14]. They wanted to make services available to patient and to have all activities as patient centered whereby all the interest of the patient was focused by the workers without minding of their economic background. This conservative government had plans in place of ensuring that they upgrade National Health Service beyond recognition since it wanted to transform all the services of National Health Service into system that are based on insurance so that all the patient could possibly benefit from the services equally and this could be at a cheaper rate since patients could receive Compensation form insurance policies which are made available to them[15].
In labour party ideologies they did not strengthen the need to boost public services since it was evident in National Health Service when they wanted to save it by implementing different changes that could make the services more efficient but they did not come up with a measure of implementing these change which made them not to make any progress.
Concentrative government was very mush involved in ensuring that reforms were made in National Health Service so that the need of all can be met efficiently. In 1980, the concentrative government increased its pace of implementing these changes whereby they culminated on the major fundamental reforms of National Health Service. It ensured that reforms were put in place which ensured that health services were offered to everyone who was in need. These fundamental reforms were strengthened by enhancement of social care and community act which ensured that all the needs of the community were met socially[16]. This act was passed and implementations put in place to ensure that all the National Health Service branches followed the requirements of the act as passed by the conservative government.
The cost which were contained by the concentrative government in implementing these changes under pinned charges since alot of cost were inccured in facilitating service to the public but in retuarn little charges were charged for the services rendered.
Thatcher being the head of leader of concentrative government in early 80s was involved in heresthetic maneuver which was in regard to depicted waitlist which had resulted from in efficiency in National Health Service. There was also lack of resources which trigger inefficiencies which were evidenced with lack of money, hospital, nurses and physicians[17]. She maneuvered waitlist which enhanced efficiency since she triggered cascade which led to introduction of unavailable features such as introduction of internal market in National Health Service. Advent of waitlist had no direct challenges on believes which were strongly held, which required National Health Service to remain entirely part of public utility.
Thatcher did not allow total privatization of National Health Service
Plans for labour government did not reduce uncertainty which were revolving around the hospital services provision since it did not have clear prescription of what was wrong or right in regard to National Health Service since they have been disconnected from factors such as financial, physical, clinical and demographic factors which cannot facilitate reform to take place.
Gordon Brown wanted to quicken health reform pace. In doing this, he disclosed a reform which was meant to shape health programmes[18]. He wanted to put plan in place which was meant for network of around 150 polyclinics which were allocated across the capital and provided a range of services which were meant to meet all routine needs of the health care. This jplan by the labour party portrayed their ideologies in trying to meet the health needs of everyone equality.
According to Blairs ideas in regard to reform the network of poly clinics will be equipped accordingly with machines such as X-ray and ultrasound madness which can enable consultants to move out of their department so that they can run other outpatient clinics which can facilitate enhancement of health services to people even while they are at their home[19]. This was supposed to be enhanced so that health services could be made available to those who are seriously sick at home and cannot go to hospital, the old and others who require.
When the labour government came into office in 1997, they continued with National Health Service reforms which were meant to develop health policies which were mostly to be based on primary health care services. The labour government established a ten year plan which was meant to initiate changes in National Health Service. They had to set their strategies of fund holding which was meant to abolish with GP practices and also primary care practices were started by the labour government. There was other activities of labour party at this time which involved establishment and abolishment of some of the strategies which were in place at that time[20]. Authorities such as regional health authorities and strategies health authorities were abolished.
Government ensured that their was shifting of balance powers which was meant to establish a clear way of making greater decision and they also had some powers to patient. They also wanted to have the staff underpinned which was under changes in various roles of organizational and relationships. Government ensured that patients are empowered and services to users are increased which meant that personalized health care was increased and this increased decision making devolution to various local organizations.
Therefore, it is noted that the two governments i.e conservative and the labour government had different ideologies, which ensured that necessary changes need to be put in place in National Health Service so that efficiency and effectiveness of the National Health Service can be facilitated to all without regarding some of the aspect such as social, financial aspect or the age of the individual. This shows concern of government in trying to deliver efficient and effective health services to its citizens and changes will ensure that no discrimination of individual who require to have an access to health care facilities.
Initiative changes which have taken place in United Kingdom National Health Service for the last 30 years have had a lot of effect to both the government and its economy[21]. First, a lot of finance has been utilized by the government to initiate these changes since every project which was started up had to be funded by the government so that prompt changes can be enhanced, some of the initiative changes were quite expensive to implement and they required modern instruments such as computers and electronic devices which were quite expensive to purchase which resulted to huge utilization of money[22]. The government was ready to spend big percentage of money to implement changes to National Health Service but some of them proved to be quite expensive to be implemented and therefore plans are still underway so that these changes can be initiated to improve the health standards of National Health Service and to facilitate better, improved and modernized services to citizens of United Kingdom.
Changes which were implemented to National Health Service also increased the efficiency of services which were offered since the services were improved and made available to all those who needed them without regarding their status or background. Some of the changes such as PFI ensured that hospital funds were used in the right way and that services were rendered to individuals without considering their economic status. Afterward GP fundholding was also introduced that availed money for use in different sectors of National Health Service which ensured that budget was equally distributed to all hospital department equally[23]. GP fundholding was introduced which enabled that competitive market was introduced which in return could boost the health provision.
Other reforms such as use of electronic card system also enabled efficient and faster way of retrieving health information of the patient which in return could boost efficiency and effectiveness of National Health Service to patients. This change also enabled faster way of sharing health data to those who are concerned such as patient, clinicians and other carers who require to evaluate the data to know the health standards of an individual[24]. Therefore there effectiveness ensured that faster and efficient services were delivered which resulted to saving so many live which could hence be lost due to delayed services or mistake made by clinicians since the records were not available to everyone at all time due to improved efficiency of services at all time.
Initiative changes ensured that there is togetherness in working i.e. integrated working methods were initiated which ensured that activities within the National Health Service were divided in the right way among staff in different department. Use of electric records also enhanced these integrated services since there was togetherness in working due to the fact that information was shared equally among those who required to access it. These modifications ensured that better services were offered to individuals in hospital since, they utilized the modified services to increase effectiveness and efficiency of services. A number of services were also integrated in hospitals which were not there xxx due to availability of money to enhance these changes. These activities enabled togetherness in working place was enhanced.
Stakeholders expectation and environment was changed as a result of these initiative changes. This is due to change of most of operations and managerial activities of the National Health Service. The patient resulted to the use of advanced services which they were not aware of and these services were offered at a cheaper rate which they did not expect to be so. These changes were quite beneficial to all those who were directly or indirectly involved in activities of National Health Service since they changed the working environment for the good of shareholders[25]. National Health Service being the fourth worlds employing body also offered job opportunities to people from different racial and ethnic background due to the changes that it implemented which changed the working environment and created more employment opportunities.
The services which were offered were modernized due to the use of modern appliances such as computers and other electronic devices to carry out a number of services in hospital[26]. Modernized services enabled that all demands of the patient and employee were met so that the resulting services which were rendered to the patient were effective and maintained high level of services which boosted the health status of United Kingdom.
These changes were quite vital in National Health Service since they enhanced basically on economic, social and political pressure which resulted to changes of the organization socially whereby the social status of shareholders was enhanced through social diversity and working together[27]. The economic status also played a role in these changes since they affected the economic status of the whole country since a lot of funds were utilized in initiating these changes. Politically, the government was involved which resulted to conservative and labour government giving different ideologies in regard to their implementation of National Health Services[28].
National Health Service reform can result to increased uncertainty since its quite difficult to predict how the money is supposed to circulate around various systems of National Health Service. It became quite impossible for finance manager to plan ahead since in health care they cannot be able to predict how to do it since they cannot predict the choice of the patient and also there are no standard set for health care treatment, payment since public health care should not be based on one’s ability to pay but it should be on free and affordable basis to everyone and also they cannot be able to estimate the expenses of PFI and its relevance impact on finances of hospital.
As a result of various reforms, acute hospital resulted to being self governing trust which was a way of freeing them from the management structure of National Health Service this was not enhanced since some of the reforms which were based on this ideologies failed to work out.
Changes that have taken place in National Health Service within the last 30 years have presented a chain of synergistic events which are seen as foundation of set of further reform which introduction is currently underway[29]. Changes of National Health Service have taken Place both structurally, management organization and in contribution of various health provisions. Management and work of National Health Service revolves around entirely on the way changes have been initiated within the National Health Service. According to the trend of changes, it is anticipates that there will be emergence of consolidation period when all these changes and reforms which are underway will be implemented. Managers need to be aware of National Health Service structures and the impact that changes have on these structures so that they can have influence on strategic decision making[30].
The following is a summary of major reforms that have taken place for the last thirty years in National Health Service.
In 1999 the consultant contract was initiated which ensured that the interest of patient were put first.
While in 1982 the health authorities were abolished and new districts were restructured there was also establishment of United Kingdom central council of nursing and 1983 auxiliary services were tendered and the following year there was appointment of general managers in all National Health Service[31].
In 1985 and 1986 a number of reforms took place whereby a project was initiated which transformed 200 nursing education and there was establishment of management board of National Health Service. In 1987 authority services were disabled and there was establishment of special health authority. Department of health and that of social security split in 1988.
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[1] Spurgeon, P. Regulation for the NHS Managing the Internal Market, London: Paul Chapman; 2003 .pp.44-57.
[2] Wolfram C, Mann R., Samson D. competition and collaboration”, Journal of Management Studies, Vol. 34(2). 1997. pp.285-314.
[3] Learhard A. Provision of Health Care: Past: 21st century. 2nd Ed. Aldershort: Stanley Thornes; 2000.
[4] Spurgeon, P. Regulation for the NHS Managing the Internal Market, London: Paul Chapman; 2003
[5]
NHS Magazine. 18 January 2008.[cited on 9 May 2008] Available from www.nhs.uk/nhsmagazine
[6] Learhard A. Provision of Health Care: Past: 21st century. 2nd Ed. Aldershort: Stanley Thornes; 2000.
[7] Medneg . 3 January 2008. [cited on 9 May 2008]. Available from www.medneg.com
[8] ACHC. 10 December 2007. [cited on 9 May 2008] Available from www.achcew.org.uk
[9] Webster, C., NHS: Political History, 2nd ed. Oxford: Oxford University; 2004.
[10] Flynn R. & Garth W. Contracting for Health: NHS. Oxford: Oxford University ;1997.
[11] BMJ. 18 February 2008. [cited on 9 May 2008]. Available from http://bmj.com/
[12] Pierre, H., Peters G. Governance, Politics and the State. Basingstoke: Macmillan, 2000.
[13] Hood, C. ” new public management “, journal of Public Administration, Vol. 69 pp.3-19.
[14] Montgomery J. Health Care Law. Oxford: Oxford University; 2003.
[15] Webster C. NHS: A Political History. Oxford: Oxford University; 2002.
[16] National Plan. 27 June 2006. [cited on 9 May 2008]. Available from www.nhs.uk
[17] DoH. 10 February 2002, [cited on 10 may 2008], available from
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[18] NCCA,. 15 March 2008,. [cited on 9 May 2008]. Available from www.ncca.org.uk/members/
[19] Fowler, A., Campbell, D. ”management in clinical pharmacy”, Journal of Operations Management, Vol. 21(3), 2001 pp.327-500
[20] Smith, M. Britain Core Executive, London: Macmillan;1999.
[21] Peters, T. Handbook for a Management , London: Pan Books; 1989.
[22] Paton, C. New labour’s health policy, Cambridge: Policy Press; 1999 pp.51-75.
[23] Webster, C., NHS: Political History, Oxford: Oxford University; 1998.
[24] Le Grand, J. Evaluating the NHS reforms. London: Kings Fund Institute. 1993. pp.243-60.
[25] Walby, H., Greenwell, P. Managing the NHS, London: Sage; 1994 pp.57-72.
[26]
Pollitt, U., Bouckaert, C. Public Sector Reform. Oxford: Oxford University; 2000.
[27] McKee, V., Healy, G. Hospitals in a Changing Europe. Buckingham: Open University Press. 2002.
[28] Newman, K. Modernizing Governance: New Labour Policy ,London: Sage. 2003.
[29]
Kennedy I. & Grubb A. Medical Law. London: Butterworths; 2000.
[30] Department of Health, 8 May 2008. [cited on 9 May 2008]. available from www.doh.gov.uk.
[31] King’s Fund. 13 April 2003 [Cited on 10 May 2008] available from www.kingsfund.org.uk/pdf/FoundationTrusts.