Structure and Management in the NHS
Introduction
The National Health Service entails the government-funded medical health care services provided to every citizen in the United Kingdom without paying the service’s full cost. These include visiting a doctor or a nurse, getting aid and treatment at a hospital when feeling unwell or injured, free maternity for women, and getting medical help from ambulances for emergencies. These services are state-funded and are collected through the United Kingdom’s residents paying taxes (Pharmafield, 2008). There are several NHS throughout the UK, as the government tries to decentralize the healthcare services to other parts such as the Scottish government, Welsh government, and North Irish Assembly (NHS across the UK, 2018). However, in Northern Ireland, the healthcare system is often known as Health Social Care Services (HSC).
The primary reason for the establishment of NHS was to bring inclusivity in the UK residents allowing them to shoulder the burden of paying healthcare services rather than allowing each person to pay for their medical care. Everyone regardless of gender, status or background were given equal opportunity were included (Pringle, 2018). However, as a government entity, NHS is caught up with bureaucracies leading to poor management and misappropriation of funds.
Lack of enough funds as a result of overspend by hospitals, mental health trust and ambulance services has led to the NHS being understaffed. In 2018, the NHS England announced over 100,000 vacancies a situation that was described as dangerously understaffed (Triggle, 2018). These vacancies include over 34,000 nurses and over 9,500 doctors. According to the NHS financial report, the services are nearing 930 million pounds (Trigger, 2018). This has led to the health care personnel who are available being overworked and underpaid while those working are on contract rather than occupying the permanent position.
Enoch Powell’s Plan
During the 1970/71 financial year, Enoch Powell’s A hospital plan for England and Wales was set to build hospitals. The primary purpose of the plan was establishing the size and types of hospitals needed along with GP and domiciliary services as well as initiating rebuilding of hospitals. The government acknowledged that the hospitals need new hospitals since there had been little hospitals built over the years. However, the cost for the programme was higher, but in the first three years, 95 significant schemes were completed with over 65 sustaining hospitals and over 80 hospitals remodelled (The Health Foundation, 1962).
The Cogwheel Report/Salmon Report
The decade of 1960s witnessed growth for the NHS as a more equitable distribution for primary care was achieved with GPs emerged as a concept health care team. The Salmon and Cogwheel report examined the role of healthcare professionals as nurses gained recognition as well as speciality grouping in medical staff. Other concerns were raised, leading to the establishment of hospitals for those with disabilities (Health in Wales | 1960’s, n.d.).
Griffith’s Report
This report was based on the effective use and management of workforce and resources. Several recommendations were made leading to the formation of general management in the NHS. Moreover, clinicians to be involved in decision making regarding prioritizing the use of resources. Furthermore, it led to the establishment of HSSB led by the Secretary of State for Health. SSB was responsible for making objectives, budgets and strategies for the NHS (National Health Foundation, 1983).
The establishment of Regional Health Authorities
The NHS Act of 1973 led to the formation of 14 Regional Health Authorities replacing the English Regional Boards. The RHA was responsible for making hospital strategies, building programs, staffing matters and allocating resources to various health authorities. However, the Health Authorities Act of 1995 replaced then with eight regional offices of the NHS executives. The establishment of regional authorities led to the decentralization of resources to local levels whereby local authorities were responsible for the needs of the patients (National Health Foundation, 1983).
Working for patients
Established in 1989, the white paper was primarily responsible for giving patients better healthcare and greater choice, generating greater satisfaction and rewarding the hard-working NHS personnel. It proposed seven key measures which include delegation of functions, allowing hospitals to apply for self-governing status as NHS hospital trust, and allowing money to follow patients across administrative boundaries. Also, Large GP practices were allowed to apply their budgets to procure services from the hospital (‘Working for patients’ white paper | Policy Navigator, 1989).
PFI (NHS)
The concept of Private Finance Initiative provides additional funds to the public projects by using private sources in paying upfront costs of design, building and maintaining NHS hospitals. This enables both parties to benefit as the private sector gains profit while the NHS a new hospital (Appleby, 2017).
The Five Year Forward Plan
The National Information Board was tasked to develop a road map showing the five-year plan for the NHS. It proposed the implementation of personalized health and care for 2020 which covers areas such as building and sustaining public trust, giving care professionals and carers access to all the data they need, making the quality of care transparent, supporting care professionals to make the best use of technological advancement and assuring best value for taxpayer’s money (National Information Board, 2015).
Demographic changes in the UK
The ageing population
Statistical evidence shows that the UK’s population is ageing. According to Office if National Statistics projections, there will be over 8.6 million people over 65 years in the next five decades. The improvement of life expectancy and decreased fertility has been cited as the critical element in the changing population with individuals having fewer children and having them in later years. The size and age structure of the UK population have a significant influence on healthcare service needs. This has been witnessed the NHS’s resources allocations based on age-weighted capitation. The increased demand for hospitalization is often age-associated locally as the majority of the elderly are likely to visit hospitals more regularly and admitted in longer days as compared to the younger people (Writer, 2020). Some conditions such as diabetes which has no cure but can be pronged by medication are common among the ageing population and affect the NHS resources.
Multiculturalism
There increased diversity of the country, bringing forth both opportunities and challenges for healthcare providers, health care systems, and policymakers in creating and delivering culturally competent services. Cultural competence is described as healthcare providers and the organization’s ability to effectively provide healthcare services that meet the patients’ social, cultural, and linguistic needs (Saha et al., 2008). Multiculturalism encompasses the notion that different cultures, races and ethnicities especially those of the minority, deserve a special acknowledgement of their differences with a popular culture. The NHS is tasked to serve and respect individuals’ human rights regardless of their race, ethnicity and background. Moreover, its social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.
Several barriers are created by cultural differences, including language, cultural traditions, cultural assumptions, and health literacy. Health care personnel have to be trained, taking a religious barrier into account, to be able to provide care for all ethnic groups living in the UK because understanding different cultures needs concerning health other nations have suffered from various illnesses. Additional, for those who don’t speak English the interpreter – the cost of £20, 30, 50, 100 dependence on language, is provided but the cost is very high, and they are affecting the NHS.
Access to care
Public satisfaction with general practice remains the primary aim of NHS. However, recent years has witnessed increased complaints from patients. According to the GP patient survey, there have been difficulties in accessing services, including declining overall experiences of making doctor appointment in general practice (NHS England, 2020). Some of the specialist hospitals are not available in the area, and people have to travel for a consultant appointment 200 miles away, and it comes with a huge cost if they have pre planned treatment. Resent epidemic situation, is unable people to receive the right treatment because of covid19, and the A&E is not available for everyone because of coronaviruses situation that is making people and accepting the medicines they need.