Why Have There Been So Many Reforms of the NHS Structure since Its Creation 60 Years Ago - Essay Example

Why Have There Been So Many Reforms Of The NHS Structure Since Its Creation 60 Years Ago? Table of Contents Introduction 3 The National Health Service From 1958-1967 4 The National Health Service From 1968-1977 5 The National Health Service From 1978 -1987  6 The National Health Service From 1988 -1997 7 The National Health Service From 1998 – 2007 9 The National Health Service From 2008 – Now 10 Discussion 11 Conclusion 16 References 17 Bibliography 22 Introduction The National Health Service (NHS) was established in the year 1948 and is primarily responsible for public healthcare in the United Kingdom. Over the years, drastic reorganisation efforts have been made in the healthcare sector. Continuous reformation in the NHS was initiated in order to improve the healthcare standards in the UK as well as significant efforts were made to lower the health related costs (Chang & et. al., 2013). Moreover, the changes have been introduced in order to shift the responsibilities of the Department of Health controlled by the central to the regional levels. The frequent reforms have been associated with the creation of several semi-independent bodies for assisting in NHS priorities and for monitoring numerous standards practiced in the different parts of the healthcare system (Boyle, 2011). However, the major factors that have been influencing the delivery of proper healthcare services in the UK have been the costs associated with meeting the healthcare requirements of increasing population. With these considerations, the paper intends to evaluate the reforms made in the NHS with respect to its structure and further aims to identify its impact on the UK healthcare system. The National Health Service From 1948-1957 The National Health Service since its establishment in 1948 has made significant contributions in relation to health services. During its initial formation years, NHS services were offered through a few doctors and nurses. At the same time, there were slight uncertainties about who will be the in-charge at the regional level. Hence, in order to facilitate enhanced services, hierarchal system of command was being followed (Stevens, 2004). The managing bodies of the NHS during 1948 included 14 regional hospital boards (RHB), 388 hospital management committees (HMCs), 36 boards belonging to governors for teaching hospitals (BGs), 138 executive councils (ECs) and 147 local health authorities (LHAs). By the time in 1956, RHB activities were decentralised to seven standing committees, six standing sub-committees, nursing committee and 23 consultants (Rivett, n.d.). The National Health Service From 1958-1967 In the second decade of the NHS, there were significant concerns related with funding, nature and control of the NHS. Due to the shortage of finance much of the improvements were made by extending the existing hospitals rather than making replacements. Additionally, it can be stated that the era of sixties did not witness any significant changes in the organisational structure of the NHS. Moreover, the tripartite services were included under the head of the board (Rivett, n.d.). Source: (Rivett, n.d.). The National Health Service From 1968-1977 During the seventies, industrial actions were not profoundly performed. Contextually, a small population of 3000 staffs were engaged in the NHS activities till 1971. The era of seventies witnessed the reorganisation of NHS. The reorganisation led towards the establishment of 14 Regional Health Authorities as well as 90 Area Health Authorities, and Family Practitioner committees. The reorganisation also resulted in the assimilation of health amenities in districts with the population ranging from 250,000-300,000 and the establishment of clear accountability of officers delegated with necessary authorities. Moreover, the structural changes also emphasised on efficient use of resources (Rivett, n.d.). Source: (Rivett, n.d.). The National Health Service From 1978 -1987  During the year 1974, NHS was reorganised and a new planning system was introduced which was focussed on the availability, quality, relevance along with timeliness of NHS information. At the same time, it was identified that geographical distribution of doctors was viewed to be quite even but still major variations were apparent on the regional basis. Contextually, in 1981, the Department of Health and Social Security (DHSS) planned to improve the hospital career structure and proposed doubling the number of consultants while on the other hand it was proposed to halve the number of senior house officers during the course of coming 15 years. Additionally, in 1984, NHS was again restructured into 14 regional health authorities (RHA), 192 district health authorities which replaced 90 area health authorities, 7 special health authorities that replaced the boards of governors of postgraduate teaching hospitals and 90 family practitioner committees (FPCs) were established. Responsively, in 1986, a combined group of professionals including NHS and DHSS was founded for detailed examination of the staffing issues. It was believed that the staffing issues then were considered to be politically sensitive. Accordingly, it was claimed that junior staff would have to work for a few more years for achieving specialist status (Rivett, n.d.). Source: (Rivett, n.d.). The National Health Service From 1988 -1997 The fifth decade of the NHS began with the financial crisis. In other words, NHS was bankrupt with the advent of the fifth decade. Several problems such as clinical disaster, nursing crisis and bed closure were the outcomes generated from the shortage of money. Contextually, major reforms were made during the 1989. According to the reform, regions and districts were liable to receive funds on the basis of their respective size as well as resident population. Additionally, the hierarchy of NHS management was also changed into ‘local dynamic’ decentralising the decision making authority to those closest to the populaces. The new structure introduced greater diversity within the NHS management. Moreover, purchasing and provision were moved apart. Consequently, districts became the purchasers while they also lost their responsibilities related to the hospital management. The reform also introduced a system of medical audit for ensuring quality of services. In addition, regional, district and family related health services and authorities were reduced in size and were primarily reformed alike the procedure followed by businesses (Rivett, n.d.). Source: (Rivett, n.d.). The National Health Service From 1998 – 2007 On 1st April 2002, major restructuring was undertaken which significantly influenced more than 20,000 staff. As the result of the 2002 restructuring, responsibilities were reallocated. It was argued that 2002 structural reorganisation depicted a lack of clear guidance. During the year 2005, labour’s election policy made a commitment to lessen management costs of the NHS by £250 million. The reduction manifesto would result in the elimination of a number of organisations. Furthermore, the reduction would also require a decline in the Strategic Health Authorities (SHAs) as well as decrease in the number of primary care trusts. The strategic reduction was also followed by the decreasing of the number of ambulance trusts. The structural reorganisation was iterative and contextually in the year 2007, again a structural reorganisation was undertaken (Rivett, n.d.). Source: (Rivett, n.d.). The National Health Service From 2008 – Now The changes in the organisational structure have been a continuous process in the NHS. Accordingly, SHAs were grouped from October 2011 and simultaneously primary care trusts (PCTs) were clustered. During the year 2008, 9 SHAs released their own reviews proposing few changes in the services. The changes proposed by these SHAs firmly argued that all the changes shall be made in order to ascertain best possible benefits to the patients (Rivett, n.d.). Currently, it has been planned to phase out SHAs by April 2013. Public Health England is to commence on 1st April 2013 in order to protect and enhance public health as well as mitigate the health disparities. Additionally, National Commissioning Board (NCB) was incorporated in October 2011. NCB is assigned with the responsibility of dealing with the funding of NHS. Moreover, foundation trusts are being assigned with the role of Monitor. Furthermore, the Care Quality Commission together with the Monitor is likely to combine their requirements. Notably, the NHS structure has recently been modified in February 2013. According to the new set up, it has been identified that Clinical Commissioning board will in-charge of the functioning of NHS. Additionally, it has been admitted that new structure will assign more responsibilities to local councils for effectively tackling public health problems (BBC, 2013). Source: (BBC, 2013). Discussion There have been numerous reasons behind continuous reforms delivered since the formation of NHS. One of the primary reasons behind the NHS transition was considered as to be the increasing costs of healthcare along with the increasing population. Thus, it was argued that historically, the governmental efforts towards the reforms were to limit the ever-growing costs related with the healthcare followed by ensuring greater productivity as well as enhanced services within the NHS. Contextually, it was admitted that the different views of the government towards restricting the healthcare costs and increasing the productivity of NHS can be attributed as the major causes behind the frequent reforms over the decades. The increasing cost, followed by NHS’s attempt to adjust itself with the inflation was perceived to be the major reason behind the constant reforms in the NHS. It is worth mentioning that every reform with respect to the reorganisation in the NHS structure have been intended towards controlling the rising costs associated with the staffs within the NHS. Evidently, the tripartite system which was aimed at reducing the extravagant cost and critical analysis of costs of treatment by doctors can be firmly related with the cost reduction reform strategy witnessed in the seventies by NHS (Iles, 2011). Additionally, the lack of presence of firm mechanisms within the NHS for ensuring the adequate supply of healthcare services where argued to be insufficient to meet the demand. In other words, the spending on doctors, drugs and hospitals were not properly managed which resulted in the underfunding in the NHS and created major costs related problems due to which reforms were made on a frequent basis (Browne & Young, 2002). Another major reason behind the continuous reforms of NHS structure can be related with the influence of political systems prevailing during the era of NHS working. NHS was to follow a strong system of political accountability. All the operations of NHS were accountable to the Secretary of State of Health through the Department of Health. It is crucial to state that the NHS’s activities are highly centralised in the hands of politicians. Additionally, the power to gain supremacy and managerial control over NHS had severe impact on the structural reforms in the NHS. The growing hostility between the political and the healthcare professionals gave birth to the new competition that pressurised the UK government to reconsider its approach towards NHS (Crown, 2000). Furthermore, people experiences in NHS was considered to be pathetic and the food offered in the hospitals were often inedible. Consequently, the people in the country were moving towards the private medicines and treatments. Thus, the need for reforms was realised in order to tackle these problems efficiently and render better healthcare services to patients at reduced costs with minimum expenditure. In addition, the other factor contributing towards the consistent reforms process in the NHS structure can be related with the intention behind reducing the management costs of the NHS. Furthermore, it was expected that the reforms in the NHS structure shall lead towards a tight and explicit financial control (Smith & Charlesworth, 2011). However, it was argued that the best model to run the NHS was liberating the NHS activities and functions. It was further believed that liberating the NHS well lead towards efficient creation of social and healthcare policies (Crown, 2010). The government’s approach towards the changes in the NHS has been viewed by a few general practitioners as a prospect to navigate the delivering of healthcare. Furthermore, it was postulated that such model shall facilitate in implementing the best practices within the NHS and thereby increasing the overall productivity of the NHS at reduced costs (Reynolds & McKee, 2012). Furthermore, the government claims to aim at improving the health along with the well-being of the British people (Mills, 2005). The classical approach towards the NHS reforms were based on reducing the competition amid the suppliers for lowering the costs associated with different purposes while it was aimed at improving the quality of the healthcare services and increasing the responsiveness towards meeting the needs of the customers (i.e. patients and commissioners). Additionally, it was believed that the reforms in the NHS will lead towards the improvement in the rate of innovation and shall help in yielding greater customer satisfaction. However, it is worth mentioning that reforms process in the NHS has always remained controversial (National Information Governance Board for Health and Social Care, 2011). According to the report published by Ipos MORI on June 8, 2012, it was ascertained that seven out of ten people were identified to be satisfied with the services of NHS. Nonetheless, it was ascertained that more people were dissatisfied with the performances of the NHS during 2011 than in 2010. Accordingly, it was postulated by the report that people have rising choices related with their treatments but it was argued that the care patterns in the NHS hardly have made any favourable changes to meet the increasing choices of people (Ipsos MORI, 2012). Moreover, the proposal to construct internal market arrangement within the NHS was not being widely supported by a large number of people within the country (Blendon & Donelan, 1989). In addition, it was also identified that almost two people among five believed that the changes made by the government in the NHS shall lead towards making the services offered by NHS worse for the customers. Consequently, the public confidence on NHS has been reducing rather than increasing due to the reforms and changes made by the government in the NHS (Ipsos MORI, 2012). According to the reforms findings, it has been ascertained that the reforms have vitally contributed in improving the hospitals’ quality and efficiency without promoting the ‘cherry-pick’ healthier customers for care (Economic and Social Research Council, 2011). Moreover, the reforms in the NHS have led towards an improved hospital management that has yielded strong and positive outcomes resulting in decreasing death rate followed by higher quality of healthcare. At the same time, it is being admitted that the competition among the public–private hospitals has also resulted in the better quality of services and reduction in the costs of treatment. Precisely stating, the reforms in the NHS can be related with good and bad experiences in the history of the UK public health. On one hand, it is believed that reforms made in the NHS were primarily intended towards cost cutting instead of focussing on improving the efficiencies of hospitals and NHS services in meeting customer requirements. On the other hand, the critical analysis of the NHS reforms illustrates that the reform process has significantly contributed towards augmenting the efficiency of hospitals in the UK (Dorgan & et. al., 2010; Campbell, 2012). Conclusion The NHS is the primary healthcare provider in the UK. It was originally founded after the Second World-War in 1948 to provide healthcare services to the people of the UK. Since its formation, the NHS has undergone several reforms and not to a great surprise recently in February 2013, NHS was restructured once again. It is worth mentioning that reforms in the NHS structure has often been claimed by many people to be directed towards reducing the costs associated with the healthcare rather than emphasising upon increasing the productivity of the NHS. It has also been argued that political control related with NHS also has led towards the frequent reforms in the NHS. Nonetheless, a majority of British people have argued that reforms in the NHS have worsened its operations. On the other hand, the evaluation of the reforms depicts that the reform processes have immensely helped in increasing the efficiency of the UK hospitals. Additionally, it has been believed that the reforms contributing towards creating the competition among the public-private hospitals have significantly resulted in improving the overall efficiency of the hospitals. Unarguably, it can be stated that liberalised NHS would have been able to deliver more stringent outcome. Finally, it can be stated the continuous reforms in the NHS do not negatively affect the healthcare system in the UK instead these reforms have also helped in achieving a few vital outcomes. References Boyle, S., 2011. United Kingdom (England) Health system review. Health Systems in Transition, Vol. 13, No. 1. Blendon, R. J. & Donelan, K., 1989. British Public Opinion on National Health Service Reform. 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