To Explore the UK Health and Social Care system and To Critically Analyse Policy/Standards In Relation To Practice - Essay Example

? Topic: Lecturer: Presentation: To Explore the UK Health and Social Care system and To Critically Analyse Policy/Standards In Relation To Practice The purpose of this paper is to explore the UK health and social care system and analyse policy/standards in relation to nursing practice. To achieve this, the paper will discuss the history, and development of the National Health Service (NHS). It will also compare and contrast the NHS structures of the four UK countries since they are managed separately. This will be followed by a discussion of the social care services sector and the independent sector. The paper will then discuss the importance of policies, legislations, and standards that govern nursing practice such as the protection of vulnerable adults, the social care bill, and the code of ethics for nurses and midwives. The paper will then analyse one of the policies by evaluating its strengths and weaknesses and finally, a summary of the areas covered along with some recommendations for the UK nursing practice. The foundation of the UK health care system as stipulated by Walsh et al. (2000, p. 164) was influenced by “intervention of the state into health and social care during world war II through emergency medical service.” The experience during the war prompted policy makers to develop a coordinated system of healthcare system whereby all services were integrated. This would enable efficient utilization of resources and delivery of services but Miller et al. (2010) argued that integration would lead to conflict of interest among different groups such as the local authorities and doctors in regard to who would control the healthcare system. A contrary view (Raffel, 2007) suggests that the formation of NHS was influenced by the Beveridge report of 1942. Beveridge had ideas which advocated for welfare state. The then secretary of health Aneurin Bevan was able to resolve the conflicting interests and following the NHS Act of 1946, the NHS was launched in July, 1948 (Department of Health, 2003). The NHS was a comprehensive health care system based on free service for all at point of delivery, clinical needs and not ability, and high quality standards. It brought together all the stakeholders including hospitals, doctors, nurses, pharmacists, opticians and dentists under one organization (Daly, 2011). Its aim was to promote good health and not simply to treat illness hence it was planned, funded and coordinated by government and delivered through local nationalized services (Fincham, 2011). However, Currie (2005) suggests that though the service seems to be free for all, it is not the case since prescription charges of one shilling (5p) were introduced in the 1950s, abolished in 1965 and reintroduced in 1968. Dental services were also charged. The NHS solved many of the problems present in the era before its introduction such as shortage of facilities and trained manpower, inequitable distribution of services, uneconomical use of services and inadequate funds (Fincham, 2011). On the other hand, Stretch (2007) argues that it resulted in a lot of problems. The three tier system which lasted up to 1974 led to lack of coordination between the family practitioner services, national hospital service, and local authorities. This is because each agency performed its work separately which led to duplication of services. Although it resolved conflicting interests by having each agency perform separate functions, the interests of the service users were overridden. The medical professionals responsible for policy formulation developed policies that served their own interests leading to inefficiency (Linsley et al. 2006). There was political debate as to the relevance of state funding and service provision due to the high costs incurred in healthcare provision. When the conservative party came into power, it started developing policies to reduce costs by introducing internal markets (Wolper, 2004). The introduction of internal markets in NHS involved use of market economics thus splitting purchasers and providers (Aldgate, 2007). The purchasers included the GP fund holders and local authorities who were previously service providers while the providers included hospital trusts. This was a two tier form of structure as opposed to the three tier used previously and was aimed at improving quality and efficiency. Research (Walsh et al. 2000) suggests that internal markets were more flexible and responsive to patients’ demands, involved accurate costs and increased choice for patients. Twaddle (2002) disagrees with this view arguing that marketisation of NHS results in competition for patients. This leads to unequal service provision as some practitioners provide better services for their patients than others thus undermining the founding principles of NHS; free, accessible health care for all. Though the system aims at providing variety of choices for service users, it also leads to loss of choice since contracts are agreed by General Practitioners (GPs), trusts and local health authorities; patients have no choice (Wolper, 2004). Much debate has been going on regarding the use of marketisation in a health care system that was developed to care for people on the basis of their needs. Some support it due to efficiency and quality while others are against it for bringing about inequalities in service provision. The different government policies regarding health care such as marketisation and devolution result in formation of different structures of the NHS. NHS in UK is managed differently for its countries (England, Wales, Scotland, and Northern Ireland). Each has its own structure but England reflects the structure of the national government health care system while the others are devolved systems. The structure of NHS in England comprises of two sections: primary and secondary care (Department of Health, 2003).The primary care is the first point of contact with patients and is delivered by a wide range of independent contractors: GPs, pharmacists, opticians, NHS walk-in centres, and dentists. The secondary care on the other hand, deals with cases referred from primary care or emergencies. The Strategic Health Authorities (SHAs) are responsible for NHS in England and are under the secretary of state who in turn reports to parliament (Johnson and Stoskopf, 2010). On the other hand, the Scottish government health directorate (SGHD) is responsible for NHS in Scotland and is headed by a chief executive who is accountable to ministers. This is because Scotland is a devolved government hence covers a small geographical area or local NHS dealing with the needs of its people while the SHAs in England cover a wider area and responsible for supervising NHS trusts in their areas (Mizrahi, 2008). Through devolution, Scotland and Northern Ireland are able to enact primary and secondary legislations for devolved matters such as health while Wales has no power to enact primary legislation (Birrel, 2009). The UK government legislates on all matters hence its decisions have impact on devolved services. Funding for devolved governments is based on England’s expenditures. The responsibility for NHS in Wales was passed to its secretary of state in 1969 (Department of Health, 2003). At first, England and Wales were under one structure which was three tier: hospital services were provided by 14 regional hospital boards; primary care was under independent contractors such as GPs, dentists, and opticians; community services included health visitors, maternity, midwives, and ambulance services provided for by local authorities. However, due to the weakness of the tripartite structure, the structure was reorganized in 1974 and was brought under regional health authorities (Wolper, 2004). Services of hospitals and local authorities were thus merged for efficiency. However, it was reorganized again in 1980s due to introduction of internal markets. The Welsh NHS provides emergency services, primary care, secondary care and specialist tertiary care (NHS Wales, 2012). Contrary to England, there are no internal markets. The Wales NHS structure involves seven local health boards (LHB) and three NHS Trusts while that of England has 10 strategic health authorities, 152 primary care trusts, and GPs responsible for commissioning. Scotland is managed by 14 area NHS boards. Each LHB for Wales runs NHS healthcare services within a geographical area while the trusts operate nationwide services and include Ambulance service, Velindre Trust and public health of Wales (NHS Wales, 2012). The LHB are also responsible for all the NHS services as opposed to the two tier system of England. The 10 SHAs are regional leaders of local NHS and are responsible for strategic development of local NHS. The primary care trusts (PCT) in England are responsible for assessing needs and commissioning services. Foundation trusts are independent regulators and reflect devolution of services (Department of Health, 2003). Unlike England which is based on competition, Wales NHS structure is based on partnership and collaboration. The internal market is intended to improve choices, quality and cost while partnership is intended to reduce bureaucracy and work better across secondary care, community care, primary care, and social care (Shaw et al. 2009). There are other bodies that provide services in Wales such as the health commission which provides guidance and advice; NHS Direct Wales provides non-emergency telephone health advice and information service. The Northern Ireland NHS provides acute and community services. It comprises of GP surgeries and clinics, health boards, agencies and five health trusts. The board is responsible for arranging modern and effective health and social care and also works with health and social care trusts which provide services to people therefore, it has an integrated NHS structure unlike England (Department of Health, 2003). The patients with long term conditions have more control over their treatment and extended direct pay for health and social care as opposed to the other countries due to integration of health and social care. Prescription charges are free in Northern Ireland from 2010/11, will be free for Scotland 2011/12, are free for Wales since 2007 but are still in existence in England (Wolper, 2004). This is due to the fact that the devolved governments are in touch with the service users and understand their needs hence can manage funds effectively. England also utilizes independent treatment centres which were phased out in other countries. Scotland is the only country that offers free personal care for its people especially those aged over 65 and also believe that patients and carers are partners in NHS provision (Glennerster, 2009). In the United Kingdom, the social care sector was influenced by the Elizabethan Poor Act of 1601 that sent people with health care, employment, housing and other needs to parishes (Matthews et al.2010). Though this was helpful to the needy in society, Fincham (2011) argues that it was discriminatory and stigmatizing to those who acquired the help. This is because the Poor Act was based on male patriarchy; men are the providers at home hence were the ones given welfare services and were aimed at punishing beggars. Furthermore, confining people especially the mentally ill in institutions was stigmatizing (Spicker, 2012). Some people also claimed that provision of social services encouraged laziness (Glennerster, 2009). The formalization of social care in the United Kingdom took place in the 19th century and was influenced by industrialisation that came with more social deprivations (Dustin, 2008). The social services were first provided through voluntary organisations and societies that were mutually owned by the communities. Surhone et al. (2010) argues that social problems are socially constructed leading to exclusion and marginalization; therefore, community should understands the needs of its population and contribute to their well being. Social care services provided by the UK social care sector include: help for elderly people; people with physical and learning disabilities; people with mental illness; child protection through fostering, accommodation in children’s homes, and adoption (Hothersall and Bolger, 2010). The health and unemployment insurance came into being through the National Insurance Act of 1911 but the welfare state emerged in 1942 through the Beveridgean report. The funding and responsibility of social care and social work services is thus the responsibility of government bodies. Care was provided by local authorities under the central government and involved institutionalization at homes. Many people especially sociologists were against this institutionalization as it denied individuals their rights and freedom to choose what they want (Lavallette and Pratt, 2006). However, Williams (2004) saw it as a way of minimizing the burden on women as they are in most cases the care givers at home. Furthermore, it created jobs for care takers in the service sector and business for the independent sector. Due to criticisms of institutionalization, community care was emphasized whereby the needy are taken care of at their homes rather than institutions. However, the feminists are very much against it as it leads to exploitation of women (Daly, 2011). Contrary to the earlier stages, the Carers Act of 1995 gave carers the rights to assess their needs when relative is being assessed but no right to services themselves (Walsh et al. 2000). Community care allows the elderly to stay at home longer before they join care homes. However, it is a burden for care givers at home especially women who have little or no support from other community members. It is also costly since no extra funds are given for home care; besides, there are no spending guidelines across the country hence inequality in service provision (Glennerster, 2009). Alcock (2008) agrees with this view emphasizing the lack of coordination between GPs and local authorities leading to differing standards of care as well as community resistance to care provision. The social care services are regulated by care quality commission to ensure quality and safety standards are maintained thus providers must register with the commission before they can be allowed to offer services. Care services are financed through direct payment, account held and managed by council or through third party. Some individuals contribute to the cost of their support especially those with high incomes while those with low incomes do not contribute. Social care is aimed at providing care for all, while maintaining their control and dignity (Department of Health, 2004). The structure of social care services sector involves family-based, statutory, and voluntary sector. The statutory care is funded by central government from the treasury through income tax. The services are free or charged on basis of means-testing (Department of Health, 2004). However, this system is rejected by people as it is not based on care need but on income and wealth (GB Parliament, 2009). This was introduced by the conservative government to encourage people to take on employment thus discouraging laziness. The department of health heads the social care system and has responsibility for funding and policy making. The social service departments under central government organize and deliver services whereas area officers manage local areas. The voluntary sector provides services through funds obtained from various sources while the private sector charges fees for its services (Moonie and Walsh, 2003). The independent sector is charged with the responsibility of delivering most of state funded social care through nursing homes and is under the umbrella of National Care Association (NCA). The association represents the interests of providers caring for people with Dementia, learning disabilities, physically handicapped, the elderly, the mentally ill and vulnerable children (Department of Health, 2004). According to O’Kell (2002) the way care is commissioned, provided and inspected is guided by legislations such as the Care Standards Act 2000, Health and Social Care Act 2001, and the NHS plan 2000. As a result, there are frequent changes in the sector which affect delivery of services. The sector is involved in planning for local social care services and also assesses individuals before accepting them in the care homes (Boschma, 2005). Though the independent sector plays a crucial role in service delivery, it is faced with numerous challenges. Demographic changes lead to boom in the sector which means increased profits but instead it leads to inefficiency (Andersen and Molander, 2003). It also leads to extended care roles for care support workers hence lack of motivation and increased turnover. Training opportunities for care providers are also not available like in public sector. Furthermore, overlapping government initiatives lead to confusion (O’Kell, 2002). However, with the planned code of practice for care workers, workforce registers, and National Minimum Standards, Clark et al. (2006) believes that the sector could solve most of its problems especially recruitment. The nursing practice is governed by various legislations, policies, and standards to ensure government objectives are achieved. The protection of vulnerable adults (POVA) policy by the government of Wales is aimed at promotion of independence and safeguarding of vulnerable adults (Department of Health, 2011). ‘In safe Hand’ is the national framework for development of policies, procedures and guidelines for POVA. The Care Standards Act 2000 established the Regulatory and National Minimum Standard regimes to cover care homes and adult placements. These dictate the minimum standards for provider operations (Chenoweth, 2011). This policy guides the behaviour of social workers while dealing with adults. Pre-employment checks are also carried out on staffs to help POVA. This ensures protection of residents as well as promoting their welfare and quality of life. The code of conduct governs performance and ethics for nurses and midwives so as to safeguard the health and well being of the public. This code is very important in nursing practice as it sets standards of education, training, conduct and rules for practicing (NMC, 2008). This ensures professional standards are maintained and that high quality services are delivered. Nurses who flout the rules set on the code risk deregistration. The NMC in UK establishes the code of conduct for nurses and midwives with aim of safeguarding health and well being of public, keeping skills up to date and uphold professional standards and maintain standards of education, training and conduct (NMC, 2008). Nursing in Nigeria is under the National Association of Nigerian Nurses and Midwives (NANNM). Its code of ethics was established 2005 aimed at enabling nurses to promote health, prevent illness, restore health and alleviate suffering (NMCN, 2005). It is based on seven principles while that of UK is based on five principles; people in your care trust you with their health, make care your first concern, protecting and promoting health and well being of those in your care and their families, maintaining high standards of practice, and being open and honest. Nigeria code involves the professional nurse and health care consumer, nursing profession, nursing practice, professional colleagues, public, and global health organisation. Both codes give clear directions as to how the nurse is supposed to conduct herself on the course of duty but the Nigerian code is more strict as it also dictates personal issues such as way of dressing, hairstyle, and make up. Nurses are also expected to attend workshops relevant to their profession once a year to improve their skills (NMCN, 2005). Respect for confidentiality, personal responsibility for omissions and non discrimination are emphasized by both codes. In the UK code, nurses are expected to have professional indemnity insurance to help them in case of claims of professional negligence. The employers thus have vicarious liability for negligent acts of their employees. The UK health and social care system is the most comprehensive in Europe and is free for all at the point of delivery. The healthcare system is operated under the NHS and is devolved to other countries of the UK. Each country manages its NHS separately but some of the services are controlled nationally through trusts in England. The NHS was launched in 1948 following the Beveridge report of 1942 and the NHS Act of 1946. The social care system is controlled b the Care Standards Act of 2000 and providers must register with care quality commission to ensure quality standards are maintained. Services are provided for free to low income earners and through means-testing for others and includes such services as; care for the elderly, and protection of children at risk. The nursing profession is governed by various policies, legislations, and standards which dictate the behaviour of nurses. It is recommended that the UK government allow more trusts to operate in other countries besides England for provision of specialised care. The devolved governments should also be given power to decide on policies regarding care and to manage funds locally rather that be funded centrally. References Alcock, P. (2008) Social policy in Britain. 3rd ed. Basingstoke: Palgrave Macmillan Aldgate, J. (2007) Enhancing social work management: theory and best practice from the UK and the USA. Connecticut: University of Connecticut. Andersen, T.M. and Molander P. (2003) Alternatives for welfare policy: coping with internationalism and demographic change. Cambridge: Cambridge University Press Birrell, D. (2009) The impact of devolution on social policy. UK: Policy Press Boschma, G. (2005) Faculty of nursing on the move, nursing at the University of Calgary. 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