National Health Service: Evolution of Healthcare in Great Britain - Assignment Example

Section/# The National Health Service: Needs of as a Function of Nurse Care and the Evolution of Healthcare in Great Britain The National Health Service of the United Kingdom is the oldest single payer system in the world today. As such, understanding the way in which it operates, allocates its resources, is organized, the level of services provided, the role of the healthcare provider (specifically primary care providers), and the way that the NHS strives to encourage and regulate healthcare services and providers are all topics that this brief analysis will consider. Rather than an exhaustive approach to one of the largest government departments that exists within the United Kingdom, this brief paper will seek to answer the aforementioned key attributes and categorize the ways in which the current NHS differs from and compares to the older NHS as well as the functional capacities that primary care providers (namely nurses) are able to bring to bear in seeking to raise the standard of care across the UK. At the conclusion of the Second World War, it was plainly obvious that the economies of Europe lay in shambles. The United Kingdom’s grip on her empire was waning and the battered and broken bodies of hundreds of thousands of war veterans returned home to take up some form or semblance of normality. Prior to the ordination of the NHS in 1946, the United Kingdom had operated on a patchwork of healthcare plans that were similar only in the fact that the majority of them required the individual receiving care to be responsible for payment of such care. However, as the notion and recognition that the United Kingdom would pursue a type of welfare state came to more and more prominence, so too did the understanding that the prior system of healthcare administration in the United Kingdom was unfit to deal with the needs of the current time. At its core, the old NHS, ushered into existence in 1948, consisted of 3 core principles: meeting the needs of everyone, being free at the point of delivery, and based upon clinical need not ability to pay. As such, this was broadened after 1969 to 7 core principles. These newer 7 core principles incorporate the initial 3 while adding to key unspecified areas that existed in the first iteration. The new 7 core principles are as follows: providing a comprehensive range of services, shaping its services around the needs and preferences of individual patients, responding to the different needs of different populations, working continuously to improve the quality of services and to minimize errors, supporting and valuing its staff, working to keep people healthy and work to reduce health inequalities, respecting the confidentiality of individual patients and providing open access to information about services, treatment and performance. In this way, the means by which the NHS seeks to implement its mission, vision, and goals for the general population of the United Kingdom is expressly enumerated upon and provides the individual with a clear understanding of the means by which services and care are to be administered. As a way to accomplish these goals, a series of trusts have been initiated. These trusts exist to hone the skills of the providers and to ensure that specific services are rendered to the end consumer in as highly an efficient manner as possible. The first of these trusts which will herein by discussed is that of the “care trust”. These care trusts work to administer primary care to those that require it. As such, the care trusts are the largest of the trusts and annually consume around 80% of the NHS total budget. These PCTs (as they are called) act as a type of regulatory mechanism whereby the primary care administrators are bound to universal standards of care and reporting requirements. Similarly, the ambulance trusts provide a level of ambulatory services within the framework of the NHS. Likewise, the mental health trusts are solely responsible for managing and treating an array of mental illness. The mental health trusts differ somewhat from the other trusts that have and will be discussed in that they also engender an element of involuntary commitment for patients who suffer from debilitating or dangerous mental disabilities. The acute care trusts on the other hand seek to oversee those primary care institutions that specialize in a type of critical care for those patients that require more than general services and more round the clock care for severe and or advanced health care issues. The primary differences between the NHS structure as it existed prior to changes primarily revolve around structural streamlining as well as certain key changes to the pension accrual system. Primary among these is the fact that the new pension accrual system is more generous in many ways than the old; however, the key downside to the new system is that non-penalized retirement has been moved from the age of 60 to the age of 65. This change is due in no small part to the fact that the external and internal financial pressures on the system as well as the demographic shift that the United Kingdom and the rest of the developed world is seeing means that longer working years are required in order to meet the cost overruns that such socialized programs incur. Sadly, many of the cost mechanisms that were originally introduced as a means to protect the average citizen from the high cost of healthcare have been lost. For instance, in 1952, it was mandated that the average cost of a prescription should necessarily not exceed 1 shilling. However, as of 2012, the number is currently approximately 8 times that amount. Similarly, the budget in real terms for the National Health Service has grown by a factor of 16 since 1948. Speaking categorically, the challenges of healthcare and the exponential growth of healthcare in the intervening period account for the large part of why costs have continued to climb. With regards to some of the key challenges that the current NHS faces, one can understandably point to the fact that the NHS like any other division of government, the NHS must compete for funding on an annual basis. Such a dependency necessarily means that the NHS along with a number of other government entities are all in search of an ever increasing portion of finite resources that the budget of the United Kingdom can offer. When one combines such an eventuality with the fact that trying economic times now greet each and every level of government, one is left with a situation in which an even smaller amount of resources must be spread amongst necessary government functions mandated by law. Furthermore, the political shifts that occur between key parities and coalition governments being formed, oftentimes between unlikely partners, means that the future of the NHS and the annual operating budget that it may expect remain far from assured. Currently, the NHS receives the second largest allotment, as a percentage of the overall budget of the United Kingdom, at 18%; second only to the social welfare agencies that receive approximately 28% of the annual budget. As of 2012, the annual operating budget for the NHS hovered around 105 billion pounds (Snow 2012, p. 7). Naturally, such a high annual budget has been a cause for some controversy both within and without the government. Only last year the National Treasury indicated that it was retaining over ? billion pounds that had been allocated to the NHS due to the fact that equipment procurement and technological acquisition that had been slated to exceed this amount had been taken care of in a highly expeditious manner and no longer required such a high funding level as initially indicated. However, with regards to the prospect of the future, it is only logical that the funding levels of the NHS will remain high and continue to climb as healthcare becomes more advanced and higher levels of expensive and cutting edge technology are utilized to protect the lives of those within the nation. Lastly, when discussing the role that the NHS plays on the health of the British citizen, one cannot minimize the role that the primary care givers play in representing the key interests of both the patient and the growth and development of increasing the national health and wellness of the population. In this sense, doctors and nurses play the primary care-giving roles in this structure. However, for purposes of this analysis, as well as for purposes of general understanding and reality, it is the nurse who most frequently interfaces with the patients and their loved ones and/or relatives. Due to the relatively smaller number of specialized doctors and the higher number of nurses, it is the nurse that the patient is most likely to see and interface with. In the broadest sense, one can understand the definition of nursing as “The protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (Herdman 2008, p. 4)). From such a broad and overarching definition, one can quickly and readily see that the nurse is the backbone of the entire NHS. Yet, the lump all nurses into a single category would be a broad oversimplification. From even a cursory analysis, one can identify adult, child, mental health, and learning disability nurses. Certainly, a further breakdown of specialization exists which serves to ensure that the needs of the individual patient are met at every single level of the healthcare system. Similarly, for purposes of the analysis that is being performed, this author has chosen to take the case of the mental healthcare nurse as an exemplification of the roles, responsibilities, values, and qualities that such an individual must engender. As with any healthcare practitioner, the mental healthcare nurse must be willing and able to be acutely attuned to the needs of his/her patient; however, the role of the mental healthcare nurse is slightly different from that of the other types of nurses that have been mentioned due to the fact that it is often incumbent upon the mental healthcare nurse to disregard the reasoning and logic of his/her patient due to the fact that the patient may oftentimes have harmful or disingenuous means whereby the wish their situation to be treated/not treated. For this factor alone, the mental healthcare nurse must maintain a delicate balance between administering to the needs of the patient and considering his/her unique inputs while at the same time maintaining a clear sense of distance from taking the advice of the patient or many of his/her inputs into the situation at hand. As a way to regulate the practice of nursing, there exists a code of standard conduct, and performance ethics known as the Nursing and Midwifery Code. These principles act as a way to underpin and define the allowable means by which nursing can be practiced as well as providing key guidance for professionals within the field. Furthermore, within the UK, nursing is regulated by Nursing and Midwifery Council. The council itself accredits and manages the application of nursing in all of its forms throughout the umbrella of the NHS. Of course a key concern with such an overarching body of accreditation and management mean that certain smaller aspects of the field of nursing are necessarily ignored and minimized as a way to capture the full embodiment of major issues within nursing in general. Continuing education and training necessarily equates to an increased quality of care and an increase in the overall body of knowledge that the practitioner herself/himself is responsible for being familiar with. Similarly, by engaging with continuing education/reflective practice, the quality of care for the individual patient is raised commensurately. Key issues such as professional accountability, evidence based practice, reflection, and team building all contribute to the proliferation of key knowledge and skills that the nurse, the NHS, and the NMC all seek to instill within the healthcare professionals within the system. With respect to the first of these, the NHS is keen to instill levels of professional accountability in order to create a more unified and symmetrically oriented system of nursing and healthcare providers within the system. By seeking to instill such a level of professional accountability, the profession can reduce the need to provide certain degrees of top down regulation as this will take place naturally within the ranks. Secondly, evidence based practice is necessary for practitioners to train and gain the necessary new skills required to become even better practitioners. As such, evidence based practice and reflection serve as the key requirement of development, training, and continuing education that all healthcare professionals should be engaging upon. Lastly, working within the team is the final requirement that serves to broaden each of the aforementioned 3 that have thus far been listed. Without a clear understanding and appreciation of teamwork and the benefits that it can bring, the other items that have been listed are entirely insular and lose the synergy that teamwork brings to the picture. In short, the NHS has made massive inroads into increasing the healthcare and lifespan of the British citizen over the more than sixty years that it has been in existence. Moreover, the role of the nurse as the fundamental building block of furthering the goals of the NHS and seeking to ensure that the health of the individual patient and the priorities of the government with regards to readily available healthcare for all is met remains the most important part of the puzzle. As the nurse is the primary individual that interacts with the needs of the populace and the administration of healthcare, this profession bears the brunt of successful implementation of better healthcare within the nation. References Herdman, T 2008, 'Nursing: is it time for a new definition?', International Journal Of Nursing Terminologies & Classifications, 19, 1, pp. 2-13, CINAHL Plus with Full Text, EBSCOhost, viewed 13 January 2013. Snow, T 2012, 'Auditors reveal ?3.2bn of NHS budget cuts, but worse is to come', Nursing Standard, 25, 50, p. 7, Academic Search Complete, EBSCOhost, viewed 13 January 2013. Read More