Origins and Evolution of the NHS and Social Care Services - Essay Example

Origins and Evolution of the NHS and Social Care Services It is easy to forget that just over fifty years ago there was no universal healthcare system in place in the United Kingdom. The availability of health care was mostly reserved for the rich. Even then, services were often concentrated in certain areas, inadequate in others or nonexistent in many rural and/or poor localities. Societal demands began to equate quality health care with an advanced culture. Low cost and free clinics began to emerge during the late 1800's. These clinics allowed heath care to be more widely available to the general population and seeking medical attention became more widespread. Health care was still sporadic and the quality of service varied extremely from location to location, but its popularity was growing as was society's reliance on it. World Wars I and II brought the issue of a national health system again to the forefront. Lessons learned during these two wars showed the benefits of organization, logistics and a centralized control. Politically, in the years following World War II, the unification of health care became a central issue. The government saw the benefits of administering the evolving healthcare system under one unified body. On July 5, 1948 the National Health Service (NHS) was born. Since its inception, the NHS has been continually changing and adapting to meet ever increasing challenges in the changing world. To understand the complexity of the NHS it is necessary to understand its hierarchical roots. NHS falls under the jurisdiction of the Department of Health established in 1974 as per the first national health reorganization. This reorganization resulted from the rethinking of how national health issues should be addressed and recognized, as well, the need for partnership, innovative solutions and measurable results. Increased authority was give to first line health providers in an attempt to streamline processes, identify problem areas and design solutions. During the process, fourteen directorates were eliminated and 3 business groups were instituted - each assigned with the task of addressing specific areas: strategic direction for health and social care; improving the delivery of services; and setting, monitoring and maintaining quality standards. Each of these directors sits on the Board of Directors and oversees the operations of the NHS. To that end, this progressive alignment has lead to a broad based approach of examining all factors affecting the NHS and health care in the United Kingdom in general. Although issues have changed over the last few decades, since the inception of this comprehensive plan, the responsibility has not. One of the recent concerns of NHS has been the difficulty in retaining and recruiting nurses and other lower paid staff due to increased costs in childcare. Additionally, hospitals operate on a continual basis and even if one can obtain childcare, the often erratic, non-traditional hours when child care is needed further limits availability. In an attempt to offset this, on May 11, 2004, the Health Secretary John Reid, announced a new child care allowance which aided students funded by NHS to receive childcare assistance. The program was estimated to cost 17 million pounds a year to operate. The program would stand to benefit approximately 6,000 student nurses. While in a student status, the reimbursement would be up to 85% of the child care costs incurred, the reimbursable amount ranging from 114 to 170 pounds per week depending on the number of children a student has. Further the launch of the program made allowance claim reimbursement retroactive to September of 2004. Announcing the Child Care program, John Reid said during his speech at the Royal College of Nursing conference, "Many NHS - funded students who are parents face difficulties when embarking in training due to increased financial commitments, including child care costs. This can make training less attractive to mature students, single parents and those with partners on a low wage." (UK DOH, 1) He further remarked, "I want parents who are interested in becoming nurses, midwives or physical therapists to start their training knowing that the NHS will help them with childcare while they learn." (UK DOH, 2) Stephen Burke, Director of the National Childcare Charity Daycare Trust, a branch of the NHS stated that the initiative was desperately needed and would go far to help student nurses with children as "Child care costs are a major barrier for parents who want to train and work." (UK DOH, 3) The Child Care Provision was a welcome addition to students; in particular, training for nursing careers within the NHS, but it was not the solution, just a step further in achieving it. Although the problem of childcare costs and availability were beginning to be addressed as early as 2004, opportunities for improvement still remain. The escalating costs and availability of childcare for NHS employees specifically has touched even higher paid employees within the system including physicians. A poll among physicians conducted by the British Medical Association (BMA) on May 6, 2005 found that: 6 out of 10 doctors do not have adequate access to affordable child care; 4 out of 10 doctors felt that the limitations of available child care had an effect on career progression and 4 out of 10 doctors felt that 24 hour child care would be the answer to current childcare problems. (Med News, 4) These findings led the BMA to demand that NHS reevaluate the current childcare crisis within the NHS system. This is, according to the BMA, "because it's a key role in recruitment and retention." (Med News, 5) If childcare costs and availability are forcing physicians to leave the NHS, how much more does it affect lower paid employees Another major challenge of the NHS has been the shortage of qualified nurses. This shortage is partly caused by childcare issues, but its scope is much larger. The age of currently employed nurses is rising; many will be eligible to retire in the next ten years. The issue needs to be addressed urgently. During a statement released in October of 2000 Christine Hancock, general secretary of the Royal College of Nursing stated that "We need simple and effective measures that will have an immediate impact." (BBC Online, 6) The RCN called for a substantial pay raise for nurses in order to promote retention. She reported that as of October of 2000 there were 20,000 nursing vacancies nationwide with 9,900 of those vacancies open for greater than three months. She also reported that the NHS had spent 344 million pounds employing temporary staff to cover nursing shortages. (BBC Online, 7) Although filling shortages is necessary, a more permanent solution is required. Concern was also voiced over the downward trend of filling more senior nursing positions. Long time employed trained nurses have fewer opportunities for promotion to fill higher paying nursing positions when the incentive is, in their opinion, most needed. Hancock reported that senior nursing positions have shrunk by 13% in the previous 8 years. Nursing employees of NHS stated that they are being required to do extra work without a hike in pay and a severely limited availability of promotion. In addition to monetary remuneration, nurses stated that they need more input in the area of patient care plans. They know what needs to be done; they just do not have the time or authority to do so. In order to reduce the severe nursing shortage, the NHS in the early 1990's began an extensive overseas recruitment initiative. As of March, 2002 there were 644,024 nurses, midwives and health visitor from overseas registered with the NHS with 30,000 alone being added since 1999. (Larusso, 8) The influx of non resident health care providers was spawned in part by NHS efforts to increase the workforce, but other factors contributed as well. The world is increasingly getting smaller as trade and economic barriers are dissolving at a fast pace. Travel is more prevalent. Skilled workers from more economically challenged nations are actively seeking employment in countries they see as having a better standard of living. Balancing the desires of the individuals with the world wide nursing crisis becomes more imperative. The Department of Health, as well as other government entities, have developed and evolved comprehensive guides to ensure that recruitment efforts are not done at the expense of other nations. Limits or total bans have been placed on recruiting from countries experiencing severe health care issues internally. NHS targets set by the Secretary of State for Health are very aggressive. These targets include the addition of 35,000 new nurses by 2008. Although overseas recruitment seems like a good solution, it is merely a stop gap measure to the nursing shortage faced by the United Kingdom. Reliance on a foreign workforce for such a critical field is dangerous. The mobility of people leads one to wonder if this dependence is wise. Although temporarily it may alleviate the problem it is by no means a permanent solution. Efforts must be made to increase the internal workforce pool and retain qualified healthcare professionals. Seeing the need to ensure procurement of adequate and properly trained medical professionals the NHS in 2000 established the Career Services branch of the NHS. Since its inception Career Services has been instrumental in the recruitment of overseas nurses as well as in setting up internal programs to improve retention and create interest in the public for pursing health service careers. Successful advertising campaigns were launched in 2003 and 2004 entitled "Smiles" and "Steps" respectively. Career Services brought the private sector media publicity to the government sector to increase the public's awareness of employment opportunities and to encourage retention by present employees, by highlighting benefits. NHS asserts that Career Services will be instrumental in ensuring that staffing levels, as required, will be met. The advertising campaign cost four million pounds from inception to completion, but NHS sees it as an investment in the United Kingdom's future. Health Secretary John Reid feels this investment was necessary and will help to stem the tide of NHS attrition and increase the desirability of NHS health service employment. Although he does not view these measures as a complete solution he sees them as important steps. In addition to the campaigns to attract new employees Reid, during the 2004 campaign launch, emphasized that other measures needed to be taken to assure proper staffing as well. He stated that "Initiatives such as more flexible working options, better and more supported career structures, family friendly practices, career breaks and access to child care coordinators, along with new pay structure agenda for change, are all playing their part in encouraging retention of staff" (BBC, 9) The reorganization of the NHS was made to ensure quality improvement in all facets of its operation - internally to employees but also externally to ensure quality service to patients. At the time of the revamp, problems existed inside the NHS, but public perception was also, at the time, deteriorating. Confidence in delivery of adequate, time efficient treatment was low. In re-inventing itself, the NHS initiated these widespread reforms to regain public trust and focus on quality of treatment for the patient as well as quality of staff. To that end, verifiable measurements needed to occur to assess progress and determine further areas for process improvement. In 1999 the National Institute for Clinical Excellence (NICE) was established to regulate national guidelines in three areas: guidance on the use of new and existing medications and treatments; guidance on appropriate treatment and care of patients with specific diseases and conditions; and guidance on whether interventional procedures used to diagnose or test are safe enough and will work well enough for routine. (NICE, 10) A performance assessment framework has been established for England, identifying six key areas of NHS performance. Each year tables are published comparing health authority and trust performance. In alignment with NICE the Health and Social Care Information Center was created to compile statistical data and publish findings of medical treatment advances and quality of service. The rationale behind this was to reduce the burden of compiling and reporting data by first line care givers and to streamline functionality of the NHS. To ensure excellence in health services is achieved, the NHS also launched the Commission for Health Improvement (CHIMP) which is trusted with maintaining high quality health care delivery and investigating and overseeing that corrective measures are made swiftly and with a continuous quality first focus. These standards are measurable and health care providers are rated based on the defined standards. Public surveys are routinely taken to ensure that patient quality issues are addressed. This proactive response will ensure positive change within the NHS. Staffing issues, health care concerns and the rising costs involved in providing services are but a few of the issues faced by the NHS. The United Kingdom has long been a benchmark provider of health care services recognized worldwide for their delivery of service funded solely by tax dollars. Evaluation of such an extensive system is complicated. Several studies have been done on evaluating the success of the new NHS. In general, marked improvement has been achieved in quality of patient care and a reduction in wait time for appointments has been found as well. Public confidence is on the rise. Yet, much more needs to be done to ensure that a strong health care program continues. This will require a unified approach in dealing with staff concerns, public perception of quality, a well trained and fully staffed compliment of health care providers as well as cutting edge technology - a formidable task indeed, but, none the less, within grasp. Works Cited LaRusso, Kathryn. "International Recruitment of Nurses in the UK." Georgetown Journal of Health Sciences. Volume 1 Number 1. 22 October 2003. Accessed 30 October 2005. (8) "New NHS childcare allowance." UK Department of Health. 11 May 2004. Accessed 28 Oct 2005 http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/enCONTENT_ID=4081974&chk=UEpWk3 (1-3) "NHS suffers from poor childcare, UK." Medical News Today. 6 May 2005. Accessed 29 Oct 2005 < http://www.medicalnewstoday.com/newssearch.phpnewsid=23959> (4,5) NICE Homepage. National Institute for Health and Clinical Excellence. Accessed 29 Oct 2005 (10) "Nurses demand 'substantial' pay hikes." British Broadcasting News Online. 23 Oct 2000. Accessed 29 Oct 2005. (6,7) "UK 'fuelling' global nurse shortage." British Broadcasting News. 21 Dec 2000. Accessed 30 Oct 2005. (9) Read More