Emerging Health Policy&Development of Professional Practice - Essay Example

 INTRODUCTION: Healthcare systems like those in the United Kingdom provide universal access to health care by relying mainly on taxes to fund the direct provision of care. But in order to control costs, it is vital to ration health services (Wolper, 2004: p.44). The United Kingdom’s network of primary care providers serve as gatekeepers, by rationing and limiting access to specialists and hospitals; thus controlling costs. The health care system suffers from waiting lists for specialized services and an undercapitalized and aging infrastructure, threatening the quality of care. The problem of rationing health care is observed to be faced by all nations. The reason may be the rapidly aging populations in the U.K. and other countries, and the need for care systems oriented towards chronic diseases and continuity of care. Changes in the health and social care policies in the National Health Service, their impact and implications on the development of professional practice: in relation to healthcare services, and to the field of diagnostic radiography in particular, are presented in this paper. The NHS was founded in 1948. According to Leathard (2000: p.276), throughout the history of the National Health Service, the organizational barriers between the NHS and the local authority for social services resulted in continued dissent among the concerned organisations. By the end of the century, New Labour attempted to address the issues through a policy of integrated care based on partnership. Joint working of NHS with local authority was to be a significant step forward. DISCUSSION: The Systems Approach: Among the different approaches to understanding organisations and their management, the classical or scientific approach, the human relations approach, and the systems approach are normally used, states Mullins (2005) as quoted in the Chartered Institute of Management (CIMA) Learning System (2007: p.16). The systems perspective considers the whole organization as an interrelationship of structure, behaviour and wider environment within which the organization exists. Management of the National Health Service, changes in its basic structure, functioning and policies, and future impacts on the development of professional practice are significant criteria. Re-organisation and change in the National Health Service: According to Alaszewski (Larkin, et al (Eds.) 1995: p.55) the desire to reduce public expenditure resulted in a substantial restructuring of the relationship between the state and the professionals with the introduction of greater competition, and the development of internal markets where full markets were not feasible. Changes in three professional groupings: the medical profession, nursing and social work were focused upon towards the end of the twentieth century . Increased monitoring was done of local authorities to ensure that the policy was developed in line with national policies, with an enhanced role for the social services inspectorate. The medical professionals could either become ‘players’ in an internal market or they could accept some managerial protection at the cost of autonomy. In nursing a major shift in power took place, ward nurses were given a lead role in financial control, enhancing consumer rights and promoting quality. A radical restructuring of social work started taking place, with additional resources flowing into social service departments (p.72). Through the Health Service Circular (A First Class Service: 1998), the new National Health Service set out a package of measures to support improvements to the quality of services to patients, and developed plans and key proposals to achieve the aim. It also reinforces the need for NHS Trusts and Health Authorities to consider how they might take forward the development of new clinical governance arrangements. According to Wall (2004: pp.65), the rise in the importance of management has been a phenomenon of the last fifty years. This has been particularly evident in the National Health Service (NHS), where management is undertaken by two main groups of people, those with a general management background and those initially trained as clinicians. There was increasing emphasis on proactive management, setting the strategic agenda, and correspondingly less inclination to be reactively concerned with problem solving (p.67). Walshe and Smith (2001: pp.21-23) as quoted in Wall (2004: p.69), state that National Health Service managers have anonymously expressed in a report on the introduction of the NHS plan (Department of Health 2000b) and its follow-up Shifting the Balance (Department of Health 2001), that reorganisations in government disrupt delivery, demotivate staff and usually fail in their objectives. They also say that policy making has been rushed and has been inadequately informed, by understanding how the NHS works. The reforms will not prove to be beneficial because of a lack of insight, ineptitude and a disregard for staff at all levels. Contrastingly, a positive picture is presented by Hyde; Cook (2004: p.4), who state that organisationally the NHS is trying to move from traditional bureaucratic monopoly to a more flexible, needs-based and technological service. There have been changes in the organisation and delivery of services: NHS trusts, primary care trusts and the emergence of workforce confederations, and the financial charging mechanisms for dental services, prescriptions, and personal care. The main criterion of the government strategy is not only the demonstration of effective change through evaluated local action, but also its achievements through sound values: partnership, equity, fairness; and the dissemination of good practice (p.6). According to a Department of Health 2002: p.1 directive, “the interests of individual patients have to be balanced with the interests of groups of patients and of the community as a whole. The interests of patients and staff do not always coincide. Managerial and clinical imperatives do not always suggest the same priorities. A balance has to be maintained between national and local priorities.” National Health Service managers need to attempt to reduce the ambiguity of their role, and recalibrate the balance between national policies and local needs (Wall, 2005: 75). Regulatory Changes: Hyde; Cook (2004: p.6) state that regulatory changes in nursing, midwifery, health visiting, and other health/ social care professions will impact upon the culture and practices of the delivery of care and the education and training of practitioners (Department of Health 2000a, 2000b). Current and future practitioners need to be appropriately skilled, adaptable, responsive, and flexible if they are to effectively anticipate and respond to the new roles and competencies that will be expected of them. For example, practitioners and students have to be prepared to: 1) Be board members of primary care trusts and other agencies. 2) Be nurse/ midwife consultants or other independent practitioners or fulfil the Chief Nursing Officer’s ten key roles. 3) Administer medications – by 2004 over 50% of nurses were to supply medicines (DoH 2000c; NHS Executive 2000). 4) Respond to the accelerating pace of scientific and technological change, the rapid growth of knowledge and the accompanying ethical and professional challenges, for example: gene therapy and cloning (p.7). 5) Deliver high quality care at the least resource intensive level consistent with quality, the appropriate evidence base and undertaken by the appropriately competent person. 6) Work in new ways not currently envisaged. 7) Anticipate and respond to the cultural changes in society. 8) Face the changing patterns of disease. 9) Meet raised and altered public expectations. 9) Meet new policy agendas – partnerships, quality issues, intermediate care, integrated services. 10) Contribute to and evaluate evidence-based practice. Future directions for health care management: Reforms and structural re-organizations continue to be introduced by governments in an apparently never-ending series of changes to the way the National Health Service (NHS) is managed. Although the Labour Government declared that there was to be a shift away from the internal market and move towards collaboration and partnerships, it is not entirely clear that the days of competition are over in the NHS (Palfrey, et al (2004: p.39). The emergence of foundation hospitals maybe a potentially divisive mechanism leading to a two-tier system, with hospitals keen to gain foundation status in order to get greater autonomy and attract a greater number of patients, and hence money (Palfrey, et al, 2004: p.39). This together with the increasing use of league tables, performance indicators and star ratings, is seen by some as evidence that competitive forces are still seen by government as a useful means of driving up performance. The main commissioning bodies or health authorities have in recent years been replaced by primary care groups/ trusts. In Managing for Excellence in the NHS, the department of Health set out the three components of the new management tasks (Department of Health: 2002: p.5): 1) Partnerships in managing clinical processes and service delivery, a recognition that clinicians and health service managers do not always see eye to eye on how services should be planned and delivered. 2) Full engagement with patients, staff and lcoal communites, including an outward accountability, through mechanisms such as patients’ forum. 3) New skills for lasting change. Department of Health (2002c: p.8) states the required “core skills” as : managing people, managing information, managing resources, managing communications. The paper also suggests the requirement for greater focus on management processes as: 1. Engaging with patients, clinicians and local communities at all levels. 2. Changing behaviours. 3. Working with local stakeholders and politicians. 4. Measured risk-taking. 5. Contributing to and leading partnerships. 6. Working across organisational boundaries. Clinical Governance: There are several factors responsible for the government’s current position on modernization (McSherry et al, 2002: p.2). Patients’ and carers’ expectations and demands of all health care professionals, have significantly increased over the past decade. This may be due to increased public awareness of healthcare provision, facilitated by the publication of important documents like the Department of Health’s Patient Charter (DoH 1992) and the Citizens’ charter (DoH 1993), both of which are freely available to the public. Other contributing factors are: changes in health policy, demographic changes, increased patient dependency, changes in healthcare delivery systems, advances in health technology, greater access to healthcare information, etc (p.2). Social Care Services: The personal social services consist of social care provided by local authority social services departments and a variety of related agencies for children and families, older people, people with physical disabilities, people with learning disabilities, and people with mental illness (Powell, 1999: p.78). The great majority of people employed by the social service department are not qualified social workers, The tasks carried out by the social work departments are extremely diverse, depending on the clients or groups with the perceived needs. The earliest and most extensive development of community care was in the mental health services (p.79). The social services department takes care of mentally ill people, children in need of care, elderly people who were in residential homes were helped with partial payment of their fees, if they were unable to pay completely. Health Promotion: Philosophy and Ethics: According to Naidoo; Wills (2000: p.113), the philosophy of health is a significant part of health promotion. Health promotion involves decisions and choices that affect other people, which require judgments to be made regarding whether particular courses of action are right or wrong. Philosophy helps practitioners to reflect on the principles of practice, and consequently be able to make practical judgments about the strategies to adopt. The three main branches of philosophy include: logic: the development of reasoned argument, epistemology: the debate and discussion of truth such as the meaning of health, and ethics: the formal study of the principles on which moral rules and values are based. The function of ethical theory is not to provide answers but to inform these judgments and to help people to work out the rights and wrongs of various options and to take a certain action. Ethical principles can help to clarify the decisions that have to be taken at work (p.116). Many health care workers (p.115) have codes of practice which set out guidelines for the fulfilment of duties. For instance doctors take the Hippocratic oath which prevents them from doing any harm. The 1992 code of practice from theU.K. Central Council for nursing, midwifery, and health visiting states the duty to respect life, the duty to do no harm and the duty to care. Smith (1999: p.39) says that health care ethics is a term that has come to the fore in the national health service during he past few years due to greater awareness of the subject and issues involved; and the challenging attitudes of both the health care professionals as well as the patients. With advances in technology, conflicts of ethics have increased in healthcare. Accountability: Powell (1999: p.235) states that John Stewart’s explanation of the two differing elements in public accountability are both important for fully developing the concept of accountability: ) Those who control public institutions should give an account to the public of their exercise of power so as to ensure discourse within the polity. 2) There should be a means by which the public can hold them to account, thereby ensuring relations of control and consent. These criteria hold true for accountability in health and social care also. Medical practitioners, nurse practitioners, and paramedical staff are all bound by the rules of accountability, without which there would be no discipline or ethical patient care. Policy making and its impact on advanced practice of Diagnostic Radiographers: The Government’s drive and ongoing desire for change and modernisation of the National Health Service is evident throughout all their policies, and it is clear that allied health professionals will be expected to contribute. Policy changes in health and social care and major political and demographic factors have influenced the development of new roles for diagnostic radiographers (Eddy, 2006: p.2) In 1995 the Calman-Hine report as quoted in Eddy (2006: p.2) advocated strategies for improving treatment outcomes and improving the quality of patient care, with a particular focus on patient centred service delivery. Patient centred care and all that it encompasses has been the focus in all government health reform subsequently, and is a prevalent theme in both the NHS plan and the NHS cancer plan. The reorganisation of cancer care into local networks was underpinned with the development of national standards of cancer care supported by the NHS cancer plan. Alongside these initiatives was the establishment of multidisciplinary teams to effectively manage episodes of patient’s care, ensuring efficiency and smoothness in the services delivered. A further streamlining of the medical and social service, is requred. Amidst all this change it was acknowledged that there was an ever increasing burden being placed on the existing workforce with particular emphasis on the deficit in numbers of health care professionals that deal with the delivery of patient’s radiotherapy e.g. oncologists, physicists and diagnostic radiographers. Diagnostic Radiographers: Continuing Professional Development Through Role Development: According to Eddy (2006: p.3), role development is a completely new practice area, and embraces aspects of both role extension and role expansion. By necessity it requires higher levels of clinical autonomy brought about by perceived shortcomings in the quality of patient care and service delivery. Often these roles are accompanied by a significant and major change in the provision and scope of practice for the radiographer. These roles have traditionally built on areas of specialist practice and would be equal to expert practice grounded in an extended period of professional development. Autonomy is relevant to complete episodes of care, from referral to discharge. Ongoing professional relationships with a wide range of healthcare professionals include those in research, teaching and service development and improvement. According to Statement No.6 of the Code of Professional Conduct of the College of Radiographers, radiographers must maintain and strive to improve their professional knowledge and competence. The code of conduct for radiographers clearly places the responsibility for continuous professional development (CPD) with the practitioners themselves. The key to effective CPD is largely recognized to lie with autonomous learning (Knowles, 1984; Forgacs, 1992) as quoted in Minton (1998: p.399). Self-direction and taking responsibility for one’s learning, enriches the learning experience, the knowledge and understanding of the subject-matter. It also increases the motivation to learn. Knowles (1984) as quoted in Minton (1998: p.399) notes that matching of learning experience with clinical requirement of knowledge and explanations, offers an effective method of continuing professional development activities. If the knowledge is learned in an appropriate manner that mirrors the clinical situation, it will add to the effectiveness of the learning experience. This view is supported by Dimond (2002: p.372), who states that therapeutic radiographers could develop their skills and knowledge in cancer care, at higher levels of professional practice, both in primary and palliative care. Challenges in the twenty-first century for health care practitioners: (Leathard, 2000: p.258): The National Health Service reforms involved dealing with certain key issues which were a legacy from the twentieth century as well as a challenge for the twenty-first: 1) Further education and training for the practitioners. 2) NHS cost and finance. 3) The place of long-term care. 4) Introduction of new potential with the formation of primary care groups. Lilley (2002: p. 82) advocates knowledge management in an organization. The author defines knowledge management as: Collecting and making accessible all the information an organization has, to help people do a better job for the patient or customer. Minton (1998: p.400) states that radiography educators are incorporating higher education concepts into all programmes of study and, when running short courses, are including workshops on Continuing Professional Development activities. Increasingly, it is left to radiography educators to promote autonomous learning, either intrinsically within the programmes or by talking about the learning experience to the practitioners who come into contact with students. Research: Continuing professional development among radiographers has been empirically studied in several research studies (Friedenberg, 2000: p.630). The author notes that we are experiencing many changes in medical practice related to the introduction of managed health care. To help the physician to cope with his increasing work load, diagnostic radiographers have been trained to perform some of the studies and other functions done by radiologists. One of the factors responsible for our changing medical environment is the concept of “skill-mix”. As applied to medicine, skill-mix implies the utilization of expertise from individuals in related fields, to complement or increase the expertise available to patients, and it is hoped, provide cost savings to the economy. One concept of skill-mix is freeing the physician from work that could be done by technologists with proper training. Over the past ten years in England, trained radiographers and technologists perform duties previously reserved for the radiologist. Under the national healt care system, there is no fee for services, hence the use of technologists does not affect the radiologist’s income. The author believes that there is no substantial difference between the work of the technologist, and that of the radiologist. CONCLUSION: According to Paton; (Ed: MacIver), (2004: p.194), although a distinction is often made between health and healthcare, the purpose of healthcare systems is to improve health, as equitably as possible. Hence healthcare systems and healthcare providers are crucial to health. They are significant for both “rescue and repair on the one hand, and for care on the other”. Paton (1998: p.132) states that all countries in the world are facing difficult choices both political and economic as regards the financing and provision of health care. These are based on the world economy in which revived capitalism demands low taxes, and the pruning of welfare states within nations. It is important that an independent assessment of the NHS reforms is conducted and publicized. Other than the productivity and quantitative outputs as a result of reform, the assessment should include the political and social contexts also, to gain valuable insights into the results of reforms implemented. 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