Nursing and Healthcare - Case Study Example

Running Head: NURSING AND HEALTHCARE IN THE UNITED KINGDOM Nursing and Healthcare in the United Kingdom of the of the Nursing and Healthcare in the United Kingdom Introduction Trends in UK general healthcare and nursing reveal a shift towards whole systems thinking.(NHS Modernisation Agency, 2005). This development is driven by an explicit focus on improving both service efficiencies and how the needs of service users are met using effective nursing. Policy action is directed at managing the provision of integrated services through the development of system technologies aimed at engineering closer inter-occupational and interagency working. Examples include the creation of shared standards, such as the use of national service frameworks, national guidelines and the development of integrated care pathways. Favourable conditions are also being created for the emergence of new occupational groups and for the configuration of new types of nursing techniques and care team. (Department of Health, 2009) Management and Leadership theories in NHS In the UK the formal system of mental health nursing work began in the late 18th century with the large-scale construction of institutions dedicated to the segregation of madness (Rogers and Pilgrim, 2001), in which psychiatric nursing emerged as the lead profession. As Scull notes, psychiatrys dominance was linked to the professions successful leadership and management in advancement of claims to possess knowledge of lunacy as a disease with biophysical origins. Echoing the claims made by other branches of medicine at this time, the jurisdiction asserted by mad doctors during the 19th century came to be a wide-ranging one, encompassing the identification of mental disorder and proper management of its cause, natural history and cure (Rogers and Pilgrim, 2001). The social organisation of psychiatry and its autonomy and power were consolidated in the 1840s with the founding of both a professional association and a journal. Particularly long-lasting claims to control areas of work can be secured in the legal arena, and in the same decade psychiatry secured an advancement of its jurisdiction in this sphere with the passing of the 1845 Lunatics Act. This saw the establishment of a medically dominated Lunacy Commission, which, Scull observes, exerted a powerful influence against the running of asylums by lay people. Psychiatry thus secured occupational closure over the work of managing mental illness through effective nursing techniques. A decade later, as Rogers and Pilgrim note, the jurisdiction of British psychiatry was sufficiently secure for an editorial in the Journal of Mental Science (now the British Journal of Psychiatry ) to declare that: insanity is entirely an ailment of the brain. The doctor is now the accountable protector of the lunatic and must ever remain so (Rogers and Pilgrim, 2001). Achievement of Quality Care Whilst doctors were successful in advancing their claims to control the emerging system of mental health care, attendants and nurses carried out most of the day-to-day work in the early asylums. Medical jurisdiction faced little challenge from this low-status group, however. No abstract body of knowledge existed to underpin their work, and many were employed solely on account of their practical skills or their physical strength (Nolan, 1993). Policymakers in the UK have long been occupied with the search for means of improving the coordination of health and social care services, and specific policy initiatives directed to this end have precipitated widespread system of work disruptions. The Chicago sociologist Everett Hughes advanced the idea that the world of work is best thought of as a dynamic and interrelated social system. (Hughes, 2001) This ecological perspective is particularly revealed in his writings on occupations. For Hughes, an occupation refers to the part played by a group in the context of a larger system of work. He introduced the concepts of mandate and licence to draw attention to occupations assertions about their status. An occupational mandate refers to the claims that a group makes about its particular contribution to society, whereas its licence refers to the actual terms of what members of that group are permitted to do distinct from the contribution of others. Hughes considered systems of work to be in flux, and evolving over time in response to wider processes (such as advances in specific technologies, and economic and social developments). Evolution of systems means that the bundle of tasks attached to particular occupational groups may change, as can their social character. Challenges might also be mounted to an occupational groups licence and mandate, processes liable to lead to realignment of the boundaries between different occupational groups in an overall division of labour. Management of Inter-professional Working The idea of bringing together different occupational groups into single teams with the aim of providing more coordinated care in the community for people with mental health problems was first suggested in Better Services for the Mentally Ill (Department of Health and Social Security, 1975). Thereafter the community mental health team (CMHT) became the key mental health services organisational innovation of the late 1970s onwards. The appearance of CMHTs was highly significant for the system of mental health nursing. Teams were potentially a site for workplace interoccupational jurisdictional competition, but also offered the prospect of occupational differences being dissolved in the pursuit of shared goals. Initially termed community mental health centres (CMHCs) in the style of their United States predecessors, CMHT numbers doubled every 2 years throughout the late 1980s (Sayce et al. , 1991). By the early 1990s over 500 were in existence in England (Onyett et al. , 1994). Continued political commitment to the CMHT model was demonstrated in the Building Bridges document (Department of Health, 1995), which reaffirmed the multi-professional team as the most appropriate means of delivering care. Within single workplace CMHTs typically brought together psychiatrists, nurses, generically prepared social workers electing to specialise in the mental health field, occupational therapists, clinical psychologists, unqualified support workers and administrative staff (Onyett et al., 1994), with nurses and social workers the most frequently encountered groups. The authority of social workers to formally participate in decision-making over the use of compulsory powers had been enshrined in the legal sphere since the end of the 1950s. The authority of nurses to carry out medically delegated tasks such as the administration and monitoring of medications was also well established. Beyond these areas significant space existed for interoccupational competition, including over the provision of individual and family-oriented therapies and attention to the practical social tasks attendant to providing care in the community. Divisions between organisations supplement systems of work in which divisions between occupations or agencies are likely to be particularly unstable, with organisational imperatives exerting a powerful (and sometimes constraining) influence over professional jurisdictions. (Department of Health, 2009) With most CMHTs funded by both health and social care bodies, changes at the agency level often had significant implications for groups and their bundles of tasks. For example, externally driven modifications to the responsibilities of local authorities introduced in the legal sphere through the NHS and Community Care Act of 1990 triggered changes in the role of social workers. Care management obliged social services departments to assume more of an enabling function, which for social workers translated into a reduction in opportunities for therapeutic practice and an increase in administrative responsibilities (McCrae et al. , 2004). Government Policies and Healthcare in the UK Policy has explicitly contributed to the appearance of new mental health worker roles in primary care, and to the creation of new inter-professional teams focusing on the provision of services (such as assertive outreach) to closely-defined groups of users. The new policy context has also fostered conditions in which service providers are able to create new groups of workers, such as associate mental health practitioners, to meet locally specific needs. This emergent approach to policy development and implementation is a significant attempt to improve services by more closely managing the unwieldy occupational and organisational division of labour associated with health and social care delivery. However, this version of whole systems thinking is both new and relatively under-conceptualised. Policymakers may be underestimating the degree to which systems of work are liable to develop in unpredictable and unmanageable ways (Allen et al, 2004). Here we suggest that attempts to modernise service delivery to better meet need, whilst laudable, run the risk of triggering significant unforeseen system disturbance. A principal aim of this paper, then, is to draw on theory and a broad historical perspective to highlight the complex ways in which systems of work evolve, and to raise awareness among policymakers, practitioners and others with a stake in the health and social care field of the potential for widespread and unpredictable change arising from developments currently taking place. (Darzi, 2008) Effects of appropriate Management Styles In recent years all parts of the UKs public services have been subjected to increasingly intense scrutiny by the state, with the aim of improving efficiency, effectiveness and the service user experience (6P and Peck, 2004a). Mental health care has emerged as a priority area for reform (6P and Peck, 2004b), with contemporary modernisation representing an attempt from the centre to more tightly manage a particularly complex system of work. This development is significant for a number of reasons. At a theoretical level, extensive and direct state intervention with the aim of improving the day-to-day functioning of systems is an eventuality not particularly envisaged by either Hughes (1971) or Abbott (1988), for whom ecologies of work are largely self-regulating. However, intervention from the state is now a major source of disturbance in the UKs system of mental health work. Role of Individuals and teams in improving Healthcare in the UK The appearance of new types of team, individual efforts, and organizations in effective nursing may also lead to a greater segmentation within occupational groups, and add to the likelihood of increased competition over control of areas of work. Intra-occupational divisions can reflect differences in the characteristics of those on the receiving end of a groups collective services. References Abbott A (1988). The System of Professions: An Essay on the Division of Expert Labor . University of Chicago Press: Chicago. Allen D (2001). 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