Government Health Issues and Management of Public Sector - Term Paper Example

Health Issues Achievement of Government’s Objectives: The NHS has been under an almost continuous of reform in order to improve the system. LeGrand (2006) points out some of the problems that plagued the old NHS and the biggest of these was the long waiting lists to obtain service. Since the NHS is a publicly funded organization and aims to provide free services to everyone, health care services need to be rationed on the basis of urgency of the need. As a result, emergency services are provided immediately, while other operations are often placed n queue depending upon the emergent nature of the patient’s need and the seriousness of the health condition. This has resulted in long waiting lists, especially in certain areas where there is a greater demand for hospital services. As a result, the wait time for surgical procedures even extended into several months.(BBC News, 2006). Although most of the hospital boards are trying their best to reduce the waiting times, there have been calls to reduce this extended waiting time for surgical procedures to be carried out for patients, since the result produced was that “only better off had opportunity if dissatisfied to go elsewhere” (LeGrand, 2004). Accordingly, the Government has instituted a program to reduce this waiting time to a period of 18 weeks, so that within this period after a patient has been referred by a GP for a surgical procedure, it is carried out.(www.18weeks.nhs.uk) Ambitious reforms were instituted by Prime Minister Blair during his second term in office, to improve the complaints against the unresponsiveness of the NHS to patient needs, with inefficient use of capacity and poor application of innovation techniques (LeGrand, 2006). As a result the Private Finance Initiative was introduced, wherein some of the NHS hospitals have been built or rebuilt by private bodies and medical services such as surgical procedures and non medical services such a scattering have been outsourced to private agencies, in order to speed up service to patients and improve this quality of service. This may be seen to be an improvement in terms of distributing the load of the NHS and allowing more efficient private organizations to step in and improve the quality of services. However, there has also been criticism of this move leveled against the Government on the grounds that the public service nature of the NHS is being compromised in order to introduce private profit making to taint the service based model. For example, there has been recent criticism of hygiene standards across NHS hospitals, which resulted in outbreaks of antibiotic resistant bacteria and part of the blame for this has been placed on the Private Finance Initiative which is lowering standards still further.(Telegraph, 2008). Cleaning services have been subcontracted to private companies, but this has resulted in inadequate levels of service which have only worsened the quality of service rather than improving it. Therefore, the question of how well the association with private agencies has been beneficial in improving NHS hospital service is still a question that is open to debate. Moreover, the lack of efficiency and speed in provision of service may still be forcing some patients to resort to the use of private health care institutions in order to receive better and faster standards of care. But they also pay for public health care services through taxes, so in effect they are forced to pay twice for the same service. Dissatisfaction with NHS services does not entitle them to relief, their only option may be to seek alternative treatment at their own expense at private health care facilities. The Government also introduced the National Programme for IT, to create an electronic booking system for patients as well as electronic patient records, providing for universal access throughout the NHS system to a patient’s records. While this was touted as a measure that would improve efficiency, the escalating costs may be rendering this an unviable project and diverting much needed funds away from patient care into the development of the electronic system.(Wearden 2004). The system has also been criticized on the grounds that it compromises the security and confidentiality of patient records. While the original objective was to ensure that patients throughout the UK can access free health services by registering with a General Practitioner, the system itself has received only lukewarm support from GPs, who have cited reasons of too much complexity and the lack of consultation facility as potential drawbacks in the scheme. This suggests that the Government may not be working in tandem with the GPs in framing such objectives, which could partly account for the low levels of success that have been achieved. Since the GP’s are the backbone of the NHS and are vital in the provision of effective medical services, it appears that there may be a greater need for the NHS to work in tandem with GP’s and for health policies and improvements in the system to be entered into only after taking their views into account. The NHS currently provides for all patients to be registered with a GP and for the GP to also reject a patient, provided good reasons are provided for the same. The NHS has functioned practically as a monopoly in the past, as a result of which a great deal of inequity existed within the NHS in the provision of services. While the association of the NHS with private health care providers may be an effective step in the right direction, there is a strong need to also allow the public greater levels of access to private health care providers through health insurance alternatives, in order to ensure that the NHS begins to function more efficiently to cope with the competition provided by alternative providers. In conclusion therefore, it appears that the Government has been taking some significant steps to tackle the problems with the NHS, some of which have arisen due to changing circumstances such as the rising incidence of certain diseases and the growing number of the elderly population in the UK. The scale of the problems are huge, but some improvements are resulting slowly but surely, Only time will tell how effective the new government initiatives will be in bringing about a successful system of governance in cooperation with private service providers……………….1040 words References: * BBC News Report, 2006. “Waiting list concerns highlighted”, (online) Available from URL: http://news.bbc.co.uk/2/hi/uk_news/england/6141634.stm (Accessed March 18. 2008) * LeGrand, Julian, 2006. “Do the reforms make sense?” (online) Available from URL: http://www.sochealth.co.uk/confs/jleg.htm (Accessed: March 18, 2008) * The Telegraph report, 2008. “NHS Trust warned over hygiene breaches”, (online) Available from URL: http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/02/05/nhygiene105.xml (Accessed: March 18, 2008). * Wearden, Graeme, 2004. “NHS IT project costs soar”, (Online) Available from URL: http://news.zdnet.co.uk/itmanagement/0,1000000308,39169940,00.htm (Accessed: March 18, 2008) * “18 weeks”, No Date. (Online) Available from: http://www.18weeks.nhs.uk/Content.aspx?path=/What-is-18-weeks/patient (Accessed March 18, 2008). Ans 2: Management in a public sector enterprise: The characteristic feature that distinguishes a public enterprise from a private one is that they are not operated from a profit based motive but from the perspective of offering collective help and they do not withhold services from “people who cannot afford them” (Flynn, 2004, p1). Within the NHS system, the Primary Care Trusts receive 75% of NHS budgets from the Department of Health based upon local populations and specific needs, to provide health and social care. The Primary Care Trusts are required to break even on an annual basis, although they are not required to post a profit as in a private institution. Secondly, within the private sector, marketing seeks to attract more customers, in the case of public services, there is no dearth of customers, and the problems lie in the rationing of services to provide equal access for everyone. While rationing is a part of all health care systems, in private health care, services are rationed out on the basis of the price mechanism so that those who can afford to pay more get the service immediately while those who cannot may have to wait for it indefinitely. In the case of the NHS however, since care if to be provided to everyone, it is rationed out on the basis of the urgency of the need, so that emergency procedures are carried out immediately, while less urgent ones may need to be scheduled on the basis of the nature of the need. Public services are financed mainly by taxation rather than direct payment by individuals, so they “are not available for sale and people cannot necessarily have more if they pay more.” (Flynn, 2004, p 8) The National Health Services in North Ireland is different from that in the UK; as a result reforms that were introduced by Tony Blair in his second term have widened the gap and increased the differences in NHS services across the United Kingdom. The most significant of these differences is in the outsourcing of medical services and providing support to the private sector, as introduced in the Blair reform Agenda, which is not strictly in accord with the non-profit making goals of public sector enterprises. For example, under the Private Finance Initiative introduced within the UK, hospitals can provide medical services through surgi-centers as well as other long term contracts such as catering through the use of services in the private sector.(DOH, 2002). Hence, in the UK, the NHS is slowly transforming itself from a purely public sector based enterprise, where management is centrally controlled to an association that is working in collaboration with private enterprises that are profit motivated, in a less centralized framework. As opposed to this, in Northern Ireland retains a health care system that is still free at the point of use, with the exception of inclusion of nominal rates for eye care and dental services as in the rest of UK, without any partnerships with the private sector. Health and Social Services are provided as an integrated service. The Primary health care organizations in Northern Ireland are the Health and Social Services Trusts (HSS), which manage their own staff and control their own budgets.(www.nursing-home-directory.co.uk). But to a certain extent, all NHS services also demonstrate some extent of operation on the basis of private organizations. The cost of drugs is charged at NHS with patients paying 10% of the cost of their cost. Although NHS services are free of cost and available to everyone, NHS trusts also have private wings in which those patients how can pay more can have access to better facilities and faster service than NHS patients. However, in terms of management in rationing out of services, there is a difference between the private and public sector. In the private sector, the rationing of scarce resources takes place only on the basis of price. Managers at private organizations focus upon attracting customers and persuading them to pay a price that is high enough to produce a profit, and also persuade them to return. In the case of a public sector organization such as the NHS, the rationing is done on the basis of need and even where better facilities are provided for those who can pay more, the motivation is not necessarily to achieve a profit or to persuade them to return, but for “the value of public service” (Flynn, 2004:9). Differences in terms of management of private and public enterprises may also exist from the perspective of the employees of the organizations. In general, employees have considered that a job as a civil servant with a public organization is more secure as opposed to short term contract work for a Government agency. However, this perspective may be slowly changing, as management consultants who work on a short term contractual basis with a government organization are likely to enjoy benefits much higher than those enjoyed by a civil servant.(Flynn, 2004, p 7). In recent years, the UK Government has been outsourcing many of its services to private contractors and this is also the case with the NHS as mentioned earlier, where medical as well as non medical services have been outsourced. International governance discourse on public organizations is now centered upon the concept of new public governance which revolves around the incorporation of higher levels of efficiency into the functioning of government organizations in order to provide enhanced public value (Boviard and Loeffler, 2003). Governance has been defined as the formal rules and processes which determine organizational function (Boviard and Loeffler, 2003). There is an increasing tendency for public sector organizations to outsource services to private organizations in an effort to introduce some efficiency, as Blair’s reforms have attempted to do. Such public sector organizations attempt not merely to serve their respective communities, but rather to take such measures that will enable communities to plan and manage their own services. (Boviard and Loeffler, 2002). There is an increasing degree of coordination with private contractors to provide the services NHS needs. In the case of Northern Ireland, there was an extensive review of public administration agencies conducted in 2005, but Ireland’s focus has been to tighten up the organization internally rather than to seek association with private agencies. The existing four Boards which functioned together in provision of health care services have been replaced by a single Health and Social Services Authority. (www.nhsconfed.org). This organization will be primarily responsible for managing all health and social service issues. The local offices of the HSSA will comprise seven local district councils. The number of trusts will also be trimmed down from the existing 18 to five integrated trusts as of April 2007. The approach of the NHS in northern Ireland is thus somewhat different to that in UK, since the objective is to streamline the existing public agency and thus introduce efficiency into operations rather than to handle the problems by entering into partnerships with private agencies or outsourcing services to them. The NHS in Ireland is however making an effort to involve the community on a wider basis along the lines suggested by Bovaird and Loeffler (2002). Four HSS councils will be replaced by one single Patient and Client Council which will engage directly with communities, in order to produce a better response by the public agency to the needs of the people. While the reduction of costs is still a factor with the NHS in northern Ireland in much the same way as in the rest of the UK, this objective is sought to be achieved through greater levels of interaction with the community to determine its needs and by streamlining the existing system. This is different from the system of new public governance being introduced through the Blair reforms, which have sought to enter into a greater level of cooperation with private agencies through the outsourcing of services in a bid to achieve efficiency. The goals in this case are not only to reduce costs but also to make the NHS a viable organization that is able to break even if not derive a profit. The NHS organization is re-developing its organizational framework in order to support a patient centered care and support system. There is increasing collaboration between medical personnel and hospital administrations, including educating nurses to become more skilled in the specialty area For example, in the Edmonton region, partnership between two public institutions has led to the development of innovative educational programs to prepare nurses to function in the critical care setting and supplement their skills, which are periodically assessed. [Pooler et al, 2005]. New clinical roles for nurses have also developed largely as a result of external policy drives, such as those sponsored by the National Health Service and the need to contain costs and make quality health care accessible to a wider base of patients. [Glen, 2003]. The NHS in northern Ireland is still functioning on the basis of the earlier model of the public sector organization, which is primarily geared towards the provision of free service to all those who require it without the end objective of trying to make the NHS a profitable organization if possible. Its objectives have been primarily centered upon improving internal administration through various streamlining measures, including the training of nurses to provide higher standards of specialty care. 1547 words. References: * Bovaird T and Loffler, E (eds), 2003. “Public Management and Governance”, London: Routledge * Boviard and Loeffler, 2002. “From excellence models of local service delivery to a comprehensive concept of ‘world class local authorities’, IN Braunig, D and Eichom P (eds), “Evaluation and Accounting Standards in Public Management”, Baden Baden: Nomos Publishers. * Department of Health News release, 2002. “New Generation surgery centers to carry out thousands more NHS operations every year”, 23 December, 2002. (online) Available from URL: http://www.dh.gov.uk/en/Publicationsandstatistics/Pressreleases/DH_4026000 (Accessed March 18, 2008) * Flynn, Norman, 2004. “Public Sector Management”, London: Sage * Glen, S, 2003. “Healthcare reforms: Implications for the education and training of acute and critical care nurses”, Postgraduate Medical Journal, 80, 706-710 * Pooler C; Slater-MacLean L; Simpson N; Giblin C, 2005. “Knowledge and skill acquisition for critical care nursing practice: Advanced Studies in Critical Care Nursing Program”, Mount Royal College, Calgary, AB Dynamics, Spring 16(1), 20-3 * “The Role of NHS Trusts and Primary Care trusts”, {Online) Available from URL: http://www.nursing-home-directory.co.uk/role-of-nhs-trusts.htm (Accessed March 18, 2008) Read More