NHS and Community Care Act 1990 - Essay Example

NHS and Community Care Act 1990 1. Introduction Community Care includes social work where the trained personnel work rendering psychosocial assistance to the patients under the National Health Service (NHS), and the legislation of NHS and Community Care Act 1990 is with reference to the health and social care in UK. The act seeks to define the role of the health authorities and the local authorities in providing community care services to the public. The need for long term care either required to be delivered through residential care or in their home with adequate support is sought to be addressed by this legislation, and the role of the social workers in this context is very significant. The nature of their duties are multifarious concerning the patients’ health, social security, psychological support to the patient and the family, ensuring support to the patient and the family at the community level, resolution of the uncertainties involved in the treatment and the support services. In fact the gamut of community care is very wide and it varies from arrangement of financial support though the NGO’s to the patients and their families to bereavement and follow-up services in coordination with the support groups and bereavement groups. Therefore, in order to make the services more effective, they need to interact not only with the families of the patients but also with the medical professionals of various disciplines to provide a comprehensive treatment to the patients and at community level for the resources that may be required in this connection apart from counseling to the patients and their families. 2. Background and brief history The social care policy in the United Kingdom evolved over a period of time, and despite the difference in structures in Scotland, Wales and Northern Ireland regions, the overall policy is ingrained in the fundamental principles of providing Social Security, Health, Housing, Education and Welfare to the public. The political expediency coupled with the movements for civil rights had shaped up the concept of community care. “Beveridge Report presented to the British Parliament British parliament in November 1942 proposed a system of social security which would be operated by the state, to be implemented at war's end... Attlee announced the introduction of the Welfare State as outlined in the Beveridge Report. This included the establishment of a National Health Service in 1948, with free medical treatment for all. A national system of benefits was also introduced to provide social security, so that the population would be protected 'from the cradle to the grave'”. (BBC) In 1948 the Poor law, passed in 1598 was abolished through National Assistance Act, with provisions for welfare services. Spicker says that the 'Welfare State' was not intended to respond to poverty; that was what the Poor Law had done. The main purpose was to encourage the provision of the social services on the same basis as the public services - roads, libraries and so forth - an ‘institutional’' model of welfare.  Therefore, the concept of community care is wider in principle and application. 3. NHS and Community Care Act 1990 Reports of the various committees such as Working Party on Joint Planning, Progress in Partnership (1981), House of Commons Social Services Select Committee Report (1985), Audit Commission, Making a Reality of Community Care 1986) and Griffiths Report, Community Care, Agenda for Action (1988) during the 1980’s had culminated into this legislation after considerable debate. Powel (2001) states, “Griffiths (1988) proposed that local authorities were strategically placed to oversee the delivery of community care within the matrix of policy, professional practice and older people themselves involved in the process… The White Paper Caring for People which followed in November 1989 accepted most of Griffith’s proposals and approved the threefold matrix of user choice, promoting non-institutional services and targeting”. 4. Main Aims and Principles of the Act Many countries rely on insurance schemes for medical treatment and care. But, the community care policy under NHS is based on autonomy, empowerment and choice which seeks to deinstitutionalize it through domiciled care on account of its advantages as highlighted by the Audit Commission in its report, Making a Reality of Community Care (1986). The community care in relation to a patient comes under the realm of the Local Authorities where the patient ordinarily resides. The local authorities shall reimburse the charges to the hospital if they are responsible for any delay in discharge from the hospitals, and as such they are required to put in place the arrangements needed for community care. The hospitals issue notices to the respective local authorities in this regard in this connection under The Community Care (Delayed Discharges etc.) Act, 2003. NHS is financed and supported by the local authorities / government. The rich are required to pay more for the benefits derived for the comparable services. NHS aims to cover all citizens of the country and even the temporarily resident people. Medical care is free at the point of use, subject to certain restrictions or changes introduced, such as dental charges and prescription changes. 5. Achievements through NHS and the shortcomings In a broader perspective, the initial misgivings with regard to the aspects such as implementation of the services and professional opposition have been overcome successfully, and this is the significant achievement. Guillebaud (1953), states “Providing the best service possible within the limits of the available resources has always been the challenge for the NHS. But it has never prevented the NHS striving for - and achieving - ambitious results. The record speaks for itself”. Viewed from the backdrop of increase in the number of people aged at 85 and over from 240,000 at the end of 1956 to 1,024,000 at the end of 2006, it can be said that the NHS has been by and large fulfilling its mission in providing community care to the society, satisfactorily. In mental health, the services are provided in a variety of settings. It takes care of the community psychiatric needs through acute wards with secured provisions as well. The service delivery in respect of learning difficulties has improved over a period of time and has become very diverse to cater to the specific needs. Triggle (2010) states that a huge cultural shift is needed in the NHS in England to ensure children get the right care, a government-commissioned review [The report, by Professor Sir Ian Kennedy] says. Abuse of elders in private setting is also a cause for concern among the professionals. NHS Quality Improvement Scotland (2003, p.1) states that the range of therapy services is available, but there are long delays for occupational and speech and language therapy. Particular problems were also noted in the provision of equipment and wheelchairs. The public expect high standards of treatment / services and advanced solutions to the diseases. Rivett states that the spectre of the rationing of care was never far from the surface internationally, not just in the UK. Therefore, proactive measures in a comprehensive manner to address these shortcomings would improve the situation. 6. Factors governing the performance The legislation is successful on so many fronts and not successful in certain areas. Apart from the increasing cost of providing care and the financial and budgetary constraints, the achievement could fall short of the expectations due to several other factors governing the performance. However, over the period of time funding has been increased by record levels to bring it at par with European standards based on GDP. This commitment on the part of the government makes NHS successful on various fronts. In the initial stages during post-war reconstruction activities, hospitals could not be given priority due to financial constraints and inadequate supply of building materials. Specialists and major hospitals were available only in the cities and not in the rural areas. The progress therefore, was slow. The NHS took off at a time when there was greater developments taking place in the pharmaceutical industry in bringing out new drugs to the markets. Technological developments in the field of electronics brought into the system an array of new instruments and expertise, on the national level. The increase in cost of providing healthcare services, lack of infrastructural facilities and lack of previous experience on the part of the government agencies in running health service were perceived as the major obstacles in the exponentially growing demand for health services. Lingering inadequacies will be a perennial issue where the expectations continue to grow at a rapid pace, always exceeding capacity. Staffing in community services, organization and management and funding have been effectively addressed by the government considering the circumstances. Apart from the availability of resources, consequently sluggish growth in capital expenditure to keep pace with the developments, privatization on a large scale to partly address these difficulties gave rise to certain issues. Powell (2001) points out that it was of concern that some authorities did not have service specifications to use with private providers. In spite of privatization, in some areas the competition is very limited. On the other hand, the entry of larger corporations is feared as it may lead to monopolistic situation in the health services. In the meantime, financial constraints faced by the private service providers and the likely-hood of their business failures raises the question of quality of care. There is growing expectation from the public, on the back of the developments in the industry, for improvements in the services. Consequently the need for increasing the responsiveness of the service to the public is palpable. The expensive drugs for the control of certain diseases like cancer and AIDS have pushed up the cost of services. On the other hand, these medical advances and breakthroughs in bio-technology have improved the quality of treatment and the developments such as imaging and new surgical techniques proved to be cost effective in diagnosis and treatment. 7. Improvement of NHS Performance The factors inhibiting growth of health services need to be addressed with a comprehensive plan by strengthening communication at all levels. Proper networking of the facilities would aid Evidence based practice for better results. Improvement in communication facilitates cost effective outsourcing of services to countries like India, Indonesia and Philippines. This will also introduce competition in private sector service providers. Preventive care should be organized at community levels by encouraging the public through advertisements to participate in the programs. For example, building up of medical history of all the older persons for providing periodical medical check-up would reduce the need for their community care. The visual impairment for instance, if not attended to in time can lead to accidents. Partnership of NHS with local authorities, NGOs and other associations at community level for programs related to environment, diet, overweight, etc. would be effective in community health care in the long run. Scheme for assessment of performance in relation to the targets and encouragement through rewards for good performance at community level enhances commitment of the social workers and other employees. These observations are broad based and not exhaustive as the scope of NHS in providing health service to the nation is very wide and multidimensional. 8. Conclusion NHS seeks to remove inequalities in health care which is fundamentally unfair. The local authorities are responsible for services to the people who need community care. In purchasing necessary services from the providers, private health organizations play an important role as NHS trusts. Though the level of service in residential care as well as home care has improved in line with the medical advances, there would always be a gap to catch up with by the NHS considering the pace of developments and the constraints involved. Networking and communication facilities need to be improved for effective storage and transmission of data which include, reports, case histories, prescriptions and radiographs. This will reduce the cost, improve efficiencies and enhance the level of coordination at the national level. Constant researches and surveys in this field is necessary for integrating the latest medical and technological developments into the system, improving the medical and social care and for eliminating the other hurdles in the mission. References BBC. Fact File : Beveridge Report, WW2 People’s War – Timeline: 1939-1945. http://www.bbc.co.uk/ww2peopleswar/timeline/factfiles/nonflash/a1143578.shtml Guillebaud (1953) Realising the Ambition, The National Health Service: A Service with Ambitions, Chapter Three, http://www.archive.official-documents.co.uk/document/doh/ambition/ch3.htm NHS Quality Improvement Scotland (2003) Physical Disability Services, Review – March 2003. http://www.nhshealthquality.org/nhsqis/files/Physical_Disabilities.pdf Powell, J. L. (2001) The NHS and Community Care Act (1990) in the United Kingdom : A Critical Review, Centre for Social Science, Liverpool John Moores University, UK. Sincronia Fall 2001, http://sincronia.cucsh.udg.mx/nhs.htm Rivett. National Health Service History, http://www.nhshistory.net/shorthistory.htm#_edn7 Spicker, P. Social Policy in the UK: An Introduction to the Social Policy. http://www2.rgu.ac.uk/publicpolicy/introduction/uk.htm Triggle, N. (2010) Huge cultural shift needed in NHS child services – review, BBC News, 16 September 2010.  http://www.bbc.co.uk/news/health-11326060 Read More