Health Policy Delivery in the UK - Essay Example

Health Policy Delivery Introduction: Dorey (2005) suggested that when it comes to public policy, the following questions are addressed: Who sets the public policy agenda Who influences the detail of public policy What makes for successful implementation of public policy Is there such a thing as 'British' public policy In contrast or in congruence, Nathanson (2007) opined that authoritative knowledge in principle, is essential to the definition and analysis of dangers to the public's health and to the deployment of an effective response. "How and by whom this knowledge is framed, to whom it is addressed, and its relative acceptability have shifted with time and circumstance," (82). Policy makers employ various initiatives to improve the management of every sectors and individuals concerned. In this essay, policy delivery in the United Kingdom health sector shall be discussed. Discussion: Health policy deals with the health care system, public health system, or the health of the general public and involves identifying or framing a problem; identifying who is affected or the stakeholders; identifying and comparing the potential impact of different options for dealing with the problem; choosing among the options; implementing the chosen options; and evaluating the impact. Stakeholders include the government, private healthcare providers such as hospitals, health plans, office-based clinicians, industry groups or the pharmaceutical, biotechnology, and medical device manufacturers and marketers, professional associations, industry and trade associations, advocacy groups, and consumers (Donaldson and Gerard, 1993). In the policy process, UK health policy encompass knowledge and effects on the networks between national government systems, arm's length bodies, the NHS, patient groups and charities, as well as information and processes in the Demand-side reform, Supply side reform, Transactional reform, Regulation or the Healthcare Commission, NICE, Therapy knowledge of gastroenterology, dermatology, cardiovascular medicine, anti-infective, sleep medicine, pain management, palliative care, oncology and neurology, identifying and utilising opportunities arising from non-medical prescribing, effective collaboration with patient groups, medical societies and Royal Colleges, managing national and regional guideline programmes producing timely responses and positive outcomes, knowledge of controlled drugs legislation, implications for commercial teams and preparation of submissions for Home Office consultations, knowledge of the NHS changing environment and incorporation into business plans and strategic marketing, Parliamentary lobbying - understanding the process, networking and influencing, submissions to Government organisations including the Home Office and Health Select Committee (Donaldson and Gerard, 1993). A policy is a deliberate plan of action that guide decision-makers in order to achieve rational outcomes that apply to governments, the private sector, organisations and groups as well as individuals (Jenkins, 1978). Policy could also refer to the process of making important organizational decisions, such as the identification of different alternative programs or spending priorities, or choosing among a list on the basis of the impact or result they will have. These can be political, management, financial, and administrative mechanisms arranged to reach explicit goals and objectives (Birkland, 2001). Birkland (1995) have pointed out that while "the study of politics has a long history, the systematic study of public policy, on the other hand, can be said to be a twentieth century creation. It dates, according to Daniel McCool, to 1922, when political scientist Charles Merriam sought to connect the theory and practices of politics to understanding the actual activities of government, that is public policy," (p.4). In most instances, according to Bridgman and Davis (2004), the eight step policy cycle includes: 1. Issue identification - In this process, emerging problems are identified, although those with visions could provide insight long before problems become obvious. In identifying health issues, Nathanson (2007) chronicled health issues on tobacco use and HIV in progressive UK, US and France using grassroots, scientific expert as well as medical field contribution in the process of the policy-making. 2. Policy analysis - Involves critical as well as careful deliberation on the impact and other effects prior to, during and after the implementation. 3. Policy instrument development - Refers to studies, scientific and academic observations, as well as all processes and material inclusions that are encompassed within the process of establishing a policy. 4. Consultation - This permeates throughout the entire process wherein experts, academic personalities, government authorities as well as organisations and advocate groups and individuals are considered for their experience, opinion and observation on certain matters that could harness a better output. 5. Coordination - This refers to the interaction and exchanges of cooperation between agencies, groups or organisations and individuals in the process of delivering health and healthcare policy to the public. 6. Decision - This is relegated to the authorities who have an important role in the process of creating and developing social and healthcare policies. 7. Implementation - The National health Services, among local and national government agencies, in cooperation with private and individuals, groups and organisations and all stakeholders work hand in hand in the process of delivering and implementing health and healthcare policies. 8. Evaluation - This is the stage where effects or results are validated, observed and noted, as well as indicated where results and goals or objectives are attained or not. The contents of a health policy are promulgated through official documents with standard formats particular to the organisation issuing the policy but components may include: The purpose statement, outlining why the health organization is issuing the policy, and what its desired effect is. The background indicating the reasons and history that led to the creation of the health policy, which may be listed as motivating factors Definitions that provide clear and unambiguous meaning for terms and concepts found in the health policy document. The applicability and scope statement, indicating and describing who the health policy affects and which actions are impacted by the policy. The applicability and scope may exclude certain people, organizations, or actions from the health policy requirements Date which indicates when the health policy comes into force. There could also be retroactive health policies but these policies are rare. A responsibilities section that indicate the parties and organizations responsible for carrying out individual health policy statements. These responsibilities may include identification of oversight or governance structures. Policy statements that indicate the specific regulations, requirements, or modifications to organizational behaviour that the policy is creating. Policies may be broken down into various types as follows: Distributive policies which extend goods and services to members of an organisation. It may also distribute costs of the goods or services amongst the members and these include government policies that impact spending for welfare, public education, highways, public safety or a professional organisation's policy on membership training. Regulatory policies which are also called mandates employs limitation on the discretion of individuals and agencies while it may also compel certain types of behaviour generally applied in situations where good and bad behaviour are regulated and punished through fines or sanctions. Constituent policies deal with laws and may create executive power entities. Miscellaneous policies are dynamic and are not static lists of goals or laws where blueprints have to be implemented, although with unexpected results. These are mostly social policies that happen on the ground and at the decision making or legislative stage. Healthcare Policy may be relegated under social policy and could be influenced by international as well as local negotiations and issues. One such instance was as described in the implementation of the United States Marshall aid to European countries between 1947 to 1951 contingent upon bilateral agreements about major issues of economic and social policy. The implementation of the Marshall Plan in Britain has coincided with the inception of the National Health Services or the NHS so that bilateral agreements has encompassed the relationship between economic recovery and a new health policy that offered universal coverage for services fully funded from tax receipts (Fox, 2004). Nathanson (2007) noted that "Policymakers require authoritative advice. Authority in public health is presumed to reside with experts in medicine and public health (but) the credibility of experts and their power relative to other actors in the dramas of public health are limited, subject to a variety of contingencies," and concluded that "expert credibility and the authority of knowledge are contingent on the characteristics of political regimes; on the social and political location as well as the framing expertise of "knowledge brokers"; and on fortuitous conjunctions of timing and opportunity. He had cited the development of the anti-smoking policy tracing influences from the grassroots advocates of the US to the publication of the Froggatt report in Britain that "provided a more powerful engine for driving policy," (76). He went on to claim that "Belief in the authority of science and distruct of energetic zealots are as much part of the public health policymaking environment in France as in Britain," (77). In his observation depicting the HIV health policies between the US and the UK, Nathanson 92007) pointed out that major differences in the policy initiatives between the two countries are: the uneven British history of treating the use of narcotic drugs legitimately within the purview of medical experts; the hermetically-sealed British political system that allows controversial policies to be decided and implemented by "delicate manoeuvrings, parliamentary persuasion and political stealth; the fortuitous circumstance that community-based programs for drug users had been initiated by civil servants within the British Department of Health of which response emerged out of "an essentially private world where policy was made by accommodation between experts and civil servants," (Stimson and Lart, 1994). This means that the public opinion was not acknowledged and that voices of voluntary organisations and advocacy groups were channelled through government-appointed advisory committees of the so-called "the great and the good," (Nathanson, 2007). Nathanson (2007) went on to identify contingencies that exemplify the variability and negotiability of expert knowledge that provides a basis for inferences: Regime contingencies was pointed out by Nathanson (2007) as hierarchical systems of political consensus that uphold the regime itself and simultaneously guarantees the authority of accredited experts and of the knowledge they purvey. He has contrasted this with the US where individualistic system as against UK's centralised, where experts compete in the open marketplace and knowledge is defended at every turn. The normative distinction between the competing and consensual cultures of knowledge lies in the pathways by which expert knowledge enters the political system and becomes part of the policy decision process. The hierarchical or centralised regime employ a strategy of incorporation where competing voices are muted through a channel of the government structure. It has also been pointed out that the dominant British model of science is "a craft activity involving accumulated experience and refined intuition, which cannot be formally specified, codified, and externally checked. Only other mature experts can judge, and their judgements are legitimately inaccessible except to a certain privileged and socially trustworthy few," (Miller, 1999). Belief contingencies - Nathanson opined that qualification of knowledge depends partially on the normative beliefs of political gatekeepers although there is an enormous certifiable knowledge that legitimates policy decisions where demand for technological and scientific knowledge to guide and inform, or bolster public policy is enormous. Although policy-makers need experts, analysis and advice is filtered through political requirements and ideological beliefs. Knowledge broker contingencies: status and expertise. Nathanson pointed out that knowledge brokers are interpreters of science among scientists and journalists, and persons in various levels of government office. Their influence also depends on the nature of the political regime. They must have sufficient clout to be heard, but they also need to be persuasive, and expert in framing and interpretation of knowledge in politically and ideologically acceptable forms. Timing and opportunity contingencies - play critical role in what is or not held to constitute knowledge. Conclusion: In the process of health policy-making and delivery, it is of importance, as emphasised by Nathanson, to give due to where credit is due. Health and science experts must sit side-by-side with government authorities in order to provide a clear and more sweeping reform as well as regulations within policy context, for the good of the individual as well as the majority. Health policy encompasses not only delivery of much needed care and intervention of patients but safeguarding the whole population, whether they are robust and healthy or in need of intervention. It must be therefore the prerogative of every health authority within the enclave of the government system to enlist the active participation of health and science experts and so-called "zealots" or advocacy groups and individuals to maintain a progressive stance in developing timely health and healthcare policies. References: Thomas Birkland (2001) An Introduction to the Policy Process Bridgman, Peter & Davis, Glyn (2004) The Australian Policy Handbook (3rd ed) Sydney: Allen & Unwin Donaldson, c. & Gerard. K. (1993) Economics of Health Care Financing.London: Macmillan Dorsey, Peter. (2005). Policy Making in Britain. Sage. Fox, Daniel (2004). "The Administration of the Marshall Plan and British Health Policy." The Journal of Policy History 16 (3), 192-209. McCool, Daniel C. (1995). Public Policy Theories, Models, and Concepts: An Anthology. Englewood Cliffs, N.J.: Prentice Hall Miller, David. (1999). "Rish Science and Policy: Definitional Struggles, Information Management, the Media and BSE." Social Science and Medicine 49, 1239-1255. Nathanson, Constance (2007). "The Contingent Power of Experts: Public Health Policy in the United States, Britain, and France." The Journal of Policy history 19 (1) 71-94. William Jenkins (1978). Policy Analysis: A Political and Organizational Perspective Read More