Health Policies and Targets within the United Kingdom - Essay Example

Evaluation of the Health Services and Health Polices and Targets within the United Kingdom: A Debate Introduction: There is widespread variation in quality of care in all major healthcare systems in the developed world. In the United Kingdom, where there is a single healthcare system, the National Health Service, the government has introduced several quality improvement measures. These include national guidelines, a system of clinical governance, imposing the importance of delivering high-quality care, and a national inspection system across areas or disciplines. Although there is evidence that the performance of the National Health Services have improved, it is not beyond criticism that there are still glaring deficiencies in services and people's access to these services. The UK National Health Services has long delivered care and public health programmes through primary care. The community oriented primary care based on general practice populations and other health workers has debatably been able to make a significant headway against all odds mainly because of failure of primary care population failing to assume responsibility and proactive ownership of the process involved in improving the health of the population. The ideal would have been tailoring the primary care according to the local needs to a personalized care. Despite predominantly biomedical and humanist orientation, general practice in the United Kingdom has long been infused with knowledge and skills traditionally associated with public health medicine. The philosophy involves protecting, maintaining, and generating good health through a combination of individual and family assessments and provision of a supportive environment. This policy, to be able to be successful, demands closer working relationships between the public and the professional and the system acting as an integrating catalyst between the two and the policies building the ground rules for close collaboration and exchanges. The clinician in this framework has essentially dual responsibility in the sense that he needs to devise and implement anticipatory measures to reduce the risk of a future illness within the guidelines of the framework as well as to treat the disease in case of an incidence. Assuming the responsibility of both community and clinical function is painstaking since this calls for establishment of a new alliance between the health professionals and patient population to co-produce health in a joint venture. Unfortunately even though, this is sound theoretically, practically, the market-oriented reforms in the health services in an attempt to redefine and strengthen the discipline of health services did not help much to improve the perceived the decline in the quality of care. This happened essentially due to a fault in the framework itself. The desired result and improvement was never achieved since the internal market within the service framework tended to separate the roles of health authorities and practitioners. The public health professionals sought to develop strategic planning and purchasing functions within the health authorities mainly to remain in control as they were, and in contrast, the fund holders dismissed the constraining disciplines of needs assessment and service evaluations (Majeed, A., 2003). Child Health Services: It is important to consider child health services in the framework. It is an important indicator for quality of care services. United Kingdom health services pay particular attention to the children in need. Children in need are defined as those who will be unable to achieve and maintain a reasonable standard of health or those whose health or development is likely to be significantly impaired or further impaired without services. This puts in place services for the children in need, for the children with disabilities, with family difficulties, and with poverty. Using school health as an example, the problems are known to be encountered liaising with the education services in organising immunisation or assisting or referring children who have difficult families, who are abused, who have disabilities or other special needs who require healthcare in schools. Despite being protected by law, policies fail to dominate the practice and overpower the red tape to implement the guidelines in the framework (Gordon, D., 2003). Maternity Care: The provision of maternity care is substantially different. It is supposed to be one of the best in the world. In the United Kingdom, all women have an assigned midwife when they are pregnant. The policy entails a collaborative care. As a result, the population can access different modes of care including shared care with the general practitioner who if need be can refer the patient to a specialist care unit. Women may elect to have home births with midwives attending at home. This is the ideal and desired situation, both in terms of patient and family satisfaction in the outcome and also in terms of economic burden on the healthcare system, but in reality unfortunately, only 2% of the births happen in this manner. It is argued that mainly due to this reasons, the birth accidents and cesarean section birth rates are low in the United Kingdom. Antenatal Screening: Antenatal screening is an important tool for ensuring health of the pregnant women and the child to be delivered. The standards of care in the UK health service require antenatal screening in every pregnant woman. The strength of the UK healthcare delivery system lies in this area in the fact that the surveillance programmes are extended to monitor the child's development also in the postpartal period (Hargreaves, K., Stewart, R., and Oliver, S., 2005). The national guideline on Health for All Children enumerates that the National Screening Committee considers evidence for effectiveness and cost benefit before recommending the adoption of screening programmes and the sub-committee on children monitors these activities. When a woman has an infant, the midwife responsible oversees the care of both the mother and the new born through the 10th day of life. After this, the care is supposed to be transferred to the health visitor attached to the relevant general practice where the family is registered. The health visitor is trained in the early child health and development. This activity as enumerated in the framework should continue for 5 years. As a result, the health services and policy framework theoretically have made provisions for care of each child in the country with named responsibility and assignment. Arguably, this is not the case in reality. The reason is resource constraint. That which appears to be a sound policy is marred by the fact that the health visitors rather than covering a patch, are now attached to the general practices and have become a part of the primary care team. The approach of decentralization to ensure better access to care thus again is back to square one at the cost of quality of care. The paediatricians, whether in the hospital or in the community even though are basically secondary or tertiary care personnel, can assume the primary care roles in such situations where manpower and resources are limited. To achieve the quality care in such situations, the framework appears to be rigid in not allowing the paediatricians to assume care in the primary role despite the personnel assigned the role of primary care appears to be inadequate. The result is failure of the agenda and policy (Macfarlane, A. and Mugford, M., 2000). School Health: After delivery, each child is assigned and registered with the general practice. The general practice team continues its primary care clinical role throughout childhood until the school health programme assumes a population-based healthcare role for the children in school-health age. Paediatricians are not allowed to participate in this programme, although they are allowed to serve as community paediatricians in every district. The idea is that in this programme, the paediatricians will be inducted only if there is necessity of secondary or tertiary care. The role of a paediatrician requires, however, a range of skills related to interagency collaboration and population-based public health in association with skills in specialized individual clinical care. They are supposed to provide support and services for children with disabilities and chronic illnesses and would deliver care as members of multidisciplinary teams delivering these cares. It is argued that reality differs grossly from the framework guidelines. Many of these positions are vacant due to lack of personnel and resistance of the primary authority against collaboration. Significant health inequalities still exist for children of the United Kingdom tied mainly to the growing impact of poverty on child health outcomes. The opposition stands strong since the success of immunization programmes in children achieving a 95% coverage points to remarkable capacity of the National Health Service system with local responsibility for monitoring, quality control, and delivery to attain complete coverage of immunization goals. This also indicates that the success of this programme is produced by restructuring the framework guided by the needs. The other programmes related to this area are not successful as much. These are child health surveillance, school health programmes, and other health promotion services. The main reason for apparent failures is the need for development of a comprehensive network of care available to children and their families on an individual and neighbourhood basis, and that is lacking. These need to be flexible, accommodative, and need to be reviewed and restructured on a regular basis. Even if that is done in most of the situations, constraints in resources and foresightedness of the authority prevents that to happen as it would be desired to happen (Oliver, A. and Nutbeam, D., 2003). Conclusion: The UK health system is one of its kinds in the world, but there are still holes in the safety net, and failures exist. The adolescents are known to be not served well by the health systems. There are many other deprived areas and groups, and the irony is that the authorities would not pay much attention until the problem snowballs into a crisis so as to need intervention, modification of policies to achieve goals, and correction of failure. Reference List Gordon, D., (2003). Health Policy in Relation to Improving Equity in Child Health. Pediatrics; 112: pp. 725 - 726. Hargreaves, K., Stewart, R., and Oliver, S., (2005). Newborn Screening Information Supports Public Health More Than Informed Choice. Health Education Journal; 64: pp. 110 - 119. Macfarlane, A. and Mugford, M., (2000). Birth Counts: Statistics of Pregnancy and Childbirth, I. 2nd ed. London, United Kingdom: Stationery Office; 2000. Majeed, A., (2003). Universal Health Coverage In The United Kingdom. Journal of Ambulatory Care Management; 26(4): pp. 373-377. Oliver, A. and Nutbeam, D., (2003). Addressing Health Inequalities In The United Kingdom: A Case Study. Journal of Public Health Medicine; 25: pp. 281 - 287. Read More