The Default Strategy to Deal with Economic Depression: The Impact of Austerity on the Service Use - Essay Example

THE IMPACT OF AUSTERITY ON THE SERVICE PEOPLE USE due: Table of Contents Table of Contents 2Introduction 3 Comparing and contrasting the health policy in the US and Greece to the UK 4 The consequences of austerity in the US and Greek health services 6 How austerity affects health and social care delivery 7 How austerity affects the organisation 8 Loss of organisational activity 9 The Nicholson challenge 10 The nurses work as a leader to improve the health services 11 Application of core concepts and principles 12 Conclusion 14 To sum this up, austerity is a challenge in the health care system because the reduction of health care expenditure restricts its development. The austerity measures are brought about by the financial turbulences experienced by individual states. Some austerity measures result to reduction in minimum wage, loss of employees and reduction in health care services. The most unfortunate fact is that austerity does not come by accident, but it is created by a group of individuals who force institutional difficulties and policies that do not consider the welfare of the people. To fight austerity, organisations should look for other ways of reducing expenditure. For instance, proper use of resources, active stakeholder engagement and reduction of leakage can balance some of the public expenses (Rao 2014:31). When the government is able to cater for health insurance cover to citizens from low socio-economic background can help reduce the gap in health service (Silva & Bucek 2014:148). The government should find ways of funding social programmes for social-economic sustainability (Rao 2015:25-34). Finally, with the continuing NHS changes in the UK, there is an opportunity for other bodies such as NGOs providing support. The old hierarchy of the health care system is taken over by a multilevel and composite equilibrium in power. In the new system the national and regional authorities, GPs, hospitals and local authorities perform a vigorous function in policy and decision-making procedures. 14 Bibliography 15 Introduction Austerity is defined as the default strategy to deal with economic depression (Blyth 2013:128). As argued by Blyth (2013), the main cause of austerity was the activity of bailing that led to debt. The debt resulted in crisis that caused austerity (p. 231). In the health care system, austerity is defined by the budget cuts in public health and care system by the government. The Nicholson challenge was developed by Sir David Nicholson in May 2009. He proposed a way of permitting the NHS to satisfy the growing demand for care without expanding the health budget. This was done through attaining an efficient savings gain between £15 and £20 billion in five years (Great Britain 2013:6). Austerity in a healthcare system is influenced by the procedures the government put in place focusing on economic improvements (Karanikolos et al. 2013:1323-1331). The centre of attention is the cost welfare and market aligned approaches which are anticipated to solve health care system difficulties. From the perspective of human rights, health care improvement and application of actions will influence the affordability and accessibility of health care. They also claim that the health care reforms will lead to certain groups being discriminated, which will go against the right to health (Oebes, Ferguson, Markovic & Nnamuchi 2014:405). This essay will critically analyse the challenge of austerity faced by the healthcare system. It will further describe the effect of the challenge on health policy and nursing practice. In addition, it will analyse the Nicholson Challenge and Five Year Forward View. Moreover, it will compare and contrast the health policy in the US and Greece to that of the UK and how austerity influenced the delivery of social and health care. Besides, this essay will elaborate on how power and abuse of power affect nurses as leaders of change. Finally, it will talk about one of the 6Cs of nursing and continuity of care in adult nursing. This essay will try and explain the question ‘Is austerity a challenge in a health care system?’ Comparing and contrasting the health policy in the US and Greece to the UK Information from the World Health Organisation shows that health policy is defined as the plans, actions and decisions that are managed to attain particular health care objectives in the community. A clear heath care policy describes the future vision that assists in instituting target and reference points for short and long term use in the health care environment. This implies that they are the guidelines set to be utilised in the health care environment. A health policy describes the anticipated functions of various groups and priorities, constructs an accord and notifies individuals (World Health Organization 2014: para 1). The US use more than twice per capita on health care in private and public institutions. The high cost of health care in the US is not caused by the magnitude of the services given, but the high prices charged. For long the US has been distinct in its policy for not requiring private and social enrolment in insurance schemes. However, the US does not provide cheap prime health care services. There are various insurance firms that provide National Health Service (NHS) coverage and social insurance to people. They include Indian Health Service, Medicare, Medicaid and the Veterans Administration Health service (Pharmacy and the US Healthcare System 2013:27). More than fifty million American citizens lack health insurance and according to the federal law, are entitled to ‘stabilisation’ of high-risk medical state. The proper use of the Patient Protection and Affordable Care legislation, the US just like the UK, depends on the restricted private insurance market and a person is expected to buy a health care cover against an event of illness. The United Kingdom provides health care insurance to its citizens who are not able to buy insurance in the private market (Linden 2010:101). Additionally, the US federal government does not give insurance coverage to people who cannot pay health care insurance in the private market (Béland, Morgan & Howard 2014:117). Both the US and the UK have expanded concern about the standard and result of care that is pushed by the developing shortages in care and public events (Rasmussen, Howard & United States 2013:82). The two countries have initiated structures to deal with these matters. The initiatives focus on the larger system, organisation, individual and group levels. There are various elements that affect efforts by the two countries which they should balance the quantity of trade-offs in centralisation and decentralisation in attempts to maintain the standard of enhancement over time (Ferlie & Shortell 2001:281-315). In Greece, access to health services is influenced by occupational and citizenship status. The health system is funded by the private payments, state budget and social insurance allowances (Voncina et al., 2006: 1-108). The biggest share of health disbursement comprises of private spending in the form of personal payment that leads to increasing in health spending. Unlike the United Kingdom, Greece does not have a good framework on delivery of services, organisation and financing (Mossialos, Allin & Davaki 2005:151-168). The high amount of private spending is in contrary to the principle of equity and fair financing in health care services (The European Observatory on Health Systems and Policies 2010: xv). This is different from United Kingdom where the health services are free. The National Health Service (NHS) gives preventive drugs, hospital services and primary care to ‘ordinary resident’. Voluntary Health Insurance schemes referred to as private medical insurance covers over 12% of the population. The private medical insurance provides access to the private sector for critical elective care (The European Observatory on Health Systems 2011: xviiii; Ifanti, Argyriou, Kalofonou, & Kalofonos, 2013: 8-12). The consequences of austerity in the US and Greek health services In the US, the prime players in health service are the state and the medical profession. The government insurance was developed, and the doctors were subjected to it. The result was generous payment and professional self-regulation to make sure the doctors submitted to the state authority. The business and political leaders view the cost of health service as very expensive (Kane, Singer, Clark, Eeckloo & Valentine 2012:1680-1689). The leaders in the private and public welfare view their role as ‘payer’ not guarantor and this lead to the parties regulating the amount paid. The U.S. Medicare scheme embraced new regulations on physician spending and hospitals. In regard to this, the U.S. doctors do not have authority because their decisions are micromanaged, and their fees are negotiated. In addition, the health plans are undertaken with chosen providers, and this gives the providers power in health care politics (Brown 2012: 1597439). The professional influence is reduced by a public authority’s move to minimise the development of medical expenditure through budgetary controls and new regulatory. In the USA, the two public health insurance programme that consist of Medicaid and Medicare and private health schemes control provider fees (Levin & Shapiro 2004:30). In Greece, the biggest sickness funds that cover over ninety percent of the population are joined into National Organisation of Health Service Provision. The institution main function is to provide primary care that consists of pharmaceuticals specified outside the hospital and diagnostic tests. The primary contributors are the employer and employee grants for sickness funds and the state support through subsidy in annual GDP at 0.6 % (Triandafyllidou, Gropas & Kouki 2013:171). The government provided money to cater for primary care of farmers in rural health facilities and outpatient hospital departments. This created a problem because the doctors giving care to members of National Organisation of Health Service Provision did not have a specified salary. As a result, the physicians were permitted to work part time for the institution and practise privately. In the organisation setting, the doctors were allowed to provide free 150 or 200 consultations to patients in a month for a fee of €10 per visit. This led to compromise in the health service since the patient was not aware if he/she was among the 150 or 200 free visits in a month (Triandafyllidou, Gropas & Kouki 2013:171). The health service was in chaos because the doctors were complaining over unpaid fees for services given. On the other hand, the patients protested because the doctors charged illegal fees and were not available. The institution complained that the doctors did not cooperate and that the government gave inadequate funds. This leads to a violation of human right to health because the individuals in need are not able to consult doctors. In the community setting the health, service is faced with inadequate staff and shutting of some clinics (Kentikelenis & Papanicolas 2011:190). How austerity affects health and social care delivery The politicians through adopting strict austerity standards and trimming principle social programmes at a time when people need them have resulted to the destruction of many lives. It is caused by misinformed trials to bring the shore up financial market and budgets to an equilibrium (Stuckler & Basu 2013: 26). The cuts in disability benefits state that the working-age households should obtain £500 in a week. The households receiving allowances from disability living allowance, a new personal independence payment, the support component of employment and support allowance (ESA) and attendance allowance are exempted. The disabled individuals included in the cap under ESA, receive income support, housing benefit, child support and carer’s allowance. Majority of the disabled people are not exempted from the cap and are, therefore, their lives are affected (Shaping our lives 2013: para 2). According to Slay & Penny (2013), the austerity affects most the disabled, the elderly, low-income earners, the unemployed and the young. The low funding by the local authorities results to projects coming to a stop or promote corruption where the projects must go on (Slay & Penny 2013:23). From the perspective of service delivery and providers, austerity has resulted to loss of experienced and valuable employees in service delivery. There is no ability to satisfy the increasing demand for services because of trimming on staffing and resources. From the perspective of service providers, there are increasing workloads and bad terms and conditions for employees. Most of the staff feel stressed and demoralised that makes it difficult to retain employees in community and public sectors. The standard of service delivery is also affected and of low standard (NatCen Social Research (n.d.):11). The people given funded social care are reduced by 40% since 2009. The move towards individual budgets and personalised services has resulted in most of the day centres shutting down. The provision of prime services such as meals on wheel has also stopped. According to Klein (2010), austerity has resulted in the cancellation of operating schedules, shortage in staff and bed closures (p.145). In history, the NHS closed the biggest number of ward beds in 1977, 1978, 1987 and 1988. Klein argues that towards the end of the financial year it was normal to have temporary closing of wards. This happened as a result of NHS cutting down the budget from 4 to 1.3 percent between 1987 and 1988 (Klein 2010:145). Therefore, austerity has resulted in many walk-in centres closing at night. According to Monitor (2014), the walk-in centres are closed when the demand is high. This is at a time when ambulances require medical attention (p.79). The paramedics need the services provided by the walk-in centres to give treatment to a patient (Monitor 2014:79), but they cannot do so. How austerity affects the organisation The austerity affects both the public and private sector organisations. The organisations work toward a fiscal responsibility and equitable budgets that are ‘meaner and leaner’. The effect of austerity is experienced in increased work stress of the office holder (Dewe, Cox & Leiter 2003:243). The austerity in organisations is mainly under two categories: a) Severity Austerity will impact on objectives, survival or programme probability, availability of other funds, size and frequency of cuts, and existing institution lack of activity. b) Time pressure The austerity in the organisation affects the clarity of data, response time, and quantity of forewarning and the duration of cuts. The more the time pressure and the severity related to budget cut the higher the possibility of encountering stress in an institution. The impact of austerity in an organisation is experienced through tense organisational environment, personal and job life conflict, and poor incentives (Burke & Leiter 2000: 232-258). In addition, job insecurity, inadequate engagement in decision making and work overload. There are twelve dysfunctional organisational outcomes caused by austerity, including the following: decrease in morale, loss of organisation activity, and lack of credibility of top management. In addition, the surfacing of politics, the curtailment of innovation, and the absence of long-term planning, centralisation and scapegoating are dysfunctional outcomes. Moreover, resistance to change, turnover, and in-fighting and across the board instead of prioritised cuts are some of the dysfunctional outcomes. Loss of organisational activity Different austerity procedures and diminished public expenditure incapacitate the social and physical infrastructure to manage different exceptional occurrences. These happenings lead to more abandoning of the weak population, and the recovery becomes more expensive. The cost of recovery is high because of inadequate money for minimising the possibility of unfavourable results. The loss of jobs, closure of local facilities, the erosion of public sector pensions and home foreclosures contribute to the lack of organisation activity. In addition, lack of employment protection in employees’ transfers as a result of cuts in spending leads to loss of organisation activity (Rao 2015:37). The Nicholson challenge The Nicholson challenge refers to a set of decrees that Sir David Nicholson outlined in regard to National Health Service in England (NHS) (Garber 2011:4). The decrees were supposed to find ‘efficient savings’ in the middle of the UK economy turbulence. It entailed a request by Nicholson for the NHS to get ‘efficiency savings’ of £15 to £20 billion by 2015. He implied that better methods of working must be established instead of more expenditure. He warned that if the challenge was not fulfilled more money would be required, or minimum desirable outcomes would be attained (Great Britain 2013:2). The Five-Year Forward View to support the Nicholson challenge states that to save £20 by 2015, the Department of Health commenced QIPP challenge (quality, innovation, productivity and preventive) initiatives (Great Britain 2012:12). The committee for the Department of Health mentions the QIPP as the Nicholson Challenge. In addition, the committee proposed that the implementation of the Nicholson Challenge needed a different approach in the manner care, and health services are conveyed (Great Britain 2012:13). The plan targets to save 40% through minimising the tariff in the acute sector that constitute £2 billion per year. Currently, the tariff covers £30 billion income per year for trusts; therefore it indicates a gain of almost 7% per year in productivity. Likewise, necessities and local factors to detain money to satisfy the limits for surpluses and forward to the coming year and react as a guard to fulfil the government’s expenditure reforms (Great Britain 2012:66). The quality initiative focuses on preserving the quality and well-being standards while embracing the strict techniques one of them is the NETS (North East Transformation System). The innovation initiative entails utilisation of the invention, innovation and adopting new concepts to implement the North East strategy into force (Department of Health 2013: para 4). The prevention initiative is concerned with maintenance of significant fair and better health. The productivity is the principle value of the policy. The productivity initiative position QIPP with the financial provocations anticipated in the NHS starting 2011/12 onwards and outline the 15 to 20 percent cost enhancement through cash-releasing. The QIPP initiatives put more emphasis on general practice on leadership in particular personal job designation (Mcsherry 2012:236). The nurses work as a leader to improve the health services Leadership is the procedure of recognising targets, giving motivation to other individuals to act, and giving motivation and support to attain mutually discussed objectives. For a nurse to perform a leadership role he/she must possess the leadership skills. A nurse leader is a visionary with strategies, ideas and aspiration to manage their services and teams to subsequent goals. An efficient nurse leader utilise problem-solving procedures, preserve group efficiency and grow group identity. The nurse leader is passionate, possess motivational effect on other individuals, seek to motivate others, dynamic and focus on solutions. The nurse leadership basically consists of resolving conflict, acting with integrity, making decisions, and delegating appropriately. In addition, they develop and are conscious of the feeling of other staff. These aspects are geared toward linking leadership with successful growth of the team members (Nursing Times 2014: para 5). In regard to the political context, the nurse leader respond to the dynamic health care surrounding that includes expectations by the organisation and change to national and local policies. The role of a nurse leader as an advocate he/she is obligated to take and be alert of suitable action in regard to any situations of illegal, impaired, unethical and incompetent practice. The nurse leader works in collaboration with other health care givers to make easy ethical decision making and enhance patient care (Wittmann-Price & Thompson 2010:475). In addition, the nurse leader can summon other medical professionals to take part in family care discussions in relation to ethical issues. The role of a nurse in advocacy comprises of three parts; (1) to notify the patients of their rights in specific circumstances; (2) to make sure the patient is offered the essential information to guide in decision making; (3) to reinforce patients decisions (Society et al., 2011:63). According to Society et al., (2011), the responsibility of a nurse in patient advocacy is to preserve patient privacy, respect, security, safety, preserve and enhance human diversity, dignity, autonomy and rights (p.63). According NMC code of conduct, a nurse leader should collaborate with others to promote and safeguard the wellbeing of the patients under care, carers, community and their families (Nursing and Midwifery Council 2008:3). The nurse should act promptly if the patient is at risk because of actions conducted by fellow staff or any other person. Likewise, the nurse should report to the authority if there are difficulties that hinder performing his/her role under the code of conduct. Furthermore, a nurse should notify the appropriate authorities in writing if the difficulties in the care setting pose individuals at risk (Nursing and Midwifery Council 2008:3). Application of core concepts and principles I will discuss the concept of care in the 6Cs of nursing and continuity of care in the elderly. Caring in the aged enhances their holistic welfare despite the existence or lack of illness. The health promotion endeavours focus on preserving the ability to take care of the elderly. The self-care concept consists of three terms that are utilised together to outline various factors of a person’s attempts to retain maximum functionality and health (Anderson 2011:104). The self-care deficit applies when an individual cannot take care of self. In such a case the majority of the people require nursing or medical intervention. The nurses employ activities for daily living (ADLs) which are the core for self-care occupations of the elderly (Benzel 2012:693). The self-care includes acquiring personal control on an individual’s health. In addition, self-care involves embracing the healthy lifestyle behaviours concerning nutrition, fitness and relaxation. Moreover, it consists of training on how to accomplish the expected changes. The nurses duty is to provide activities that will enhance the self-care expertise for example group or individual activities (Kramer-Kile & Osuji 2014:480). The setting is used to teach the patient on how to become an enlightened medical user. The patient is given the screening and prevention guidelines, for instance, prostrate assessment and mammogram. The nurse must make sure the habitat is conducive to help the elderly to utilise the knowledge to make decisions and accept self-responsibility. The nurse is supposed to be a partner in caring of the elderly and provide the necessary information required by the patient (Brunner & Smeltzer 2010:1391). This enables the elderly to make a decision on the treatment to be undertaken. The elderly get the opportunity to learn on ways of enhancing their health through managing stress effectively, avoid alcohol misuse, taking medications safely and sustaining a nutritious diet. The elderly recognise that self-care encompassed habits that enhance health and the standard of life. Conclusion To sum this up, austerity is a challenge in the health care system because the reduction of health care expenditure restricts its development. The austerity measures are brought about by the financial turbulences experienced by individual states. Some austerity measures result to reduction in minimum wage, loss of employees and reduction in health care services. The most unfortunate fact is that austerity does not come by accident, but it is created by a group of individuals who force institutional difficulties and policies that do not consider the welfare of the people. To fight austerity, organisations should look for other ways of reducing expenditure. For instance, proper use of resources, active stakeholder engagement and reduction of leakage can balance some of the public expenses (Rao 2014:31). When the government is able to cater for health insurance cover to citizens from low socio-economic background can help reduce the gap in health service (Silva & Bucek 2014:148). The government should find ways of funding social programmes for social-economic sustainability (Rao 2015:25-34). 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