The National Health Service, Social Care and Independent Sectors in the UK - Coursework Example

Critical Discussion of the NHS, Social Care and Independent sectors in the UK Student’s Name Instructor’s Name Course Code and Name University Date of Submission Critical Discussion of the NHS, Social Care and Independent sectors in the UK Introduction The National Health Service (NHS) has been the pioneer publicly funded healthcare system in the UK making it the oldest in the world. This system has been supporting legal residents of the UK by providing hospital services for free and at lower rates at the point of use. The health sector in the UK has changed over the years with changes in form of health care reforms taking place in the UK. The aim of this research is to make an assessment of the NHS by comparing the system as applied in England, Wales, North Ireland and Scotland (McBain 2006, p. 8). Further, the research would analyze the social and independent sectors in the UK. In addition, the research would analyze the role of the Nursing and Midwifery Council in relation to regulating the conduct and practice of the nursing and midwifery profession in the health organizations. More so, the research would try to provide an understanding of the Policy and Standard of Care and Legislation of Nursing Practice. The research will analyze the Code of 2008, which provides standards for conduct, ethics and performance for midwives and nurses. This will be helpful in developing the theoretical framework that would relate the standards to patient care in the UK. The importance of the analysis is to identify the strengths and weaknesses of the NMC code in relation to the theoretical framework. Background of the NHS The NHS was established in 1958 by the then health secretary Aneurin Bevan with the primary goal of making good healthcare available to everybody regardless of their wealth or status in society. The system was to work in such a way that the health services were financed purely on taxation, which citizens paid according to their means. In the period between 1948 and 1974 the NHS operated a tripartite system where it was structured into three parts namely primary care, Community services and hospital services (Greer 2004, p.10). The primary care part was made up of medical practitioners who were independent contractors and the executive councils, which administered contracts and dealing with patient complaints. Community services involved maternity and child welfare clinics, health visitors, health education, vaccination and immunization. Finally, hospital services consisted of 14 regional hospital boards established in England and Wales to manage hospital services. Devolution in the UK meant that the four nations namely England, Scotland, Wales and North Ireland pursued different models in relation to their NHS policies. Specifically, Scotland bent on professionalism, England on markets, Wales on localism and North Ireland on permissive management (Greer 2004, p. 10). This signified the implications of politics on the direction of each health services and policies in the UK. In particular, Scotland’s professionalism model tried to align hospital organizations with the existing structure of medicine where clinical networks were encouraged. This increased the role of professionals in resource and rationing allocation. The model based on Wales localism integrated health and local governments in order to coordinate care by focusing on determinants of health instead of treatment of the sick (NHS Wales 2011, p.5). On the other hand, the market model as applied by England on its NHS system made use of independent trusts that are similar to private companies, which contract each other while other thirty regulatory organizations ensure quality of services. Under this model regulation, competition and management are key to value creation for health spending. The North Ireland approach was focused on keeping services going in tough conditions while producing little with regard to overall policy and enforcement. Social Care Sector in the UK Social care services cover people in need of support due to disability, illness, poverty or old age. In particular, the local authorities were responsible for providing social care but had the option of providing the services directly or through independent institutions under the supervision of the local authorities (Kress 2003, p.121). The Poor Law and the Public Assistance following the Local Government Act of 1929 were the only publicly funded social care in the UK. It was until 1834 that the Poor Law was amended to withdraw relief from those people who were deemed capable to work. In 1929, the Local Government Act transferred all the powers under the Poor Law to public assistance committees of local councils. It was the implementation of the National Assistance (NA) Act of 1946 established the National Assistance Board (NAB) which took up the social care services and divided old and disabled people into the sick, who were placed in hospital and those requiring care who were placed under residential homes that the local authorities were supposed to avail (Kress 2003, p.123). In comparison to the NHS services that were free at point of delivery, social care services were charged based on means-tested charges by the local authorities. In Wales for example the care and social services inspectorate (CSSIW) is responsible for regulating and inspecting the all the registered service providers with regards to social services for the people in Wales. The CSSIW registers service providers, inspects the services and provides an independent appraisal through reports and receives complaints and concerns from users of the services (Care and Social Services Inspectorate Wales 2007). The difference between the Wales social cares system and the UK system is that services are provided by independent entities as opposed to that involving the local authorities. Independent Sectors in the UK The independent health care services providers have in recent times been on the rise since the public sector has been contracting independent providers to offer home care and health services. Although the four governments have had different approaches to independent service providers, England has been spearheading this approach out of their market model. It is these councils that contract the independent providers to provide homecare services. The local councils have been having challenges with regards to cuts in their budgets, thus have had to re-assess those eligible for care and now offer support to only the one that require critical or substantial needs. More so, the independent sector has found it hard to work with the contract prices offered by the local authorities as they have had to prioritize cost over quality since prices have failed to integrate the impact of inflation when being calculated. The independent sector currently provides about four fifths of the publicly funded homecare (UKHCA, 2013, p. 5). However, the current regime in England has adopted the principles of the Dilnot Commission Report which proposed a cap to be set in order to limit the contribution people were required to make to their own care, and also provided an extended means test (UKHCA 2013, p. 5). Understanding of Policy and Standard of Care and Legislation of Nursing Practice The Practice Standards and Guidelines for Nurses and Midwives with Prescriptive Authority which came into effect on 1st December 2010 replaced the 1st Edition of 2007 of the Practice Standard for Nurses and Midwives with Prescriptive Authority. This legislation was founded on a dual framework of professional regulation and medicines legislation. It is the medicines Regulations that is the first framework for providing specific legal authority for a nurse and midwife to prescribe. The second framework was established by the Bord Altranais which is the statutory regulatory body for nurses and midwives through the professional regulation and guidance for the registered nurse prescriber as part of its function under the Nurses Act of 1985. However, its overall responsibility is in the interest and protection of the public. The professional regulatory framework for nurse and midwives is established through the Nurses Rules of 2007 and was amended through the Nurses Rules of 2010 which allowed for the creation of a division of the Register for Nurse Prescribers. Over the years the Bord Altranais has developed guidance documents which included the guidance to Nurses and Midwives on Medication Management (2007), Recording Clinical Practice-Guidance to Nurses and Midwives (2002), Practice Standards for Midwives (2010), The Code of Professional Conduct for each Nurse and Midwife (2000), and Scope of Nursing and Midwifery Practice Framework (2000). This provides the legislative framework that enables nurses and midwives to conduct and practice professionally. The policies and standards that regulate nursing practice in the U.K guide the licensed nurses and midwives on their day-to-day conduct when in hospital organizations. The task of development of policies and standards related to the nursing practice lies squarely on the Nursing and Midwifery Council which is the regulatory authority in the U.K. the policies and standards relate to the standards of practice and code of ethics that nurses and midwives have to adhere to as well as guidelines relating to the training of nurses. Also, the policies provides a uniform way of regulating the nursing profession as well as providing continuous assessment by monitoring implementation of the said policies both by hospital organizations and nursing professionals. It is these policies that ensure that nurses are provided with a good working environment so as to ensure they adhere to particular standards relating to their conduct. The code is one such policy as it provides the standards of conduct for both nurses and midwives. The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives The Code as famously know came into being in 2008 and which provided the standards for training and conduct of nursing professionals in the health organization in the UK. The Nursing and Midwifery Council (NMC) is the regulatory authority for nurses and midwives in England, Wales, Northern Ireland and Scotland (Nursing and Midwifery Council 2010). A register of both the nurses and midwives is maintained by the NMC for those currently in practice and is responsible for renewing membership and removal of nurses from the register due to failure to uphold standards set out. The NMC is responsible for setting standards for education, training and conduct that midwives and nurses in its quest to ensure that they deliver high quality healthcare over their careers (Nursing and Midwifery Council 2010). It is the role of the NMC to ensure that nurses and midwives constantly update the knowledge and skills and upholding the standards of their professional code. The first standards for the code requires nurses to treat each person different from the other by respecting their dignity (Nursing and Midwifery Council, 2008, p. 2). It is the role of nurses to help people who need their services in order to ensure they access the relevant social and health care as well as support and information. The code emphasizes on the need of medical practitioners to uphold confidentiality (Nursing and Midwifery Council 2008, p. 2). Further, they are required to always seek permission or approval from the patients before any treatment or care is begun. The code bars nurses from accepting hospitality in form of gifts from patients or members of their families by maintaining clear professional boundaries (Nursing and Midwifery Council 2008, p. 3). There are standards requiring nurses to always consult their colleagues so as safeguard those under their care (Nursing and Midwifery Council 2008, p. 2). They are allowed to work under teams where they share their skills and experience and also allowed to delegate their duties to practitioners who are able to carry out the instructions. The code further provides guidance with regard to management of risk as it provides that nurses should report to higher authorities when they experience problems in their environment of care. The final standards for the code cover integrity and reputation with regards to professional nurses (Nursing and Midwifery Council 2008, p.8). They are further required to uphold the laws of the respective countries where they practice and inform the NMC when they have been charged or found guilty of any criminal offences (Nursing and Midwifery Council 2008, p. 8). Registered nurses are required to inform their employers when their fitness to practice has been brought to question. In real sense, the code provides a guide on the conduct of nurses and midwives in a hospital environment. Strength of the NMC Code The code is anchored on equality and integrity as most of the standards center around them. It tends to provide solutions to the challenges that are experienced by nurses in real life when in practice (Robinson 2009, p.9-10). In particular, the requirement with regards to hospitality and gifts ensures that nurse do not give preferential treatment to patients or members of their family. This ensures that the interests of the patients are taken into consideration thus increasing accountability. The aspect of managing risk makes sure that nurses are responsible and accountable for their actions as they are allowed to consult widely before addressing an issue that is risky so as to take into consideration the wellbeing of the patient (Lipley 2009, p.7). Where the nurse is allowed to gain consent from those in authority enable them to consult widely as required by the code providing a trend where standards complement each other and help in understanding other standards. The code provides for written evidence in case of problems in the environment of care, especially where the NMC is conducting investigations with regards to concerns and complaints from patients or members of the public with regards to the practice of a particular nurse or midwife. Evidence is demanded when medical practitioners are delivering care to patients. Record keeping has also been discussed under the code as it has emphasized on the need for accurate and up-to-date information with regards to events that take place with regards to assessment, treatment and medication given to patients. This allows for audit trail to be established in case of professional negligence for insurance providers and the NMC during the assessment and appraisal of nurses and midwives (Lipley 2009, p.7). The other strength of the code is that it provides for dispute resolution measures, which include internal and external investigations where the medical practitioner is required to provide defense under such conditions. It further, applies the common laws legislated in the four nations by ensuring that nurses apply the standards hand-in-hand with the laws of the nations they practice from. The code also recognizes that the care environment requires the input of different professionals with different skills and experiences, provides standards that guide the engagement of nurses in such teams in relation to how they are supposed to share their knowledge and skills. In addition, the registration of nurses and midwives is on renewable terms where the nurses are required to seek registration after a year, or three which allows the NMC to monitor how they have fared in terms of learning and developing their performance and competencies. This allows nurses to update their knowledge by attaining new skills from the regular learning thus enabling them to deal with new problems in relation to their services (Mac Lellan 2007, p. 28) Weaknesses of the NMS Code of 2008 The code of 2008 has been criticized for not addressing in detail particular aspect in relation to the conduct of nurses and midwives, which will be discussed under this section. To start with, the code fails to provide more information with regard to the fitness to practice for a professional is called into question. In addition it only provides standards for the conduct of nurses and midwives but does not address the environment where they operate from; there are no standards for reporting concerns thus do not encourage communication in a hospital organization. This explains the conflict that exists between the professional medical practitioners and the health structure in England. This has been attributed to the increased regulatory environment for the professionals in England. The NMC is specifically concerned with the welfare of the patients and only regulates the nursing and midwifery professions to ensure quality of services. This means, the body approaches health care services from the side of patients as opposed to both parties while it collect registration fees from the nurses. In short, the NMC does not play the enforcement role in real life as its only point of contact is during the registration and investigations that are instigated by the public. In practice a patient is likely to get better service or care from a nurse working in the independent sector compared to the public sector where overcrowding and lack of resources characterize the hospital environment. The hospital environment has an impact on the practice of nurses and midwives and should have been considered under the code. Conclusion The NHS has evolved to the institution it is currently, but has developed under four different models after devolution took place in the UK. Although, the four models have faced challenges they have developed structures that suit their respective cultures in relation to health services. This has seen health care services still being provided by the NHS while the independent sectors and local authorities take up social care services. The social care services have been charged on a means-testing basis. The local authorities continue to be the largest buyer of social care services for the independent contractors although there has been an increase independent care providers for persons contributing towards their private care as well as direct paying individuals. This is soon getting controlled if legislation already in parliament England passes. This will set a cap on the contribution a member contributes to such a scheme. The legislative framework that relates to the nursing profession has continued to be the backbone for policies and standards that govern the conduct of nurses and midwives. The Code of 2008 as established by the NMC provides standards for practicing nurses and midwives to uphold in their work stations in provision of care to patients. Even though it has been associated with enhancing the level of engagement between nurses and patients in a professional manner it has been weak in terms of addressing concerns from the nurses and midwives with regards to the hospital organization environment. In particular, the NMC has not been playing its regulatory role in totality based on the fact that it only relies on the public and nurses to report issues. To conclude, there is need to develop standards that cover nurses in relation to a poor hospital organization management culture. List of References Baille, L, Gallagher, A, & Wainwright, P 2008, Defending Dignity-Challenges and Opportunities for Nursing. Royal College of Nursing. Viewed from http://www.rcn.org.uk/data/assets/pdf_file/0011/166655/003257.pdf Care and Social Services Inspectorate Wales 2007, About Us. 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