The National Health Service In the UK for International Nurses - Essay Example

THE NATIONAL HEALTH SERVICE (NHS), SOCIAL CARE AND INDEPENDENT SECTORS IN THE UK: A CRITICAL DISCUSSION By (Name) Course title Name of tutor Institution name Department Date of Submission Introduction The National Health Service (NHS) is one of the bodies that attract a pull of important and varied stakeholders who are concerned and work for the good of the public in the United Kingdom. It is an affiliate and an umbrella body to other professional organizations such as the Nursing and Midwifery Council (NMC), also a major participant in the health sector in United Kingdom. Given the diverse nature of the bodies and their components, there have been various elements of law that govern the practitioners within them. While standards are laid down to assure quality control, ethical considerations are enshrined in the legislation and the benchmarks in order to integrate culture and justice to the vital aspects of health, such as the quality of care and competency of the care givers. The support departments and the mainstream care givers comprising of the nurses, midwives, pharmacists and even medical doctors are required to work within the set rules and perform to the laid down standards in their practice to safeguard the safety and health of the population (Ball 2007). The constituents of the legal documents that are formulated for the specific sake of the health care practice in both government and private sector are evaluated against their performance as evidenced by the consumers and producers alike in order to give an appraisal that is constructive and, ultimately, improve the level and quality of care to consumers. To satisfactorily do this, the National Health Care commissioning, the standard of care and legislation in practice, the performance of the NHS code of conduct and the ethical guidelines for nurses and midwives are put into perspective to assess the current situation and recommend the way forward based on the findings. Structure Overview Since the passing of the Health and Social Care Act 2012, UK’s NHS has been undergoing structural changes. Many of those changes took effect in April 2013 and have had an effect on who makes decisions regarding NHS services, the commissioning of the services and how even how money is spent (BBC 2013). The changes have also seen some organizations abolished. For example, strategic health authorities (SHAs) and primary care trusts (PCTs) are out, and are replaced by clinical commissioning groups (CCGs). CCGs and NHS England (previously known as NHS Commissioning Board) commission most of the NHS services. The local authorities have taken a bigger role in the new structure, now responsible for new public health commissioning, including overseeing budgets for public health. The duties of health and wellbeing boards include encouraging integrated working between service commissioners across social care, health, public health and children’s services. Local authorities are also expected to work even more closely with community groups and agencies, and health care providers to tackle challenges like obesity, drug misuse, smoking and alcohol. A new regulator, Monitor, has also been introduced. It regulates all services funded by NHS (BBC 2013). National Health Care Commissioning According to the Department of Health (2010), commissioning is a process that ensures that the needs of the people are met through the health care services that are provided. Commissioning is a useful policy in the health care that enables the National Health Service to achieve its objectives. Boil (2011), argues that this policy improves the quality and safety of the health services offered, gives patients a variety of choices and diversifies service provision. In addition, it is through commissioning that provision of health care has been taken outside hospital settings. Moreover, different groups of people including the disadvantaged are now able to receive equitable health care. As already mentioned above, PCTs used to commission majority of NHS services, in the process controlling 80 percent of the NHS budget (Maynard and Ludbrook 2010). Since PCTs were abolished in April 2013, CCGs have taken over many of its functions, as well as the functions previously under the Department of Health. CCGs include all GP practices and health professionals. CCGs now commission services, including: planned hospital care; mental health care and learning disability services; rehabilitative care; most community health services; and emergency care services. The service providers commissioned (including charities, social enterprises, NHS hospitals and private sector providers) must, however, meet NHS standards and costs. In this regard, these service providers must assure CCGs of the quality of their services, taking into account the guidelines of National Institute for Health and Care Excellence (NICE) and the Care Quality Commission’s (CQC) report on service providers. The UK NHS works towards providing and improving public health and health services respectively. In this respect, care is done at different levels: primary level care is essentially the “‘gateway’ to receiving more specialist care” (BBC 2014, 1), and includes GP practices; secondary level care, provided in hospital settings, includes elective and emergency services; and tertiary levels care involves services to people with existing and, therefore, require greater levels of specialist attention (BBC 2014). Most important, UK’s NHS operates on the premise of collective responsibility. In this regard, while the state is primarily responsible for the provision of comprehensive health services to the people, the private sector, independent sector and even voluntary groups are called upon to join in. In fact, the private sector has over the years delivered large volumes of publicly funded services. Moreover, according to a report by the Institute for Fiscal Studies (IFS) and the Nuffield Trust, independent sector providers account for the largest share of spending in secondary care (Nuffield Trust, 2013). The Oman Health Services system is structurally similar to the UK NHS in a number of ways. Oman’s Public Health Care System also emphasizes all the three levels of care: primary, secondary and tertiary. It also emphasizes the need for collective responsibility. This, however, mainly involves the public and private sectors although there are also a few voluntary bodies, such as non-governmental/profit organizations and community support groups (Alshishtawy 2010). For example, primary care is provided by local public health centers in collaboration with community support groups (EMRO 2006). Even then, the state remains the biggest player in the health sector. The country’s public sector runs about 90 percent and 98 percent of hospitals and hospital beds respectively. Moreover, 78 percent of doctors and 92.5 percent of nurses in the country work in the public sector. The country’s Ministry of Health runs approximately 85 percent and 86 percent of hospitals and hospital beds respectively, as well as 70 percent and 85 percent of doctors respectively. This influence extends to policy-making and allocation of responsibilities and funds (EMRO 2006). Standards of Care and Legislation Practice There are four areas of practice within nursing: children nursing, adult nursing, mental health nursing and disability nursing. These categories require skills unique to them which are set out by law. The minimum levels set must be attained by the nurse in order to be registered formally to start practicing. Generally, nurses are expected to have certain basic competencies: interpersonal skills, professional values and leadership and decision making ones. While these are not so specialized skills, they play major role in the success rate of a health provider and patient interaction (Nursing and Midwifery Council 2014). The organization takes it upon itself to ensure that the nurses update their knowledge in line with the current developments within their fields in order to improve the nature and level of care for the patients. This may mean further training or on the job learning of new concepts and best practices. It is the responsibility of the immediate supervisors and the top management to implement the standards of in any health care setting despite the emphasis on responsibility from every person involved in health care delivery. This is not only existing in the organizational policies but also recognized by law to the normal operations in the health sector especially as pertaining nurses and midwives’ practice. The nursing management legislation bestows the powers regarding the proper implementation of the standards of the profession in the top management and personnel with equal capacities while delegating the responsibilities to the individual who involved in the patient care. This enables the law to hold the higher office bearers responsible for the offenses or misdoings of their juniors in order to set a legislative chain of command and execution that trickles down to each professional irrespective of the work setting or location to achieve higher efficiency in monitoring and evaluating health care delivery in the UK (McQueen 2004). The essence of legislation is to govern the nursing practices in the United Kingdom. It spells out the requirements for practice, the scope of work and the supervision needs and authorities in the field of nursing for practitioners in the United Kingdom. This document is revoked by the new rules that amend the earlier versions. The legislation then is to be monitored and any discrepancies handled. The channel of command and the powers given to a professional officer at any given level is set to be equal throughout the country. Also, the minimum capacity of the health professional’s structure is to give the most at any stage while upholding the same quality of service that is checked by the regulations. The end result should be a uniform standard service that is consistent from one region to another and from one level of care to another. Ball (2007), a medical consultant, agrees with the Nursing and Midwives Council on a number of ways including the criteria used in the formulation of the structure of care (Ball 2007, pp. 69), However, there have been outcries among the health practitioners who feel that the laws are set to not to favour their operations. They claim that some of the rules are limiting their capacity and capability to help the clients while others are imposing unreasonable penalties on them even when they are working in good faith (Miller 2013). Exploration of the NHS Code for Standards of Conduct The National Health Service, as the overall body overseeing all health practices in the United Kingdom, serves the critical role of moderating and facilitating the care given and how it is offered by the public and private sectors. Bodenheimer (2006), evaluated the effectiveness of the NHS affiliate bodies in the provision of health care and concluded that there are many areas of concerned to be addressed by the body and its subsidiaries. The effectiveness of the health service organizations within the NHS is a matter of public interest since it determines the quality of care that a consumer receives at the very end of service provision. The performance of health sectary is directly related to the standards embedded in the National Health Service. These benchmarks work in synergy with the ethical code of conduct to tie the hands of the health professionals into delivering quality service that meet the needs and expectations of the population (Aiken et al. 2008). The environments in which the health providers operate is moderated by the NHS and greatly determine the quality of care. The NHS and the social care unit work together to deliver standards in health care that meet international standards. The innovations brought about by the social sector and the third sector makes the realization of health goals achievable for all levels of health consideration. There are reported human and machine errors that amount to violations of the code of conduct against he wills of the practitioners. These are highly increasing due to the unchecked integrating of information systems in health care delivery (Ash, Berg, and Coiera 2004). The prevalence of such cases raise concern that he NHS code of conduct requires review to make it more meaningful for the persons it is meant to govern. Many private institutions such as the Social Care Institute for Excellence (2012) have echoed their voices raising the concerns of the national health policy in relation to the operations of the health providers in the United Kingdom and England in particular. The expectations laid down by the NHS for the affiliate such as the social service and the third sector are concerning the harmonization of health services in the United Kingdom. The collaboration among these bodies is to make the service delivery efficient and effective for the public. However, the code of conduct in specifying the competencies required by law for the practice of health provision for both the public and private sector left out important elements of the nature of care that determine the type and kind of treatment offered to a health consumer. The overall effect is unwarranted restrictions that limit the ability of the professionals to give the acre they are capable of in their respective areas of jurisdiction. For instance, the ethical code requiring that nurses perform only drug administrative functions and not in-depth diagnosis make the professional leave too much burden on the limited medical doctors who cannot health in meeting the need of the population (Rosenstein and O’Daniel 2005). Instilling a culture of competence and value is not a matter of chance for the NHS but a result of hard work with policies elements put in place to ensure that tall professionals adhere to the rules and safeguard the interests of the consumer (Dixon-Woods et al. 2013). The code of conduct on the scope of work that can be performed by the nurses and other health providers are moderated by the standards which become a norm for the sector of health. The contents of the health policy outlined by the government of the Great Britain works in supplement with the code of conduct for the NHS in offering the guidelines that health care providers follow (Tope and Thomas 2007). Many aspects of the law that prohibit practice and unethical conduct at work make the health system safe for the public besides allowing for the means of assessing the effectiveness of the sector in meeting the needs of the consumers. While job satisfaction is an intrinsic element in the health care sector, the codes of conduct sometimes become disruptive and lower productivity. As a result, many practitioners are experiencing reduced motivations and job satisfaction due to the imposed rules that limit their scope of work (Utriainen and Kyngäs 2009; Rhodes, Morris, and Lazenby 2011). The competence of the nurses, the midwives and other health professionals are not only affected by the rules but also by the manner in which they are implemented. A culture of justice is missing in most cases with the health provider given the full burden without any consideration for the situation and the work environment that might have had a bearing into the outcome of any incidence (Johnston and Smith, 2006). In Oman, Standards of Care and Legislation Practice are not separated from the Code of Ethics (discussed below). Performance and Ethics for Nurse and Midwives The Nursing and Midwifery Council (NMC) set regulations and requirements that a nurse needs to be registered for practice. These elements highlight the same views of expectations and performance in the field as opposed to the classroom experience and so needs the combined use of training and experience. The rules are slightly difficult from the ethical code of conduct of the expectations of the professionals in terms of virtues. It spells out what is legal and that which is illegal in the practice of midwifery and nursing while giving the probable alternative courses of action for each deviation and how to avoid them. This set out guideline that can enable and professional nurse or midwife work within the legal frame work for the good of the patient. This is a commendable step given that health is one of the social aspects of life that encompasses social believes and views of the subjects despite making the practice of health delivery more complex than if there is freedom in handling clients who are from diverse backgrounds (Kalisch 2006). The ethical needs also require the nurses and midwives to work within their scope of expertise to ensure that the safety of the patients are not unnecessarily risked. This is enshrined in the limits of work that a health care professional who fall into the two categories can afford to offer given the training and experiences. For instance, both nurses and midwives who may consider working in positions that are different from their original entry codes of registration are not supposed to operate as if they possess qualifications in those areas. According to Imison and Bohmer (2014), such acts are likely to mislead both the patients and the management of such institutions and may result into unprecedented risks. NMC (2014), however, notes that registered nurses and midwives develop their skills and competence beyond the scope of their initial registration and may not be limited by boundaries of field of practice. Nurses and midwives are expected to be confidential in handling private information about the patients they are attending to. All private information given to them by the patients must be concealed so as not to reach the general public. They must also ensure equitable and quality delivery of health services without discrimination. The interests and wellbeing of the patient are given first priority by the health practitioner ahead of anything else (Landrigan et al. 2010). For these reasons, consent or permission has to be sought from the consumer before any procedure or medication is offered to protect the health care provider from accusations of doing their own procedures and medications against the will of the patient. Ethical behavior also involves the protection of the rights of vulnerable persons. In this regard, the NHS works through certain legislations and schemes to provide guidance on dealing with these said vulnerable persons. Protection of Vulnerable Adults (POVA), for instance, started in July 2005, is to help protect vulnerable adults placed in registered settings. Those found to have harmed the vulnerable are added to the POVA list and banned from ever working in care settings for vulnerable adults. The Mental Capacity Act seeks to ensure the rights of an individual are still protected if they lose their mental capacity, that is, the capacity to make their own decisions. Protection of Children Act (POCA) is another related legislation (Julie 2009). In terms of performance, nurses are expected to work as part of a team only delegating effectively and holding full responsibility of the works of their junior colleagues at the work place and in any single assignment. The professionals are expected to uphold the integrity of their fields as well. A negative painting of the professional is not taken to be injurious to the single practitioner but to the entire profession in the field damaging the reputation of the work done by the experts (Fotaki, and Ruaned, 2013). Lastly, the nurse or midwives is expected to stick to the safest ways of protecting both the patient and self from any risk that is eminent or unforeseen in the process of treating the patient. For instance, medical health insurance for self is viewed as a way of protecting both the self and the client in delivering health services to the consumers (Nursing and Midwifery Council, 2008). Oman’s NMC is very much like UK’s. They are both informed by the international standards of nursing and midwifery code of practices and ethics. Like the UK’s, Oman’s NMC code is purposed towards informing nurses and midwives about the standards of professional conduct and accountability they must abide by; informing the public as well as employers about what to expect; and guiding ethical practice. In this regard, it emphasizes the need to respect others (patients); honesty and integrity; safe and competent care; team work; confidentiality and privacy; risk management; and quality nursing care (Oman NMC 2011). Conclusion Health care delivery in the United Kingdom is a complex framework that has many players. The nature of work of health providers in the event of dispute rests with the NHS and the NMC that carry on the disciplinary cases that involve their members. While the NMC is a subsidiary of the NHS, it performs main function given that it serves the interest of important stakeholders who are the nurses and midwives. These are the professionals who are human capital in health care delivery. Commissioning of NHS has enabled the health sector to improve quality and safety, and encourages equitable distribution of the health care services. The Primary Care Trusts gets a larger fund allocation which helps them operate within the objectives of NHS by meeting the needs of the local population. Recommendations would be to include aspects of just culture in order to understand the work environment of the health care provides into consideration in setting ethical standards for them. 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