The Role of Case Management in the UK - Coursework Example

Running Head: Health and Social Policy UK Critical Evaluation of Role of Case Management In Relation To Development of Health and Social Policy in UK [Name of Writer] [Name of Institution] The growing need for improvements in the quality of health care has led to many initiatives by the governments around the world. The United Kingdom has been one of the fore runners in this area, and the efforts are visible by the fact that almost all areas of social, health care and political establishments take an active part in the promotion of feasible policies related to health care. Along with this is the active amount of public participation that has been included and encouraged during the years. The result is a multitude of government and health care policies that address almost all areas of human healthcare, and all age groups with different challenges, for example mental, psychological or physical issues. (Zairi & Jarrar, 2001) These reforms aim at improving the already present services with a more personalized touch. The role of NHS has been pivotal in the formation of the current health care system. It is on the basis of this national system that the various other systems and formularies have developed. (Social Policy in the UK, 2005) And it is with this in mind that due credit must be given to the NHS for increasing its standards and modifying its policies year by year, with the results that now it focuses mainly on gaining maximum performances from its various sectors with reduced costs. It is an established fact that primary care curtails one of the least medical costs when applied correctly within a system or a country. This is in comparison to other health care systems such as the secondary, tertiary and the private health care. Increased teamwork and less “hierarchy and beurocracy” are the leading causes of successful health care delivery. (Zairi & Jarrar, 2001) Amidst the good working of the NHS several flaws still remain. The main causes of these less than optimum performances in the NHS are due to “complexity, heterogeneity, uncertainty and ambiguity” within the system. By eliminating these factors, NHS will be able to provide a much improved health care system with fewer loopholes. (Zairi & Jarrar, 2001) “The introduction of Organizational Effectiveness Model in the NHS has been very helpful in identifying the key factors for achieving business excellence within health care.” (Zairi & Jarrar, 2001) This model is able to chart the effectiveness level of a business by appointing a score system. The potential of this model in improving research and expertise is endless. NHS has played an important role in the management of individuals with mental health issues, and has issued many programs for the management of such cases. With the prevalence of mental health problems in up to 50% of the hospital patients, with more who are care home residents, it is important to address the issue as soon as possible. With policies directed towards these individuals, it is hoped that improvement will take place in the lives of the patients and their families, lesser dependency for the patients and more active inclusion in the society. (Department of Health, 2002) Mental illness is perhaps one of the most prevalent factors that cause organizational losses, coming next only to pneumoconiosis and hypertension and heart related issues. In an organization, this can lead to decreased production, the amounts of benefits that the employee receives, the amount that is paid to overtime employees for the replacement, disruptions in the work, and administrative costs of managing absence and rescheduling work. (Briner, 1996) Depression is the most common cause of disability worldwide, and in the UK, the costs that mental illness leads to is more than 19 billion pounds a year. NSF mainly focuses on the age groups of working adults up to 65 years of age, and encloses health promotion, primary and specialist care and long term programs in its agenda. For individuals who are above the 65 year limit, the NSF for older people curtails to the needs of them. This nondiscriminatory method of health care provision is made accessible, with high level of care provision. The care policy aims to help individuals gain more independence who benefit from it. With the identification of causes of depression, the NSF aims to reduce these causes and help patients cope with them. It also aims to provide a round the clock service to the patients, so that proper and urgent care can be given whenever it is needed. (NSF for Mental Health, 2003) Mental illnesses are mostly seen in patients who have psychological or physical morbidity. With the help of primary care and service providers, NSF aims to provide all the necessary services required for such patients. NSF also aims to provide and ensure the health status of the carers themselves, and addressing the needs of the employees. (NSF for Mental Health, 2003) The NSF’s mental health services, which aim to provide safe, sound and supportive services, aim to make mental health a national priority. It is with this in framing that the introduction of the White Paper Saving lives: Our Healthier Nation has been introduced, which primarily is aiming to reduce the frequency of suicide rates by 20% by the year 2010. (Securing Better Mental Health of Older Adults, 2005) With a high prevalence of mental disorders in the common population to a high degree the need to provide health services is important. (NSF for Mental Health, 2003) The White paper allows more freedom to local people as well as the communities in matters of public services, and through improving relationship and coordination of the government with the people and the local communities. (CPA, 2006) The White paper not only includes the management of elderly, the vulnerable people and the children and their social and health issues, but also addresses the economic development, housing and planning and climate changes etc. For its implementation, the paper “our health, our say” addresses plans, priorities and objectives. The periodic update will include the various tools and methods used in the implementation of the policy along with feedback and feasibility, which in turn will help in developing and improving further strategies. (CPA, 2006) With plans to increase and recruit new health care workers, along with early and more frequent interventions, home treatments, women only day services and specialist supports, the NSF is following its new and improved mental health care agenda of 2000. Along with the NSF plan is the introduction of National Suicide Prevention Strategy, the Mental Health Act and Bill, and the Updated Drug Strategy. (NSF for Mental Health, 2003) All these strategies are aiming to reduce the alarming rates of morbidity and mortality associated with mental illnesses, while at the same time providing optimal health care and recruitment of such individuals into the national workforce. The Griffiths report was one of the significant helpers in the development of NHS, which correlated the “organizational structure and the informal networks within the trust.” It claimed that by replacing the consensus management system with the “single line management structure”, the effectiveness and efficiency of the organization will improve. (Zairi & Jarrar, 2001) However, the mute response it has received may stem from the fact that flaws in the NHS system pointed out were noted before the publication of the report and therefore, no new evidence or conclusions have been drawn from the study. (Zairi & Jarrar, 2001) The development of these policies has been taking place since 1993, with the introduction of the NHS and Community Care Act. Subsequent policies are mainly the result of these two initiatives. There has been much speculation over what system is better for the care of elderly people. Whereas Scotland for example supports integrated care approach, England has shown more interest in the intermediate care approach. The Department of Health of UK in 2001specifically included intermediate care within the NHS care services for the elderly people. This allowed the older people to have access to intermediate care facilities so as to “promote their independence, and prevent unnecessary hospital visits and stays. The introduction aimed at averting crises, active rehabilitation following an acute hospital stay, and where long term care is being considered.” (DoH, 2001) But the introduction of these policies although may have been well intentioned, fall behind on two aspects. Firstly, the policies have not completely met the actual needs and requirements of these patients, and secondly, age discrimination has become a very serious issue in these services. Both these issues become more evident when compared with the policies formulated for young adults with the same mental illnesses. In order to remedy these two problems, it is important that more awareness and improvements should take place with regards to professionals’ attitudes and skills. Policies must be formulated which are in consistency with the Single Assessment Process, with the involvement of both the local and national authorities. (DH, 2002) These policies also require the introduction of specialist services for patients who suffer from dementia, co morbid conditions, and psychotic ailments, cases where national guidance or mental health act may be included. Specialists’ intervention may help in the development of better service developments and strategic plannings. (DH, 2002) What is more important in such cases is the correct identification, and thereby assigning the correct treatment plan for individuals according to their needs and not relying solely on the age group to categorize the patients. Both young and old patients can benefit from the plans made for the other group, with proper access provided to them. Also important is the identification of the various needs of the patients and thereby providing them with such services that give a one to one personalized care. The above factors along with a better re sourcing will ensure a good health care provision to such patients. (DH, 2002) With the help of common assessment framework, the older adults would be able to continue towards “self determination and planning for independence.” Into the Common Assessment Framework the integration of The Care Program Approach and the Person Centered Planning will help in achieving these goals. (Common Assessment Framework, 2006) By implementing policies that help individuals with mental illnesses and addressing other related special needs, the government will be better able to provide a system that is more self care oriented rather than welfare dependent. By improving the productivity of these individuals, more productivity can be achieved both in the economy as well as the society. Implementing such improved and individualized structures in the society will help in achieving the Lisbon goals. (Lisbon Strategy for Jobs and Growth, UK National Reform Program, 2005) By incorporating such individuals in the general public workforce, it is expected that more economic growth and fiscal sustainability will be achieved. On a more personal level, it will provide a person self reliance and self determination, with an increase in the personal benefits on a societal level. Adding a component of flexibility with regards to individual needs and circumstances, people will get more employment opportunities, more incentives and benefits, and reduced work barriers due to educational or skill deficiencies. (Lisbon Strategy for Jobs and Growth, UK National Reform Program, 2005) These Lisbon goals since there implementation in the late nineties, have shown large improvements and impressive performances. This can be seen by more than 70% employment rate with increased older people employment rates of 56.2%. The current Lisbon goals aim to increase this employment rate to 80%, of which one million people will be older people. (Lisbon Strategy for Jobs and Growth, UK National Reform Program, 2005) The Wanless review has been highly complimented in this matter. The report has very accurately described the needs of the elderly in the UK and the future trends in this area. The report has pointed out and supported a very important fact currently a norm in the elderly care. With increased demands and costs, individuals with the most severe needs are being catered to, and by doing so, ignoring the less serious or severely afflicted individuals. With less attention to moderate to low cases, there increases the risk of these same cases to become potentially severe cases, which in turn may lead to further hospital patients and health care costs that were otherwise preventable. The Wanless review, by pointing out three potential ways to manage the elderly care scenario, has been of tremendous help in formulating policies for the future. (Mullholand, 2006) Along with the NHS various private initiatives have also come into the mainstream of health care. Case in point is the Private Finance Initiative, which raises money to construct new institutes and services. The reason for its popularity lies in the fact that is an interesting alternative to public sector borrowing schemes. It is in this context that the role of a case manager becomes clear. A case manager is a social worker who is specifically assigned to manage cases of developmentally disabled, and to help them in acquiring agencies and services for their particular illnesses. He or she is the key player to identify, assess and thereafter communicate the specific needs of the patient to the health care and social service, and ensure the acquisition of the proper services for the patient. He or she is also responsible to handle the different steps and transactions of the process, and should be able to follow through and evaluate the efficacy and appropriateness of the plan according to the patients needs. (Social Worker, Case Manager, 1996) In this manner, many nurses, therapists and social workers are eligible to be called case managers. The above stated responsibilities have been described in a nutshell. Case management is a complex and demanding work and requires expertise and competency. And it is for this reason that the minimum requirement for the recruitment of a case manager is a bachelor degree in social work from any recognized institution, along with experience in the related field. (Social Worker, 1996) Case management curtails many aspects of the healthcare and social service system, and in a way a case manager becomes a patron for the patient to help him get the best health care and social care benefits. This means that a case manager needs to have fluent knowledge of “laws, regulations, policies, and procedures pertaining to development disabilities.” (Social Worker, 1996) Also needed are knowledge about the community resources and a good communication skill, both verbal and written. (Social Worker, 1996) Case management has been exceedingly beneficial in providing services for persons “whose needs do not fall within a boundary of a single agency or professional group.” (Case Management, An Introduction, 2006) Since its introduction, case management has shown many significant benefits. It has lessened the vulnerable older adults’ needs for institutional attention and care. It has in addition increased the levels of satisfaction and well being of the elder people. Both these effects have been achieved with no increase in the cost for social services. These schemes have been beneficial both in the institutionalized as well as the multidisciplinary schemes.(Challis, 2001) The key principals of case management include a proactive care and a multidisciplinary approach to patient care, collaboration of work internationally and with the secondary care systems, identification of high risk hospital admission cases and formulating personalized care plans for such cases, and management of such cases to their completion. This objective evaluation also includes the assessment of family and social status as well as the primary caregiver, reasons for requiring case management and the psychological and/or physical need of the patient, the spiritual and cultural and related factors, and the expectations of the client along with his or her mental capacity of learning, independence, community integration and work. (Management, BABICM, 2005) These case management principals are aimed to reduce the frequency of patient admissions along with the lengths of such admissions, as well as improving outcomes and functioning and quality of life for the patient. (Supporting People with Long Term Conditions, 2006) However, while demonstrating many positive aspects of the policies, case management does have its challenges. The first is to identify who qualifies for the policies, and second is how to allocate these resources properly. Although the document issued by the UK policy, “caring for people” states that care management should be applicable to all people, there is a need to identify cases that are in most need of intensive case management. (Challis, 2001) Factors such as staff availability and resources are major determinants for allocations. Therefore, for such cases who are in urgent or intense need, allocation of the case managers must be a priority, while other less severe cases should be managed by a combination of “effective assessment procedures, individual care plans and regular reviews” in the institutions. (Challis, 2002) The above statements only add to the already present confusion of health care delivery, as the policies are still very vague with regards to identification and allocations for different patients. Again, the policies do not address the issue of level of interventions. By identifying and demarcating these levels, better management for workforce issues can be achieved. (Challis, 2001) In conclusion, the new policies have been very helpful in identifying, promoting and planning strategic steps in order to tackle the issue of mental illness, the depriving of elders from proper health care services and the economic implications of such issues. There is need for more critical evaluations and more in depth research and planning to increase the productivity of the health care systems, and only by doing so will we be able to achieve a solid all rounding health care plan, beneficial for all people. REFERENCES Rob B. Briner, 1996.ABC of Work Related Disorders: Absence from Work. BMJ 1996; 313:874-877. CPA, Centre for Policy on Aging, 2006. Site last accessed on December 12th, 2006. www.cpa.org Common Assessment Framework, Why Have a Common Assessment Framework? Site last accessed on December 12th, 2006http://www.socialcare.csip.org.uk/index.cfm?pid=7 Case Management, an Introduction, 2006. British Association of Brain Injury Case Managers. Site last accessed on December 12th, 2006. http://www.babicm.org/case_management.htm David Challis, 2001. Assesment and Care Management: Developments since the Community Care Reforms. Site last accessed on December 12th, 2006. http://www.archive.official-documents.co.uk/document/cm41/4192/v3ch5.pdf Department of Health, Securing Better Mental Health for Older Adults, 2002. Lisbon Strategy for Jobs and Growth, UK National Reform Program, 2005 Site last accessed on December 12th, 2006. http://www.dwp.gov.uk/publications/dwp/2006/nrp/uk-lisbon-nrp-05.pdf Helen Mulholland, 2006. Q&A The Wanless Social Care Review. Site last accessed on December 12th, 2006 http://politics.guardian.co.uk/publicservices/story/0,,1743289,00.html NSF for Mental Health, 2003. Site last accessed on December 12th, 2006. http://www.psnc.org.uk/uploaded_txt/NSF_Mental_Health_Book.pdf. Management, British Association of Brain Injury Case Managers, 2005. site last accessed on December 12th, 2006. http://www.babicm.org/Guidelines_2005.pdf. Securing Better Mental Health for Older Adults, 2005. Site accessed on December, 2006. http://www.dh.gov.uk/assetRoot/04/11/50/80/04115080.pdfhttp://www.dh.gov.uk/assetRoot/04/11/50/80/04115080.pdf Social Policy in the UK, 2005. Site last accessed on December 12th, 2006. http://www2.rgu.ac.uk/publicpolicy/introduction/uk.htm Social Worker, Case Manager, 1996. Site last accessed on December 12th, 2006. http://www.co.dane.wi.us/emprel/cls_specs/sw_case_manager.pdf Supporting People with Long Term Conditions, 2006 Site last accessed on December 2006 http://www.longtermconditions.csip.org.uk/article.asp?pageid=2878 Wanless Review of Social Care in the UK, 2005 site last accessed on December12th, 2006. http://www.ageing.ox.ac.uk/ageinghorizons/news/individual%20news%20items/wanlessreview2005.htm Mohamed Zairi & Yasar F. Jarrar, 2001. Measuring Organizational Effectiveness in the NHS. The 6th TQM World Congress, 2001. Read More