National Health Services Original Expectations and Changes - Term Paper Example

NATIONAL HEALTH SERVICES ORIGINAL EXPECTATIONS AND CHANGES What were the original expectations from the NHS in 1948? Did the organisation and structure of the service help to achieve these expectations? Introduction The National Health Services (NHS) is one of the premiere government agencies implementing health care services to the people. It is the publicly-supported health care system which encompasses England. It provides various health interventions and services to the people in terms of health interventions, diagnosis, and rehabilitation. It is one of the oldest health systems in the world and it is able to function because of taxes and other sources of government funding. It is also available to all residents in the UK. When the NHS was first established in 1948, there were different expectations for the service. This paper shall discuss these original expectations and how these expectations have been fulfilled throughout the years. It shall also discuss whether or not the organization and structure of the service helped to achieve these expectations. This paper is being carried out in order to establish a clear and comprehensive understanding of the subject matter based on a thorough analysis of relevant elements. Discussion The NHS was established in 1948 with three core principles: it was to be universal, meaning it would provide health care of an equal standard in the entire UK; it was to be comprehensive, meaning, it was to cover all health needs; and it was to be free at the point of delivery, available to all citizens equally, based on need and the ability to pay (NHS, 2002). In order to manage costs of these services, while still maintaining efficiency, the government authorities eliminated the mixed system of social insurance, as well as private insurance, in favour of central taxation. The insurance system at that time became too expensive, failing to cover half of the population, mostly women, children and the elderly, and providing inadequate care for those who were covered (Keep our NHS Public, n.d, p. 1). The NHS is largely supported by central taxation. It has been finalized as a viable source of funding for the NHS because it is related to a person’s ability to pay; it is cheaper to manage; it separates clinical decision-making from funding, giving the opportunity to doctors to highlight what is best for the patient without any consideration made for revenues; and it makes health care binding to society based on the principle that all people must care for each other in hard times (Keep our NHS Public, n.d, p. 2). The NHS structures have changed over the years from 1948 to 1980, most especially based on rational planning which highlighted the redistribution of health resources based on need and efficiency through integration (Keep our NHS Public, n.d, p. 2). The goal was to make health services highly available, with its structures supported in different parts of the world. The original NHS seems to be based on command and control, however, much of the decision-making processes have been devolved to the district levels (NHS Executive, 1996). The Department of Health issued instructions; however, much discretion was also given to the local authorities where the services reached the grassroots level. The local authorities had much control over their activities and these functions have successfully been seen in other territories of the UK (NHS Executive, 1996). In effect, autonomy and divergence was given to local health authorities. The elements and structures of the NHS were also integrated to the services provided in the preventative, primary, secondary, and even tertiary care. The Department of Health and the NHS Executive were concerned with the development of strategies and implementing policies, as well as the establishment of nation-wide purposes like workforce planning, management of NHS properties, data gathering, and information technology (Department of Health, 2000). In the actual practice, most of these functions were carried out in relation to the various regions and local districts. On the other hand, regional health boards were concerned with the health planning and supervision of tertiary care provision in their areas, including various health interventions like blood transfusion, cancer care, IT, ambulance services, and education (Emslie, 2001). The district health authorities were concerned with planning and provision of secondary services, as well as supervising primary care. The GPs were considered the independent contractors of the NHS, and were not directly employed under the system (Keep our NHS Public, n.d, p. 3). Public health and communicable disease control was managed at various levels. In effect, the planning for health services was very much fluid and in line with the changes in the health sector, as well as the technologies and advancements in health. The NHS was established with a strong sense of political accountability. Its affiliates were highly accountable to the Secretary of State for Health and specific reports, both in terms of financial activities and policy implementation were submitted annually to the parliament (Talbot-Smith and Pollock, 2007, p. 31). The patients and the public were also represented in the local councils in the public health boards. This was assisted by the Community Health Councils (CHCs), local independent bodies, and by volunteers. The NHS affiliates were compelled to confer with the CHCs in relation to major changes in local health services, and later, these CHCs could discuss their concerns with the Secretary of States (Rawlins and Littlejohns, 2000, p. 118). The regulation and the setting of standards for training and accreditation of the medical profession were not within state authority as the medical professions managed themselves. The General Medical Council which included doctors and other health specialists were therefore authorized to certify and license health professionals and to establish the standards of education, clinical performance, and professional actions for doctors (Lilley, 2003, p. 82). This council was also supported by the Royal Colleges of medicine, and other organizations which set forth the standards of education, training, and knowledge in various respected areas. The Department of Health was represented in the Colleges; however they did not have the power to direct these colleges (Keep our NHS Public, n.d, p. 3). Workforce planning was managed by the DH, as it controlled various medical schools in the country; and it also had more control in the postgraduate level of Colleges in terms of approving training programs in various hospitals. The NHS has gone through various changes throughout the years, and these changes have significantly impacted on the organization structure, and management. Its original goals were set forth in 1948, however, changes were needed in order to reorganize and realign its activities to meet its original as well as evolved goals (Jones and Jenkins, 2002, p. 17). In 1974, the first major reorganization was carried out in order to “provide a fully integrated service in which every aspect of health care could be provided by the health professions” (DHHS, 1972). As a result, various changes were introduced in the management teams at the regional and local levels. A crucial feature included the consensus decision-making process which aimed to support centralization, but with the medical professional staying constant in its autonomy (Pratt, et.al., 2002, p. 16). Such new management methods were crucial to the system. These methods helped ensure the unitary and pluralistic nature of the system, making sure that the parties involved did not have conflicting objectives which contradicted with the consensus system (Jones and Jenkins, 2002, p. 17). The pluralistic nature introduced into the reorganized system acknowledged the differing interests of the organizations where parties had priorities which conflicted with each other, making the consensus process more difficult and forcing parties to compromise (Wortham, 2003). The overall goals of the process were to establish an agreement through the consensus process and within the supervisory teams. Such a consensus decision-making process was considered slow and it compromised the decision-making processes. Inasmuch as others considered it weak, the reorganized NHS was still considered a successful organization (Jones and Jenkins, 2002, p. 18). With the reorganization process, the management posts were eventually able to set forth for the AHPs at the local levels. The reorganized system was further supported by Margaret Thatcher’s pronouncement on and publication of the document Patients First (Evans, 2004, p. 67). This document sought to simplify the structure of the NHS and help implement the recommendations of the Royal Commission. This document aimed to transfer authority to the local level in terms of services provided. The District Health Authorities were also compelled to be responsible bodies within the new structure, being involved in planning and service provisions (Evans, 2004, p. 67). In effect, the policies in the DHA and the NHS from the late 70s into the early 90s were mostly based on the Patient First document which highlighted the government’s goals of bringing the services close to the patients, as well as simplifying the health services for the people. More improvements to the NHS were again seen with the reorganization of the NHS in 1982, and the Patient First program became the standard by which the changes were implemented in the years which would follow (Evans, 2004, p. 68). The NHS was started as the first and most comprehensive health service in the world (Skousen, 2008). It was based on socialist principles, which was the primary consideration for the government’s efforts to rebuild after the Second World War. In the years that followed however, the hopes and expectations for the NHS have failed in so many respects. Even with yearly increases in funds poured into the system, UK’s population still have encountered difficulties in terms of their health services (Scrutton, 2011). Issues which relate to health include funding shortages, inadequate staff, inadequate hospital beds, and failure of management. Past failures have been based on inadequacy of resources which have also curtailed and compromised the activities of the NHS and its agencies and affiliates (Scrutton, 2011). Such cycle of sickness and demands for resources have continued and have remained unchanged throughout the years. The original goals of the NHS, essentially to offer free health services at the point of care have mostly been affected by the significant cost involved in providing such services. It is admittedly an expensive venture with costs increasing with each year exponentially. It represented about 3.4% in 1949 of the GDP, and it rose to 7.71 % in 2005, and this figure shall continue to rise (Scrutton, 2011). In 1949, about 437 million pounds were allocated to the NHS, about 9 pounds per person, and now, it is about 1567 pounds per person. The increases in the NHS have caused much political turmoil throughout the years, and it has even brought down governments since 1951, and is continuing to do so (Scrutton, 2011). And yet, the NHS is still demanding for more resources and is still unable to deal with such demands. It can be said with certainty that the organization and its structure has been unable to fulfil the original goals of the NHS because there are gaps in the services and issues being encountered with the system which imply the inadequate delivery of these health services. Based on the constant changes made to the NHS throughout the years, gaps in the fulfilment of its goals have been apparent. From 1948 to 1974, the NHS was in its administrative phase with changes made accordingly; from 1974 to 1982, the planning phase was entered with changes made in this regard in the delivery of services; from 1982-1990, the NHS entered the managed phase, and implemented changes in related aspects of care delivery; from 1990 to 1997, the market phase was seen and finally, from 1997 to the present, the new NHS was introduced (The Economics Network, n.d). During the administrative phase, there were apparent inequalities seen, socially, geographically and in terms of patient categories. During the planning phase, the effectiveness of the organization improved, and its efficiency and equity also became apparent (The Economics Network, n.d). However, it was too bureaucratic and failed to respond to the needs of the NHS and the patients in general. During the management phase, the Griffiths report highlighted the need for good general management within the NHS, as well as the fiscal accountability of the clinicians working within the system (The Economics Network, n.d). In effect, the lines of accountability in the system improved. In the market phase, Thatcher’s belief in the free markets increased the efficiency of the NHS. However, in this phase, there were limited choices and decreased equity. In the current context of the NHS, there seems to be a need to emphasize on partnerships and joined-up thinking with other health agencies (The Economics Network, n.d). Moreover, the need to deal with inequalities within the system became apparent. Conclusion The original expectations from the NHS in 1948 primarily related to free health services to all. These goals were founded on strong principles of care and of service for all. The organization and the structure of the NHS however did not sufficiently help in achieving these expectations. The organization was underfunded for one, and its structure did not adequately ensure health services for all regardless of individual and demographic qualities. Discrimination in the delivery of services was still apparent and the essential health issues of the people were still not adequately resolved. In effect, the same issues seen before the NHS was started were still not adequately addressed by the organization and structure of the NHS. The reorganization and changes implemented on the NHS throughout the years, helped to resolve these issues, however, in essence, the crucial problems on inadequate funding, as well as inadequate health services still dominate the health sector. Without major changes in terms of funding and staff increases, these problems will remain unsolved and the goals of the NHS will likely remain inadequately met. Works Cited Department of Health. 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