National Health Service Improvement Planning - Essay Example

NHS Improvement Plan: Is It Enough The National Health Service (NHS) Improvement Plan 2004 had been dubbed as a "patient-centered" proposal that set out a 10 year plan in the process reform of the NHS. Over the past years, the NHS in England had to undergo several major improvements in health care service for patients. After decades of underinvestment, the NHS has begun to turn itself around, with unprecedented increases in the money it can spend. As its budget has grown from 33 billion to 67.4 billion, the average spending per head of population has gone up from 680 to 1,345 (Department of Health, 2004). The NHS Improvement Plan outlined the policy on empowering patients and we will be giving further details in due course. The Department of Health will support the development and application of decision aids that support patients and help them to make the right choices (Doctor, 25 October 2005). The idea was to have care needs rooted in primary care settings and underpinned by improved communication with new partnerships across the health and social care spectrums (Elliot, 19 August 2005). However, the one clause of the NHS Improvement Plan 2004 had been a cause for debate. It indicated that private firms will be carrying out up to 15 per cent of all NHS operations. This will amount to one million every year. In 2004, they perform just 100,000. Thus, those NHS hospitals which fail to attract patients could be forced to close. This led to fears that communities could be left without a local trust. Private firms will also provide more diagnostic services such as MRI scans and radiotherapy services and will even be able to set up their own GP surgeries to treat NHS patients. The proposals drew sharp criticism from the Tories, who said Labour had already failed to meet many other pledges to improve the NHS. It had failed to end the postcode lottery for prescribing cancer drugs and is likely to have missed a target to provide an extra 7,500 consultants pledged. Liberal Democrat health spokesman Paul Burstow also attacked the Government's "tick-box culture". A spokesman for the Department of Health said the five-year plan was not a series of targets. Rather, it was "painting a picture of what the Health Service would be like in 2008".Health workers' union Unison welcomed plans to cut waiting lists but warned that reliance on the private sector would damage the NHS (The Daily Mail 25 June 2004, p. 19). Moreover, British doctors condemned the government's initiative to increase patients' choice as failing to deliver real choice to patients. In their conference, the doctors voted overwhelmingly against the expansion of private treatment centres, which they said were draining resources from NHS hospitals. For instance, Dr Chaand Nagpaul, a GP in north London, proposed two motions at the BMA's annual representatives' conference in Llandudno questioning the value of the initiative and private treatment centres. He called the government's plan to give patients a choice of four or five centres in which to have their operation a "political gimmick" that failed to deliver what patients wanted from the health service. "What patients want is the NHS on their doorstep and more time with their GP," he said. "What is being offered by the government is a choice of where patients can have their operation. Patients do not get to choose their surgeon or what investigations or treatment they have." The promotion of choice for patients, as described by Prime Minister Blair, left unclear lines of clinical accountability if things went wrong, Dr Nagpaul said. It was also wasting NHS resources and contributing to the creeping privatisation of health care. His motion for the government's initiative to be piloted before national implementation was carried by the conference. However, Dr Nagpaul failed to win support for the British Medical Association (BMA) to directly oppose the government's plans. Doctors also raised concerns about private treatment centres. Dr Nagpaul said that because they were standalone units they could "cherry pick" uncomplicated patients, leaving the NHS to deal with any complications that might arise. "To make matters worse, they'll perversely gain at the expense of NHS hospitals, by being paid the same national tariff prices under 'payment by results' as NHS hospitals, who will be treating the remaining more expensive, complex ill patients for no extra money," he added (Kmietowicz, 3 July 2004). In a system characterized by a lack of financial restraints, it is not surprising that Great Britain will spend far more on health care; the surprise was how little health the nation was able to buy with all the extra money spent. Despite years of insistence by politicians and physicians that the NHS had the best medical care in the world, there is scant evidence that the additional expenditures led to improvements in longevity, infant mortality, morbidity, or days lost from work, relative to other countries spending less than half as much per person. What has become apparent is that the real inflation-adjusted hourly wages of workers have stagnated, and even declined, while the cost per hour of employer-provided health benefits has soared, and that the government has been burdened by billions in deficits attributable to the soaring costs of health care. The nation has searched for an organizational structure that would add the missing elements of planning, coordination, and control to the health care system to improve efficiency and limit total expenditures. With this improvement plan, the NHS will suffer greatly in losses because now patients will have the option to choose privately-operated hospitals. On the other side, the idea of involving patients and the public in dialogue about health care planning and delivery has been around for many years, which is the basis for the NHS Improvement Plan . In practice most healthcare organisation Chief Executives could give evidence that their organisation had consulted the community on the latest plans for service reconfiguration, and most clinicians would genuinely believe that patient involvement happens on every occasion in the consulting room. Unfortunately, as these examples suggest, patient, carer and public involvement is often assumed or simply misunderstood. For many in healthcare, the leap may not always be made to the underlying reason for involvement, which is to develop a partnership that enables dialogue about choices; choices which in turn lead to the best possible experience of health care (Squire et al., 2006). Organisational strictures often militate against the development of this dialogue. One of the biggest challenges is ensuring that the organisational and team cultures that surround the relationship between patient and healthcare professional actively support the principles of partnership. These cultures need to continue to nurture the practice of compassion and engagement with patients and carers for all healthcare staff in their training, ongoing professional development and daily practice (Sweeney et al., 2005). For radiotherapy, the NHS improvement plan had its advantage because it specified in its clause that "over 50% of NHS Trusts have redesigned roles in radiology and radiotherapy services to reduce waiting. Advanced Radiographer Practitioners can now interpret the results of diagnostic tests, with Assistant Practitioners being trained to undertake diagnostic procedures". The impact of this could lead to more marginal errors because less trained radiographers undertaking diagnostic procedures. In the over all, the impact of NHS Improvement Plan to radiotherapy practitioners could be more on the dangerous side, than being an advantage. The Radiotherapy departments of the NHS could lose clients to private sectors because of the "patient choice" clause that would compel patients to opt for private radiotheraphy services. Clearly, the NHS Improvement Plan stated that in order to deliver choice, the NHS would need to innovate - and that the blurring of professional boundaries provided scope for creativity. This innovation would create some radically different types of service provision and "free up the entrepreneurialism within primary care and develop new types of provider organisations" (Craig, 25 June 2005). However, aside from "fragmenting care", the NHS Improvement Plan Professor would lead planning bodies to no longer able to allocate resources on the basis of need. Professor Allyson Pollock suggested why the NHS Improvement Plan problematic: "If 17m of elective care in London goes into the private sector Hospitals are barely breaking even now, and most are running significant financial deficits if you move money out you are also losing money for IT and other services. The private sector had the ability to "cherry pick" more routine cases, leaving very expensive treatments behind in the NHS and "undermining the core function of the NHS, which is risk pooling" (McGauran, 27 November 2004). With all the disadvantages wielded by doctors about the NHS Improvement Plan, the government should look for ways to mend these loopholes in the clauses that the plan recommended. They should propose a "win-win" solution so that all parties -- the doctors, medical practitioners and especially the patients - will grasp the full advantage of the true-blue "improvement" of the British health service. Bibliography Craig, G. 2005, June 25.Practice: The rise of private primary care.Chemist & Druggist:16. Department of Health (2004), The NHS Improvement Plan: Putting People at the Heart of Public Services, The Stationery Office, London, March. Doctor. 2005, October 25. Power to the patient. p.3. Elliot, R. 2005, June 25.GP practice: Better care for the long-term.GP:18. Farrell, C. (2004), Patient and public involvement in health: the evidence for policy implementation, Department of Health, London, May, p. 16. Firth, J., Newton, R., Anwar, S. 2004. Patients as teachers in rheumatology: a new approach to patient involvement, Bradford Teaching Hospitals NHS Trust, Bradford. Kmietowicz, Z. 2004, July 3. Doctors condemn "patient choice" initiative as no real choice at all British Medical Journal, 329:14. Acquired online at http://www.bmj.com/cgi/content/full/329/7456/14-a McGauran, A. 2004, November 27. Moving 15% of procedures to private sector will wreck NHS. British Medical Journal, 329:1257. Acquired online at http://www.bmj.com/cgi/content/full/329/7477/1257-b Reid, J. 2004. Managing new realities - integrating the care landscape, speech by Rt. Hon. John Reid MP, Secretary of State for Health, Guardian Conference, Birmingham. Squire, S., Greco, M., O'Hagan, B., Dickinson, M. and Wall, D. 2006. Being patient-centred: creating health care for our grandchildren. Clinical Governance: An International Journal; Volume: 11 Issue: 1; 2006. Sweeney, G., O'Hagan, B., Squire, S., Powell, C. (2005), "The Patients Accelerating Change Project: does it make any difference", Clinical Governance: An International Journal, Vol. 10 No.1, pp.72-83. The Daily Mail. 2004, June 25. Part one of Reid's five-year plan for the NHS. Stop fiddling the figures. P. 19. Read More