The Nhs In England Health And Social Care Essay

The Nhs In England wellness And Social Cargon EssayNational Health Service had been created in 1948 and for the last decades it has been facing numerous reforms and morphological changes in attempt to raise its effectiveness and competitiveness and to reduce costs.This report foc hires on measuring stick analysis of major external factors and trends that might influence hereafter activity of NHS and shape its structure.Findings of the report areSocialPopulation of England has increased by 7% in last 4 decades and with average age of 38.8 years (from 34.1 years in 1971)1. Overweight/obesity, ethnic differences in health care approach and high treatment costs for immigrants certify main affable challenges for the NHS. Citizen participation, social inclusion and partnership programs are seen as possible answer to these challenges.TechnologicalCoalitional government ended National Programme for IT in England and is preparing innovative Information Revolution.late(a) reforms that include abolishment of primary-care trusts and establishment of GP commission require modern IT solutions.Increasing community and home found health care are based on efficient telehealth and telecare serves and require further development of IT technologies.Additional investment in research and development of IT technologies is necessary in order to plow with development of modern health care services.EconomicalNHS will receive signifi shtuptly lower annual budget increase, compared to previous years and it is expected to present 20bn (GBP) in savings by 2013-14.With the abolition of PCT budget of roughly 80bn (GBP) will be transferred to prudence by GP commission. policy-makingCoalitional government presented new reforms that concentre on implementing administrative and structural changes in NHS. Emphasis of the reforms is on giving much(prenominal) power and choice to the consumers, decentralising focal point and significantly trim back administrative costs.Introducti onThis management report is a musical note analysis of the NHS in England. The report sets out the key issues within each STEP for the governing and can be used as the basis for further analysis. A conclusion identifies the key issues arising from the STEP analysis for the NHS in England and also sets out the strengths and weaknesses of the STEP approach and the challenges encountered when at a lower placetaking the analysis.STEP 1 SocialThe majority of the state in England and Wales use the services of the NHS (about 8% of the macrocosm use close health care). The NHS ingests to be aware of demographics changes as this will go through a significant impact on demand for NHS services as a hale and on demand for particular products and services. The key social issues that the NHS in England wishings to consider arePopulation growth rate and age profileHealth of the general populationIssues related to ethnicityIssues related to immigrationGovernance patterns, social inclusion and partnerships building.Population growth rate and age profileThe UK population reached 59.8 cardinal in 2004 its highest ever level. It has increased in size by 7 per cent in the three decades since 1971, when the figure was 55.9 million. But this population growth has non occurred at all ages. In fact, many age groups set out shrunk and so have become a smaller likeness of the whole population. The ageing of the population will affect the types of services required and the way in which they are provided.Population healthAbout 46% of men in England and 32% of women are overweight (a body mass index of 25-30 kg/m2), and an additional 17% of men and 21% of women are obese (a body mass index of more than 30 kg/m2 ). Overweight and obesity increase with age. About 28% of men and 27% of women aged 16-24 are overweight or obese neverthe slight 76% of men and 68% of women aged 55-64 are overweight or obese. Overweight and obesity are increase. The percentage of adults who are obe se has roughly threefold since the mid-1980s. The effect of these trends is increasing requirements for different types of equipment (eg. stronger beds).EthnicityPakistani and Bangladeshi men and women in England and Wales reported the highest rates of non good health in 2001. Pakistanis had age-standardised rates of not good health of 13 per cent (men) and 17 per cent (women). The age-standardised rates for Bangladeshis were 14 per cent (men) and 15 per cent (women). These rates, which take account of the difference in age structures between the ethnic groups, were around twice that of their White British counterparts. Chinese men and women were the least likely to report their health as not good. Women were more likely than men to rate their health as not good across all groups, apart from the White Irish and those from Other ethnic groups. Reporting poor health has been shown to be strongly associated with use of health services and mortality. White Irish and Pakistani women in England had higher GP polish off rates than women in the general population. Bangladeshi men were three times as likely to visit their GP than men in the general population after standardising for age.ImmigrationSince 2004, a record 1.8 million foreign workers have come to Britain, including an estimated 700,000 from Eastern Europe. And yes there have been problems. Migrants have put pressure on the NHS by using casualty departments as GP surgeries. TB rates are also up and the cost of translators in hospitals to deal with foreign patients can be crippling for health authorities.Governance patterns, social inclusion and partnerships buildingCitizens participation becomes more and more important to fill the gaps of governments failure. Many initiatives related to ordinary health issues, for example reducing the incidence of drug misuse, can never be achieved without involving citizens. The UK is a pioneer in deliberative democracy, which is an ideal vehicle for the promotional mat erial of health based voluntary / statutory orbit partnerships.STEP 2 TechnologicalThe increasing efficiency and effectiveness of the NHS in England is dependent upon the capture use of technology, and affects both the acute and primary care sectors. The key technological issues soon facing the NHS in England areThe IT impact of the abolition of Primary Care Trusts (PCTs) and the endure to GP deputationHow to address the results of the UK Governments changing national health IT policyContinuing the development of teleheath and telecare to shift the balance of care from the acute to the community sectorIn general, continuing to fund and integrate technological developments in service provision that offer improvements in economy, effectiveness and efficiency.The abolition of Primary Care TrustsThe abolition of PCTs and the move to GP Commissioning fashion there is a motivating to ensure effective IT structures are in place to support the move. PCTs will need support to ensure the data they hold is dealt with appropriately be it destruction or move to other organisations. There may be a need to consider national guidance.GPs and service providers will also need support to ensure their IT systems are able to communicate with each other effectively and have the capacity to deal with increased records. There may be a need to consider national guidance.National health IT policyThe new confederation government ended the National Programme for IT in England and has just finished consultation on its new Information Revolution.23The previous programme aimed at providing a number of national IT services, such as Choose and Book (the national electronic referral system) PACS (central picture archiving service for eg x-rays) and the national electronic subscriptions service. Some of these programmes were completed under the previous government, however, galore(postnominal) are still in development. The compact government has expressed their appetite for local IT solutions, however, many of the programmes are tied to national contracts with the private sector. The NHS in England needs to examine the cost of termination (and the costs of providing alternative local solutions) vs continuing with the existing contracts, contrary to government policy. There is a need for further clarification from the government and advanced engagements from the NHS with the coalition.The development of telehealth and telecareMoving care into the community and supporting people to live in their own homes for longer requires increasing use of telehealth and telecare technology. There are numerous benefits for the NHS in England and its users, for example those in rural communities able to access consultant appointments via computer rather than travelling loose distances, and more people living longer in their own homes.These developments need continuing support from the centre if health bodies are to continue to develop these. rudimentary funding may also be required to continue research into this area and technological development.Continuing technological developmentsThe NHS in England needs to continue promoting the benefits of new technologies to health bodies and providing support (small scale funding, guidance) to help trusts implement these. The 2009 NHS IMT Investment Survey indicated that capital investment at local level has remained static over the one-time(prenominal) 5 years, it is only the injection of central funding that has led to increases in this area. Emphasis needs placed on health trusts to continue to fund developments.4STEP 3 EconomicThe key economic issues facing the NHS areThe outlook for public sector financesThe effect of GP delegacyThe impact of faculty pay and conditions (cost of labour)The cost of capital/diminishing capital resource and investmentPublic sector financesAs a result of the coalition governments desire to address the effects of the global economic crisis and its attempt to promptly red uce the budget deficit, resources available from central government are projected to increase less quickly than in recent years. The rise for 2011 of just 0.1% represents a significant decrease in funding compared to increases in recent years. This is further compounded by cuts in the levels of cash received by hospitals for treating patients. Commentators suggest that the effect of the cuts will require the identification of 20bn (GBP) in savings by 2013-14. The NHS in England needs to quickly fall upon how it will continue to provide care with reduced levels of funding. This may include actions such as reducing rounding levels and increasing out-sourcing of services.Effect of GP CommissioningThe abolition of Primary Care Trusts and the move to GP commissioning brings both opportunities and risks associated with the handover of almost 80bn (GBP) from central to local control. While previous experience would suggest that GP commissioning improves efficient use of resources (effici ency fell by 1.6% after the abolition of internal markets in 1997) (see reference 1) it is possible that individual hospitals, patients and the GPs themselves may lose out. GPs may spend more time involved in administrative tasks and less time with patients patients may be affected by the level of engagement with commissioning on the part of their GP and some hospitals will fare better than others under the revised arrangements. Retaining control of NHS spending is a significant challenge when accountability for the use of public funds essentially lies in the hands of private contractors. Effective financial controls will be necessary to ensure demand management is not simply left on the shelf and that resources are used both effectively and efficiently.Pay and conditionsStaff costs as a proportion of total costs are high within the NHS. The effects of minimum wage and, more recently, the implementation of the European Working Time Directive continue to drive costs up, even as staf fing levels remain static or fall. Efforts to ensure trusts comply with the Working Time Directive have backfired by ensuring staff record hours worked more accurately leading to increased overtime payments and identification of additional need. In addition, the effect of cuts in staffing both through voluntary and imperative redundancies will place additional (albeit relatively short-term) pressure on finances in the form of pay-offs and pensions.Capital assets and investmentsMany PCTs acknowledge that the current period imposes reductions in capital investment. Short term savings accrued by delaying investment may lead to increased costs in the future. In addition, numerous trusts have sold off capital assets to remain competitive in recent years, thereby reducing asset value now and for the future. The use of PFI/PPP/DBO may offer short-term benefits (by reducing direct capital expenditure) but risks remain with regard to the long-term commitment and associated cost of such cont racts.STEP 4 PoliticalThe change in government from Labour to Conservative/Liberal Democrat in 2010 resulted in a significant shift in political attitudes towards the NHS in England. The drive to reduce centralised control and increase local responsibility has resulted in a number of key policy initiatives.Coalition programmeThe coalition programme for healthcare included the following subjects5Greater financial autonomy for local bodiesInvolvement of GPs in tackling health care problemsImproved access to contraceptive healthcare for disadvantaged areas diminution of long-term costs.The specific programme for the NHS included the following6Real term budget increase for next 5 years.Reduction of quasi-non-government-organizations (quangos).Cut administrative costs by 30% and use these resources to support doctors and nurses.Discontinue closure of AE units and of maternity wards.Restructure health system giving more power and freedom of choice to patients and transferring commissioni ng powers from PCTs to GPs.Development of monitoring system to oversee aspects of access, competition and price-setting in NHS.Establishment external and individual board to divvy up resources and provide commissioning guidelines.Introduction of rating system for health care providers that will lay off patients contributions and will be accessible online.Reform NICE into value-based pricing, to allow broader access to drugs and treatments for those who need them.Introduction of per-patient funding for hospices and providers of palliative care, and allocation of additional 10 million pounds a year from the budget to support these childrens hospices.Improvement of service quality through involvement of independent and voluntary providers and through giving patients ability to choose provider that suits them most.ReformsAndrew Lansley, the health secretary, introduced plans for NHS reform in August 2010 (White write up of announced reforms is available here).The main topics were78D elivering commissioning power to purchase health care for the patients to GPs who are to join consortia by 2013.Abolishment of 10 strategical health authorities and of approximately 150 primary-care trusts and transfer some of their services to external non-for-profit outfits.NHS hospitals are to become foundation trusts and to enjoy greater autonomy in revenues and funding.Patients will be available to choose GPs regardless to their geographical areas, to make shared decisions on their health treatments and to enjoy published data on hospitals and doctors (results, postponement times, rates, etc.).NHS funding will increase in real terms for the following 5 years but it will have to do more for its capital reduction of managerial costs by 45% efficiency savings of 20 billion pounds, which are to be reinvested to support quality and outcomes.Establishment of an independent NHS Commissioning Board, which will allocate and account for NHS resources and will audit on implementation o f quality improvement and patient involvement and choice.ConclusionThe NHS in England is currently facing a period of change that will affect all aspects of its operation. Delivering the required political reforms within the constraints of the current financial climate will be challenging. Coupling this with increasing demand for services caused by an ageing population and the associated technological developments that need to be put in place for this to be managed means the NHS in England must be clear on its purpose, its direction and its strategy for achieving these.RecommendationsRe-examine the purpose, direction and over-arching strategy of the NHS in England to ensure they remain fit-for-purposeDevelop appropriate national strategies for each element of the organisation (eg IMT) to ensure there is clarity about what is required of trusts.Emphasise citizen involvement and partnership programs.Develop appropriate IT and technological infrastructures to support new reforms.Streng ths and weaknesses of the STEP approachSTEP analysis has strengths and weaknesses. The key issues identified by the group areStrengthsThe analysis can help focus an organisation on the key factors in each environment ensuring they think about each step. It is quite a simple process that allows consideration of many variables.It enables the organisation/unit to look outwith their immediate environment to consider important external factorsThe approach can be linked with other models (typically SWOT) to increase its profitIt encourages strategic thinking and planning and allows the organisation to anticipate future issues.WeaknessesAssessing the importance of issues can be challenging if appropriate and robust data is not available. Accessing useable data can be time consuming and therefore has a cost attached.The use of the four steps can mean a pigeon-holing of some issues that span across other themes (such as the impact of government policy)It is a task perhaps best done with a group in individual rather than in isolation so that ideas can immediately be discussed/challenged and priorities for the issues included are agreed by consensusConsidering the factors in isolation makes it difficult to identify linkages between the various elementsIt may be effectual to keep the focus of the analysis specific as then the outputs may be more useful rather than general statementsForecasting leads to multiple possible futures there is a danger of assuming hypotheses are truthThe exercise needs to be recurrent to remain useful to account for pace of change/changing realities.Challenges encountered by the group in conducting the analysisThe group encountered the following challengesconsidering the factors in isolation do it difficult to identify linkages between the various elements. It may have been useful to circulate our lists in advance to encourage cross-fertilisation and consistency across the 4 factors (Delphi approach)undertaking an analysis of an institutio n with which some members of the group had little familiarity led to increasing reliance on assumptionswe ended up with quite a broad target topic, if we had narrowed our focus the results may have been more usefulaccessing relevant data was difficult in some areas and hence time-consuming.References for STEPhttp//rapidbi.com/management/created/the-PESTLE-analysis-tool/http//www.healthknowledge.org.uk/public-health-textbook/organisation-management/5b-understanding-ofs/assessing-impact-external-influenceshttp//www.nhsemployers.org/EmploymentPolicyAndPractice/EqualityAndDiversity/e-d-in-practice/get-to/IdentifyingTheObjectivesAndOutcomes/Pages/PEST_Analysis.aspxhttp//www.herefordhospital.nhs.uk/Portals/0/MembersArea/IBP/Appendix%20X%20-%20PEST%20and%20SWOT.pdfhttp//newsfan.typepad.co.uk/pestle/2009/03/pestle-summary-united-kingdom.htmlhttp//www.coursework4you.co.uk/essays-and-dissertations/pest-analysis.phphttp//www.statistics.gov.uk/downloads/theme_compendia/fom2005/04_FOPM_AgeStruct ure.pdfhttp//www.annecollins.com/obesity/uk-obesity-statistics.htmhttp//www.medwaypct.nhs.uk/explore-nhs-medway/news/media-releases/proposed-changes-to-workforce-and-education-in-the-nhs-making-our-views-count/Does the British media hate the NHS?http//www.guardian.co.uk/society/2001/jun/14/NHS.conferenceshttp//www.mirror.co.uk/news/top-stories/2007/10/18/immigration-the-true-cost-to-britain-115875-19969602/