The NHS began with the post war Labour government. The objective aim was to provide free health care from cradle to grave provided by the state. It truly was the jewel in the crown for Clement Atlee's welfare state. The question however has arisen of how far have the governments attempted to improve the provision of health care without diminishing the shine of the jewel and without conflicting with Aneurin Bevan's principles.
Have the government succeeded at delivering to society's expectations with the occurrence of a widening population, advances in technology, the birth of new treatments and the nature of the NHS changing in comparison to how it originally was. Now at a time, where the general election is near, each political party will want to show the public that they are the right party to manage the NHS, they are the right party to manage the institution that binds our nation together. This essay will explore the attempts placed by the government to improve health care but more importantly how successful have these efforts been.
1992 saw Major's government create the 'Internal Health Market'. Market forces were now introduced in the NHS. This service was divided into 2 groups. They were purchasers who consisted of 'Regional Health Authorities' and fund holder GP's. They received money directly from the government to spend freely on what provides the best deals for patients. The other group was providers. The provider's earned money by selling services to purchasers. The providers were hospital trusts which were self managed businesses.
The aim of this health market was to continue Thatcher's aim of becoming more cost effective but also to become more competitive. However this was seen as a contradiction in its own terms in achieving its aims due to expensive administrative costs. There were also allegations of unfairness and talk of a health service rationing was in existence. This overall led to the crucial weakness that the patient's quality care lost priority to balancing books by managers whom ran the NHS. Hence overall, this was not a successful attempt to progress the health provision.
It was the failure of the Internal Health Market which led to Tony Blair famously telling voters they '24 hours to save the NHS' on the eve of the 1997 election. During the first 2 years of government, New Labour continued Conservative spending and no attempt was placed to reverse policies such as charges for both dental and optician services and prescription charges rising with inflation. The funding for NHS represents 1/3 of the governments departmental funding. In 2002, Gordon Brown in his budget stated that i?? 40 bn over a period of 5 years placed in the NHS.
This was a 7. 4% expenditure rise per annum. The NHS spending was now 3 times more than it was in 1996. This was seen as a very egalitarian approach from Labour as they attempted to improve health care maintaining the principle of democracy by ensuring this is what the government is doing for the people. This improved health care as the number of front line staff was up by 2. 6% hence new contracts with consultants, GP's and nurses were placed as money was reaching the frontline in the NHS. However in 2007, the funding scooped down to a staggering 4. 4%.
It is believed that i?? 8- i?? 10 bn is likely to be cut in 3 years from 2011. Alternatively, the Conservative Party state that they intend not to cut spending on the NHS rather they aim to place a 1% increase on spending as they believe that long term investment in required. Recently health secretary Andy Burnham stated that over the next 4-5 years between i?? 15 bn and i?? 20 bn will need to be saved. It is also crucial for the NHS to save i?? 15 bn by 2015. Alternatively however, The Liberal Democrats stated in their 2009 conference that they aim to save the NHS i??
500 million a year by 'savage cuts'. This is by slashing spending on NHS QUANGO's. They attempt slash spending on the QUANGO's by 20% and the pay of health service managers as to their accordance 'The NHS is a bureaucratic monster'. The Conservatives are in consensus with this as announced on their 2009 conference they believe i?? 1. 5bn a year can be saved on bureaucracy. Shadow Health Secretary Andrew Lansley too believes a third can be saved on the cost of the annual i??. 4. 5bn cost of QUANGO's and NHS management in England. British Medical Association's (BMA) chair man Dr.
Ian Bogle believes in consensus with The NHS Modernisation Board that more investment still has to be put in to make a long term difference as it has to be an ongoing commitment of a stable amount of money placed in. The modernisation board also found difficulties with limited capacity of funds, old buildings and out of date equipment thus one can say that in the short term health care was booming but in the long term now, this is not the case. Due to the problem arisen by state funding, there has been an increased role of the private sector in health care provision.
Firstly there is the idea of Private Finance Initiatives (PFI's). This was originally introduced by The Conservatives and cynically criticised by Labour whilst in opposition. However in 1997 when Labour was elected they extended and embraced the programme. The treasury saw PFI's as a good way to raise money for NHS hospitals. It has been argued by Brown that PFI's is the 'only way to raise money to fund new hospitals' however, this is seen not to be the case as it can be paid for through taxation.
NHS patients are also being treated in private hospitals to reduce waiting times. This can therefore, be argued as fundamentally altering the way in which the NHS operates as it will become more personalised and individualised for the few. This contradicts the idea of universal treatment as it won't fit the need of all patients. The International Monetary Fund in October 2009 stressed more private involvement to help with the NHS deficits. 1 in 10 operations conducted are carried out in a private sector.
In accordance to the Independent Healthcare Association (IHA) 50,000 patients have undergone treatment in the private sector since 2001. The private involvement in the NHS is limited to providing non emergency services and some have involvement in GP's. Minister's however, aim to encourage private sector involvement in primary care to fill gaps in areas which have struggled to gain doctors. On a business level the government believe that this will improve health care by not only encouraging businesses but also encouraging extra service competition.
This is a very controversial issue but the government state the private involvement is the only way to increase the capacity within the NHS. On the other hand others may argue this has not attempted to improve the provision of health care as September 2002 saw that private involvement 'Is a privatisation of stealth' is what health unions state as it primarily undermines the foundations of the NHS, that health care should be free rather a price being paid. There is also the issue of the birth of a two-tier health system, and this contradicts the notion of a fair health care for all.
The GMB report showed that companies will make an excess of i?? 3 bn profit from PFI agreements over 30yrs. Any collaboration between public bodies, such as local authorities or central government, and private companies tends to be referred to a public-private partnership (PPP). Tony Blair was keen to expand the range of private public partnerships because he believed it was the best way to secure the improvements in public services that Labour promised election.
He believed private companies are often more efficient and better run than bureaucratic public bodies. In trying to bring the public and private sector together, the government hoped that the management skills and financial acumen of the business community will have created better value for money for taxpayers. However many public sector unions, however, remained sceptical – and are particularly concerned about the extension of the private sector into new areas like schools and hospitals which had traditionally been publicly run.
Currently private clinics such as Independent Sector Treatment Centres (ISTC's) are under inspection to ensure safety measures are in place as it subsequently emerged that no emergency blood supplies on site and vital medical equipment was no available. This has asked the question of whether the private sector is reliable for the quality of basic compassionate care. ISTC's were set up by the department of health in 2003 to perform common elective procedures on NHS patients. Their initial goal was to perform 250,000 operations over 5 years.
Evidence from a Panorama documentary showed that some private contractors are paid 10% more than the NHS for operations and tend to be over paid. In support for private involvement are the Conservatives whom are in consensus with Labour but are not in agreement with the NHS seeing an extra i?? 20 million spent of maximising the involvement of private firms as prior focus should be placed on what is occurrence rather than what could be. The use of private involvement has ultimately asked the question of whether the private sector is reliable for improvement of the quality of basic compassionate care.
Many believe that the performance of the health care provision has indeed improved but to what extent. New Labour have introduced targets which are made up of 24 core standards and 10 developmental standards covering seven key areas. Such key areas were safety, accessible and responsible care, clinical cost effectiveness etc. They set the level of quality care which every patient should expect wherever they are treated in the NHS. These targets focused, in large part, on speeding up access to care.
For instance, people arriving at A&E departments were supposed to be seen within four hours, and GPs were told to offer an appointment within 48 hours of a request. 2005 saw the star ratings to be replaced by a five-level worded grading system. This has been seen as an improvement to the health provision as more emphasis is placed on patients' experiences and is not as crude and simplistic to the NHS as was the star ratings. Both the BMA and Parents Association welcomed this improvement as they believe that the health system to the patients need is now a better system that uses fewer targets and gives patients more useful information.
However the targets have faced rigorous criticism as it forces doctors to concentrate on meeting targets rather than treating patients according to their needs. In order to meet waiting list targets more straightforward cases have been prioritised at the expense of more complex cases. A primary example of this would be Staffordshire Hospital where 400 more deaths occurred between 2005- 2008. This was due to target pressure and the hospital being so distressed in achieving their targets to be a foundation and to be more efficient that the patients care was not taken at face value.
This has been seen as ironic as in 2007 the hospital was classes as 'good' during inspection highlighting that targets have not been an improvement rather they have been a disincentive to quality of care and an incentive to quantity. The targets can be seen as a success and an improvement to the NHS as 2010 mortality ratings were achieved. Existing outcome targets in areas such as cancer and coronary heart disease will run until 2010. Before the introduction of the targets in 2002 23% of patients would spend 4 hours or more waiting for treatment.
In 2004, after introduction of the targets only 5. 4% of patients spent 4 hours or more in A&E. MRSA cases have fallen dramatically as a result of target-setting. It is down about 27 per cent in one quarter of the year and nearly 40 per cent in a year. The Conservative however Party aims to scrap targets as they believe it is detrimental to the health care provision and create more problems than solving. Andrew Lansley has accused the government of being pig headed due to their obsession with targets.
This mirrors the view of The BMA as they believe that professional judgement is taken away from the professionals themselves. The targets have led to some success in weak areas such as waiting times but are damaging to the bigger picture, to the essence of the NHS which is the health care the patient received. The Darzi Review by Lord Darzi on the 60th anniversary of the NHS said to improve the performance of hospitals, information regarding the quality of an NHS body's service will be published on the web and on clinical 'dashboards' in hospitals and GP surgeries.
The dual shine to the NHS was that it was a fair system hence everyone could get the health care they need without the question of wealth. The Government in 1997 aimed to maintain this principle and improve it further by setting up The National Institute for Clinical Effectiveness (NICE) to end all inequalities within the availability of drugs. NICE decides which drugs are available in England, Wales and Northern Ireland. In Scotland there is the Scottish Medical Consortium. The overall aim of NICE was to reduce the imbalance and improve the injustice from the postcode lottery and NHS top ups.
The post code lottery is the variations in the provision and quality of services. This is because where you live defines the standards of services received. This is a very controversial issue as it demoralizes the concept of the NHS being a 'national' service. In 2001 Labour in their election manifesto attempted to tackle this issue by stating it will force health authorities and trusts to pay for drugs which are approved by NICE. This has been argued as an improvement to ensure the patients have fair access and high standards of care across the UK.
The NHS top-ups are payments made by patients who choose to pay privately for extra treatment in addition to the care provided to them free at the point of delivery by the NHS. This has recently become a divisive issue as cases have shown patients being denied NHS care because they pay for drugs that are not available on the NHS. The BMA chairman Dr. Hamish Meldrum believed this goes against the values of the NHS. The NHS top-ups ban has just recently been lifted and now patients can supplement their NHS care by paying for drugs privately.
The BMA are in agreement with this and believe that this is a practical way of balancing the rights of individual patients. The Liberal Democrats too are in agreement with this view as they believe the values of fairness and equality which the NHS bases itself on is sustained. The method used to decide find the worth of the drug is the cost benefit analysis where if the benefits outweigh the costs the drug is worth its availability. The green light by NICE then determines whether or not a drug becomes available.
However physicians argue that NICE as a company tend to improve the provision of health care however, their calculation to decide whether a drug should be available is flawed as patients miss out on basic medicinal benefits. The Darzi Review seconds this as he stated that the time taken to authorise a drug should be sped up. It currently is 2 years but should be 6 months. The Conservatives are in consensus with the Darzi review this as they aim to reform the way drugs are priced so that all new treatments that are clinically effective are made available so that more improvement can be made to aim to deliver to the expectations of patients.
The Darzi Review also proposes a NHS Constitution. This should set out commitments to patients, public and staff in the form of rights to which they are entitled and pledges which the NHS will strive to deliver, together with responsibilities which the public, patients and staff owe to each other to ensure the NHS operates fairly and effectively whether this is short term or long term care. Long term care is care that covers everything from residential and nursing homes to home care.
It is provided by a range of different organisations including local authorise, the NHS and private and voluntary organisations. Currently anyone in England with a home or savings of i?? 23,500 or more is not given state funding to a care home or help from social services. Due to this principle many pensioners are then forced to sell their homes or assets to fund long term care. It has been argued that there was a black hole in funding for long term care. In order to improve this provision all 3 main political parties are in consensus for improvement but again offer different approaches.
Labour firstly in their 2009 annual conference promised a new National Care Service, to run alongside the National Health Service, for 350,000 pensioners who require assistance with every aspect of day-to-day living – from dressing to cooking, but the Government had yet to flesh out the details of how much the scheme would cost. Ministers ruled out raising taxes and instead put forward three options whereby the state provided a basic package and the public contributed the rest.
This could either be done through paying any costs themselves, taking out insurance or introducing a compulsory fee. They said the bill for residential accommodation, which is often cited as the reason people are forced to sell their homes, can be deferred until death when it is taken from a person's estate. The Liberal Democrats however in their annual conference state they aim to introduce the 'universal care payment' to help those aged over 65 who need personal long term care.
This mirrors The Conservative Party recently announced proposals to an extent as they are offering a voluntary one-off fee of i?? 8,000 at age 65 to waive residential fees for life. The scheme could be operated by existing insurers using branded products, with the government setting out basic rules and safeguards to ensure it remained financially viable over the long term. They insist the voluntary scheme would be self-financing as only 20% of those paying in would get ill enough to have to draw on the scheme, and say no public money would be needed to operate it.
Conservatives say that 45,000 people are forced to sell their homes each year to pay for residential care, with a typical two-year stay costing i?? 52,000. Pressure Group Age Concern are in consensus with these proposals and believe they should be in place but are also concerned about the issue of compulsory fees and there are still big question marks over funding. They believe that councils should be properly funded to provide care so no incentive is provided to place the elderly into care homes.
This is due to the proposals did not mention money. However this can be because any changes would be so far away that it would be impossible to say what the budget would be. In conclusion it can be said that to a certain extent the government have succeeded in improving the provision of health care. For example waiting times have reduced, Top up care is now available, there have been talks of reforming the long term care available and organisations such as NICE have been set up to reduce inequalities and unfairness within the system.
No-one could foresee the advances in medicinal, social sciences and technology that exists today and the fact the government of a country the size of the UK could meet the cost of such a service. It can be said that better choice and quality of care and efficiency is central to the Government's agenda for modernising and improving and creating a patient centred NHS as Brown said in the 2009 conference 'It is now more than ever important to create a patient centred NHS'. All 3 main political parties are in consensus for this hence differences between these parties are now more than ever blurred.
As Brown stated in the 2009 annual conference, ' For us the NHS has not been a 60-year mistake but a 60-year liberation. ' The NHS is committed to improving access to services and increasing the choice patients can exercise when they use these services. However, as our government does not wish to do itself down it will never admit to its failings in the system such as staff shortages, lack of equipment, deductions in funding and old buildings which highlights the overall extent to whether these improvements can be concluded as a success.
In the current economic climate the government is concerned in improving the health provision but also maintaining that it is run cost effectively in the long run. As all in all it can be said that funding is the underlying problem which shadows itself over the success of the health provision. The money in the NHS is not enough to provide for the aging societies expectations therefore asks whether we can have a patient centred NHS.
We have two generations of people who take their health for granted in that they feel in all occurrences it is the NHS's responsibility to provide treatment for free to the detriment of the older generation who placed the NHS on its feet and now need the services and cannot get them. At the time of the general election drawing near, it is time that the Government did what it so often promised and so often fails to do, and really put the patient first. This is the only way society will see an improvement in the health provision.