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I am looking into the delivery of health care in the NHS. I will be looking at the original remits of the NHS, the ideological and political context in which the NHS was formed and also looking into the governments new White Paper “Liberating the NHS”. Other areas I will be looking into include; the political and ethical issues that are involved in the inequalities in provision and access to health care services as well as looking at how the NHS works with e the private sectors.

Looking firstly at the NHS and the original remits, the NHS was formed/established in 1948, It come out of a long held ideal that food healthcare should be available to all, regardless of wealth or the ability to pay. It was established by Aneurin Bevam who was at the time health secretary. The formation of the NHS marked the start of the health service; it was the first time that doctors. Hospitals, nurses, pharmacists, opticians and dentist were brought together under one umbrella organisation. The main principles were that it was free, and it would be financed entirely from taxation, this meant that people pay into it according to their means.

“From the cradle to the grave” This was one of the original ideas of the NHS; it would give/provide medical Helpance all through a person life. The NHS was set up just after the 2nd world war and people badly needed medical help and Helpance. 60 years ago medication and treatment was seen a s a source or real worry to many families and something that could not of been afforded. Other remits were that anyone living in the country and visiting could see a GP/Doctor and go the hospital for free. Before this people simply didn’t go to the doctors, they couldn’t afford it and would rely on home remedies and the charity of doctors giving free advice and help.

If we look at the three core principles that the NHS was built on, these were; that it needs to meet the needs of everyone, that its free at the point of delivery and that is be based on clinical need, not ability to pay.(http://www.nhs.uk/NHSEngland/thenhs/about/Pages/ nhscoreprinciples.aspx).In July 2000, the NHS was modernised and new programmes were brought in, these required that – The NHS provide a wider more comprehensive range of services, the NHS will meet the needs of individuals, their families and there carers. There were also other new programmes brought in looking at improving the NHS and how it operated as a whole.

The new “White Paper” “Liberating the NHS” (2010) is the governments long term vision for the future of the NHS. It sets out that they will put patients at the heart of everything the NHS does, focus on continually improving those things that really matter (i.e. patients and the public) and finally, empower and liberate clinicians to innovate, with the freedom to focus on improving healthcare services. The government also has other key strategies: “We will increase health spending in real terms in each year of this Parliament. Our goal is an NHS which achieves results that are amongst the best in the world”.

Putting patients and public first

“We will put patients at the heart of the NHS, through an information revolution and greater choice and control”

Improving healthcare outcomes

“To achieve our ambition for world-class healthcare outcomes, the service must be focused on outcomes and the quality standards that deliver them. The Government’s objectives are to reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all”.

Autonomy, accountability and democratic legitimacy

“The Government’s reforms will empower professionals and providers, giving them more autonomy and, in return, making them more accountable for the results they achieve, accountable to patients through choice and accountable to the public at local level”.

Cutting bureaucracy and improving efficiency

“The NHS will need to achieve unprecedented efficiency gains, with savings reinvested in front-line services, to meet the current financial challenge and the future costs of demographic and technological change”

Conclusion: making it happen

“We will maintain constancy of purpose. This White Paper is the long-term plan for the NHS in this Parliamentary term and beyond. We will give the NHS a coherent, stable, enduring framework for quality and service improvement. The debate on health should no longer be about structures and processes, but about priorities and progress in health improvement for all”.

(http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117794.pdf)

The proposal of the white paper is that as much as 80% of the NHS budget will be in the hands of family doctors by 2013. Many people feel that these changes are effectively being introduced without any real testing to see if they will work or if they will actually bring around better care for patients. GP’s will take over from primary care trusts and purchase large chunks of care such as hospital admissions and out of hour care. The areas they will not be responsible for will fall under the care of local authorities. England’s 35,000 family doctor practices will form themselves into about 500 consortia, based on geographical area. So they could be responsible for patient populations as large as one million and as small as 100,000. They will either manage themselves or, more likely, will take on managers from the PCTs and strategic health authorities, which are also being abolished. Alternatively, they can take on a private company to manage them, and there are several waiting in the wings for his opportunity. Hospitals will all be required to become foundation trusts by 2014, giving them more autonomy and freedom as to how they provide their services. They can also borrow money without asking the Treasury, and Mr Lansley is very keen that many form themselves into “mutual trusts” a lot like John Lewis, in which staff run the centre. Some people believe that this could all lead to the privatisation of the NHS. The new government is allowing them opportunities to step into the new regime. GP’s may now have to take back the responsibilities of out of hour care. The new regime “No decision about me, without me” is at the heart of the white paper. What is not clear is what happens when a profit is made or, equally, when a deficit is run up. Patients should have more choices and patients will now be asked how their experience was during their care.

(http://www.channel4.com/news/nhs-white-paper-liberating-the-health-service)

The main benefits that should be seen from this is that GP’s will know there patients on a more personal level, they will make logical decisions. It will bring costs down such as pharmaceuticals and prevent the NHS going further into debt. It will also stop them from working towards incentives. However only one in four of Britain’s doctors thinks the government’s controversial NHS shake-up will improve patient care, according to the biggest survey of medical opinion since ministers unveiled their radical reforms. Andrew Lansley’s belief that the most far-reaching changes to the service in its 62-year history will lead to higher standards is shared by only 23% of doctors

There is some good news for Lansley in the poll. Of the GPs, 62% thought there were family doctors in their locality who could lead the new commissioning consortiums. And 40% of all the doctors believed the reforms would encourage closer working between GPs and their hospital colleagues (though 37% disagreed).

(http://www.guardian.co.uk/politics/2010/oct/24/nhs-white-paper-doctors-survey)

Political and ethical issues surrounding the inequalities in providing access to health services, in 1999 labour that were in government set up NICE (National Institute for health and Clinical Excellence). They decide what medicines should be available to the NHS. They work out whether a drug is worth paying for, weighing up its costs against the benefit it is likely to bring. They also consider is drugs or treatments will benefits patients, will help the NHS meet its targets, for example by improving cancer survival rates, Is value for money, or cost effective. The government developed NICE to get rid of ‘the post code lottery’ – where some drugs and treatments were available in some parts of the country, but not in others. It’s worth knowing that they fund the majority of drugs they assess. Since they started in 2002, they have funded 7 out of 10 (70%) of the cancer drugs they’ve assessed.

However a report “Exceptional Progress” has found there is controversy surrounding NICE. Patients are being denied access to drugs for rarer cancers because the NHS treatment watchdog is acting contrary to the recommendations of a government inquiry, a report claims today. (NICE) is “failing to follow the spirit” of guidelines designed to improve access to end-of-life cancer treatments. It claims that as many as 16,000 patients have been denied access to drugs because the watchdog had concluded unfairly that they did not meet the criteria for consideration, or they were deemed too expensive – without proper negotiation with pharmaceutical companies. “It is unacceptable that many thousands of patients are still missing out on the treatment they need, and which their doctors want to give them, because NICE has decided that their treatment does not meet some arbitrary criteria,” Mr Wilson said. He added that NICE was failing to assess drugs quickly enough – taking 21 months to appraise new cancer drugs, rather than the six months promised by ministers by 2010.

(http://www.timesonline.co.uk/tol/news/uk/health/article7061769.ece)

This is against the original ethics that the NHS was set up for; some patients are missing out on drugs which could be of immense benefit to them. An example of this is patient inequality in Essex where a doctor treating three people for exactly the same eye disease, treats each differently because they live in three different areas. One of the three is getting Lucentis the drug tailored to treat their condition, the second receives a drug which was not designed to treat the eye condition; but which does the job at a much smaller price, while the third is left with no drug therapy at all. The programme also spoke to best-selling author Terry Pratchett who has been forced to look elsewhere for Aricept, the Alzheimer’s medicine denied to him by the NHS. NICE ruled that Aricept should be limited through the NHS to people in the later stages of the disease and Pratchett is still in the early stages of PCA, an early-onset form of Alzheimer’s which he was diagnosed with in 2007. The author now pays for the drug himself which he says has been vital in allowing him to cope with the symptoms of his condition, and says that not making it available earlier to other sufferers who cannot afford to pay is “an insult” which needs to be re-thought.

(http://news.bbc.co.uk/1/hi/programmes/panorama/7563701.stm)

There are big gaps between regions and areas; in some cases the north is better at treating certain conditions than the south and vice versa. A report by the Daily Mail shows how Statistics showed the average waiting time from seeing a GP to having an operation was 180 days in the Trent region, 182 days in the Northern and Yorkshire regions and 193 days in the North West. But patients must wait for 217 days in the South East, 207 days in London and 206 days in the Eastern region. There was a rise of 1.6 days in delays on average in the South East compared with the same time last year. In the same, period delays fell by 8.7 days in Trent and the North West.

(http://www.dailymail.co.uk/news/article-70414/North-south-divide-NHS-waiting-times.html)

Finding a dentist is becoming more and more difficult. There is a culture of drill and fill, but because dentists receive a flat salary they no longer have any financial incentive to carry out difficult work such as crowns and bridges. An NHS dentist recently resigned due to ‘stupid’ system that requires him to complete 49 ‘units of dental activity’ a day to fulfil his NHS contract and get paid. Under the contract, check-ups count as one unit, minor dental work and fillings – no matter how many – are three, while more complicated procedures can be worth up to 12. Disillusioned, he has decided to give up his practice in Penzance, Cornwall, and take early retirement, leaving his 4,000 patients without an NHS dentist in an area where 20,000 already cannot find one.

(http://www.dailymail.co.uk/news/article-484066/Dentist-fed-drill-targets-quits-NHS.html)

This again goes against the principles both politically and ethically. The NHS was set up to be free and give everyone the same level of treatment and help regardless of wealth. However these few examples show how it is people with money are gaining in healthcare and the NHS is stopping treatments and drugs due to financial funding, meaning that patients are losing out on much needed treatment because the government decided that it’s not cost effective. This is wrong ethically because you are putting a price on a person’s life. Over the years healthcare has become more of a business and we are seeing more privatisation coming in. the post code lottery proves that money is at the heart of decisions on whether a patient is seen to and how they are treated.

The NHS works with private sectors and third sectors to deliver better outcomes and services for patients who come first. They play an extremely important role in helping the NHS in providing much needed services. Private sectors not only help in hospital but also with services in the local community. One of there aims is to cut hospital admissions, an example of this is A private sector provider in Sheffield has installed electronic monitors in the homes of people suffering from chronic obstructive pulmonary disease, allowing them to reduce visits to hospital by 50 per cent. Another is A private sector company in Poole has put under one roof a GP surgery, a pharmacy, an optician and services for physiotherapy, back pain and podiatry.

(http://business.timesonline.co.uk/tol/business/industry_sectors/public_sector/article7050344.ece)

There is also other instances were GP’s have used private sectors not only to provide patients with a better service but to reduce costs. A patient in Bexley Kent needed a scan for his heart condition; this would normally mean he would be sent to his local hospital in Kent. However he picked up from his souse and was sent to a private hospital in London. The bill for this bespoke service is picked up by Peter Aylott’s local primary care trust in Bexley. In the past eight months it has sent more than 80 patients to Harley Street for these scans. The alternative was to have an angiogram were 1 in 500 patients suffer a heart attack or a stroke. The scan is also cheaper, says Dr Kostas Manis, a GP in Bexley. “The angiogram is £1,300 in the NHS, and the private clinic scanner is £900 and we’re negotiating to bring the figure down to £600.” This shows how the NHS working with private sectors helps not only patients in that they get a quicker appointment but they also get something that is much more beneficial and safer to them. It also allows the patients to see a specialist for longer, rather than the normal 5 – 10 minutes they get to see the Doctor for up to half an hour. This is truly putting the patient first, it does however, have financial benefits to it, and it reduces costs to the local GP’s and makes managing their budgets much easier. Faced with a £20m deficit in 2007, the primary care trust decided to hand over the bulk of commissioning power to GPs. They now control 70% of the £150m budget for Bexley.

This all looks good, patients get a quicker appointment, its better and more tailored to their needs and it reduces the cost of the local primary care trust, meaning that the community has more money to spend in other areas. There is also consequences however of GP’s turning to private sectors. Looking at this same example, the local hospital in Kent – Queen Mary’s hospital in Sidcup, will now lose out on patients going there for this condition, meaning that the hospital has less money coming in and could see them have a long term shortfall in revenue. There are plans by the Government to permit hospitals to compete on price for the first time, raising the prospect of two-for-one deals on surgery and cut-rate consultations for certain specialties. This will come into effect from next April. Prices for operations and other treatments are currently fixed by the Department of Health and hospital trusts are only permitted to compete on quality, offering better outcomes, cleaner wards or shorter waiting times to win contracts from GPs. The risk is that some hospitals may lower their prices, which will be superficially appealing, but offer a less good operation and GP commissioners may not be able to spot that it is less good.