Identify and discuss current trends in the Healthcare sector

by annabella63 (student)

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William Beveridge had a vision of “social reconstruction and social progress”. In 1942 he set out a plan to end what he called the “five giant evils”. He identified them as want, disease, ignorance, squalor and idleness, his report was called the “Social Insurance and Allied Services”. He proposed that everyone in work would pay a contribution into the state insurance fund. In 1946 the National Insurance Act was passed and payment into it became compulsory. The National Health Service was introduced on the 5 July 1948; the principles at its heart were of a long-held ideal that “good healthcare should be available to all, regardless of wealth”. Sixty years on this core principle still remains at the heart of the National Health Service and it has grown to become one of the largest publicly funded health organisations.(NHS Choices, 2012).On July 10 2010, the NHS White Paper is introduced by the government. This is a vision of how the government would like the NHS to progress and is followed by the Health and Social Care Act in 2011.This paper is fundamentally the biggest change the NHS has seen since the start of it in 1948. (Nuffield Trust, 2012).The ageing population and dementia care are placing great demands on an already stretched National Health Service. In this essay I will be discussing the implication of the Health and Social Care Act, and how this is affecting the NHS, its employees and care of the elderly.

The Health and Social Care Bill received Royal Assent and became the Health and Social Care Act 2012 on 27 March 2012.The act proposes to abolish the Strategic Health Authorities and also Primary care Trust, and to replace them with Clinical Commissioning Groups (CCG). Clinical Commissioning Groups are groups of GP’s who are responsible for planning and designing local health services in England. These groups will work in partnership with patients and health and social care groups. They are overseen by the NHS Commissioning Board. (NHS, 2012)

General practitioners will be given more power and it proposes to “free up providers to innovate, empowers patients and gives a new focus to public health.”(Department of Health, 2012). Rowenna Davis who writes for the Guardian newspaper states that, under the new reform GPs will be “Too powerful and too little accountable to local communities.” (Davis, 2012).Another critic of this act is Rosie Taylor of the Telegraph who states that “GPs should be dealing with patients” and also they do not have “sufficient training to be managers”. She also feels that there could be a “conflict of interest” as GPs will not be self-regulating. (Taylor, 2012).

Tim Ross of the Telegraph newspaper reported that one of the clinical commissioning groups set up to implement the proposals has expressed its opposition to the Health and Social Care Bill. Dr Sam Everington from this appointed CGC and also a member of the General Medical Council stated that “your rolling restructuring of the NHS compromises our ability to focus on what really counts …improving quality of services for patients”, (Ross, 2012).The Royal college of Nursing (RCN) also strongly opposed the Health Care Bill. They wanted the bill to be withdrawn and for peers to vote against it. This decision was taken by RCN Council because all other avenues of debate had not succeeded to find an adequate solution. The RCN outlined “18 assurances which had to be addressed to ensure that the reforms would deliver a health service fit for purpose”. To date the RCN still do not feel these strategies have been met. (RCN, 2012)

Another concern for the RCN is the “Nicholson Challenge”, which is a campaign to save £20bn in the NHS by 2014/15.The RCN states that this is creating immense difficulties for staff. (RCN, 2012) In a survey conducted by RCN, some 5% of their members expected to lose their jobs within the next year and 7% expected to be down banded. They also go on to discuss how their “Frontline First” campaign has exposed 48,000 job cuts. The RCN is now advocating that staffing levels are protected and will be pursuing for an amendment through the House of Lords with this issue in the Health and Social Care Act. (RCN, 2011)

In a letter to the Times newspaper Dr Peter Carter, Royal College of Nursing states that “We recognise the need to provide NHS services more cost-effectively, but we believe this can and must be achieved without taking unnecessary risks and damaging care”. He also states that to save £20bn is “extremely risky and potentially dangerous” (Carter, 2012). Adam Brimelow Health Correspondent, BBC News stated that Health Minister Dan Poulter had said the RCN's use of the word "crisis" was “scaremongering and did not reflect reality”. (Brimelow, 2012). Matthew Offord Member of Parliament for Hendon states that “There has been a lot ...

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Matthew Offord also discusses how the NHs needs reform because of the aging population and the specialist care that they will need. He states that “putting in more money without reform won’t meet the healthcare needs of this and subsequent generations”. (Offord, 2012) Many would agree that the reforms are not meeting the needs of the elderly. Ann Abraham, the Health Service Ombudsman, suggested that the NHS was "failing to meet even the most basic standards of care”. After a thorough investigation, these findings were disclosed in the Ombudsmen’s Care and Compassion report. Of all the complaints that they had to deal with, care of older people had twice as many, then any other age group combined. (Abraham, 2011)

In reply to these findings Nigel Edwards, chief executive of the NHS Confederation was quoted by Nick Triggle of BBC news, that these findings were “completely unacceptable”, but added that an “overwhelming majority receive good care” (Triggle, 2012). Care services Minister Paul Burstow agreed with Edwards statement and stated that the government reforms of the NHS would “strengthen the voice of patients” (Burstow, 2012)

Nick Triggle, health correspondent, BBC News argued that the NHS is facing its most “challenging period since it was created”. He mentions that the ever growing ageing population brings with it substantial problems regarding care. He states that two thirds of hospital beds are now occupied by the over 65.He suggests that one solution is to move care into the community. (Triggle, 2012) Jocelyn Cornwell, who is Director of The Point of Care programme for the Kings fund wrote an article voicing concerns about the treatment of the elderly in our hospitals. In this report it was found that staff who were questioned felt that the elderly “do not belong here; it's just not the right place for them; it would be better if they could go somewhere else.” It was also found that in one hospital that the average age of patents in a medical bed was 82. Most believed that an acute ward was not the best place for them. (Cornwell, 202)

David Oliver Clinical director for older people at the Department of Health stated that people are being placed in to nursing homes needlessly, and these homes do not have the skills to deal with their problems. He told the House of Lords that the treatment these older people received was “worse than you might get in prison”. (Oliver, 2012) Care minister Norman Lamb has said that the care sector is not “fit for purpose”. In a damming report he stated that there was a “significant lack of corporate accountability for the quality of care”. He also questioned whether the Care Quality Commission Group (CQC) which was formed in 2009 to regulate quality in a number of services in the NHS had the necessary skills and expertise to thoroughly scrutinise these services. (Lamb, 2012) Chief executive of the NHS Confederation, Mike Farrar also voiced concerns about the readiness of the CQC.In a major survey carried out by the NHS confederation board, 69% of respondents questioned lacked faith in the CQC. Mike Farrar also states that these new national organisations need to work together instead of creating unnecessary conflict. (Farrar, 2012)

The Health and Social care Act 2012, will introduce the new health and wellbeing boards. They are part of the government’s plan to “improve the health and wellbeing of the local community”. The pivotal part of the board is to create a current NHS. The board will link together the clinical commission groups and local councils. They will undertake the Joint Strategic Needs Assessment (JSNA) and will collaborate together on how best to deal with the community’s health and care. (DH, 2012) Richard Humphries, wrote an article for the Kings fund and stated that he sees this as a positive move and felt that this will offer communities a “platform on which local system leadership can grow”. Bringing together these organisations is a necessity because of the growing long term conditions such as dementia. (Humphries, 2012) Graham Jones MP feels that the health and wellbeing board has become simply “a crutch for the NHS' and “hasn't the ability to recognise and tackle the bigger issues.” He also states that the board in his constituency are only dealing with the clinical needs of his constituents and need to consider the bigger picture. The issues that he felt needed addressing were “obesity, poor housing, and under employment” as these factors contribute to ill health. He felt that the Health and wellbeing board were letting down his constituents. (Jones, 2012) Giles Peel who wrote an article in the Health Service Journal discusses the problem of delivering care in remote and rural areas. He stated that people living in hard to reach communities and where resources can be scarce, more than most need the Health and Wellbeing board to “act quickly and integrate their provision of service not just the commission of them”(Peel,2012).

In a damming report called the Atlas of Variation that was obtained by the Guardian newspaper, Randeep Ramesh talks of large regional variations in patient treatment. The postcode lottery of treatment has been brought to light in the biggest analysis of health care in England. Ministers accept that there would always be some disparities in care cost because of varying needs of different populations, but “unwarranted” inequalities need to be addressed. The report shows that the most glaring contrast was in the prescribing of anti-dementia drugs. The variation was quite distinct considering that medication and treatment can help “temporarily improve or stabilise symptoms"(Ramesh, 2011).Lord Howe, spoke of “The Atlas of Variation” report and said it will enable commissioners to recognise disparities in variations of patients care. He also mentioned that NHS Outcomes Framework will hold the NHS to account for this, and that Commissioners will apply penalties if any organisation is not delivering improvements for patients. (Howe, 2011)

The Prime Minister David Cameron has launched a programme called the National Dementia Challenge. This illness is viewed as the most “important issues we face as the population ages”. Although the number of people with this condition is increasing there is also a lack of awareness and discrepancies in the care that they receive. By working with wellbeing boards, Healthwatch, Public Health England and clinical commissioning groups they hope to improve the care offered to dementia sufferers. (DH, 2012).

On 25 October 2012 the Secretary of State for Health announced that £50 million will be made available in 2013-2014. This money is to enable people with dementia to live a better quality of life. The number of people with dementia in England is set to increase by around 50 per cent to 1 million over the next 10 years. The government estimates only around 42 per cent of people with dementia receive a formal diagnosis. In a progress report the health and care champion group announced that it has developed a “tool kit” to enable the NHS to improve its diagnosis rates. By working with clinical commissioning groups they hope that this will be achievable. They will also use the NHS Outcomes Framework 2013/14 to measure progress (DH, 2012). Dr Andrew McCulloch, chief executive of the Mental Health Foundation, praised the decision to double the funding into dementia research, while Shirley Cramer, chief executive of Alzheimer's Research UK, described it as a 'turning point' in the battle against dementia. (Net doctor, 2012).

The Health and Social care Act has created great debate and opposition for the Government. The National Health Service is facing one of its biggest challenges since it was formed in 1948. With the rise in the ageing population and also the changing demographics that encompasses this genre change does need to happen. Staff cuts and funding reductions will most certainly create difficulties with the delivery of care being offered to the ageing population. However, I have shown that the Health and Social Care Act may address some of the issues that are facing this Health Care Sector.

Word count 2172.

References

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Birmingham South Central Commissioning Group. (2012) what are Clinical Commissioning Groups? Available at: (Accesses on: 9 December 2012).

Brimelow, Adam. (2012) Nurses warn of 'workforce crisis' in NHS.Available at: (Accessed on 29 November 2012).

Burstow, P. (2012) Dementia care: Hospitals 'must make improvements’. Available at: (Accessed on: 30 November 2012).

Cameron, D. (2012) Prime Minister’s challenge on dementia. Available at: (Accessed on 4: December 2012).

Carter, P. (2012) Health and Social care Bill - RCN comment.Avialable at: (Accessed on: 3 December 2012).

Cornwell, Jocelyn. (2012) Are hospitals any place for the elderly? Available at: (Accessed on: 3 December 2012).

Davis, R. (2012) NHS reforms live blog - what's going on inside the NHS.Available at: (Accessed on: 3 December 2012).

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Oliver, D. (2012) Do we normalise frailty and disability in older people? Available at: (Accessed on: 28 September 2012).

Peel, G. (2012) Are wellbeing boards working? Available at: (Accessed on: 5 December 2012).

Ramesh,R. (2011) NHS postcode lottery survey reveals wide UK disparities. Available at: (Accessed on: 1 December 2012).

Ross, T. (2012) Scrap NHS Bill, say doctors who will run reform. Available at: (Accessed on: 29 November 2012).

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Identify and discuss current trends in the Healthcare sector

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