Until recently there were only comparatively minor changes in the way the NHs was structured. However the NHS has now undergone major reforms that have been more far reaching than any other changes under taken since it was set up in 1948.
These reforms are set out in four government white papers:
- Promoting better health (1987), which concerns primary health care.
- Working for patients (1989), which discusses the management and provision of services.
- Caring for people (1989), concerning community care.
- The new NHS (1998), which sets out the future of the NHS.
In addition to these white papers, the NHS and Community Care Act 1990 had important consequences for the way health and social care agencies are organised. At the centre of the reforms to health and social care was the idea there should be a clear division between purchasing and the provision of services. The idea of purchasers and providers might be best understood by thinking about obtaining estimates for the catering at a wedding reception or some other large social event. You decide it would be too difficult or expensive to provide the catering yourself, so you contact a number of catering firms to supply the estimates. Once you studied the estimates which firm provides the best value for money. You contact the firm again and go ahead to book the supply the catering. In this situation, you are the purchaser of the services. The catering firm you have chosen is the provider of the services, and you have chosen your provider by comparing the services offered by the same market. NHS and social service departments who have responsibility for ‘buying’ service departments (the purchasers – deciding the NHS budget should be spent on and deciding on the allocation of funds for the provision of different services) and those departments which decide who should provide these services, e.g., hospitals, dentists, and district nurses. In the health service the old district health authorities become the purchasers, together with some GP group practices, which become GP fund holders. In social services departments, it was senior managers who become the purchasers. Residential homes, day centres and home care units become the providers.
The funding of services
Health and social care services can be funded in a variety of ways.
Statutory services
A vast majority of the proportion of the health education, social services for early years are funded by the government. In recent years there is seen to be many changes of the way funding mechanisms operate and the level of autonomy that is given to local areas or departments in using the funding to provide services.
Central government expenditure on hospitals and community health services and family health service, which has doubled, rises from 21,771 million in 1988 to 445,346 million in 1998. In England the number of doctors on family health services list has risen steadily to 26,855 in 1997, with a vast majority of patients per doctor deciding slightly from 1,902 in 1993 to 1,885 in 1997.
Primary care groups, there is soon to be established primary care trusts, which be responsible for the provision and development of primary health services and community health services.
Within education the majority of funding is still from central government.
Recent legislative changes have meant that school can opt from local authority control and access resources direct from central government. Schools that don’t opt out still exercise more control over resources management of schools initiative. This is generally regarded as being positive change which has given local head teachers and governors more say how resources are deployed, and they can therefore tailor provision to the needs of the local population. In addition to special school provision there were over 250,000 pupils in the schools in England in January 1999 who had a statement of special educational needs.
Personal social services provide range of services for early years, both directly, for example social workers who work with families and children in need- and – indirectly- for example in registering and inspecting nurseries and childcare facilities. In addition, families with dependant children are offered support by the social security system in the form of cash benefits. Child benefit was received by 7 million families in Britain in 1997-98. The growth in lone parent families means recipients on one- parent benefits has increased over the last decade from 469,000 in 1981-82 to over one million in 1997-98. Recent years have seen an increase in the provision of nursery places for children, through fewer are directly provided by local authorities.
Voluntary services
There are many voluntary services involved with early years provision. These may be very specific, for example the National Autistic Association, or more general, for example the NSPCC.
Although the aims of the organisations vary they usually share a main purpose, which is promoting awareness, raising funds and providing services for children and their families.
Independent services (private)
In recent years there has been a considerable growth in private nurseries. These are run by individuals or companies, though they must be registered by social services. These are also growing number of childminders, which reflects the tendency of increasing numbers of working women which are away from home and the desire shown by increasing number of parents for their children to begin education before statutory school age. The government has acknowledged this trend and education for the age of four years old is funded by the local authority, provided the establishment can show it is working towards the desirable outcomes of early years curriculum.
BIBLIOGRAPHY
Moonie, N. (1996) Advanced Health and Social Care, Heinemann, publishes (Ltd) Oxford.
Reddington,. A. And Waltham, P. (1995) GNVQ Intermediate Health and social care, Nelson, Publishers (LTD) Surrey.
Statutory services
