The UK health and social care system provides free medical and surgical treatment to all citizens and long term registered residents, through the National Health Services (NHS) and Department of Health (DH).The NHS is in charge of the healthcare and DH governs the NHS. The system also provides social services which support and protect people who are vulnerable/at risk, provides private residential homes and home care (independent sector), voluntary services for everyone, provide protection and improve the health of communities and promote health. The system gives opportunity to everyone who uses the services to rise their opinions about the services they receive throughout the four countries; England, Scotland, wales and Northern Ireland. For the system to function effectively and provide all the services mention above, it has to follow specific policy and practice approved by minster of health in UK.
The National Health Services (NHS) of the UK since 1948 to present is well known as the world’s biggest publicly capital to health services. The NHS intended to deliver care to all its populace in a fair and efficient manner (Klein, 2006). Its main aim was to ensure better and free healthcare are provided to all citizens despite of their income. However services like the optical, prescriptions and dental are exception as part of the free services. Generally, the NHS is funded through taxation paid by employees directly from their salaries rather than requiring from insurance payments. Although NHS is managed separately throughout Scotland, England, Northern Ireland, and Wales, they tend to keep constant in many respects. Thus they urged to belong to the same ‘Unified system’. DH (2010) state that “worldwide the NHS employs more than 1.7millons, half of the employed includes the Doctors, Dentists, Medical and Ambulance staffs, Nurses and lastly both the community and hospital health services”. NHS has a unique structure from other healthcare systems, it consists of Primary and Secondary care.
Furthermore, best features of NHS are the Authorities and Trusts services practiced all around UK. In Primary Care, services are delivered by the Gps, Pharmacists, Optometrists and Dentists. The GPS are the frontline contact with the UK health care system as well as working with other practitioners to provide all the care needed by the patients. Unlike in Africa, every patient has a right to be registered with GP of their choice in the UK. On the other hand, dentists, pharmacists and optometrists are under private sector although there are some circumstance where it falls under NHS, for example if the patient is admitted in NHS hospital and the services is part of the treatment care. Free prescription is available for NHS client with an exception to control drugs. Likewise, NHS provides free eye test and glasses. Secondary care is divided into elective and emergency care. Elective care is a planned, non-emergency care between the doctor and the patient. Department of Health (2010) acknowledges that in England “patients have the right to access NHS services with minimum waiting times or NHS to take rational steps to offer an alternative care”.
Emergency care is located in all main hospitals in UK. The NHS makes sure all emergency departments are staffed by doctors, emergency specialized nurses, medical technicians, radiology, healthcare assistance and sometimes voluntary emergency staff. The emergency services are free for all UK residents. NHS trusts is a link between the healthcare organization and the NHS itself. They are six trusts and two health authorities. Primary care trusts (PCT’s) responsible for primary care together with other organizations work hand in hand to make sure all the needs of the communities are met effectively. PCT’s takes up to eighty present of the NHS budget as it is the main center of NHS (Williamson, 2008). In acute trust it said to be the “financial aid” for the hospitals, meaning they manage money spend by the hospitals to promote high quality care so as to improve their services. Acute trusts are responsible for hiring healthcare provider, medical technicians, and non-medical staffs from the receptionist to the domestics and security staffs. With the acute trusts, the hospital is able to form a learning institution for training health professionals.
The ambulance trusts in the UK unlike in other countries not only serve the emergency cases; but also provide transport for patients from their homes to the hospitals for normal routine treatments. NHS reported that the numbers of Ambulance calls have increase by third. Furthermore, the foundation trust involves people working closely with the organization, taking part in decision making plans for their future regarding local and social care provided by the NHS and improving the quality services provided to them. Care trusts are more focused in England with few in wales, Northern Ireland and none in Scotland. Lastly is the mental health trust which provides counseling and psychological treatments and therapies together with the families and the community. Currently they are more health authorities in England than in other UK countries. In England it is referred as Strategic Health Authorities (SHAs), Health Boards in Scotland, in Wales known as Regional Health Authorities and in Northern Ireland it called the Social Services Board.
These Health Authorities are known to improve local health services in all geographic areas by developing plans for strategic in care delivery. In addition according to Chris B and Anne W (2007, p.79) “Health Authorities are responsible for measuring and monitoring the performance of PCTs and the NHS Trusts against government targets”. On July 1948 just when NHS started, the Minister of Health raised three principals for the NHS which includes; NHS has to endure the needs of everyone, should be free at all point and should not be based according to the ability to pay but be based on clinical needs. March 2011 DH raised a new NHS constitution made up of seven principals. The main aim for the constitution as acknowledged by the Department of Health (2010) was to set out principles of the NHS and patient’s rights.
These rights explains how healthcare services are accessed, how much of care should be received, information on how treatments are available, right to confidentiality to complain. Every ten years the constitution shall be renewed. Social care involves helping and supporting those living in the community and residential care unit who are threatened or vulnerable to society. In UK social care is divided into three categories the Adult social care, Child social care and the care workforce. Adult social care includes elderly clients, people with mental health needs, physical and learning disabilities, alcoholics and drug addicts, homeless people and domestic abused victims. Child social care involves supporting children in need of foster care, adoption, child protection, young offenders and the homeless.
The care workforce means providing resource, support and training to people working in social care setting. According to most recent figures published by skills For Care (2005) “almost nine hundred and twenty two thousand people are employed in social care sector. Of which five hundred and fifth nine thousand are in services for elderly, one hundred and seventeen thousand work with people with learning disabilities, one hundred and twenty three thousand are under children’s services and the rest sixty three thousand are in mental health”. Adult social care focuses on helping people to live their lives as independently as possible. National Institute for Social Work (NISW, 2010) reported that social workers are now involving people with physical and mental disabilities in many activities, which help them to live their lives more independently. Moreover, the social worker frequently visits those in needs and assists them in their activity of daily living.
According to the homeless link (2009-2012) The Health Service and Community Care Act 1990 s47 states that in case any person is in need of house or a place to stay, social services authority have the right to assess that person and provide him/her with a house based on Housing Act. The child social care main responsibilities are to protect and safeguard the welfare of every child in the society. They work closely with children, young people, families, carers and other organizations for better solutions. Child protection is well explained through the Children Act 1989 which states that, “local authorities must investigate if they suspect that any child is suffering or prone to suffer in their homes”, and also the authorities are responsible for providing “services for both the children and their families when in need”. In 200 UK government published a green paper based on the death of a girl who was abused, tortured and killed by her own great aunt (Victoria Climbie).
It titled “Every child matter”, the paper talked about the child Act 2004 and the educational Act 2005 encouraging to protecting the child before the crisis. Royal College Of Nursing (RCN, 2010) defines the Independent Sector (IS) as organization’s contribution to the assessment needs, planning and wide delivery of health and social care to individuals. These sectors include nursing home care, private hospitals and charities organizations. IS is used as a healthcare delivery system for the NHS in primary, secondary and social care. Also it said to be a financing of physical capacity in buildings and equipment (RCN, 2010). The independent sector treatment center (ISTC’s) in the UK was created for the purpose of reducing the waiting time for the NHS client in order to provide care to all at any point. Other reasons for ISTC’s includes increasing measure available to patient’s treatment, gives patients options of where they would like to be treated and encourage innovation of the health care provision (DH, 2002).
The relationship between the NHS and the Independent sectors is bonded by an agreement made between the two sectors. The important part of the agreement was that it should not change the fundamental principal of the NHS service that is; HealthCare shall not be based according to the ability to pay but according to the needs. Secretary of state for health (2000) quoted “based on agreement plan, a patient will remain under NHS care even if they are treated in private sector and the care will be free at all point regardless of who or where the care is being provided”. The NHS trusts also count on IS in reducing their waiting time list by using elective measures in areas like ophthalmology or orthopedics. The IS has become the main services provider for the elderly who have left the secondary care but are still not well enough to be discharged to their homes. The King’s fund (2009) added, through ISTC programme NHS will be able to obtain services in higher quantity than before.
Talbot-smith and Pollock (2006, p.68) states that although the DH argued that the use of IS helps in overcoming NHS staff shortage, nurses and medical staffs takes most of the work in IS. The Nursing and Midwifery council (NMC) is a formal enactment document set by the UK parliament through the Nursing and Midwifery Order 2001 with an aim of safeguarding the wellbeing and the health of the public. The NMC policy in England, Wales, Scotland and Northern Ireland includes, setting education standard for nurses and midwives and provide training for better quality of care throughout their careers. In addition NMC encourages both midwives and nurses to upgrade their education in terms of knowledge and skills to date. High supervision is conducted by the NMC to ensure all the practices perform by nurses and midwives are safe and according to the policy of practice in the UK.
Any allegation against nurses and midwives made about the code, that is if not following the code are strictly investigated according to the law. In nursing it is important to understand and put in practice the code and standard of care as stated by the NMC. There are four core principals published in May 2008. First it refers about the importance of trust between the care giver and their client. This is achieved by treating every individual with respect, working together with others, families and the community for better care quality, provide high standard of care to patient all the time and practice honesty. Next is on accountability, as any other professions, nurses and midwives are fully answerable to their action and omission for any practice and they should be able to rationalize their action and decisions based on the patient best interest.
Nursing and midwifery council (2010) stated, Failure to justify action may pursue the law to judge the fitness of practice which might jeopardize the NMC registration. Prior the care of patient without discrimination and act as their advocator, by helping them in accessing information regarding health and social care. Confidentiality is one of the key aspects in healthcare system. Furthermore as acknowledged by the NHS Choice (2010), consent is a very important asset in all medical set ups. It is said by the law of International Human Right to be the most threated if not practiced well. NMC (2010) code also enhance that nurses should support and respect patient’s rights on refusing or accepting their care regardless of their conditions. And they must always involve patient in decision making for the care plan.
In addition, relationship between the health care providers and the patients must be professionally. No favor or hospitality should be practice which can lead to special or better treatment care (NMC code 2010, no. 18.). The NMC (2010) states that in order to treat or care for any client either in the hospital or home, nurse must have a valid insurance for professional protection. Failure to provide the insurance protection, the employer has the responsibility to report them immediately and the employee will have to answer to the court. Dimond (2011) added that “in situations where an employer has not passed on legal responsibilities, the NMC propose that the person to get a satisfactory professional indemnity insurance. If the employer is not in a position to acquire this, a proof from a registrant must be obtained to show that the client is informed of the situation and can claim for professional negligent at any particular time”.
Lastly this essay shall look into Mental Capacity Act as one piece of policy of practice in the UK.it states the strength and weakness of the Act and how it can be used in both theory and practical. Mental Capacity Act (MCA) 2005 under the parliament of the UK nation outlines legal information on protecting those who are not able to make their own decisions. For instance the reasons could be because of mental health illness, physical and learning disabilities, stroke or injury to the brain. All Decisions must comply with the MCA. The MCA covers in England and Wales only supported by the code of protection (the code). The code offer information and guidance on how the act is practice, including those working or caring for vulnerable people lacking the capacity. Moreover, Patient.co.uk (2012) added that the MCA is governing by the court of protection in UK. In Britain, the MCA only imply to people who are age 16 or over. The first section Mental Capacity Act outlines the five core principles of the MCA under legal requirement. Foremost is the a presumption capacity, meaning any adult must be assumed to be having the capacity and also have the right to his/her decision unless proved otherwise.
Next explains that individual have the right to be supported in making their decisions before concluding that they cannot make for themselves. Likewise no one shall be labeled as not able to make his/her own decisions based on previous or recent unwise decisions. In addition to principles of the MCA, Lord Chancellor (2007) stressed that any decision made on behalf of any person who may lack capacity to make his/her own decision should always be of best interest. Lastly before making decisions for those who lack capacity, that is on their behalf, least restrictive measures in involvement have to be practice regarding freedom and rights of that person actions (DH 2008). There are some situations whereby decisions made on behalf of individual with lack of capacity are not included by the Act. May be it could be due to decision being very personal to that person or may be because the situation is already under other legislation bodies like Data Protection Act or Human Right Act. For instant these decisions are well explained in section 27, 29 and 62 of the MCA. Section 27 denies permission on decisions concerning family relationship including marriage and divorce consent.
Mental Health Act Matter, mentioned in section 28 does not permit giving treatment or consent for a person who is said to be mentally ill. Next is on Right to Vote (MCA, section 29), again it does not permit on voting on behalf of others. In section 62 Lord Chancellor (2007) clarifies that there is no part in the MCA section that states decisions which relates to murder or helping in committing suicide is allow on behalf of people who lack capacity. Assessment of lack of capacity and best interest decision making (section 2-4),defines being labeled as mental capacity fit as the ability to make own decisions at a given situation.it also says no one can decide that an individual has insufficient decision making capacity by looking at his/her age, behavior or appearance( social care institution for excellent, 2009). The assessment test for testing capacity is done with an aim to find out whether there is any interference to the normal structure and function of the brain.
According to MCA, a person is unable to make his/her decision if they fall under the following categories; one if they could not comprehend any information or hold on to long to the information given to them and not able to decide fast. Two if they do not think before they act constantly and finally they could not communicate according to their decisions (Social care institution for excellent 2009). The MCA is guided by new rules of power and organization bodies throughout the system in order to protect those who lack capacity.
First is the Lasting Power of Attorney (LPA), whereby a person is selected to look after people who are vulnerable in relation to their health, financial and welfare future. Second is the Court of Protection body. That is, individual lacking the capacity are fully protected through supervision for those acting on their behalf. Moreover, through The Public Guarding people who lack capacity are protected from abuse. In conclusion as reported by (social care institution for excellent, 2009) decisions on treatment and where a person should live are represented by the Independent Mental Capacity Advocates (IMCAs).
IMCAs also are responsible in representing those under adult protection. Through the MCA, people can make an in advance decision on the refusal of treatment in case they lack the capacity in future. Criminal offence policy is also included on MCA, the policy presents a new criminal offence for those who practice battery or neglect of people who lack capacity. In conclusion, the health care delivery system of the UK remains unique in term of cost and quality of care. The NHS is in control of almost the whole system in the four UK countries, with few in private sector.
Although there is a strong link between the private sector and NHS, the NHS principles remains unchanged, meaning HealthCare shall not be based according to the ability to pay but according to the needs. In addition the social care provides a wide range of support and safeguards the welfare for both adults and young people. The NMC policy is very important in nursing; it sets up the code of practice and the standard of care in the healthcare system. Furthermore, Mental Capacity Act consist of legal information and requirements on protecting people who are not able to make decision on their own in terms of health, financial and other important life events.
Courtney from Study Moose
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