NHS plan 2000 For this unit I need to research the impact of one national policy on care practice and provision. I will be accurately and independently applying an in depth knowledge and understanding to give a comprehension explanation of the impact of one national policy on care practice and provision. The NHS plan 2000 is a health service ‘designed around the patient’ which provides more NHS funding to care practices and provision. This gives people better access and quality care that is up to date for the 21st century.
It is built in order to keep peace with the changing society of today. This encourages training to be handled in a more modern way and treatment to be updated. Some of the main points of this policy is to have more and better paid staff using new ways of working, reduced waiting times and high quality care centred around patients, and improvements in local hospitals and surgeries. To do so, there will need to be more funding from the NHS to provide better care.
This policy will provide quality assurance for most patients and is another layer of confidence to providing the care of the best quality that is needed. In the hospital, this will assure Nicola that her physiotherapy is of the best quality possible and that it is updated as much as possible. Here are some print screens from the government website. [pic][pic][pic] [pic][pic][pic] [pic][pic][pic] This could be beneficial to people who use service as they will provide quality assurance for the patient and give them confidence in their care, service providers and services.
For example; if Nicola (my client) were to have any concerns about her care or any queries, she can get information from the NHS plan as well as the Strategic Health Authority and the Care Quality Commission with their reports and evaluations. This is, also, beneficial to the service providers because it fosters a healthy, safe, and hospitable environment without having stressed patients, stressed staff or using treatments that don’t work which can lead to law suits or conflicts between service providers, or between service providers and people who use services.
Even though this plan was set out in 2000 (so, it is 13 years old), it is still reliable as it is regularly updated and this process is, reasonably, timeless as the process is just ensuring that the services are updated not actually updating these systems themselves. They are basically the observers of these Hospitals and GP surgeries. I will be looking at the impact of this legislation on my two services from my AO3 using my client in AO4 (the General practitioner and the physiotherapist for Nicola who has cystic fibrosis as well as many other side effects).
The two services that I will be using are the Norfolk and Norwich University Hospital (NUUH) and the Bridge Street Surgery in Downham Market and I will be looking at the advantages and disadvantages of the plan on these said services and the implications on my client. This will affect the NNUH because the NHS plan promises: More power and information to the patients This promises that patients can have a ‘choice initiative’ where they have the option of five different hospitals to receive surgery.
They have the ability to access information about many hospitals in order to make an informed decision and to make the right choice in their care. They can access this information through websites, the hospital and their practitioners. Nicola would have the option (if need be for her to go into hospital to receive treatment) to go to many hospitals near her and could look on the internet to see what hospital specialises in cystic fibrosis to achieve the best quality of care.
Patient and public involvement means that the public can be involved with general care and in; mainly, what is needed to upkeep a hospital or surgery and what needs improved upon or corrected. There are many services that give the public access to these sorts of adjustments and the NNUH offer PALS (Patient Advice and Liaison Service). All NHS Trusts and Primary Care Trusts have PALS in operation providing immediate help and information about services. They also give advice about the NHS Complaints Procedure.
The LINk (Local Involvement Network) was created in Norfolk to monitor, evaluate and influence the provision of health and social care services. These services range from GP’s and dentists to domestic and day care services and hospitals. It is made up of members of the public, local user groups and representatives from voluntary and community organisations, the LINk will ensure that the views of patients and members of thee public are taken into account so that services improve.
They do this by; giving NHS trusts and Adult Social Services ongoing feedback on the quality and delivery of their services, conveying the views of local people to health and social decision-makers (commissioners) so that services cater for the needs of Norfolk residents, helping government regulators, like the Healthcare Commission, access local information and LINk views, informing local government Overview and Scrutiny Committees about issues under LINk scrutiny.
OSCs (Overview and Scrutiny Committees) were set up from January 2003 and were done in local councils and social services responsibilities, Norfolk County Council, and they can analyse health services and this adds to improving the health care services in the local areas. OSCs: • Take on the role of scrutiny of the NHS – not just major changes but the ongoing operation and planning of services • Are able to refer contested service changes to the Secretary of State for Health • Are able to call NHS managers to give information about services and decisions • Report their recommendations locally Have to be consulted by the NHS where there are to be major changes to health services. Information is always available to the general public (this can be reviews, access to care etc. ) This information would come in the form of leaflets, websites, magazine articles etc. [pic] Websites are easily accessible for anyone who has the internet or access to the internet. It is so helpful that someone looking for information can zoom in on the information, click on tabs to change what they want to look at and have external links to send them to different areas of information.
The text is written at a nearly basic level with very little academic language so many more people can understand it and this eliminates the factor of indirect discrimination towards those who are less educated. Also, the text is evenly spaced and in different colours so that even people who may be dyslexic or have reading problems or are young. This means that the website caters to as many people as possible through this use of communication and layout. This helps the patients make a well informed decision.
These magazine articles are not biased as they are from an outside point of view which gives the reader an objective point of view, this also helps the patients decide what hospital to go to in order to receive their surgery. It is available to the general public so those who are unsure, whether they were receiving care or not, can decide prior to their need of care. This would be beneficial to my client in particular because she cannot travel long distances without getting uncomfortable and she has easy access to the internet, and the local hospital that provide this information.
Strengths of ‘more power and information to the patients’ are that the patients (especially Nicola as she is a teenager and will be emotional) will be comforted knowing that they have the freedom of choice of where to go and who to trust, they will then feel like they have power or control over their care, they will have a sense of responsibility which will comfort the patient considerably and put them at ease of their care being in their hands. However, they may choose the wrong option and then have no one but themselves to place the blame.
However, they may not see it this way and choose to attack the hospital and have a long legal battle if something goes wrong. For example; if they stop taking medication after surgery then they will be forced to take responsibility. Also, some who are choosing between hospitals may not have access to this information; especially, those who are older as they may not be able to access the internet easily or travel to purchase magazines or collect leaflets etc.
The strengths of the hospitals using this policy is that it rids them of liability which will cover them in court cases if a patient tries to blame their primary hospital for something that went wrong which they would not win as they chose a different hospital themselves. The better ratings of a hospital, the more likely they are to gain patients, therefore, they will receive more money from the government to fund their hospital more which provides quality care and this will roll onto more patients and so on… More hospitals and beds
This plan came into play in 2000 when the NNUH was being constructed, until then there were fewer beds in their plan, but then this plan came into action and a further 144 beds were added including intensive care beds, medical, and surgical beds. For the public and my client, this gives the advantage of more space available for comfort advantages, and there is more available space for them to get treatment. Also, their treatment will be more precise as the staffs are not trying to rush patients in and out of hospital to reserve beds.
For Nicola, this will mean that her treatment is more effective and more care is taken with her difficult disease. For hospitals, this encourages more patients to come in and receive their care which results in more funding. However, even though there are more beds available, there is still the same amount of space so the hospital may be too compact. More doctors and nurses The NNUH is the first new university teaching hospital in England for over 30 years.
This hospital was built with the purpose to teach and has the latest technology to cater to as many needs as possible and to train staff to ensure they produce the best and most competent staff members possible. With its latest technology and advanced training, the NNUH becomes a lot more attractive to staff wishing to train so recruitment is more accessible and easier to handle. Since the year 2000, staff members has increased by 11% overall and the increase has been high in the number of doctors (502 ? 575) and nurses (2,094 ? 2,455).
This means that the care provided matches the number of patients they have (low staff-patient ratio) meaning that every patient shall receive the best quality of care that they are able to provide and will receive the quality of care that they are entitled to. With more staff, this means that each staff member will have a bit of a lighter workload which will result in un-rushed care which is, therefore, more effective. Shorter waiting times for hospital and doctor appointments The NHS has been working on this particular policy particularly as it is one of the most complained about factor of health care.
The plan is to ensure that patients have to wait a maximum of 17 weeks for an appointment. This is an impressive improvement from previous years’ waiting times; • 2004: 9 MONTHS • 2005: 6 MONTHS • 2006: 3 MONTHS So far, this plan has been successful and will continue this streak of improvement is the staff-patient ratio remains as low as possible. The Accident and Emergency target is to ensure that 90% of patients do not have to wait more than four hours to be seen by a sort of practitioner.
To achieve this target, the A+E service has employed five new doctors (at the NNUH) to enable quick and effective treatment in emergencies. They have decided this because emergency care has increased by 10% in the last few years or so, with the most common case of emergencies being drunken behaviour and home accidents and alcohol is becoming more and more popular. The A+E at the NNUH have been given a further ? 60,000 for ‘upgrade-construction’; this is where facilities such as the “see and treat” cubicles which enable those with minor injuries to get quick care.
With reduced waiting times, patients recovery odds are higher with more effective care being produced. This would be effective for my client as, if her CF takes a sudden turn, she can be seen to as quickly as possible to avoid mucus building up in her lungs more and her illness being irreversible. However, this costs the hospital more money as they will need to employ more staff, have longer opening times, and purchases of more resources to provide for more patients. This could start to drain the NHS of money. However, it is unlikely that the NHS will run out of money. Cleaner wards, better food, better facilities in hospitals
The NNUH has top of the range facilities and more than would be found in many other hospitals. It has: • Shops that are open at reasonable hours during the week and the weekend • a restaurant that serves hot and cold food which caters for a wide range of customers and patients • 4 coffee shops that are open during all visiting hours • An outdoors children’s play area where children can play whilst the parents sort what needs to be sorted • Toilers (disabled, baby changing facilities, male and female) • Post-boxes Phone-boxes for those who do not have access to a phone • Cash machines for the coffee shops, shops and restaurants • Smoking areas as it is now illegal (since 2004) to smoke in public buildings, especially in a hospital • Car parking • Nearby bus station for those who cannot drive or access any other form of transport. These facilities aren’t necessary for the patient’s health but, using the holistic approach, it important to have all these factors right to have effective quality care as they will feel relaxed and more comfortable.
As well as having the best non-medical care possible, it also has state-of-the-art medical care which specialises in radiotherapy, teaching, ultrasounds, maternity etc. Most of this is because of the Care Quality Commission which encouraged the new hospital to offer an excellent patient environment. The hospital caters to as many people as possible with single, private, and shared rooms, a good use of natural light (big windows) and hatever false light is provided will be eco-friendly to preserve money and the earth. They also provide radios, bedside telephone, television (where patients have one hour of free viewing a day – where children and elder adults receive unlimited viewing). This encourages the patients to feel as comfortable as they can be, especially if they are staying for a long time and they would feel comfortable coming back if need be. The same applies to the A+E department as ? 0,000 has been spent on improvements suggested by service users such as plasma screen televisions that display information, a more comfortable seating area, entertainment for children such as a play area and toys, improvements to the bereavement room, and a fridge for patient use. This would definitely benefit my client as, when she goes to hospital, she is likely to spend a lot of time in there as her treatment has to be gradually done, so she will feel comfortable and will be willing to come back to the same hospital if her problems relapse.
If the hospital performs well then they will earn more points from the NHS which will result in more funding. However, some of the money that was put into up-to-date equipment could have been used for vaccinations which are more useful to the patients. However, every cost is a risk as they cannot predict the reviews from service users so they may lose money or gain some, depending on the investment. Money is also spent on training the staff to the most modern techniques and knowledge, increasing the size of departments, and enabling more modern procedures and equipment.
Local NHS organisations that perform well will receive more freedom to run their services as they wish This could result in the hospital having unique care, and therefore, become more successful and gaining more patients and working its way to being the most successful hospitals in the area and having the most successful surgeons and doctors wanting to work there which can help it expand and help others more. However, they could also use the freedom to become lazy or have a lack of guidelines and they may not be able to cope.
This means that they will need the NHS to guide them again and it will be more difficult to become independent again. They may have less internal and external inspections so they may not see that their quality of care is becoming less efficient. It could go either way and the only way to measure whether the NHS services should get more freedom is by conducting repeated external inspections and observing their progress over time whilst giving them more and more freedom.
The freedom that they would get includes use of the NHS’s money as they please and where they think is necessary. They are able to tailor what the NHS provides to their hospital in particular rather than hospitals as a whole around the country. Nurses and other staff will have greater opportunity to extend their roles This encourages nurses and other staff to train in other specialities so that their skills and areas of expertise are extended to other areas as well as their primary course so they may have a deeper understanding of other areas.
This will benefit many others as the staff will feel more confident in treating patients, staff can have a bit more leeway as not as many staff members will be constantly needed as others can train to work in many areas and know at least the basics of what needs to be done. It would mean that the NHS would have to pay less for vital training if they could train just one person to do two people’s jobs. However, they would need to ensure that these people are capable enough to provide the efficient care with these two job roles, they must be able to perform to the best of the abilities that someone who specializes in this area can.
It also means that the number of job vacancies will decrease with individuals managing more roles, even though this would save the NHS money through decrease in employment, this means that graduates will be less likely to get a job, the unemployment rates will raise and people are less likely to study medicine and take that career path. Patients with specific needs can get used to having fewer practitioners around, so they may feel more comfortable. Patient surveys and forums to help services become more patient-centred
There are several forums that NNUH offers, many of them would be similar to the forums that allow patients to find services when they complain. This allows patients to choose their own care and make their own decisions when it comes to what could improve their quality of care. These forums include: • PALS (Patient Advice and Liaison Service) NHS trusts and Primary Care Trusts all have this service that provide immediate and on the spot help and information about health services. • LINk (Local Involvement Network) This is made up of members of the public, representatives from voluntary and community organisations, and local user groups.
The LINk will make sure the patients and members of the public have an opinion which is taken into account to ensure that services improve as much as possible. They do this by: – giving NHS Trusts feedback on the quality of their services – conveying the views of local people to health and social care commissioners so that services cater to the needs of the residents – helping government regulators, like the Healthcare Commission, access local information and LINk views – informing local government Overview and Scrutiny Committees about issues under LINk scrutiny The Health and Social Care Act 2001 placed a duty on the Secretary of State for Health to make arrangements for advocacy services to be provided to people wishing to make a complaint about their NHS care • Overview and Scrutiny committees (OSCs) • From January 2003, OSCs were set up in local councils with social services responsibilities (in our case Norfolk County Council) and they have the power to scrutinise health services. This contributes to their wider role in health improvements and reducing health inequalities for their areas. OSCs scrutinize the NHS – not just major changed but the ongoing operation and planning of services.
The OSCs; • Are able to refer service changes to the Secretary of State for Health • Are able to call NHS managers to give information about services and decisions • Report their recommendations locally • Have to be consulted by the NHS when there are to be major changes health services. These forums will help the patients be involved within the state of the hospital and the care that they are to receive from them. They will enable the patient to have more of an input in their care and therefore more satisfied while giving reviews on the hospital, meaning that the hospital gets benefits also.
An example of a questionnaire that could be given to the patients at NNUH would be: [pic] This would help the patients as they are receiving the care that they deserve and the hospital would be trying to give the best care that they can. This, in turn, would help the hospital because; if the hospital is seen to be performing at extraordinary capacity, then they will be given rewards such as more money and freedom. Modern IT systems in hospitals Having modern IT systems would be a way to ensure that everything is up to date in hospitals with modern equipment.
It has lots of advantages, for example; • Keeping patients information confidential in safe and secure files which is only easily accessible to authorised people so they can access the information in a hurry • Having this kind of system in a computerised format would mean that all practitioners can access this information in an emergency Patient’s records and information is so vital because they hold all information about that patient such as; allergies, previous medical history and family medical history.
This gives practitioners guidelines on how to treat a patient with regards to what medication to prescribe and what tests to take. For example; if a woman’s medical history stated that she was pregnant, the practitioners would know not to do an x-ray on her. This benefits all practitioners and patients as safety will always be a priority and the patients care will always be recorded on a database that means is never lost so if there are any legal issues, this information and evidence will be stored.
IT systems will also ensure that all those who have access to patients will be stored as restricted access will be a priority to ensure safety. Safety also includes locking doors so those who are not permitted access cannot enter. They would also lock doors for quarantine purposes so diseases or infections cannot be spread such as MRSA (Methicillin-resistant Staphylococcus aureus) which is a disease that was spread about hospitals which made patients very ill.
In conclusion, the standards and improvements set by the NHS Plan 2000 would benefit my client and other patients significantly as it improves the quality of care given by hospitals and improves the hospitals in general. This improved quality of care could mean that Nicola may have a lengthened life span and better service. The NHS plan would also affect the GP surgery that I have chosen (Bridge Street Surgery). These changes have many effects on the GP surgery to help it improve. Such as; Patients can see a GP within 48 hours
This means that patients can see their GP in an emergency without having to wait for an appointment to be convenient to everyone else. This is far more efficient and effective and means that the patient will have more of a chance of making a full recovery. This would benefit my client especially because, if her condition worsens, it will need immediate relief and care because, otherwise, her condition will be irreversible and her life expectancy may be shortened. If she is treated quickly and effectively, her chances of making a full recovery are higher.
Other patients will benefit for the same reason. If the patient is of the aging population then a quick appointment will be as beneficial because they are not able to travel very often, for some of them, and will need an appointment whilst they still can travel. Patients will be more satisfied with their care, which means that they will give the surgery better reviews, which means that the surgery will get more freedom and more money to carry on providing better quality of care. So, this part of the policy will benefit both the patients and the surgery further.
There are a few disadvantages of this policy as well, for example; sometimes GPs may not have enough time to see patients so one of three things would have to take place: 1) The patient would have to see another GP, and whilst they may receive quick care, they may not be satisfied with their unfamiliar doctor and so they may not trust them and feel uneasy which can be a barrier against quality care. 2) The surgery would have to employ more GPs, and this would mean that some patients would have to change practitioners and the surgery would have to spend money to afford their wages.
However, this does mean that more patients can be seen quickly again. 3) The doctors will have to work more hours which could, in turn, end up in some quitting because of these long hours and they may not work to the best of their ability. GP now paid on contract GPs are paid on the basis of meeting set quality standards and meeting the particular needs of the population but with this policy it means that they will be paid on the quality of their performance and work which will encourage them to work harder, to earn more money, which will result in better quality of care for patients.
This means that Nicola can find the best practitioner possible and get the best quality of care possible. For the surgery, this means that they will be rewarded for their quality of care with freedom and money from the NHS. This may not benefit the GPs though as their pay may fluctuate and the surgery would be rewarded for their efforts. Also, the surgery would have to pay more money to provide higher wages. But this money would be provided by the NHS because they are funding the surgery for their service.
Multi-disciplinary teams/multi-purpose premises GPs now work alongside nurses, pharmacists, hospitals etc. This would be to provide a more holistic approach to caring for the patients. This would work well for my client as she will need many practitioners to help her and with this policy, they can all work together to maintain a highest possible level of health. For all patients, this means that they will receive the best care possible and without the stress of carrying information and organising everything themselves.
This will provide the best quality care that will benefit the patient and will work effectively. This will benefit the surgery as they will get rewards for their quality care. Electronic prescriptions This enables prescriptions to be emailed to patients and kept on an electronic database so that other practitioners can see what medication has been given to the patient so that they will know not to cross over drugs that do not agree with each other. For example; the famous actor, Heath Ledger, died because doctors cross-prescribed his drugs which led to him having a heart attack.
This saves paper and, therefore, saves money for the GP surgery, so it is more environmentally friendly. However, it can be filled out without permission and be counterfeit. Some members of the population may not be able to access the internet; for example; those of the older population or those who cannot afford it, or email systems may not work, the internet may interfere with the processing of information and information may then be lost. Also, if the system crashes then all the information may be lost which can result in crossing of drugs.
This may be a disadvantage to the surgery as they will need to constantly make sure that their systems are immaculate and hire staff to maintain their needs. GPs premises refurbished or replaced Premises being refurbished would mean that the area will be nicer for patients and staff so they will enjoy their work more and patients will be more likely to want to talk and visit so refurbishments could enhance communication. The hygiene rates will improve, it will attract more patients and the more patients they have, the more money they will receive. Nurses undertaking more roles
This means that nurses will be able to train more in different specialities so that they will be able to transfer roles when needed or take on more than one role. This will enable them to have more knowledge about other areas which gives those more of a holistic approach to a patient’s care. If there was an emergency and there were limited staffs, nurses could cater to the patient’s needs also without wanting others to get involved when they may be busy, the surgery will need to spend less on hiring specialists, the nurses may be happier being able to have less of a restricted job.
However, the nurses could be stressed as the surgery may rely on their skills too much, the nurse would have to be fully efficient in each role and perform to her best if the surgery can fully rely on them for those roles, unemployment rates may increase as surgeries and the NHS will cut corners where they can by only hiring one member of staff who can fulfil two roles instead of one member of staff to one role. In conclusion the GP surgery will improve significantly with the NHS Plan 2000 as communication, patient numbers and satisfaction in the work place will be enhanced as well as quality assurance for patients.
My client will feel more satisfied going to the surgery with any bothers she may have about her care and be satisfied that she will get seen to and treated as soon as possible. However, there is no area in this plan which links the GP surgery and the hospital so appointments between the GP deciding on what actions to take towards Nicola’s care and the hospital appointment itself may take some time and by then, her condition may worsen considerably. • Class notes • http://www. dh. gov. uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_118523. pdf •
