Professional Studies: Health Policies

1. Professional Studies: Health Policies Ian Grigor School of Healthcare Studies University of Leeds

2. Aims • To consider the impact of recent NHS policies on the delivery of care services • To relate new NHS policies to the current 10-year strategic document

3. Objectives • To tease out the key points from the NHS; Modern Dependable (1997) • To represent the key points in a PEST analysis • To tease out the key points from The NHS Plan (DoH 2000) • To represent the key points in a PEST analysis • To see how these policies balance against performance

4. The New NHS; modern, dependable (DoH 1997) • Internal market (abolish) • Status of NHS in 1997 (after 18 years of Conservative Government) • Quality is variable (NICE) • Variability in treatment regimes (prompt high quality treatment) • Inequalities in health ( Health Action Zones and Health Improvement Programmes) • Fractionated care delivery (integrated system of care) • Dated and dissociated information systems (use of IT to create modern/integrated information systems)

5. The New NHS; modern, dependable as a PEST analysis POLITICAL aspects • The White Paper • Annual Planning and Priorities Guidelines

6. The New NHS; modern, dependable ECONOMIC aspects • £1 bn from red tape • Expectations always exceed capacity • Better use of resources (abandon internal market) • Align clinical and financial responsibility • The health of the economy depends on the health of the NHS – it helps ensure a healthy workforce

7. The New NHS; modern, dependable SOCIAL aspects • Guaranteed fast-track cancer services (2 weeks from GP to surgeon) • Primary care delivering locally • Cut waiting lists for treatment • Growing public expectations • Demographic changes (rising numbers of elderly) • Universal screening for prostate cancer not worthwhile

8. The New NHS; modern, dependable TECHNOLOGICAL aspects • NHS Direct • Quicker test results • On-line booking of out-patient appointments • NHS Net • Medical advances

9. The NHS Plan (DoH 2000) – 10 year strategy • Status of NHS in 2000 (after 3 years of Labour Government) • Grossly underfunded (sustained increases in funding) • Lack of national standards (what happened to NICE?) • Old-fashioned demarcations between staff and barriers between services (remove but what about Griffiths’ report in 1983?) • Extended roles of non-medical staff (see above) • Support staff to receive Individual Learning Accounts of £150 per annum (see above)

10. Priorities and planning guidance for the NHS To provide the overall context for the planning and delivery of health services and to focus the NHS on the most pressing national priorities

11. Priorities and planning guidance for the NHS Therefore, local plans need to reflect local needs and priorities but within the framework of the national picture. This applies to plans prepared by health authorities, NHS trusts and GPs

12. Purpose of the NHS • promoting health • preventing ill-health • diagnosing and treating disease and injury • caring for those with long-term illnesses and disabilities

13. The performance of the NHS is judged on 3 fronts • equity • efficiency • responsiveness

14. Medium term priorities are the main priorities as foreseen in the next 3-5 year span • the development of a primary care-led NHS • effective purchasing and provision of comprehensive mental health services supporting R&D • continuing health care for elderly, disabled, vulnerable people and children • developing NHS organisations as good employers

15. How is the NHS measuring up at this time? NSF - mental health How successful has the “Community Care (Caring for People)” strategy been? What problems have hampered its success and how could the problems be overcome?

16. How is the NHS measuring up at this time? The strategy of "A Primary Care Led NHS" is to enable decisions to be taken as close to patients as possible, with a greater voice for patients and their carers. Has this strategy been successfully implemented?

17. How is the NHS measuring up? The planning and priority guidelines identify priorities. By definition, then, there will be winners and losers. However, if everything is a priority, nothing is a priority. Is this an acceptable ethos in the management of healthcare?

18. The National Planning and Priorities Guidance 2003-2006 • The Government has defined this as:- “…a focus on priorities: we cannot make progress at the same pace in every area." • Comments, please! • This strategy will focus on:- • Reducing health inequalities – how? • Contributing to the drive to reduce drug misuse • Local determination of healthcare priorities • Electronic booking of hospital appointments • Intermediate care i.e. at home

19. Plans for 2003-2006 - Improving the patient experience • Introducing bedside TV and telephone systems in every major hospital by December 2004 • Eliminating Nightingale wards for older people by April 2004

20. Plans for 2003-2006 Implications for the workforce • Addressing critical issues, particularly the Working Time Directive (The Council of the European Union1993) • Electronic bookings of hospital appointments to suit patients • Electronic prescriptions (50% by December 2005: 100% by December 2007) • Patient care record (2005-2010)

21. Shifting the balance of power(DoH 2001; 2002) • empower frontline staff and patients in the NHS • giving locally based primary care trusts the role of running the NHS and improving health in their areas

22. Managing for excellence in the NHS(DoH 2003) • focus even more on working with clinical staff to manage clinical processes and service delivery • work more closely with patients, communities and staff • learn the new skills we need to do this, to manage the expansion of the service and to introduce and manage change

23. Objectives • To tease out the key points from the NHS; Modern Dependable (1997) • To represent the key points in a PEST analysis • To tease out the key points from The NHS Plan (DoH 2000) • To represent the key points in a PEST analysis • To see how these policies balance against performance