Development of Health Care Strategies and Policy in the UK
Health and Social Policy
Introduction:
In this essay we will discuss the health care plans and objectives, beginning with the definition of health and an analysis of the Constitution of the World Health Organization highlighting which are the areas of health care policy that seems to have received greatest attention. Health relates to physical and emotional well being and this is emphasized even further in the British idea of a welfare state were health relates to social policy and serves as one of the most important areas of governmental concerns. The health care sector of the UK government represented by the NHS and department of health is discussed extensively with health care programs, implementations of change within the health care settings, modernization, collaborative working approaches and a general improvement of health care services being emphasized as essential to realization of a successful health care policy in the UK. We also discuss obesity and smoking related problems within this general context of health care and social policy to show how polices or administrative aspects are related to health care services implementation in general
Defining Health and Healthcare
The World Health Organization defines Health as a state of complete mental, physical and social well-being and not just a condition free from disease and abnormality. The Constitution of the WHO is given as follows: Source: WHO constitution, 2005
THE STATES Parties to this Constitution declare, in conformity with the Charter of the United Nations, that the following principles are basic to the happiness, harmonious relations and security of all peoples:
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, and political belief, economic or social condition.
The health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and States.
The achievement of any State in the promotion and protection of health is of value to all.
Unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is a common danger.
Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development.
The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.
Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people.
Governments have a responsibility for the health of their peoples, which can be fulfilled only by the provision of adequate health and social measures.
Worldwide Health Policies:
The legislative and administrative measures on health policy within the divisions of WHO are carried out by Health Policy Analysis Programme (HPA) which is now fully integrated into that of the European Observatory on Health Systems and Policies. Among the Health policies, the Health Impact Assessment (HIA) program adopted by the WHO is a major opportunity to integrate health concerns into all other related policies. HIA influences the decision-making process, and addresses all determinants of health, providing a new direction for participation and empowerment in health related issues and decisions. The overall aim of health policies is to track the use of HIA and to evaluate its effectiveness identifying what are the factors that can help in successful implementation. Along with the Health impact assessment which serves as a decision making tool, the health targets are instruments that can facilitate achievement of certain health policies as they represent commitments of reaching or fulfilling specified outcomes in health care objectives within a defined time frame. Health targets have been identified by the member states of the WHO European Union and OECD countries as tools for both policy formulation and implementation. Health targets have been the focus of several health related discussions and have contributed substantially to national and sub-national health polices (WHO report on Health Policy, 2005). In order to maintain the effectiveness of health target programs and health impact assessment, the European Observatory on Health Systems and Policies launched a three year multi-country project on the effectiveness of HIA in August 2004, and this was co-funded by the European Commission under the Public Health Programme. As far as the WHO Environmental Health Policy is concerned, most European countries have addressed national health policies through the national environment and health action plans (NEHAPs). The WHO reports that Poor environmental quality contributes to 25 -33% of global ill health. Environmental health policy involves collaborative working different sectors and ministries, and the policy-making procedure itself involves many stakeholders in the phases of planning and consultation (WHO report, 2005).
One of the important health policies is the evidence on health needs and interventions (ENI) Programme at the WHO Europe committee which helps assure staff and programmes which uses available evidence in providing advice and recommendations to member states. One of the goals of WHO is to ensure that there is a link between potential interventions programmes or policies and improvements in public health for the primary areas of advice and recommendations. The ENI programme is an important part of the European Advisory Committee on Health Research (EACHR)and is a division of the WHO advisory mechanism on health research, the primary role of which is to advise the WHO regional director for Europe on priorities and policies for development of research. WHO/Europe defines evidence as follows:
findings from research and other knowledge that may serve as a useful basis for decision-making in public health and health care. (WHO report, 2005)
The ENI policy makes WHO/Europe accountable toWHO’s Member Statesas WHO is expected to make use of best available evidence to provide advice and recommendations for health policies to member states and it would be unethical if WHPO could not keep up to the requirement.
Health and Social Policy in the UK
A Policy has been defined as:
‘The process by which governments translate their political vision into programmes and actions to deliver ‘outcomes’ – desired changes in the real world’
Modernizing Government White Paper (2001) – See DH report 2005, Health Policy
A more working definition for policy is as follows:
“A course of action with general applicability, requiring agreement at ministerial or ‘top of the office’ level”
(Professor Mike Richards 2003) See DH report 2005, Health Policy
The Department of Health suggests a Policy is usually developed within complex systems and with many deadlines and pressures; the DH Policy Collaborative is a unique collaborative approach in which health professionals and administrators need to work within the constraints of this restrictive and complex health environment and despite this be able produce benefits to the teams involved. In this period when the Department of Health (DH) is undergoing major organizational changes the Policy Collaborative complements the downsides of organizational change through promoting learning of new and innovative ways of addressing health issues.
With public demands up for a faster and better NHS and social service, and for improved levels of public safety, the health department is working towards developing the right leadership for the whole healthcare system and also to secure delivery (Stephens 2004; Castledine 2004).
The different health policy teams involved in health care implementation plans in different departments and their foci of work are given below:
Source: DH report on Health Policy, 2005
Policy teams involved in phase 1 of the DH Policy Collaborative
Policy team
Focus of the work as part of the Collaborative
Envisaged distinctive learning
Transplant team
Policy regarding tissue banking and the development of EU legislation
Working with the NHS and other stakeholders on a high-risk, esoteric issue with a European dimension
Cancer team
The introduction of the NHS Bowel Cancer Screening Programme
Developing a bowel cancer programme fit for implementation, whilst taking account of the issues for symptomatic services
Older people’s NHS/social care policy teams and workforce team
To ensure the availability of an integrated health and social care workforce to help older people to maintain their independence
Integration of workforce and service policy making and health and social care expertise
NHS Standards team
The preparation and publishing of statements of standards in relation to the provision of healthcare by and for English NHS bodies and cross-border SHAs
Policy making around a ‘bright idea’ with urgent deadlines and devil in the detail
Within the UK the NHS and Department of Health including the NHS executive set a national framework within which healthcare services are delivered and implemented. The health department uses several different policy measures and tools such as legislation, circulars and guidance, corporate contracts, financial levers and review meetings. Many national level departments and organizations such as the Audit Commission, Clinical Standards Advisory Group, parliamentary committees, the royal colleges and specialist associations, and the Mental Health Act Commission have an impact on research implementation (Klein 1989). As the DH reports, policy measures can have unanticipated consequences and can conflict with policy goals and their may be many obstacles to evidence based practice. There is a growing awareness for the need to identify solutions to problems within the NHS ad health policy initiatives and certain reforms on evidence based care also need evaluation.
The aims of the DH policy for improvement of healthcare services are given as follows (DH report on Health Policy, 2005)
• To support the policy teams in reaching their objectives set within a specified time period
• To include wider stakeholder involvement in the process of developing health policy further
• To make implementation the primary measure of the DH policy making process
• To help project teams and wider stakeholders with handling of issues relating to implementation throughout the policy development process.
• To ensure a coherent, integrated set of policies supporting an agreed strategy.
• To take learning and experiences from the policy implementation programme and use that learning to develop an improved policy development and management process
• To improve ways of working and learning from experiences within DH
• To be informed of the ‘policy management toolkit’
• To involve participation and support of colleagues in managing change in policies within the DH
• To develop measures that can demonstrate real progress of the ‘Excellence in Policy Making’ criteria set out in the NHS management objective.
• To give time for creative thinking and implementation of policies, testing small changes, using examples of best practice and achievement
• To be brave in testing new ways of working and striving for excellence in policy making and challenging the ‘status quo’.
• To take measured risks in the quest for continuous improvement in policies and to achieve an excellent policy.
Health policy within the UK is incorporated within the concept of a British welfare State. The concept of a welfare state refers to government policies and objectives that strive for an ideal model of provision where the state accepts responsibility for providing comprehensive welfare in all areas to its citizens (Brown, 1995). Within the UK, the idea of a welfare state suggests government objective to provide its citizens with guaranteed minimum income, social protection and provision of healthcare and other services at the best possible level. The health care sector of the UK government is largely controlled by the Department of Health with the policy decisions taken by the DH and implemented in association with the NHS. The key elements considered within a welfare state framework are Health, Housing, Welfare, Employment and Social Security.
Healthcare Management in the UK – Evidence and Studies
Eccles et al (2005) suggested behavioral changes of health care professionals as an important factor of policy implementation. They write that routine healthcare is a haphazard and unpredictable process and the usefulness of results of implementation is quite limited. Their study explored the role of a theory based framework and suggests that some methods that could be used to operationalize the framework in the context of designing and conducting interventions which are aimed at improving the use of research findings by individual healthcare professionals or teams. This particular research aims o understand the importance of theory based research of health care services and emphasize on the role of behaviors and attitudes of health care professionals in successful implementation of health care plans.
Cauchi (2005) highlights the challenges of integrated governance in the NHS with emphasis on collaborative and multi-agency working beginning from April 2005 and this according to him poses a challenge for all medical personnel with the nurses being given a leading and more responsible role in the management of clinical cases.
Glen (2004) offers a wide ranging analysis and scrutiny of roles of professionals in the medical, nursing and healthcare sectors. Glen suggests that a coherent vision of the future is needed to shape the future of the health workforce and also argues that this requires moving beyond the presumption that medical reforms are primarily focused on shifting the responsibilities of doctors on to the nurses. The paper claims that the implications of changes in health care roles and the ability of existing professionals to function effectively in the future will require education, training and human resource investments which are supportive of these changes implied. The need to have a clear definition of competence and a national standard to practice has been recognized as essential especially as nurses work in acute critical care settings. A correlation between levels of practice, education ad remuneration has been suggested as important in management of health care. The author suggests that educational programmes for senior nurses should be in coherence with educational programmes required for modernizing medical careers. The paper also suggests that the NHS modernization agenda and government’s health services improvement require certain changes within the culture at higher educational institutions, professional organizations, workforce development agencies and NHS trusts.
The NHS healthcare policy on obesity have made several suggestion on whether junk food advertisements should be banned (Patchell and Paterson 2004) to spreading awareness on the need to have a balanced diet (Price, 2005). A balanced healthy diet cuts down on risks of obesity, diabetes and heart diseases and keeps the citizens healthy and active if it is also combined with a healthy and active lifestyle and this approach has been taken up by the Department of Health to promote awareness and reduce health problems.
For reducing other problems such as smoking, several measures have been taken up by the DH and NHS and these policies and initiatives range from community interventions using co-ordinated, widespread, multi-component programmes to try and influence behavior that would help in preventing smoking in young adults (Sowden et al., 2003) to effectively addressing tobacco control within health promoting NHS trusts as part of its network of health promoting hospitals (HPH) (Quinn et al, 2001).
Conclusion:
In this paper approached the problem of health and health care implementation program using worldwide and British perspectives of welfare and discussed related social policies and plans for implementation of these policies. We discussed in brief, the objectives of the WHO and the NHS, the different departments involved in a new collaborative framework of healthcare within the NHS, the aims of health care policy and the associated problems and obstacles in implementation of these policies. In this context we discussed specific cases of health care policies related to two major problems of obesity and smoking. We suggested along with evidential studies that maintaining modernized health care services and collaborative approach in the NHS are key elements of future health care improvement plan and also involve promoting awareness of the needs of an active and healthy lifestyle in individuals. Thus along with governmental efforts, individual awareness are key to better health and future well being and seem to form an obvious part of social policy.
Bibliography
Annandale, Ellen. The sociology of health and medicine :a critical introduction /Ellen Annandale. Cambridge :Polity Press,1998.
Brown, John, The British welfare state :a critical history /John Brown. Oxford :Blackwell,1995.
Inequalities in health :the Black report /Sir Douglas Black … [et al.] ; edited and with an introduction by Peter Townsend and Nick Davidson. Harmondsworth :Penguin,1982, c1980.
Checkland K, Harrison S. Policy implementation in practice: the case of national service frameworks in general practice. J Tissue Viability. 2004 Oct;14(4):133-6.
Castledine G. A nursing perspective on the new plan for the NHS. Br J Nurs. 2004 Aug 12-Sep 8;13(15):926.
Cauchi S. Integrated governance: is this the future? Prof Nurse. 2005 Mar;20(7):53-5.
Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N. Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005 Feb;58(2):107-12.
Glen S. Healthcare reforms: implications for the education and training of acute and critical care nurses. Postgrad Med J. 2004 Dec;80(950):706-10.
Ham C J (1992). Health policy in Britain. Macmillan, London
Hayes J. Time to change. Nurs Stand. 2005 Feb 23-Mar 1;19(24):78.
Klein R E (1989). The politics of the NHS. Longman, London
Dilemmas in UK health care /edited by Carol Komaromy 3rd ed.
Buckingham :Open University Press,2001.
Health and disease series ;bk. 7 Previous ed.: 1993.
Lea, Ruth, Healthcare in the UK :the need for reform : IOD policy paper /Ruth Lea. London :Institute of Directors,2000.
Price S. Understanding the importance to health of a balanced diet. Nurs Times. 2005 Jan 4-10;101(1):30-1.
Patchell C, Paterson M. Should junk food advertisements be banned? Nurs Times. 2004 Jan 20-26;100(3):19.
Quinn J, Sengupta S, Cleary H. The challenge of effectively addressing tobacco control within a health promoting NHS Trust. Patient Educ Couns. 2001 Dec 15;45(4):255-9.
Sowden A, Arblaster L, Stead L. Community interventions for preventing smoking in young people. Cochrane Database Syst Rev. 2003;(1):CD001291.
Stephens R. A new era of health care. Nurs Manag (Harrow). 2004 Sep;11(5):12-3.
Stevens S. Reform strategies for the English NHS. Health Aff (Millwood). 2004 May-Jun;23(3):37-44.
Taylor RT. Effecting change in the NHS. Hosp Med. 2004 Sep;65(9):568.
Turner JJ. The GMC: expediency before principle: GMC reforms may damage the NHS. BMJ. 2005 Jan 29;330(7485):252; discussion 254.
Timmins, Nicholas. The five giants :a biography of the Welfare State /Nicholas Timmins. London :HarperCollins,1995.
Ujah EU, Bradshaw L, Fishwick D, Curran AD. An evaluation of occupational health services within the NHS in London. Occup Med (Lond). 2004 May;54(3):159-64.
Wilson T, Buck D, Ham C. Rising to the challenge: will the NHS support people with long term conditions? BMJ. 2005 Mar 19;330(7492):657-61. Review.
Webster J. Leading the switch to patient-centred care. Prof Nurse. 2004 Oct;20(2):20-1.
Websites:
www.who.org
http://www.euro.who.int/healthtopics/HT2ndLvlPage?HTCode=health_policy
www.nhs.uk
www.dh.gov.uk – for DH reports
http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/MentalHealth/MentalHealthList/fs/en?CONTENT_ID=4031694&chk=87%2BXMM
