The Birth and Principles of the National

Learning outcomes 1 & 2

The National Health Service (NHS) was founded in post-war era of 1948 and was first of its kind. The NHS was the first comprehensive health care system that offered free and universal health care at point of delivery (Gilbert, Clarke and Leaver, 2014). The intention behind the creation of the NHS was based on the idea that health care services should be accessible to everyone irrespective of financial status. Further, the essence of this is based on three fundamental principles, that is: it meets the needs of everyone, it is free at the point of delivery and should be based on the clinical needs of the person instead of their ability to pay for the services (Thomas and Rosser, 2018).

There are certain ethical issues for which the study does not feet the ethical code of conduct. The participants were going through shock during the study though there is empowerment of the participants. In addition to this, there are several ethical issues related to the Milgram’s study of obedience which are degree of deception as well as the participants are suffering from serious stress. But the participants were not informed properly with clear and concise information about the study and there are possible risk factors during the experimental activities and this leads to psychotically harm to another individual. The participants are distressed and demonstrated the signs of stress trembling, sweating, digging, biting lips and nervous (Ilfeld, 2018). The ethical issue of the study is right to withdraw consent where the participants were not allowed to withdraw their consent from the experiment at any time during the study. Lack of debriefing is another ethical issue, where Milgram never completely revealed the actual purpose of the study which is serious concern during the experience.

The NHS constitution is predicated on the rights and pledges for patients along with the public and health professionals. As a legally binding document, the NHS constitution for England stipulates the aims and principles of operation in the NHS in conjunction with supporting values of the NHS (Tingle, 2019). Along the same lines, Hughes (2009) articulates the underpinning values of the NHS constitution as to pledging to the public, public responsibility, staff rights and duties. These underpinning values can further be summarised in six core principles including: ‘care based on clinical need and not ability to pay’, ‘The NHS aims to provide excellent care’, ‘Services reflect the needs and wishes of patients and their carers’, ‘NHS workers across boundaries and in partnership with other organizations; social care’, ‘NHS offers good value for money from public funds’, and “NHS is accountable”. Although the constitution affirms these pledges and rights to the public, patients and staff, it’s not always well understood or known to the public or even to its staff.

Nonetheless, in demanding fast phase NHS settings keeping up with up to date regulations concerning patient safety, safe alignments doesn’t always occur. Similarly, the same can be said about the health professional relationships. Likewise, there is a need for better NHS regulations on how to navigate these issues of clinical importance. Furthermore, existing system remains insufficient in the collection, storage and sharing of patient safety data across the NHS. There is also need for such hub to facilitate a one-stop patient safety network. Various essential publications concerning codes of practice have emerged recently, however, it is not always easy to track down these practice codes and therefore they can be missed. The NHS constitution for England therefore attempts to strike that balance. One of the debatable factors surrounding the NHS is the quality and outcome framework, which is a system launched in 2004; essentially incentivising health care through paying general practice based on national evidence- based quality standards in public health and clinical practice (Thorne, 2016). The NHS Outcomes Framework sets out the national framework used by the Secretary of State in monitoring the progress of the NHS. In regards to its effectiveness, this does not set out the delivery of these outcomes. Innovation comes in play in that it is upon the NHS to determine the best ways in which it can deliver improvements through collaborating with Clinical Commissioning Groups (CCGs) to make use of the tools at their disposal. There are around five domains that act as indicators in the NHS Outcomes Framework: Treatment of people in safe environments and free from avoidable harm, Promotion of positive care experience, ensuring that people recover from ill health episodes or injury, enhancing the quality of life for people with chronic conditions, and prevention of premature deaths.

According to Thorne (2016), the current quality and outcomes framework does so little in addressing health inequality gaps, there should be iterations so that the outcome frameworks may address crucial public health problems. In spite of efficiency improvements of almost 20 billion sterling pounds, the NHS system still depicts both financial and performance strains. As more people are living longer, the UK population ages, exerting certain strains on the health service. Moreover, increase in chronic illness, multi-morbidities and cognitive impairment will also see a significant rise (Government office for science, 2016). The NHS faces challenges of an ageing and growing population with the numbers showing greater prevalence of conditions that are long- term in nature.

In 2019, a long term strategy was published by the NHS following extra funding from the Prime Minister (NHS, 2019). The plan was initiated in a bid to minimize and eradicate the challenges the NHS faces; there were longer waiting times for treatment, inadequate doctors, nurses and other medical staff; and most important of all, all year round performance targets were missed. Additionally, from a long term perspective, the potential economic impact of Brexit could powerfully act as a disincentive for health and care staff working in the NHS and social care settings, for instance, the fall in value of the pound would lead to different financial strengths in regards to income; which amplifies the already existing challenges faced by the NHS such as shortage of healthcare workers; with the current workforce of about 5% of the 1.2 million workers of the NHS coming from the EU (Morgan, 2020). The new plan meant to focus on the capability of the NHS towards delivery, and how. The NHS model of care is to be shifted towards: better coordination of emergency care in order to reduce demands in emergency departments, reduction of outpatients by a third, closer service integration in communities for people with chronic illnesses, and more preventative models of care (Alderwick, 2019).

Within healthcare organizations, clinical governance leads play a crucial role in embedding pursuit of excellence. More often than not, they are the first contact points in regards to any issue of poor performance, quality standards and general practitioner appraisals (Gerada and Cullen, 2004). Evidently, the health service nurses, doctors and other health care professionals in power dynamics have a unique position. As such, they are required to acquire a set of skills and specialised knowledge while they are in control. The patients are positioned as the weaker party, primarily because of the fact that patients require access to treatment and the health care skills which are possessed by the health professionals. A refined stakeholder consultation and improved NHS knowledge and skills framework would attempt to clearly define the core activities and skills required in meeting the activities (Specchia et al, 2015). In regards to service improvement, therefore, key clinical governance, which comprises of governance, management and clinical practice, upon clear division of management and governance roles, effectively help in the execution of clinical activities (Brennan and Flynn, 2013). Associated management and leadership strategies currently being used orient around epidemiological change, shifting expectations and roles, human resource management, intensified management, changing structures into much more efficient structures, and efficiency- saving. Leaders and management with relevant and adaptable capabilities are crucial in high quality healthcare service delivery.

Taking into consideration the NHS Constitution, Five Year Forward View, its 2019 long term plan and Outcome frameworks, the registered nurse’s knowledge and understanding of the health inequalities is very important. This nurse has the duty to identify and evaluate these inequalities as they occur. The plans also importantly raise the aspect of innovation in service delivery, this basically involves the introduction, development and mainstreaming of new technologies in order to improve service delivery; this innovation in healthcare in Europe become increasingly important as the challenges create a fundamental need to rethink the organization and financing of healthcare services and systems. The staff, nurses included, should undertake to adapt innovation processes in local contexts, evaluate and demonstrate the effectiveness of the innovation being introduced. In addition, there should be effective communication across the organisations. Observed across different population groups, the variation in health outcomes is significantly influenced by such inequalities. In order to address these inequalities, awareness is a very important aspect of care; nurses should be able to successfully identify and address health inequality, which in turn enables a holistic approach to patient care (McFarland and MacDonald, 2019).

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References

• Alderwick, J. (2019) The NHS long term plan. BMJ; 364, pp. 184 .
• Brennan, N., Flynn, M. (2013) Differentiating Clinical Governance, Clinical Management and Clinical Practice. Clinical Governance An International Journal; 18(2), pp. 114-131
• Gerada, C., Cullen, R. (2004) Clinical governance leads: roles and responsibilities. Quality in Primary Care; 12, pp. 13-18
• Gilbert, B., Clarke, E., Leaver, L. (2014) Morality and Markets in the NHS. Int J Health Policy Management; 3, pp. 371-376 Government Office for Science (2017) Government Office for Science annual report: 2016 to 2017 (Accessed on 02 May 2020)
• Hughes, R. (2013) The NHS Constitution. British Journal of Healthcare Assistants; 3(6) Maruthappu, M., Sood, H., Keogh, B. (2014) The NHS Five Year Forward View: transformative care. British Journal of General Practice; 64(629), pp. 635 McFarland, A., MacDonald,E. (2019) Role of the nurse in identifying and addressing health inequalities. Nursing Standard. Doi: 10.7748/ns.2019.e11341
• Morgan, E. (2020) ‘Beyond Brexit: The multiple challenges facing the NHS’, itv news (Accessed on 03 May 2020) NHS (2019) The NHS long term plan. 2019. National Health Service Specchia, M., Poscia, A., Volpe, M., Parente, P., Capizzi, S., Cambieri, A., Damiani, G., Ricciardi, W., OPTIGOV collaborating group., De Belvis, A. (2015) Does clinical governance influence the appropriateness of hospital stay? BMC Health Services Research, 15 (142)
• Thomas, B., Rosser, E. (2018) Responsibility, research and reasoning: nursing through 70 years of the NHS. British Journal of Nursing; 27(13) Thorne, T. (2016) How could the quality and outcomes framework (QOF) do more to tackle health inequalities. London Journal of Primary Care; 8(5), pp. 80-84 Tingle, J. (2019) The new NHS patient safety strategy. British Journal of Nursing; 28(14)