Introduction: services, creating more of a market place

Introduction:The purpose of this report is to analyse the effects of twogovernment reforms on the NHS, service users and staff. The report also looksat the relationship between the NHS and multinationals. The Health and Social Care Act 2012:The Health and Social Care Act was introduced in 2012 and ‘isthe most fundamental reorganisation of health and social care since theinception of the NHS’ (Kennedys, 2012).

The reform aimed to create increasedpatient choice and to solve the financial issues and pressures faced by the NHS(Patient4NHS, 2017), as well as promoting ‘the closer integration of services'(The Kings Fund, 2015). The government introduced the ‘Any Qualified Provider’policy, which aimed to create closer integration between the statutory, privateand voluntary sector (see appendices 1). Evidence shows that the reform ‘led toa large number of contracts being awarded to private providers’ (The KingsFund, 2017) which is beneficial to the NHS as they can ‘deliver some clinical and non-clinical services’ (TheKings Fund, 2017), reducing pressures faced by the service. This is alsobeneficial for the private sector, as they are able to offer their services topatients, giving them more choice in their care.The act created clinical commissioning groups, allowingprofessionals to buy in services, creating more of a market place within healthcare, ’emphasising adiverse provider market, competition and patient choice as ways of improvinghealth care’ (The Kings Fund, 2015). The health care providers (suchas GPs), who know the patients best, are in control of the services providedfor their local population. This is beneficial to the service user as it shouldcreate a decrease in waiting times, as if there is no availability, the NHS canbuy provision elsewhere and get a patient seen at a faster rate.

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The serviceuser also has more choice in what care they receive and where. The integrationbetween services also means the NHS are saving money, as patients are seen toquicker and may therefore have a quicker recovery time, meaning there is likelyto be an increased availability of beds within hospitals. The reform has its challenges, as the introduction ofclinical commissioning groups has limited patient choice, as some servicesavailable within one area are not available in another. Helen Rae (2014) pointsout that ‘patients…on thesame ward are being asked for their home address, so that the staff can decide what health support services they can beoffered’. Furthermore, the reform leading to increased marketisation createsthe ‘risk of private companies putting profit before patient’s needs’ (Rae,2014). The Francis Report 2013:The Francis Report was introduced in 2013 following the’failings in care at Mid Staffordshire NHS Foundation Trust between 2005 and2009′ (The Health Foundation, no date). The report has 290 recommendations forchange, which include improving care and compassion.

The reform saw thecreation of whistleblowing and this has benefitted the NHS, as it has allowedhealth care professionals to feel more confident in raising a concern, leadingto improvements to the service and overall improving patient care. However,this may create defensive practice within the NHS, as staff may not alwaysvoice what they think is right in fear of being wrong.  As a result of the reform, the NationalInstitute for Health and Care Excellence (NICE) released guidelines to ‘helpensure safe and efficient nurse staffing levels on hospital wards that provideovernight care for adult patients in England’ (NICE, 2014) following theconcern of staffing issues.

This is beneficial as it ensures the right amountof staff are in place providing the correct care for patients, relieving thepressures for health care professionals. It also benefits the NHS as they have strategiesto follow on safe staffing requirements (see appendices 2). This will also benefitthe service user, as they will be more satisfied, as they are receiving highquality care.

The Francis report has been unsuccessful in relieving pressurefrom staff, and ‘87% of nurse leaders across the UK are concerned about overallvacancy rates in their organisation’ (Royal College of Nursing, 2017). This hasled to the NHS recruiting staff through agencies, which is expensive for them, as ‘agency charges for nursesincreased by around 30% from 2012 to 2015’ (NHS Improvement, 2016). The Francisreport also led to the creation of the Friends and Family Test. This hasenabled the NHS to get feedback from the patients and make improvements.However, making these improvements may be time-consuming and costly.

Health Care Organisations and Multinationals:A healthcare organisation refers to ‘the system or program by which health care is madeavailable to the population and financed by government, private enterprise, orboth’ (The Free Dictionary, no date). A multinational is ‘a large corporationwith operations and subsidiaries in several countries’ (Dictionary.com, nodate). Healthcare today is about partnership working and there are a lot ofcompanies working alongside the NHS, for example, Interserve and Bupa.Interservehealthcare ‘delivers bespoke healthcareservices to clients in their own homes and healthcare establishments throughoutthe UK’ (Interserve Healthcare, no date). They also ‘recruit the frontlinestaff to deliver services within a variety of healthcare settings’ (InterserveHealthcare, no date). The Dudley NHS foundation trust, which includeshospitals such as Russells Hall and Corbett, work with Interserve.

Across thetrust, Interserve have 600 employees who ‘manage anddeliver non-clinical support services on a daily basis’ (The Dudley Group NHS FoundationTrust, no date). These services include security, maintenance, catering and portering(see appendices 3). This partnership has been beneficial as it has improved servicesavailable to patients within hospitals.

It is also cost-effective, as hospitalscan provide good quality services at a much lower cost, and the money saved canbe spent elsewhere within the NHS. Bupa is another example of a multinational company. Benefitsto Bupa working within the UK is that they promote patient choice, giving thepatient more options and control in terms of their health care (see appendices4). The NHS can learn from new technology and ideas provided by thesemultinationals, which they cannot afford, and as a result provide higherquality care. However, Bupa have provision in the UK for their multinationalclients, and people travel to the UK to use this facility.

This is adisadvantage of multinational companies as if an operation goes wrong, the NHShave to fix the problem, and this can be costly. Furthermore,the NHS can be over-reliant on multinationals which is not always beneficial. Anexample of this when the government asked if the pharmaceutical supplier ‘BigPharma’ could lower their prices, but instead they threatened to remove allsupply (Withers, 2017). These complicated contracts threat the needs of theservice user, and shows how a lot of the multinationals are aboutprofit-making.Reformswithin health care have allowed private companies, such as Bupa, to enter themarket and compete for tenders. This competition impacts health care as itmeans prices are lowered, however this doesn’t necessarily mean patientsreceive high quality service.

For example, multinational companies can lackregulation as they are not based in the UK and therefore are not regulated inthe same way, which can be a risk to patients. A positive aspect to this is itshould increase the effectiveness of private sector, as they are aware they arein competition, and if a patient is not happy they will go elsewhere.Conclusion:This report has analysed the impact of reforms on the NHS andthe importance they have had on improving healthcare for patients. The reformshave overall been beneficial for the health care professionals and NHS itself. Furthermore,I can understand that the NHS are reliant on multinationals to provide certainservices despite the costs.