Introduction: services, creating more of a market place


The purpose of this report is to analyse the effects of two
government reforms on the NHS, service users and staff. The report also looks
at the relationship between the NHS and multinationals.

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The Health and Social Care Act 2012:

The Health and Social Care Act was introduced in 2012 and ‘is
the most fundamental reorganisation of health and social care since the
inception of the NHS’ (Kennedys, 2012). The reform aimed to create increased
patient 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, private
and voluntary sector (see appendices 1). Evidence shows that the reform ‘led to
a large number of contracts being awarded to private providers’ (The Kings
Fund, 2017) which is beneficial to the NHS as they can ‘deliver some clinical and non-clinical services’ (The
Kings Fund, 2017), reducing pressures faced by the service. This is also
beneficial for the private sector, as they are able to offer their services to
patients, giving them more choice in their care.

The act created clinical commissioning groups, allowing
professionals to buy in services, creating more of a market place within health
care, ’emphasising a
diverse provider market, competition and patient choice as ways of improving
health care’ (The Kings Fund, 2015). The health care providers (such
as GPs), who know the patients best, are in control of the services provided
for their local population. This is beneficial to the service user as it should
create a decrease in waiting times, as if there is no availability, the NHS can
buy provision elsewhere and get a patient seen at a faster rate. The service
user also has more choice in what care they receive and where. The integration
between services also means the NHS are saving money, as patients are seen to
quicker and may therefore have a quicker recovery time, meaning there is likely
to be an increased availability of beds within hospitals.

The reform has its challenges, as the introduction of
clinical commissioning groups has limited patient choice, as some services
available within one area are not available in another. Helen Rae (2014) points
out that ‘patients…on the
same ward are being asked for their home address, so that the staff can decide what health support services they can be
offered’. Furthermore, the reform leading to increased marketisation creates
the ‘risk of private companies putting profit before patient’s needs’ (Rae,

The Francis Report 2013:

The Francis Report was introduced in 2013 following the
‘failings in care at Mid Staffordshire NHS Foundation Trust between 2005 and
2009’ (The Health Foundation, no date). The report has 290 recommendations for
change, which include improving care and compassion. The reform saw the
creation of whistleblowing and this has benefitted the NHS, as it has allowed
health care professionals to feel more confident in raising a concern, leading
to improvements to the service and overall improving patient care. However,
this may create defensive practice within the NHS, as staff may not always
voice what they think is right in fear of being wrong.  As a result of the reform, the National
Institute for Health and Care Excellence (NICE) released guidelines to ‘help
ensure safe and efficient nurse staffing levels on hospital wards that provide
overnight care for adult patients in England’ (NICE, 2014) following the
concern of staffing issues. This is beneficial as it ensures the right amount
of staff are in place providing the correct care for patients, relieving the
pressures for health care professionals. It also benefits the NHS as they have strategies
to follow on safe staffing requirements (see appendices 2). This will also benefit
the service user, as they will be more satisfied, as they are receiving high
quality care.

The Francis report has been unsuccessful in relieving pressure
from staff, and ‘87% of nurse leaders across the UK are concerned about overall
vacancy rates in their organisation’ (Royal College of Nursing, 2017). This has
led to the NHS recruiting staff through agencies, which is expensive for them, as ‘agency charges for nurses
increased by around 30% from 2012 to 2015’ (NHS Improvement, 2016). The Francis
report also led to the creation of the Friends and Family Test. This has
enabled 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 health
care organisation refers to ‘the system or program by which health care is made
available to the population and financed by government, private enterprise, or
both’ (The Free Dictionary, no date). A multinational is ‘a large corporation
with operations and subsidiaries in several countries’ (, no
date). Healthcare today is about partnership working and there are a lot of
companies working alongside the NHS, for example, Interserve and Bupa.

healthcare ‘delivers bespoke healthcare
services to clients in their own homes and healthcare establishments throughout
the UK’ (Interserve Healthcare, no date). They also ‘recruit the frontline
staff to deliver services within a variety of healthcare settings’ (Interserve
Healthcare, no date). The Dudley NHS foundation trust, which includes
hospitals such as Russells Hall and Corbett, work with Interserve. Across the
trust, Interserve have 600 employees who ‘manage and
deliver non-clinical support services on a daily basis’ (The Dudley Group NHS Foundation
Trust, no date). These services include security, maintenance, catering and portering
(see appendices 3). This partnership has been beneficial as it has improved services
available to patients within hospitals. It is also cost-effective, as hospitals
can provide good quality services at a much lower cost, and the money saved can
be spent elsewhere within the NHS.

Bupa is another example of a multinational company. Benefits
to Bupa working within the UK is that they promote patient choice, giving the
patient more options and control in terms of their health care (see appendices
4). The NHS can learn from new technology and ideas provided by these
multinationals, which they cannot afford, and as a result provide higher
quality care. However, Bupa have provision in the UK for their multinational
clients, and people travel to the UK to use this facility. This is a
disadvantage of multinational companies as if an operation goes wrong, the NHS
have to fix the problem, and this can be costly.

the NHS can be over-reliant on multinationals which is not always beneficial. An
example of this when the government asked if the pharmaceutical supplier ‘Big
Pharma’ could lower their prices, but instead they threatened to remove all
supply (Withers, 2017). These complicated contracts threat the needs of the
service user, and shows how a lot of the multinationals are about

within health care have allowed private companies, such as Bupa, to enter the
market and compete for tenders. This competition impacts health care as it
means prices are lowered, however this doesn’t necessarily mean patients
receive high quality service. For example, multinational companies can lack
regulation as they are not based in the UK and therefore are not regulated in
the same way, which can be a risk to patients. A positive aspect to this is it
should increase the effectiveness of private sector, as they are aware they are
in competition, and if a patient is not happy they will go elsewhere.


This report has analysed the impact of reforms on the NHS and
the importance they have had on improving healthcare for patients. The reforms
have overall been beneficial for the health care professionals and NHS itself. Furthermore,
I can understand that the NHS are reliant on multinationals to provide certain
services despite the costs.







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