Contemporary issues on NHS

A policy is typically defined as a principle or rule to guide decisions and achieve rational outcomes. It is not used normally what is actually done, it is normally referred to as either procedure or protocol. A policy will contain what and the why procedures. A policy can be considered as a statement of intent. Policy may apply to generalized private sector organization and groups and individuals. In another way policy can be defined as a collection of different ideas and methods which is used for the improvement in any field including health care and the other hand, health policy is a practical device or advantageous procedure and positive course of action.

Social Policy is a subject area, not a discipline; it borrows from other social science disciplines in order to develop study in the area. The contributory disciplines include sociology, social work, psychology, economics, political science, management, history, philosophy and law. The name social policy is used to apply 1) that policies which are used by the government use for welfare and social protection, 2) to the ways in which welfare is developed in a society and to the academic study of the subject. In the first sense, social policy is particularly concerned with social services and the welfare state. Improvements to social policy are a key element of development and the achievement of human rights. Many social policies are addressed by the third committee of the UN general assembly.

Health policy can be defined as the decision, plans and action that are undertaken to achieve specific health care goals within the society. According to the World Health Organization, health policy can achieve several things. It defines the vision of the future. We can define the different categories of the health policies, eg pharmaceutical policy, public health and personal health care policy, tobacco control policy. Before 1990 there was a good collaboration of health and social care policy.

Contemporary issues on NHS

National Health Services is the United Kingdom health services organization. The short form of National Health Services is NHS. It was stabilised in 1948. It was grown the world’s largest publicly funded services. It is also known as a most efficient, most comprehensive and egalitarian. In the Second World War and difficult scenario NHS was established. The principle of NHS always remains in the core. It was born for good health care and should be available to all. The NHS is the free services for anyone who is resident of the United Kingdom. The NHS only charges some prescription and optical and dental services. NHS is giving the free services more than 60 million people. It covers everything such as antenatal screening routine treatment for coughs and colds to open heart surgery, accident and emergency treatment and it also covers the end of life care.

Mainly it is funded from taxation. In United Kingdom they have separate management in England, Wales, Scotland and Northern Ireland; in many respects they are similar. Despite their separate management and funding there is no any discrimination when a resident of one country of the United Kingdom requires treatment in another although a patient will often be returned to their home area when they are fit to be removed?

It is the huge organization. In this organization have more than 1.7 million employees and half of them are clinically qualified, including 120000 hospitals doctors 400000 nurses 40000 GP’s practises and 25000 ambulance staff. The NHS of the England is the biggest part of the system It is caring more than 51 million people and employing 1.3 million people. The number of patients using the NHS is large. Every 36 hours it is dealing a million in the England, in Scotland 463 in minute and more than 700000 people will visit on NHS dentist and 3000 heart operation, here are 10000 GPs in nationwide. Each GPs look more than 140 patient in a week.

NHS is spending big amount of money. When the NHS established the starting budget of the NHS is 9 billion and now the budget of the NHS is 100 billion in year which is increasing by 4% every year. It is spending 60% of the budget to pay the staff, and 20% for the drug suppliers and remaining 20% is spending for the equipment and training costs. 80% of the total cost is distributed by the local trusts.


We know that the “health is wealth”. In any country of the world health is the backbone of the country and the main important is government funded health organization. If any policy is taken related to the health it affects the outcomes of the services. In the United Kingdom NHS is only one and which cover the almost 100% of the services. Now the government took a new policy for NHS Which is liberating the NHS. The Health and Social Care Bill was introduced into Parliament on 19 January 2011. The Bill is a crucial part of the Government’s vision to modernise the NHS so that it is built around patients, led by health professionals and focused on delivering world-class healthcare outcomes.

The Bill takes forward the areas of Equity and Excellence: Liberating the NHS (July 2010) and the subsequent Government response Liberating the NHS: legislative framework and next steps (December 2010), which require primary legislation. It also includes provision to strengthen public health services and reform the Department’s arm’s length bodies.

The Bill on health and social care 2011 contains provisions covering five themes:

It is strengthening commissioning of NHS services

It is increasing public voice and democratic accountability.

liberating provision of NHS services

strengthening public health services

Reforming health and care arm’s-length bodies.

Structure of NHS

Department of health

Strategic health authorities

Primary care trusts

GPs Dentists Hospitals


The Department of Health (DH) is in overall charge of the NHS with cabinet minister reporting as secretary of state for health to the minister. The 10 Strategic Health Authorities (SHA’s) are under the department of health which oversee all activities of NHS IN England. The strategic supervision of NHS is controlled by each SHA in its area. The NHS services of Scotland, Wales and Northern Ireland runs separately by the developed administrations. Primary care trusts are divided into primary care and secondary care. Primary care is the front line services. GPs, Dentists are primary care where people contacts first time. Secondary care can be defined as a acute health care and can be either elective or emergency care. Primary care is the centre of the NHS and they cover and control 80% of the NHS budget. These are the local organizations so they know the needs of community and they can make sure the organizations providing health and social care services are working effectively. The PCTs oversee 1800 NHS dentist and 29000 GP. Here are 175 acute NHS trusts and 60 mental health trusts which control the 1600 NHS hospitals and specialists care centres.NHS ambulance trusts provides the emergency ambulance services, in UK there are 11 ambulance trusts.

The NHS structure shown below which will be happened after reforming,

Independent board

250 + GP consortiums GPs Dentist specialist service

Hospitals, community services, mental unit intensive core


After reforming the NHS structure there would be the change in the management not in the whole system of the NHS, but changing the management system it directly affect the top to bottom shake of the NHS. which will directly affect the model of care of the NHS.

Reasons of reforming the NHS

NHS is the great national institution. The main principle of the NHS when it was founded is free at the point of use and available to every one based on need and it is not focused for ability to pay. Most of us believe it can be so much better for both the patient and professionals. So that the government took the bold vision for the NHS future, which is ‘equity and excellence’. According to the different surveys and analysis NHS of the United Kingdom is world class. It is giving the facility without cost and it is also employing more than 1.6 million people which mean it is giving a good services. According to the Health secretary Andrew Lansley says that NHS is the world class in some respects but it is not good enough in some areas eg ; rate of mortality, United Kingdom is the 2nd largest mortality rate among the 24 richest country in the world and rates of mortality for some respiratory diseases and the stroke has been the worst in the developed world. Now the NHS has too much bureaucracy, after reforming NHS would be more accountable to the patients and all the staff will free from excessive bureaucracy. In the structure of the NHS there are 10 strategic health authorities, 175 NHS trusts and 60 mental health trusts. After reforming It will increases spending on real terms of the health not in managing. Department of the health says NHS has further to go on managing care more effectively and international evidence prove it.

The changes of NHS are

The main changes are fundamental changes to structure and the operation which changes the social economic and managerial changes. The main structure of changes is a England’s 175 or so primary care trusts will be wound up in 2013 and their work, commissioning healthcare will pass to groups of GPs called general practise commissioning consortiums (GPCCs). Every GPCCs which will have existing practises will have own budget. The constriums will collect the £ 80 billion from the total budget of NHS and GPCCs are agreed to contacts with hospital and other. More than 200 GPCCs have been set up. The outcomes or changes will be taken by keeping the patient on the heart of the NHS. The patients will have more choices and control by the easy access of the GPs and hospitals. Patient will have the right of decision making about their treatment and care. It will be focused in clinical outcomes. Success will be measured by the bureaucratic process targets, but the against results that really matter to patients such as improving cancer and stroke survival rates. The capacity will be increases or will empower the professionals. Doctor and nurse will have right of professional judgement about the patient treatment. This thing will be supported by controlling the front line staff. If patient want they will have the access information, they can make choices. Patient will have the right of choosing the GP practise, consultant led-team and any provider. Hospitals will require to open their mistake, if something wrong patient must know it. The patient voice will strengthen by local authorities. The targets will be removed with no clinical justification. The quality standard of NICE will inform the commissioning of all NHS care and payment system. The drug companies will be paid by the value of their new medicines, follow of money will be transparent, comprehensive and stable payment system across the NHS to promote high quality care, drive efficiency and support patient choices. The service provider will get the money according to their services performance, payment should reflect outcome not just activity and provider an incentive for better quality. The NHS fundamental structure is controlled by the department of health, after reforming there would be one independent and accountable NHS commissioning board, and NHS will be the under control of this commissioning board. This board will allocate the NHS resources lead on the achievement of health outcomes. This board will promote and improves the patient involvement and choices. Another duty of this board will promotes equality and tackle inequalities. Day by day the minister power will be limited for the decision of NHS. The changes will be shaking top to bottom of NHS structure.

Benefits of NHS reforms

It is the big institution of health. After reforming there should be some changes with the facility of the NHS. GPs could more than double their income to £ 300000 per year this is the direct impact of the NHS reforms. It also cuts the bureaucracy. NHS foundation trusts are given significantly greater financial freedom and power. It increases the quality of primary medical services. Now the NHS budget is increasing 4% per year after reforming it will increase just 0.1% per year.

Model of care

Model of care is directly impact to the patients and it affects the whole output of the organization. I have already described the model of care in changes of NHS. when the people born in the world at first he is known only male and female at that time there is no any discrimination like that way United Kingdom National Health Service believes in the universality. In NHS there is no any discrimination for the treatment of the patient, it is only believe for the medical requirement, it doesn’t separate the richest and poorest of the people. It gives the treatment free of the cost. If the people of the different country which have more than 1 year resident permit he is also can take the benefit of the NHS. While starting the NHS at that time people have no right of choices, but now a days they have right of taking decision of their care. Day by day patients are increasing and also the NHS also increasing employee’s which gives the good services for the patient which is the positive point of the model of care. We know that NHS is employing the large number of employees.

Now a day United Kingdom government is focusing the reforms of the NHS, many arguments were taken about the patient of care; I thought it’s better to describe the different arguments here. British Medical Association is the leading association of the medical staff in the UK, but the British Medical Association said against the reforms of the NHS. According to the BMA: more than 150 organizations and 80 percent budget of the NHS will go to the GPs hand. Financially and managerial power is given to GPs which increases the bureaucracy. This proposal is unmanaged damaging and unjustified. This damages the patients care. There are different surveys says after reforming its affect a patient care. According to the Unison after the cutting of the staff its directly increase the workload for the nurses and doctor and other staff. The survey said that 88% think that during first year of the coalition government their workload has increased, and 65% said that rise of hitting patient care and safety. Around 67% of nurses said that increasing the workload direct impact on their health, and 69% said their job is not suitable or bad for family life. This will direct affect the model of care. Beside these arguments I thought that after reforming the NHS the model of care would be better. Equality and excellence liberating of the NHS Says patient are always in the core and after reforming patient will have many choices, they will have their decision for owns care, and they can tell no decision without me, which is not in the today’s model of care. Managerial cost will be saved which will be used to empower the technical and professional things, these things increases the model of care better.


Health is the backbone of the any country without healthy people country cannot be developed. Health and social care policy is directly related to the health of the people. So that government should think about how to take the policy, policy should not be taken without justification. I have already mentioned that policy is the key role of the development. Now the Government took the new policy about the National Health Services (NHS). in the history of the NHS government took many policies related to the health but this policy would be the biggest policy which will change the fundamental or it will shake the top to bottom of the NHS. in my opinion government should take the policy step by step not like big shake up. The implementation of this policy is very costly. British Medical Association already rejects this policy and many people are against of this. Health and social care policy and model of care are interrelated; this means how the patient will be treated, if the policy is failed then what would be the condition of the country. This policy cuts the thousands of jobs which will increase the unemployment, this policy increase the price competition allowing hospitals to undercut one another to attract patients, poses a risk to standard of care. some surveys said doctor will be the account after implementing this policy. ‘Health is wealth’ This is the universal truth so that government should not play the life of the people. According to health secretary Andrew lansley this policy “equity and excellence liberating NHS” will make the NHS bright future.