Key Topics in Healthcare Management

Understanding the Big Picture

Robert Jones, Fiona Jenkins

• Publisher: CRC Press
• Year: 2018
• Print ISBN: 9781138444072
• eBook ISBN: 9781315345147
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Information is a key resource to primary health care and is increasingly required in individual practices. This book will demystify the subject, which is often presented in complex terms. It sets out in a simple and interesting way what information those working in primary care will need, the systems required to deliver them and how to set them up. Information and IT for Primary Care uses exercises, stories, key points, case studies, model answers and think boxes. Worldwide web links refers the reader to resources and shows how to get the most out of your computer. The book is user-friendly, jargon free and based on primary research evidence. It is essential reading for everyone working in primary care organisations including GPs, practice managers and nurses, and staff working in community trusts and the NHS.

Chapter 1

Public policy reforms and the National Health Service strategic development agenda

Patricia Oakley

Introduction

A dynamic Public Policy Reform agenda

As an illustration of the dynamic situation; at the time of writing, for instance, the Government is working on complex legislation and major proposals to:

• reform the way in which medical and professional staff are going to be reaccredited and validated in the future during all of their working lives
• develop public service commissioning in the NHS, the secondary education service, and the prison and probation services, which will have a bearing on how therapy services will be developed in the future
• build up the intriguingly titled ‘3rd sector’ as a supplementary provider of public services which will affect future models of care provision.

Within this changing environment, the aim of this chapter is to pinpoint the key policy areas which are now fairly stable features of the Public Policy Reform Agenda so that Allied Health Professions (AHPs) Managers can start to see more clearly how their AHP services will be commissioned, provided, and quality assured in the future. To this end, this chapter represents a synthesis of much research which has been augmented by the Author’s practice in many streams of policy and development work across the public sector. Parts of this chapter have appeared in earlier forms in various working papers, policy masterclasses and their supporting notes, and service evaluation reports for clients especially over the last five years.

The context for developing AHP services in the 21st century

There are at least five important forces which are driving the development of AHP services in the 21st century:

1. the changing population profile and people’s needs as they live longer in a more independent way while being increasingly sensitive to the tax burden
2. the desire to achieve a more ‘joined-up’ approach to public service policy-making, service commissioning and its provision, with the desired collective effect of achieving ‘improved outcomes’
3. the desire to achieve a more locally accountable government structure in the form of devolution to the Regional Assembly Governments in Wales, Scotland, Northern Ireland and London, and possibly – in time – to the other English regions
4. the changing legal context being driven by shifts in European law, for example in employment practices and the free movement of labour across member states, and in clinical practices and the conduct of safer and more rigorous clinical trials
5. The changing risk management environment as a result of major inquiries and legal rulings clarifying and assigning duties and responsibilities.

Taking the first point to locate this introductory discussion in AHP services, within the last ten years, there have been several major reports on people’s changing needs for health and social care including:

• the Report of the Royal Commission on Long Term Care, 1999¹
• the Audit Commission’s series of reports²,³,⁴,⁵,⁶ covering health and social care provision, 1997–2000
• the Department of Health (DH) proposals to improve chronic disease management.^7,8

These reports, and many others, have explained why, and informed how, AHP services should be delivered in a more integrated way focusing on chronic disease management with an emphasis on self-care and the provision of intermediate care. The comparative review by Ham et al⁹ of hospital bed utilisation in the NHS with the US Kaiser Permanente and Medicare Programmes in 2003 gives an initial analysis of the data to support this proposition.

The other driving forces will be discussed in the relevant sections below.

The structure of this chapter

This chapter also discusses Government policies in a hierarchical analysis which covers:

• an overview of the Public Service Reform Agenda to show the common ideas emerging across the public service so the NHS reforms can be located in the wider policy context
• an overview of the NHS commissioning reforms including the development of the more aggregated primary care trusts (PCTs) in England and their equivalents in the devolved administrations
• an overview of the NHS provider organisations including the social enterprises and voluntary sector which make up the ‘3rd sector’ and the changing regulatory structure which affects the workforce.

The chapter concludes with an assessment of the potential collective impact of these reforms on developing AHP services in the 21st century and it offers AHP managers a ‘watch list’ of key issues which they will need to address in order to reform their services.

The public service reform agenda

Developing commissioning and providing

The public service reform agenda emphasises the separation of service commissioning from its provision. For example, in social services, which have operated this policy for many years, the White Paper for England,¹⁰ sought to further integrate health and social care provision, and to develop more integrated service commissioning for care of the elderly and for those with long-term conditions. Similarly, the Government’s proposed reform of the provision of secondary schools in England will result in the Local Education Authorities becoming in time, commissioners of secondary education and secondary schools developing in a more independent and plural way driven by local demands.¹¹

The Government also proposes a major reform of its prison and probation services (for England and Wales) following the Carter Review.¹² This in effect follows the pattern above but requires new and complex legal powers to develop ‘Correctional Services’ commissioning, through a new body called the National Offender Management Service, and a more integrated prison and probation service which focuses on providing prisoners with bespoke rehabilitation and treatment programmes so that their resettlement in the community is likely to be more successful. Currently, up to 60% of discharged prisoners reoffend and return to prison within one to two years of their discharge date. Critically, much of the rehabilitation and treatment programmes required consist of education and skills building supported by mental health and detoxification treatment programmes.

In addition, in respect of the ‘Lifers’ and those detained indefinitely in the specialist psychiatric prisons, the Government proposes a programme of support as these prisoners become old and infirm, and suffer from the normal process of ageing including senile dementia. Because the reform programme is so complex and sensitive, it will take a number of years to implement but clearly there are overlaps between the programme commissioners for correctional services and the emerging commissioning roles for the education, health and social services.^13,14

‘Choice’ and patient power

The ‘choice’ agenda reflects in part the shifting public attitudes to public service provision, especially in England. This is illustrated by two contrasting populations of mature and elderly women. On the one hand, is a group of women born after World War Two – the ‘baby boomers’ who are relatively more educated, especially as a result of the education reforms that took effect in the mid to late 1960s and who have had jobs resulting in pension contributions and savings over a long working life. This group forms the next generation of women pensioners who are in effect ‘healthier, stealthier and wealthier’. They have different attitudes to public service provision which they have contributed to for all their working lives and they tend to be well-informed ‘consumers’.

In contrast, there is a group of women pensioners who have experienced the horrors and deprivations of life before and during the Second World War and who saw the birth of the NHS and its universal ‘free’ service. They tend to be less ‘muscular’ in asserting their rights. With an emphasis on looking after themselves and their family, mature and elderly women form the backbone of the UK carer ‘workforce’, and they are critical to the well-being of not just themselves but also of their families. In policy terms, the Government needs to satisfy both groups to prevent a two-tier service emerging. For brevity, this is a gross simplification of the social group mixes as the story is indeed much more complex. However, this brief explanation underpins, in part, the Government’s proposals to develop under the aegis of the White Paper, the ‘Expert Patient’ Programme, focusing on Long Term Conditions such...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• List of figures
• List of tables
• List of boxes
• Series foreword
• Foreword
• Preface
• About the editors
• List of contributors
• List of abbreviations
• List of books in this series
• 1 Public policy reforms and the National Health Service strategic development agenda
• 2 Managing change: a Framework for the Management of Change
• 3 Care pathways and the Allied Health Professional
• 4 Communication and the health professional
• 5 Managing staff and Human Resources
• 6 Getting it right: the quality of care
• 7 User involvement in services for disabled people
• 8 Corporate governance and the health professional
• 9 Organisational behaviour: understanding people in healthcare organisations
• 10 Managing health and safety in the workplace
• 11 Managing work-related stress
• Index