The National Health Service (NHS) provides healthcare for all UK citizens based on their need for healthcare rather than their ability to pay for it. NHS is funded by taxes. This report identifies the problem with NHS with problem solving tools and techniques. For finding this problem Casual Loop and BOT methodologies has been used.
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NATIONAL HEALTH SERVICE (NHS):
On 5 July 1948, NHS was launched by Health Secretary Aneurin Bevan and for the first time health care became free to all UK citizen. In 1952, Patients started being charged for prescription. First mass vaccination programme for polio and diphtheria started in 1958. Before this, there were 8000 cases of polio and 70000 of diphtheria each year. In 1961, contraceptive pills were launched which gives women control over how many children they have.
In 1962, Health Minister Enoch Powell put forward The Hospital Plan which set out a 10 year vision for hospital building. Every population of 125,000 was to get a hospital or district general hospital as they become known. In 1967 Abortion Act was passed by a free vote of MPs and introduced by Liberal MP David Steel which made abortion legal up to 28 weeks if a woman’s mental or physical health was at risk and further limit reduced to 24 weeks in 1990.
In 1968, UK’s first heart transplant surgery was carried out in the National Heart Hospital in London with 18 doctors and nurses operating a 45 year old man for seven hours. CT scanners were used for first time in 1972. CT scanners started to be used on patients through the development of the previous five years. CT scan machines take pictures of the body to develop 3D images, revolutionising investigations of the body. World’s first test tube baby was born on 25 July 1978 before midnight in Oldham District General Hospital. To reduce breast cancer deaths in women over 50, breast screening was introduced in 1988 and along with improved drug treatment screening was estimated to have cut deaths by a fifth.
In 1990 NHS and Community Care Act was introduced by the legislation which was known as the NHS internal market with health authorities given their own budgets to buy care for local populations from hospitals. In 1994 organ donor register created to co-ordinate supply and demand. It was the result of a five year campaign by John and Rosemary Cox whose son Peter died in 1989 and he had asked for his organs to be used to help others. In 2006, patients were given the choice of four or five hospitals, ending the long held tradition of going where GPs decides. The scheme has now been extended to include all hospitals in England but not adopted elsewhere in UK.
A review of the political, economic, social and technical (PEST) environment involves analysing the environment for any organisation. UK based healthcare provider for the public, NHS funded by contributions made from taxes distributed by the government to each of the trusts. NHS operates within a politically stable economy with funds pledged by both previous and current governments to the service for improvements in healthcare and salaries for staff.
NHS facing the economic environment is a growing economy with a rising elderly population and less working people to support them. It has become increasingly difficult to recruit medical staff and shortages have often been counteracted by employing staff from other European Union countries which in turn increases the population within the UK. The social environment shapes beliefs, values and norms (Kotler). Belief is the core values of the health service and the services it offers was high on the public’s list of concerns during the last general election as if NHS is an internal part of the UK and its culture. The technological environment is moving fast within the health care sector with continually development of drugs, advancement of techniques for operations and the use of technologies for both medical and administrative procedures.
There is no real competitor for the NHS although it doesn’t have monopoly in the market.
Accident and Emergency service is unique to the NHS though private hospitals are available throughout the UK.
The NHS has continued to grow and expand upon its services since it was established in 1948.
NHS maintains good relationship with health community partners.
Due to increasing population NHS is unable to cope with the demand.
High waiting time for the patients.
Bad behaviours and attitudes of some staff.
Uses of marketing strategies to raise the profile of the NHS.
Partnerships and joint ventures with private and voluntary sector.
Work of contractors affects image of NHS.
High turnover of staff.
Shift of services to primary care.
CAUSAL LOOP DIAGRAM:
Causal Loop Diagram’s contain several components:
One or more feedback loops that are either reinforcing or balancing processes.
Cause and effect relationships among the variables.
Where feedback reduces the impact of change, it is a Balancing loop. Balancing loops try to bring things to a desired state and keep them there.
Where feedback increases the impact of change, it is a Reinforcing loop. Reinforcing loops compound changes in one direction with even more changes in that direction.
Causal Loop Diagram has two kinds of relationships between variables:
When variable A changes, variable B changes in the same(S) direction. It is indicated by (S) in the diagram.
When variable A changes, variable B changes in the opposite (O) direction. It is indicated by (O) in the diagram.
The Causal Loop Diagram for NHS contains variables which are as follow:
Number of Doctors, Nurses and other medical staff: – The number of doctors, Nurses and other medical staff working in the NHS is inversely related to the waiting time for patients. This implies that when the number of staff increases, the waiting time for patient’s decreases because of added capacity. The number of staff working with NHS depends on softer variables such as their morale and work environment.
Number of Patients on the Waiting List: – This refers to the number of patients on NHS waiting list. The waiting list becomes short when a large number of patients shift from NHS to private health care and becomes particularly long due to seasonal peaks.
Waiting time: – This is time a patient has to wait before he/she can be treated by NHS.
Number of hospitals, beds, medical equipment: – The number of hospitals, beds and medical equipment are dependent on the annual NHS budget and funding. If there is a lack of these resources than it would increase tension in the system and it would take longer to treat patients.
Perceived quality of Health Services (Waiting time, Treatment and After Care): -This varies from patient to patient, if the waiting time is too long, the perceived quality of the service is low and this in turn causes more people to complain against the NHS.
Number of Complaints: – Dissatisfaction of the patients due to increase in waiting times leads to an increase in complaints against the NHS. This increases pressure on the government and the Department of Health by acts of the National Audit Office.
Number of Patients shifting to private Health care: – The patients dissatisfied by the long waiting times of NHS, started complaining and shifting to private health care.
Government action: – Longer waiting lists increased media pressure causing the Government to increase its annual NHS budget which relaxes the system temporarily as new funds increases the NHS capacity.
Investment in facilities, Medical equipment and information technology: – An increase in the NHS budget allows the NHS to hire more medical staff and improve the capacities in hospitals. More patients can be treated within short time and the waiting lists can become shorter as the budget increases.
Partnership with Private Health Care: – NHS cannot cope with the excessive demand when the waiting lists become too long. So it tends to outsource its service to private health care e.g. BUPA, NHS express surgery units in partnership with state run German and French health care firms. This is quick and short way to fix the problem and tends to bring down the waiting time in the short run.
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Morale of doctors and other medical staff: – This is a soft variable that depends on factors like the quality of the work environment in the NHS hospitals, the work pressure and employee satisfaction. The morale of doctors and other medical staff has a positive effect on the quality of service provided to patients. It also determines the number of doctors and medical staff that stay with NHS or join NHS.
Number of patients coming back to the NHS: – The waiting list tends to decrease when a large number of patients shift to private health care or/and when the NHS budget is increased to support improved health care. The waiting time for the treatment becomes short and due to this some of the patients who had previously shifted to private health care return to NHS. This once again increases the waiting list of the patients.
All the actions and movements of these variables are shown in the Causal Loop Diagram of NHS (figure 1)
Figure : Causal Loop Diagram for NHS
= Loop 1(Balancing Loop) = Loop 5(Reinforcing Loop)
S = Augmenting Relationship O = Inhibiting Relationship
The causal loop diagram suggests that a deeper set of forces is at work and the problem situation to be modelled is complex and dynamic. It is necessary to consider both hard variable (number of beds and hospitals) and soft variables (morale of staff). There are 6 loops in the system. There are 2 positive loops or reinforcing loops and 4 loops are negative or balancing loops.
In loop 1, increasing number of patients on waiting list increases the waiting time which leads to dissatisfaction and complaints against the NHS. This also switches some patients to private health care. Increasing pressure from public and media forces the government to increase the NHS budget. This tends to have positive effect on the system by increasing NHS capacity and reducing the waiting list.
Loop 1 is affected by loop 5 which is positive and reinforcing loop. Some patients decide to return to NHS from private health care as waiting list is decline. This increases the waiting list once again. Hence, there are no proper solutions to the problem or solution is difficult to achieve.
Many obvious solutions to the problem like increasing the NHS budget failed in the past. The causal loop diagram contains more negative loops than positive loops. Hence the system appears to be a negative system that tends to counter uncontrolled deviation and stabilise if the waiting list increases significantly.
NHS is the UK health care service run by the government funded through the taxes. This report shows environmental condition of NHS through PEST analysis and Strengths, weaknesses, opportunities and threats of NHS through the SWOT analysis. The causal loop diagram for NHS point out the main problem of NHS which is increasing waiting time for patients and a temporary increase in resources (NHS budget) gave short run solution for the problem.
Collaboration with private health service to decline waiting time.
NHS should maintain good relationship with private health service.
NHS should overcome its weakness through its strength and reduce its threats through appropriate use of its opportunities.
Increase its work force and equipment.
NHS should stop the contract based employee and there should be better coordination between doctors, nurses and other employees.
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