The Role of the Patient as End User of the NHS Essay

The Role of the Patient as End User of the NHS

            The British government, by taking on the challenges and conventions of brokering a national healthcare system, has committed itself to the elevation of a program that is equal and of a necessarily high-standard.  However, the impingement of ingrained social preconditions such as the persistence of regionally based poverty, ethnic isolation or a dearth of opportunities within a geographical setting has had the effect of retaining a high degree of inequality and quality shortfall in locations throughout our national healthcare system.  The research here identifies a primary need for the National Health Service to more effectively invoke public involvement by identifying the patient as the end-user and working to effectively serve the interests and needs made thereby more directly apparent.

            The socialized state of healthcare here dictates that the onus falls upon the British government to ensure that all facilities and practitioners are abiding a shared standard of quality.  Thus, one of the key challenges to the British government’s implementation of its healthcare strategy is the demand placed upon it to work to establish a streamlined standard for the monitoring of quality and the improvement of adherence to such a standard across a variety of healthcare settings.  The recommendations which will be observed here will consider the role played by the identified health system user in determining the best course of improvement in staffing, resource and facility.  These latter three categories of consideration also refer to stakeholders which may be addressed as health system users in some context as well.  Collectively, these stakeholders are beholden to the administrative imposition of the British government and the National Health Service, which shapes policy, approach and financial allotment.  Therefore, the oversight and will of the NHS in addressing the needs of the patient are tantamount to the prospects of a positive transitional improvement of health system standards.  Thus, an identification of the core challenges facing the British healthcare policy will suggest that such issues as socioeconomic inequality, poor facility oversight and an over-corporatization of a socialized program have diminished the value placed upon the insight of the system user.  This has, in turn, diminished the overall quality of the healthcare standards in Britain.

            This is a problem which is philosophically inconsistent with the mission of the NHS, which proceeds from the view of healthcare as being an entitlement to all Britons.  With regard to the notion of healthcare as a fundamental right “irrespective of income,” “the United Kingdom has considered it a part of the welfare state.”  And yet, it cannot be asserted that the British healthcare model “has fully accomplished the goal of meeting quality, equitable access and cost effectiveness.” (Yates, 1)(Adenarin, 109)  One of the major consequences of its systematic failure to achieve a shared standard of quality healthcare to all is the National Health Service’s incapacity to transcend entrenched social patterns of living standard inequality.  Public facilities accessible to the impoverished are routinely marked by lower standards, fewer resources and a smaller pool of qualified professionals than those availed to the middle class and affluent, rendering British healthcare directly reflective of many of the iniquities which its creation has been intended to combat.  The social conditions in Britain have had the impact of imposing obstacles upon the effective delivery of its promises for the National Heath Service.  Indeed, according to the Commission For Health Improvements “risk factors for serious service failure occur at three levels: operational or clinical specialty level, strategic or trust wide level and national/health community level.” (CHI, 2)  In all of these context, the greatest risk is imposed upon the patient, and more specifically, upon those who are in groups generally excluded from the health benefits availed to the affluent or optimally located.  In spite of their shared origin in a nationally brokered system, a great many regions, and specifically those of rural, minority or socio-economically disinclined populations have tended to possess a far lower level of access to practicing physicians.

            One of the results of this incapacity to retain suitable treatment accessibility standards is a general shortcoming of resources at the disposal of the NHS for the proper accommodation of its public.  With inequality persisting across the British system, many hospitals are simply unable to accommodate patients at all, quality of the care almost totally aside.  Indeed, the duration which one must often wait in order to receive needed treatment “in the British and NHS is so bad that an EU ruling is now forcing it to send seriously ill people abroad for surgery.” (Gorman, 1)  This suggests a clear disconnect between the needs of the system user and the availability of either resources of the political will to accommodate all.

            It under this consideration that the public health system in Britain has begun to undergo some modest but positive change.  There is indeed a concerted and declared interest on the part of the Department of Health and the National Health Service to begin to move Britain toward a system in which patient needs are elevated to the primary consideration, instead of being perceived as factorial variables in the financial and administrative decision-making process.  Today, numerous efforts have begun to see the light of day which are predisposed to addressing the needs of the system and user and incorporating this input into actionable decisions regarding resource distribution and policy improvement.  To this end, “the Local Government and Public Involvement in Health Act, introduced in Parliament in December 2006, introduced a number of measures relating to local government and the involvement of local communities.” (DH, 1)  The notion of bringing local communities into a process that ultimately creates a discourse with national policy-makers would be an essential first step in improving the recognition of the use which is necessary to begin to offer him improvements.

            At present, one of the core issues facing administrators is that of diversity, which poses a special challenge in attempting to understand the needs of the user.  Certainly, it is reasonable to argue that the user of the health system is represented by a broad array of different populations.  This is why it is important for the NHS to be acquainted not just with the idea of a multitude of groups in its public, but with some level of understanding as to how different ethnic groups endure different health scenarios in the national context.. The relationship between ethnicity and health is clear and problematic. The United States should provide us with a cautionary example of the dangers in the commercialization of health agencies.  There, socioeconomic disparity has precipitated a sobering reality that life expectancy, infant mortality and ailment survival rate are all health indexes where white Americans fare considerably better than such ‘minorities’ as African Americans. According to the Centers for Disease Control, as of 2004, a white male has an average life expectancy at birth of 75.7, where the average black male will have the average life expectancy of 69.8 years. Likewise for women, white females can anticipate an expectancy of 80.8 years, where black females are expected only to life an average of 76.5 years. (CDC, 1) These are the types of inequalities which suggest that the non-socialized health system is inherently poorly equipped to contend with the challenges implied by diversity.
Indeed, there is a relationship between diversity and poverty which is often disregarded, but which in the above-noted context bears a direct correlation to such crucial matters as whether an individual has access to a primary care physician or is in possession of health coverage.  In the U.K., there is an increasing danger that the failure to acknowledge end-user needs will ultimately render a system which is categorically based on economic imperatives.  Of course, as demonstrated above, this would be a distinctly negative outcome and would be counterintuitive to the needs suggested by the discussion here on the patient’s role.    And this is felt in a trend which has increasingly threatened to subvert the sustainability, and even the relevance, of the public healthcare service.  In its place, those users who are willing to pay out for health insurance coverage are availed distinctly better treatment than are those subjected to the accepted vagaries of a shorthanded public program.  Among the inescapable advantages of paying out of one’s own pocket for insurance coverage is the precious accessibility of surgical attention, a commodity of some scarcity for many beholden to the accessibility provided by the NHS.  Indeed, it is a notable imbalance that, for example, “although only 11% of the population is insured, over 30% of hip replacement operations are paid for privately.” (Yates, 1)

            This is a challenge which has serious implications to the general reliability of the nation’s public health policies to suitably maintain a level of shared health quality. Prominent cases from the 1990s illustrate that, indeed, there is a distinct failure on the part of many facilities within the British Healthcare system to provide either the basis or the action for the adoption of necessary improvements.  Close consideration of cases where public health has been failed by public institutions indicates that facilities such as these, which experienced a detectable crisis of care quality, “had poor and ineffective systems for quality improvement which made little contribution either to detecting the quality problems or to dealing with them.” (Walshe, 251)  This issue of the detection of quality problems is core to our discussion, as it reveals the single most important contribution to be made by the patient.  As the healthcare system’s primary interest, the user will at this level understand intimately the implications of care procedures, resources and policies.  Taken objectively, the anecdotal and pathological review of individual patient experiences will yield necessary insight into the outcomes which have been precipitated by a reigning inequality of access.

            This requires a close relationship between the patient and the healthcare worker. Physicians, nursing professionals and other practitioners or specialists will be the key link between the perspective of the patient and the health system itself.  This shows, as noted earlier in this account, that additional system users such as the healthcare professional will be central to evoking the contributions of the primary user.         The healthcare worker and the patient will play a key role in collaborating on the future improvement of the NHS, which must use such personnel in order to better understand the features of the health system which are causing this failure in public effectiveness.  The involvement of both parties is crucial as their contribution will be a recognition of the street-level realities facing the public.  With regard to the accessibility, equality and quality of available public health, the two parties are instrumental in orienting policy-makers toward decisions based upon real experiences rather than remote economic approaches.  “For those working in the NHS having the skills to involve patients and the public is becoming increasingly important.  Trust executives and some of those working in health authorities have had some experience of facing public meetings or holding other consultations but many people working in the NHS have no real experience of involving patients or the public in healthcare, over and above their day-to-day interaction with patients.” (Chambers et al, p. 6)  This means that there is a real and concrete need, as will be addressed in the recommendations section, for personnel training descendent from an end-user orientation across the entire heath service system.

            An additional conflict to meeting patient needs is a willful failure to acknowledge their expressed or observable interests.  Relating again to the subjects of inequality that negatively impact the attendance of general patient needs is the problem of the healthcare system’s apparent priorities.  An effect of the unachieved standards for a consistency in the quality and nature of care is that many practitioners and facilities are actually withholding of some treatments at their disposal for purposes of economy.  Cancer vulnerability is one point of interest, where the healthcare system’s “bureaucrats won’t pay for chemotherapy drugs routinely used,” in countries with more privatized systems. (Gorman, 1)  As a result, Britain suffers from relatively high right of fatalities for such treatable conditions as breast cancer, which its patients record only a 67% five-year survival rate.  (Gorman, 1)  This means that in spite of the clear recognition in certain instances of that which constitutes the most beneficial approach from the perspective of the patient, financial considerations may yet win out.

            At present, the National Healthcare Services is both in acknowledgement of its failures thus far, and is in the implementation phase of a long-term resolution to the imbalance.  The multitude of approaches which it has proposed appear to correctly acknowledge the root causes of the shortcomings in this system.  Namely, those social conditions which are at the root of the inherent inequality in a system which is designed in a spirit directly contrary to this reality have been identified in key findings by the NHS itself.  In order to rectify this inequality, the NHS and the CHI, referenced earlier in this account, are intended toward a development of standards which are produced on patient-yielded findings.

            By announcing its targeting in 2000 of the inequalities fundamentally responsible for the imbalance in healthcare distribution by engaging more directly local public agencies and community organizations, the NHS partnered itself at the federal level with various other government agencies to attack poverty and social inequality as a whole.  This would help to attend to the resource shortcomings which have caused a de-emphasis on patient interests.  As noted above, one of the key instigators to the imbalance of care quality is the incentive apparent to practitioners in providing care to those best suited financially to afford it with expedience and the highest of quality.  Such is demonstrated by the distribution of medical practitioners in far greater numbers and levels of available in affluent areas, where those distinguished by ethnic minority groups or lower socio-economic strata enjoy roughly 50% less access to a physician than their well-off counterparts. (NHS, 1)

            Moreover, there is evidence to suggest that the need for greater oversight of healthcare activities at the individual facility level is directly correlated to addressing the low end of this imbalance.  In medical facilities where inequality or financial prioritization have diminished the quality of care, the absence of an acknowledgement either of patient interests or government oversight would allow disaster. Such is eminently proved by such historic tragedies as the case denoted by the Bristol Inquiry.  Here, the Bristol Royal Medical facility was deemed responsible for the deaths of potentially up to 100 babies, who were subjected to unnecessary and complex heart surgery.  The failure of the government to intervene would illustrate a horrific disconnect between operational interests and public health interests, implicating the government for its apparent detachment from the end-user. (Gilespie, 19)  This landmark tragedy would come to inform many of the publicly willed improvements in British healthcare and the patient orientation of the NHS.  Thus, many of the recommendations here proceed from a recognition of a great many needs for systemic improvement of the healthcare service.

            Thus, as a key element of its plan for improvement of its achievement of equality and accessibility goals, the NHS has emphasized the greater presence of medical practitioners in those regions and communities demonstrating the greatest need for such attention.  Such a strategy would, however, need to be combined with the implementation of plans affecting a wider rang of social impasses, most notably the pattern of a negative health disposition inherently demonstrated in those individuals subsisting from birth in poverty.  For those who have been born into poverty in Britain, life-expectancy is immediately 9 years briefer than that availed to the affluent child, who has access to screening, medication, efficient doctors and expedience procedural attention throughout his medical lifespan.  (NHS, 1)

            The primary goal of Britain’s National Healthcare System is to ensure that a fundamental entitlement such as medical treatment is available to all, regardless of ethnic or socioeconomic disposition.  And yet, it faces the inevitable roadblocks to this balance that are produced by inherent inequities throughout British society.  This is the essential challenge set before the British government, which must overcome in simultaneity the shortcomings in the quality of its care and the imbalances in its society which have made such shortcomings more apparent in some settings than in others.

            The new demands placed upon healthcare contexts by these standards will demand a socially responsible form of entrepreneurship which effectively combines the interests of the medical institution and the interest of the patient.  To this extent, a medical facility may uniquely benefit from the development of a business which consciously and structurally acknowledges its role in society by transcending that to which it is legally instructed in order to provide the greatest extent and value of services which can be achieved according to the needs of both the business and society.  (Cooymans and Hintzen 2000). This involves a careful balancing of business and social interests which are, of course, largely intertwined within care organisations. The socioeconomic environment, as we have recurrently noted here, may likely be quite varied and will place huge pressure on administrators to abide more nationalized and more strictly enforced standards.  However based on definably social values, this should be deduced as a positive pressure currently placed upon government officials and facility administrators.

            Additionally, it is here recommended that the National Health Service impose greater scrutiny on the activities and practices of British healthcare facilities in all contexts, regardless of ethnic, socioeconomic or geographical distinctions.  This must inherently be combined with a thorough public allotment through the NHS of the proper resources with which to do so.  The issue of accountability is paramount in a discussion of system-wide improvements and must itself be based on the data input by the end user.  The accountability associated with quality of care policy and the various social partners impacted by this transition are together implicated in a process aimed at improving not only effectiveness and quality of care but also use of publicly availed resource.

            In resolution to the discussion here, we consider a 2000 report released by the NHS which addressed the need to properly incorporate all relevant social indicators relating to the system end-user, such as income, education and access to public resources in its drive to improve oversight and qualities of its medical outlets.  This appears to be a sensible strategy, acknowledging that at the roots of even the most socially conscientious healthcare system reign some of our culture’s lasting prejudicial proclivities.  Our medical community must be at the front lines of banishing such proclivities to the annals of history while simultaneously returning the interest of medicine from finance to patient care.

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