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This essay will evaluate recent developments within Health and Social care policy. It will focus on the development of charges within the NHS, the ideology behind it and its impact on women, different ethnicities and those living in poverty. It will then go on to analyse the differences in formation and adaption of this policy from devolved governments in Wales and Scotland. Before the start of the ‘welfare state’ in 1948, the majority of Health and Social care services were subsidised by benevolent donations to voluntary hospitals, or through service users paying for their own care.
This is due to the ideology of the time being that of the government not being responsible for the nation and that people were to stand on their own two feet and support themselves. However, following the massive devastation to the country, both physically and mentally, following WWII, the government’s ideology changed. The labour government in power at the time felt that the nation’s welfare was their responsibility and so the ‘welfare state’ was born.
Everyone was entitled to free NHS health care and there was no criteria or eligibility attached. In 1952 the first charges had been introduced in an effort to fund the rapid growth of costs incurred by the NHS, people now had to pay for prescriptions, dentures and spectacles. This move was due to the government’s ideology slowly changing to one of paying for yourself if you can afford to do so, and eligibility and criteria was attached to certain services. If you did not meet the requirements you had to pay.
During the 1980s, under the Conservative governance of Margaret Thatcher, the ideology had gone full circle and was back to that of non-dependence of the ‘Welfare State’ and the responsibility of the nation lay with the individual, not the government. It was a time of taking away universalism with a residual attitude. As a result of this shift in attitude present charges were increased and new charges were introduced as a means to reduce public spending (Thornes, 2000:97). Eligibility, criteria and targeting meant that only those most vulnerable were able to access Health and Social care services for free.
In 2013 the present ideology is similar to that of 1952. The Conservative, Liberal Democrat coalition government maintain the ideology of taking away universalism and standing on your own two feet. They feel that in having charges for NHS services the stigma attached to welfare will be reduced and individuals will feel that they deserve the service they are accessing (Thorne, 2000:97). The government also feel that it will prevent the abuse of free services by discouraging people from using Health and social care services which they are not in need of.
This is evident with the proposal for those that visit A&E to be charged ? 10 as a means to prevent unnecessary use of the service. A&E specialist believe that 30% – 40% of visits are unnecessary and that in having a ? 10 charge upon arrival, which is fully refunded should the condition warrant A&E attention, will significantly reduce the amount of people taking up vital resources (Campbel, 2014). This charge is set to reduce unnecessary visits and waiting times to those who are in actual need of emergency care, however experts feel that they will ‘penalise poorer patients’.
Dr Helen Stokes-Lampard, a spokeswoman for the Royal College of GPs has said that “Charging patients for the use of emergency departments would put us on the slippery slope towards the Americanisation of healthcare, where only those who can afford to get it get the care and attention they need,” (Campbel, 2014). Dr Mark Porter, chairman of the BMA, said: “The majority of GPs and hospital doctors are committed to an NHS that delivers care on the basis of need and not the ability to pay.
In this survey, two thirds of GPs state they are against [charges] for using A&E services … it runs the risk of deterring vulnerable patients who genuinely need help from seeking treatment at a time when many people, from all backgrounds, are struggling financially. “(Campbel, 2014). This shows that the government is not promoting equality and that services will only be available to those that can afford them. Another charge which is proving to be detrimental is that of the 2011 charge for care during pregnancy and childbirth to migrant women.
This policy has had a negative impact on both those giving and receiving care. Migrant women are not attending appointments or are running away from hospitals as a result of being unable to pay thousands of pounds for treatment, this puts both mother and baby at risk of complications which are not detected in early pregnancy, which is evident in a newspaper article from December 2013 highlighting the negative impact of the policy in which midwives are warning us that the fees are endangering migrant women (Taylor, 2013).
Susan Bewley, a professor of complex obstetrics at Kings College London agrees that charging migrant women for NHS antenatal care is putting pregnant women in danger (Taylor, 2013). The policy is written in very complicated language which means that eligibility and criteria is very hard for migrant women and professionals to understand and is resulting in some pregnant women being declined treatment and care due to misinterpretation. This goes against the core values of midwifery. In an article in the Nursing Times, David Foster wrote about the 6 Cs of Health and Social care and how they are essential for the NHS to deliver fair, consistent care to those who require it ( Foster, 2012:12).
In declining care to migrant women, midwives are not only ignoring the core values of midwifery, they are putting lives at risk and failing to fulfil basic Human rights and are not promoting equality. In March 2011 the department of health published the NHS constitution, which sets out the core principles of the NHS. One principle which is in contradiction to the charges placed on pregnant women is that “We have a responsibility to maximise the benefits we obtain from NHS resources, ensuring they are distributed fairly to those most in need.
Nobody should be discriminated or disadvantaged and everyone should be treated with equal respect and importance” (NHS choices, 2013). Care, compassion, courage, communication, commitment and competency are values which should be predominant within midwifery, however in adhering to the 2011 policy midwives are failing to maintain the 6Cs. Communication is a big issue as the policy is open to misinterpretation and so compassion and care are also lacking within the sector as midwives are refusing care to women (Taylor, 2013).
The commitment to provide the best possible care to all pregnant women is being compromised as some midwives have been quoted as feeling like ‘Immigration officers’ and so their roles are under question (Taylor, 2013). In another article in the Nursing Times by Maria Flynn, she explains that organisational culture, policy and politics can exert a damaging influence on caring values (Flynn, 2013:12) which supports the negative impact the charges are having within the midwifery profession.
After the Francis report was published, following the incidents within the Mid Staffordshire hospital, it was found that nurses and midwives felt frustrated at not being able to fulfil their role correctly as a result of the restrictions put in place by policies and that the compassion deficit is more likely to be down to political ideology driving health policies then shortcomings in caring values .
After extensive research I have been unable to find any positive impacts on both service users and providers with regard to the implementation of charges within the NHS. According to an article from the BBC news Scotland the department of health claim that charges were introduced to ‘plug gaps in funding’ and that the fees raised around ? 450 million a year, which is the salaries of 18,000 nurses or 3,500 hospital consultants (BBC news Scotland, 2011). However it is apparent that the fees are not being spent on employing more staff as Laura Donnelly, health correspondent for the Telegraph reports.
There is currently a shortage of 20,000 nurses within the NHS and an investigation into 14 hospitals with unusually high death rates highlights the common factor as inadequate staffing levels (Donnelly, 2014). On 1 April 2011 prescription charges were abolished in Scotland. BBC news Scotland reports that “The Scottish Greens said it believed there should be equal access to the NHS and that meant free access to everyone at the point of use, including free prescription. ” (BBC news Scotland, 2011).
Daniel Martin, of the Mail online, described it as “the latest example of ‘medical apartheid’, where the devolved nations enjoy better health services despite paying far less tax per head” (martin, 2011). The ideology of the devolved Scottish government is one of universalism and in helping the majority of the population of Scotland who are living in deprived conditions. The English government still fund Scotland using the Barnett formula: (Martin, 2011). Policies are developed in Scotland by the Scottish parliament, which is made up of 129 public servants who are politically impartial, and the Scottish government.
The Scottish parliament debate matters of importance (which are devolved), such as health care, then vote on legislation holding the Scottish government to account. The Scottish government decide how the country is run and implement laws passed by parliament. This is very different to the English way of developing policies as that involves all parties agreeing to what is proposed and is a fair way of ensuring the policy is fit for purpose.
With the abolishment of prescription charges the Scottish parliament looked at the savings it would make to families living in poverty and the health benefits to those who could not afford to pay for drugs (Explanatory notes, 2005). However it did not recognise the cost it would have on the health of people suffering with cancer. Due to drug companies charging large amounts for certain cancer drugs, as a result of eradicating prescription charges, the SNHS cannot afford to purchase these drugs and so cancer sufferers are having to either go without or move to England, where the drugs are available.
Maureen fleming, 63, faces the dilemma of raising the ? 10,000 needed for a 3 month supply of the cancer drug she needs or to move to England. Scottish labour leader Johan Lamont said the Scottish NHS’s ? 7. 2 million bill for paracetamol prescriptions would pay for 200 patients to get cetuximab for a year. She said: “In the First Minister’s Scotland, if you have a headache your prescription is free. If you have cancer, your prescription can cost ? 3000 a month. ” (Gardham, 2013).
In conclusion it is evident when looking at fees in the English and Scottish NHS that there are positives and negatives to both countries. England may have a lot of criteria and eligibility in order for prescriptions to be free to those who need it, however in having fees in place the NHS in England is able to purchase expensive drugs which are not available to people living in Scotland where prescriptions are free to all. It is apparent that there should be some compromise between both policies in order for those in genuine need to access the care they require.
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