What are the challenges facing NHS Managers in contemporary society today?
The NHS is a national healthcare service which was created to ensure everyone within the UK had equal and fair access to a healthcare service regardless of their socioeconomic background (1). The NHS is a publicly funded entity which is derived from tax and national insurance
the above graph demonstrates how the NHS budget has increased over the years and is set to increase further this shows how the NHS is having a financial crisis which has been caused variety of burdens and challenges, without a solution the NHS is at risk of collapsing as funding from taxation can’t adequality fund the NHS without impacting the budget of other public services such as the education system (2). The remaining body of this essay will aim to discuss the current challenges faced by the NHS and how this has financially impacted the NHS
Challenges faced by the NHS:
• Ageing population- due to healthcare advancements the average life expectancy has been consistently rising with an average life expectancy of 79-83 years for babies born today (3, chapter 4) This has led to a greater financial strain being placed on the NHS as the number of health issues significantly increases past the age of 65 as illustrated by the below graph (3).
Due to the fact that those aged above 65 have a greater number of hospital admissions this means they are greater expense to the NHS as each admission will cost the NHS. The below graph illustrates the cost per person for the NHS based on age groups showing as age increases the cost towards the NHS also increases (3)
An ageing population is a major challenge for the NHS as life expectancy is constantly increasing an there is no ethical way to address the issue as everyone according to the NHS values is granted equal rights to the healthcare system therefore, we can’t exclude certain age groups in order to aid the financial crisis.
• Greater expectations- originally the aim of the NHS was to tackle disease however recent changes in the public perception of what makes adequate healthcare has resulted in a shift in the services offered by the NHS with more emphasis being placed on social care and mental health issues as well as other services such as antenatal and maternity services have meant that the priorities of the NHS have changed and developed over time. As the NHS now provides a greater number of services this has meant the NHS budget has also had to increase to be able to provide the resources necessary. As the public’s perception of what is adequate healthcare has changed so have the clinical priorities of the NHS with the NHS now focusing more on learning disabilities such as autism as well as continuing to work on areas such as mental health and diabetes which is detailed within the NHS five-year plan (5). For example, mental health services related to the NHS receive 13.8% of the health budget (6) this is linked to our greater expectations of the NHS as mental health has only recently become a clinical priority therefore showing how our changing views are having a financial impact on the NHS. The change in the services provided by the NHS can be seen as a challenge as the clinical priorities are constantly evolving which means greater expenditure for the NHS however the healthcare budget is no ablevvv. and accommodate the increased expenditures therefore adding to the financial crisis (2)
• Delivery of cost-effective care- it can be argued that the NHS is not able to provide cost effective care as this clash with the core value of the quality of care. The quality of care value states that patients must be the number 1 priority and that high quality of care is care that is ‘safe, effective and focused on patient experience’ (7). The NHS five year forward plan states the goal of gaining efficiency savings of £22 billion due to the ongoing financial constraints (4)(8). In some areas the NHS has succeeded in providing cost effective care whist still providing patient centric care for example the average length of stay for inpatients is on average 7.0 days (10) and the average bed stay falling from 10.5 days in 1974 to 4 days in 2014(8) this shows how the NHS is succeeding in providing cost effective care as decreasing length of stay will also reduce the cost per patient. However, there is also many shortcomings within the area of cost-effective care for example antibiotics are often overprescribed with up to 23.1% of antibiotic prescriptions being deemed inappropriate10), this is just one area in which the nhs is not encouraging cost effective care and with the population continuing to rise cost effective care is even more crucial in order to allow the NHS to continue.
• Productivity of the A&E- currently the nhs is under scrutiny for not being able to adequality meet targets set in the 5 year forward plan. one key area being looked into is how effective and productive the emergency care network is, the aim is to better integrate the different A&E departments and services that help to provide urgent care (12). One critical area which is used to evaluate the productivity of the A&E is the use of the four hour standard which looks into the average time a patient has to wait within the A&E till they are transferred over to another department, the NHS mandate states that at least 95% of patients should meet the 4 hour standard. one way in which the NHS is failing is within the A&E department as waiting times are constantly increasing and the 4 hour standard hasn’t been met since July 2015(13)
The above graph demonstrates the increases in A&E waiting times as fewer patients are able to be treated as admitted within 4 hours (14). There are a plethora of reasons that the A&E department is failing however the main issue regarding the A&E department is that the waiting times continue to increase despite the fact that the department budget is constantly increasing, this suggests that the money is not being used effectively and therefore one of the main reasons for the NHS failing financially. One reason why waiting times is increasing is partially due to more admissions and attendances and this is due to an increasing population as an increasing population brings an increasing amount of health issues(11) more pressure on the A&E could also be due to people attending unneccesarily and therefore wasting valuble time. Some patients may attend unneccesaarily due to the fact that it is difficult to make a GP appointment etc(11). Is has been found that 11% of patients are discharged from the A&E without requiring treatment and 39% are discharged having received only guidance(15) however it is important to note that not all these patients should be considered to have wasted the NHS/A&E time as although they weren’t admitted to beds they still required some form of assistance from a healthcare professional. One way to combat the increased attendance and admission of non emergency patients has been through the introduction of the 111. The 111 telephone system essentially aids and directs non emergency patients who don’t immediately need a hospital bed therefore helping to reduce the traffic of the A&E(16). Another area which needs to be addressed is the staffing issue which is not only a problem for the A&E but the whole NHS. The royal college of medicine found that the A&E department had the highest attrition rates of doctors in training compared to the rest of the NHS(17) main steps have been taken to address the lack of staff from increased university admissions(18) to creating new roles e.g. physician associates however the fact still remains that the A&E and the NHS is general have a high workload and there is a certain amount of the workload that individual staff can take without straining them physically and mentally and negatively impacting morale.
Conclusion- the current financial state of the NHS is a culminatiomn