Developing Patient Choice In Nhs Health And Social Care Essay

Developing Patient Choice In Nhs Health And Social Care Essay This essay investigates how patient choice in the NHS has been developed by New Labour and coalition government. I will do this by first defining the term choice and then providing some background information on the emergence of choice agenda under the 1979-1990 government of Margaret Thatcher. . I will then go on to discuss how patient choice has been developed under the New Labour and coalition governments that followed by discussing the reforms that both have implemented in relation to the patient choice agenda. Finally, I will examine the uptake of patient choice agenda. This is likely to include patient travel distances in order to access better and faster healthcare, as well as the performance ratings of hospitals, which are published online and so available to the public to use. However, people that live in certain areas in the UK tend to have a somewhat limited choice of medical care providers. Overall, choice empowers the general public, offering them the ability to make aut onomous decisions about their health-care providers and likely to improve the health outcomes of the British people. The patient choice agenda outlined above relates to offering patients a choice among various types of service providers in the NHS analogous to that of the private healthcare market . Central to it is the notion that without competition, there is no real choice, and therefore a choice among competing options is offered which is intended to improve quality and efficiency. This market discipline will motivate less competitive healthcare providers to upgrade their services to attract customers while giving customers a wider range of options (Le Grant, 2007). Thatcher Government (1970-1990) developed patient choice in order to create a dynamic market-orientated system in the NHS. She intended to introduce this form of internal market as a means of increasing efficiency and to develop the NHS into a more business-type model (Driver and Martell, 1998).Thatchers administration intended to achieve these changes though the adoption of a privatisation scheme focused on providers and purchasers . The idea of patient choice derived from the fact that GPs exercised choice on behalf of patients. Extending the choice agenda aims to eliminate or minimise the healthcare inequalities faced by less affluent patients, to whom it offers equal opportunities of services (Dixon and Le Grand, 2006). In 2005, MORI reported that 50 percent of the general public preferred to select healthcare providers outside of their local areas, which was something that the NHS had not provided for in its original manifestation (Popper, Wilson and Burgess, 2005). Thus, a large proportion of the general public clearly favours the idea of being able to select alterative healthcare providers. However, merely increasing patient choice may not successfully eliminate inequities (Oliver and Evans, 2005, p. 68). Certainly, offering choice to the general public is less likely to improve inequity if non-existent varieties exist within the uptake of choice. Wealthy patients have resources to opt for private healthcare providers if they believe that their local providers offer poor quality of services and low rating (Davies, Tavakoli, Malek, 2001). Therefore, the idea of equal access for meeting the equal needs of all people has failed. New Labour accepted the neoliberal model that had been developed by Thatchers administration during the 1980s and further developed by the Major government of the early-mid 1990s. In 1997, with New Labours ascent to power, patient choice was increased with some important reforms that promoted the patient choice agenda, including the establishment of Foundation Trusts (FTs) and the rating system (Driver and Martell, 1998). These reforms aimed to produce cheaper, better quality services by incentivising healthcare providers to compete for funding that equated to the number of patients they treated (Peck, 2003). Another reform introduced was Payment by Results, which pays secondary care providers using a standard fee tariff linked with the amount of patients treated. This reform enabled patient choice upon referral from GPs. Thus, this conception of the choice agenda served to improve waiting list times and the quality of services offered. Lastly, the government put in place a targets s ystem that measured the uptake of choice. The government also shifted the focus from competition while continuing to promote the business model by promoting partnerships between healthcare providers (Peck, 2003). In order to promote real choice, the market is obliged to offer alternative providers of goods and services (Smith, 2005). Private healthcare providers have operated within the internal market since 1948, providing their services at a standard tariff (Peck, 2003). The internal market that was operated under New Labour was less focused on competition, but rather towards promoting the efficiency and quality of services. Davies, Tavakoli, Malek (2001) argue that patients opt for private healthcare providers over public healthcare providers when they are able to because private providers offer good service quality. In general, patient choice tends to enhance competition among providers, who strive to attract customers in the way that any other private firms do. Private healthcare providers generally cover limited, mainly non-emergency services and as private businesses, are primarily focused on making profits. Therefore, private providers cost more than services offered by the NHS and hence this market attracts wealthier competitive patients (Le Grant, 2007). Middle class patients are likely to select private providers because material resources are not an issue.  [1]   In the 2010 White Paper, Equity and Excellence: Liberating the NHS, the coalition government set out to promote patient choice by introducing a commissioning board to the NHS. The Commissioning Board monitors the performance of primary care providers to ensure that high standards of service care are offered and that patients are involved in decision making as much as possible. The Commissioning Board is also responsible for improving equity within healthcare. Finally, the government seeks to promote patient choice though increasing competition among medical providers. Under the Foundation Trusts obtained the role as regulators that supervise tariff costs and encourages efficiency. Despite these developments, the fact remains that choice is not real possibly for patients living in certain areas of the UK (Spiers, 2008). People that live in rural area are likely to be excluded from selecting their healthcare providers. One of the reasons for this is that less affluent patients are less motivated to travel greater distances due to car ownership being lower among disadvantaged groups (Appleby and Dixon, 2004). Some people in low-paid employment are also unable to take time off from work to seek medical attention, preventing them from further exercising choice. Additionally, people travelling long distances tend to have poor attendance records for primary care appointments. A study conducted by RAND in 2008 also shows that age, gender and social class differences can serve as obstacles to people in exercising choice, while people over the age of 60, housewives and the working class tend to limit their travelling distances for providers (both primary and secondary c are (Powell, 2008). Hence, gender, social class and age are found to be important factors that determine the uptake of choice for healthcare providers. Affluent patients often have resources to purchase houses in areas near to good-quality healthcare providers. However, Popper, Wilson and Burgess (2005) argue young, affluent patients and those living in inner city areas of London are likely to opt for alternative healthcare providers, whereas disadvantaged patients with low levels of education are found to opt for alternative medical providers the least. Certainly the uptake of choice among less well-off patients would be more likely to improve if subsidised transport were offered to people and covering additional transport funding incurred by people who are not located close to alternative providers. Thus, an effort to improve these issues may encourage poor patients to travel longer distances to have their treatments.  [2]   Another factor is the lack of available information, which can prevent patients from exercising choice over medical providers (Fotaki, Roland, Boyd et al., 2008). It is believed that some people require additional support in their choice of healthcare providers. Often, less well-off patients, those with low levels of education and the elderly require supplementary assistance in order to be able to make effective choices (Powell, 2008). These types of groups are less likely to have access to the internet and friends working as medical professionals in the NHS to help them navigate the system. However, making use of internet sources have been criticised for being resource-intensive and a real problem for those who are not computer literature. Published data is a key element for choice and outlines the performance of various healthcare providers. Making use of this type of data can serve to make patients more autonomous and responsible for their own health (Davies, Tavakoli and Malek, 2001). In general, healthcare providers services are rated using ranking systems. With their reputations at stake, medical providers are motivated to improve the quality of their services in order to remain in business. Often, disadvantaged groups use performance data more than middle class people to make healthcare choice (Collins, Britten, and Ruusuvuori, 2007). A lack of available data though is a major factor preventing them from exercising their choices. The patient choice agenda aims to lead to inequality in the medical system. Appleby and Dixon (2004) claim patient choice agenda in healthcare is far more complex rather than just focusing solely on resources. Poor people tend to lack the self-confidence and knowledge to converse with healthcare providers in a medical vocabulary  [3]  . Oliver and Evans (2005) state patients poor abilities of expression create imperfect freedom of choice in decision-making amongst individuals. Hence, these issues lead to an unequal ability to navigate the system (Mandelstam, 2007, p. 109) Providing people with choice rather than voice to express tend to be more effective for less well-off patients (Barr and Fenton, 2008). The patient choice agenda offers disadvantaged groups the opportunity to be heard and promotes the necessary self-confidence to exercise choices, in parallel. Thus, choice empowers patients who are the least knowledgeable about how to use the system to their advantage. Middle class people, on the other hand, have the educational capacities, resources and skills to manipulate the system in a way that suites their interests (Spiers, 2008). Certainly, affluent patients are more proactive than less-well of patients in relation to the uptake of choice. Hence, privileged patients are more articulate, confident and persistent, which means that the system in its current form suites privileged patients over poor people. The impact of patient choice on health service delivery provides mixed views. Patient choice may improve the quality of services offered in the internal market in response to waiting list times, which it may also markedly reduce (Le Grant, 2007). GP fund-holders can improve waiting list times upon referral to hospitals and may also reduce prescription costs. An example that illustrates this capacity is found in a study conducted by the London Patient Choice Project during 2006 (Dixon and Le Grand, 2006). This study states that patients are inclined chooses for alternative providers in order to reduce waiting list times. Certainly, competition, along with large numbers of healthcare providers, may further reduce waiting list times. However, patients dissatisfied with services offered by medical providers can opt to search for alternative medical providers that meet their needs. Under the internal market, money dictates the choices that patients make, meaning that hospitals lose money if patients choose alternative medical providers (Dixon and Le Grand, 2006). Thus, healthcare providers must be responsive to consumer demands in order to remain in business, unless they are likely to face closure. Patients often empower medical experts to decide on their treatments because of the generally held view that the doctor knows best (Burge, Devlin, Appley, et al., 2004, p. 190) Often, patients shift choice into the hands of doctors, particularly in life-threatening situations. In such serious situations, medical staff are likely to decide on treatments on behalf of patients. Therefore, the choice agenda in this case is not taken into account. However, Popper, Wilson and Burgess (2005) suggest that seven out of ten patients prefer to relocate treatment choices to primary care providers. This example tells us that people like the idea of having an input in relation to deciding on medical providers. In reality, GPs are seen as the gatekeepers for making medical choices (Powell, 2008, p. 77). They act as agents for the patients, and are often empowered to select treatments on their behalf, thus undermining the ability of patients to exercise choice. This happens because of people tend to have limited skills and access to information that could otherwise inform them of the various treatment options available. As mentioned above, middle class people are often also better informed of premium treatments options, usually having better access to the internet and sources such as books and journals that inform them of the various treatments available. People with lower levels of education do not generally have access to journals and books which would allow them to make meaningful choices. The London Patient Choice Pilot study (in 2008) on the other hand, contradicts this view. This study claims that the up-take of choice among people with various levels of education has little significan ce, with only a two percent difference between people with various levels of education with regard to looking for hospitals that provide treatment (Spiers, 2008). In conclusion, middle class people benefit from the choice agenda to a far greater degree than the working class. Middle class groups have higher levels of income, which allow them to purchase houses near good-quality medical providers. In addition, the middle classes have access to information and money that enables them to travel further in order to have access to the best services. It must also be questioned as to whether patients want choice rather than just high overall quality, as most patients like the idea of a good local medical provider (both primary and secondary providers), rather than travelling longer distances to have their treatment.

A Lesson Before Dying by Ernest J. Gaines

In the beginning of the novel A Lesson Before Dying Jefferson's lawyer in an attempt to defend him calls him a pig. He indicates that Jefferson has no ability to think so he could not have done things with thought. He Is trying to help but had deprived Jefferson of his own self-worth as a man. The idea of what makes a man is central to the idea of the story. As Grant helps to teach and educate Jefferson he helps to establish a bond with the man. As Jefferson has the chance to talk with Grant and learn he becomes more aware that he is a man with ideas and thoughts and not an nimal.Grant helps Jefferson to Identify himself as a man by giving him a voices to be heard. Being a man Is about recognizing that one Is a man first. Grant In many ways had not fully recognized his own manhood. Grant explains to Jefferson that a hero Is above other men because he thinks of others before himself. Although he understands the definition, he does not live it. He wants to live for himself. He starts a bar fght in the Rainbow Room, believing he was doing it in defense of Jefferson. In fact, Grant was only thinking of himself never noticing how he hurt others.Not only id he tear up the bar, Vivian had to leave her Job early to come drag him out. Following Grant's criterion, Rev. Ambrose Is a hero, having put his entire congregation before himself. Jefferson also has the potential to do something for others that they could not do for themselves. He can make Miss Emma happy by eating her gumbo. He can chip away at the myth of white superiority and show everyone – both white and black – that he is a man. † â€Å"At the beginning of the novel, Grant is convinced that any dignity he has comes from his high level of education.This attitude prevents him rom getting through to Jefferson, who is of significantly lower social status than Grant. It also brings him Into conflict with Reverend Ambrose, who believes that dignity can only come from faith in God†at the Christmas pageant, Ambrose even implies that Grant is no better than Jefferson, because neither man has faith. By the end of the novel, both men learn from Jefferson that dignity is intrinsic and comes from loving and being loved, and does not come from external sources like religion or education. † 3. I can see the parallels between Jefferson and Jesus.Both were innocent men who were executed. In chapter 28, Jefferson seems to see that parallel himself when he says to Grant, â€Å"Your cross, Nannans cross, my own cross†¦. You'all axe a lot, Mr. Wiggins†¦ .Who ever card my cross? † It is Grant who has learned a lesson, though: â€Å"My eyes were closed before this moment, Jefferson. My eyes have been closed all my life. Yes, we all need you. Every last one of us. † As for scriptural connotations of the word â€Å"lesson,† all I can think of Is that Jesus was called â€Å"rabbi,† or teacher. HIS method of â€Å"teaching† was to tell stories, or what we might call today â€Å"object lessons. These stories are classified as parables. In a sense, A Lesson Before Dying is itself a parable. Indeed, in one of his parables, Jesus taught â€Å"don't cast your pearls before swine,† which is exactly how Grant felt at the beginning. Why teach someone so ungrateful of his help. He comes to learn, however, that redemption belongs to everyone. could not have done things with thought. He is trying to help but had deprived animal. Grant helps Jefferson to identify himself as a man by giving him a voices to be heard. Being a man is about recognizing that one is a man first. Grant in many ways had not fully recognized his own manhood.Grant explains to Jefferson that a hero is Following Grant's criterion, Rev. Ambrose is a hero, having put his entire congregation Grant. It also brings him into conflict with Reverend Ambrose, who believes that dignity can only come from faith in God–at the Christmas pageant, Ambros e even himself when he says to Grant, â€Å"Your cross, Nannan's cross, my own cross†¦ . You'all axe a lot, Mr. Wiggins†¦ .Who ever car'd my cross? † It is Grant who has learned a connotations of the word â€Å"lesson,† all I can think of is that Jesus was called â€Å"rabbi,† or teacher. His method of â€Å"teaching† was to tell stories, or what we might call today

Journey Representations through Texts and Visual Image Essay

From the area of study on journeys, several texts evidently provide and present ideas, concepts and themes on journeys. A journey can be considered a physical movement from one place to another, but there are much deeper meanings conveyed in a journey. This can be seen in two of the Peter Skrzynecki’s poems in the core text ‘Immigrant Chronicles’. The poems ‘Crossing the Red Sea’ and ‘Feliks Skzrynecki’ significantly convey the meaning of journeys. The poems with an internet article titled ‘Journeys: A Cycle of Sacred Time’ and a journey related photograph influentially demonstrate how there is more to a journey than just physical movement. All these texts convey to the responder the many themes and concepts associated with journeys which at first sight seem physical, but actually also emotionally and spiritually affect the protagonist of the journey. In Peter Skrzynecki’s ‘Crossing the Red Sea’ the poem tells us about the post-war immigrants leaving on board a ship sailing towards Australia. The poem catches the immigrant experience at a point between two worlds. The depiction of the great physical journey that these immigrants are taking also lets the responder see the inner journey involved for the immigrants. The techniques used in ‘Crossing the Red Sea’ help to convey its meaning of journeys to the responder. The biblical allusion in the title is appropriate to the Israelis being led out of repression in Egypt by Moses through the Red Sea, to the Promised Land. For the immigrants they are leaving war torn Europe to Australia, their land of promise. For the Israelis it was a journey of liberation from slavery and oppression. Similarly, the immigrants are escaping post-war tyranny in hope for a better future. Another bit of biblical allusion mentions some of the immigrants sensing they are born again, like Lazarus in the bible. Imagery also creates much of the meaning in this poem. The immigrants are described with ‘milk white flesh’ showing that they are sickly and seemingly unhealthy. Another piece of imagery is created through the colour red. Red is used in the poem to symbolise two extremes. ‘Of red poppies, once behind the forest when the full moon rose ’ – these lines are used to describe the beauty of the flowers and creates an attractive scenery. But the next bit of dialogue contrasts the beauty of red by using the colour to describe blood. The line ‘Blood leaves a similar dark  stain’ shows how red can be of beauty and good, but can also symbolise terrible tragedies, evil and death in the form of blood. The contrast shown in the colour in the poem is perhaps not only a piece of imagery, but a clear motif as it relates to the contrast of emotions of the immigrants. They are glad about new hope and beginning, but are sad and scared about leaving their home on this journey. Emotive language is used in the poem to trigger the responder’s emotions. Examples of emotive language include ‘shackles’, ‘sunken eyes’, ‘secrets’ and ‘exiles’. All these words are used to describe the pain or suffering experienced by the immigrants prior to their journey. The language used also creates the feeling that the immigrants are leaving their homeland in disgrace because of the immense hardships that they have experienced. Alliteration is used in the line ‘shirtless, in shorts’, emphasising the soft, quiet situation that the immigrants on board are in. The symbolism of the equator in the closing of the poem represents the boundary between their old home and their new beginning. The division of northern and southern hemisphere represents great change for the immigrants, both mentally and culturally, as their optimistic future and their new home are beckoning them. As the poem suggests there is more to a journey than the physical movement involved. The emotions of the immigrants are deeply explored and their inner journey is obvious to the responder. The journey here is not entirely optimistic and has deep emotional effects on the immigrants. Uncertainty is present and there are memories of the past as well as hope for the future. We learn how the previous experiences of the immigrants have affected their mental state. The main theme the poem is trying to convey about journeys is that a physical journey will tie in with the mental and spiritual side of the protagonist. This idea is similar to what we have discussed in class during this area of study. The protagonist of a journey will not only be affected physically but they may emotionally change, grow or learn new things. The poem ‘Feliks Skrzynecki’ also conveys journeys as more than just physical movement from one place to another. In this poem Peter Skrzynecki discusses the life of his father Feliks Skrzynecki and the struggles involved in his  journey migrating to Australia. The respect that Peter has for his father is evident in the poem but his perspective of the physical journey which they both took is different to his father. There are several poetic techniques used in the poem to convey meaning on journeys. Alliteration – ‘skilled in slaughtering’ describes his father who used to be a hard labourer and how his life was full of action. Many similes are also used to give us a clear description of Feliks Skrzynecki. He ‘loved his garden like an only child’ – this shows that he was a caring and devoted family man, to both his son and home. The lines ‘fingers with cracks like the sods he broke’ illustrates the extent of his old laborious life in Poland. Near the end of the poem the simile describing his father ‘like a dumb prophet’ expresses how his father knew that his son was moving further away from his heritage and there was nothing he could do about it. Descriptive language with words such as ‘gentle’ and ‘softness’ reveal the tenderness of Feliks Skrzynecki, while on the other hand, emotive words such as violently, slaughtering and darkened expresses his rough life in the past and toughness of this man, not just physically, but also mentally. The images of his rough and damaged hands and how they ‘dug cancer out of his foot’ reveals the hardships he had had to endure and also show us the trauma and severity of his past. The symbolism of the son pegging his tents further and further south of Hadrian’s Wall shows that Peter Skrzynecki is moving away from his father’s eastern European culture into Australian culture. As the different perspectives of father and son are given in this poem we can see the inner journeys which they have both gone through. Feliks Skzrynecki has, in migrating to Australia, missed his old lifestyle, heritage and culture, while his son has grown up in a totally different world to the one his father has known, and the absence of the same heritage and culture has made father and son somewhat detached from each other. A clear theme in this poem is that the result of a journey can benefit the protagonist but can also generate sadness and misery as the protagonist misses his or her home. This is evident for Feliks Skrzynecki and ‘Crossing the Red Sea’ also has a similar concept with the immigrants in two states of mind. Clearly the poem reinforces the idea that a physical journey can very much be an inner one. The internet article ‘Journeys: A Cycle of sacred time’ is very much a source which supports the ideas and concepts explored in the Skrzynecki poems. The article talks about how taking a trip, such as a holiday, is different to a journey. The article expresses that there is a great difference between just travelling and actually experiencing the journey. The article uses imagery to capture the responder’s attention. The article tells the responder to imagine you are at a holiday location and you are actually present with what you are experiencing rather than just keeping busy taking photos of sights. ‘Journey goes beyond the restraints of physical time and space. Journey feeds the soul.’ This statement from the article describes the mental and inner process of learning and growth involved in journeys, and that physically your destination is insignificant. The article mentions that physical travel is not a prerequisite for journeying, again stating tha t it is the inner process that matters not the physical destination. Another theme expressed about journeys in the article is that a true journey cannot happen in isolation. Connecting with others is the way for experiencing your journey. This idea is somewhat in contrast to the concept of personal journeys we have studied. The importance of self-growth and learning about yourself is required in personal journeys, but this article is saying that to grow and learn, you need to communicate and correspond with other people. The article uses techniques such as imagery to stimulate the responder’s thoughts, large and bold writing for significant or important text and uses several quotes to support the themes it is trying to convey. The final source relating to journeys and conveying significant themes is a photograph showing a number of travelers in the middle of their journey on top of a large mountain. The number of large mountains in the background and the scenery suggests that the location is somewhere foreign and faraway from the protagonists’ home. The protagonists in shadowy figures suggest some sense of mystery on this journey. This sense of mystery expresses inner journeying as well as the physical travel shown in the photo. The different contrast in colors of the foreground, middle of the image, and background show there are several parts or sections to a journey. The image of these protagonists journeying across a great landscape is comparable with the poem  Ã¢â‚¬ËœCrossing the Red Sea’ in the allusion the poem creates of journeys. The long shot taken of the protagonist also show that their journey is long and difficult and the sense of difficult journeys is similar to all three other sources. The theme of the physical journey providing an inner or imaginative experience is also evident in the photo, through the landscape and scenery, which seems surreal and dreamlike. Overall the sources discussed all hold important and valuable ideas and concepts on journeys, and they show us that journey is not just physical travel but also an emotional and inner experience.

Governments Immense Control Over the American Population...

When a politician speaks does it cross the minds of others to truly believe and trust that they know what they are talking about? What is politics? Politics is the art or science of government, especially the governing of a political entity, such as a nation, and the administration and control of its internal and external affairs (Politics Definition). The government regulates or censors everything from what we watch on TV to what the future of America (i.e. children) learns at school. Is this type of control necessarily a good thing? Politics and politicians alike should not have as much power in the control of the lives of people. Most laws have been passed for the personal gain of those it is implied to help. Laws are being passed†¦show more content†¦Congress passed the Alien and Sedition Acts in 1798 prohibiting false, scandalous and malicious writing against the government which was repudiated by the Republicans in power in 1802. For the next twenty-five years, the only punishment was practiced by private citizens who attacked alleged libelers. Although censorship in some cases is a necessary thing, for example, children’s programming, kids do not need to be exposed to that sort of information. Adults need that information because, they’re the ones who are voting and taking a control of the nation. At the high school level the students need to learn and be told what is going on. The only high school students that have any inkling of what is going on would be the seniors in government. What about the freshman, sophomores, and juniors who have an interest in the government. Those students are the future politicians of our nation and will be having a say in how it is ran. It maybe, because the government is afraid that the young people will develop the wrong ideas, that the Government has no flaws. In reality they are correct in there thinking of this but, us as kids still want to know what is happening. Not everything needs to be told to us but we at least want a summary of what is going on. The American people should be able to have a voice in any pending Bills being passed. Such as the Health Care Reform Bill, that President Obama is working on currently at the moment. Many doctors are for the bill and theShow MoreRelatedThe First Strange Place : Race And Sex778 Words   |  4 Pagesseveral different ways. Over twelve million Americans will serve in the military, women will work in positions previously held by men in defense factories, along with blacks and whites working side-by-side in the military and war jobs, and the mass movements of the population throughout the country to find high paying defense job. Beth Bailey and David Farber’s book, The First Strange Place: Race and Sex in World War II Hawaii discusses the â€Å"cultural contact† between Americans. 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