Choosing Health: making healthier choices easier The essay will start by looking at the brief history, before and after the creation of NHS in 1948. A white paper “Choosing Health: making healthier choices easier” (DOH 2004) in its entirety will be used to critically analyse health policies that have direct relevance upon current practices. National Service Framework (NSF) which provides national standards to reduce variations in care (Dimond, 2008) will be used to measure the standard and expected targets sets by the white paper.
The report will also look at the appliance of the principles of integrated governance which is used by NHS to measure the quality of services and high standards of health care provision. The report will conclusively analyze the white paper in relation to the changing emphasis in risk management, from a person-centred to a system-approach. Prior to the formation of NHS in 1948, healthcare was regarded as a luxury that could be afforded by few people.
Although charges were introduced at some point, but did little to rescue the growing health needs (Rees 2001) The unmet Public health demands have always been the main concern of the ruling governments, which was the drive behind the formation of NHS in 1948. The NHS was born out of desire to establish a free health care that would be available to all at the point of delivery and funded purely by taxpayers (Digby 1999) This concept has been widely commended, however, the NHS has become a victim of its own success due to the huge healthcare demands that regularly outweighs the available resources.
The statement from Aneurin Bevan “We shall never have all we need” (Bevan, 1958 cited in Tippett, 2004, p. 111) signifies that expectations would always exceed capacity and for this reason, NHS will continue to introduce guidelines, new commissions and guidance to meet the 21st century demands. Outcome 1 A health policy offers a framework to evaluate performance, and help to bring together professionals and other sectors around health problems and to legitimize actions, especially when it is part of a sensible planning to hange (WHO 1989). The white paper “Choosing Health: making healthier choices easier” (DOH 2004) provides a unique opportunity for building awareness around health issues and allows citizens to voice their opinion. One of the main underpinning principles identified by the white paper is reducing obesity, improving diet nutrition and well being of people with mental health problems. One of the policies recommended to address the issue of nutrition includes the five a day program and the school fruit and vegetable scheme (DoH, 2004a).
The aim is to raise the public’s awareness of healthy eating through the adequate consumption of fruits and vegetables. In 2006, front of pack signpost food labelling was also proposed by the Food Standards Agency (FSA), to encourage and increase good dietary intake through the provision of clear, easy to read and understand information concerning the nutritional content of food. Another recommendation by FSA is the traffic light system used to denote low medium and high levels of fat, saturated fat, sugars and salt in food (FSA, 2007).
The direct impact upon practice from the white paper is the birth of ‘Pathways to Work’ programme, which provides support for people with mental health problems to return to work. This is a strategy to identify and remove barriers that may prevent people with mental health problems returning to work. The action will challenge the stigma often associated with mental health problems. The ‘Pathways to Work’ pilots, include the Condition Management Programmes (CMP) which is regarded a hugely successful partnership between the NHS, Jobcentre Plus and the private and voluntary sectors.
The programmes are commissioned by Primary Care Trusts (PCTs) designed and delivered to meet the identified needs of the individual and the district. The results to date show considerable reduction in the number of people relying on income benefits and has led to increased physical activities among the populations (NHS 2009) Outcome 2 Another key strategy adopted by NHS is the introduction of National Service Framework (NFS), which is designed to provide national standard and to reduce variations in the process of providing health care to the population (Dimond 2008).
That is, to improve the quality of health services and ensure that everyone gets the same level of care. A unique example is the Improving Mental Health and Well Being in England published in autumn 2005, which is regarded as a National Service Framework for Mental Health (NIMHE 2005). The document was produced to implement and reinforce the commitment made in the white paper Choosing Health: making healthier choices easier. “We will ensure that standard one of the NSF for Mental Health, which deals with mental health promotion, is fully implemented (DOH 2005, Section 39).
The document identifies key mechanisms for the delivery of mental health promotion and how success might be measured. For example, to raise public awareness not only on how to look after their mental health but other people as well. It also illustrate on how to involve all communities, organizations, and sectors, in taking positive steps to promote and protect mental well-being. It is argued in the documents that, little improvements achieved in mental wellbeing will definitely attain significant cost benefits through the improvements of people’s physical health, productivity and quality of life (NIMHE 2005).
This idea is supported by Wanless (2004) who calculated that the cost benefit of improved mental health care would be a net saving to the government as a whole of some ? 3. 1 billion a year. One of the public health major issues is how to tackle the unemployment and worthlessness among its people (Singleton 2006). As a solution, the document advocates The Pathways to work pilots which provide a model that includes personal support for the people off work, partnership with primary care and employers who in return are expected to support return to work.
This in essence will specifically address mental health related unemployment and the mental health impact of being unemployed or on incapacity benefit (Hughes 2002). Outcome 3 The words “Clinical Governance” is used mostly to describe a systematic approach designed to maintain and improve the quality of care to patients (Nicholls 2000). However, when integrated it is defined as ‘Systems, processes and behaviours by which trusts lead, direct and control their functions in order to achieve organisational objectives, safety and quality of service and in which they relate to patients and carers, the wider ommunity and partner organisations’. (DoH 2006, p. 10). The definition addresses the systemic approach at the primary levels when delivering quality health care. In other words, Clinical Governance applies to all health Authorities, Primary Care Groups, Primary Care Trusts and to all NHS Trusts but the concerning issue is the manner and structure the components are structured, monitored and how they are linked to the standard laid down by the Commission for Health improvement in United Kingdom and how they are integrated with the performance of the management procedures of each PCTs (Pridmore and Gammon 2007).
Arguably, failure to adopt a simple and comparable method of applying authority may generate misunderstanding for health professionals, which may lead to lack of engagement and disappointment. However, by placing patients at the centre of healthcare, from planning through to delivery, is the key to the modernisation agenda and pivotal to the development of clinical governance (Lugon and Secker- Walker 2006) This mean, the Primary Care Trusts (PCTs) are responsible to ensure that all services provided are safe and of excellent quality. It also signifies that PCTs are expected to work with patients, carers and other health professionals.
These methods will inevitably support the improvement of services and reduction of risks to both patients and staff. Although, CG does not set a clear framework for actions but its key principles are a logical approach to quality improvement, clear lines of accountability for clinical quality systems and effective processes for identifying and managing risk and poor performance. (NAO 2007). For example the white paper ‘Choosing Health’ which is seen as a government strategy to help people make healthy choices and avoid health inequalities nationwide, clinical governance is regarded as the major linchpin that will enable the strategy to work. Outcome 4 In clinical practice, risk management is defined as assessment, analysis and management of risks to recognise events that may lead to harm in the future and to minimise the chances of future reoccurrence (NPSA 2007). (Steele 2002). In a wider context, NHS (2008) refers to risk management as a broad subject that covers both clinical and non-clinical services, which can be described as a systematic identification, assessment, prioritisation and reduction of risks to patient, staff and members of the public.
The two definitions especially the latter highlight the importance of improving quality health care services that is central to the standard on safety. If the strategy is properly planned, it will identify system failures or defend inadequacies in a health organisation and will enable service providers to proactively put in place remedies to rescue situations before an accident takes place (Steele (2002). Whichever approach is adopted, it must be patient centred. That is keeping the service users at the centre by involving the family members, carers and friends in the care planning.
It is agued that involving people that care about a service user is one of the most fundamental tenets of any person-centre approach (Allen et al 2008). In mental health, the best support would be keeping the service user healthy and safe in a way that best suit them. This is only achievable in a mental health settings through an accurate risk assessment techniques and rigorous planning. (Lewis 2007). One of the actions proposed to meet the goals set in the white paper “Choosing Health” progress report is to guarantee the provision of quality services and to ensure the needs of the service users are centred (DoH 2007).
The best applicable tool for this purpose is the Care Programme Approach (CPA) which has become the foundation of current policies designed for the provision of quality mental health services (NHS 1999). The CPA which became the interface for the involvement of the multidisciplinary team was initially designed to improve quality level of care through a follow-up system for the service users leaving the mental health hospitals. However, in mental health, most of the safety problems such as suicidal, absconding and the vulnerability of women on mixed wards to sexual assault face complex systemic causes.
Some of the actions advised to be taken as mentioned in seven steps to patient safety in mental health (NPSA 0842: 2008) is to listen respectfully and systematically to the service users, their relatives and carers whenever they are informed that something is wrong (NPSA 0842: 2008) Finally, the author has discussed the usefulness of: National Frameworks, clinical governance, policies and risk management to provide a person-centred quality healthcare services nationally.
The white paper ‘Choosing Health’ provides clear understanding that the government and individuals alone cannot make progress on healthier choices except by working in corporation across the Primary Care Trusts, the NHS, businesses, the media, employers’ real progress will be realised. References Allen J, Neill M, Woodhead N, Reid S, Erwin L & Sanderson H (2008) Person Centred Risk Course Book, Stockport, HSA Press. Department of Health (2004) Choosing Health: Making healthy choice easier. [Online]. Available from: http://www. dh. gov. k/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4094550 [Assessed 5th July 2009] Digby A (1999) The Evolution of British General Practice, 1850-1948. Oxford Press, UK Dimond, B. (2008). Legal aspects of nursing. Pearson, Longman. Harlow Food Standards Agency. (2007). Retailers, manufacturers and service providers that use signpost labeling. [Online]. Available from: http://www. food. gov. uk/foodlabelling/signposting/retailtraffic [Accessed 28th February 2009]. Hughes S (2002) A toolkit for mental health promotion in the workplace: Trent mental health in the workplace project London: mentality
Lewis I (2007) Foreword: Independence, Choice and Risk: A Guide to Best Practice in Supported Decision Making. London, Department of Health pp 1-2. Lugon Myriam, Secker- Walker Jonathan (2006) Clinical Governance Editorial: Integrating quality Clinical Governance Bulletin vol. 6 3 pp. 1-12 National Health Services (1999). Our healthier nation: Modern Standards and Service Models. NHS, London Nicholls S, Cullen R, O’Neill S, HalUigan A (2000) Clinical governance; its origins and foundations, Clin Perform Qual Health Care 8(3): 172-8 National Health Services (2009) Case study 8: well-being programme shows positive results. Online]. Available from: National Institute for Mental Health in England (2005) Maki. ng it possible: Improving Mental Health and Well-being in England. Published by Care Services Improvement Partnership 19th October 2005 http://www. dh. gov. uk/en/Publichealth/Choosinghealth/Browsable/DH_5891793 [Accessed 17 August 2009]. National Audit Office (2007) Improving Quality and safety Progress in Implementing clinical Governance in Primary Care: Lessons for the New Primary Care Trusts The Stationary Office Pridmore, J. A. , and J. Gammon. (2007). “A comparative review of clinical governance arrangements in the UK. British Journal of Nursing (BJN) 16, no. 12: 720-723. Rees R (2001) Poverty and public health, 1815-1948. Heineman Educational Publishers, UK Singleton, C. (2006). Improving life for local people The Health of Derbyshire Report, director of public health report. Derbyshire; Derbyshire County Council. Scally G. & Donaldson L. (1998) CG and the Drive for Quality Improvement in the new NHS in England. [Online]. Available from: http://bmj. bmjjournals. com/cgi/content/full/317/7150/61 [retrieved at 26th August 2009 from] Steele C (2002) An Introduction to Clinical risk management. Blackwell Science Ltd Journal of Advance Nursing, 35 (1) 139-140
Tippett V (2004) Medical ethics and law: an introduction. Radcliffe Publishing Ltd, UK Wanless D. (2004). Securing good health for the whole population: Final report. London; H. M. S. O. World Health Organisation, Regional Office for Europe. (1989). Saint Vincent Declaration. Diabetes Mellitus in Europe: a Problem at All Ages in All Countries, a Model for Prevention and Self-care. Italy; WHO World Health Organisation: World Health Report (2000). Health systems: improving. [Online]. Available from: performance. [http://www. who. int/m/topics/world_health_report/en/index. html] [Accessed 21st July 2009].