Chaos & Complexity in the NHS Flashcards
Describe the Department of Health’s Business Plan 2014-15 for the NHS and what this involves.
Three goals for the future:
- LIVING AND AGEING WELL (preventing people from dying prematurely, transforming care outside hospital, focus on primary care, social care reforms, improving treatment/care for dementia)
- CARING BETTER (improve standard of care, change way technology and information is used, make progress towards achieving ‘parity of esteem’ between mental and physical health)
- PREPARING FOR THE FUTURE (improve productivity and sustainability, value for money for taxpayer, contribute to economic growth, develop capability and resilience, stewardship role of Department of Health).
Do this by:
- Leading confidently
- Building capability
- Improving policy making
- Increasing openness
Describe the NHS Outcomes Framework 2016-17.
Preventing people from dying prematurely - e.g. from major causes of death, in those with mental illness or learning disability
Enhancing quality of life for people with long-term conditions - ensure they feel supported, improving functional ability, reducing time spent in hospital, enhacing QOL for carers, enhacing QOL for those with mental illness or dementia or multiple LTCs
Helping people to recover from episodes of ill health or following injury - improving outcomes from planned treatments, preventing LRTIs in children from becoming serious, improving recovery from stroke, improving recovery from injuries/trauma, improving recovery from fragility fractures, helping older people to recover their independence after illness/injury, improving dental health
Ensuring that people have a positive experience of care - improving people’s experience of outpatient care and A&E and end of life care, improving hospitals’ responsiveness to personal needs, improving access to primary care services, improve experience of maternity services and of healthcare for mental illness and of young people’s experiences, improving people’s experience of integrated care
Treating and caring for people in a safe environment and protecting them from avoidable harm - reducing incidence of avoidable harm, improving culture of safety reporting, improving safety of maternity services
Define health literacy.
The individual’s cognitive and social skills that determine the ability to access, understand and use health information in a way that will promote their own health.
Define patient education.
Any set of planned educational activities/organised learning experiences that intend to improve (or enable change of) patient’s health behaviours and/or health status. It aims to slow deterioration of a disease, or to maintain/improve health outcomes.
Outline the following policy from the DOH “Liberating the NHS: No decision about me, without me. 2
This is to implement SHARED DECISION MAKING, so clinicians and patients work together, and make it become the norm in the NHS. This is important as it has been shown it leads to better outcomes and also patients want to be more involved in their care than they are at the moment. This is PATIENT-CENTRED CARE.
This would involve greater national provision of decision aids, including shared decision making in commissioning and contracts, including it in training, better provision of shared decision making, monitoring the quality of shared decision-making…
Outline the proposed junior doctors’ contract.
- Saturdays and Sundays will count as “plain time” (part of a junior doctor’s normal working week) and this now stretches to 10pm.
- Will receive extra money for working at least seven full weekends a year up to a maximum 10% increase in their pay.
- Pay is going down from 50% extra for a shift to 37% for working at least eight hours any time between 8pm and 10am.
- Increase in their basic pay of 10%-11%
- Separate 8% uplift so long as they do on-call work
- Pay premia for young doctors opting to specialise in A&E, psychiatry and oral and maxilo-facial medicine have been increased to £20,000
- Doctors doing locum shifts will have to first offer their services to the NHS, they will get a 22% bonus every time they do.
- Set up the new role of guardians of safe working to ensure doctors aren’t working excessive hours
- Inequalities for part-time female junior doctors - unable to find childcare for extra weekend shifts, but now have mentor so they receive ‘targeted accelerated learning’
What is meant by the inverse care law?
People who need the most care are least likely to receive it (the perverse relationship between the need for health care and its actual utilisation).
It essentially arises because of income inequalities.
In areas with most sickness and death, general practitioners have more work, larger lists, less hospital support and inherit more clinically ineffective traditions of consultation than in the healthiest areas; and hospital doctors shoulder heavier case-loads with less staff and equipment, more obsolete buildings and suffer recurrent crises in the availability of beds and replacement staff.
Where does the inverse care law operate more completely?
Where medical care is most exposed to market forces, and less so where such exposure is reduced.
When did privatisation of the NHS start?
Why is this problematic? (3)
1980’s by Thatcher government
Increasing inequality in health
Enhancing private wealth
Reinforcing class-based health access
Average GP consultation with middle class patient took __ minutes; working class equivalent took __ minutes.
- 2 minutes
4. 7 minutes
What is meant by the business rhetoric?
What is the main aim?
What was the problem and how was it corrected?
The GP contract of 2004
To reward those who work in deprived areas to try and reverse the inverse care law.
Created a two-tier system in which some practices found themselves with considerably fewer resources than they had under the old system, so a correction factor was introduced (Minimum Practice Income Guarantee). This is being phased out however.
What is the Social Value Act?
2013 legislation that places a legal obligation on all public sector commissioners to consider how they could improve the economic, environmental and social well-being of their population through their procurement activities.
This includes promoting good quality jobs, reducing social isolation, and improving health literacy.
What is patient centred care?
Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.
What are the four principles of person-centred care?
- Affording people dignity, compassion and respect.
- Offering coordinated care, support or treatment.
- Offering personalised care, support or treatment.
- Supporting people to recognise and develop their own strengths and abilities to enable them to live an independent and fulfilling life.
What is health education?
Interventions that provide learning opportunities directed towards achieving change in health risk behaviours, or the maintenance of health enhancing behaviours.
Health education can include personal or mass media campaigns directed towards individuals or groups of individuals.
