English
中文Introduction
NHS started its journey on July 5th, 1948 with three basic principles as guide to its future activities. These principles included meeting the needs of everyone, free services at the point of delivery and provision of services based on clinical needs instead of the individual’s ability to pay. The modernisation that took place in the year 2000 added more principles to this list. The history of progress of NHS is a massive success story. Financial problems lie at the base of most issues and NHS has strived hard to cope with financial problems throughout it journey. But a point comes when mere spending of money is not enough. Proper planning and its implementation are required along with monitoring to judge the effectiveness of planning. NHS of the future will posses a cross-departmental interaction for the purpose of education and training of general public about their health. However due the ever-changing nature of the economical and health conditions, nationally and internationally, the policies of NHS are reshaped very often. Many newly emerging concepts in health care, like ‘personalized care’ or ‘clinical governance’; make the working of NHS even more challenging. Every time a new policy is implemented, a vast change in the structure of the organization becomes imperative. This not only affects the progress rate of the organization as a whole, but also has effects on the working individuals of the organization.
Discussion
Globalization is perhaps the most effective drive for change in all aspects of our lives. As various economies, beliefs and cultures merge together, new ideas, needs and problems arise. Although NHS is not competing internationally, its services are definitely influenced by global changes that occur in health care systems worldwide. Although NHS has undergone several major reforms over the years, it still has among its main principles the principle of providing health care services to all, “free at the point of delivery” (Robinson et al, 2007) .As the public becomes aware of the health facilities available to other nations globally, the demand for increased facilities may rise. This will become a challenge for NHS in future. Moreover, as increasing number of immigrants enter UK, a new door of challenges for NHS will open. Surveys have shown that patients from areas which have a diverse population have lower levels of satisfaction with NHS services. The challenge is to maintain the confidence of public in the system which is essential for its sustainability. Travellers from other countries to UK increase the risk of bringing with them infectious diseases which have been eradicated from our society. Outbreaks of infectious diseases are likely to occur due to this factor. Moreover that fact that immunity to various infectious diseases among different populations vary, makes it important that measures are taken to protect the spread of diseases to which British population is prone. This factor may add to the work load of NHS while making it impossible to say anything about the future of control of infectious diseases which are not local, but imported.
Despite the fact that NHS has made achievements which are substantial, there are various areas which demand attention and a change of work plan. Perhaps the most important thing to do is to involve the health care professionals and patients in the policy making process of NHS. Health being a matter of life and death will be dealt better by health care professionals instead of politicians. In future we can expect that the policies of NHS are made keeping in mind the views of those who are directly affected by these policies.
Shortage of trained health care professionals still exists. A number of foreign qualified health care professionals contribute to the working of NHS. There is need to train more health care professionals on local basis. These professionals include doctors, nurses and also pharmacists. Since NHS is planning the formation of polyclinics, the nurses should be trained accordingly. In recent years, pharmacists have been given the right to ‘supplementary prescription’. Now that this kind of ‘supplementary prescribing’ has become part of our health care system, the clinician-pharmacist relationship will become even more significant in the coming times (Root, 2003). This makes the training of pharmacists even more important. We can expect that the problem of shortage in the number of health care professionals as well as in their training quality will be resolved by the time NHS is a hundred years old.
Climate change will definitely affect human health in future. A series of negative health effects might occur as a result of global warming. These effects include increased mortality from heart attack and stroke, greater incidence of cholera and malaria, and more cases of food poisoning (McMichael, 2006). This realization will support the cause for pre-emptive strategies. The identification of these health risks will provide the guiding principles for planned strategies in future. The NHS needs to stay prepared for the expected increase in demand for treatments of health problems which are directly or indirectly linked to climate change. If proper planning is done, and inputs from other departments which are directly related to climate matters are considered at the right time and given due importance by making effective rescue plans, we can anticipate that this climate change will have the least drastic effects on our population.
Genetics will play a major role in moulding the structure and activities of NHS in future. As new discoveries are made in the field of genetics, we are having a better understanding of the relationship between genes and disease. However the answer to the question about the level of impact of genetics on health services is not very clear cut. It is indeed a subject of much controversy. It is therefore important that the policy makers of NHS are aware of the uncertainty that surrounds the future of genetics in health care issues. Identification and isolation of specific genes has become possible by the development of new genetic techniques. As a result accurate prediction of risk and diagnosis of disease has become possible. NHS holds the responsibility to decide how and why this kind of screening tests should be introduced into the health service. A major issue in this regard is that, if a person who is presently healthy undergoes a genetic test which detects the early stages of a disease and points out that this individual is going to be a victim of that disease in future, gives rise to discriminating behaviours. Studies have shown that the effect of environment on gene expression is greater than what a test can reveal (Dawson, 2007). Then there will be an issue of funding the genetic testing by NHS in future. Many questions arise in this regard. For example: should the genetic testing of an incurable disease be funded by NHS? Or should genetic testing be applied on general population or to only those at increased risk of a disease? (Lenaghan, 1998). Logic suggests that a genetic test should be carried out only if something positive can be done clinically after the diagnosis e.g. early detection of cystic fibrosis improves the prognosis if treatment is carried out. The fact that every individual has the right to both knowledge and ignorance of their future health, implies that opting for or denial, of genetic testing should be the choice of the individual, not NHS. Apart from genetic testing, advances in the field of pharmacogenetics are opening up new areas of controversy. Drugs which have a mode of action which directly affects the working of DNA will prove to be revolutionary in the treatment of various diseases. The newly rising concept of ‘personalized medicine’ will be the future of drugs. This will not only add to the burden on testing and diagnosing facilities, but also on the pharmaceutical producers. From the above discussion it is obvious that the application of genetics in health care services is a very controversial issue. At the same time its importance in health care cannot be denied.
The steps taken by NHS today will mould the future shape of NHS services and the reflection of these services will decide how these services are perceived in future. The concept of ‘personalized care’ and the wider implementation of ‘Clinical Governance’ are the areas where NHS is putting much stress. Much work needs to be done in connection with these concepts as yet. But once they are implemented on the national level, the quality of health services provided by NHS is likely to improve to an extent that will have the potential to satisfy the majority of the population.
Conclusion
NHS plays a central role in the health care system of UK. Despite the fact that NHS has displayed many satisfactory advances in its working, over the years, the fact that the ever-changing health scenarios and ever changing needs of the society, still pose a challenge. Many new concepts like ‘clinical governance’, establishment of polyclinics, personalized care and making supplementary prescription by the pharmacists legalized are introduced to modify the health care system for maximum benefits of common population. Implementation of these concepts throughout the national health care system not only needs continuous efforts but also considerable time. Apart from all these, as new discoveries and new methods of treatment become available, NHS has the responsibility of making them available to the public. Climate change and insufficient qualified staff pose a challenge for the working of NHS. While NHS makes attempts to resolve these problems, it will definitely have to change itself to a much greater extent. It is likely that the newly emerging concepts in health care throughout the world will mould NHS in such a way that it will be absolutely unrecognisable when it celebrates its hundredth birthday.
