A Comparison Of Public Health Policies In The UK And Ireland

Healthcare System in the UK

Public health policy refers to decisions, activities and plans which are executed in order to accomplish specific objectives of health care in the society. An ideal health policy should achieve the goals related to explaining a vision regarding the future which will assist in establishing targets for the short and medium term. It shall outline the priorities and expected goals for various groups along with building consensus and informing people (WHO, 2018).

As per Gov.UK (n.d) public health is about helping the individuals for staying healthy and protecting them from possible hazards to their health. The government of UK wants that every citizen should be able to make better choices irrespective of the situations and to minimize the risk and the impacts of illness. In this context, the National Health System in the UK has emerged as one of the biggest health care system in the entire world. It aims at implementing a strategy which shall generate a more responsive and patient-centered NHS which is the best in the world.

As per O E C D Health Policy Overview (2016), the healthcare in Ireland is administrated by the Health Act 2004 which has formulated the Health Service Executive to be accountable to provide health and personal social service for every citizen of Republic of Ireland. So, this essay compares and contrasts the health policies of the two countries and along with making recommendations on the global health challenges in the country sharing its borders with the UK i.e. France.

In UK, the healthcare system is a devolved matter with all the regions having their own mechanisms related to publicly funded healthcare. They are subsidized by different governments and parliaments thereby forming a smaller private sector and voluntary provision. As a result, each region has a distinct policy and priority thereby creating a variety of differences amongst these systems.

In spite of the variety of healthcare services in different regions of UK, the performance of National Health Service (NHS)   has proved to be an international benchmark for comparing and contrasting the health care services in the international scenario. It was established under the Health Act 2009. The ‘NHS Constitution’ has brought the principles and purposes of NHS and its values have been evaluated by patients, public and staff. NHS has employed 1, 32,662 medical practitioners and 4, 08,160 nurses in the year 2008 (Grosios, Gahan and Burbidge, 2010).

In each of the regions of UK, the NHS has its own structure and arrangements. The healthcare system of UK is divided into two categories: It deals with procedures, strategies and management while another one deals with the real medical and clinical care which is further categorized into primary, secondary and tertiary care. The primary care consists of community cares, GPs, Pharmacists and GPS while the secondary care comprises of hospital-based care which is accessible through GP referral followed by the tertiary care which are specialized hospitals. But gradually, the primary and secondary care is being merged and the barriers are removed between the two with emphasizing on the choice of the patients to select between the two.

Department of Health and NHS

In England, the Department of Health is accountable for directing the NHS, public health and delivery of health and social care by evaluating the policies, strategies and resources along with reviewing the performances and setting of national standards. At present, 10 Authorities of Health govern NHS at the local level. The Primary Care Trusts provide governance and commission services along with making sure that the public health care services are available and there is a provision for community services (Buse, Mays and Walt, 2012).

As per Commissioning Handbook for Librarians (2018) the Department of Health, NHS, NHS England, Public Health England and Clinical Commissioning Groups are some of the public health organizations in England.  The Department of Health is accountable for ensuring public health, , social care , managing national health services and public safety and emergency. The agenda for DH and its agencies for the year 2015- 2022 is mentioned in their Shared Delivery Plan. It consists of developing the safest and the best health care quality facilities.

It aims at improving the care of the outdoor patients and the competence and output of the health care system. It attempts to improve the performance against the benchmarks along with achieving financial balance. It assists in preventing the ill health and assisting the citizens so that they can live healthier lives. The Department of Health helps in supporting research, innovation and growth thereby enabling the common man and the society to make decisions about their own wellbeing. It helps in evaluating and developing the working for improving the services with the help of digital technology, transparency and information (Murray et al., 2013).

The second component is the National Health System (NHS) of Great Britain. The Mandate of NHS sets out the objectives of Department of Health (DH) and illustrates the areas of social wellbeing and care in which the administration expects that NHS Commissioning Board can make developments in the areas of prevention of people from dying in an immature stage. It also aims at enhancing the quality of life for people and helping them to recover from ill health and injury. It helps in assuring that people have a optimistic experience of care at the hospitals and clinics and they should be treated and protected from the probable hazards posed to them (World Health Organization,2014).

The NHS policies are constituted by the NHS Constitution which endeavors to bring together the expectations of patients, staff and the general public from the National Health Service. The NHS England business plan or the operational plan explains the 11 point NHS scorecard which is introduced for measuring the performance of key priorities. It is formulated on its strategy known as Everyone Counts: Planning for Patients 2013/14. The NHS Outcomes Framework sets out the corresponding indicators which are used for measuring the developments in better results of health.

Clinical Commissioning Groups (CCGs)

The NHS England (NHSE) was introduced in April 2013 and they were prior known as the NHS Commissioning Board. The NHSE regulates the administration of NHS in England, particularly the CCGs, Commissioning support Units and Area teams. It is accountable for assigning some specialized services comprising of armed and forces health services, dental health care, offender health care, primary care, public health commissioning and specialized services assigning (Mackenbach, J. and McKee, 2013).

Another component of public health policy is Clinical Commissioning Groups (CCGs). They are classes of general practice which act along with the local community, services and patient groups in order to spread awareness about local health services. The CCG Outcomes Indicator Set offers unambiguous and comparative information for CCGs, local authorities, Health and Wellbeing Boards, public and the patients about the superiority of health services which are commissioned by CCGs and the related outcomes of health.

The areas of work for Public Health England (PHE) consist of public health, local government, public safety and national health services and emergencies. The public health is evaluated through a public health outcomes framework which is accumulated by Public Health England. It represents the data pertaining to public health for displays in England and at the local authority levels. The data is depicted in the Public Health Outcomes Framework Data Tool in which different areas are contrasted against the benchmark activities of the other authorities.
In the year 2013, the total health care expenditure in the UK as a proportion of GDP was 8.5% which is below the OECD average rate of 8.9% and less than the amount spent by its comparable economies such as France which was around 10.9% of GDP (Street et al., 2014).

There is accessibility to the primary health care services in the UK but there is a scope to upgrade the quality of services. The admissions in the hospitals for heart failures is lowest in the UK as compared to other OECD countries while the admissions for asthma and COPD are above the average rate of OECD. So, the decrease in admissions in the hospitals is a major concern because of the high cost of admission and the disturbance it causes to the health care (O E C D  Health Policy Overview, 2016).

Unlike the UK, the healthcare system of Ireland is governed  by Health Service Executive and is funded by general taxation of the country. The citizens of Ireland are authorized to receive the benefits of public health care system. The general public is required to pay a subsidized amount for the health services received by them. The fees charged are dependent upon income, age, disability and illness of the person. The maternity services and care of the children up to the age of six months are received free of cost. The emergency care is provided for the amount for   €100 for the visit to the Accident and Emergency Department. The total health care expenditure spending by the Government of Ireland was 125% of the total GDP in the year 2014 (Trading Economics, 2018).

Public Health England (PHE)

The facility of Medical Card is available for the holders in order to provide them free of cost hospital care, dental services, GP visits, aural and optical services, medical appliances and prescription drugs. This facility is available to those who receive welfare payments and those who are low earners. Those who are suffering from cancer, thalidomide syndrome and surgical symphysiotomy are automatically entitled to the card. Almost 31.9% of the population of Ireland is currently holding the medical card.

The hospitals in Ireland offer a range of healthcare facilities comprising of accident and emergency services. In the recent years, there has been a reduction in the mortality rate which was caused due to cancer, stroke and heart disease. Apart from this, the mortality rate for heart diseases has been decreased by 59% . The deaths caused due to cancer have been decreased by 21% (McGorry, Bates and Birchwood, 2013).

Unlike UK, the eight regional health boards are organized under the Department of Health. The eight regional health boards have same structures along with three areas of programs comprising of special , hospital services or psychiatric hospitals and community care. The health boards comprise of representatives of senior medical professionals, local authority councilors and people who are chosen by the Minister of Health who meet once in every month (Liverani, Hawkins and Parkhurst, 2013).

Apart from this the voluntary and community organizations address the issues of ill health and poverty. These organizations work for the health services through the national bodies such as Disability Federation of Ireland. These organizations work for specific disorders such as motor neuron disease, Huntingdon’s disease and muscular dystrophy.

Unlike the UK, where the health policy is influenced by the Department of Health, the health policies of Ireland are influenced by the developments in the UNO through the World Health Organization. The WHO has played a crucial role in motivating the members to set the standards for health care and prevention of disease so that life expectancy is improved.

The National Action Plan for Social Inclusion 2007-2016 targets on the cancer inequities along with the development of indicators forms the basis of geographical areas and levels of deficiency. The action plan would facilitate the planning of health services for minority groups and on the other hand, a national intercultural strategy shall address the unique facilities of health and support necessities catering to the minority groups like refugees, travelers and migrants. The National Health Service of UK does not comprise of such policies which cater to the needs of the migrants, refugees, and travelers (Harvey, 2007).

Healthcare System in Ireland

As per the Department of Health (n.d.) Project Ireland 2040 is the initiative by the Government of Ireland which is implemented for making Ireland a better country by investing to improve the infrastructure of health. For accomplishing this, the health services will be directed towards primary and community care through which the health care needs shall be met locally with high-quality emergency care provided in the acute hospital settings.

As per Government of Ireland (2018) for implementing the project, 10.9 billion euro would be invested in the projects and programs along with reform initiatives in the health sector. A new system has been introduced in Dublin, Cork and Galway which is known as “Ambulatory Elective –Only Hospital” amenities. These facilities shall provide low complexity and high volume procedures which focus on the day and outdoor patients along with a range of ambulatory diagnostic services.

These facilities shall work parallel to those provided by the general hospitals and their aim is to increase the capability of the hospital system. It will improve the quality of outcomes for patients through increased efficiency and reduced cancellations.

The plan for public health care includes the establishment of New Children’s hospital along with Pediatric outdoor patient and urgent care centers which will enhance the acute services regionally and nationally. It will have the facility for 380 individual indoor patient rooms.

Another project being executed under the plan is the National Forensic Mental Health Hospital Project. IT shall cover all the modern amenities and open by 2020. A 120 bed national forensic mental health hospital is central to the modernization of mental health services which is aligned with the vision for change policy. In addition to this, the National Program for Radiation Oncology comprises of delivering replacement and additional facilities for delivering of radiation oncology services at the public hospitals of Dublin, Galway and Cork so that future and existing demands can be met (Bigdeli et al.,2012).

Under this strategy, the phase 1 has already been delivered in the form of additional and replacement linear accelerators at the public hospitals. By the end of 2020, the replacement and additional amenities would be provided at Cork. Additionally, capital funding shall allow for the evolution of the cancer facilities in alignment with the National Cancer Strategy. It includes the expansion and development of medical oncology units and day wards and evolution in the diagnostic facilities and investments in the infrastructures (Greer et al., 2013).

Medical Card

Phase 1 of   National Rehabilitation Hospital will deliver a 120-bed modern hospital which will comprise of support therapies for pediatrics and brain injury wards along with hydrotherapy units and sports hall which will be operational by2020. Phase 2 comprises of expansion of services so that all the existing therapies and supports the amenities to the new hospitals.  The National Maternity Strategy provides an appropriate environment for facilitating the delivery of modern and safe quality services where the women’s need for privacy and dignity are protected.

In alignment with the health strategy, there is a shift towards primary health care services which shall meet the emerging demands of health and social care services. The management of chronic diseases is prioritized in this aspect. Under the National Development Plan, the construction program for Primary Care Centers will be continued through a direct building by the Health Service Executive with the help of private sector using an operational lease or through a public-private  partnership (Marmor and Wendt, 2012).

The nursing homes across the country have been replaced and renovated for providing better facilities to the older people and disabled people. The accommodation standards require important investments to be done for up gradation, replacement and renovation. The government of Ireland intends to replace and renovate 90 nursing homes over the next 5 years. The National Development Plan shall assist the capital program regarding the disabled people. It comprises of purchase and adaptation of houses along with the renovation of residential care units (Harris-Roxas et al., 2012).

The NDP endeavors to evaluate a structured replacement program for equipment and ambulances and minor capital works in order to meet regulatory and clinical infrastructure standards. As there is a continuous need for maintaining and upgrading the healthcare equipment and amenities so accommodation standards, regulatory environment and health technology have continued to develop so that the medical and diagnostic equipment must be upgraded or replaced for meeting the regulatory standards. Additionally, the specific redevelopment program will be executed to modernize the acute services of hospitals (Turner, 2018).

In this context, France which shares its borders with the UK has been confronted with the health issues arising due to excessive smoking and intake of alcohol. In the year 2014, it was reported that 22% of the adults in France smoke every day which is above the average statistics of the European Union. Also, 15% of adults were obese in the country which has increased from 9% in the year 2000. Thus overweight and obesity has also increased from 11% in the year 2001-02 to 14% in the year 2014. It has also been identified that cancer is an important reason for death in France thus accounting for 28.5% in the year 2014 (OECD/European Observatory on Health Systems and Policies, 2017).

Hospitals in Ireland

In this context, some of the recommendations to control and curb cancer from the country are firstly the risk stratification procedures should be implemented in clinical practices which demands considering the organizational features of the French healthcare systems. It requires the participation of health care systems who shall be involved in risk stratification. They shall classify women to be stratified and the process used to offer genomic profiling. They shall also review the validated factors of risk and clinical data which is valid for individual assessment of risk (Howlett, Mukherjee and Woo, 2015).

It has been observed that most of the cancers are associated with the use of tobacco which is prevalent in France along with unhealthy diet and infectious agents. If the disease is detected at an early stage then it can be cured. There are two strategies for early detection of the disease. It involves the awareness of the patients of the early signs and symptoms of cancer. It also refers to proper diagnosis and guidance by the health provider to the patient regarding the treatment of the disease.

The treatment should comprise of national or regional screening of asymptomatic so that it can be detected at the early stage.In this context, proper diagnosis and treatment should be available to the patient. The basic principles of control of cancer in this regard are that there should be leadership so that clarity and unity of purpose should be created. The team building and continuous learning and mutual recognition should be encouraged amongst the medical practitioners of France to curb this disease at the early stage (Cacari-Stone et al., 2014).

The stakeholders should be involved in the decision-making process to enable them to actively participate in the decision making process and their commitment for the benefit of the program. The planning process should comprise of the assessment of the medical needs for curing cancer stakeholders and grouping the risk and the existing plans and services for reacting to the needs. The first stage comprises of assessing the current state of treatment of cancer in France.  For this, the medical authorities in France should assess the number of people suffering from curable cancer and those with non-curable cancers. Through this, it shall be possible for estimating the number of patients who can be benefitted from the appropriate diagnostic and treatment services (Pearlman et al. , 2016).

Through this assessment, the most common type of cancers which can be detected and cured can be analyzed by the French health care system. The proportion of adult citizens who are suffering from cancer and can be treated can also be analyzed by this strategy. Then the existing diagnosis and treatment plans and activities should be assessed so that the gap can be identified between what is needed t provide services to the population and what is currently available. In this context, it is crucial to recognize that the diagnosis and treatment comprise of the complex component and it is closely connected to early detection and palliative care activities (El-Jardali et al., 2012).

Conclusion

It is followed by assessing the effectiveness of diagnostic and treatment services. In this context, in the medium and long-term the effective diagnosis and treatment program should result in a good coverage of the target groups and in improving the survival and curable rates for patients suffering from cancer. It can help in improving the quality of life for cancer survivors. It should be followed by assessing the safety of the patients in the diagnosis and treatment program (Curado and de Souza, 2014).

The assessment of satisfaction of the consumers in relation to the diagnosis and treatment services should also be evaluated. Step 2 identifies the gap in the services provided for cancers which are treatable but not curable. It is associated with where does France wants to be in relation to achieving success in diagnosing the patients suffering from cancer which is treatable but not curable (John, 2013).

It implies defining the target population in France for their diagnosis and treatment. In case of curable cancers, the target population should be all the patients of the certain age group in which cancer has been detected through an early detection test or a routine examination. The group also includes children with a high probability of being cured (Chevreul et al., 2015).

The identification of gaps in treatment and diagnosing techniques and probable corrective measures shall also be considered in this regard. It is further recommended that the objectives for diagnosis and treatment services should be set and they should respond to the necessities of the people who are suffering from curable cancers or those which are treatable but not curable. It should be directly associated with gaps which are identified in the services (Coleman, 2014). 

The feasibility of diagnosis and treatment interventions should be examined in this regard. It is dependent upon the available skills and infrastructures and the knowledge and attitude of the target population. For the efficiency of the diagnosis and treatment program, the people suffering from curable cancers should be targeted and good quality services should be delivered for an infinite duration. In this context, the ethical aspects should also be addressed (World Health Organization, 2015).

The patients should be given the opportunity to make their own choices regarding the diagnostic and therapeutic interventions. Their values should be respected if they are from different cultural backgrounds.  The resources should be equally distributed to all the categories of patients. The priorities should be set as the resources are limited. In order to make sure that the diagnosis and treatment are efficient, they should form a part of the national cancer control plan of the country. For this, there should be a committee which guides the overall control planning of cancer and establish criteria for selecting the priorities (Blank, Burau and Kuhlmann, 2017).

Conclusion

Hence, to conclude, it can be said that the health care system in any country should produce safe, effective and effective innovations for curing the deadly diseases such as cancer, Ebola etc. The healthcare policy should combine public-private partnership, academic research and involvement of major stakeholders which are specialized in emerging products and services for curing those diseases. Innovation in providing health care facilities is a key to resolving the issues of public health.

The stakeholders should create partnerships to increase the effectiveness through mutually beneficial relationships which are built upon mutual faith and capacities of the partners belonging to various disciplines and sectors. They should also respond to the necessities of the patients who are at risk of developing those diseases or are already suffering from such diseases so that their physical, psychological and spiritual needs are catered through the full continuum of care.

The decision-making approach of all the stakeholders should be based on evidence and social values of the country. The resources should be used in a cost-efficient manner so that the target population should be befitted in a sustained and equitable manner.A systematic approach should be applied by implementing a comprehensive program with interconnected components which share the same goals and which are assimilated with similar programs and health systems. The diagnostic and treatment processes should be continuously improved with innovation and creativity so that the efficiency should be maximized and the cultural and social diversity is addressed along with meeting the needs and challenges of the dynamic environment.

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