Department of Care and Professional Studies Edexcel Level 3 for Children and Young People’s Workforce Unit 13 Promoting Children’s Learning and Development in the Early Years Assignment Task 1 Direct Observation

Department of Care and Professional Studies Edexcel Level 3 for Children and Young People’s Workforce Unit 13 Promoting Children’s Learning and Development in the Early Years Assignment Task 1 Direct Observation and Professional discussion Assessment Criteria (Unit 13) 1. 3explain how the documented outcomes are assessed and recorded 2. 2engage effectively with children to encourage the child’s participation and involvement in planning their own learning and development activities. 3. 2prepare, set out and support activities and experiences that encourages learning and development in each area of the relevant early years framework 4. work alongside children, engaging with them in order to support their learning and development 4. 3 use language that is accurate and appropriate in order to support and extend children’s learning when undertaking activities While on work experience you will be visited by your tutor/teacher who will observe your practice to de termine your competency. Your tutor will observe you and record your performance and where it meets the criteria listed above it will be recorded on the ‘Direct Observation’ pages in your Professional Practice Log. All observed criteria will be credited to you. In some cases where a criteria has not been full demonstrated through observation, the visiting teacher will ask you an oral question or hold a professional discussion with you to enable you to fully meet that criteria. This discussion will also be recorded in your Professional Practice Log but on the ‘Professional Discussion’ page and where competency is confirmed you will credited with the criteria, Task 2 – Underpinning Knowledge Evidence Assessment criteria (Unit 13) 1. explain each area of the areas of learning and development and how these are interdependent Assessment criteria (Unit 12) 1. 1explain the legal status and principles of the relevant early years framework/s, and how national and local guidance materials are used in settings Scenario You have been asked to prepare an information pack for the new students who will be starting your setting next term. You should provide guidance which explains the follo wing : a)The purpose and legal status of the early years frameworks and how it relates to achievement of the Every Child Matters Outcomes (Unit 12 – criteria 1. ) (Unit 13 – criteria 1. 2) b) Provide explanations of each area of learning and development identifying their interdependency. Internally verified _______________________________ Date ______________ Task 3 Promoting Children’s Learning and Development This task links to your practical placement. The play and learning activities that you carry out while in each of your placements will be used to meet the assessment criteria for this task Assessment criteria (Unit 13) 2. use different sources to plan work for individual child or group of children 2. 2support the planning cycle for children’s learning and development 3. 1explain how practitioners promote children’s learning within the relevant early years framework. 4. 2explain the importance of engaging with a child to support sustained shar ed thinking 5. 1 reflect on your own practice in supporting learning and development of children in their early years. 5. 2 demonstrate how to use reflection to make changes in own practice In each of your three placements, following consultation with your supervisor, you will plan, provide and evaluate five learning activities/experiences that promote children’s learning and development. For each activity you must show the flowing:- ?your planning (criteria 2. 1;) ?evaluation of the child/children’s learning outcome with recommendations for extending the child/children’s learning (criteria 3. 1; 4. 2. ) ? evaluation of your plan with recommendations for improvement and changes to your own practice (criteria 2. 2; 5. 1; 5. 2)

Brave New World Double Entry Journals Essay

It was because about 3 centuries ago all classes of people were conditioned to like nature and transportation but that meant on the weekend they were unproductive so now they are conditioned to like transportation and country sports, which means they still consume transportation. | Pg. 30 â€Å"Human beings used to be. † he hesitated; the blood rushed to his cheeks. â€Å"Well, they used to be viviparous. †| What does viviparous mean? The context of it in the book seems to be like a bad word would be today to say. After this line it says â€Å"Born†. Viviparous: (of an animal) Bringing forth live young that have developed inside the body of the parent. (Dictionary. com) I was right it meant to have kids, BNW people are so used to babies being hatched and don’t know what it’s like for someone to give birth. | Pg. 32 â€Å"Moral education, which ought never, in any circumstances, to be rational. †| The D. H. C. expresses the idea that moral education is accepted in the society. However, those morals are determined by ‘The World Controllers’. Reasoning, fate, or God do not play a role in moral education. Nothing is to ever be based on proper reasoning and especially emotion. | Pg. 34. â€Å"Till at last the child’s mind is these suggestions, and the sum of the suggestions is the child’s mind. And not the child’s mind only. The adult’s mind too all his life long. The mind that judges and desires and decides- made up of these suggestions. But all these suggestions are our suggestions! † The Director almost shouted in his triumph. â€Å"Suggestions from the State. †| Everything the people think or want to do is from the state. People can’t/aren’t allowed to think for their self’s. They are told what they do and don’t like. The Director seems very proud about how the state can decide on what the kids are to know/learn. If you think about it closely this is almost done in today’s society. Schools are all regulated per region in the world and things are chosen on what kids should learn, and what is morally right/wrong. | Pg. 35 â€Å"Nowadays the Controllers won’t approve of any new game unless it can be shown that it requires at least as much apparatus as the most complicated of existing games. †| Why would the controllers not allow a game that is simpler than any current games? All games must be more complex in how it works than current ones to be approved. Is this done to make people who invent things to think harder too make it more complex that in turn, the people are thinking harder and able to hopefully produce better things for the society? | Pg. 35 â€Å"Two children, a little boy of about seven and a little girl who might have been a year older, were playing, very gravely and with all the focused attention of scientists intent on a labor of discovery, a rudimentary sexual game. â€Å"Charming, charming! † the D. H. C. repeated sentimentally. | Is it just me or is it weird that the society pushes promiscuously on kids age 7 and 8. Also the director seems to enjoy watching the two kids erotic behavior. | Pg. 35 â€Å"This little boy seems rather reluctant to join in the ordinary erotic play. †¦.. â€Å"And so,† she went on, turning back to the Director, â€Å"I’m taking him in to see the Assistant Superintendent of Psychol ogy. Just to see if anything’s at all abnormal. †| Maybe there isn’t anything wrong with the boy, BNW society is basically forcing little kids to explore/have sex with each other. What can the superintendent of psychology tell you other than that the kid doesn’t ant too have sex. It is also creepy that they all look the exact same. | Pg. 39 â€Å"Our Ford’s: History is bunk. History,† he repeated slowly, â€Å"is bunk. †Ã¢â‚¬  | I know in real life Henry Ford said something along those lines; â€Å"†History is more or less bunk. It’s tradition. We don’t want tradition. We want to live in the present, and the only history that is worth a tinker’s damn is the history that we make today. † (Chicago Tribune, 1916). | Pg. 41 â€Å"I’ve been feeling rather out of sorts lately,† Fanny explained. â€Å"Dr. Wells advised me to have a Pregnancy Substitute. â€Å"But, my dear, you’re only nineteen. The first Pregnancy Substitute isn’t compulsory till twenty-one. †| Since no one in the society has children it seems as though once each female turns 21 they have a pregnancy substitute to mimic pregnancy. This is maybe done so no one has an odd urge to have a baby. | Pg. 42 â€Å"Again? † Fanny’s kind, rather moon-like face took on an incongruous expression of pained and disapproving astonishment. â€Å"Do you mean to tell me you’re still going out with Henry Foster? †| In the society it seems like a very big disapproval of people especially to date/marry. People are only supposed to go out together one night, have sex, and be done with each other that is why Fanny is questioning Lenina. | Pg. 45 â€Å"After all, every one belongs to every one else. †| This keeps coming up throughout the book that after all everyone (belongs/works) to/for everyone else. The society here shows that they believe everyone is equal. Why would they make differ class groups for the society? | Pg. 47 â€Å"They say somebody made a mistake when he was still in the bottle-thought he was a Gamma and put alcohol into his blood-surrogate. That’s why he’s so stunted. | So in the BNW society to stunt the growth and brainpower of select groups they put alcohol into the blood that is transferred over the embryo to stunt the growth. In today’s time research has been shown that if you drink alcohol when pregnant a baby can be born with birth defects or have a mentally disorder. | Pg. 48 â€Å"The Nine Years’ War began in A. F. 141. à ¢â‚¬ Ã¢â‚¬ ¦. â€Å"The Nine Years’ War, the great Economic Collapse. There was a choice between world Control and destruction. Between stability and . †| It can be inferred that the conflict broke out in Europe, affected most of the planet, and caused massive physical damage. It is repeatedly stated that chemical and biological weapons were used during the war, particularly in mass air-raids against cities. Following the war, the global economy collapsed and created an unprecedented worldwide economic crisis. The new world leaders tried to forcibly impose their new ideologies on Earth’s populations. This met with widespread resistance, including large-scale riots. Realizing that they could not force people to adopt the new lifestyle, the World Controllers instead united the planet into the One World State and began a peaceful campaign of change. This campaign included the closing of museums, the suppression of almost all literature published before 2058, and the destruction of the few historical world monuments that had survived the war. | Pg. 51 â€Å"Ending is better than mending† | There are many meanings to this statement. One could be the clear one that when you have an old pair of clothes to throw it out instead of trying to fix it. This helps the BNW economy by people always spending money to buy new clothes. A second point I took from this quote was with the ‘Nine Years War’ that it was better to end and restart how the world worked than trying to reorganize the planet and trying to pick up from where we were before the war. | Pg. 51 â€Å"The introduction of Our Ford’s first T-Model . †| At first I thought their god/creator was some guy named Ford but now I’m peaty sure Huxley implies that it is Henry Ford. I stated this because Ford’s first model of car he made was called the T-Model. (Wikipedia) | Pg. 64 â€Å"It’s not enough for the phrases to be good; what you make with them ought to be good too. | He is telling him that it doesn’t matter if the phrases are good it’s how you make them good. He is implying the idea of using your mind and not what is given to you. Future Rebel? | Pg. 67 â€Å"Fine to think we can go on being socially useful even after we’re dead. Making plants grow. †| Even after your dead th e society still uses you for it’s personal gain they take your body and it’s turned into fertilizer for crops to grow!!! | Pg. 75 â€Å"Orgy-porgy, Ford and fun,Kiss the girls and make them One. Boys at one with girls at peace;Orgy-porgy gives release. †| This is talking about and orgy. The last stanza of â€Å"orgy-porgy gives release† as the violent passion surrogate, the surrogate pregnancy and the soma, is a sign that the World State has not been able to completely annihilate from human nature. There is still some need for liberation, a need to experience strong emotions that have not been completely wiped out through conditioning. Solidarity Service is one of many mechanisms used to channel state of the excitement, so that they present no threat to state power. | Pg. 77 â€Å"Not more than half a dozen people in the whole Centre had ever been inside a Savage Reservation. As an Alpha-Plus psychologist, Bernard was one of the few men she knew entitled to a permit. For Lenina, the opportunity was unique. †| What is a savage reservation? Is it an area where they keep a group of normal people like you and me in today’s time? In case something goes wrong or for emergencies they can have back up DNA. | Pg. 78 â€Å"â€Å"In a crowd,† he grumbled. â€Å"As usual. † He remained obstinately gloomy the whole afternoon; wouldn’t talk to Lenina’s friends (of whom they met dozens in the ice-cream soma bar between the wrestling bouts)†| It seems like people in BNW like too be in crowds and together. But Bernard seems like the only person who doesn’t like to be with groups of people. Is this because of something going wrong when he was in a test tube? | Pg. 84 â€Å"Don’t imagine,† he said, â€Å"that I’d had any indecorous relation with the girl. Nothing emotional, nothing long-drawn. †| The director is thinking that Bernard is thinking the director had more than a sexual relationship with the women he brought to the reserve, which is against BNW rules in the society because after all everyone belongs to everyone. Pg. 88 â€Å"Five hundred and sixty thousand square kilometers, divided into four distinct Sub-Reservations, each surrounded by a high-tension wire fence. †| Why would the reservations have to be subdivided and need for instant death electric fences? Maybe each reserve has a different race and they want each race to be separate and to protect their own traditions and culture. It is maybe also for science to not be able to get i n to the people in the reserves. |

A Critical Analysis Of “The Send Off” By Wilfred Owen Essay

This essay intends to examine the poem â€Å"The Send Off† by Wilfred Owen. Owen wrote this poem while he was stationed at Ripon army camp. He was based there after being a patient at the Craiglockhart War Hospital, this is where he met Robert Graves and Siegfried Sassoon. Owen was at Ripon between March and June, 1918 and died in action on the fourth of November 1918. â€Å"The Send Off† is a poem about some troops that have just come from a sending off ceremony before departing by train, presumably to the frontlines of World war One. The poem has many themes running through it. Some of these are death, strangers, flowers, secretiveness and healing. The poem opens with a very claustrophobic first line – â€Å"down the close, darkening lanes they sang their way† The words ‘down’, ‘close’ and ‘darkening’ provide the reader with a feeling of doom, claustrophobia and fear of uncertainty. The image of going ‘down’ provides the reader with the images of death, darkness, being buried, walking the trenches and going to hell. This opening line also provides a rather prophetic image of people being sent to concentration camps, by train, in World War Two. Further enhanced by ‘siding shed’. From the phrase â€Å"they sang their way2 there is an opposed feeling of happiness to the claustrophobia. However, the singing changes from happiness when the poem is read again and the other themes are considered. Flowers are the next prominent theme displayed in this poem. They appear in line four, stanza one and line fifteen, stanza three. â€Å"Their breasts were stuck all white with wreath and spray As men’s are, dead.† The flowers are described as white and in wreath form, the reader may imagine in this line that white lilies are associated with funerals. The language in this line gives the impression that the troops are covered in white flowers  and that the flowers are ‘stuck’ to their ‘breasts’ as in a coffin. This is further enhanced by the abrupt end to this line ‘dead’. The impression is that the soldiers are predresseed for their own funerals. â€Å"Nor there if they yet mock what women meant Who gave them flowers.† In this line the poet is asking if the women, who gave the troops the flowers, realise that the flowers are symbolising the reality of the horrors and the almost certain death that these troops are going to face in the frontline. The theme of funerals is picked up again in stanza two – â€Å"Dull porters watched them, and a casual tramp Stood staring hard,† The strangers, the porters, tramp, guard and women are all watching the troops, covered in flowers march from their army camp to the train station. The troops, in deliberately, are predressed for their funeral and there are no apparent cheers or voices in the poem as they depart, they are leaving silently, secretly and this leaves the reader feeling that it is a funeral convoy passing by and that the troops are experiencing foreboding of doom and may well be resigned to their fate on the frontlines. â€Å"They sang their way dimly gay† further shows that the troops are resigned to their fate and are singing their way to almost certain death.. interestingly, there is a large amount of secretiveness throughout this poem. It is first apparent in stanza three – â€Å"So secretly, like wrongs hushed-up, they went.† This line makes the reader question why the troops are departing so secretly, then in line thirteen the phrase – â€Å"We never heard to which front these were sent.† Shows that the troops and general public were not aware of where the troops would go to fight, or what the true nature of the realities would be when they got to their destination and that the public were not made aware of these realities and truths, in fact it was concealed from them. The secretiveness is also mentioned in stanza two, lines nine and ten – â€Å"Then unmoved, signals nodded, and a lamp Winked to the guard.† Here the theme of secretiveness is displayed through the imagery of the signals nodded and a lamp winked, the reader feels conspiratorial messages conveyed through Morse code. In the last stanza the secretiveness theme appears again, but this time, it is linked with the return of the soldiers. This stanza implies that only a few of these soldiers are likely to survive the war and return to their homes. However, they will ‘creep back’ implies that the soldiers may not wish to return as heroes and may need to heal themselves both mentally and physically. In conclusion â€Å"The Send Off† by Wilfred Owen starts off as a poem about a sending off ceremony towards the end of the war but in fact goes on much deeper to discuss the differences between what people at home perceive the war to be and the actual realities that the soldiers face at the frontlines. The last stanza hints at healing, and suggests that those few soldiers who do return may wish to do so silently, and not as heroes, and may not wish to discuss the realities and horrors that they have experienced. Thus, the  title is rather ambiguous.

Case Analysis Euro Disney Essay Example | Topics and Well Written Essays - 3250 words

Case Analysis Euro Disney - Essay Example on to the Hofstede’s cultural dimensions, the key points of cultural differences between USA and France include the Power Distance Index (PDI, Individualism or collectivism, long-term orientation, uncertainty avoidance index and masculinity (Geert Hofstede Cultural Dimensions, 2009). According to Miron (2009), the United States has a lower average PDI score than France. America was normally focused on accumulating more power to gain more global influence while France concentrated on increasing flexibility. The French rejected the American managers to preside over Euro Disneyland with the idea that the French managers have the necessary capability and skills necessary for managing the company. The American managers in Euro Disneyland had become unpopular among the community and French workers because most of them did not make the necessary effort required to learn the local language as well as understanding and embracing the local culture. Individualism defines the way people value themselves as well as their close relatives. Miron (2009) posits that the rate of individualism is higher in America than in France. Most of the American employees have a tendency of looking after themselves or their immediate family members. The French culture is more collective compared to that of the Americans. The collective culture emphasises on what is best for the group. This is an element of communism that is applied in management and for which most American managers lacked while handling the French employees. For instance, the American managers suggested, â€Å"...men’s hair to be cut above the collar and ears with no beards or moustaches.† (Krishna; 251) This typical appearance and dress code was practised by the American family values. The individuality of the French culture was portrayed by the demonstrations and protests that resulted from the change in the rule. These were meant to preserve the French law,  "...prohibits employers from restricting individual and

A Moral Dilemma Assignment Example | Topics and Well Written Essays - 500 words

A Moral Dilemma - Assignment Example In addition, education also causes people from different backgrounds to interact and socialize. In this way, education works to promote diversity and intrapersonal understanding among human beings. People from different backgrounds meet and socialize in learning institutions where individuals learn socialization skills, which also enhance problem-solving abilities. From the above perspectives, education is an important aspect of human right that everyone should obtain up to the highest level possible. With regard to the moral dilemma scenario above, the girl was right in making the steps she undertook in various ways. To begin with, education is a fundamental part of life that promotes enlightenment of individuals about world issues (Cox & Klinger, 2004). Education brings about exposure and enables understanding of general environmental concepts unknown to uneducated persons. Adequate understanding of various global concepts is important in fostering and enhancing problem solving and decision-making skills of individual learners (Kail & Cavanaugh, 2013). The move by the parents to prevent their daughter from continuing with her education in favor of caring for the younger siblings would hamper the girl from gaining the knowledge about various world concepts. Education is an important tool in enhancing individuals’ and social security. Through education, a person is able to gain sufficient self-awareness and self-concept, which are important in enabling nurturing individuals’ relation with the environment and other people (Ungar, 2011). Denying the girl opportunity to continue with her education would compromise the quality of her self-awareness and understanding. Since it was her life and she might have had the desire to relate positively with the environment, the girl had the right to apply every possible technique to persuade her parents let her

Ethics for toy industry Essay Example | Topics and Well Written Essays - 750 words

Ethics for toy industry - Essay Example wever, attractive and large though the business is, there are certain concerns associated with the safety standards used in the manufacture of toys and the health implications for their children. There is added concern for this as today the toys’ manufacturing units are located in far off offshore places with varying manufacturing standards (Becker, 2008). These concerns are based on several researches that have found toxic and harmful substances in popular toys. More recently, an environmental research group has found that in a sample of 15,000 toys taken from various toy stores across the US, 1 in 3 contained large amounts of lead, flame retardants and arsenic (Clifford, 2008). These toys were manufactured in the US, China and other parts of the world and freely available in the US, a fact that indicates that either there is lack of adequate legislation or that there is inadequate monitoring of the standards. There may be a lack of legislation that targets specific harmful s ubstances due to inadequate research or due to low public awareness about the harmful impacts of certain substances. For example, it is only recently that research and public opinion against the use of phthalates in toys has led to the development of laws covering this chemical. However, even in the case that there are not adequate legislation or enough public awareness, the continued use of substances like phthalates and lead cannot be justified by the toy manufacturers on an ethical ground.

Reflection on first year of university Essay Example | Topics and Well Written Essays - 1500 words

Reflection on first year of university - Essay Example It is for this reason that the news of receiving an admission letter offering me a chance to pursue a degree at the university, which is the dream of every student, came as a surprise not only to me but also to those who knew me well. Surprisingly life at the university seemed to a very different meaning from what I had initially been made to believe. My first year at the university has not only been a success but has also availed a different world opening new experiences to me. During my first year of study, I have excelled both academically and outside the classroom environment. I have had experiences and learnt several things that I am convinced have pushed me a step closer towards achieving my lifetime dreams. Brought up in an environment where standing in front of even a small group of people was a reserve for the leaders in various positions in the society, or the educated elite, I consider standing in front of the class and making a presentation as the most important achieveme nt of the year. Like many other students in my class, when the content, which was to be covered in our first year of study, was given to us and we realized that the culmination of the first year work was a class presentation, I could not resist the temptation of not making it. Never had I been faced with such a situation before and the thought of standing in front of so many students together with our teacher was almost unbearable. Nevertheless, I knew from the word go I could not entertain the temptation of giving up and my philosophy was to always give the best I could regardless of the complexity of the situation at hand. Furthermore the exercise was supposed to impart in us better organisational and multitasking skills. Owing to the situation at hand, I knew I hand to make thorough preparations if my presentation was to earn me any good results. I therefore embarked on a mission to take advantage of any chance to stand and address groups of people however how small these may be in an attempt to boost my confidence come the final day of presentation. I could spend several minutes trying to figure out how the presentation would be and at times even had imaginary presentations in my mind. Multitasking between several activities was the order of the day, I had walk from home to university each day and not the everyday chores could be left unattended. Each day came with its new set of challenges and the situation always seemed to be getting demanding with each new day. Assignments were piling up fast and time seemed to fly out as the deadline dates always seemed sooner than expected. Despite our concerns about the increasing workload, no one seemed to give a listening ear. Pressure was mounting up on me and I did not know where to start neither where to end. To me leisure was outdated and spells of work were often followed by long spells of sleep because of accumulated tiredness; moreover, there was so much to handle in so little time. Balancing between these w as the turning point between those succeeded and those who failed and equipped with this knowledge, I struggled until I was convinced my last calorie of energy had burnt out. I knew the kind of life I was bound to live after my education would be greatly shaped by the kind of grades I could get here at the university; to me, the journey had just begun and there was no turning back. To an ordinary observer, my paths may seem to be running

Banks Deal with Document not with Goods, Services or Performance to Essay

Banks Deal with Document not with Goods, Services or Performance to Which the Documents May Relate - Essay Example Bank regulations are just examples of the commercial laws that have received a considerable amount of attention in recent times (Grath, 2012, P. 124). These regulations are often established to ensure transparency between banks and individual clients and among the banks themselves. That is, banking regulations subject banks and their clients to certain guidelines and restrictions in the manner in which they conduct their businesses. The necessity of banking regulation, control and standardisation is emphasized by the interconnection the banking industry has with the other sectors of the economy. Banking regulations thus serve to lower or alleviate the risks that banks are exposed to and any disruptions and interruptions emanating from adverse economic and banking conditions (Grath, 2012, p. 45). Additionally, bank regulation reduces the criminal risks to which banks are exposed besides promoting and ensuring the confidentiality of banks (Miller & Gaylord, 2010, P. 46). This paper exp lores the statement that banks deal with document not with goods, services or performance to which the documents may relate, as stated in Article 5 of the UCP 600. This statement is explored in regard to the Letters of credit principles of autonomy, compliance principle and fraud, citing several case laws. The Letter of Credit and the UCP The importance of the letter of credit to the current commercial society is evidenced by the numerous rules established to regulate and control its use. Among these rules that regulate transactions involving the letter of credit is the UCP 600 (The 2007 Revision of Uniform Customs and Practice for Documentary Credits), prepared by International Chamber of Commerce’s (ICC) Commission on Banking Technique and Practice. The UCP 600 was approved by the ICC Commission on Banking Technique and Practice on October 25, 2006 but the rules became effective on July 1, 2007. The two unique articles included in the UCP 600 are Article 2 on â€Å"Definit ions† and Article 3 on â€Å"Interpretations†, both aiming at improved clarity and precision in the rules. Prior to the 2007 version of the UCP, earlier versions appeared in 1933, 1951, 1962, 1974, 1983 and 1993. The prominence of UCP is evidenced in the current commercial environment by the many credit letters that are subjected to the latest version of UCP, UCP 600. Therefore, the credit letter is one of the many documents which banks deal with, instead of focusing on the use or performances with which the documents relate (Gutteridge & Megrah, 1985, P. 25). That a bank should deal with documents and not the use or performance to which these documents relate is statement contained in the Uniform Customs and Practices for Documentary Credits (the UCP), a set of rules targeting documentary credits in circumstance in which a credit is specifically indicated to be subject to the rules (Baker & Dolan, 2008, P. 93). The current version of the UCP rules, in use since July 20 07, is referred to as UCP 600. The basic principle of documentary credit that outstands in Article 5 of the UCP is that ‘banks deal with documents and not with goods, services or performance to which the documents may relate, a statement reinforced by Article 14(h), which states that in situations in which a credit is attached to conditions that do not stipulate the documents for compliance to the condition, banks have the latitude to consider

Pakistan's need for economic growth focusing on solar energy and Research Paper

Pakistan's need for economic growth focusing on solar energy and working water filtration plants - Research Paper Example Energy is required to operate any institution in the modern world. On the other hand, the management of energy and its efficient use can reduce the demand of energy. Energy efficient devices and appliances save a lot of electrical units. Electrical energy is mostly generated by utilizing the fossil fuel resources. With the passage of time, the fossil fuel resources are becoming short due to the depletion in the fossil fuel reservoirs. As, the supply is becoming short the demand of the fossil fuel resources is rising and thus the value of the fuel resources is increasing. It is a general concept that fossil fuel based generated power is considered the costliest power as compared to hydro power or solar or wind. A research designed to evaluate the water shortage in the world depicts that about 1.3 billion people worldwide suffer from water shortage. People, in the underdeveloped and developing regions of the world, are more likely to catch the diseases that are transferred from contami nated water. Water contamination kills more people in underdeveloped regions than cancer, aids and other such diseases. People are less aware of water filtration and treatment. Small scale water filtration plants can solve the problem and prevent diseased water from entering the human body. Low energy consuming filtration plants based on solar distillation, RO filtration or other water purification methods can be utilized that consume less energy and still maintain the acceptable quality of water. Pakistan shows the similar conditions as other under developed countries due to the lack of the clean drinking water, lack of electrical energy, lack of heath services and lack of economic stability. A deep study depicts that the cost of electrical energy in Pakistan is 13 times the cost of electrical energy in Saudi Arabia. There is a need to develop a small or a large scale power generation units by utilizing the solar energy in Pakistan to bring economic stability. On the other hand, it is equally important o provide people with safe drinking water by utilizing the small scale water filtration plants. Research Questions Can solar energy and small working water filtration plants bring economic stability is Pakistan and how women can play their part in he economic stability of the Country? Body of the Paper The maintenance cost of the fossil fuel based power plant is considerably high. Moreover, a fossil fuel based power plant can be only 40% efficient, as the major part of the fuel converts to waste heat. Besides the environmental perspective, it is also economically less feasible to utilize coal, oil or gas for power generation. On the other hand, in future the fuel will cost more than the current price due to its short supply in the future. The need of the time is to utilize the alternate resources for the generation of energy1. Solar and wind energy have more potential than our current needs. Solar energy can be utilized to generate power directly by utilizing t he solar photovoltaic panels. It can be adopted individually or on a large scale. It is an efficient way to generate energy. Economic Evaluation of Solar energy Solar energy converts solar radiation into electrical energy. Solar energy has two contents; one is light energy and other content is thermal energy. Solar Photovoltaic cells are capable of converting solar light into electrical energy that can be stored in batteries and can be utilized in night. Solar energy can be harnessed for individual as well as industrial demand. Solar PV panels only consume sun radiations to generate energy. Solar light is free of cost and it will remain till the solar system remains2. The

The French and Indian war Essay Example for Free

The French and Indian war Essay The French and Indian war which took place from 1754 to 1763 was fought between the French, American Indians and Great Britain. Contrary to what the title might imply the French and Indian war was not a battle fought between the French and Indian but a war fought against the British with the French and American Indians as allies. This war also goes by the name of the Seven Years’ War as it was part of the Seven Year’s war that also took place throughout Europe and Asia (Anderson, F. , 747). The main conflict over the start of the war was an expansion of territory, both New England, under British rule and New France, under French rule, wanted to expand their territory. The outcome of this war was highly important to the forming of the United States as France ceded all of its territory to the east of the Mississippi river including French Canada to the British, left Great Britain in so much debt it raised colonial taxes, and trained future military leaders that the conclusion of the French and Indian War lay the seeds for what would ultimately result in the American Revolution and the formation of the United States of America. This war is considered to be the last major war between, France, Great Britain the Native Americans. Unlike previous wars this siege began on American soil and moved its way into Europe. The Native Americans did fight on both sides but they are primarily considered to have allied with the French. It was during this war that many of the future leaders of the American Revolution, such as George Washington, would fight ironically for Great Britain. As most wars in this time period occurred over the acquisition of land or expansion of territory. Due to Britain’s strong Navy the British were able to colonize much of the Eastern Seaboard as they had superior ability to transport supplies as well as colonists. British claims to North American soil came from royal grants that had no definite boundaries towards the west (Asimov, I. , 174-175). The French additionally wanted to expand their territory and used Robert de LaSalle’s exploration to claim the Mississippi river and its surrounding basin for the French. This also would include what is known as the Ohio River Valley basin (Anderson, F. , 2005, 9-10). Both countries wanted to expand their hold over the land for the natural resources available including fur trading, fertile soil for farming, control of important fishing grounds and other trades that contributed to economic stimulus. The British colonists also feared the French’s influence on religion. British subjects were primarily protestant and the French were Roman Catholic and had many active Missions within North America. A French control of North America would provide a threat to the British colonist’s religious beliefs and like-wise the French feared the British rule as under British law Catholics were still persecuted. (Anderson, F. , 2005, 85) Though fighting in North American finished in 1760 the actual end of the war was not until 1763 with the signing of the Treaty of Paris and the Treaty of Hubertusburg. France lost all of its territory in North American East of the Mississippi river, including Canada, and retained two small islands off of Newfoundland. France regained the two Caribbean Islands of Martinique and Guadeloupe, previously occupied by the British. Spain gained Louisiana as compensation for losing Florida to the British as well as Cuba and Manila. There was also many other territorial shifts throughout Asia as British regained control of India and Sumatra as an example. The outcome of this was the key that set events into motion for the future formation of the United States of America. (Marston. , D. , 84) Great Britain was now in control of the majority of North America. But the war and resulting treaty had left enormous debts as France had traded French Canada for the Caribbean islands. The islands provided a large economic value as they were a large source of sugar and being small islands much easier to defend. Great Britain chose to pay off its debts from tax money collected from the colonies. The end of the French control in North America also influenced the start of the American Revolution as it united the colonists to focus on one enemy, namely the British instead of having to worry about additional conflict. The increase in taxes as well as the withdrawal of French rule in North American would prove fuel for increasing conflicts between the colonies and Great Britain and ultimately result in the American Revolution and the formation of the United States or America. (Anderson, F. , 2005, 242-250) It should also be noted that many of the American Revolutions military leaders participated in the French and Indian War. George Washington commanded troops at the first confrontation of the French and Indian war were he was sent to negotiate boundaries with the French at Fort Duquesne, currently Pittsburgh. A skirmish occurred in which a French officer was killed and added weight for the French to resist (Ellis, J. , 5). Additional Revolutionary war heroes served under the great general Edward Braddock during the French and Indian War,; Brigadier General and Adjutant General Horatio Gates, Captain Daniel Morgan of â€Å"Morgan’s Sharpshooters† rifle company, and Major General Charles Lee of the Continental Army to name but a few (Higginbotham, D). It is possible that without the French and Indian War the United States of America would not be what it is today. The French and Indian war directly resulted in partitioning North America in a way the resulted in what is known as eastern United States over one rule, the British. It resulted in an increase on taxes which is a direct precursor to the American Revolution as increased taxes stemmed various rebellious demonstrations most notably the Boston Tea Party. The French and Indian war removed a potential threat of the French from colonist’s minds, allowing them to completely focus on the British and experience in the army during the French and Indian war produced great revolutionary leaders like George Washington. Without the French and Indian war it is doubtful weather these events would have occurred which would have culminated in the formation of the United States of America. Without the French and Indian War George Washington might have just been a farmer and the United States might not have become independent. Who knows the United States under British rule might have resulted, only stretching to the Mississippi and another country might have formed, perhaps under Spanish rule to the West. Bibliography: Anderson, F., Crucible of War: The Seven Years War and the Fate of Empire in British North America, 1754-1766. New York: Knopf, 2000, page 747 Anderson, F. , The War that Made America, Viking Penguin, 2005, pages 9-10, Asimov. , I. , The Shaping of North America. , Houghton Mifflin Company, Boston, 1973, pages 174-175 Ellis, J. , His Excellency George Washington. New York: Vintage Books, A Division of Random House, Inc. , 2004, page 5 Higginbotham, D. Daniel Morgan: Revolutionary Rifleman. University of North Carolina Press, 1961 Marston, D. The French-Indian War 1754-1763. Osprey Publishing, 2002, page 84

Healthcare Reforms in England Issues of Efficiency

Healthcare Reforms in England Issues of Efficiency The healthcare service in England attempts to improve the overall healthcare service have been ongoing through some of the most radical reforms since its inception as a comprehensive public service since 1948. The noticeable need of a free healthcare service was essential after the state of the country due to the world war. Once the NHS was established it saw many reforms led by diverse types of governments at different times. Despite the scale of the reforms they have preserved their core principle of A free service at the point of delivery 1 till this very day. Even though they have adopted the core principle they still face huge challenges; as demands and costs are still rising, the entirety of the service is increasingly being looked at. This paper looks at the reforms the NHS has been through and analyses each reform in the light of Efficiency: the capability of the NHS, whether the reform made the NHS more competent, Equity: bringing fairness and equal right for the patients as well as the staff, Quality: whether adapting the reforms improved the patients ability to acquire different types of healthcare services without any predicament and obtain high-quality healthcare services. Methodology This paper was conjured up by the use of reports published by NHS Publications website. Journals and studies on NHS reform via the scientific database PubMed were also utilized. To gain info on the theories the NHS was formed on, management theory books by Max Weber, Henri Fayol and Frederic Winslow Taylor were used. Results/Discussion Each reform improvised the NHS in many ways, in relation to Efficiency the NHS since its inception has seen major investments and new hospitals built, employment of up to date technology allowing more patients to be seen within an applicable time and budgets been controlled efficiently with the aim to reduce costs each year allowing the NHS to run efficiently. In terms of Equity after the publication of the Black report, the NHS has improved on giving equal opportunities to its minor ethnic groups of staff. Also the equal treatment of patients regardless of their social class has been improved since the Blair era. The NHS in terms of quality has become one of the world leading healthcare providers. Measuring their services against standards set by the NHS ensured that they are meeting the set standards. The major investment in staff in 2000 saw a number of lives saved in the past 10 years. The NHS has met quality standards that are accepted by its patients and valued as a first class service. Conclusion Overall the NHS has seen many reforms which have lead to the NHS becoming a world class service. Since the reforms in the 1960s to the latest plans of the new coalition government the NHS has improved immensely in terms of efficiency, equity and quality and the future also looks bright for the NHS. Introduction: Healthcare service in England was launched in 1948 with an aim to provide universal healthcare to its citizens which is free at the point of use and available to everyone based on need, not ability to pay 1. The NHS was established after World War II where the country needed a stable healthcare service 2. The initial idea was that no-one should be deterred from seeking health services by a lack of resources and the founder Aneurin Bevan: Minster of Health stated A free service at the point of delivery 3. Till this day they have been providing free healthcare service to the citizens of England. In 1948 Sir William Beveridge, a British Economist and a Social Reformer conferred details of his radical plans for economic and social reform in post-war Britain. Sir William proposed major healthcare service changes on the basis that the country needed the abolition of want before the enjoyment of comfort and suggested a scheme where every kind of medical treatment would be available for everybody. 1,3 Pre NHS There has been some form of state-funded provision of health and social care in England prior to the NHS for 400 years.4 Prior to a health system being formed, attaining healthcare service in Britain in the 1930s and 1940s was difficult. Life expectancy was very low and thousands of people died of infectious diseases like pneumonia, meningitis, tuberculosis, diphtheria, and polio each year.4 The poor never had access to medical treatment and they relied instead on dubious and sometimes dangerous home remedies. Either that or they relied on doctors who gave their services free to the poor patients. The Hospitals charged for treatment and although the poor were reimbursed and before they received treatment they had to pay.4 Figure 1 shows the life expectancy that has changed since the NHS was introduced. Figure 1.Life expectancy changes since 1840 5 The need for free healthcare was widely recognised, but it was impossible to achieve without the support or resources of the government. A study showed that experts believed and have written extensively on the reasons of why a health service was needed.6 These included: The appearance of a view that health care was essential, not something just imparted erratically by charity The drastic effects of the war that made it possible to have a massive change of the healthcare service being provided, rather than just an incremental alteration As younger members of the country were becoming increasingly educated in the medical profession they had a view of things could be handle in a more efficient way. The hospitals having financial problems, funds not sufficing.6 Having looked at the reasons to why a health service was needed the government made plans and core principles were established: 6 Regardless of persons status they were eligible for health care, even people temporarily residing or visiting the country.ÂÂ   People could be referred to any hospital. The healthcare service was financed almost 100% from central taxationÂÂ   Care was entirely free at the point of use6 The main achievement was that the poor who in the past went without medical treatment now had access to free healthcare.6 NHS today and NHS employment NHS is one of the largest organisations in the world with an annual budget of around ÂÂ £80 billion employing more than 1.7 million people and treating over one million people every 36 hours.7 In general, healthcare service being provided within England to every single citizen is a difficult commission to undertake and consequently the system needs efficient health personnels to help run the system economically. Today the view of the healthcare service in England is that the NHS is a world leader and provides first class service that other countries envy. Countries all over the world seek to learn from the comprehensive system of general practice, and its role as the medical home for patients, providing continuity of care and coordination.8 Other countries look at English NHS system and use them as a guideline to run their healthcare system. NHS Structure The healthcare service in England has been run in a structural way with the Secretary of state and Department of Health controlling the overall NHS in England. The secretary of state for health has the responsibility of reporting to the prime minister. There are10 Strategic Health Authorities (SHAs) in England which are controlled by the Department of Health, they oversee all the activities within the NHS and the SHAs supervise all the NHS trusts in its area. Primary care plays a major role in community healthcare and is central to the NHS. Services under NHS trust (Secondary Care) include Hospitals, Mental Health services, Learning disability services and Ambulances. The overall structure of the NHS is shown below in Figure 2. 9 Although this is the current NHS structure with the new government in power, changes are to follow. Figure.2 overall structure of the Healthcare system in England 5 NHS Reforms Since its inception in 1948 the NHS has seen many reforms in terms of managing the way they provide healthcare service. The DoH has a lot of control and influence the major decisions taken in the reforms. The overall expectations of Healthcare service in England are of a high calibre, which requisites high-quality management capacity.10 In the 1980s and early 1990s prominence was on recuperating management. The recent focal point has been on development of leadership within NHS. With the new government, new ideas and plans will be imposed to see improvements in quality of healthcare being provided, cut down on costs making it more efficient and in terms of equity provide equal service to everyone. Table 1 briefly enlists the reforms that have taken place since its inception in 1948. Table.1 Reforms in the NHS: 1948-2010 Period the reforms were in place Reform and theory of Management 1948- 1960 Managers as diplomats 1960s Scientific Management and the Salmon report 1970s Classical Management, Systems Approaches and the 1974 Reorganization 1980s The Griffiths report and Managerialism 1990s Working for Patients and the Internal Market 2000 The NHS Plan (DOH 2000) and the Third Way. 2010 NHS White Paper 2010: Equity and excellence: Liberating the NHS Healthcare service and Reforms in other Developed Countries Healthcare reforms within developed countries can be analyzed in order to compare whether the healthcare services in England have been successful in its bid to ensure efficiency, equity and quality. Attempts to handle reforms of the healthcare system in the European countries have been an ongoing process for 30 years. Although the reforms have taken throughout the 30 years in different ways, their main emphasis has been on improving the cost-effectiveness of the healthcare service. In the early 1980s the EU countries were looking at cost containment. The feature in the 1990s was to endorse efficiency in terms of introducing competition and markets in the healthcare system. Since 2000 the focus has switched to effectiveness; promoting various notions of healthcare in terms of quality.11 Over the course of the 20th century the countries of Europe have established significant success in improving the healthcare service for their citizens. However they still face challenges in the form of restraining costs, improving quality and providing universal healthcare access, these have put the European healthcare services under immense pressure.11 Looking at another OECD: USA, A report on A review of health care reform in the United States assessed whether the USA have been successful in providing healthcare. The findings showed that United States spent more per capita on health care than any other OECD country, yet its health outcomes lagged behind other countries.12 This shows they are struggling with efficiency issues and are still countering challenges in providing quality healthcare service that is expected from the citizens of the USA. Especially in the last few years Healthcare reform has been a major activity of the federal government, in order to revolutionize and develop the service overall. The 3 goals of optimizing cost, access and quality still remain a challenge within the healthcare society in the U.S.12 They concluded that USA still faced many challenges in running the national healthcare service, a key challenge they face is the utter complexity of the system, with its numerous public and private providers.12 Another OECD country reviewed in terms of healthcare service being provided and the reforms that have taken place is China. A report from on From a national, centrally planned health system to a system based on the market: lessons from China concluded: China is the country that has undergone the highest number of health care reforms. Since 1978, China saw many reforms and they also followed the way as the EU countries, with the healthcare system starting from governmental, centrally planned and a collective system to ending up as a heavily market influenced system. Now, thirty years later, the Chinese government openly concede that the reforms were unsuccessful and seek innovative and fresh directions.13 This illustrates that China is also in a healthcare crisis and looking to implement different strategies in order to gain control of Chinas Healthcare system. Having reviewed the healthcare service being endowed in these developed countries, it demonstrates that they are all on an identical level as the healthcare service being provided in England and all face similar challenges. All these developed countries are looking to develop the countries overall healthcare service in terms of efficiency, equity and quality. NHS Plan 2000 and the future of NHS Since the last reform: The NHS plan 2000 14, a lot has transformed in terms of funding and operating the healthcare system in England. Especially with the new coalition governments idea of cutting budgets it is a difficult time the NHS is going through and will necessitate a lot of expertise and world class management to get through todays financial and economical predicament. An additional indication that will be taken into deliberation is the election of the new plans set out in the NHS White Paper 2010. As the new coalition government has come into authority there have been huge changes to overall budgets for the public services and this possibly will have a consequence on the way the NHS operates in England. 15 The reforms have encompassed a significant impact on the organisation and deliverance of health care service in England. Wide array of transformations have been pioneered in an attempt to ensure the NHS is managed more resourcefully and effectively. This report will examine whether these reforms have on the whole improved the healthcare system in England in terms of efficiency, equity and quality and if the publics requirements have been convened. Aims: To examine the healthcare reforms in England since its inception and to assess whether these reforms have improved factors of efficiency, equity and quality in providing healthcare. Objectives: To review the reforms in the NHS since its inception in 1948 To examine whether these reforms improved efficiency, equity and quality of healthcare To assess the key features of healthcare reforms proposed by the current government and their implications on the NHS To put forward plans for the future of the NHS Methodology: A number of sources were consulted to conjure up this paper and examine the healthcare reforms in the NHS. Scientific search engines and databases such as PubMed, Google Scholar and Science Direct (Date accessed 20/10/10) were used to gain literature reviews but results from Google Scholar and Science Direct were dismissed as they were too vague and irrelevant to this topic. With PubMed following keywords were inserted Healthcare, Reforms and England. The data was also set from 1948 to 2010 when searching for reports as this would set the inclusion criteria. The reports and journals since 1948, when the NHS was established were used. Even though history before 1948 was looked at for study purposes, reports before NHS establishment; these were regarded as the exclusion criteria as reports werent looked at prior to 1948. Healthcare service within Britain was looked at in general but for the results of this report, the inclusion criteria was healthcare service in England as it just look ed at the healthcare service being provided within England. The exclusion criterion was healthcare service in Scotland, Wales and Northern Ireland. For the first part of the report, the introduction: where the report looked at the history of the NHS. The resources used included looking at general management books looking at management theories. The classical theories of Max Weber, Frederic Taylor and Henri Fayol were the backbone of the NHS and that is why these were used. Another source to produce this paper was the Department of health (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/index.htm) where the publications and reports about the NHS in general were looked at. This paper used a lot of publications produced by the Department of health and the NHS publications as these sources are reliable; these were seen as good foundation to work from. One of the main publications used was The NHS white paper: Equity and excellence: Liberating the NHS presented to Parliament by the Secretary of State for Health, this was a key entity in writing up this paper. As the paper didnt contract with experiments and clinical trials, it didnt look at a lot of statistics; the majority of its content was obtained from qualitative data. Results/ Discussion Having carried out the required literature searches and reading journals, reports and Department of Health Publications, results were gathered and have been shown below with the discussion of the key topics. The results look at each reform taken place in the NHS and then goes onto analyse the plans set by the new government. Having looked at the reforms and the new plans the paper than talks about efficiency, equity and quality related to each reform. Reforms in the healthcare service in England The healthcare service in the UK has undergone a number of reforms since its inception in 1948. Prior to 1948, healthcare service was provided in England but due to the increasing pressures for efficiency and quality in health services it lead to these developments and reforms in healthcare being provided. A more overtly management-oriented approach to the healthcare service delivery was adopted based on classical management theories to gain more control of the healthcare service in England. 16,17 Classical theories and Scientific Management: 1960s The NHS was based on the classical theories of Frederic Winslow Taylor, Henri Fayol and Max Weber. 16-19 Table 1: Frederic Winslow Taylors four main scientific management principles. Replacing rule-of-work thumb methods with methods based on a scientific of the tasks Scientifically train each individual rather than leave them to train themselves Cooperate with each worker to ensure that the scientific method is being followed Divide workload equally between managers and staff Table 2: Henri Fayols Modern Operational Management approach. Division of work- Specialization for efficiency Authority Responsibility- Both are related, the latter arising from the former. Discipline-Requires good superiors at all levels Unity of Command- Employee should receive orders from one superior only Unity of Direction- Each group of activities with the same objective must have one head and one plan Subordination of individual to general interest- When the two are found to differ, management must reconcile them Remuneration-Should be fair and satisfactory Centralization-Extent to which authority is concentrated or dispersed Scalar chain/line of authority-Needs to be sensible, clear and understood Order : Right thing/person in the right place Equity- Equal opportunity for everyone Stability of tenure- Unnecessary turnover is both the cause and effect of bad management Initiative- Thinking out and execution of a plan Thinking out and execution of a plan Table 3. Max Webers Bureaucratic approach. Power-Ability to get things done, often by the use of threats or sanctions Authority- Ability to get things done because of the position that justified someone in terms of legitimacy Formal approach Hierarchical authority Extensive roles and procedures- Uniformity of decisions and actions Job description- Clear-cut division of labour and High level of specialization Discipline These classical theories contributed a lot to the healthcare service in England and still do to this day.16-19 The classical writers thought of the NHS in terms of purpose and formal structure. They created a formal structure on which the NHS could run on. They also looked at job design, scientific selection and development of workers. The classical theories generally serve as a backbone to the present day NHS management. Although the classical theories made a big contribution to the healthcare service in England it had its limitations and wasnt the most effective way. One drawback was that it wasnt evidence based; it didnt look at the way staff did their tasks and didnt look at the well being of staff, the human and social aspects of work. It just treated them like machines. The theories didnt look at motivating the staff and developing them in their own interests, had they done this staffs work quality wouldve enhanced thus providing an efficient service to patients and overall improve the quality of healthcare service in England. Overall the classical theories were too concrete and fully based on rules and procedures. In terms of efficiency the theories bought a set way of running the healthcare service in England. Once the NHS was established it introduced equity as well as healthcare service was now available to anyone. The NHS was just established and with these set in place in the 1960s the qua lity of service would improve from now with further reforms to come. Salmon Report: 1960s One of the first reforms took place since the NHS was established was in the 1960s. The Salmon Report bought findings and changes which included that workload should be equally distributed between managers and practitioners.20 The NHS would also get rid of matrons and replace them with a hierarchy of nurse managers. The introduction of several additional layers to the management hierarchy; in order to improve efficiency in operating the NHS. This lead to responsibility being equally distributed and the service met its aims and objectives more efficiently. Another change was that nurse managers would contribute to the overall management of the service through the medium of consensus management teams and thus improve efficiency and quality within the NHS. Having nurse managers lead to them taking control of set responsibilities and helped in general running of tasks at ward level leading to an improvement in general quality in the healthcare service being provided. 1974 Reorganization: 1970s The aim of this reform was to attain greater integration of the healthcare service in order to provide more stability and increase efficiency. The reorganisation also introduced more central control in order to: 21 ensure policies were implemented improve accountability encourage delegation develop democratic decision-making process These changes lead to a more structured way for managers to follow and enhance the quality of the healthcare service. By the mid 1970s quality was improving but there were still concerns of equity in the NHS. There were still clear differences of health sufferers in terms of social class; figures showed that people in lower social classes more likely suffered from diseases. There were several possible explanations for these inequalities. Natural and social selection. This would depend on the view that people who are fittest are most likely to succeed in society, and classes reflect this degree of selection. Poverty leads to ill health, through nutrition, housing and environment. Cultural and behavioural explanations. There are differences in the diet and fitness of different social classes, and in certain habits like smoking. 22,23 Overall in the 1970s the quality of healthcare service was still improving, equity issues were still a concern and in terms of efficiency they were recuperating the NHS. The Griffiths Report: 1980s This reform was a major point in NHS history, the Griffiths Report identified problems such as the healthcare service was institutionally inactive and that the local health authorities were filled with directives without being given any clear procedures to follow.24 The Griffiths report stated that changes were difficult to achieve but gave recommendations to improve the NHS. It introduced a more formal and modern way of management. It gave increased participation for managers in setting and controlling budgets. The report also gave greater emphasis on cost awareness in order to improve efficiency. A Clear and quick decision-making process was introduced to improve quality of service provided to patients. The managers in local authorities were given a more clearly defined direction and the overall staffs were better informed.24 The Internal Market Working For Patients: 1990s Another reform in the 1990s took place, this bought a new dimension to the NHS; large publicly-owned hospitals could opt to become self-managed trusts. This meant that health services could be bought by private investors i.e. patients themselves thus allowing them to take control of the way they want the service. Even large GPs could become fund holders and be both purchasers and providers of care.25 This reform lead to introduction of greater flexibility thus allowing more effective matching of patients needs and care. Money followed the patients through the system of purchasing and providing of healthcare service, this led to equity being improved as patients had more selection of services. This reform led to higher competition in providing quality healthcare service, the costs decreased and the general quality increased. The NHS Plan 2000 The NHS Plan 2000 made key findings : the NHS is a 1940s system operating in the 21st century and that it lacked of national standards. It also said that there were barriers between staff and providing services. There were a lack of clear guidelines and the NHS structure has over-centralization.14 Plans to diminish problems and propose new plans such as introducing Modern Matrons to improve the management of services, a strong leader with clinical experience and with clear authority at ward level, improve efficiency by setting standards and controlling resources these were there aims.14,26 The figure below shows the comparison of the 1948 and the new NHS model outlining the key differences. Figure.4 the key difference between the 1948 model and The NHS Plan 2000 model 14 The NHS Plan 2000: Achievements This reform set out specific targets which were achieved in order to improve efficiency, equity and quality of healthcare service in England: Over 100 new hospitals by 2010 and 500 new one-stop primary care centres Clean wards and better hospital food 7,000 extra beds in hospitals Over 3,000 GP premises modernized Modern IT systems in every hospital and GP surgery 7,500 more consultants and 2,000 more GPs 20,000 extra nurses and 6,500 extra therapists Childcare support for NHS staff with 100 on-site nurseries.26 These targets were achieved in 2008 and it led to the improvement of efficiency as the number of GPs and consultants employed were increased. The modernisation of technology and IT systems led to quality of service being improved as high investment in high quality equipment made the NHS one of the worlds top quality service. Since 2000 NHS has improved the overall service and met its objectives. NHS Implications: Equity and excellence: Liberating the NHS With the new coalition government coming into election another set of reforms have been proposed as they hope to improve the overall healthcare service in England. The main aims and objectives to improve the healthcare service are varied and very detailed but to summarise it these are the points covered:15 Increase health spending in real terms in each year of this Parliament 15and also that there goal is an NHS which achieves results that are amongst the best in the world 15. However the government will uphold the foundation that the NHS was formed on; a comprehensive service, available to all, free at the point of use and based on clinical need, not the ability to pay 15. The government than goes into detail of what they arrange to initiate to make an efficient healthcare service: acknowledge the fact that patients come first and therefore will give them greater choice and control. An example of this is that a patient will be able to choose any GP practice, consultant, and choice of treatment consequently improving equity of the service. The government endeavours to develop the healthcare outcomes: set objectives such as reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all 15. By doing this they are ensuring they are driving efficiency and improving the service. In order to achieve the objectives that the government sets, the ability for service providers to have more autonomy, responsibility and accountability will be a means to achieving efficient results. A big change will be the establishment of a NHS Commissioning Board. The board will be accountable for making sure health outcomes are achieved, allocate resources and have the lead on quality improvement and to tackle inequalities that exist in the NHS. Overall the reforms in the NHS Paper 2010 will provide the NHS with greater incentives to increase efficiency, equity and quality. Efficiency The healthcare system in England has on the whole perceived a huge improvement in terms of efficiency since its inception in 1948. A system has been established where it endows with one of the best services in the world but there are still room for improvements. An analysis of the services gives evidence such as the NHS building 100 new hospitals since 2000, therefore improving the efficiency and allowing better access for patients. 27 Even though there continue to be a lack of quality and accessibility to services across the country. The patients havent been able to impose enough pressure to force improvements. The NHS need to give patients more control over the health services they have access to improve efficiency. In 2008 investment in the NHS as a whole rose from ÂÂ £43.9bn per year in 2000, when the NHS Plan was launched, to ÂÂ £92.6bn. another measurement of efficiency is looking at numbers of early deaths from cancer, coronary heart disease and suicide; they continue to fall as services improve; over 98% of patients at Accident and Emergency (AE) Departments are seen within 4 hours; and hospital waiting lists are lower than ever, with half a million fewer patients waiting since lists were at their peak.28 One key way to achieve the set objectives is to cut down NHS managements costs by 45% over the next four years enabling them to free up investment for further improvements.28 Much has been achieved during the last five years of investment and reforms. For example, the significant investment in NHS staff, along with more flexible working, is facilitating healthcare professionals to take advantage of the freedom thus improving their commitment to the NHS. NHS staff working flexibly and using improved technology are better able to respond to patients needs and changing expectations and are achieving improvements in quality and productivity across the system.27 Since 1948, the NHS budget on average has risen over 4% in real terms each year; this is something they hope to resolve as the NHS will face a sustained and substantial financial constraint if it continues. They hope to avoid the financial crisis that happened in the NHS in the 1970s. The NHS hopes to release up to ÂÂ £20 billion of efficiency savings by 2014, which will be reinvested to suppor Healthcare Reforms in England Issues of Efficiency Healthcare Reforms in England Issues of Efficiency The healthcare service in England attempts to improve the overall healthcare service have been ongoing through some of the most radical reforms since its inception as a comprehensive public service since 1948. The noticeable need of a free healthcare service was essential after the state of the country due to the world war. Once the NHS was established it saw many reforms led by diverse types of governments at different times. Despite the scale of the reforms they have preserved their core principle of A free service at the point of delivery 1 till this very day. Even though they have adopted the core principle they still face huge challenges; as demands and costs are still rising, the entirety of the service is increasingly being looked at. This paper looks at the reforms the NHS has been through and analyses each reform in the light of Efficiency: the capability of the NHS, whether the reform made the NHS more competent, Equity: bringing fairness and equal right for the patients as well as the staff, Quality: whether adapting the reforms improved the patients ability to acquire different types of healthcare services without any predicament and obtain high-quality healthcare services. Methodology This paper was conjured up by the use of reports published by NHS Publications website. Journals and studies on NHS reform via the scientific database PubMed were also utilized. To gain info on the theories the NHS was formed on, management theory books by Max Weber, Henri Fayol and Frederic Winslow Taylor were used. Results/Discussion Each reform improvised the NHS in many ways, in relation to Efficiency the NHS since its inception has seen major investments and new hospitals built, employment of up to date technology allowing more patients to be seen within an applicable time and budgets been controlled efficiently with the aim to reduce costs each year allowing the NHS to run efficiently. In terms of Equity after the publication of the Black report, the NHS has improved on giving equal opportunities to its minor ethnic groups of staff. Also the equal treatment of patients regardless of their social class has been improved since the Blair era. The NHS in terms of quality has become one of the world leading healthcare providers. Measuring their services against standards set by the NHS ensured that they are meeting the set standards. The major investment in staff in 2000 saw a number of lives saved in the past 10 years. The NHS has met quality standards that are accepted by its patients and valued as a first class service. Conclusion Overall the NHS has seen many reforms which have lead to the NHS becoming a world class service. Since the reforms in the 1960s to the latest plans of the new coalition government the NHS has improved immensely in terms of efficiency, equity and quality and the future also looks bright for the NHS. Introduction: Healthcare service in England was launched in 1948 with an aim to provide universal healthcare to its citizens which is free at the point of use and available to everyone based on need, not ability to pay 1. The NHS was established after World War II where the country needed a stable healthcare service 2. The initial idea was that no-one should be deterred from seeking health services by a lack of resources and the founder Aneurin Bevan: Minster of Health stated A free service at the point of delivery 3. Till this day they have been providing free healthcare service to the citizens of England. In 1948 Sir William Beveridge, a British Economist and a Social Reformer conferred details of his radical plans for economic and social reform in post-war Britain. Sir William proposed major healthcare service changes on the basis that the country needed the abolition of want before the enjoyment of comfort and suggested a scheme where every kind of medical treatment would be available for everybody. 1,3 Pre NHS There has been some form of state-funded provision of health and social care in England prior to the NHS for 400 years.4 Prior to a health system being formed, attaining healthcare service in Britain in the 1930s and 1940s was difficult. Life expectancy was very low and thousands of people died of infectious diseases like pneumonia, meningitis, tuberculosis, diphtheria, and polio each year.4 The poor never had access to medical treatment and they relied instead on dubious and sometimes dangerous home remedies. Either that or they relied on doctors who gave their services free to the poor patients. The Hospitals charged for treatment and although the poor were reimbursed and before they received treatment they had to pay.4 Figure 1 shows the life expectancy that has changed since the NHS was introduced. Figure 1.Life expectancy changes since 1840 5 The need for free healthcare was widely recognised, but it was impossible to achieve without the support or resources of the government. A study showed that experts believed and have written extensively on the reasons of why a health service was needed.6 These included: The appearance of a view that health care was essential, not something just imparted erratically by charity The drastic effects of the war that made it possible to have a massive change of the healthcare service being provided, rather than just an incremental alteration As younger members of the country were becoming increasingly educated in the medical profession they had a view of things could be handle in a more efficient way. The hospitals having financial problems, funds not sufficing.6 Having looked at the reasons to why a health service was needed the government made plans and core principles were established: 6 Regardless of persons status they were eligible for health care, even people temporarily residing or visiting the country.ÂÂ   People could be referred to any hospital. The healthcare service was financed almost 100% from central taxationÂÂ   Care was entirely free at the point of use6 The main achievement was that the poor who in the past went without medical treatment now had access to free healthcare.6 NHS today and NHS employment NHS is one of the largest organisations in the world with an annual budget of around ÂÂ £80 billion employing more than 1.7 million people and treating over one million people every 36 hours.7 In general, healthcare service being provided within England to every single citizen is a difficult commission to undertake and consequently the system needs efficient health personnels to help run the system economically. Today the view of the healthcare service in England is that the NHS is a world leader and provides first class service that other countries envy. Countries all over the world seek to learn from the comprehensive system of general practice, and its role as the medical home for patients, providing continuity of care and coordination.8 Other countries look at English NHS system and use them as a guideline to run their healthcare system. NHS Structure The healthcare service in England has been run in a structural way with the Secretary of state and Department of Health controlling the overall NHS in England. The secretary of state for health has the responsibility of reporting to the prime minister. There are10 Strategic Health Authorities (SHAs) in England which are controlled by the Department of Health, they oversee all the activities within the NHS and the SHAs supervise all the NHS trusts in its area. Primary care plays a major role in community healthcare and is central to the NHS. Services under NHS trust (Secondary Care) include Hospitals, Mental Health services, Learning disability services and Ambulances. The overall structure of the NHS is shown below in Figure 2. 9 Although this is the current NHS structure with the new government in power, changes are to follow. Figure.2 overall structure of the Healthcare system in England 5 NHS Reforms Since its inception in 1948 the NHS has seen many reforms in terms of managing the way they provide healthcare service. The DoH has a lot of control and influence the major decisions taken in the reforms. The overall expectations of Healthcare service in England are of a high calibre, which requisites high-quality management capacity.10 In the 1980s and early 1990s prominence was on recuperating management. The recent focal point has been on development of leadership within NHS. With the new government, new ideas and plans will be imposed to see improvements in quality of healthcare being provided, cut down on costs making it more efficient and in terms of equity provide equal service to everyone. Table 1 briefly enlists the reforms that have taken place since its inception in 1948. Table.1 Reforms in the NHS: 1948-2010 Period the reforms were in place Reform and theory of Management 1948- 1960 Managers as diplomats 1960s Scientific Management and the Salmon report 1970s Classical Management, Systems Approaches and the 1974 Reorganization 1980s The Griffiths report and Managerialism 1990s Working for Patients and the Internal Market 2000 The NHS Plan (DOH 2000) and the Third Way. 2010 NHS White Paper 2010: Equity and excellence: Liberating the NHS Healthcare service and Reforms in other Developed Countries Healthcare reforms within developed countries can be analyzed in order to compare whether the healthcare services in England have been successful in its bid to ensure efficiency, equity and quality. Attempts to handle reforms of the healthcare system in the European countries have been an ongoing process for 30 years. Although the reforms have taken throughout the 30 years in different ways, their main emphasis has been on improving the cost-effectiveness of the healthcare service. In the early 1980s the EU countries were looking at cost containment. The feature in the 1990s was to endorse efficiency in terms of introducing competition and markets in the healthcare system. Since 2000 the focus has switched to effectiveness; promoting various notions of healthcare in terms of quality.11 Over the course of the 20th century the countries of Europe have established significant success in improving the healthcare service for their citizens. However they still face challenges in the form of restraining costs, improving quality and providing universal healthcare access, these have put the European healthcare services under immense pressure.11 Looking at another OECD: USA, A report on A review of health care reform in the United States assessed whether the USA have been successful in providing healthcare. The findings showed that United States spent more per capita on health care than any other OECD country, yet its health outcomes lagged behind other countries.12 This shows they are struggling with efficiency issues and are still countering challenges in providing quality healthcare service that is expected from the citizens of the USA. Especially in the last few years Healthcare reform has been a major activity of the federal government, in order to revolutionize and develop the service overall. The 3 goals of optimizing cost, access and quality still remain a challenge within the healthcare society in the U.S.12 They concluded that USA still faced many challenges in running the national healthcare service, a key challenge they face is the utter complexity of the system, with its numerous public and private providers.12 Another OECD country reviewed in terms of healthcare service being provided and the reforms that have taken place is China. A report from on From a national, centrally planned health system to a system based on the market: lessons from China concluded: China is the country that has undergone the highest number of health care reforms. Since 1978, China saw many reforms and they also followed the way as the EU countries, with the healthcare system starting from governmental, centrally planned and a collective system to ending up as a heavily market influenced system. Now, thirty years later, the Chinese government openly concede that the reforms were unsuccessful and seek innovative and fresh directions.13 This illustrates that China is also in a healthcare crisis and looking to implement different strategies in order to gain control of Chinas Healthcare system. Having reviewed the healthcare service being endowed in these developed countries, it demonstrates that they are all on an identical level as the healthcare service being provided in England and all face similar challenges. All these developed countries are looking to develop the countries overall healthcare service in terms of efficiency, equity and quality. NHS Plan 2000 and the future of NHS Since the last reform: The NHS plan 2000 14, a lot has transformed in terms of funding and operating the healthcare system in England. Especially with the new coalition governments idea of cutting budgets it is a difficult time the NHS is going through and will necessitate a lot of expertise and world class management to get through todays financial and economical predicament. An additional indication that will be taken into deliberation is the election of the new plans set out in the NHS White Paper 2010. As the new coalition government has come into authority there have been huge changes to overall budgets for the public services and this possibly will have a consequence on the way the NHS operates in England. 15 The reforms have encompassed a significant impact on the organisation and deliverance of health care service in England. Wide array of transformations have been pioneered in an attempt to ensure the NHS is managed more resourcefully and effectively. This report will examine whether these reforms have on the whole improved the healthcare system in England in terms of efficiency, equity and quality and if the publics requirements have been convened. Aims: To examine the healthcare reforms in England since its inception and to assess whether these reforms have improved factors of efficiency, equity and quality in providing healthcare. Objectives: To review the reforms in the NHS since its inception in 1948 To examine whether these reforms improved efficiency, equity and quality of healthcare To assess the key features of healthcare reforms proposed by the current government and their implications on the NHS To put forward plans for the future of the NHS Methodology: A number of sources were consulted to conjure up this paper and examine the healthcare reforms in the NHS. Scientific search engines and databases such as PubMed, Google Scholar and Science Direct (Date accessed 20/10/10) were used to gain literature reviews but results from Google Scholar and Science Direct were dismissed as they were too vague and irrelevant to this topic. With PubMed following keywords were inserted Healthcare, Reforms and England. The data was also set from 1948 to 2010 when searching for reports as this would set the inclusion criteria. The reports and journals since 1948, when the NHS was established were used. Even though history before 1948 was looked at for study purposes, reports before NHS establishment; these were regarded as the exclusion criteria as reports werent looked at prior to 1948. Healthcare service within Britain was looked at in general but for the results of this report, the inclusion criteria was healthcare service in England as it just look ed at the healthcare service being provided within England. The exclusion criterion was healthcare service in Scotland, Wales and Northern Ireland. For the first part of the report, the introduction: where the report looked at the history of the NHS. The resources used included looking at general management books looking at management theories. The classical theories of Max Weber, Frederic Taylor and Henri Fayol were the backbone of the NHS and that is why these were used. Another source to produce this paper was the Department of health (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/index.htm) where the publications and reports about the NHS in general were looked at. This paper used a lot of publications produced by the Department of health and the NHS publications as these sources are reliable; these were seen as good foundation to work from. One of the main publications used was The NHS white paper: Equity and excellence: Liberating the NHS presented to Parliament by the Secretary of State for Health, this was a key entity in writing up this paper. As the paper didnt contract with experiments and clinical trials, it didnt look at a lot of statistics; the majority of its content was obtained from qualitative data. Results/ Discussion Having carried out the required literature searches and reading journals, reports and Department of Health Publications, results were gathered and have been shown below with the discussion of the key topics. The results look at each reform taken place in the NHS and then goes onto analyse the plans set by the new government. Having looked at the reforms and the new plans the paper than talks about efficiency, equity and quality related to each reform. Reforms in the healthcare service in England The healthcare service in the UK has undergone a number of reforms since its inception in 1948. Prior to 1948, healthcare service was provided in England but due to the increasing pressures for efficiency and quality in health services it lead to these developments and reforms in healthcare being provided. A more overtly management-oriented approach to the healthcare service delivery was adopted based on classical management theories to gain more control of the healthcare service in England. 16,17 Classical theories and Scientific Management: 1960s The NHS was based on the classical theories of Frederic Winslow Taylor, Henri Fayol and Max Weber. 16-19 Table 1: Frederic Winslow Taylors four main scientific management principles. Replacing rule-of-work thumb methods with methods based on a scientific of the tasks Scientifically train each individual rather than leave them to train themselves Cooperate with each worker to ensure that the scientific method is being followed Divide workload equally between managers and staff Table 2: Henri Fayols Modern Operational Management approach. Division of work- Specialization for efficiency Authority Responsibility- Both are related, the latter arising from the former. Discipline-Requires good superiors at all levels Unity of Command- Employee should receive orders from one superior only Unity of Direction- Each group of activities with the same objective must have one head and one plan Subordination of individual to general interest- When the two are found to differ, management must reconcile them Remuneration-Should be fair and satisfactory Centralization-Extent to which authority is concentrated or dispersed Scalar chain/line of authority-Needs to be sensible, clear and understood Order : Right thing/person in the right place Equity- Equal opportunity for everyone Stability of tenure- Unnecessary turnover is both the cause and effect of bad management Initiative- Thinking out and execution of a plan Thinking out and execution of a plan Table 3. Max Webers Bureaucratic approach. Power-Ability to get things done, often by the use of threats or sanctions Authority- Ability to get things done because of the position that justified someone in terms of legitimacy Formal approach Hierarchical authority Extensive roles and procedures- Uniformity of decisions and actions Job description- Clear-cut division of labour and High level of specialization Discipline These classical theories contributed a lot to the healthcare service in England and still do to this day.16-19 The classical writers thought of the NHS in terms of purpose and formal structure. They created a formal structure on which the NHS could run on. They also looked at job design, scientific selection and development of workers. The classical theories generally serve as a backbone to the present day NHS management. Although the classical theories made a big contribution to the healthcare service in England it had its limitations and wasnt the most effective way. One drawback was that it wasnt evidence based; it didnt look at the way staff did their tasks and didnt look at the well being of staff, the human and social aspects of work. It just treated them like machines. The theories didnt look at motivating the staff and developing them in their own interests, had they done this staffs work quality wouldve enhanced thus providing an efficient service to patients and overall improve the quality of healthcare service in England. Overall the classical theories were too concrete and fully based on rules and procedures. In terms of efficiency the theories bought a set way of running the healthcare service in England. Once the NHS was established it introduced equity as well as healthcare service was now available to anyone. The NHS was just established and with these set in place in the 1960s the qua lity of service would improve from now with further reforms to come. Salmon Report: 1960s One of the first reforms took place since the NHS was established was in the 1960s. The Salmon Report bought findings and changes which included that workload should be equally distributed between managers and practitioners.20 The NHS would also get rid of matrons and replace them with a hierarchy of nurse managers. The introduction of several additional layers to the management hierarchy; in order to improve efficiency in operating the NHS. This lead to responsibility being equally distributed and the service met its aims and objectives more efficiently. Another change was that nurse managers would contribute to the overall management of the service through the medium of consensus management teams and thus improve efficiency and quality within the NHS. Having nurse managers lead to them taking control of set responsibilities and helped in general running of tasks at ward level leading to an improvement in general quality in the healthcare service being provided. 1974 Reorganization: 1970s The aim of this reform was to attain greater integration of the healthcare service in order to provide more stability and increase efficiency. The reorganisation also introduced more central control in order to: 21 ensure policies were implemented improve accountability encourage delegation develop democratic decision-making process These changes lead to a more structured way for managers to follow and enhance the quality of the healthcare service. By the mid 1970s quality was improving but there were still concerns of equity in the NHS. There were still clear differences of health sufferers in terms of social class; figures showed that people in lower social classes more likely suffered from diseases. There were several possible explanations for these inequalities. Natural and social selection. This would depend on the view that people who are fittest are most likely to succeed in society, and classes reflect this degree of selection. Poverty leads to ill health, through nutrition, housing and environment. Cultural and behavioural explanations. There are differences in the diet and fitness of different social classes, and in certain habits like smoking. 22,23 Overall in the 1970s the quality of healthcare service was still improving, equity issues were still a concern and in terms of efficiency they were recuperating the NHS. The Griffiths Report: 1980s This reform was a major point in NHS history, the Griffiths Report identified problems such as the healthcare service was institutionally inactive and that the local health authorities were filled with directives without being given any clear procedures to follow.24 The Griffiths report stated that changes were difficult to achieve but gave recommendations to improve the NHS. It introduced a more formal and modern way of management. It gave increased participation for managers in setting and controlling budgets. The report also gave greater emphasis on cost awareness in order to improve efficiency. A Clear and quick decision-making process was introduced to improve quality of service provided to patients. The managers in local authorities were given a more clearly defined direction and the overall staffs were better informed.24 The Internal Market Working For Patients: 1990s Another reform in the 1990s took place, this bought a new dimension to the NHS; large publicly-owned hospitals could opt to become self-managed trusts. This meant that health services could be bought by private investors i.e. patients themselves thus allowing them to take control of the way they want the service. Even large GPs could become fund holders and be both purchasers and providers of care.25 This reform lead to introduction of greater flexibility thus allowing more effective matching of patients needs and care. Money followed the patients through the system of purchasing and providing of healthcare service, this led to equity being improved as patients had more selection of services. This reform led to higher competition in providing quality healthcare service, the costs decreased and the general quality increased. The NHS Plan 2000 The NHS Plan 2000 made key findings : the NHS is a 1940s system operating in the 21st century and that it lacked of national standards. It also said that there were barriers between staff and providing services. There were a lack of clear guidelines and the NHS structure has over-centralization.14 Plans to diminish problems and propose new plans such as introducing Modern Matrons to improve the management of services, a strong leader with clinical experience and with clear authority at ward level, improve efficiency by setting standards and controlling resources these were there aims.14,26 The figure below shows the comparison of the 1948 and the new NHS model outlining the key differences. Figure.4 the key difference between the 1948 model and The NHS Plan 2000 model 14 The NHS Plan 2000: Achievements This reform set out specific targets which were achieved in order to improve efficiency, equity and quality of healthcare service in England: Over 100 new hospitals by 2010 and 500 new one-stop primary care centres Clean wards and better hospital food 7,000 extra beds in hospitals Over 3,000 GP premises modernized Modern IT systems in every hospital and GP surgery 7,500 more consultants and 2,000 more GPs 20,000 extra nurses and 6,500 extra therapists Childcare support for NHS staff with 100 on-site nurseries.26 These targets were achieved in 2008 and it led to the improvement of efficiency as the number of GPs and consultants employed were increased. The modernisation of technology and IT systems led to quality of service being improved as high investment in high quality equipment made the NHS one of the worlds top quality service. Since 2000 NHS has improved the overall service and met its objectives. NHS Implications: Equity and excellence: Liberating the NHS With the new coalition government coming into election another set of reforms have been proposed as they hope to improve the overall healthcare service in England. The main aims and objectives to improve the healthcare service are varied and very detailed but to summarise it these are the points covered:15 Increase health spending in real terms in each year of this Parliament 15and also that there goal is an NHS which achieves results that are amongst the best in the world 15. However the government will uphold the foundation that the NHS was formed on; a comprehensive service, available to all, free at the point of use and based on clinical need, not the ability to pay 15. The government than goes into detail of what they arrange to initiate to make an efficient healthcare service: acknowledge the fact that patients come first and therefore will give them greater choice and control. An example of this is that a patient will be able to choose any GP practice, consultant, and choice of treatment consequently improving equity of the service. The government endeavours to develop the healthcare outcomes: set objectives such as reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all 15. By doing this they are ensuring they are driving efficiency and improving the service. In order to achieve the objectives that the government sets, the ability for service providers to have more autonomy, responsibility and accountability will be a means to achieving efficient results. A big change will be the establishment of a NHS Commissioning Board. The board will be accountable for making sure health outcomes are achieved, allocate resources and have the lead on quality improvement and to tackle inequalities that exist in the NHS. Overall the reforms in the NHS Paper 2010 will provide the NHS with greater incentives to increase efficiency, equity and quality. Efficiency The healthcare system in England has on the whole perceived a huge improvement in terms of efficiency since its inception in 1948. A system has been established where it endows with one of the best services in the world but there are still room for improvements. An analysis of the services gives evidence such as the NHS building 100 new hospitals since 2000, therefore improving the efficiency and allowing better access for patients. 27 Even though there continue to be a lack of quality and accessibility to services across the country. The patients havent been able to impose enough pressure to force improvements. The NHS need to give patients more control over the health services they have access to improve efficiency. In 2008 investment in the NHS as a whole rose from ÂÂ £43.9bn per year in 2000, when the NHS Plan was launched, to ÂÂ £92.6bn. another measurement of efficiency is looking at numbers of early deaths from cancer, coronary heart disease and suicide; they continue to fall as services improve; over 98% of patients at Accident and Emergency (AE) Departments are seen within 4 hours; and hospital waiting lists are lower than ever, with half a million fewer patients waiting since lists were at their peak.28 One key way to achieve the set objectives is to cut down NHS managements costs by 45% over the next four years enabling them to free up investment for further improvements.28 Much has been achieved during the last five years of investment and reforms. For example, the significant investment in NHS staff, along with more flexible working, is facilitating healthcare professionals to take advantage of the freedom thus improving their commitment to the NHS. NHS staff working flexibly and using improved technology are better able to respond to patients needs and changing expectations and are achieving improvements in quality and productivity across the system.27 Since 1948, the NHS budget on average has risen over 4% in real terms each year; this is something they hope to resolve as the NHS will face a sustained and substantial financial constraint if it continues. They hope to avoid the financial crisis that happened in the NHS in the 1970s. The NHS hopes to release up to ÂÂ £20 billion of efficiency savings by 2014, which will be reinvested to suppor