Social services have been pivotal to human survival and existence for decades. However, in a regulatory sense, it was first established with the passage of the National Assistance Act in 1948 (Anderson et al., 2021). Yet, the origins of social aid may be traced back centuries, to the Victorian Poor Law and workhouses of the 15th century and the cooperative and friendly groups of the 19th century (Anderson et al., 2021). Nevertheless, the Beveridge inquiry was founded in 1941 to create a deep sound foundation for welfare (Anderson et al., 2021). Its report from the succeeding year outlined strategies for defeating the “Five Giants” of poverty, sickness, idleness, filth, and ignorance. After building a substantial nationalized health industry in the 1950s, several governments of the era began to evaluate how the services should be handled closely.
However, there were various changes in the following years. Throughout the 1960s, numerous hospitals were erected as capitalism-ruled health programs (Paton, 2022). A district general hospital was also built about the same time to offer comprehensive, well-coordinated services to the local population (Paton, 2022). Therefore, only patients who needed relatively specialist treatment had to go to regional hospitals for cardiology and neurosurgery (Paton, 2022). Corporate health management also gained popularity in the 1970s as the NHS was redesigned in 1974 to improve service coordination (Paton, 2022). The NHS adopted population-based funding and integrated public health with community and hospital services (Paton, 2022). England and Wales adopted the 1983 Mental Health Act though the Royal Commission 12, which made these proposals, rejected NHS general administration (Paton, 2022). This was a significant issue of contention that saw delayed progress in NHS governance and general growth.
Serving patients’ needs presented comprehensive plans outlining the most dramatic NHS reforms. It marked a critical shift since its founding, breaking the post-war consensus about the NHS’s administration in the 1990s—the updated, dependable NHS, which appeared in December 1997 (NHS Reforms Timeline, 2022). In many ways, it constituted an improvement over the Working for Patient-era administration of the NHS rather than a revolution. The Commission for Hospital Improvement was established as the first organization to formally evaluate the performance of NHS hospitals by the Health Act of 1999 (NHS Reforms Timeline, 2022).
The Standard Care Act 2000 was legislated to repeal the Registered Homes Act 1984 (NHS Reforms Timeline, 2022). In 2001 the NHS plan was formalized by the Health and Social Act 2001 (NHS Reforms Timeline, 2022). The National Health Service Reform and Health Care Professions Act of 2002 authorized the power to be transferred from regional health departments to strategic health officials (NHS Reforms Timeline, 2022). These legislations were critical in authenticating the shift and ensuring that the NHS remained independent and transformed lives as desired.
Specific key legislations were vital in the localities. Primarily, local health and well-being boards were established by the Health and Social Care Act of 2012 in every local government area to promote the other (Agrawal & Prabakaran, 2020). Local health commissioning groups were required to support integration when it would identify opportunities for improvement or reduce inequities. In 2013 Integrated Care: Our Shared Commitment emerged (Agrawal & Prabakaran, 2020). Twelve national partners and the Department of Health committed to immediate and sustained intervention to make coordinated and integrated care and health the norm by 2018 (Agrawal & Prabakaran, 2020). The Care Act 2014 came to its legislation (Preston-Shoot, 2020). The law mandated local governments to encourage integration when it would increase welfare, improve quality, or avoid the development of care requirements.
There were also spending regulations in this line of critical laws. Local governments in England were mandated by the Spending Review and Autumn Statement 2015 to prepare plans outlining how they will integrate health and social care services by the year 2020 (Miller et al., 2019). During the next five years, sustainability and change strategies were monitored, and local health organizations were tasked with developing plans to improve services and finances. The emphasis shifted from planning to collaborations (Miller et al., 2019). The integrated care systems version of 2018 ensured more sophisticated versions of Sustainability and Transformation Partnerships, giving local NHS organizations more control over how they spend available funds and how well their healthcare systems are managed (Bockey et al., 2020).
National bodies only guarantee plans at the system level, not those of specific organizations. The Data Protection Act of 2018 granted individuals the right to know what details the government and other organizations had on file about them (Bockey et al., 2020). Primary care networks were established so that general practitioners may integrate primary care programs into their local communities and interact with other pertinent organizations in 2019 (Bockey et al., 2020). With these, the NHS and general healthcare have appropriately been regulated for the benefit of their patients.
Organization and Provision of Care Services
The healthcare system in the United Kingdom is devolved for better care provision. Wales, Northern Ireland, England, and Scotland have their distinct system of healthcare provision, which are publicly and privately funded (Deeming, 2019). The primary healthcare provider in England is the National Health Service (NHS) which is similar to Wales and Scotland as they also have their own respective NHS as the primary healthcare system provider (Harrington et al., 2021). Health and Social Care, more often abbreviated to “NHS” for shorthand purposes, provides most of Northern Ireland’s healthcare services. Local Directors of Social Services and the National Health Service (NHS) in England report to the Department of Health, which is responsible for coordinating all aspects of social care in the country.
Decision-making procedures in social care and health may be complicated and include many individuals, with many organizations in charge of different policy formulation and implementation areas. Integrated care systems are the most recent project to develop cooperation between social care and NHS (Deeming, 2019). Decision-making, funding, and accounting are all handled differently in the NHS, social care, and public health than in other sectors (Moon et al., 2019). NHS England, Public Health England, NHS Improvement, and the Local Authorities comprise the health and social care sector.
Care and health policy in England is overseen and funded by the government department, the Department for Health and Social Care. NHS England is under its purview. NHS England establishes the NHS’s goals and direction and leads advancements in social care and health in England. NHS Improvement is responsible for monitoring NHS trusts and helping them develop sustainable financial operations (Paton, 2022). Public Health England is responsible for safeguarding and enhancing the nation’s well-being and health and decreasing health disparities.
Clinical Commissioning Groups (CCGs) are associations composed of primary care providers operating in a local area. They are overseen by a board of medical professionals, other clinicians, and individuals without a medical background. The primary function of CCGs is to provide emergency care, urgent care, mental health services, community care, and elective hospital services to residents in their locality. Regarding funding, CCGs receive most of the budget allocated by NHS England, accounting for two-thirds of the total spending (Paton, 2022). The Integrated Care System (ICS) is an emerging healthcare framework integrating health and social care resources to enhance personalized patient care. Some consider ICS the most promising innovation in the realm of Sustainability and Transformation Partnerships (STPs), which are strategic collaborations aimed at driving long-term, transformational changes in health and social care systems.
As health is devolved, Wales may operate differently from England. Its “flying physicians” service and transplant program presumes permission for organ donation unless a person opts out has earned notice and appreciation (Moon et al., 2019). However, Scotland’s healthcare is poor and linked to NHS boards’ unwillingness to buy a stereotactic ablative radiotherapy system, a pricey but effective radiation technology, that worries cancer doctors. Nevertheless, local governments provide several necessary and voluntary services to their inhabitants. Social care, vulnerable people and children, and public health are their responsibilities. Hertfordshire has three NHS clinical commissioning groups with heavily populated towns and broad rural areas (Syddall et al., 2019). They operate directly in the county since one acute trust covers West Essex and East Hertfordshire residents. Independent social and health care providers and NHS acute and community trusts serve Hertfordshire. Hertfordshire social and health care require cross-organizational coordination due to the environment.
Similarities that run across the regions of England are that doctors are the principal providers of primary care and the regulators of secondary consideration. Individuals are encouraged to register with a local clinic for medical care, and general practices are typically consumers’ initial point of contact (Tikkanen et al., 2020). Nevertheless, because many practitioners are complete and do not take new patients, the options available to individuals are very restricted. In some locations, primary care services are provided through walk-in clinics; registration is unnecessary.
Evaluation of Reflective Practices Relating to Care Delivery
Reflective practice refers to reflecting on one’s activities to engage in a continual learning journey. By theme evaluation and grouping, the results of a comprehensive literature review on reflection provide a five-component reflective model that integrates one’s thoughts and actions (Anderson et al., 2019). The paradigm included exploratory, attentive, iterative thinking, and critical the underpinning conceptual frame, a perspective on the transformation, and the self.
Reflective practice helps practitioners objectively assess their most significant strengths and weaknesses. The meditative practice promotes fascinating cognitive processes and reasonable approaches. According to research, doctors and nurses who reflect on their behaviors deliver better patient care (Mantzourani et al., 2019). Research has examined how reflective practice tactics might help healthcare workers make decisions. Physicians and nurses have used de-briefing sessions to enhance deep thinking and decision-making. Guided contemplation with preset questions may help practitioners identify unusual or complex cases. When a final diagnosis matches a valid hypothesis, reflection may be used to make an informed decision. Reflective prompts enhanced accuracy and reduced misdiagnoses (Anderson et al., 2019). Additional research supported that physicians require a reflective portfolio as a lifetime educational resource (Mantzourani et al., 2019). Its importance in care and practice ensures professionals perform well.
A scenario example where reflective practice can be implemented to help healthcare practitioners develop further in their careers is when there is a missed diagnosis. John, a doctor at EPZ Medical Center, does several random tests on one of his patients, Erick, and overlooks specific symptoms. John diagnoses Erick with bladder cancer and begins therapy for that illness when, in reality, Erick has prostate cancer and should be treated differently. When Erick does not respond appropriately to the treatment, John can conduct a series of reflections to find what might be going wrong and eventually begin the whole diagnosis fresh.
Analysis of Theoretical Concepts Related to Evidence-Based Practice
Apart from these, evidence-based practice is another critical concept that has to be integrated into care. The meticulous and cautious utilization of current research, professional medical opinion, patient values and preferences, and other factors determine treatment decisions (Nadalin Penno et al., 2019). Case studies, scientific data, expert opinion, and randomized controlled clinical trials give the best evidence. Scientific approaches include quantitative, qualitative, and descriptive. Studies may inform patient care and requirements when adequate data is obtained. Scientific concepts and professional opinions may inform healthcare decisions (Nadalin Penno et al., 2019). Congestive heart failure, diabetes, and asthma have evidence-based therapies. Medical therapy uses numerous strategies, but not always. EBP has had a few essential principles since its start. The literature defines EBP as research questions using the finest evidence, patient preferences, medical skill and expertise, values and matters, and proof (Nadalin Penno et al., 2019).
Clinical judgments should include the five factors to increase patient safety and well-being. Nurses must use complex thinking and expertise to perform a clinical inquiry, interpret a critique, and pick the best research evidence for a decision. They must also correctly identify contextual factors that affect research evidence utilization while making nursing care judgment decisions and plans (Nadalin Penno et al., 2019). Decision-making requires pertinent information and expertise. Management struggles because practitioners choose based on their opinions rather than the best data. Due to its frequent judgment flaws, one’s opinion lacks the credibility of other evidence (Patricia et al., 2022). Information processing and cognitive limitations cause biases that impair judgment.
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