Digital Governance and the NHS

The benefits of a fully-digitalised public healthcare system are significant. Digital health is an essential tool in order to improve efficiency, provide coordinated care, and make real health improvements. However, the National Health Service (NHS) has yet to provide a fully digitalised system to patients and providers despite technological advances in recent years. This chapter will thus describe the progress which has already been made in providing remote health services within the NHS. It will also explore problems arising from digitalising health services and the management of health both within the institution and through more informal networks beyond the NHS.

The Place-Based Challenge

When considering the provision of healthcare services, it is necessary to examine action at a local level and problems that local health service providers must face. This is essentially because it is within individual communities and neighbourhoods that most public healthcare interventions take place. Local intervention is also important in order to coordinate a more even pattern of healthcare provision across the regions. There are significant disparities between regions and inter-regions of the UK. Recent cuts to public services, welfare benefits, and public employment have severely affected those regions. This chapter will thus explore health inequalities and inequity of supply across the devolved administrations, regions, and sub-regions. It will then review policy to address health inequalities and consider to what extent the current public health service governance framework, and especially health service provision at the local level, can mitigate disparities in health outcomes. It includes a short section on the response to the Covid-19 pandemic in the regions.

Personal and Public Involvement in Healthcare Provision

Personal and public involvement in healthcare provision has become an essential part of the governance framework of the National Health Service (NHS) today. Patient safety, quality, and responsiveness of care are the main priorities of national healthcare providers. Yet in practice, there are significant limitations to the introduction of a true patient- or person-centred approach, which will be described in this chapter. Two case studies have been included to illustrate the challenges to implementing a true person-centred approach in the NHS. The first relates to the Mid-Staffordshire Hospital Trust where hundreds of patients died as a result of sub-standard levels of care. The second focuses on a family's struggle to access a joined-up package of care for a Parkinson's disease sufferer in a primary care setting.

Financial Governance and the NHS

Faced with significant difficulties to meet financial costs owing to increased demand for healthcare, National Health Service (NHS) organisations are looking to maintain tight financial control and reduce expenditure where possible. Significant price hikes in essential medicines can also raise challenges to the supply of necessary drugs for the population. The NHS continues to supply healthcare free at the point of use and any attempts to introduce charges remain unpopular. There have been a number of ways in which providers endeavour to reduce costs: rationalisation (reduction of services or certain costly drugs) or through increasing the role of private providers in healthcare provision. This chapter thus reviews the funding challenges the NHS is currently facing and how financial governance is evolving to meet those challenges.

Managing Public Healthcare Services in an International Economy

This chapter differs somewhat in its approach to governance issues compared with the previous chapters as it goes beyond the national framework. In essence, the national and sub-national issues at stake do not quite capture the full picture when considering the future challenges of the provision of public healthcare services in the UK. This chapter looks at healthcare service exchanges across borders. Indeed, there has been a significant expansion of services trade, and in particular health services, which have grown not only thanks to a number of institutional frameworks but also to the support of the British government and health stakeholders. However, there are also a number of risks involved in the international exchange of health services, which can have a significant impact on public healthcare systems.

Integrated Care

Delivering high quality health and social care is considered to be one of the key governance challenges in the UK. People are living longer, and chronic diseases are more prevalent, which puts ever more pressure on health and social services to deliver. In order to better co-ordinate these services and deal with increased demand and funding pressures, authorities at both national and local levels are moving towards integrated care services. However, the integration of these services is plagued with difficulties. This chapter will explore the complexities of joining-up health and social care. It includes a case study of Continuing Healthcare (CHC), which is a package of care provided by the National Health Service (NHS) and which involves a number of providers across the health and social care sectors. While much of the chapter focuses on health and social care challenges in England, it will finish with analysis of Scotland's progress towards integrated services.

The Role of Health Professionals

Staff governance is a major challenge for the NHS. It refers to the framework for managing employees in the National Health Service (NHS). Professional practitioners, in particular doctors and nurses, have a key role to play in the running of the NHS, but there are many challenges in managing staff and especially ensuring high retention levels. This chapter begins by explaining the power relations within the NHS and among some of the key actors. It then highlights some of the key challenges including those posed by the loss of European Union (EU) staff following the UK's decision to leave the EU. In particular, it explains why it has become increasingly difficult in recent years to retain staff in the NHS. It then discusses some of the measures to stem the haemorrhaging of staff.

Market-Based Governance in Public Healthcare Delivery

This chapter analyses the market-based reforms introduced in the UK. From 1979 onwards, it is clear that market governance has been central in the delivery of public healthcare services in the UK. The move towards using private sector techniques to run public health services has been reinforced over the last few decades, and New Public Management (NPM) reforms have often been more pronounced than in many other European countries. The chapter considers how public health services have been reconfigured within the changing boundaries between the state and its citizens. The government still continues to play a major role in the running of health services and decision making, even in the new configuration of public health services and the extension of informal networks, but health policy is also now formulated through a variety of different actors. This chapter will finish by presenting how healthcare is organised today in the UK following these reforms.