HealthCare Report

This report analyzes the challenges faced by the NHS London Accident and Emergency (A&E) department in meeting its four-hour waiting time target. It examines the existing healthcare structure, public health concerns, and financial models. The report also provides recommendations for improving the department's efficiency and effectiveness, including increasing staff, medical resources, and infrastructure, as well as implementing appropriate leadership styles.

HealthCare

Table of Contents
INTRODUCTION...........................................................................................................................1
BACKGROUND.............................................................................................................................1
RATIONALE...................................................................................................................................2
RELATED WORK..........................................................................................................................2
RECOMMENDATIONS.................................................................................................................5
EVALUATION................................................................................................................................6
CONCLUSION................................................................................................................................9
REFLECTIVE ACCOUNT.............................................................................................................9
REFERENCES..............................................................................................................................10

INTRODUCTION
The four-hour accident and emergency (A&E) department in NHS, London performs
against the target to admit or discharge 95 per cent of patients within four hours. It is a source of
significant public, media and political interest (Giuntella, Nicodemo and Vargas-Silva, 2017).
Albeit, majority of accident and emergency departments in NHS London were not able to meet
the target since the summer of 2013. In this context, the following assignment will focus on
ascertaining the existing health care structure of National Health Service, London. The public
health and population health will be analysed in this assignment. With the help of relevant
articles, a robust argument will be established in this report that enriches the subject matter more
efficiently. Furthermore, the financial model for care delivery will be provided in this report.
Leadership theories which can be implemented by health care professionals within the
organisational framework will be elaborated in this report. Eventually, some of the best
recommendations will be provided to the management of NHS London so that they can eradicate
the issues and work efficiently to accomplish their four hour target.
BACKGROUND
In order to measure the performance of NHS accident and emergency department,
waiting times are used by the management to assess the performance of NHS London. The
accident and emergency department in England has been classified into three main types
(Mohammad and Shetty, 2016). Type 1 departments are major emergency department that
provides a consultant-led 24 hour service to the patient with full fledge facilities for resuscitating
patients. For instance patients suffered from cardiac arrest. Type 2 department are for specific
conditions with single specialists. For instance, patient suffering from eye problem or dental
problems. Type 3 departments are established to provide treatment for minor injuries and
illnesses such as stomach aches, cuts and bruises (Di Somma and et.al., 2015). The most high
profile measure which helps in measuring the performance of accident and emergency
department of NHS is the four hour standard. This standard was mandated by NHS England
where they pledge to set out at least 95 per cent of patient who attends accident and emergency
department should be admitted to hospital, transferred to another provider or discharged within
four hours (Appleby, Thompson and Jabbal, 2014). The four-hour target results in reducing the
overall waiting times and enhancing the satisfaction of patients. But it also increases the
workload pressure on nurses and other health care professionals which hamper their quality of
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care and the level of support from secondary and primary care. There were certain problems such
as high occupancy of bed, pressure on staff which increases their stress and lack of availability of
medical resources affects the policy greatly and the system reached near its breaking point
(Doherty, 2017). There are other issues in meeting four-hour target which hampers the accident
and emergency department quality of care. Patients waiting on trolleys for over four hours before
being admitted to hospital have almost trebled, and delayed ambulance handover at A&E have
risen by over 70 per cent.
RATIONALE
NHS London has been facing loads of challenges in meeting four hours deadline which they
mandate in 2013. Frequent breach of deadline, overloaded and increase in strain in staff, lack of
resources, poor quality of care, etc. are some of the issues stated by health care professionals. In
this context, this study is conducted in order to identify the reasons for breach of four hour time
and providing recommendations which can be implemented by the authorities in order to
enhance the system effectively and efficiently. This study will also help the researcher to know
more about NHS London and its health structure which helps him or her in enhancing his or her
level of education and knowledge.
RELATED WORK
The National Health Service is the universal medical care provider for the people living
across UK. The main objective and aim of the organisation was to make sure that the services
offered to people meets clinical needs of each and every individual who visits NHS. The
organisation focus on providing effective and beneficial health and social care services to the
people of the community. There are many services provided by NHS to their patients such as
cancer treatment, rehabilitation, psychological treatment and other healthcare services.
According to (Stoddart and et.al., 2017), NHS has a rule that focus on providing health services
to people efficiently and in a speedy manner. The NHS states that they admit and discharge a
patient after check-up in four hours. Also, establishment has a well framed organisational
structure that helps in achieving the organisation goals and objectives effectively. There are
various department of NHS which looks after different kind of patients and individuals visiting
the organisation to experience effective health care services. The internal organisational working
environment and structure of staff as well as the patients and public experience or perception of
the NHS as service users are the two effective definitions of the positive culture in NHS.
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According to (Hunter and et.al, 2017), NHS focus on multi discipline working as they think it is
important for a health care organisation that aims to offer healthcare services to each and every
individuals. It also helps the organisation to provide efficient services to the people and also
reduce patients waiting time. Due to the increase in population and diseases in the environment
the needs of healthcare is increasing day by day with a high rate. In order meet the increasing
demand of the health care services it is important for the NHS and other related organisation.
The NHS is a leading health care service provider in London which is a popular tourist
destination and economical strong region. However, the population of the place is increasing day
by day so as the need of health care services. There are many issues that arise related to the
health and well-being of the individuals as well as the society. The major issues related to health
in London and other cities of UK are smoking, alcohol abuse etc.
National health services also develop various campaign and event related to the health
and well-being of the people such as rehabilitation to homeless people. The organisation is
focusing on identifying and analysing various issues related to health care of the people living
Financial can be alluded as a wide term used to decide different factors, for example, pay,
instruction, occupation and so on. In setting to this, there are different components that influence
the health, for example, way of life decisions, joblessness, segregation and access to data. As
indicated by situation, there are around 70,000 vagrants in UK, who encounter an abnormal state
of pressure, strain and psychological maladjustment. The vagrancy urges or powers them to
lessen worry through different kinds of medications, liquor or smoking. They figure it will assist
them with coping up with their pressure or psychological instability; the examination reasoned
that between 70 to 90% of destitute grown-ups are dependent on smoking. Because of absence of
cash, these individuals begin smoking hand moved cigarettes without channels utilising reused
tobacco which is extremely hazardous for individuals; as gathering smoking expands the odds of
disease and growth. These practices are profoundly affecting individual's well-being and it
likewise expanded the rate of throat and mouth tumour among vagrants. Because of joblessness
and destitution, individuals are presented to these circumstances of medication and smoke
enslavement when contrasted with claim decisions. Individuals are getting used to medications,
liquor and cigarettes as they feel it lessens pressure or mental weight however in effective way
they are hurting their own well-being. The way of life of individuals greatly affects an individual
health, for instance: a man who can't purchase solid sustenance won't have the capacity to
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increase great health. This is unmistakably watched that individuals with low pay are relatively
undesirable and dependent on smoke, medications and liquor. The NHS also needs to consider
various laws and regulations related to health care services as the legal system of UK is very
concerned about the effectiveness and efficiency of the services provided to the people related to
their health and well-being. There are different laws and directions created by the legislature that
are should have been considered or taken after by different social insurance associations. In
setting to this, legislature of UK uses different media, and promoting instruments, for example,
hoardings, daily paper and so on with a specific end goal to spread mindfulness identified with
health. The Government attempted to create and distribute different articles and data about group
health and in addition individuals living in it. There are different conflicts made by government
with a specific end goal to assist individuals with quitting smoking or some other medications
(Cleverley and et.al, 2017). Numerous recovery focuses are set up to help individuals who are
dependent on any medication, liquor or tobacco smoking. The Acheson Report distributed in
2013, spoke to that the presence of disparities identified with health and connection among
different social classes. This report verified that the death rate is low; the high society individuals
may face quick mortality decrease. In the year 2014, UK government distributed another report;
Skadon Mavron which recognises individuals in different gatherings and with respect to the
exploration, passing rate in fragment fifth was twice when contrasted with the demise rate in
portion first. Besides, this hole among the demise rate in two classes is expanding with a high
rate, a significant number of the administration investigate or reviews by registration have
presumed that more than 170 million individuals all around the globe die because of different
sorts of malignancy consistently. The principle reason found for the tumour in individuals was
because of utilisation of cigarettes or some other type of tobacco. It is imperative for the
legislature to guarantee individuals are getting mindful of results caused by cigarettes or tobacco
utilization. There are different overviews which discovered that individuals with low level of
salary are very presented to medications, liquor and tobacco utilisation and the reason is absence
of training or mindfulness. This causes disparities in health between poor and rich individuals.
These statistics concludes that there is a great need of health care services in London and other
cities in UK. The major problem arises presently in NHS is that they are not able to offer fast
services to the people. Their agenda of four hours waiting time is failing due to increase in
demand and needs of the people with respect to heath care services. In order to overcome these
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issues, the NHS tried to perform various activities and implemented different techniques such as
developing NHS practitioner health programme team which received the innovation in mental
health in primary care award in the year 2014. The people were shown that the practitioner were
passionate and successful individuals who are working in order to improve the mental health
service provided by NHS in London, UK. The NHS's organisational culture is focusing on
building positive relationship between patients and professionals so that it can be easy to
understand and provide effective health care services to the people.
RECOMMENDATIONS
Accident and emergency department in NHS London waiting time has been gradually
increased over recent years, thus breaching its four hour deadline mandate by NHS England. In
this context, the load has been directly increased on staff and hospital administration. In order to
eliminate this issue and enhance the effectiveness in the policy, researcher has provided few
recommendations which are listed below: Increase number of staff: It was identified that due to lack of staff availability, the
accident and emergency department were not able to achieve their desired or set target of
four hour waiting (Brailsford and et.al., 2016). Thus, in order to accomplish the aim and
objectives effectively and efficiently, it is recommended to the management of NHS to
hire more clinical and health care professionals in Accident and Emergency department
NHS London. In this manner, the workload can be delegated effectively and staff strains
and stress can be reduced ultimately. Increasing medical resources: It was found that due to inadequate medical resources, the
health care professionals were not able to handle and manage the increasing patients rate
at Accident and Emergency Department. Lack of availability of beds and other medical
resources affects the four hour waiting and increases the waiting time of patients (Lane,
Monefeldt and Rosenhead, 2016). Thus, it is recommended to the management of NHS
London to manage their inventory and ensure that availability of beds should be in
Accident and Emergency Department of NHS London. This will help in accomplishing
the desired aim and objectives of the management. Expanding infrastructure: Patient's rate in Accident and Emergency Department has
been increasing rapidly. The existing infrastructure of NHS London remains incapable in
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receiving and treating all the patients within their four hour waiting time. In this concern,
it is recommended to the management of NHS London to expand their infrastructure for
accident and emergency department. In this way, they will be able to handle and admit
the patient and discharge them within their four hour deadline.
 Following appropriate leadership style: Leadership style plays a crucial and prominent
role especially at hospitals. Precise leadership style will foster the organisational growth
and development whereas inappropriate leadership style hinders organisational
development (Siciliani, Moran and Borowitz, 2014). NHS London has been facing issues
due to inappropriate autocratic leadership style which increases strain and stress among
staff. Thus, it is recommended to the management to follow precise and appropriate
leadership style in order to attain their four hour waiting time.
EVALUATION
NHS London is current is facing an emergency is a critical or life-threatening situation at
workplace while furnishing various kinds of emergency healthcare facilities which is needed by
patients most immediately. It has examined that NHS accident and emergency department are
failing to meet the recommended four-hour waiting times within London hospital areas. So, in
order to provide effective care facilities to nearby London city people, they have to make
betterment within its healthcare management structure by which they will be able to perform will
in critical accidental situations of patients (England, 2016). There are several types of emergency
departments are working in the hospital which is noticed that they are not performing their each
one task properly, so it makes negative impact upon its healthcare provision practices and
goodwill of the hospital efficiently. Hospital's emergency department must be operated within 24
hour services with full resuscitation facilities and designated accommodation for the reception of
accident and emergency patients within hospital. Currently, the organisation is facing several
types of management challenges in hospital in order to furnish proper NHS accident and
emergency department services providing within four-hour and less than it as well. In case of
serious injury time duration, physician needs to have execution of all healthcare activities in
designated accommodation for the reception of accident and emergency patients. Doctor of the
NHS London hospital requires leading Nurses and assistance doctors properly for arranging
appropriate resources which are needed most immediately for provision of various types of
healthcare services to overcome from such situations. So, it has noticed that, NHS London is not
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performing well in case of provision of meet the recommended four-hour waiting times within
London hospital areas (Care Quality Commission, 2012). London city conduct wide range of
population in the city and multiple numbers of emergency cases is being addressed by its
healthcare professionals within organisation efficiently. NHS London currently is not following
appropriate structure at workplace in order to overcome from critical emergency condition. The
city hospital has offered a scheme, in which they are willing to serve better healthcare services
within four-hours. According to current scenario, department of emergency healthcare provision
was not able to fulfil immediate requirement of patients which is required for emergency
treatment and treatment for infectious disease. As management consultant, I need to provide
proper recommendations upon this crucial circumstances of the hospital in which they would be
able to serve better healthcare services within determined hours. Existing emergency department
is following up poor management approaches because of having weak healthcare structure at
workplace to attaining each patients within given time period (JA and IE, 2012). Due to these
issues and problems, its management department requires implementation of strategic
management approaches by which they can make betterment in emergency services and meet to
recommended four-hour waiting times facilities within business environment. Having public
health consideration is one of the most responsibilities of its professionals for properly delivering
quality of healthcare services by which each of their patients and client can get desired
healthcare transformed services within the hospital.
Population of London city comes into the largest volume of the country, so in this case,
there must be availability of better and quick emergency facilities in case of serious injury
conditions. Population’s health has to do with the health of a specific group of individuals. Its
healthcare professionals require ensuring that they are delivering the population and public
healthcare accurately to avoid confusing their current challenges facing towards emergency
services. In order to attain their desired goals and objectives towards supplying quality of
healthcare services within hospital's environment, its management need to improve structure of
the way of working in emergency circumstances. Moreover, proper ambulance services and
medicines must be presented at workplace to instantly reach out to the patients and get them to
hospital areas within short time, so they will capable to having treatment of their patients
effectively.
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A financial model can assist hospitals and health system to prepare for and make success
to accountable care. According to current financial model of the business, they are nit attaining
the financial goals and able to offering affordable healthcare services in emergency cases. So,
hospital's management team require to assess including enrolled and claims data, hospital
financial data and local market conditions information to identifying the proper costing of
provision of effective or quality of care to patients at affordable prices (Radnor Holweg and
Waring, 2012). So, financial model of the business is necessary to move one segment of
population to accountable care at a time. As per targeted audiences of city, they have to forecast
arriving of emergency cases and on which, they need to prepare financial model to categorise
classes of its patients who mat reach out within hospital within expected time duration.
Apart from its, management department and leaders require to have utilisation of
situational leadership system at workplace for delivering proper guidelines to its sub-ordinate
executives and nurses to arrange necessary resources within operational theatres and handle it
within the best possible manner. They have to provide motivation to its assistant physicians and
nurses for completion of each task in predetermined time duration in order to make sure that
within four-hour, they will be able to serve better quality of healthcare facilities to its patients
within emergency cases. In addition, social culture of London populations also making impact
upon arriving and attaining patients within hospitals perfectly. Social culture of the city's
population is influencing them in making choice of selection of NHS London hospital's four-
hour emergency facilities efficiently.
Beside from it, several types of prevention might be taken by professionals in case of
provision of effective healthcare services upon given time period. So, several types of emergency
and immediate initiative can be taken by its management department for reducing the incidents
of accidents in the city by making aware people to causes of accidental situations and its harms.
Moreover, promotional model can be utilised by its healthcare promotional to having prohibition
of negative habits which is making cause of having disease within patient’s body. So, NHS
London hospital require to provision of alternative healthcare preventions such as telehealth,
decision support system and expert system which immediately available at workplace and
various clinical houses which is established in city (Turner, O'Cathain and et.al., 2013). Patients
must be provided emergency helplines to its professionals in case of making instant
communication with hospital helpline centres, who can arrange proper resources which are
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needed for emergency situation at the time. So, it can be said that various initiatives have been
suggested for the hospital which must be taken by its management professionals in case of
meeting its desired success upon removing issues and attaining the aim of furnishing four-hour
waiting time.
CONCLUSION
From the above report, it can be understood that the four hour Accident and Emergency
(A&E) Department in NHS, London performs against the target to admit or discharge 95 per cent
of patients within four hours. Majority of accident and emergency departments in NHS London
were not able to meet the target since the summer of 2013. In this context, the following report
aids in demonstrating the health structure of NHS London. The three types of accident and
emergency departments incorporated in hospitals in England have been briefly described. The
reviews of other and senior authors have been elaborated in this study. After analysis and
evaluation of present condution at NHS London, precise recommendations have been made in
this report.
REFLECTIVE ACCOUNT
In this report, I have examined the challenges and issues faced by NHS London in order to
accomplish their four hour waiting time. I have selected NHS London as it is one of the
renowned hospital in England. In addition, I have evaluated the reviews of authors in explicit and
succinct manner thus, readers will be able to know more comprehensively about the issues and
challenges. Eventually, I have listed some recommendations which can be imposed by the
hospital administration in order to achieve their target.
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REFERENCES
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Brailsford, S.C., and et.al., 2016. Emergency and On-Demand Healthcare: Modeling a Large
Complex System. In Operational Research for Emergency Planning in Healthcare:
Volume 2 (pp. 13-30). Palgrave Macmillan, London.
Care Quality Commission, 2012. The state of health care and adult social care in England in
2011/12 (Vol. 763). The Stationery Office.
Di Somma, S., and et.al., 2015. Overcrowding in emergency department: an international
issue. Internal and emergency medicine, 10(2), pp.171-175.
Doherty, M., 2017. In patients with suspected strokes that are FAST positive does direct
conveyance to CT reduce door to scan time? (Doctoral dissertation, University of
Cumbria).
England, N. H. S., 2016. Implementing the five year forward view for mental health. London:
NHS England.
Giuntella, O., Nicodemo, C. and Vargas-Silva, C., 2017. The effects of immigration on NHS
waiting times.
JA, V. and IE, R., 2012. Reducing emergency admissions: are we on the right track?. Bmj, 345,
p.23.
Lane, D.C., Monefeldt, C. and Rosenhead, J.V., 2016. Looking in the wrong place for healthcare
improvements: A system dynamics study of an accident and emergency department.
In Operational Research for Emergency Planning in Healthcare: Volume 2 (pp. 92-121).
Palgrave Macmillan, London.
Mohammad, R.K. and Shetty, R., 2016. Analysis Of Accident And Emergency Department
(A&E) Waiting Times For Patients Referred To An Offsite Specialty Within A Multisite
Trust. emerg Med J, 33(12), pp.928-928.
Radnor, Z. J., Holweg, M. and Waring, J., 2012. Lean in healthcare: the unfilled promise?. Social
science & medicine, 74(3), pp.364-371.
Siciliani, L., Moran, V. and Borowitz, M., 2014. Measuring and comparing health care waiting
times in OECD countries. Health policy, 118(3), pp.292-303.
Turner, J., O'Cathain and et.al., 2013. Impact of the urgent care telephone service NHS 111 pilot
sites: a controlled before and after study. Bmj Open, 3(11), p.e003451.
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Stoddart, G.L. and Evans, R.G., 2017. Producing health, consuming health care. In Why are
some people healthy and others not? (pp. 27-64). Routledge.
Hunter, C.L., Goodie, J.L., Oordt, M.S. and Dobmeyer, A.C., 2017. Integrated behavioral health
in primary care: Step-by-step guidance for assessment and intervention. American
Psychological Association.
Cleverley, W.O., 2017. Essentials of health care finance. Jones & Bartlett Learning.
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