National Health Service
The NHS in England, NHS Scotland, NHS Wales, the affiliated Health and Social Care in Northern Ireland were established together in 1948 as one of the major social reforms following the Second World War. The founding principles were that services should be comprehensive and free at the point of delivery; each service provides a comprehensive range of health services, free at the point of use for people ordinarily resident in the United Kingdom, apart from dental treatment and optical care. Dr Somerville Hastings, President of the Socialist Medical Association proposed a resolution at the 1934 Labour Party Conference that the party should be committed to the establishment of a State Health Service. Conservative MP and Health Minister, Henry Willink, first proposed the National Health Service in 1944 with the publication of a White Paper "A National Health Service", distributed in full and short versions as well as in newsreel by Henry Willink himself. Henry Willink's National Health Service received cross party support and became Westminster legislation for England and Wales from 1946 and Scotland from 1947, the Northern Ireland Parliament's Public Health Services Act 1947.
NHS Wales was split from NHS in 1969 when control was passed to the Secretary of State for Wales before transferring to the Welsh Executive and Assembly under devolution in 1999. Calls for a "unified medical service" can be dated back to the Minority Report of the Royal Commission on the Poor Law in 1909, but it was following the 1942 Beveridge Report's recommendation to create "comprehensive health and rehabilitation services for prevention and cure of disease" that cross-party consensus emerged on introducing a National Health Service of some description; when Clement Attlee's Labour Party won the 1945 election he appointed Aneurin Bevan as Health Minister. Bevan embarked upon what the official historian of the NHS, Charles Webster, called an "audacious campaign" to take charge of the form the NHS took; the NHS was born out of the ideal that good healthcare should be available to all, regardless of wealth. Although being accessible regardless of wealth maintained Henry Willink's principle of free healthcare for all, Conservative MPs were in favour of maintaining local administration of the NHS through existing arrangements with local authorities fearing that an NHS which owned hospitals on a national scale would lose the personal relationship between doctor and patient.
Conservative MPs voted in favour of their amendment to Bevan's Bill to maintain local control and ownership of hospitals and against Bevan's plan for national ownership of all hospitals. The Labour government defeated Conservative amendments and went ahead with the NHS as it remains today. Bevan's principle of ownership with no private sector involvement has since been diluted, with Labour governments implementing large scale financing arrangements with private builders in private finance initiatives and joint ventures. At its launch by Bevan on 5 July 1948 it had at its heart three core principles: That it meet the needs of everyone, that it be free at the point of delivery, that it be based on clinical need, not ability to pay. Three years after the founding of the NHS, Bevan resigned from the Labour government in opposition to the introduction of charges for the provision of dentures and glasses; the following year, Winston Churchill's Conservative government introduced prescription charges.
These charges were the first of many controversies over reforms to the NHS throughout its history. From its earliest days, the cultural history of the NHS has shown its place in British society reflected and debated in film, TV, cartoons and literature; the NHS had a prominent slot during the 2012 London Summer Olympics opening ceremony directed by Danny Boyle, being described as "the institution which more than any other unites our nation". Each of the UK's health service systems operates independently, is politically accountable to the relevant government: the Scottish Government. NHS Wales was part of the same structure as that of England until powers over the NHS in Wales were firstly transferred to the Secretary of State for Wales in 1969 and thereafter, in 1999, to the Welsh Assembly as part of Welsh devolution; some functions may be performed by one health service on behalf of another. For example, Northern Ireland has no high-security psychiatric hospitals and depends on hospitals in Great Britain at Carstairs hospital in Scotland for male patients and Rampton Secure Hospital in England for female patients.
Patients in North Wales use specialist facilities in Manchester and Liverpool which are much closer than facilities in Cardiff, more routine services at the Countess of Chester Hospital. There have been issues about cross-border payments. Taken together, the four National Health Services in 2015–16 employed around 1.6 million people with a combined budget of £136.7 billion. In 2014 the total health sector workforce across the UK was 2,165,043; this broke down into 1,789,586 in England, 198,368 in Scotland, 110,292 in Wales and 66,797 in Northern Ireland. In 2017, there were 691,000 nurses registered in the UK, down 1,783 from the previous year. However, this is the first time nursing numbers have fallen since 2008. Although there has been increasing policy divergence between the four National Health Services in the UK, it can b
History of pharmacy
The history of pharmacy as an independent science dates back to the first third of the 19th century. Before pharmacy evolved from antiquity as part of medicine. Paleopharmacological studies attest to the use of medicinal plants in pre-history. For example, herbs were discovered in the Shanidar Cave, remains of the areca nut in the Spirit Cave. Sumerian cuneiform tablets record prescriptions for medicine. Ancient Egyptian pharmacological knowledge was recorded in various papyri such as the Ebers Papyrus of 1550 BC, the Edwin Smith Papyrus of the 16th century BC. In Ancient Greece, according to Edward Kremers and Glenn Sonnedecker, "before and after the time of Hippocrates there was a group of experts in medicinal plants; the most important representative of these rhizotomoi was Diocles of Carystus. He is considered to be the source for all Greek pharmacotherapeutic treatises between the time of Theophrastus and Dioscorides."From 60 and 78 AD, the Greek physician Pedanius Dioscorides wrote a five volume book, De Materia Medica, covering over 600 plants and coining the term materia medica.
It formed the basis for many medieval texts, was built upon by many middle eastern scientists during the Islamic Golden Age. The earliest known Chinese manual on materia medica is the Shennong Bencao Jing, dating back to the 1st century AD, it was attributed to the mythical Shennong. Earlier literature included lists of prescriptions for specific ailments, exemplified by a manuscript "Recipes for 52 Ailments", found in the Mawangdui, sealed in 168 BC. Further details on Chinese pharmacy can be found in the Pharmacy in China article; the earliest known compilation of medicinal substances in Indian traditional medicine dates to the 3rd or 4th century AD ). There is a stone sign for a pharmacy with a tripod, a mortar, a pestle opposite one for a doctor in the Arcadian Way in Ephesus, Turkey. In Japan, at the end of the Asuka period and the early Nara period, the men who fulfilled roles similar to those of modern pharmacists were respected; the place of pharmacists in society was expressly defined in the Taihō Code and re-stated in the Yōrō Code.
Ranked positions in the pre-Heian Imperial court were established. In this stable hierarchy, the pharmacists—and pharmacist assistants—were assigned status superior to all others in health-related fields such as physicians and acupuncturists. In the Imperial household, the pharmacist was ranked above the two personal physicians of the Emperor. In Baghdad the first pharmacies, or drug stores, were established in 754, under the Abbasid Caliphate during the Islamic Golden Age. By the 9th century, these pharmacies were state-regulated; the advances made in the Middle East in botany and chemistry led medicine in medieval Islam to develop pharmacology. Muhammad ibn Zakarīya Rāzi, for instance, acted to promote the medical uses of chemical compounds. Abu al-Qasim al-Zahrawi pioneered the preparation of medicines by distillation, his Liber servitoris is of particular interest, as it provides the reader with recipes and explains how to prepare the `simples’ from which were compounded the complex drugs generally used.
Sabur Ibn Sahl, however, the first physician to initiate pharmacopoedia, describing a large variety of drugs and remedies for ailments. Al-Biruni wrote one of the most valuable Islamic works on pharmacology entitled Kitab al-Saydalah, where he gave detailed knowledge of the properties of drugs and outlined the role of pharmacy and the functions and duties of the pharmacist. Ibn Sina, described no less than 700 preparations, their properties, mode of action and their indications, he devoted in fact a whole volume to simple drugs in The Canon of Medicine. Of great impact were the works by al-Maridini of Baghdad and Cairo, Ibn al-Wafid, both of which were printed in Latin more than fifty times, appearing as De Medicinis universalibus et particularibus by `Mesue' the younger, the Medicamentis simplicibus by `Abenguefit'. Peter of Abano translated and added a supplement to the work of al-Maridini under the title De Veneris. Al-Muwaffaq’s contributions in the field are pioneering. Living in the 10th century, he wrote The foundations of the true properties of Remedies, amongst others describing arsenious oxide, being acquainted with silicic acid.
He made clear distinction between sodium carbonate and potassium carbonate, drew attention to the poisonous nature of copper compounds copper vitriol, lead compounds. He describes the distillation of sea-water for drinking. After the 5th century fall of the Western Roman Empire, medicinal knowledge in Europe suffered due to the loss of Greek medicinal texts and a strict adherence to tradition, although an area of Southern Italy near Salerno remained under Byzantine control and developed a hospital and medical school, which became famous by the 11th century. In the early 11th century, Salerno scholar Constantinos Africanus translated many Arabic books into Latin, driving a shift from Hippocratic medicine towards a pharmaceutical-driven approach advocated by Galen. In medieval Europe, monks did not speak Greek, leaving only Latin texts such as the works of Pliny available until these translations by Constantinos. In addition, Arabic medicine became more known due to Muslim Spain. In the 15th century, the printing press spread med
Classification of Pharmaco-Therapeutic Referrals
The Classification of Pharmaco-Therapeutic Referrals is a taxonomy focused on defining and grouping together situations requiring a referral from pharmacists to physicians regarding the pharmacotherapy used by the patients. It has been published in 2008, it is bilingual: English/Spanish. It is a simple and efficient classification of pharmaco-therapeutic referrals between physicians and pharmacists permitting a common inter-professional language, it is adapted to any type of referrals among health professionals, to increase its specificity it can be combined with ATC codes, ICD-10, ICPC-2 PLUS. It is a part of the MEDAFAR Project, whose objective is to improve, through different scientific activities, the coordination processes between physicians and pharmacists working in primary health care. Pharmaceutical Care Foundation of Spain Spanish Society of Primary Care Doctors Raimundo Pastor Sánchez Carmen Alberola Gómez-Escolar Flor Álvarez de Toledo Saavedra Nuria Fernández de Cano Martín Nancy Solá Uthurry It is structured in 4 chapters and 38 rubrics.
The terminology used follows the rules of ICPC-2. Each rubric consists in an alphanumeric code and each title of the rubric is expressed and explained by: – A series of terms related with the title of the rubric. – A definition expressing the meaning of the rubric – A list of inclusion criteria and another list with exclusion criteria to select and qualify the contents corresponding to a rubric. – Some example to illustrate every term. It includes a glossary of 51 terms defined by consensus, an alphabetical index with 350 words used in the rubrics. E 0. Effectiveness / Efficiency, unspecified E 1. Indication E 2. Prescription and dispensing conditions E 3. Active substance / excipient E 4. Pharmaceutical form / how supplied E 5. Dosage E 6. Quality E 7. Storage E 8. Consumption E 9. Outcome. I 0. Information / Health education, unspecified I 1. Situation / reason for encounter I 2. Health problem I 3. Complementary examination I 4. Risk I 5. Pharmacological treatment I 6. No pharmacological treatment I 7. Treatment goal I 8.
Socio-healthcare system. N 0. Need, unspecified N 1. Treatment based on symptoms and/or signs N 2. Treatment based on socio–economic-work issues N 3. Treatment based on public health issues N 4. Prevention N 5. Healthcare provision N 6. Complementary test for treatment control N 7. Administrative activity N 8. On patient request. S 0. Safety, unspecified S 1. Toxicity S 2. Interaction S 3. Allergy S 4. Addiction S 5. Other side effects S 6. Contraindication S 7. Medicalisation S 8. Non-regulate substance S 9. Data / confidentiality. Pharmaceutical care Referral Pastor Sánchez R, Alberola Gómez-Escolar C, Álvarez de Toledo Saavedra F, Fernández de Cano Martín N, Solá Uthurry N. Clasificación de Derivaciones Fármaco-terapéuticas. MEDAFAR. Madrid: IMC. ISBN 978-84-691-8426-4 Álvarez de Toledo Saavedra F, Fernández de Cano Martín N, coordinadores. MEDAFAR Asma. Madrid: IMC. Álvarez de Toledo Saavedra F, Fernández de Cano Martín N, coordinadores. MEDAFAR Hipertensión. Madrid: IMC. Aranaz JM, Aibar C, Vitaller J, Mira JJ, Orozco D, Terol E, Agra Y.
Estudio sobre la seguridad de los pacientes en atención primaria de salud. Madrid: Ministerio de Sanidad y Consumo. Aranaz JM, Aibar C, Vitaller J, Ruiz P. Estudio Nacional sobre los Efectos Adversos ligados a la Hospitalización. ENEAS 2005. Madrid: Ministerio de Sanidad y Consumo. Criterios de derivación del farmacéutico al médico general/familia, ante mediciones esporádicas de presión arterial. Consenso entre la Sociedad Valenciana de Hipertensión y Riesgo Vascular y la Sociedad de Farmacia Comunitaria de la Comunidad Valenciana. 2007. Fleming DM; the European study of referrals from primary to secondary care. Exeter: Royal College of General Practitioners. Foro de Atención Farmacéutica. Documento de consenso 2008. Madrid: MSC, RANF, CGCOF, SEFAP, SEFAC, SEFH, FPCE, GIAFUG. 2008. García Olmos L. Análisis de la demanda derivada en las consultas de medicina general en España. Tesis doctoral. Madrid: Universidad Autónoma de Madrid. Garjón Parra J, Gorricho Mendívil J. Seguridad del paciente: cuidado con los errores de medicación.
Boletín de Información Farmacoterapéutica de Navarra. 2010. Pharm Care Esp. 2003. Hospital Ramón y Cajal, Área 4 Atención Primaria de Madrid. Guía Farmacoterapéutica. Madrid. CD-ROM. Ley 29/2006, de 26 de julio, de garantías. BOE. 2006 julio 27. Ley 41/2002, de 14 de noviembre, básica reguladora de la autonomía del paciente y de derechos y obligaciones en materia de información y documentación clínica. BOE. 2002 noviembre 15. Ley Orgánica 15/1999, de 13 de diciembre, de Protección de Datos de Carácter Personal. BOE. 1999 diciembre 14. Organización Médica Colegial. Código
Nursing home care
Nursing homes known as old people's homes, care homes, rest homes, convalescent homes, provide residential care for elderly or disabled people that includes around-the-clock nursing care. These terms have different meanings in the same or different English-speaking countries to indicate that the institutions are public or private or provide assisted living or more or less nursing care and emergency medical care. A nursing home is a place for people who don't need to be in a hospital but can't be cared for at home. Most nursing homes have skilled nurses on hand 24 hours a day; some nursing homes provide short-term rehabilitative stays following surgery, illness, or injury. Services may include occupational therapy, or speech-language therapy. Nursing homes offer other services, such as planned activities and daily housekeeping. Nursing homes may be referred to as convalescent care, skilled nursing or a long-term facility. Nursing homes may offer memory care services. Starting in the 17th century, the concept of poorhouses were brought to America by English settlers.
All orphans, mentally ill and the poor elderly were placed into these living commons. In the twenty-first century, nursing homes have become a standard form of care for the most aged and incapacitated persons. Nearly 6 percent of older adults are sheltered in residential facilities that provide a wide range of care, yet such institutions have not always existed. Before the nineteenth century, no age-restricted institutions existed for long-term care. Rather, elderly individuals who needed shelter because of incapacity, impoverishment, or family isolation ended their days in an almshouse. Placed alongside the insane, the inebriated, or the homeless, they were categorized as part of the community's most needy recipients; these poorhouses gave a place where they could be given daily meals. Poorhouses continued to exist into the early 20th century despite the criticism. Much of the criticism stemmed from the conditions of the poorhouses; the Great Depression overwhelmed the poorhouses as there were a lot of people that needed help and care but not enough space and funding in the poorhouses.
Due to Muck Raking in the 1930s the less than favorable living conditions of the poorhouses were exposed to the public. Poorhouses were replaced with a different type of residential living for the elderly; these new residential living homes were called board-and-care homes or known as convalescent homes. These board-and-care homes would provide basic levels of care and meals in a private setting for a specific fee. Board-and-care homes proved to be a success and by World War 2, the new way of nursing homes began to take shape; as the times continued to change, the government identified the issue of people spending extensive amounts of time in hospitals. To combat these long stays in short-term settings, board-and-care homes began to convert into something more public and permanent, state and federally funded. From this, by 1965 nursing homes were a solid fixture. Nursing homes were a permanent residence where the elderly and disabled could receive any necessary medical care and receive daily meals.
Though nursing homes in the beginning were not perfect, they were a huge step above almshouses and poorhouses in regards to following laws and maintaining cleanliness. From the 1950s through the 1970s the dynamics of nursing homes began changing significantly. Medicare and Medicaid began to make up much of the money that would filter through the homes and the 1965 amendment laws enforced nursing homes to comply with safety codes and required registered nurses to be on hand at all times. Additionally, nursing homes may sue children for the costs of caring for their parents in jurisdictions which have filial responsibility laws. In 1987, the Nursing Reform Act was introduced to begin defining the different types of nursing home services and added the Residents' Bill of Rights. Today nursing homes are different across the board; some nursing homes still resemble a hospital. Nursing home residents can pay for their care out of pocket, others may receive medicare for a short time and some may use long-term insurance plans.
Across the spectrum, most nursing homes will accept medicaid as a source of payment. In most jurisdictions, nursing homes are required to provide enough staff to adequately care for residents. In the U. S. for instance, nursing homes must have at least one registered nurse available for at least 8 straight hours a day throughout the week, at least one licensed practical nurse on duty 24 hours a day. Direct care nursing home employees include registered nurses, licensed practical nurses, certified nursing assistants, physical therapists, amongst others. Nursing homes require that a registered nurse monitor residents; the RN's job duties include implementing care plans, administering medications and maintaining accurate reports for each resident and recording medical changes and providing direction to the nursing assistants and licensed practical nurses. The LPN monitors residents’ well-being and administers treatments and medications, such as dressing wounds and dispensing prescribed drugs. A nursing assistant provides basic care to patients while working directly under a LPN or RN.
These basic care activities referred to as activities of daily living, can include assisting with bathing and dressing residents, helping residents with meals, eit