5.3 Law and health policy: changing the balance of power
In short a new balance between professional legal practice autonomy and the
perceivedpublicinterestcanbeseentohavebeendrawninthedeliveryofhealth
care legal services. This has been achieved by a new emphasis on centralisation.
Similarly doctors, nurses and other health carers are also facing centralist
pressuresthatareimpactingontheirownprofessionalpractice.Aswehaveseen,
theconceptofaqualitydriven,patientcenteredNHSfirmlyunderpinsthisLabour
Government's NHS policy, and the NHS Plan [1].
Inordertounderstandhowthelegalenvironmentofnursingcareoperates,itis
important to have some understanding of the policy concepts andinitiatives that
aredrivingchangesinclinicalpracticeintheNHS.Thesechangeshaveanimpact
onlegalpracticesandtheymustallbeconsideredtogetherinordertoseethefull
picture.TheNHSWhitePaper[20]whichsetouttheGovernment'sprogrammefor
aten year modernisation programme of the NHS stated six guiding principles
which included:
`... Patients will get fair access to consistently high quality, prompt and
accessible services right across the country
...toshiftthefocusontoqualityofcaresothatEXCELLENCEisguaranteedto
allpatients,andqualitybecomesthedrivingforcefordecision-makingatevery
level of the service ...
...to rebuild PUBLIC CONFIDENCE in the NHS as a public service, accoun-
table to patients, open to the public and shaped by their views.' .p. 11)More details on the reform framework followed the publication of a consultation
document,AFirst Class Service: Quality in the New NHSwhich set out the main
elements of the Government's health quality reform programme [21].The main
elements are:
`Clearnationalstandardsforservicesandtreatments,throughNationalService
Frameworks;
The creation of a new National Institute for Clinical Excellence;
Local delivery of high quality health care, through clinical governance under-
pinned by modernised professional self-regulation;
Extended lifelong learning;
Effective monitoring of progress through a new Commission for Health
Improvement, NHS Performance Assessment Framework and a new national
survey of patient and user experience.'The NHS National Plan [1], discussed above, and subsequently the Health and
SocialCareAct2001,taketheseissuesfurtherandfocusontheempowermentof
the patient and improving health quality.
5.3.1 The reforms: CHI an dNICE
Key health reforms are now enacted in the Health Act 1999. Section 18 places a
newdutyofqualityonNHSTrusts,PrimaryCareTrustsandHealthAuthoritiesin
addition to their common law duty of care. Section 18 .1) provides that it is the
68 Nursing Law an dEthics