Consumer Psychology Essay Example | Topics and Well Written Essays - 2500 words

Consumer Psychology - Essay Example The main purpose of the survey was to observe the impact of its advertisements on the people so that the organization could identify the target market and at the same time inject fresh ideas into its advertising strategy. The positive information that has come out of this survey is that significant percentage of people above the age of 20 gave clear indication that their buying decision is swayed by the visual and textual content of the advertisements. The company too, needs to target people above the age of 20 years to market its products. The beer and ale are popular amongst the youth and Arran must target this group primarily because they are open to new ideas and products. By targeting this segment, Arran can strengthen its market position. Another major target markets are the retailers and hotel industry. While retail market would need ales and beers in the bottles, the hotel industry can also have it in cask format. The advertisements should be versatile in their approach to attract clientele from diverse segment of the market. Consumer psychology and analysis of database of customers are important part of market strategy which helps one to know the changing preferences of the customers in the rapidly changing times. Prices may not be very important part of the strategy with the old customers but competitive pricing helps to bring in new clients. Whenever new products are to be launched, it is important that trend in the customers’ needs and requirements are studied in advance so that appropriate strategy could be developed. While the growth and the future prospects of the business depend on the input data as they are able to divulge vital information about the products and the customers, strategic marketing through widespread appealing advertisement is a vital factor that helps to bring in new clientele. Arran Breweries was conceptualized by Richard and

New Federalism in USA Research Paper Example | Topics and Well Written Essays - 1000 words

New Federalism in USA - Research Paper Example This essay stresses that the congress is an important body in the new federalism. The success of the statutory federalism depends on its restraint not to overuse its powers. It is because of the lack of restraint that the courts come in to limit the congressional powers. This can however prove to be less effective. For example, in Brady’s bill, the congress can use its spending powers to achieve the same purpose that it had intended to achieve by using the statute. Similarly, in the case of Lopez, the congress had intended to use the Gun Free School Zones Act to make it criminal possessing guns near the school periphery. The congress could use the commerce clause in this instance to link this law to the interstate commerce. It is for this reason that Ferejohn states that the judicial mechanisms used to regulate congress are blunt tools. Under the commerce clause, as stated the congress has the power to regulate all economic activities that involve the different states. This cl ause gives the congress broad powers over all the commercial interests of the nation. The commerce clause has brought in a lot of debate on the powers of the congress and whether the courts can limit the same powers. This report makes a conclusion that the new federalism has made significant progress in the politics of the United States of America. However, it has been faced with what seems like a tug of war between the congress and the federal government. The judiciary through case law, solves the disputes that may come in. The devolution aspect of the new federalism has greatly shaped the economy of many states as the federal government provides block grants to the states. These block grants are meant to solve various social issues in the states.

Can Sinkers claim demurrage against the cricket clubs Essay

Can Sinkers claim demurrage against the cricket clubs - Essay Example Vessel will be losing her time and the connected payment. In the present case, reaching the berth and unloading the goods took longer time than expected and the vessel has gone onto demurrage. The popular rule is 'once on demurrage, always on demurrage'. As an exception, demurrage would not occur if the delay was purely due to ship owner's fault and as the repercussion of actions taken by him suitable for his convenience and benefit. "The freighter of a ship is bound not to detain it, beyond the stipulated or usual time, to load or deliver the cargo, or to sail. The extra days beyond the lay days (being the days allowed to load and unload the cargo) are called the days of demurrage. The term is likewise applied to the payment for such delay, and it may become due, either by the ship's detention, for the purpose of loading or unloading the cargo, either before, during or after the voyage, or in waiting for convoy2." A shipowner will be entitled to unliquidated damages for being detained while loading or unloading, or delivering a consignment, within the stipulated time, if the delay happens for no fault of his or his representatives. In some transactions, to be safe, there could be an agreement to pay demurrage, which is usually for preventing the shipowner from demanding an enormous sum if an unfortunate delay occurs. As a result of this written understanding and agreement, if the demurrage is fixed at a certain rate per hour, the shipowner would be unable to demand more money as demurrage. According to John Wilson, "Liability for the payment of demurrage accrues immediately on the expiration of the lay days and runs continuously through Sundays, holidays and other periods normally excluded from laytime, e.g. bad weather working days3." Demurrage or the dead freight can occur at any point of affreightment. It is actually a fixed sum per hour or per day that charterer has to pay the vessel owner for the delays while loading and unloading of his consignments, and the time lost (beyond the stipulated time) and these days are called lay days. "If no demurrage is provided for by the charter-party, and the vessel is not loading or discharging beyond the lay days, the shipowner is entitled to claim damages in respect of the loss which he has suffered by the detention of his ship4" This is mainly to force the charterers to load and unload within the time fixed. If the time is not fixed, then it might be difficult for the shipowner to prove that the ship has run onto demurrage. There are difficult circumstances, honouring difficult judgements too. "Where time under a limitation clause runs from completion of discharge of the cargo, but there was no cargo to discharge, the judge held that the limitation clause does not apply. He refused to imply additional words into the clause that would have allowed time to run from when the cargo should have been discharged since, if the parties had wanted to provide for such a circumstance, they could easily have done so. The judge also held that, in addition to damages for repudiation, the shipowners could claim demurrage that had accrued before the charterparty was repudiated5". http://www.onlinedmc.co.uk/odfjell_seachem_v__continentale.htm As both the clubs are named as consignees in the receipts, even though they did not do the transactions personally through

Economics Trumps Ideology week 3 dissc 1 Essay Example | Topics and Well Written Essays - 500 words

Economics Trumps Ideology week 3 dissc 1 - Essay Example As a result, the Populist movement was launched in 1890s with the aim of resolving the hardships confronted by the peasants and the working class. It was organized to seek financial assistance and to aid the farmers and laborers in improvement of their work activities (Wormser, 2002). The formation of Populist movement was based on economics as the farmers and the working-class faced paucity of finances to run their work operations effectively. This was attributed to the prevalent economic recession in USA in early 19th century, which lowered the revenues, and dragged the farmers and laborers in losses. Thus, it is difficult to separate the economic and ideological principles while defining the Populist movement. This is because the economic concepts of slump and recession and falling prices are explained as a major reason of the problems faced by the working laborers leading to organizing Populist movement. Likewise, the ideology of the working class and the Republican and Democratic parties is emphasized while explaining the tussle between these two classes. James Weaver was the head of the Populist movement or the People’s Party. Initially, the party met with success under his presidency and formed coalitions of white and black laborers against the federal government. This coalition managed to take over the state of North Carolina in 1896, which was an initial victory for the party. However, the success was transitory. The reliance on traditions made it difficult for the members of Populist movement to cope up with the transformations taking place in the business environment. The racial discrimination found between the black and white laborers blocked the chances of success, and ultimately led to failure of the Populists. The role of economics in killing the Populist movement was evident. The financial crisis arising from the racial discrimination between the

Modelling a Database for a Garment Manufacturing Company Essay Example for Free

Modelling a Database for a Garment Manufacturing Company Essay This project will contain information on the processing involved in modelling a database for a Garment Manufacturing company. It will also document how to create letter and fax templates that make the work more efficient. The database will hold details about the suppliers, customers and stock etc. The garment style, size, how many ordered and deadline dates for the garments to be finished will also be data which is stored in the table. The end-user Mr Jordan will be able to recall information on any of his suppliers or customers. He will be able to link what the customer orders to what he has to order from his suppliers or if the customers provides their own supplies he will see the amount needed. Mr Jordan will be able to send letters automatically to his customers and suppliers about work and orders. The database will be developed using Microsoft Access, the supplier and customer letters will be created in Microsoft Word and merged with data from Microsoft Access. Background to Organisation The Garment Manufacturing Company is called Air Ltd, it is located in Stratford and is owned by Mr Jordan. There are nine workers, which Mr Jordan is in charge of. He takes care of every aspect of the business himself apart from parts of the accounts. All of the other nine workers are arrange in a production line around the work place. Mr Jordan deals with the customer enquiries, orders and suppliers etc. At the moment letters are created from scratch in Microsoft Word. Information Technology is not used much as it could be at the present time. Current procedures Customers get into contact with the company and talk about their order and the type of work required to meet their needs. This would include the design styles, materials and number of garments etc. Either the customer provide their own materials or they set out their order to Mr Jordan so he can go to his supplier. The company then makes a sample garment which is shown to the customer if they are pleased with it then production starts, if not then amendments are made. At the moment if letters need to be sent out to customers or suppliers they are created individually instead of making a template and using mail-merge. From customer orders Mr Jordan notes down how many garments to be made, style of garment and size on paper, all of this documentation is kept in a folder. Image of Mr Jordans customers order detail sheet. [image002.jpg] The customer detail sheet is in tabular form where records are filled in about each of the individual garments. For example data such as size, colour and style etc. would be held on the sheet. Mr Jordan takes care of all of these sheets in a folder. When they are out dated and are no, longer of any use they are disposed of. Strengths of the current system The strengths of the following system are: All of the workers are used to the current system this means that nobody has to be trained to use any new equipment. For example none of the workers have to be trained on how to use computers. Most work is carried out by hand , this is a strength because if machines were used and any one of them broke down the production of the garments would have to be stopped. Weaknesses of the current system The weaknesses of the current system are: All documentation is carried out on paper. All letter to customers are created individually. The business does not use e-mail to communicate with its customers or suppliers. The business does not have a web site advertising its service and goods. If vital business documents are lost, there is no backup. There is no form of a factory outlet. Objectives for the new system Store details about the customers permanently. Store details about the suppliers permanently. Easily be able to input data concerning the ordering of materials. For example, style, material, size, colour etc. Be able to print out order details for the worker to use. Check his status with the suppliers. For example, material ordered etc. Send out letters to customers using mail merge for better efficiency. Print out an update of all deadlines to be met. End-user and functional requirements Store details about the customers permanently The database will need to store details of the name of the company, its address and the telephone number. The user will sometimes want to display details of all the customers. It will be useful if the customer company names are in alphabetical order. The user might want to send the customers letters which means that the postcode will have to be stored in a separate field. Store details about the suppliers permanently The database will store details about the suppliers. For example the user will sometimes want to list the names in alphabetical order this means that the first name will have to be stored in a separate field to the middle and last name. If the user wants to send the customers letters to inform them about orders etc he will need to store the post code part of the address in a different field. Store details about the suppliers permanently The database will store details about the suppliers name and address. The suppliers table will be similar to the customer table. But the user will send letters to the suppliers concerning the orderinf of raw materials etc. Easily be able to input data concerning the ordering of materials. For example, style, material, size, colour etc. The user will easily be able to in put the data u sing Microsoft access instead of inputting the data on paper using a hand made table where he could be creating a more efficient table using access. Be able to print out order details for the worker to use. The user will be able to print out details of the customers orders. For example, the number of garments, style, material etc. Check his status with the suppliers. For example, material ordered etc. The user should be able to access details about what he has ordered and what there is to pay at the touch of button Send out letters to customers using mail merge for better efficiency. The user will be able to send out letters to the customers and suppliers quickly and efficiently using mail merge with Microsoft Access and Microsoft Word Print out an update of all deadlines to be met. The user will be able to print out a list of all deadlines to be met of all of the customers so the workers can work efficiently. Working Constraints End-user skill level The end-user(s) have used modern computers before based upon Windows 95. The user has used a modern computer to create letters and do calculations on Microsoft Excel. The user can only do simple calculations and nothing too complicated. The user can create letters for suppliers and customers by using a word processor. Mr Jordan is new to Microsoft Word but is getting the hang of it. He does not know much about the advanced features of the software. Mr Jordan will need some form of support in using the advanced features. Mr Jordan can use any simple software, but will have to apply himself slightly to be able to get the hang of the advanced features. His experience with IT is very limited. The new system must be easy to understand so that the vital functions can be successfully carried out. No errors should occur, everything should be clear. Availability of hardware and software The previous software that Mr Jordan was using is called Lotus Word Pro96 but has recently purchased a new PC with Microsoft Office 2000 on it. This new computer is manufactured by Compaq and has the following specification: 900Mhz processor 64Mb RAM 13Gigabytes HDD 17 inch VDU Cannon Bubble Jet printer BJC4200 Microsoft Office 2000 Mr Jordan has an ideal specification if not too good for the functional requirements. The software in the school will easily correspond with Mr Jordans PC since in school Microsoft Office 97 is available. Time constraints The deadline for the project is to be completed for the 30^th March. This gives approximately nine weeks for development, testing and documentation. Documentation will take up a great deal of the time this means that time will be a major constraint upon the completed system. Initial time plan Consideration of solutions Data such as company names and addresss will need to be stored along with ordering details etc. this means that a database must be used. A word processor will also be needed because letters have to be created for the customers. Mail merge could be used. There are two choices for the type of database: relational or Flat-file. Flat-file A Flat-file database will not be suitable because it would mean that all of the field would have to be stored in one table. For example, supplier, customer and order fields will all be in the same table. This would then lead to there being data in the table that is not needed. For example, each time a customer made an order their name and address will have to be recorder in that record. If this type were to be used then it would take up a lot of space and hold useless data. It would also make it hard to search in the basic ways that you do. It will be hard to develop it so that the end-user will be able searc h for a certain supplier or customer without all of the other irrelevant details coming up. It would also make it increasingly difficult to use the mail merge facility. Concluding this we now know that a spreadsheet is not suitable for our purpose because it is just like a Flat-file if not nearly enough the same thing. Relational database This form of storage is much more flexible than Flat-file because it allows the data to be split up into separate tables. This is more efficient because each table contains information about a single entity. Now that information is in its individual tables, data redundancy is avoided. By linking all of the tables the whole structure will be able to be searched in a variety of ways. There are a great amount of relational database options in the market but the two main ones are Microsoft Access and Lotus Approach. These are both very suitable choices. Out of the two I will use Microsoft Access because it is more common compared with Lotus Approach and also because I am more familiar with the Microsoft environment. Overall I feel that Microsoft Access is easier to understand the instructions are clearer which makes it easier to follow. The terminology used in Access is better than that used in Lotus Approach. The form will be used to enter record of orders, suppliers and customers etc. This will make the business more organised and thus more efficient. The queries will be used to see who is ordering what and how much is owed to suppliers or owed by customers. To produce the templates for the letter I have chosen Microsoft word because it can easily be linked to Microsoft Access. It will also enable the letter to look professional as you can set any of your own preferences. For example, margin width, header and footer etc. Functions in Microsoft word such as MacroButtons, Date fields can make the end-user develop the letter template for his suitability. Other functions like AutoCorrect and AutoText will give the user an option for creating many types of customised letters for different kinds clients. My other options for word processors were Lotus WordPro, WordPad, Microsoft Publisher, Microsoft Paint and Word Perfe ct. These were not as suitable as Microsoft Word because some of them do not allow me carry out the advanced features that I wish to and also because most of them will not be able to link with Microsoft Access.

Compare and Contrast two Theories of Major Depression

Compare and Contrast two Theories of Major Depression Depressive disorders are the most frequently diagnosed psychopathological disorders; the two most common forms of depression are unipolar and bipolar disorders. This essay will focus on unipolar disorder and for simplicity, will be referred to as depression. Even though social factors evidently contribute to depression, it makes more sense that such disorder should have biological basis. Hammen, 1997 proposed four different reasons to support such belief: Symptoms of depression include physical changes, depression appears to run in families, success of medication and particular kinds of illness/injury/drugs could give rise to depression. This essay will explore the similarities and differences between the biological and psychological explanations of depression, specifically looking at neurotransmitter dysfunction (biochemical factors), genetic factors (twin/adoption studies), Becks theory of depression (cognitive explanations), Freuds theory (psychodynamic explanation) and life event s (socio-cultural factors). One biological account for depression is that biochemical factors are involved; the view indicates that depression is caused by a deficiency of neurotransmitters; norepinephrine and serotonin. Norepinephrine levels in the brain are often low in depressed patients. In addition, post mortem studies have revealed an increased density of norepinephrine receptors in the brains of depressed suicide victims (Bunny and Davis, 1965). On the other hand, the link between low synaptic serotonin level and depression is supported by the fact that the cerebrospinal fluid in depressed patients holds a smaller amount of a major serotonin by-product, demonstrating a lower level of serotonin in the brain (McNeal and Cimbolic, 1986). Moreover, Delgado (1994) demonstrated low serotonin levels was associated with depressive symptoms by giving depressed patients (on antidepressants) a special diet which lowered their level of tryptophan, one of the precursors of serotonin; patients reported depressive symp toms which disappeared when their diet returned to normal. Although the biological explanations of depression have received more research support, the psychological explanations have also been significant. It is likely that, the biological factors cause the development of depression, while the psychological factors maintain the disorder. It is also likely that two or more factors are needed for such disorder to develop. People may become depressed only if they have low levels of serotonin, feel helpless and blame themselves for the negative events that happen to them (Comer, 2003). An alternative explanation for depression is Becks, 1967 (cited in Davey, 2008) cognitive theory of depression, a psychological account. He proposed that depressed individuals feel the way they do since their thinking is biased towards negative interpretations of the world; this is caused by acquiring a negative schema during childhood. Such negative schemas are triggered whenever an individual encounters a new situation similar to the original conditions in which the schemas were learnt. Negative schemas are also subject to certain cognitive biases in thinking; both negative schemas and cognitive biases maintain the negative triad, a negative view of one self, the world and the future. Other cognitive explanations include the learned helplessness theory (failing to control unpleasant experiences) and the hopelessness theory (negative expectations of the future). Both explanations differ in terms of treatment. Treatment stemming from the biochemical account (antidepressants) treats the symptoms and not the ultimate cause with only about 65% effectiveness; in contrast the cognitive accounts are associated with successful therapies for depression. Butler and Beck (2000) concluded that about 80% of adults benefited from cognitive therapy which aims to treat the cause of the disorder. Becks cognitive therapy was more successful than drug therapy and had a lower relapse rate, supporting the proposition that depression indeed has a cognitive basis. In support, Wu, Buchsbaum, Hershey, Johnson and Bunney (1999) demonstrated that uncontrollable negative events (learned helplessness) led to changes in norepinephrine and serotonin levels; further illustrating how by treating such biochemical changes, the ultimate cause of depression is not dealt with. Despite these differences in treatment, a similarity between the treatments is the effects are not imme diate. It takes a number of weeks before the effects of drugs (antidepressants) on depression can be noticed regardless of the fact that antidepressants raise serotonin levels immediately; low levels of neurotransmitters therefore cannot be the straightforward explanation for depression (Kennett, 1999 cited in Cardwell Flanagan, 2004). Moreover, cognitive therapy sessions are taken over weeks, even months before results are noticed. An additional similarity is that not everyone who suffers from depression is helped by serotonin-based drugs and cognitive therapy (individual differences), suggesting that there are other causes for the disorder. In terms of biochemical factors, it is not clear why some people become depressed when their serotonin or norepinephrine levels are low, whereas others with low levels of serotonin or norepinephrine remain depression free. Freud, 1917 (cited in Strachey, 1961) established a further psychological account for depression. He described how, when a loved one is lost, there is a phase of mourning however for some, this phase never seems to end; they continue to exist in a state of melancholia (Freuds term for depression). Freud also believed that we unconsciously harbour negative feelings towards those we love and when we lose those we love, these negative feelings are turned on ourselves. In some cases, we continue a pattern of self-abuse and self-blame; according to this view, depression is anger turned against oneself. A further psychological account is life events (socio-cultural factors). Brown and Harris (1978) studied depressed women in London and found two situations which appeared to increase a persons helplessness to life events. First was the presence of long-term difficulties and secondly the existence of vulnerability factors. Dohrenwend, Shrout, Link, Martin and Skokol (1986) supported this by claiming that depressed patients characteristically experience higher level of negative life events in the year before a depressive episode. The psychological accounts reject the view that the disorder is caused by genetics and brain chemistry but by life events the environment. Similarly, the biological accounts reject the view that depression is caused by psychological factors; instead it favours the idea that the disorder is caused by a deficiency of neurotransmitters, neurocognitive impairment and genetics. Freud focused on the relationship between an individual and a loved one whereas the genetic explanation ignores the impact of the environment. The genetic explanation is an alternative biological account; the view considers that certain individuals have certain genes which predisposes an individual to the disorder. Moreover the disorder can be inherited; as a result of this we would anticipate to find that relatives (i.e. twins) have similar chances of developing depression. Studies of twins have consistently found concordance rates of around 46% for monozygotic twins compared to 20% for dizygotic twins (McGuffin, 1996) suggesting depression has a substantial inheritable component. Further evidence comes from adoption studies; Wender in 1986 studied the biological relations of adopted people who had been hospitalised for serious depression and found there was a much higher incidence of depression in these relations than those of a non-depressed control group. The evidence for biological factors in the onset and progress of depression is strong but not as strong as that for schizophrenia; as with schizophrenia, many of these biological factors (i.e. genes, biochemical factors) are not ultimate causes and may be only peripherally or indirectly involved. A fundamental difference between the biological accounts (biochemical and genetic factors) and the psychological accounts (Freuds theory and life events), is that the biological accounts are based on an internal origin of depression within an individual, both our genes and our biochemical levels are within us, whilst Freuds theory and life events are focused on external events from our bodies (i.e. the loss of a loved one). A similarity between the biological accounts and Freuds theory is both are determinist, indicating that depression is down to factors outside our control (genes, biochemistry, subconscious, thoughts). Some would argue that depression is developed due to factors within our control (i.e. way we think), the approach Becks cognitive theory of depression takes. Additionally, Becks theory of depression is not determinist; it explains how depression is down to our thinking and how we have the ability to change these thoughts, especially through successful cognitive thera py. A similarity between the biological accounts, Freuds and Becks theory is that they can all be argued to be reductionist. The biochemical and genetic explanation does not take into account significant psychological stressors (i.e. life events), making the theories over simplistic when considered as an explanation of depression; reducing the explanation of depression down to biological factors alone. However, research has shown that our environment can affect factors such as our biochemistry (Wu et al., 1999) suggesting that other factors do in fact play a part in the development of depression. The fact that these explanations do not consider both environmental and cognitive factors as reasons to the development of depression is a negative criticism. Both Freuds and Becks theory of depression reduce depression down to the loss of a loved one and the way we think, in addition both theories do not consider other possible factors such as genes. A further similarity is that, all accounts f or depression do not provide a complete explanation of the disorder, ignoring important factors which have evidently shown to influence the development of depression. It is perhaps best to consider an approach which incorporates both biological and psychology factors in explaining the development of depression. The diathesis-stress model indicates that there is a genetic vulnerability to the disorder but this triggered when an individual has been exposed to a stressful life event. Both these factors are necessary for such disorder to develop, this is way not all children (twins) with depression develop the disorder and why the concordance rate for the disorder in monozygotic twins is nothing like 100%. To conclude, both biological and psychological accounts are related to some successful therapies. They are interdependent in so far as it is clear that some people are vulnerable to becoming depressed and for example, life events may trigger the onset of depression. Both explanations are determinist since they suggest that internal/external events cause depression; differences between both the biological and psychological explanations can be found b y looking at specific accounts, and for example, looking at the lack or strength of research evidence and the implications.

The Delivery Of Health Care Health And Social Care Essay

The Delivery Of Health Care Health And Social Care Essay I am looking into the delivery of health care in the NHS. I will be looking at the original remits of the NHS, the ideological and political context in which the NHS was formed and also looking into the governments new White Paper Liberating the NHS. Other areas I will be looking into include; the political and ethical issues that are involved in the inequalities in provision and access to health care services as well as looking at how the NHS works with e the private sectors. Looking firstly at the NHS and the original remits, the NHS was formed/established in 1948, It come out of a long held ideal that food healthcare should be available to all, regardless of wealth or the ability to pay. It was established by Aneurin Bevam who was at the time health secretary. The formation of the NHS marked the start of the health service; it was the first time that doctors. Hospitals, nurses, pharmacists, opticians and dentist were brought together under one umbrella organisation. The main principles were that it was free, and it would be financed entirely from taxation, this meant that people pay into it according to their means. From the cradle to the grave This was one of the original ideas of the NHS; it would give/provide medical assistance all through a person life. The NHS was set up just after the 2nd world war and people badly needed medical help and assistance. 60 years ago medication and treatment was seen a s a source or real worry to many families and something that could not of been afforded. Other remits were that anyone living in the country and visiting could see a GP/Doctor and go the hospital for free. Before this people simply didnt go to the doctors, they couldnt afford it and would rely on home remedies and the charity of doctors giving free advice and help. If we look at the three core principles that the NHS was built on, these were; that it needs to meet the needs of everyone, that its free at the point of delivery and that is be based on clinical need, not ability to pay.(http://www.nhs.uk/NHSEngland/thenhs/about/Pages/ nhscoreprinciples.aspx).In July 2000, the NHS was modernised and new programmes were brought in, these required that The NHS provide a wider more comprehensive range of services, the NHS will meet the needs of individuals, their families and there carers. There were also other new programmes brought in looking at improving the NHS and how it operated as a whole. The new White Paper Liberating the NHS (2010) is the governments long term vision for the future of the NHS. It sets out that they will put patients at the heart of everything the NHS does, focus on continually improving those things that really matter (i.e. patients and the public) and finally, empower and liberate clinicians to innovate, with the freedom to focus on improving healthcare services. The government also has other key strategies: We will increase health spending in real terms in each year of this Parliament. Our goal is an NHS which achieves results that are amongst the best in the world. Putting patients and public first We will put patients at the heart of the NHS, through an information revolution and greater choice and control Improving healthcare outcomes To achieve our ambition for world-class healthcare outcomes, the service must be focused on outcomes and the quality standards that deliver them. The Governments objectives are to reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all. Autonomy, accountability and democratic legitimacy The Governments reforms will empower professionals and providers, giving them more autonomy and, in return, making them more accountable for the results they achieve, accountable to patients through choice and accountable to the public at local level. Cutting bureaucracy and improving efficiency The NHS will need to achieve unprecedented efficiency gains, with savings reinvested in front-line services, to meet the current financial challenge and the future costs of demographic and technological change Conclusion: making it happen We will maintain constancy of purpose. This White Paper is the long-term plan for the NHS in this Parliamentary term and beyond. We will give the NHS a coherent, stable, enduring framework for quality and service improvement. The debate on health should no longer be about structures and processes, but about priorities and progress in health improvement for all. (http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117794.pdf) The proposal of the white paper is that as much as 80% of the NHS budget will be in the hands of family doctors by 2013. Many people feel that these changes are effectively being introduced without any real testing to see if they will work or if they will actually bring around better care for patients. GPs will take over from primary care trusts and purchase large chunks of care such as hospital admissions and out of hour care. The areas they will not be responsible for will fall under the care of local authorities. Englands 35,000 family doctor practices will form themselves into about 500 consortia, based on geographical area. So they could be responsible for patient populations as large as one million and as small as 100,000. They will either manage themselves or, more likely, will take on managers from the PCTs and strategic health authorities, which are also being abolished. Alternatively, they can take on a private company to manage them, and there are several waiting in the wi ngs for his opportunity. Hospitals will all be required to become foundation trusts by 2014, giving them more autonomy and freedom as to how they provide their services. They can also borrow money without asking the Treasury, and Mr Lansley is very keen that many form themselves into mutual trusts a lot like John Lewis, in which staff run the centre. Some people believe that this could all lead to the privatisation of the NHS. The new government is allowing them opportunities to step into the new regime. GPs may now have to take back the responsibilities of out of hour care. The new regime No decision about me, without me is at the heart of the white paper. What is not clear is what happens when a profit is made or, equally, when a deficit is run up. Patients should have more choices and patients will now be asked how their experience was during their care. (http://www.channel4.com/news/nhs-white-paper-liberating-the-health-service) The main benefits that should be seen from this is that GPs will know there patients on a more personal level, they will make logical decisions. It will bring costs down such as pharmaceuticals and prevent the NHS going further into debt. It will also stop them from working towards incentives. However only one in four of Britains doctors thinks the governments controversial NHS shake-up will improve patient care, according to the biggest survey of medical opinion since ministers unveiled their radical reforms. Andrew Lansleys belief that the most far-reaching changes to the service in its 62-year history will lead to higher standards is shared by only 23% of doctors There is some good news for Lansley in the poll. Of the GPs, 62% thought there were family doctors in their locality who could lead the new commissioning consortiums. And 40% of all the doctors believed the reforms would encourage closer working between GPs and their hospital colleagues (though 37% disagreed). (http://www.guardian.co.uk/politics/2010/oct/24/nhs-white-paper-doctors-survey) Political and ethical issues surrounding the inequalities in providing access to health services, in 1999 labour that were in government set up NICE (National Institute for health and Clinical Excellence). They decide what medicines should be available to the NHS. They work out whether a drug is worth paying for, weighing up its costs against the benefit it is likely to bring. They also consider is drugs or treatments will benefits patients, will help the NHS meet its targets, for example by improving cancer survival rates, Is value for money, or cost effective. The government developed NICE to get rid of the post code lottery where some drugs and treatments were available in some parts of the country, but not in others. Its worth knowing that they fund the majority of drugs they assess. Since they started in 2002, they have funded 7 out of 10 (70%) of the cancer drugs theyve assessed. However a report Exceptional Progress has found there is controversy surrounding NICE. Patients are being denied access to drugs for rarer cancers because the NHS treatment watchdog is acting contrary to the recommendations of a government inquiry, a report claims today. (NICE) is failing to follow the spirit of guidelines designed to improve access to end-of-life cancer treatments. It claims that as many as 16,000 patients have been denied access to drugs because the watchdog had concluded unfairly that they did not meet the criteria for consideration, or they were deemed too expensive without proper negotiation with pharmaceutical companies. It is unacceptable that many thousands of patients are still missing out on the treatment they need, and which their doctors want to give them, because NICE has decided that their treatment does not meet some arbitrary criteria, Mr Wilson said. He added that NICE was failing to assess drugs quickly enough taking 21 months to appraise new canc er drugs, rather than the six months promised by ministers by 2010. (http://www.timesonline.co.uk/tol/news/uk/health/article7061769.ece) This is against the original ethics that the NHS was set up for; some patients are missing out on drugs which could be of immense benefit to them. An example of this is patient inequality in Essex where a doctor treating three people for exactly the same eye disease, treats each differently because they live in three different areas. One of the three is getting Lucentis the drug tailored to treat their condition, the second receives a drug which was not designed to treat the eye condition; but which does the job at a much smaller price, while the third is left with no drug therapy at all. The programme also spoke to best-selling author Terry Pratchett who has been forced to look elsewhere for Aricept, the Alzheimers medicine denied to him by the NHS. NICE ruled that Aricept should be limited through the NHS to people in the later stages of the disease and Pratchett is still in the early stages of PCA, an early-onset form of Alzheimers which he was diagnosed with in 2007. The author n ow pays for the drug himself which he says has been vital in allowing him to cope with the symptoms of his condition, and says that not making it available earlier to other sufferers who cannot afford to pay is an insult which needs to be re-thought. (http://news.bbc.co.uk/1/hi/programmes/panorama/7563701.stm) There are big gaps between regions and areas; in some cases the north is better at treating certain conditions than the south and vice versa. A report by the Daily Mail shows how Statistics showed the average waiting time from seeing a GP to having an operation was 180 days in the Trent region, 182 days in the Northern and Yorkshire regions and 193 days in the North West. But patients must wait for 217 days in the South East, 207 days in London and 206 days in the Eastern region. There was a rise of 1.6 days in delays on average in the South East compared with the same time last year. In the same, period delays fell by 8.7 days in Trent and the North West. (http://www.dailymail.co.uk/news/article-70414/North-south-divide-NHS-waiting-times.html) Finding a dentist is becoming more and more difficult. There is a culture of drill and fill, but because dentists receive a flat salary they no longer have any financial incentive to carry out difficult work such as crowns and bridges. An NHS dentist recently resigned due to stupid system that requires him to complete 49 units of dental activity a day to fulfil his NHS contract and get paid. Under the contract, check-ups count as one unit, minor dental work and fillings no matter how many are three, while more complicated procedures can be worth up to 12. Disillusioned, he has decided to give up his practice in Penzance, Cornwall, and take early retirement, leaving his 4,000 patients without an NHS dentist in an area where 20,000 already cannot find one. (http://www.dailymail.co.uk/news/article-484066/Dentist-fed-drill-targets-quits-NHS.html) This again goes against the principles both politically and ethically. The NHS was set up to be free and give everyone the same level of treatment and help regardless of wealth. However these few examples show how it is people with money are gaining in healthcare and the NHS is stopping treatments and drugs due to financial funding, meaning that patients are losing out on much needed treatment because the government decided that its not cost effective. This is wrong ethically because you are putting a price on a persons life. Over the years healthcare has become more of a business and we are seeing more privatisation coming in. the post code lottery proves that money is at the heart of decisions on whether a patient is seen to and how they are treated. The NHS works with private sectors and third sectors to deliver better outcomes and services for patients who come first. They play an extremely important role in helping the NHS in providing much needed services. Private sectors not only help in hospital but also with services in the local community. One of there aims is to cut hospital admissions, an example of this is A private sector provider in Sheffield has installed electronic monitors in the homes of people suffering from chronic obstructive pulmonary disease, allowing them to reduce visits to hospital by 50 per cent. Another is A private sector company in Poole has put under one roof a GP surgery, a pharmacy, an optician and services for physiotherapy, back pain and podiatry. (http://business.timesonline.co.uk/tol/business/industry_sectors/public_sector/article7050344.ece) There is also other instances were GPs have used private sectors not only to provide patients with a better service but to reduce costs. A patient in Bexley Kent needed a scan for his heart condition; this would normally mean he would be sent to his local hospital in Kent. However he picked up from his souse and was sent to a private hospital in London. The bill for this bespoke service is picked up by Peter Aylotts local primary care trust in Bexley. In the past eight months it has sent more than 80 patients to Harley Street for these scans. The alternative was to have an angiogram were 1 in 500 patients suffer a heart attack or a stroke. The scan is also cheaper, says Dr Kostas Manis, a GP in Bexley. The angiogram is  £1,300 in the NHS, and the private clinic scanner is  £900 and were negotiating to bring the figure down to  £600. This shows how the NHS working with private sectors helps not only patients in that they get a quicker appointment but they also get something that is much more beneficial and safer to them. It also allows the patients to see a specialist for longer, rather than the normal 5 10 minutes they get to see the Doctor for up to half an hour. This is truly putting the patient first, it does however, have financial benefits to it, and it reduces costs to the local GPs and makes managing their budgets much easier. Faced with a  £20m deficit in 2007, the primary care trust decided to hand over the bulk of commissioning power to GPs. They now control 70% of the  £150m budget for Bexley. This all looks good, patients get a quicker appointment, its better and more tailored to their needs and it reduces the cost of the local primary care trust, meaning that the community has more money to spend in other areas. There is also consequences however of GPs turning to private sectors. Looking at this same example, the local hospital in Kent Queen Marys hospital in Sidcup, will now lose out on patients going there for this condition, meaning that the hospital has less money coming in and could see them have a long term shortfall in revenue. There are plans by the Government to permit hospitals to compete on price for the first time, raising the prospect of two-for-one deals on surgery and cut-rate consultations for certain specialties. This will come into effect from next April. Prices for operations and other treatments are currently fixed by the Department of Health and hospital trusts are only permitted to compete on quality, offering better outcomes, cleaner wards or sho rter waiting times to win contracts from GPs. The risk is that some hospitals may lower their prices, which will be superficially appealing, but offer a less good operation and GP commissioners may not be able to spot that it is less good.