The HiSET Test - High School Equivalency Exam

The HiSET Test - High School Equivalency Exam On January 1, 2016, the GED (General Educational Development) test, offered by GED Testing Service, changed big time, and so did the options available to the states in the U.S., each of which sets its own requirements. States now have three testing choices: GED Testing Service (partner in the past) HiSET Program, developed by ETS (Educational Testing Service) Test Assessing Secondary Completion (TASC, developed by McGraw Hill) This article is about the new HiSET test offered in: HawaiiIowaLouisianaMaineMissouriMontanaNevadaNew HampshireNew JerseyTennesseeWyoming If your state isnt listed here, it offers one of the other high school equivalency tests. Find out which one in our list of states: GED/High School Equivalency Programs in the United States Whats on the HiSET Test? The HiSET test has five parts, and is taken on a computer: Language Arts - Reading (65 minutes)40 multiple-choice questions that require you to read and interpret literary texts from various genres, including memoirs, essays, biographies, editorials, and poetry. Language Arts - Writing (Part 1 is 75 minutes; Part 2 is 45 minutes)Part 1 has 50 multiple-choice questions that test your ability to edit letters, essays, newspaper articles, and other texts for organization, sentence structure, usage, and mechanics.Part 2 involves writing one essay. You will be graded on development, organization, and language. Mathematics (90 minutes)50 multiple-choice questions that test your reasoning skills and understanding of numerical operations, measurement, estimation, data interpretation, and logical thinking. You may use a calculator. Science (80 minutes)50 multiple-choice questions that require you to apply your knowledge of physics, chemistry, botany, zoology, health, and astronomy. Interpretation of graphs, tables, and charts is involved. Social Stud ies (70 minutes)50 multiple-choice questions regarding history, political science, psychology, sociology, anthropology, geography, and economics. You will be required to distinguish fact from opinion, analyze methods, and judge the reliability of sources. The cost of the test, as of January 1, 2014, is $50 with individual parts costing $15 each. The $50 price includes free test prep and two free retests within 12 months. Fees may be slightly different in each state. Test Prep The HiSET website provides a free tutorial video, study companion in the form of a PDF, sample questions, and practice tests. You can purchase additional prep materials on the website. The HiSET site also offers some helpful tips and strategies for passing the test, including how to know if youre ready, how to organize your time, how to answer the multiple-choice questions, and how to approach the essay question on the writing part of the language arts test. The Other Two Tests For information about the other two high school equivalency tests, see: The GED TestThe Test Assessing Secondary Completion (TASC) coming soon!

National Negro Council of Women

National Negro Council of Women   Overview Mary McLeod Bethune established the National Council of Negro Women (NCNW) on December 5, 1935.   With the support of several African-American women’s organizations, the NCNW’s mission was to unify African-American women to improve race relations in the United States and abroad. Background Despite strides made by African-American artists and writers of the Harlem Renaissance, W.E.B. Du Bois’ vision of an end to racism was not during the 1920s. As Americans- especially African-Americanssuffered during the Great Depression, Bethune began to think that a unified group of organizations could lobby effectively for an end to segregation and discrimination. Activist Mary Church Terrell  suggested that Bethune form a council to help in these efforts. And the NCNW, â€Å"a national organization of national organizations† was established. With a vision of â€Å"Unity of Purpose and a Unity of Action,† Bethune efficiently organized a group of independent organizations to improve the lives of African-American women. The Great Depression: Finding Resources and Advocacy From the outset, NCNW officials focused on creating relationships with other organizations and federal agencies. NCNW began sponsoring educational programs. In 1938, the NCNW held the White House Conference on Governmental Cooperation in the Approach to the Problems of Negro Women and Children. Through this conference, the NCNW was able to lobby for more African-American women to hold upper-level government administrative positions. World War II: Desegregating the Military During World War II, the NCNW joined forces with other civil rights organizations such as the NAACP to lobby for the desegregation of the U.S. Army. The group also worked to help women internationally. In 1941, the NCNW became a member of the U.S. War Department’s Bureau of Public Relations. Working in the Women’s Interest Section, the organization campaigned for African-American to serve in the U.S. Army. The lobbying efforts paid off. Within one year, The Women’s Army Corps (WAC) began accepting African-American women where they were able to serve in the 688th Central Postal Battalion. During the 1940s, the NCNW also advocated for African-American workers to improve their skills for various employment opportunities. By launching several educational programs, NCNW helped African-Americans gain necessary skills for employment. The Civil Rights Movement In 1949, Dorothy Boulding Ferebee became the leader of the NCNW. Under Ferbee’s tutelage, the organization changed its focus to include promoting voter registration and education in the South. The NCNW also began using the legal system to help African-Americans overcome obstacles such as segregation. With a renewed focus on the burgeoning Civil Rights Movement, the NCNW allowed white women and other women of color to become members of the organization. By 1957, Dorothy Irene Height became the organization’s fourth president. Height used her power to support the Civil Rights Movement. Throughout the Civil Rights Movement, NCNW continued to lobby for women’s rights in the workplace, healthcare resources, prevention of racial discrimination in employment practices and providing federal aid for education. Post-Civil Rights Movement Following the passage of the Civil Rights Act of 1964 and Voting Rights Act of 1965, the NCNW once again changed its mission. The organization focused its efforts on helping African-American women overcome economic problems. In 1966, the NCNW became a tax-exempt organization that allowed them to mentor African-American women and promote the need for volunteers in communities across the country. The NCNW also focused on providing educational and employment opportunities for low-income African-American women. By the 1990s, the NCNW worked to end gang violence, teenage pregnancy and drug abuse in African-American communities.

Criminal Justce Tools Assignment Example | Topics and Well Written Essays - 250 words

Criminal Justce Tools - Assignment Example rst pioneered through the use and acceptance of the Uniform Crime Report (UCR) by both federal police agencies (such as the Federal Bureau of Investigation) and by local and state police organizations of the United States of America which enabled law enforcement organizations to enhance their crime fighting strategies based on effective criminal information gathering methods and effective analyst of data. As technology continues to evolve, the advent of the computer and consequently, the creation and use of advance analytical software or programs have greatly influenced the further effectiveness of police information management systems. Police intelligence or Law Enforcement Intelligence is a relatively new concept of policing since by tradition, most police agencies do not maintain a dedicated unit with full time intelligence officers and analysts, nor does most police agencies involved in the collection, collation, management or even share criminal information with appropriate members of the intelligence community. The need however for a police agency to have a dedicated intelligence capability have become more relevant with the advent of transnational crime and terrorism in the global scene, with law enforcement becoming more integral and dynamic with the continuing refinement of police methodologies and access to resources that better allows the police to more effectively serve the community. One of the most significant strides in technology which contributed to relevance of law enforcement intelligence is the existing and emerging technologies brought about by custom made software dedicated for law enforcement analytical functions, data management, intelligence production and dissemination. The dissemination of much needed intelligence by means of the internet makes its easier for large, medium and small police agencies to share intelligence and disseminate the same to other police agencies or jurisdiction, therefore directly contributing not only in

Economic Essay Example | Topics and Well Written Essays - 500 words - 6

Economic - Essay Example The Assad regime, as well as the rebel forces, violated an otherwise, failed UN - backed cease-fire, led by the former Secretary-General of the United Nations, Koffi Anan, in late October. The fighting has heightened in neighbouring Lebanon, home to Iran-backed Hezbollah, and prompted cross-border shelling between Syria and Turkey. The unrest also proved to be an attraction for global jihadists like the al-Qaeda-linked groups, fighting for the formation of an Islamist state (Landis 75). Following the Syrian civil war, the Arab League acted swiftly and immediately suspended Syrian membership to the organization, In addition, the league imposed imposed stringent economic embargos in November 2011(Masters). Despite the lack of support from Syria’s friendly nations like Russia, the sanctions have had a noticeable economic impact. The European Union sanctions have also served to redefine partnerships with other powers, both globally and in the Middle East. The EU, supported by the US sanctions, initially asked Al-Assad to negotiate with the opposition to cease repression, and  leave office as from August 2011 (Balfour). The sanctions against Syria are unprecedented since they accumulated the whole set in just a few months. Some of the notable sanctions entail an energy embargo. Prior to the embargo, the EU’s import of Syrian crude was worth over â‚ ¬3 billion a year, mostly to Italy and Germany. The economic sanctions have had a significant impact on the Syrian economy. Oil is the mainstay of the Syrian economy, and the Western ban has exacted a heavy toll on the country. In view of these developments, Sufian Allaw, the Wyrian oil minister, indicated that the imposed restrictions cost the country about $4 billion (â€Å"Syria Says†). The United States also placed a range of sanctions on Syria that prevent aid and restrict bilateral trade. Before the

Nationalization of Oil Industry Essay Example | Topics and Well Written Essays - 1750 words

Nationalization of Oil Industry - Essay Example Argentinean President Cristina Fernà ¡ndez de Kirchner in April 2012 has announced that Argentina would take control of Repsol YPF, the country’s biggest crude oil producer, by nationalizing 51 percent of the company’s shares (Gaudà ­n, 2012). Until 1999 YPF was the largest oil company in Argentina and was owned by the government. However, lack of efficient management and expertise was pulling down profits in the oil industry. As a result, the government started encouraging foreign investment in the market so as to invigorate oil production. Between the years 1993 and 1999, Madrid based Repsol had acquired 100 percent of the company’s shares (Weinstein, 2012) and its name was changed from YPF to Repsol YPF. Spain is the largest foreign investor in Argentina with the European market being the largest export market for the country (Hernandez, 2012). However, the current dispute is over a slump in investment by the Spanish owner of YPF, which is leading to a drop in energy output in Argentina.In the home country, Buenos Aires based YPF is considered an emblem of state pride (Economist, 2012a). Nationalization of the $18 billion worth company in 2012 would bring huge revenue to the cash-strapped government, which is a significantly beneficial aspect of the President’s decision. Hence nationalization of the country’s biggest oil company is apparently a populist move by the President. Energy officials from Brazil and the President of Uruguay have praised this action (Economist, 2012a).... Justifications Cited for Nationalization of Oil In the home country, Buenos Aires based YPF, is considered an emblem of state pride (Economist, 2012a). Nationalization of the $18 billion worth company in 2012 would bring huge revenue to the cash-strapped government, which is a significantly beneficial aspect of the President’s decision. Hence nationalization of the country’s biggest oil company is apparently a populist move by the President. Energy officials from Brazil and the President of Uruguay have praised this action (Economist, 2012a). Ms. Fernandez has accused Repsol in terms of its failure to make enough investment in exploiting the resources of the country. YPF has declared that it has discovered an oil shale site whose estimated potential yield would be 23 billion barrels approximately (Forero, 2012). In the context of soaring cost of oil, which is damaging the country’s economy, the lack of potential investment in Argentinean gas and oil reserves is a primary show cause behind the seizure of Repsol YPf’s shares. The President said that Repsol was not producing enough oil and was therefore failing to meet the country’s total energy requirements. Argentina is currently facing a serious shortage in its total production of energy. This situation is being fixed by importing energy at a higher price from other countries (Economist, 2012a). Ms. Fernandez has said that if this continues Argentina would become an unviable state for investment (Macalister, 2012). Pressure exerted by the government on YPF was increasing since the past two months before the decision of nationalization was taken. It is evident that the current situation has been created as a turn from the 2004

Native Americans (Subordinate Group) Essay Example for Free

Native Americans (Subordinate Group) Essay One often wonders where the Native North Americans originated from. Some theories have been discussed about the peopling of the Americas. Early theories involving lost tribes and continents were based purely on speculation instead of actual scientific facts. Discoveries made during many archeological expeditions have helped shape the always changing interpretations by adding more questions and more theories. There have been genetic and linguistic studies which raised more understanding and brought new questions. It is theorized that during the latter part of the Cenozoic era, also known as the age of mammals that the Wisconsin glaciation caused enough of the planet’s water supply to turn into ice. This lowered the oceans and exposed now submerged land. This event created a stretch of land that the large mammals of the Ice Age era, along with the natives of that era, could very well have migrated across the newly formed land bridge, which now connected two continents. This land bridge is known as the Bering Strait, or Beringia. During the time that Beringia existed, the Wisconsin glaciers most likely prohibited migration to any southern or eastern regions. Another theory suggests that the early natives may have inhabited the now Alaskan region because it was ice-free due to low precipitation. Several melts over a period of time created passageways, and evidence from archeological site implies that there was an ice-free corridor for thousands of years. It was during another melt approximately ten thousand years ago, that a second corridor was most likely formed farther east along the borders of Saskatchewan and Canada plains. This points to the possibility that the ancient people could have traveled eastward along the rivers in the Great Plains, and down further south. The Indians known to history as the Sioux are also known as Lakota, Dakota, and Nakota, meaning allies. This is my heritage. I am a member of the largest division of Siouan family, otherwise known as Sioux. The name is from a term given to the largest and well- known of the tribal groups. At one time, my people stretched from the west banks of the Mississippi northward from Arkansas and the Rocky Mountains. The Dakotas also inhabited territory east of the river up to Wisconsin and Missouri. They were here to encounter DeSoto on his journey in 1541, when he reached the Indian villages in what is now eastern Arkansas. Another hundred years passed before any mention of Sioux existing, when in 1658 some Jesuit missionaries heard of the existence of about thirty Dakota villages just north of a Potawatomi mission. This was located at about the head of Green Bay, Wisconsin, in St. Michael. It was during the middle 1600’s when the Sioux, along with the Arapaho and Cheyenne had to migrate further westward towards the Great Plains to what is known as North Dakota, Minnesota, and South Dakota. This migration was mainly due to the O jibwa and Chippewa tribes pushing them out of the Great Lakes region. The Ojibwa and Chippewa had been pushed out of their own land that had been further east, by the European settlers of that time. In 1805 Lewis and Clark passed through the center of this region and made contact with the Sioux tribes. After this took place, several more expeditions brought traders that settled among the tribes, and in the course of some time, permanent settlers arrived. This made the area so small that eventually the people of my tribe were forced to live in Indian Territories or confined to Nebraska, the Dakotas, or Montana. This brought on a series of raids and counter raids that lasted from roughly 1850 through 1890 and were known as the Sioux Wars. In the first years of the twentieth century, the Dakotas also known as Tetons began the process of adapting to their new way of life. They still had strong faith in their own traditions, but realized that the old way was gone forever. Numerous changes with the economy and politics were forced on my people by the government. The people strived to establish a life for themselves that used both new changes, but still remained true to their values and beliefs. During the rest of the twentieth century, all of the reservations for the Dakotas, Lakotas, and Tetons lost more land due to ownership passes and inheritances. Division between rural dwellers and people who live in town have grown bigger. Rural residents tend to retain their use of native language, and be involved in cultural events, when townspeople adapt other aspects of the American culture. Most of the Sioux nation and other groups of American Indians live in South Dakota, Oklahoma, New Mexico, and North Dakota at present time on privatized land created by the government many years ago. Wendy Coghill ETH/125 Text Citations: Bonvillain, Nancy. Seeking a New Way. Teton Sioux, Indians of North America, Heritage Edition. Philadelphia: Chelsea House Publishers, 2004. American Indian History Online. Facts On File, Inc. http://www. fofweb. com/activelink2. asp? ItemID=WE43iPin=INATS06SingleRecord=True (accessed May 22, 2011). Text Citations: Waldman, Carl. arrival of humans in North America. Atlas of the North American Indian, Third Edition. New York: Facts On File, Inc. , 2009. American Indian History Online. Facts On File, Inc. http://www. fofweb. com/activelink2. asp? ItemID=WE43iPin=ind5278SingleRecord=True (accessed May 22, 2011). Text Citation: Waldman, Carl. Assimilation. Word Dance: The Language of Native American Culture. New York: Facts On File, Inc. , 1994. American Indian History Online. Facts On File, Inc. http://www. fofweb. com/activelink2. asp? ItemID=WE43iPin=ind2991SingleRecord=True (accessed May 22, 2011). Text Citation: Waldman, Carl. Sioux. Encyclopedia of Native American Tribes, Third Edition. New York: Facts On File, Inc. , 2006. American Indian History Online. Facts On File, Inc. http://www. fofweb. com/activelink2. asp? ItemID=WE43iPin=ind2432SingleRecord=True (accessed May 22, 2011).

Effects Of Globalization: Competition And Business Opportunities

Effects Of Globalization: Competition And Business Opportunities In many countries, globalisation provides a mechanism through which poverty can be reduced. The rapid growth of these emerging economies also provides substantial with new markets for exporters and investors and cheaper, more diverse goods and services for consumers (Kohler, 2002). In the essay, I will discussing the view that globalisation has not only significantly increased competition and business opportunities but has and will continue to so, increasing living standards. I will also further in evaluating the issues relating to investment, growth and development, and economic performance levels between countries. In todays world, trade has increasingly global in scope. There are several reasons for this. One of the reasons is technological. The improved on transportation and communication of today has made trade more practical. Technology change is represented as the driving force of globalisation i.e. changes in technology and production methods that determine the future of workers managers and their interrelationships. The use of internet and computers are increasingly based on technologies as it main driving forces. The former general director of World Trade Organisation (WTO) Mike Moore has expressed this view as technology can be the friend of the people (Benedek, 2007, pg21). Technological change has helped fuel the rapid rise in global economic activity, especially in relation to communication and transport. Transport costs have fallen and the worldwide travel has increased exponentially. This has had a direct impact on the structure of industry, with tourism now being the second bigge st industry as well across a whole range of other business activities. The other reason is free trade. Many barriers to trade have been removed mostly by the WTO. This makes trade cheaper and looks more attractive to business. Globalisation can be considered as a business that wants to expand their business significantly. In general, globalisation for a business means, not only did they expand their client base and support but also on other countries as well. Through globalisation, most companies significantly increase their earnings that enhance the improvement of the company. As more employees are hired, the experienced ones increase their chances of promotion. Moreover, giving them the opportunity of being a leader in working in other countries and experiencing a totally different culture with a good salary. However, globalisation can be dangerous in some company, if they are not careful in implementing changes. Globalisation has brought in new opportunities to developing countries. These developed countries have greater access of markets and technology that improved productivity and higher living standard. But globalisation has also thrown up new challenges like growing inequality across and within nations, volatility in financial market and environmental deteriorations. Globalisation also supports productivity, cultural intermingling and cash flow into the developing countries. Hence, there are some disadvantages of globalisation that should be overlooked such as unemployment and difficulty of competition. Thus globalisation responds the needs of 7 million people. Moreover, the standard of living as at now compare to 50years ago is a lot better, as they are more machines and system invented in developed countries. Cultural intermingling enlarges with globalisation that enables people from all over the world able to communicate effectively. However, hand sharing traditional behaviour causes fading as boundaries is disappearing. Brittan (1998) states that the high levels of unemployment in developing countries are caused by globalisation. The employment rate reflects not only the economic situation but also to some extent social conditions. However, not all countries with high unemployment rates face social problems. According to Brittan (1998), globalisation led to an increase in the wealth of developed countries and also not to the bigger poverty in the developing countries. Brittan furthers more saying that the improvement in economic growth in the economic situation in the skewed distribution of income between developed and developing countries. However, Hak-Min (1999) argued from the view of Brittan that the distribution of income between developed and developing countries has become less skewed by indicating that globalisation in the integrated world economy has lead to industrial growth in a limited number of developed countries. In the late nineties, over 90% of all financial transactions of the world were executed in 25 of 121 countries worldwide (Hak-Min, 1999). Less than 1% of the total worldwide transactions were shared in the globalised capital flows from the developing countries. Law (1988) saw these developments as the transactional stage in the development of capitalism. In the 1980s, globalisation has become an important policy issue for several reasons particularly in developing countries. Most developing countries now face more intense international competition and often greater opportunities with large proportions of their economies subject to market forces, particularly international ones. During the late nineties, many developing countries were restricted on foreign direct investment (FDI) that brought down tariff rates. In general, the higher growth and productivity, the less poverty in developing countries. Round (2002) states that in anti-globalists, globalisation adversely affects the poor in the poor countries while pro-globalists claim that it has lead to poverty reduction. Some countries that managed the globalisation process illustrate that it can be a powerful force for economic growth whereas, those who were affected were evidenced by dismal record on economic growth and poverty. It is clear that globalisation has failed to rid the world of poverty. Rather than being an unstoppable force for development, globalisation now seems more like an economic temptress, promising riches to everyone but only delivering to the few. In the 20th century, global average per capita income raised the income gap between the rich and the poor countries that has been widening for many decades Williamson (2002). It is argued that both rich and poor benefit from such a process. Politically, globalisation brings us closer together. Political ties help stabilise relationships and offer the opportunity for countries to discuss their differences. However, imperfect the current global political system might be, the alternative of independent nations is seen as potentially far worse. In addition, not all countries benefits equally from globalisation. Some people that have wealth will, as always, posses more opportunity to benefit from the globalised world, whether from lower prices, cul tural experiences or political agreements. In the other hand, it is argued that globalisation contributes to growing inequality and further impoverishes poor nations. Globalisation allows multinational corporations based largely in the USA, Europe and Japan, to exploit their dominant position in foreign markets. By exploiting the low wage labour, companies are able to compete more effectively on world markets. The major benefit of globalisation has improved living standards derived from a better division of labour. Developing countries specialise in intensive tasks, developed countries have to use employees in more productive ways. Most of the developing countries do not have the scientific and educational support, which the developed countries will have to move onto higher technology products. During the 19th century, Marx views on capitalism posed as a central contradiction. Marx argued that there was a fatal flaw that capitalism led to unprecedented growth. The source of this growth was the ability of capitalists to exploit their labourers and as growth and wealth increased the conditions of the workers would be declined. Marx furthers his argument that the world capitalism might lead to even greater problems for the workers in the less advanced areas because of their even weaker position as subjects of an imperial master. In conclusion, globalisation has an impact that enable worldwide prosperity to grow and the gap between developed and undeveloped countries to decrease. Globalisation plays an important role in solving the development problems of developing countries. More so, globalization has also shown its impact in narrowing the world by bringing nations on a single platform but realistically, this platform has not only expanded the gap between the nations but has also brought pains and sufferings to the less privileged. The way around the industries is a matter of much concern as the water body of this area contains the entire overflow discharged from the industries as a waste product. This waste product is either thrown out in the air or is flown in the water and occasionally buried in the soil, making the people to suffer from all kinds of danger.   Enabling people of one nation to communicate with those of the other nations is the biggest achievement in terms of globalization. The culture, trade, business, ethics and conduct of one group in one part of the world can influence others may or may not be of same nation.   There are various aspects where globalization has massively affected the world in industrially, it has provided the outside to the production market with an improved access to a wide range of foreign products and as a result globalization has increased huge number of customers for itself and this has helped in the progress of goods and materials between and within the national limitations.   Financially globalization has opened the way to obtain external financing opportunities to the borrowers.   Economically the freedom of exchange of goods and capitals tells us that the markets are consistent and any kind of economic fall down in one country could be supervised by others.    Politically, the United States has come up with the ultimate power in the period of globalization as it has strong and wealthy economy. There is a flow of information from one part of the globe to another and even to the distant locations, through the means of satellites, wireless communication or through internet.   Globalization has also given birth to great fight and has made the market an open place to stand out with skills and quality.  Culturally, cross-cultural contacts are the result of globalization. It has produced improved understanding towards cultural diversity and has also promoted travels and tourism to understand each other to a greater amount. This has improved greater customer products and has also has generated a pseudo-cultural patterns.   Socially, due to globalization the social network of people is expanding and people are able to understand each other in a better way howsoever isolated geographically they may be.  In the technical aspect, any kind of technological progress can be communicated to other parts of the world and as a result feedback to further develop it can be obtained.   Privatization of the NHS: Staff and Patient Views Privatization of the NHS: Staff and Patient Views Staff and Patients Perception on the Government’s Proposal of the Part Privatization of the NHS Anne Cook 1. Abstract The National Health System (NHS) provides medical care, generally free at the point of use, to all people in the United Kingdom. The NHS is the responsibility of the Ministry of Health. In recent years, using the Private Finance Initiative, elements of health care are increasingly being placed on long-term contracts with the private sector. Medical staff and the public at large are currently dissatisfied with the move to part privatization and believe that patient care will be compromised, particularly for those unable to opt out of the NHS and become paying patients. Job losses in the medical profession have occurred and the public feel that the basic right of free medical care should not be moved to private enterprise that is profit driven. This is seen as undermining a fundamental right of all citizens. The Ministry of Health, on the other hand, defends their position stating that the move is in the best interests of the public and the profession, and state that patients will have more choices as a result of the new system. They do acknowledge that there are cases of cost overruns that were not initially budgeted for. The public feels betrayed by the changes to what was a fundamental right to free medical. The paper concludes that the transition is difficult and could take years to show the required improvements. There is no buy-in to the change from staff within the profession or the public; this is likely to be due to a lack of marketing of the changes, no buy-in from the stakeholders and a mistrust of the motives for partnering with the private sector. 2. Table of Contents (Jump to) 1. Abstract 2. Table of Content Introduction 3. Literature Review Government Paper Table 6, p26 Comparison of Increases in PFI Project Costs (million pounds) Public Feedback on PFIs in the Health Sector Tory Stand on the NHS Financial Status Medical Personnel Disillusioned Summary 4. Research Objectives 5. Research Methodology Porter’s 5 Forces Diagram. SWOT Analysis Diagram PEST Analysis Diagram 6. Research Findings Porter’s 5 Forces Model Summation of Porter’s 5 Forces Model S.W.O.T Analysis Summation of S.W.O.T. Analysis P.E.S.T Analysis Table – Age Structure in the UK 2001-2051 Introduction The National Health Service (NHS) was set up in the United Kingdom in 1948 to provide healthcare for all citizens, based on need, not the ability to pay. The NHS is funded by the taxpayer and managed by the Department of Health, which sets overall policy on health issues. It is the responsibility of the Department of Health to provide health services to the general public through the NHS. Many changes have occurred over the years, but the basic principal of free medical services for all has been a fundamental right within the United Kingdom for nearly 60 years The following information from the official NHS website summarizes the current method of operations within the system and mentions the controversial introduction of the Private Finance Initiative. Ref [1]http://:www.nhs.uk A feature of the NHS compared to other public healthcare systems in Continental Europe is that not only does it pay directly for health expenses (with partial exceptions like prescriptions and dentistry it is free at the point of use), it also employs the doctors and nurses that provide them, and in most cases owns and runs its hospitals and clinics. However, under the [2]Private Finance Initiative, an increasing number of hospitals have been built (or rebuilt) by private sector consortia, and have non-medical services (such as catering) provided under long-term contracts by the same consortia. As reported on [3]http://en.wikipedia.org/wiki/Private_Finance_Initiative, clearly the costs of the PFIs are currently an issue. The scale of PFI projects in the Health Education sector since 1997 is now having a serious impact on Public Service Budgets. Because the projects are more expensive in the Private sector (On average 30% more than if the Government borrowed the money and did the work in the Public sector) the payments to the Private owners of the PFI schemes are stretching already constricted Budgets. Many Health [4]Primary Care Trusts are in serious difficulty already, and when the level of spending falls in 2007, some may go bust. The Government is already in negotiation with Private Healthcare providers to come in and run failing Trusts. 3. Literature Review Government Paper [5]The House of Commons Research Paper 01/117, 18 December 2001 (Graham Allen) studies the Private Finance Initiative. The document states ‘Under the PFI, the public sector does not own an asset but pays the PFI contractor a stream of revenue payments for the use of the facility over a contract period’ ‘The Department of Health has signed the most PFI deals, 105, with a total value of just over 2.5 billion pounds. Under the section entitled Cost overruns the following items appear [6]Table 6, p26 Comparison of Increases in PFI Project Costs (million pounds) Initial Cost Final Cost % Increase Norfolk Norwich NHS Trust 90 144 60% Greenwich Healthcare NHS Trust 35 84 140% The report contains differing views for the cause of the severe overruns in PFI project costs. According to the private enterprise companies they blame the increases on the NHS and MoH as they are repeatedly changing the requirements from the original specifications. This could be a result of a lack of experience in managing private enterprise projects by the MoH – more efficient management and tighter control over specifications would result in major cost savings. There could be reason to revisit the bid process to identify where there are loopholes which allow the private companies to overrun and yet charge back the cost to the Ministry during the course of the contracts. Public Feedback on PFIs in the Health Sector The lobby group, Keep our NHS Public, [7]http://www.keepournhspublic.com/index.php, has a launch statement that includes the following ‘At the heart of the changes is the creation of a market that welcomes profit-driven international corporations who answer to shareholders, not patients. This market will compel hospitals and health professionals, who have traditionally cooperated to deliver healthcare, to compete with each other and with the private sector. Far from supporting the NHS, the private sector is in competition with it, and is already draining away resources and staff.’ On the web site, Frank Dobson Member of Parliament for Holborn and St. Pancras says: Before long we will have a health insurance system and the NHS role as a provider of care will be limited to picking up the difficult cases and looking after the worst off. It is time we worked together to put some chocks under the wheels of this fashionable bandwagon. The campaign launched in late September and has already won the backing of hundreds of senior doctors, academics, health workers and trade union leaders, celebrities, MPs and local campaigners for its launch statement. The lobby group feels strongly that the NHS is being divided up and the only driver for its continuation will be profits and not the medical well being of the patients. They have garnered support from many leading medical professionals since their launch. And the campaign is rapidly gaining momentum. Saturday 11th February 2006 Tory Stand on the NHS Financial Status The Guardian, http:/ / www.guardian.co.uk/ uk_ news/ story/ 0,,1707494,00.html of February 11th 2006, states the Tory case of the financial state of the NHS NHS in England heading for  £750m deficit, say Tories. The Tories have accused the government of burying evidence of a worsening financial crisis in the NHS that is starting to seriously damage the quality of patient care. Andrew Lansley, the shadow health secretary, said he had data from strategic health authorities showing the NHS in England is heading for a deficit of  £752.6m by the end of the financial year, compared to the  £200m overspend hoped for by Patricia Hewitt. Lansley said Hewitts intervention had forced down the quality of patient care with many trusts delaying operations. This tactic has failed because hospitals continue to pay staff for doing less work transferring overspending from PCTs to hospital trusts. 22 SHAs in England forecast deficits, two surpluses and four in balance. This statement not only highlights the deficit anticipated, but it also points to an administrative situation that is convoluted and inefficient. The over run on anticipated deficit is huge and points to a lack of monitoring and cost reductions over a long period. Medical Personnel Disillusioned The Guardian, April 13, 2005, printed an article entitled ‘Disillusioned Doctors Drop Support for Labour, http://society.guardian.co.uk/nhsplan/story/0,7991,1458601,00.html Only a third of a group of doctors who signed a public letter urging voters to support Labour in 1997 would do the same again, it emerged today. Disillusionment with Tony Blairs decision to pursue the same internal market policies as his Conservative predecessor was one of the main reasons why the doctors had deserted Labour this time round, according to the results of a new survey. In their original letter, the doctors had condemned the internal market forces in the NHS as a cancer eating away at your NHS. But of the original 59 GPs, consultants and academics who put their names to the letter published only a few days before the 1997 general election, only 17 said they would sign a similar letter warning voters that if the Conservatives won on May 5, the NHS as we know it would disappear, according to the results of the survey. Emeritus professor of clinical biochemistry at the University of Surrey, Vincent Marks, who put his name to the original letter, said today: Most of us feel that we have been badly let down. The dismantling of the NHS has continued apace. Consultant cardiologist at St Bartholomews hospital in London Duncan Dymond, who was also one of the original signatories, said: The government has missed a huge opportunity with the health service. There has been marginalization of the clinician and manipulation of patients to satisfy bureaucrats. Orthopedic surgeon Anthony Jones from Swansea in Wales, who also put his name to the letter in 1997, said: The cancer of the internal market has prospered under Blair. The doctors involved in the above intend withdrawing their votes in order to take a stand against the current changes within the NHS. Undeniably, they believe in the principals of a united medical service to the public who are currently promised a free medical system for all UK citizens. These medical professionals are prepared to make a political statement to show their lack of support for the current government handling of the NHS Dr Eric Bowman, from Scotland who responded to a BBC report ‘Public Health, Private Money’, echoes this negative outlook with the current situation I am a UK resident but I am also a US citizen. I prefer the UKs NHS to the nightmare of red tape, expense and iniquitous medical resourcing that is inherent in the US private system. I cannot imagine how anybody, including Blair, can consider a private healthcare system that diverts precious financial resources to profits as being efficient. I am appalled that Labour will invest in public-private partnerships rather than simply investing in the NHS. Deb McDee responded: I am an NHS Manager and was recently work shadowed by someone from a highly rated, large private company as part of a training scheme. For such a large NHS organization, he could not believe the small size of the management team, the long hours worked, the productivity and the low salaries compared to similar size and budget in the private sector. There is no chance that the private sector can run the NHS more efficiently at current funding levels. Any additional money would be swallowed up in more bureaucracy, inflated private sector salaries and a reduction in services. The above respondents identify the fact that private companies are in business to make a profit, in addition, staff are generally better paid for similar jobs. They feel that any private partnerships will prove to be more expensive than running the services under the NHS. A prominent dentist, John Renshaw, has resigned his profession over changes to the NHS. His story appeared in the Guardian on February 11th 2006 titled, ‘Top Dentist Quits over NHS plans One of Britains leading dentists is leaving the NHS to go private after 37 years, in the growing row over the way dentists will be paid in future. John Renshaws practice in Scarborough will become private in April. Mr. Renshaw, chair of the British Dental Association from 2000 to 2005, has refused to sign the new NHS contract. He says it will mean even less access to the service and lower standards of treatment. The government says the new contract provides a guaranteed income. Mr. Renshaw said: The NHS appears to want to secure a cheap deal and take control of every NHS dentists business. I will not be a party to this move and I am leaving the service for good. In addition to his BDA role, Mr. Renshaw was dental practice adviser to North Yorkshire Health Authority for 10 years to 2001 and has served on many bodies, including Scarborough Health Authority. The Royal College of Nursing expressed their frustration at the changes to their profession in the Telegraph Article ‘Plan to Part Privatize NHS Nurses Quietly Unveiled, on 26th August 2005. [8]http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2005/08/26/nhs26.xmlsSheet=/news/2005/08/26/ixnewstop.html The Government has quietly unveiled radical plans that will lead to the part-privatization of many non-hospital NHS services, nurses leaders claimed yesterday. The Royal College of Nursing accused ministers of deliberately announcing fundamental changes to the way primary health care was provided during the summer holidays and then announcing a public consultation it called little more than a facade. Plans to transfer tens of thousands of district, school and mental health nurses, health visitors and community midwives out of the NHS primary care trusts were disclosed in a letter to the heads of NHS organizations at the end of last month. It said that in future primary care trusts would commission these services from private companies, charities, local authorities and acute trusts. The RCN yesterday said the public consultation on the future of community health and social services, announced last week, and was meaningless, as the key decision to end the provision of these services by the PCTs had already been taken. Howard Catton, RCN head of policy, said: An NHS that no longer provides these services, that no longer employs these staff is a very different sort of NHS to the one the public knows. The Royal College of Nursing (RCN) is a membership organization with over 370,000 members in the United Kingdom. Most members are Registered Nurses but student nurses and Advanced Healthcare Assistants are also admitted. These prominent professionals and the largest representative group of nursing professionals are outraged at the division of the medical services and part privatization. They raise the question of charities being called on to provide certain services – charities are currently stretched financially and are unlikely to be able to take on responsibilities that have previously been handled by the NHS. Part-privatization of ambulance work sparks union anger, written by the Guardian Social Affairs Editor, John Carvel. – The article below, printed on October 13th, 2005, is a single example of numerous instances where medical services have been outsourced. Most of the ambulance service in Surrey is to be hived off to a private company specializing in prison management, immigration detention centres and court escort duties, which broke off from Group 4 security services last year. The Surrey ambulance service said yesterday it was deeply disappointed at a decision by local NHS commissioners to transfer all non-emergency ambulance work to the Worcestershire-based company GSL. In a further ratcheting up of private sector involvement in the NHS, the company will become responsible for transporting about 150,000 patients a year on journeys to and from hospital. The NHS ambulance service will retain blue-light emergency work, but GSL will also look after high-dependency patients who need oxygen and constant supervision during journeys between hospitals. The company said it would acquire 60 state-of-the-art ambulances to provide patients with safe, comfortable journeys when it takes over in March. The decision to award it the contract was taken on Tuesday by a consortium of primary care trusts headed by Alan Kennedy, the ambulance trusts former chief executive. The announcement of this first major privatization of ambulance work caused an angry reaction from Unison, the public service union. Karen Jennings, its head of health, said: This is all about saving money and nothing to do with providing high-quality patient care. It will undermine the trusts ability to provide an integrated emergency service in the area. News of the deal came as the board of Thames Valley health authority took a step towards contracting out NHS healthcare management in Oxfordshire. It agreed to submit plans to the Department of Health to make NHS managers compete against the private sector for the job of commissioning services from hospitals. This could, in effect, privatize the process of deciding what health services and drugs should be available to the countys 600,000 residents. Nick Ralph, the Thames Valley chief executive, said the contractors would be accountable to a board of non-executive directors with power to look after the public interest. But Howard Catton, head of policy at the Royal College of Nursing, said contracting out strategic management could reduce the NHS to little more than a brand name for services that were managed and delivered by the private sector. This report shows a lack of communication and direction between the MoH and the NHS on policy and procedures and the way forward. In addition, the cost of providing new ambulances and training personnel who have no medical care background with be high, the private company will have built such costs into their fees to be paid by the MoH over the period of the long term contract. John Carvel, the Social Affairs editor of the Guardian on Sept 22, 2005, wrote the below article Plans to Hand Over NHS Staff and Buildings to Private Sector Health secretary Patricia Hewitt is preparing to transfer NHS hospital buildings and staff into the private sector as part of a  £3bn scheme to promote competition in the health service, the Guardian can reveal. Documents show that companies bidding for contracts to treat patients from the NHS waiting list will be allowed to take over NHS premises, doctors and nurses. Initially, they will also be guaranteed a minimum throughput of NHS patients and paid accordingly, even if the patients choose to go elsewhere. Disclosure of the â€Å"strictly confidential† documents is likely to fuel protest at the Labour conference next week that the government’s NHS reforms are in danger of destabilizing the health service, but Ms Hewitt will argue she is saving it by putting the needs of patients before those of providers. The information was provided to companies wanting to bid for 24 contracts to run treatment centres across England. They will compete with NHS trusts to attract NHS patients, who from the end of this year will have a choice of where to be treated. Ms Hewitt has said she wants them to diagnose and treat 1. 7m patients over the next five years. The documents, which were obtained by Hospital Doctor magazine, disclose plans for companies to take over the latest state-of-the-art operating theatres that are being built for the NHS at hospitals in Birmingham and the New Forest. The independent sector will also be handed the surgical units at Ravenscourt Park hospital in Hammersmith, west London, where wards have been shut due to lack of patients. Many of the 24 contracts involve â€Å"significant volumes† of patients and staff transferring from the NHS into the private units. Doctors and nurses may have little choice if they want to keep their jobs. Paul Miller, chairman of the BMA’s consultants committee, said: â€Å"It now looks as if we are at the start of a massive privatization of the provision of healthcare in the NHS.† But Ms Hewitt said his claims were nonsense. â€Å"This is all about giving patients speedier access, more choice, and improved services.† The taking over of staff and premises, without prior consultation and negotiation with the personnel involved, is a very autocratic way to shift responsibility and accountability and lacks any regard for the medical staff involved. This does imply they will retain a job, in contrast to the ambulance drivers in a prior article who would be out of work as the private company would staff the service themselves. If the NHS cannot attract patient to ‘state of the art’ facilities, I cannot understand how handing them to private enterprise will turn around the situation and make the facilities profitable. There has to be some form of financial incentive for the private sector to take on such a contract. In another article quoted, there is reference to the MoH paying private companies for patients, regardless of whether those patients take up the services in the area. If this is the case here, why wasn’t the NHS made the same offer and continued to run the facilities themselves? Vincent Marks, a professor of clinical biochemistry at the University of Surrey was quoted on May 13th, 2005, after hearing of another part privatization being announced by the then new Minister of Health, Ms Hewitt ‘Once you start farming it off into private enterprises the NHS as we understood it will gradually disintegrate. And Shadow Health Secretary Andrew Lansley added: I do agree in principle the independent sector should have a right to supply to the NHS. But not the sort of contracts the government is signing. They (independent sector providers) get more money than NHS would do. Niall Dickson, chief executive of the Kings Fund, a health think-tank, said while using the private sector in such a way had obvious advantages; there were still potential pitfalls. This will have significant implications for NHS institutions and core services, as well as the training of doctors. And British Medical Association chairman James Johnson said he was concerned the move could destabilize the NHS, as the private sector would only take on the most straightforward cases. Ms Hewitt, who was previously trade and industry secretary before taking over at health in the reshuffle last week, has also championed latest figures that have shown patients were being treated faster. The number of people waiting over six months for an operation at the end of March was 40,800 a 32.5% fall on the previous month. The overall waiting list also fell slightly to 821,700 down by 2.8% on the previous month. And a report by the NHS chief executive Sir Nigel Crisp showed the health service was ahead of target for treating heart and cataract patients. This article raises the question of training for future doctors. One can argue that if the majority of future doctors are likely to be employed in private companies rather than the NHS that the MoH could reduce funding for doctors training and training faculties in general. The private sector is unlikely to take on this responsibility and could result in a more acute shortage of trained doctors, as the cost of training would fall to the individual. Certain improvements in waiting times are indicated; however, these are a small percentage of the overall services provided and may not be indicative of a general improvement across the board. They could be achieved at the expense of others services which could have been pushed back. The Battersea and Wandsworth TUC have produced a paper titled ‘SW London Hospitals under Pressure’. This document highlights the plight of the particular area but echoes the typical situation countrywide and provides an insight into the reasons for the current state of the NHS It states that ‘consistent patterns of under resourcing and crisis measures running back to the early 1980s’. It states ‘The resort to private sector providers to plug gaps in local NHS capacity is both costly and self-defeating. Not only does it siphon vital cash from local NHS trusts, but it also increases the level of competition between the NHS and the private sector for nursing and other staff’ ‘Private contractors must be removed from the provision of hospital support services. Their role for the past two decades has been to cut the pay and conditions of staff to run down the quality of services. The constant threat of privatization has been used as a weapon to hold down the pay for other NHS staff, with dire consequences for morale.’ They make the following recommendations (summarised) Runaway costs of employing agency staff to plug gaps in the full time NHS workforce have to be tackled There is an urgent need for a thorough and independent audit of the financial situation in all local NHS Trusts, to establish a realistic baseline budget that will sustain the necessary levels of service – and the additional money must be made available, to ensure that the services are expanded as required on a stable and sustainable basis. Any planned deals with private hospitals should be abandoned, ad priority should be given instead to the most rapid possible expansion of local NHS capacity, alongside longer term plans for the renewal of old or obsolescent buildings Privatized support services which generate profits at the expense of low paid for staff must be brought back in house, with staff properly reincorporated into the NHS team. With the government currently able to borrow money on the international markets at 2% interest or even lower, all PFI schemes should be abandoned as too costly and inflexible to suit the needs of the NHS. Instead the government should make NHS capital available for the further upgrade of Epsom (hospital) and a new publicly funded hospital to replace St Helier, and local treatment centres to complement the services already available in smaller local hospitals Summary Current literature clearly indicates that the move towards part privatization of the NHS has serious negative perceptions both within the medical profession and in the general public. However, the Department of Health believes the move is already proving to be successful and that the move to further part privatization is the way forward for an efficient and effective NHS. In summary the documents highlight. Costs to the Department of Health will significantly exceed previous spending on the NHS. The move to part privatization is in the early stages and the long term management and control need to be carefully monitored and checked. The Department of Health has to sign on to long-term contracts with the private sector service providers, as stipulated in the Private Finance Initiative papers. There have been some significant overruns on initial budget figures; cause for concern when the initiative is still in the early stages and the contracts are for extended periods. The Department of Health is losing control over areas of health management. Health care providers are leaving the profession as they are disillusioned with the changes to the NHS Health care providers have