Healthcare Reforms in England Issues of Efficiency

Healthcare Reforms in England Issues of Efficiency The healthcare service in England attempts to improve the overall healthcare service have been ongoing through some of the most radical reforms since its inception as a comprehensive public service since 1948. The noticeable need of a free healthcare service was essential after the state of the country due to the world war. Once the NHS was established it saw many reforms led by diverse types of governments at different times. Despite the scale of the reforms they have preserved their core principle of A free service at the point of delivery 1 till this very day. Even though they have adopted the core principle they still face huge challenges; as demands and costs are still rising, the entirety of the service is increasingly being looked at. This paper looks at the reforms the NHS has been through and analyses each reform in the light of Efficiency: the capability of the NHS, whether the reform made the NHS more competent, Equity: bringing fairness and equal right for the patients as well as the staff, Quality: whether adapting the reforms improved the patients ability to acquire different types of healthcare services without any predicament and obtain high-quality healthcare services. Methodology This paper was conjured up by the use of reports published by NHS Publications website. Journals and studies on NHS reform via the scientific database PubMed were also utilized. To gain info on the theories the NHS was formed on, management theory books by Max Weber, Henri Fayol and Frederic Winslow Taylor were used. Results/Discussion Each reform improvised the NHS in many ways, in relation to Efficiency the NHS since its inception has seen major investments and new hospitals built, employment of up to date technology allowing more patients to be seen within an applicable time and budgets been controlled efficiently with the aim to reduce costs each year allowing the NHS to run efficiently. In terms of Equity after the publication of the Black report, the NHS has improved on giving equal opportunities to its minor ethnic groups of staff. Also the equal treatment of patients regardless of their social class has been improved since the Blair era. The NHS in terms of quality has become one of the world leading healthcare providers. Measuring their services against standards set by the NHS ensured that they are meeting the set standards. The major investment in staff in 2000 saw a number of lives saved in the past 10 years. The NHS has met quality standards that are accepted by its patients and valued as a first class service. Conclusion Overall the NHS has seen many reforms which have lead to the NHS becoming a world class service. Since the reforms in the 1960s to the latest plans of the new coalition government the NHS has improved immensely in terms of efficiency, equity and quality and the future also looks bright for the NHS. Introduction: Healthcare service in England was launched in 1948 with an aim to provide universal healthcare to its citizens which is free at the point of use and available to everyone based on need, not ability to pay 1. The NHS was established after World War II where the country needed a stable healthcare service 2. The initial idea was that no-one should be deterred from seeking health services by a lack of resources and the founder Aneurin Bevan: Minster of Health stated A free service at the point of delivery 3. Till this day they have been providing free healthcare service to the citizens of England. In 1948 Sir William Beveridge, a British Economist and a Social Reformer conferred details of his radical plans for economic and social reform in post-war Britain. Sir William proposed major healthcare service changes on the basis that the country needed the abolition of want before the enjoyment of comfort and suggested a scheme where every kind of medical treatment would be available for everybody. 1,3 Pre NHS There has been some form of state-funded provision of health and social care in England prior to the NHS for 400 years.4 Prior to a health system being formed, attaining healthcare service in Britain in the 1930s and 1940s was difficult. Life expectancy was very low and thousands of people died of infectious diseases like pneumonia, meningitis, tuberculosis, diphtheria, and polio each year.4 The poor never had access to medical treatment and they relied instead on dubious and sometimes dangerous home remedies. Either that or they relied on doctors who gave their services free to the poor patients. The Hospitals charged for treatment and although the poor were reimbursed and before they received treatment they had to pay.4 Figure 1 shows the life expectancy that has changed since the NHS was introduced. Figure 1.Life expectancy changes since 1840 5 The need for free healthcare was widely recognised, but it was impossible to achieve without the support or resources of the government. A study showed that experts believed and have written extensively on the reasons of why a health service was needed.6 These included: The appearance of a view that health care was essential, not something just imparted erratically by charity The drastic effects of the war that made it possible to have a massive change of the healthcare service being provided, rather than just an incremental alteration As younger members of the country were becoming increasingly educated in the medical profession they had a view of things could be handle in a more efficient way. The hospitals having financial problems, funds not sufficing.6 Having looked at the reasons to why a health service was needed the government made plans and core principles were established: 6 Regardless of persons status they were eligible for health care, even people temporarily residing or visiting the country.ÂÂ   People could be referred to any hospital. The healthcare service was financed almost 100% from central taxationÂÂ   Care was entirely free at the point of use6 The main achievement was that the poor who in the past went without medical treatment now had access to free healthcare.6 NHS today and NHS employment NHS is one of the largest organisations in the world with an annual budget of around ÂÂ £80 billion employing more than 1.7 million people and treating over one million people every 36 hours.7 In general, healthcare service being provided within England to every single citizen is a difficult commission to undertake and consequently the system needs efficient health personnels to help run the system economically. Today the view of the healthcare service in England is that the NHS is a world leader and provides first class service that other countries envy. Countries all over the world seek to learn from the comprehensive system of general practice, and its role as the medical home for patients, providing continuity of care and coordination.8 Other countries look at English NHS system and use them as a guideline to run their healthcare system. NHS Structure The healthcare service in England has been run in a structural way with the Secretary of state and Department of Health controlling the overall NHS in England. The secretary of state for health has the responsibility of reporting to the prime minister. There are10 Strategic Health Authorities (SHAs) in England which are controlled by the Department of Health, they oversee all the activities within the NHS and the SHAs supervise all the NHS trusts in its area. Primary care plays a major role in community healthcare and is central to the NHS. Services under NHS trust (Secondary Care) include Hospitals, Mental Health services, Learning disability services and Ambulances. The overall structure of the NHS is shown below in Figure 2. 9 Although this is the current NHS structure with the new government in power, changes are to follow. Figure.2 overall structure of the Healthcare system in England 5 NHS Reforms Since its inception in 1948 the NHS has seen many reforms in terms of managing the way they provide healthcare service. The DoH has a lot of control and influence the major decisions taken in the reforms. The overall expectations of Healthcare service in England are of a high calibre, which requisites high-quality management capacity.10 In the 1980s and early 1990s prominence was on recuperating management. The recent focal point has been on development of leadership within NHS. With the new government, new ideas and plans will be imposed to see improvements in quality of healthcare being provided, cut down on costs making it more efficient and in terms of equity provide equal service to everyone. Table 1 briefly enlists the reforms that have taken place since its inception in 1948. Table.1 Reforms in the NHS: 1948-2010 Period the reforms were in place Reform and theory of Management 1948- 1960 Managers as diplomats 1960s Scientific Management and the Salmon report 1970s Classical Management, Systems Approaches and the 1974 Reorganization 1980s The Griffiths report and Managerialism 1990s Working for Patients and the Internal Market 2000 The NHS Plan (DOH 2000) and the Third Way. 2010 NHS White Paper 2010: Equity and excellence: Liberating the NHS Healthcare service and Reforms in other Developed Countries Healthcare reforms within developed countries can be analyzed in order to compare whether the healthcare services in England have been successful in its bid to ensure efficiency, equity and quality. Attempts to handle reforms of the healthcare system in the European countries have been an ongoing process for 30 years. Although the reforms have taken throughout the 30 years in different ways, their main emphasis has been on improving the cost-effectiveness of the healthcare service. In the early 1980s the EU countries were looking at cost containment. The feature in the 1990s was to endorse efficiency in terms of introducing competition and markets in the healthcare system. Since 2000 the focus has switched to effectiveness; promoting various notions of healthcare in terms of quality.11 Over the course of the 20th century the countries of Europe have established significant success in improving the healthcare service for their citizens. However they still face challenges in the form of restraining costs, improving quality and providing universal healthcare access, these have put the European healthcare services under immense pressure.11 Looking at another OECD: USA, A report on A review of health care reform in the United States assessed whether the USA have been successful in providing healthcare. The findings showed that United States spent more per capita on health care than any other OECD country, yet its health outcomes lagged behind other countries.12 This shows they are struggling with efficiency issues and are still countering challenges in providing quality healthcare service that is expected from the citizens of the USA. Especially in the last few years Healthcare reform has been a major activity of the federal government, in order to revolutionize and develop the service overall. The 3 goals of optimizing cost, access and quality still remain a challenge within the healthcare society in the U.S.12 They concluded that USA still faced many challenges in running the national healthcare service, a key challenge they face is the utter complexity of the system, with its numerous public and private providers.12 Another OECD country reviewed in terms of healthcare service being provided and the reforms that have taken place is China. A report from on From a national, centrally planned health system to a system based on the market: lessons from China concluded: China is the country that has undergone the highest number of health care reforms. Since 1978, China saw many reforms and they also followed the way as the EU countries, with the healthcare system starting from governmental, centrally planned and a collective system to ending up as a heavily market influenced system. Now, thirty years later, the Chinese government openly concede that the reforms were unsuccessful and seek innovative and fresh directions.13 This illustrates that China is also in a healthcare crisis and looking to implement different strategies in order to gain control of Chinas Healthcare system. Having reviewed the healthcare service being endowed in these developed countries, it demonstrates that they are all on an identical level as the healthcare service being provided in England and all face similar challenges. All these developed countries are looking to develop the countries overall healthcare service in terms of efficiency, equity and quality. NHS Plan 2000 and the future of NHS Since the last reform: The NHS plan 2000 14, a lot has transformed in terms of funding and operating the healthcare system in England. Especially with the new coalition governments idea of cutting budgets it is a difficult time the NHS is going through and will necessitate a lot of expertise and world class management to get through todays financial and economical predicament. An additional indication that will be taken into deliberation is the election of the new plans set out in the NHS White Paper 2010. As the new coalition government has come into authority there have been huge changes to overall budgets for the public services and this possibly will have a consequence on the way the NHS operates in England. 15 The reforms have encompassed a significant impact on the organisation and deliverance of health care service in England. Wide array of transformations have been pioneered in an attempt to ensure the NHS is managed more resourcefully and effectively. This report will examine whether these reforms have on the whole improved the healthcare system in England in terms of efficiency, equity and quality and if the publics requirements have been convened. Aims: To examine the healthcare reforms in England since its inception and to assess whether these reforms have improved factors of efficiency, equity and quality in providing healthcare. Objectives: To review the reforms in the NHS since its inception in 1948 To examine whether these reforms improved efficiency, equity and quality of healthcare To assess the key features of healthcare reforms proposed by the current government and their implications on the NHS To put forward plans for the future of the NHS Methodology: A number of sources were consulted to conjure up this paper and examine the healthcare reforms in the NHS. Scientific search engines and databases such as PubMed, Google Scholar and Science Direct (Date accessed 20/10/10) were used to gain literature reviews but results from Google Scholar and Science Direct were dismissed as they were too vague and irrelevant to this topic. With PubMed following keywords were inserted Healthcare, Reforms and England. The data was also set from 1948 to 2010 when searching for reports as this would set the inclusion criteria. The reports and journals since 1948, when the NHS was established were used. Even though history before 1948 was looked at for study purposes, reports before NHS establishment; these were regarded as the exclusion criteria as reports werent looked at prior to 1948. Healthcare service within Britain was looked at in general but for the results of this report, the inclusion criteria was healthcare service in England as it just look ed at the healthcare service being provided within England. The exclusion criterion was healthcare service in Scotland, Wales and Northern Ireland. For the first part of the report, the introduction: where the report looked at the history of the NHS. The resources used included looking at general management books looking at management theories. The classical theories of Max Weber, Frederic Taylor and Henri Fayol were the backbone of the NHS and that is why these were used. Another source to produce this paper was the Department of health (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/index.htm) where the publications and reports about the NHS in general were looked at. This paper used a lot of publications produced by the Department of health and the NHS publications as these sources are reliable; these were seen as good foundation to work from. One of the main publications used was The NHS white paper: Equity and excellence: Liberating the NHS presented to Parliament by the Secretary of State for Health, this was a key entity in writing up this paper. As the paper didnt contract with experiments and clinical trials, it didnt look at a lot of statistics; the majority of its content was obtained from qualitative data. Results/ Discussion Having carried out the required literature searches and reading journals, reports and Department of Health Publications, results were gathered and have been shown below with the discussion of the key topics. The results look at each reform taken place in the NHS and then goes onto analyse the plans set by the new government. Having looked at the reforms and the new plans the paper than talks about efficiency, equity and quality related to each reform. Reforms in the healthcare service in England The healthcare service in the UK has undergone a number of reforms since its inception in 1948. Prior to 1948, healthcare service was provided in England but due to the increasing pressures for efficiency and quality in health services it lead to these developments and reforms in healthcare being provided. A more overtly management-oriented approach to the healthcare service delivery was adopted based on classical management theories to gain more control of the healthcare service in England. 16,17 Classical theories and Scientific Management: 1960s The NHS was based on the classical theories of Frederic Winslow Taylor, Henri Fayol and Max Weber. 16-19 Table 1: Frederic Winslow Taylors four main scientific management principles. Replacing rule-of-work thumb methods with methods based on a scientific of the tasks Scientifically train each individual rather than leave them to train themselves Cooperate with each worker to ensure that the scientific method is being followed Divide workload equally between managers and staff Table 2: Henri Fayols Modern Operational Management approach. Division of work- Specialization for efficiency Authority Responsibility- Both are related, the latter arising from the former. Discipline-Requires good superiors at all levels Unity of Command- Employee should receive orders from one superior only Unity of Direction- Each group of activities with the same objective must have one head and one plan Subordination of individual to general interest- When the two are found to differ, management must reconcile them Remuneration-Should be fair and satisfactory Centralization-Extent to which authority is concentrated or dispersed Scalar chain/line of authority-Needs to be sensible, clear and understood Order : Right thing/person in the right place Equity- Equal opportunity for everyone Stability of tenure- Unnecessary turnover is both the cause and effect of bad management Initiative- Thinking out and execution of a plan Thinking out and execution of a plan Table 3. Max Webers Bureaucratic approach. Power-Ability to get things done, often by the use of threats or sanctions Authority- Ability to get things done because of the position that justified someone in terms of legitimacy Formal approach Hierarchical authority Extensive roles and procedures- Uniformity of decisions and actions Job description- Clear-cut division of labour and High level of specialization Discipline These classical theories contributed a lot to the healthcare service in England and still do to this day.16-19 The classical writers thought of the NHS in terms of purpose and formal structure. They created a formal structure on which the NHS could run on. They also looked at job design, scientific selection and development of workers. The classical theories generally serve as a backbone to the present day NHS management. Although the classical theories made a big contribution to the healthcare service in England it had its limitations and wasnt the most effective way. One drawback was that it wasnt evidence based; it didnt look at the way staff did their tasks and didnt look at the well being of staff, the human and social aspects of work. It just treated them like machines. The theories didnt look at motivating the staff and developing them in their own interests, had they done this staffs work quality wouldve enhanced thus providing an efficient service to patients and overall improve the quality of healthcare service in England. Overall the classical theories were too concrete and fully based on rules and procedures. In terms of efficiency the theories bought a set way of running the healthcare service in England. Once the NHS was established it introduced equity as well as healthcare service was now available to anyone. The NHS was just established and with these set in place in the 1960s the qua lity of service would improve from now with further reforms to come. Salmon Report: 1960s One of the first reforms took place since the NHS was established was in the 1960s. The Salmon Report bought findings and changes which included that workload should be equally distributed between managers and practitioners.20 The NHS would also get rid of matrons and replace them with a hierarchy of nurse managers. The introduction of several additional layers to the management hierarchy; in order to improve efficiency in operating the NHS. This lead to responsibility being equally distributed and the service met its aims and objectives more efficiently. Another change was that nurse managers would contribute to the overall management of the service through the medium of consensus management teams and thus improve efficiency and quality within the NHS. Having nurse managers lead to them taking control of set responsibilities and helped in general running of tasks at ward level leading to an improvement in general quality in the healthcare service being provided. 1974 Reorganization: 1970s The aim of this reform was to attain greater integration of the healthcare service in order to provide more stability and increase efficiency. The reorganisation also introduced more central control in order to: 21 ensure policies were implemented improve accountability encourage delegation develop democratic decision-making process These changes lead to a more structured way for managers to follow and enhance the quality of the healthcare service. By the mid 1970s quality was improving but there were still concerns of equity in the NHS. There were still clear differences of health sufferers in terms of social class; figures showed that people in lower social classes more likely suffered from diseases. There were several possible explanations for these inequalities. Natural and social selection. This would depend on the view that people who are fittest are most likely to succeed in society, and classes reflect this degree of selection. Poverty leads to ill health, through nutrition, housing and environment. Cultural and behavioural explanations. There are differences in the diet and fitness of different social classes, and in certain habits like smoking. 22,23 Overall in the 1970s the quality of healthcare service was still improving, equity issues were still a concern and in terms of efficiency they were recuperating the NHS. The Griffiths Report: 1980s This reform was a major point in NHS history, the Griffiths Report identified problems such as the healthcare service was institutionally inactive and that the local health authorities were filled with directives without being given any clear procedures to follow.24 The Griffiths report stated that changes were difficult to achieve but gave recommendations to improve the NHS. It introduced a more formal and modern way of management. It gave increased participation for managers in setting and controlling budgets. The report also gave greater emphasis on cost awareness in order to improve efficiency. A Clear and quick decision-making process was introduced to improve quality of service provided to patients. The managers in local authorities were given a more clearly defined direction and the overall staffs were better informed.24 The Internal Market Working For Patients: 1990s Another reform in the 1990s took place, this bought a new dimension to the NHS; large publicly-owned hospitals could opt to become self-managed trusts. This meant that health services could be bought by private investors i.e. patients themselves thus allowing them to take control of the way they want the service. Even large GPs could become fund holders and be both purchasers and providers of care.25 This reform lead to introduction of greater flexibility thus allowing more effective matching of patients needs and care. Money followed the patients through the system of purchasing and providing of healthcare service, this led to equity being improved as patients had more selection of services. This reform led to higher competition in providing quality healthcare service, the costs decreased and the general quality increased. The NHS Plan 2000 The NHS Plan 2000 made key findings : the NHS is a 1940s system operating in the 21st century and that it lacked of national standards. It also said that there were barriers between staff and providing services. There were a lack of clear guidelines and the NHS structure has over-centralization.14 Plans to diminish problems and propose new plans such as introducing Modern Matrons to improve the management of services, a strong leader with clinical experience and with clear authority at ward level, improve efficiency by setting standards and controlling resources these were there aims.14,26 The figure below shows the comparison of the 1948 and the new NHS model outlining the key differences. Figure.4 the key difference between the 1948 model and The NHS Plan 2000 model 14 The NHS Plan 2000: Achievements This reform set out specific targets which were achieved in order to improve efficiency, equity and quality of healthcare service in England: Over 100 new hospitals by 2010 and 500 new one-stop primary care centres Clean wards and better hospital food 7,000 extra beds in hospitals Over 3,000 GP premises modernized Modern IT systems in every hospital and GP surgery 7,500 more consultants and 2,000 more GPs 20,000 extra nurses and 6,500 extra therapists Childcare support for NHS staff with 100 on-site nurseries.26 These targets were achieved in 2008 and it led to the improvement of efficiency as the number of GPs and consultants employed were increased. The modernisation of technology and IT systems led to quality of service being improved as high investment in high quality equipment made the NHS one of the worlds top quality service. Since 2000 NHS has improved the overall service and met its objectives. NHS Implications: Equity and excellence: Liberating the NHS With the new coalition government coming into election another set of reforms have been proposed as they hope to improve the overall healthcare service in England. The main aims and objectives to improve the healthcare service are varied and very detailed but to summarise it these are the points covered:15 Increase health spending in real terms in each year of this Parliament 15and also that there goal is an NHS which achieves results that are amongst the best in the world 15. However the government will uphold the foundation that the NHS was formed on; a comprehensive service, available to all, free at the point of use and based on clinical need, not the ability to pay 15. The government than goes into detail of what they arrange to initiate to make an efficient healthcare service: acknowledge the fact that patients come first and therefore will give them greater choice and control. An example of this is that a patient will be able to choose any GP practice, consultant, and choice of treatment consequently improving equity of the service. The government endeavours to develop the healthcare outcomes: set objectives such as reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all 15. By doing this they are ensuring they are driving efficiency and improving the service. In order to achieve the objectives that the government sets, the ability for service providers to have more autonomy, responsibility and accountability will be a means to achieving efficient results. A big change will be the establishment of a NHS Commissioning Board. The board will be accountable for making sure health outcomes are achieved, allocate resources and have the lead on quality improvement and to tackle inequalities that exist in the NHS. Overall the reforms in the NHS Paper 2010 will provide the NHS with greater incentives to increase efficiency, equity and quality. Efficiency The healthcare system in England has on the whole perceived a huge improvement in terms of efficiency since its inception in 1948. A system has been established where it endows with one of the best services in the world but there are still room for improvements. An analysis of the services gives evidence such as the NHS building 100 new hospitals since 2000, therefore improving the efficiency and allowing better access for patients. 27 Even though there continue to be a lack of quality and accessibility to services across the country. The patients havent been able to impose enough pressure to force improvements. The NHS need to give patients more control over the health services they have access to improve efficiency. In 2008 investment in the NHS as a whole rose from ÂÂ £43.9bn per year in 2000, when the NHS Plan was launched, to ÂÂ £92.6bn. another measurement of efficiency is looking at numbers of early deaths from cancer, coronary heart disease and suicide; they continue to fall as services improve; over 98% of patients at Accident and Emergency (AE) Departments are seen within 4 hours; and hospital waiting lists are lower than ever, with half a million fewer patients waiting since lists were at their peak.28 One key way to achieve the set objectives is to cut down NHS managements costs by 45% over the next four years enabling them to free up investment for further improvements.28 Much has been achieved during the last five years of investment and reforms. For example, the significant investment in NHS staff, along with more flexible working, is facilitating healthcare professionals to take advantage of the freedom thus improving their commitment to the NHS. NHS staff working flexibly and using improved technology are better able to respond to patients needs and changing expectations and are achieving improvements in quality and productivity across the system.27 Since 1948, the NHS budget on average has risen over 4% in real terms each year; this is something they hope to resolve as the NHS will face a sustained and substantial financial constraint if it continues. They hope to avoid the financial crisis that happened in the NHS in the 1970s. The NHS hopes to release up to ÂÂ £20 billion of efficiency savings by 2014, which will be reinvested to suppor Healthcare Reforms in England Issues of Efficiency Healthcare Reforms in England Issues of Efficiency The healthcare service in England attempts to improve the overall healthcare service have been ongoing through some of the most radical reforms since its inception as a comprehensive public service since 1948. The noticeable need of a free healthcare service was essential after the state of the country due to the world war. Once the NHS was established it saw many reforms led by diverse types of governments at different times. Despite the scale of the reforms they have preserved their core principle of A free service at the point of delivery 1 till this very day. Even though they have adopted the core principle they still face huge challenges; as demands and costs are still rising, the entirety of the service is increasingly being looked at. This paper looks at the reforms the NHS has been through and analyses each reform in the light of Efficiency: the capability of the NHS, whether the reform made the NHS more competent, Equity: bringing fairness and equal right for the patients as well as the staff, Quality: whether adapting the reforms improved the patients ability to acquire different types of healthcare services without any predicament and obtain high-quality healthcare services. Methodology This paper was conjured up by the use of reports published by NHS Publications website. Journals and studies on NHS reform via the scientific database PubMed were also utilized. To gain info on the theories the NHS was formed on, management theory books by Max Weber, Henri Fayol and Frederic Winslow Taylor were used. Results/Discussion Each reform improvised the NHS in many ways, in relation to Efficiency the NHS since its inception has seen major investments and new hospitals built, employment of up to date technology allowing more patients to be seen within an applicable time and budgets been controlled efficiently with the aim to reduce costs each year allowing the NHS to run efficiently. In terms of Equity after the publication of the Black report, the NHS has improved on giving equal opportunities to its minor ethnic groups of staff. Also the equal treatment of patients regardless of their social class has been improved since the Blair era. The NHS in terms of quality has become one of the world leading healthcare providers. Measuring their services against standards set by the NHS ensured that they are meeting the set standards. The major investment in staff in 2000 saw a number of lives saved in the past 10 years. The NHS has met quality standards that are accepted by its patients and valued as a first class service. Conclusion Overall the NHS has seen many reforms which have lead to the NHS becoming a world class service. Since the reforms in the 1960s to the latest plans of the new coalition government the NHS has improved immensely in terms of efficiency, equity and quality and the future also looks bright for the NHS. Introduction: Healthcare service in England was launched in 1948 with an aim to provide universal healthcare to its citizens which is free at the point of use and available to everyone based on need, not ability to pay 1. The NHS was established after World War II where the country needed a stable healthcare service 2. The initial idea was that no-one should be deterred from seeking health services by a lack of resources and the founder Aneurin Bevan: Minster of Health stated A free service at the point of delivery 3. Till this day they have been providing free healthcare service to the citizens of England. In 1948 Sir William Beveridge, a British Economist and a Social Reformer conferred details of his radical plans for economic and social reform in post-war Britain. Sir William proposed major healthcare service changes on the basis that the country needed the abolition of want before the enjoyment of comfort and suggested a scheme where every kind of medical treatment would be available for everybody. 1,3 Pre NHS There has been some form of state-funded provision of health and social care in England prior to the NHS for 400 years.4 Prior to a health system being formed, attaining healthcare service in Britain in the 1930s and 1940s was difficult. Life expectancy was very low and thousands of people died of infectious diseases like pneumonia, meningitis, tuberculosis, diphtheria, and polio each year.4 The poor never had access to medical treatment and they relied instead on dubious and sometimes dangerous home remedies. Either that or they relied on doctors who gave their services free to the poor patients. The Hospitals charged for treatment and although the poor were reimbursed and before they received treatment they had to pay.4 Figure 1 shows the life expectancy that has changed since the NHS was introduced. Figure 1.Life expectancy changes since 1840 5 The need for free healthcare was widely recognised, but it was impossible to achieve without the support or resources of the government. A study showed that experts believed and have written extensively on the reasons of why a health service was needed.6 These included: The appearance of a view that health care was essential, not something just imparted erratically by charity The drastic effects of the war that made it possible to have a massive change of the healthcare service being provided, rather than just an incremental alteration As younger members of the country were becoming increasingly educated in the medical profession they had a view of things could be handle in a more efficient way. The hospitals having financial problems, funds not sufficing.6 Having looked at the reasons to why a health service was needed the government made plans and core principles were established: 6 Regardless of persons status they were eligible for health care, even people temporarily residing or visiting the country.ÂÂ   People could be referred to any hospital. The healthcare service was financed almost 100% from central taxationÂÂ   Care was entirely free at the point of use6 The main achievement was that the poor who in the past went without medical treatment now had access to free healthcare.6 NHS today and NHS employment NHS is one of the largest organisations in the world with an annual budget of around ÂÂ £80 billion employing more than 1.7 million people and treating over one million people every 36 hours.7 In general, healthcare service being provided within England to every single citizen is a difficult commission to undertake and consequently the system needs efficient health personnels to help run the system economically. Today the view of the healthcare service in England is that the NHS is a world leader and provides first class service that other countries envy. Countries all over the world seek to learn from the comprehensive system of general practice, and its role as the medical home for patients, providing continuity of care and coordination.8 Other countries look at English NHS system and use them as a guideline to run their healthcare system. NHS Structure The healthcare service in England has been run in a structural way with the Secretary of state and Department of Health controlling the overall NHS in England. The secretary of state for health has the responsibility of reporting to the prime minister. There are10 Strategic Health Authorities (SHAs) in England which are controlled by the Department of Health, they oversee all the activities within the NHS and the SHAs supervise all the NHS trusts in its area. Primary care plays a major role in community healthcare and is central to the NHS. Services under NHS trust (Secondary Care) include Hospitals, Mental Health services, Learning disability services and Ambulances. The overall structure of the NHS is shown below in Figure 2. 9 Although this is the current NHS structure with the new government in power, changes are to follow. Figure.2 overall structure of the Healthcare system in England 5 NHS Reforms Since its inception in 1948 the NHS has seen many reforms in terms of managing the way they provide healthcare service. The DoH has a lot of control and influence the major decisions taken in the reforms. The overall expectations of Healthcare service in England are of a high calibre, which requisites high-quality management capacity.10 In the 1980s and early 1990s prominence was on recuperating management. The recent focal point has been on development of leadership within NHS. With the new government, new ideas and plans will be imposed to see improvements in quality of healthcare being provided, cut down on costs making it more efficient and in terms of equity provide equal service to everyone. Table 1 briefly enlists the reforms that have taken place since its inception in 1948. Table.1 Reforms in the NHS: 1948-2010 Period the reforms were in place Reform and theory of Management 1948- 1960 Managers as diplomats 1960s Scientific Management and the Salmon report 1970s Classical Management, Systems Approaches and the 1974 Reorganization 1980s The Griffiths report and Managerialism 1990s Working for Patients and the Internal Market 2000 The NHS Plan (DOH 2000) and the Third Way. 2010 NHS White Paper 2010: Equity and excellence: Liberating the NHS Healthcare service and Reforms in other Developed Countries Healthcare reforms within developed countries can be analyzed in order to compare whether the healthcare services in England have been successful in its bid to ensure efficiency, equity and quality. Attempts to handle reforms of the healthcare system in the European countries have been an ongoing process for 30 years. Although the reforms have taken throughout the 30 years in different ways, their main emphasis has been on improving the cost-effectiveness of the healthcare service. In the early 1980s the EU countries were looking at cost containment. The feature in the 1990s was to endorse efficiency in terms of introducing competition and markets in the healthcare system. Since 2000 the focus has switched to effectiveness; promoting various notions of healthcare in terms of quality.11 Over the course of the 20th century the countries of Europe have established significant success in improving the healthcare service for their citizens. However they still face challenges in the form of restraining costs, improving quality and providing universal healthcare access, these have put the European healthcare services under immense pressure.11 Looking at another OECD: USA, A report on A review of health care reform in the United States assessed whether the USA have been successful in providing healthcare. The findings showed that United States spent more per capita on health care than any other OECD country, yet its health outcomes lagged behind other countries.12 This shows they are struggling with efficiency issues and are still countering challenges in providing quality healthcare service that is expected from the citizens of the USA. Especially in the last few years Healthcare reform has been a major activity of the federal government, in order to revolutionize and develop the service overall. The 3 goals of optimizing cost, access and quality still remain a challenge within the healthcare society in the U.S.12 They concluded that USA still faced many challenges in running the national healthcare service, a key challenge they face is the utter complexity of the system, with its numerous public and private providers.12 Another OECD country reviewed in terms of healthcare service being provided and the reforms that have taken place is China. A report from on From a national, centrally planned health system to a system based on the market: lessons from China concluded: China is the country that has undergone the highest number of health care reforms. Since 1978, China saw many reforms and they also followed the way as the EU countries, with the healthcare system starting from governmental, centrally planned and a collective system to ending up as a heavily market influenced system. Now, thirty years later, the Chinese government openly concede that the reforms were unsuccessful and seek innovative and fresh directions.13 This illustrates that China is also in a healthcare crisis and looking to implement different strategies in order to gain control of Chinas Healthcare system. Having reviewed the healthcare service being endowed in these developed countries, it demonstrates that they are all on an identical level as the healthcare service being provided in England and all face similar challenges. All these developed countries are looking to develop the countries overall healthcare service in terms of efficiency, equity and quality. NHS Plan 2000 and the future of NHS Since the last reform: The NHS plan 2000 14, a lot has transformed in terms of funding and operating the healthcare system in England. Especially with the new coalition governments idea of cutting budgets it is a difficult time the NHS is going through and will necessitate a lot of expertise and world class management to get through todays financial and economical predicament. An additional indication that will be taken into deliberation is the election of the new plans set out in the NHS White Paper 2010. As the new coalition government has come into authority there have been huge changes to overall budgets for the public services and this possibly will have a consequence on the way the NHS operates in England. 15 The reforms have encompassed a significant impact on the organisation and deliverance of health care service in England. Wide array of transformations have been pioneered in an attempt to ensure the NHS is managed more resourcefully and effectively. This report will examine whether these reforms have on the whole improved the healthcare system in England in terms of efficiency, equity and quality and if the publics requirements have been convened. Aims: To examine the healthcare reforms in England since its inception and to assess whether these reforms have improved factors of efficiency, equity and quality in providing healthcare. Objectives: To review the reforms in the NHS since its inception in 1948 To examine whether these reforms improved efficiency, equity and quality of healthcare To assess the key features of healthcare reforms proposed by the current government and their implications on the NHS To put forward plans for the future of the NHS Methodology: A number of sources were consulted to conjure up this paper and examine the healthcare reforms in the NHS. Scientific search engines and databases such as PubMed, Google Scholar and Science Direct (Date accessed 20/10/10) were used to gain literature reviews but results from Google Scholar and Science Direct were dismissed as they were too vague and irrelevant to this topic. With PubMed following keywords were inserted Healthcare, Reforms and England. The data was also set from 1948 to 2010 when searching for reports as this would set the inclusion criteria. The reports and journals since 1948, when the NHS was established were used. Even though history before 1948 was looked at for study purposes, reports before NHS establishment; these were regarded as the exclusion criteria as reports werent looked at prior to 1948. Healthcare service within Britain was looked at in general but for the results of this report, the inclusion criteria was healthcare service in England as it just look ed at the healthcare service being provided within England. The exclusion criterion was healthcare service in Scotland, Wales and Northern Ireland. For the first part of the report, the introduction: where the report looked at the history of the NHS. The resources used included looking at general management books looking at management theories. The classical theories of Max Weber, Frederic Taylor and Henri Fayol were the backbone of the NHS and that is why these were used. Another source to produce this paper was the Department of health (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/index.htm) where the publications and reports about the NHS in general were looked at. This paper used a lot of publications produced by the Department of health and the NHS publications as these sources are reliable; these were seen as good foundation to work from. One of the main publications used was The NHS white paper: Equity and excellence: Liberating the NHS presented to Parliament by the Secretary of State for Health, this was a key entity in writing up this paper. As the paper didnt contract with experiments and clinical trials, it didnt look at a lot of statistics; the majority of its content was obtained from qualitative data. Results/ Discussion Having carried out the required literature searches and reading journals, reports and Department of Health Publications, results were gathered and have been shown below with the discussion of the key topics. The results look at each reform taken place in the NHS and then goes onto analyse the plans set by the new government. Having looked at the reforms and the new plans the paper than talks about efficiency, equity and quality related to each reform. Reforms in the healthcare service in England The healthcare service in the UK has undergone a number of reforms since its inception in 1948. Prior to 1948, healthcare service was provided in England but due to the increasing pressures for efficiency and quality in health services it lead to these developments and reforms in healthcare being provided. A more overtly management-oriented approach to the healthcare service delivery was adopted based on classical management theories to gain more control of the healthcare service in England. 16,17 Classical theories and Scientific Management: 1960s The NHS was based on the classical theories of Frederic Winslow Taylor, Henri Fayol and Max Weber. 16-19 Table 1: Frederic Winslow Taylors four main scientific management principles. Replacing rule-of-work thumb methods with methods based on a scientific of the tasks Scientifically train each individual rather than leave them to train themselves Cooperate with each worker to ensure that the scientific method is being followed Divide workload equally between managers and staff Table 2: Henri Fayols Modern Operational Management approach. Division of work- Specialization for efficiency Authority Responsibility- Both are related, the latter arising from the former. Discipline-Requires good superiors at all levels Unity of Command- Employee should receive orders from one superior only Unity of Direction- Each group of activities with the same objective must have one head and one plan Subordination of individual to general interest- When the two are found to differ, management must reconcile them Remuneration-Should be fair and satisfactory Centralization-Extent to which authority is concentrated or dispersed Scalar chain/line of authority-Needs to be sensible, clear and understood Order : Right thing/person in the right place Equity- Equal opportunity for everyone Stability of tenure- Unnecessary turnover is both the cause and effect of bad management Initiative- Thinking out and execution of a plan Thinking out and execution of a plan Table 3. Max Webers Bureaucratic approach. Power-Ability to get things done, often by the use of threats or sanctions Authority- Ability to get things done because of the position that justified someone in terms of legitimacy Formal approach Hierarchical authority Extensive roles and procedures- Uniformity of decisions and actions Job description- Clear-cut division of labour and High level of specialization Discipline These classical theories contributed a lot to the healthcare service in England and still do to this day.16-19 The classical writers thought of the NHS in terms of purpose and formal structure. They created a formal structure on which the NHS could run on. They also looked at job design, scientific selection and development of workers. The classical theories generally serve as a backbone to the present day NHS management. Although the classical theories made a big contribution to the healthcare service in England it had its limitations and wasnt the most effective way. One drawback was that it wasnt evidence based; it didnt look at the way staff did their tasks and didnt look at the well being of staff, the human and social aspects of work. It just treated them like machines. The theories didnt look at motivating the staff and developing them in their own interests, had they done this staffs work quality wouldve enhanced thus providing an efficient service to patients and overall improve the quality of healthcare service in England. Overall the classical theories were too concrete and fully based on rules and procedures. In terms of efficiency the theories bought a set way of running the healthcare service in England. Once the NHS was established it introduced equity as well as healthcare service was now available to anyone. The NHS was just established and with these set in place in the 1960s the qua lity of service would improve from now with further reforms to come. Salmon Report: 1960s One of the first reforms took place since the NHS was established was in the 1960s. The Salmon Report bought findings and changes which included that workload should be equally distributed between managers and practitioners.20 The NHS would also get rid of matrons and replace them with a hierarchy of nurse managers. The introduction of several additional layers to the management hierarchy; in order to improve efficiency in operating the NHS. This lead to responsibility being equally distributed and the service met its aims and objectives more efficiently. Another change was that nurse managers would contribute to the overall management of the service through the medium of consensus management teams and thus improve efficiency and quality within the NHS. Having nurse managers lead to them taking control of set responsibilities and helped in general running of tasks at ward level leading to an improvement in general quality in the healthcare service being provided. 1974 Reorganization: 1970s The aim of this reform was to attain greater integration of the healthcare service in order to provide more stability and increase efficiency. The reorganisation also introduced more central control in order to: 21 ensure policies were implemented improve accountability encourage delegation develop democratic decision-making process These changes lead to a more structured way for managers to follow and enhance the quality of the healthcare service. By the mid 1970s quality was improving but there were still concerns of equity in the NHS. There were still clear differences of health sufferers in terms of social class; figures showed that people in lower social classes more likely suffered from diseases. There were several possible explanations for these inequalities. Natural and social selection. This would depend on the view that people who are fittest are most likely to succeed in society, and classes reflect this degree of selection. Poverty leads to ill health, through nutrition, housing and environment. Cultural and behavioural explanations. There are differences in the diet and fitness of different social classes, and in certain habits like smoking. 22,23 Overall in the 1970s the quality of healthcare service was still improving, equity issues were still a concern and in terms of efficiency they were recuperating the NHS. The Griffiths Report: 1980s This reform was a major point in NHS history, the Griffiths Report identified problems such as the healthcare service was institutionally inactive and that the local health authorities were filled with directives without being given any clear procedures to follow.24 The Griffiths report stated that changes were difficult to achieve but gave recommendations to improve the NHS. It introduced a more formal and modern way of management. It gave increased participation for managers in setting and controlling budgets. The report also gave greater emphasis on cost awareness in order to improve efficiency. A Clear and quick decision-making process was introduced to improve quality of service provided to patients. The managers in local authorities were given a more clearly defined direction and the overall staffs were better informed.24 The Internal Market Working For Patients: 1990s Another reform in the 1990s took place, this bought a new dimension to the NHS; large publicly-owned hospitals could opt to become self-managed trusts. This meant that health services could be bought by private investors i.e. patients themselves thus allowing them to take control of the way they want the service. Even large GPs could become fund holders and be both purchasers and providers of care.25 This reform lead to introduction of greater flexibility thus allowing more effective matching of patients needs and care. Money followed the patients through the system of purchasing and providing of healthcare service, this led to equity being improved as patients had more selection of services. This reform led to higher competition in providing quality healthcare service, the costs decreased and the general quality increased. The NHS Plan 2000 The NHS Plan 2000 made key findings : the NHS is a 1940s system operating in the 21st century and that it lacked of national standards. It also said that there were barriers between staff and providing services. There were a lack of clear guidelines and the NHS structure has over-centralization.14 Plans to diminish problems and propose new plans such as introducing Modern Matrons to improve the management of services, a strong leader with clinical experience and with clear authority at ward level, improve efficiency by setting standards and controlling resources these were there aims.14,26 The figure below shows the comparison of the 1948 and the new NHS model outlining the key differences. Figure.4 the key difference between the 1948 model and The NHS Plan 2000 model 14 The NHS Plan 2000: Achievements This reform set out specific targets which were achieved in order to improve efficiency, equity and quality of healthcare service in England: Over 100 new hospitals by 2010 and 500 new one-stop primary care centres Clean wards and better hospital food 7,000 extra beds in hospitals Over 3,000 GP premises modernized Modern IT systems in every hospital and GP surgery 7,500 more consultants and 2,000 more GPs 20,000 extra nurses and 6,500 extra therapists Childcare support for NHS staff with 100 on-site nurseries.26 These targets were achieved in 2008 and it led to the improvement of efficiency as the number of GPs and consultants employed were increased. The modernisation of technology and IT systems led to quality of service being improved as high investment in high quality equipment made the NHS one of the worlds top quality service. Since 2000 NHS has improved the overall service and met its objectives. NHS Implications: Equity and excellence: Liberating the NHS With the new coalition government coming into election another set of reforms have been proposed as they hope to improve the overall healthcare service in England. The main aims and objectives to improve the healthcare service are varied and very detailed but to summarise it these are the points covered:15 Increase health spending in real terms in each year of this Parliament 15and also that there goal is an NHS which achieves results that are amongst the best in the world 15. However the government will uphold the foundation that the NHS was formed on; a comprehensive service, available to all, free at the point of use and based on clinical need, not the ability to pay 15. The government than goes into detail of what they arrange to initiate to make an efficient healthcare service: acknowledge the fact that patients come first and therefore will give them greater choice and control. An example of this is that a patient will be able to choose any GP practice, consultant, and choice of treatment consequently improving equity of the service. The government endeavours to develop the healthcare outcomes: set objectives such as reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all 15. By doing this they are ensuring they are driving efficiency and improving the service. In order to achieve the objectives that the government sets, the ability for service providers to have more autonomy, responsibility and accountability will be a means to achieving efficient results. A big change will be the establishment of a NHS Commissioning Board. The board will be accountable for making sure health outcomes are achieved, allocate resources and have the lead on quality improvement and to tackle inequalities that exist in the NHS. Overall the reforms in the NHS Paper 2010 will provide the NHS with greater incentives to increase efficiency, equity and quality. Efficiency The healthcare system in England has on the whole perceived a huge improvement in terms of efficiency since its inception in 1948. A system has been established where it endows with one of the best services in the world but there are still room for improvements. An analysis of the services gives evidence such as the NHS building 100 new hospitals since 2000, therefore improving the efficiency and allowing better access for patients. 27 Even though there continue to be a lack of quality and accessibility to services across the country. The patients havent been able to impose enough pressure to force improvements. The NHS need to give patients more control over the health services they have access to improve efficiency. In 2008 investment in the NHS as a whole rose from ÂÂ £43.9bn per year in 2000, when the NHS Plan was launched, to ÂÂ £92.6bn. another measurement of efficiency is looking at numbers of early deaths from cancer, coronary heart disease and suicide; they continue to fall as services improve; over 98% of patients at Accident and Emergency (AE) Departments are seen within 4 hours; and hospital waiting lists are lower than ever, with half a million fewer patients waiting since lists were at their peak.28 One key way to achieve the set objectives is to cut down NHS managements costs by 45% over the next four years enabling them to free up investment for further improvements.28 Much has been achieved during the last five years of investment and reforms. For example, the significant investment in NHS staff, along with more flexible working, is facilitating healthcare professionals to take advantage of the freedom thus improving their commitment to the NHS. NHS staff working flexibly and using improved technology are better able to respond to patients needs and changing expectations and are achieving improvements in quality and productivity across the system.27 Since 1948, the NHS budget on average has risen over 4% in real terms each year; this is something they hope to resolve as the NHS will face a sustained and substantial financial constraint if it continues. They hope to avoid the financial crisis that happened in the NHS in the 1970s. The NHS hopes to release up to ÂÂ £20 billion of efficiency savings by 2014, which will be reinvested to suppor

Women in The Color Purple and The Handmaids Tale

Women in The Color Purple and The Handmaids Tale [NM1]The most common way people give up their power is by thinking they dont have any.[1] [NM2]This quote from Alice Walker encapsulates the premise of her novel The Color Purple and Margaret Atwoods The Handmaids Tale. Both novels aim to educate and enlighten their audiences to the psychological effects of female subjugation. Walker and Atwood utilise a myriad of literary techniques, and the power of the female first-person narrative; illuminating to all readers the victimisation and suppression of women in patriarchal societies and households. Walkers quote is reflective of the protagonists in both novels; only when they think they have no power, is when they are truly powerless. This theme can be ascertained from the opening epistles of The Color Purple, the reader is immediately lambasted with the psychological effects of persecution on the protagonist, Celie, at the hands of her father[2], Alphonse. Walkers deployment of the first-person epistolary structure subconsciously precipitates for the reader becoming Celies emotional muse. Walker forces us to see Celies undistorted emotions in the truest form possible as Celie writes her letters for God, not an audience, allowing the letters to reflect her emotions, unplagued by an America burdened by institutional racism and patriarchy. Thus, the letters highlight the psychological effects of sexual and societal subjugation, undistorted by the environment that submerges her. Walker presents African-American homes[3] as parallel to white households, with the dominant male asserting power over the women and children, comparable to how the African-Americans were treated by the racist white society of 1930s America.[ 4] Walker adheres to the traditional literary representation of African-American women[5] in the novels inauguration, representing Walkers protagonist, as a victim of her society and environment. Psychologist Charles L. Proudfit, published, Celies Search for Identity: A Psychoanalytic Developmental Reading of Alice WalkersThe Color Purple.[6], labeling Celie as having gone through the typical thought process a child abuse victim. Celies first letter opens: Dear God, I am fourteen years old. I am I have always been a good girl.[7] Celie crosses out I am, changing the auxiliary verb to have, self-justifying her subjugation[8], believing the abuse is deserved and her treatment is justified[9]. The auxiliary device is jarring to the reader as Celie believes only God will see the letters, yet she doesnt feel that she is a good girl, despite being the most divine character in the novel, epitomised by Walker naming her Celie, a derivative of caelummeaning heaven in Latin. The crossing out I am reaffirms Proudfits analysis, she no longer believes that she is a good girl, but rather a tainted stain on the fabric of society; reiterated by the usage of the past tense, surrendering the prior image she had of herself. Walkers presentation of Celie suggests that she wholeheartedly believes that she is deserving of the abuse. Celie does not respond with rage to her subjugation initially, bowing to the agonistic authority of her Pa stating, sometimes it bees that way.[10] Subsequently, validating the abuse she is receiving by crossing out her past self-image, replacing it with the new solemn view point. The understated nature to the mentality change highlights the damaging psychological effects of the subjugation of women, a clear reference to Walkers driving quote. Celie thinks she has no power; but in reality, Celie has more power than anyone truly knows. Walker includes this to show that only when a woman gives up her power is when she is actually powerless, illuminated th rough the structure and deployment of specific language devices evoking a poignant response from both contemporary and contextual audiences. Comparably, in Margaret Atwoods, The Handmaids Tale, the women are subjected to incomprehensible oppression. In the dystopic, fundamentalist administration, Gilead, the female characters are stripped of the individualism that truly makes them women, their identities quashed and cut to fit the roles the government established to continue their patriarchal agenda. Atwood presents the abrasiveness of Gilead as a microcosm of everyday society in conjuncture with The Color Purple being representative of domestic life. Atwoods heroine, a female assigned as Offred, had the onerous burden of being a Handmaid; assigned as a surrogate to elitist, Serena and Fred Joy (alias, The Commander.) In her placement, Offred lost all freedoms she enjoyed pre-Gilead, replaced with set meals, activities and as a prerequisite of her role prearranged sexual intercourse sessions. Despite showing the dreadful conditions of Gilead, allegorically this can be interpreted as a social commentary from Atwood, repres enting patriarchal abusive relationships. In these relationships, the misogynistic figure controls every facet of life with abuse not exclusively physical. Instead, affecting every aspect of the recipients life, entailing financial and most destructively, mental abuse, with real and Gileadean society modelled around the idea that, A rat in a maze is free to go anywhere, as long as it stays inside the maze[11]. Represented further by the prearranged ordinances of the Handmaids, akin to Celie, the Handmaids and the people stuck in real abusive relationships they cannot escape. Correspondingly, in many abusive relationships the recipients begin to think what they are facing is normal per se, rather than fighting, accepting their suffrage as something to be expected; represented initially in both novels. Subsequently, relinquishing all power that they held reinforcing the idea of Alice Walker, psychological subjugation stretches into every single part of our lives, no matter where you g o, you can never escape your own mind. Prior to Gilead establishment, readers see Offred character as a rumbustious spirit, breaking free from societal norms, seen in Atwoods analeptic digressions from her unconventional relationship, meeting Luke at cheap hotels for sex. However, when delivered to Gilead she forgets the power that she holds, her perseverant psychological state is disintegrating with the threat of the Colonies[12] reinforcing to the reader the idea Offred must mentally shackle herself adhere to the limitations of life established. Reflecting to the audience that authoritarian subjugation has the power to inflict so much fear that we strip ourselves of the desire to fight for the liberty and freedom that we know is right. Highlighting the contrast between the protagonists, Offred is aware of her subjugation and is unable to rebel against it due to the potential backlash. Contrastingly, Celie, as aforementioned appears accepting of her role as deserved, or inevitable; alternatively, Offred preaches passive resistance taking liberation from the psychological onslaught. This can be ascertained by the description of her existence as theatrical: I stand on the corner pretending I am a tree.[13] Here, Walker presents to the reader the resilience of women in the face of patriarchal subjugation, and reflects the quote of Walker. Offred refuses to give up her power as can be seen from the choice of verb pretend. Suggesting, as a woman she has not changed psychologically due to her subjugation, rather she must appear changed to survive; separating herself from the image expected of her, never losing sight of how she perceives herself despite the indoctrination she is subjected to. Atwood encapsulates this by the comparison to a tree, trees perceiver throughout history, standing, unmoving, dependant on humans for preserving its life, exactly like Offred. Alternatively, others readers may interpret this as, despite not being able to escape physically from its surroundings but can soar upwards above the small, damaging thoughts of man; and survive unchangingly preserving its own identity, flourishing and blooming in the process. This is where we can see Offred, she conforms to the regime, but does not allow it to define her changing her self-perception, separating her physical and mental self. Offred understands she is just playing a role; analogous to a tree, despite all that is going on around her she is able to stay strong and unwavering in her quest to survive. The only way she can do this is by maintaining her mental strength and thus her power, despite the depravity circulating around her. Consequently, Atwood presents to the reader that Offred, despite not being a conventional literary hero -submitting outwardly to the regime- is unquestionably powerful, inspiring people in comparable real life positions, reinforcing the idea via tree imagery that by maintaining psychological strength she can never be felled. As aforementioned, Walker presents Celie in accordance with the traditional representation of African-American women in literature: timid, weak. Nevertheless, she undergoes a psychological transformation becoming an empowered woman, when she builds her relationship with the psychologically liberated Shug Avery. Prior to Averys arrival, Celie idolises her second to God alone. Shug becomes dependant on Celie whilst she nurses her, temporarily allowing Celie to feel equal to someone. In the process, Shug fills Celies emotional void she was deprived of, when Olivia was taken, Celie works on Shug like she a doll or like she Olivia.[14] Walkers diction, utilising the common noun doll produces connotations of childhood and play. Therefore, its prevalence in the sentence could represent that Celie has been deprived of a childhood due to the subjugation she encountered, but now she has Shug as her dependant, she appears psychologically liberated. Accordingly, Walkers syntax metaphorically rep resents to the reader the evolution of Celies character development. This interpretation is reinforced by critic and psychologist Daniel W. Ross, Celie in the Looking Glass: The Desire for Selfhood in The Color Purple. Ross identifies the doll as a transitional device for girls developing in childhood, preparing for the nurturing roll that they will experience as future mothers. A modern reader may not interpret it this way as in the 21st century not all women want to grow up to have children. However, when published in 1982 this was the norm of society, especially within the context of a 1930s African-American community in the South. With Ross interpretation and understanding of Walkers intentions, one can see that when people have the support to break free they do. Celie has clearly begun to employ some of the psychological growth stunted in her childhood, Shugs presence and later friendship acts as a tool for Celie enabling her to continue maturing despite the subjugation targete d against her by Mr.______. In conjunction with Walker, Atwood portrays the psychological effects of subjugation on Offred as decreasingly damaging, with her resilience against the regime. The structure of Offreds internal dialogue as a palimpsest of past events embodies the idea that Gileadean attempts to indoctrinate psychologically, but has failed control their private cognitions. This theme is shown in Offreds description of the Lilies of the Valley and its previous function as a theatre, Students went there a lotà ¢Ã¢â€š ¬Ã‚ ¦ women on their own, making up their mindsà ¢Ã¢â€š ¬Ã‚ ¦ We seemed to be able to choose, then.[15] Atwoods analepsis represents to the reader despite the subjugation encountered in the patriarchy, a better way of life exists, almost as a vision of higher reality, identically to the role God and Nettie play for Celie. Despite these flashbacks being painful for Offred, by forcing herself to remember she keeps her power and the tenacity for survival. Atwood uses these flashbacks to sho w Offred rebelling against the indoctrination as early as Chapter five setting a precedent for the rest of the novel, and for people in real life situations comparable to Celie. Chapter five is when Offred becomes aware of her subjugation and wants to fight it, following an encounter with Japanese tourists, We are fascinated, but also repelled. They seem undressed. This shows immediately quickly from the start of the novel, the weak can be indoctrinated, if you are not strong and dont maintain your mental strength in the subjugating surroundings you will fall. Nevertheless, Atwood presents Offred as a macrocosm of all women with the idea that a woman always has the power to think no matter what situation she is in. We can see this with the realisation that follows Offreds quote I think: I used to dress like that. That was freedom. [NM3]This quote explicitly highlights Offreds psychological development, from accepting the ideas promoted in Gilead to an outright rejection of the philo sophy of the role females are supposed to undertake. The punctuation of this quote acts as an audible and visible barrier between the mind control of Gilead and the mental liberty that Offred desires. Atwood tactfully uses the colon in place of a comma to show the separation between her desire to think and the actual thoughts that she has. Atwoods presentation allows the reader to see the cognitive functions of her brain, rejecting the indoctrination that she had received at the red centre. Also, extenuating how far society has affected her that it takes time and effort to come to a judgement that she previously associated with on a material level. By opening this door, Atwood presents the idea that having made this initial rebellion, she is reclaiming her power and can move on to reject other elements of society. Shunning Aunt Lydias freedom from in favour of having the freedom to, and thus we can see a decrease in the psychological effects that the authoritarianism has on her. Hen ce, Atwoods reinforcement of Walkers theme, when one becomes mentally liberated from subjugation they gain the metamorphic ability to transform into an unstoppable entity with the power to continue your personal insurgence. Celies psychological development, isnt dependent on Shug alone, she also learns to live alone and function as an independent woman; comparable to Offred, just in a different society. Walker portrays Celie as conquering her subjugation gaining her freedom from the patriarchal society by taking control of her own life but not sacrificing her femininity in the process, as being strong and feminine two things often not mutually associated. Celie takes up sewing, traditionally a matriarchal chore for women who are confined to a domestic setting. But, Walker takes this and turns it into an outlet of expression, creativity and freedom as well as a lucrative business in the process, profiting on femininity. Despite being unrealistic that an African-American girl could make this monumental shift in her life, it should be remembered that these are not explicitly real people but rather representations of a wider narrative that the authors want to convey. When this is considered the deus ex mach ina is powerful symbolism representing, when women are psychologically liberated from subjugation anything is possible for anyone, promoting an idea of female expressionism and psychological advances. We gain this understanding as it exemplifies Walkers own beliefs on feminism and equality as she is a firm believer that femininity doesnt mean subjugation[16]. Reflected by Celies deliverance from subjugation through associating with female characters and partaking in feminine hobbies. If Celie gained her psychological strength by taking on something characteristically male, with men the reader would not have the same veneration towards Celie, breaking from societal convention. In a society dominated by men Celies unique femininity flourishes, showing that women do not need men to succeed highlighting the importance of female cooperation and bonding. Professor Mae G. Henderson[17] reinforces that its female bonding which restores a womens sense of completeness and independenceà ¢Ã¢â€ š ¬Ã‚ ¦ [Celie] exemplifies the power and potential of this bonding. Celies business is metaphorical in the need for female empowerment, its her business and female bonding that has freed her and now she is gaining success Walker reflects this in her mental state. Therefore, the business acts as an important symbol in Celies psychological development. No longer does she feel she deserves the abuse described by Proudfit, comparably to Offred shes striving to create a better tomorrow for herself, reclaiming her mental power lost in her subjugation. Atwood concludes Offreds journey from victim to rebel through the cassette tapes. These recordings prove to Atwoods readers that Offreds consciousness and ability to remember her life prior to Gilead enables her to live on, never relinquishing the past. Whether Offred witnessed the fall of Gilead is left ambiguous, but she proves the regime didnt take her psychological strength. The tapes metaphorically represent her ability to be heard above the government, the indoctrination of the Aunts and the fear of The Eyes all unsuccessful in their psychological subjugation of Offred. Atwood presents that the attempts to psychologically subjugate Offred was never as strong as the desire of women to overcome the problems they are faced with. Similarly, Celies final letter shows the extent to which her character has developed across the breadth of the novel. The novel ends with the realisation that although her generation is growing older, the reunion with her children and Nettie has made her f eel younger than ever; providing psychological closure for the absence of childhood that she has endured. Now she can appreciate the virtue of youthfulness that was stripped from her at the start of the novel. Walker opened with a quote from Alphonse, You better not never tell nobody but God. Itd kill your mammy. Readers can see that in the opening parts of the novel Celie adheres to this subjugation and her letters are never titled to anyone other than God, showing how her voice was suppressed by her father. However, by the end of the novel Celie is talking to all things on earth and otherworldly breaking secular liminality Dear God. Dear stars, Dear trees, Dear sky, Dear peoples, Dear everything. Therefore, we can wee that Walker concludes her novel similarly to Atwood; with both protagonists overcoming the psychological effects of their subjugators by allowing their voices to be freed. Howbeit, where the authors differ is through the legacy their characters leave behind in their messages, both can be seen as mutually optimistic consisting of the fall of Gilead, and a jubilant Celie reunited with her family, giving Celies tale a conclusive ending. But, Atwoods shows, whilst undeniable victories have been made for feminism, society is still misogynistic, ascertained from the language used by Professor Pieixoto being almost identical to that being used in Gilead. Thus, whilst presenting the idea that when one woman is freed from the subjugation the next shall follow; its still the job of her readers and to keep on fighting as society, despite becoming a long was is still patriarchal is not the answer reinforced by the fact that Offred rejected her mothers activism and consequently we are never sure if she enjoys liberation. The authors, via the protagonists take us on a subconscious journey through society with the first-person narrative. Allowing the reader to gain a personal insight into what the individual stories represent, and the best way that the author s can do this is through psychological evaluation. As the brain is something we can never escape, both authors aim to educate the reader on the effects that subjugation has and how by coming together; women can defeat this and triumph against any challenge. Hit this: Critical evaluative application Presents a critical evaluative argument with sustained textual examples. Evaluates the effects of literary features with sophisticated use of concepts and terminology. Uses sophisticated structure and expression. Exhibits a critical evaluation of the ways meanings are shaped. Evaluates the effects of literary features and shows a sophisticated understanding of the writers craft. Presents a sophisticated evaluation and appreciation of significance and influence of contextual factors. Makes sophisticated links between text and contexts. [1] The Best Liberal Quotes Ever : Why the Left is Right (2004) by William P. Martin, p. 173. [2] Later revealed not to be the biological father but at this stage of the novel all the reader and Celie know alike is that he is Pa. [3] //leading to criticism from many Critics as they believe that Walker gives an unrealisitic interpretation of African-American men making them seem barbarous. [4] -2 [5] Valerie Sweeney Prince, Burnin Down the House: Home in African American Literature, New York: Columbia University Press, 2005 [6] Charles L. Proudfit, Celies Search for Identity: A Psychoanalytic Developmental Reading of Alice Walkers The Color Purple, University of Wisconsin Press, Madison, JSTOR. [7] Alice Walker, The Color Purple, Hachette UK, google books,p. 6. [8] https://books.google.co.uk/books?id=jhPGJeTIIisCpg=PA182lpg=PA182dq=heroine+celiesource=blots=D1Y9ayFzjAsig=y2h-11mMOkKSFBJu_FiyItjcYxAhl=ensa=Xved=0ahUKEwjQnO2t4cfSAhWJA8AKHSULDs0Q6AEIPjAI#v=onepageq=heroine%20celief=false come back to [9] Charles L. Proudfit, Celies Search for Identity: A Psychoanalytic Developmental Reading of Alice Walkers The Color Purple, University of Wisconsin Press, Madison, JSTOR. P. 17. [10] [11] P. 174 [12] [13] Alice Walker, The Handmaids Tale, Random House,   New York. P. 30. [14] Color purple pg. 42. [15] HT pg. 40. [16] https://www.theguardian.com/books/2013/mar/09/alice-walker-beauty-in-truth-interview women, at this point, are comfortable referring to themselves as guys, and basically erasing their femininity at every opportunity. I dont get it. [17] S peaking in Tongues and Dancing Diaspora [NM1]AO1: Articulate informed, personal and creative responses to literary texts, using associated concepts and terminology, and coherent, accurate written expression. 26.7% AO2: Analyse ways in which meanings are shaped in literary texts. 26.7% AO3: Demonstrate understanding of the significance and influence of the contexts in which literary texts are written and received. 21.9% AO4: Explore connections across literary texts.   14% AO5: Explore literary texts informed by different interpretations. 11% [NM2]Handmaids tale society is so oppressive See Libby Barton for essay title [NM3]Puritan link

Sympathy for the Devil Essay -- Literary Analysis, Frankenstein

The gothic novel is previously associated with being a ‘rebellion against constraining neoclassical aesthetic ideals of order and unity, in order to recover a suppressed primitive and barbaric imaginative freedom.’ (Botting, 1996: 98) It is often considered a premature manifestation of the emerging values of Romanticism. Although the gothic genre is somewhat shadowy and difficult to define it can be seen as having a number of characteristics or conventions. This can be observed in Frankenstein including the ‘stereotypical settings, characters and plots, an interest in the sublime, the production of excessive emotion in the reader, an emphasis on suspense, the notion of the double and the presence of the supernatural.’ (Botting, 1996: 102) The genre develops more than an understanding of the various modes of destructive violence, social repressions, and disturbing sexual energies characterizing particular moments of modernity. It begins to be integral to the formation self-representation and maintenance of the modern world we inhabit. The degree in which the protagonist characters in the novel portrayed as either innately virtuous or evil and its contribution to their identity. The novel Frankenstein finds itself a victim of psychoanalytical criticism. The purpose of this essay is to investigate the identity of Frankenstein and his relation to the creature using the psychoanalytic theory. This essay will discuss the evidence showing the reason why the creature is a more appealing character by observing closely the relationship between Victor Frankenstein and his monster. In addition, the epistolary form used in the novel as well as character development will also be referenced. The monster represents a part of Frankenstein's fr... ... the horrific result of in her novel. Frankenstein is more than a ghost story; it is a social narrative and a political manifesto. Neither Victor nor his creation displays actions or attitudes that constitute â€Å"goodness† under this particular perception of human nature. Yet the creature continues to prove him more sympathetic than his creator does because he is far more aware of his own wrongness than Victor is. Victor is appallingly hypocritical; the monster is merely realistic, and indignant towards Victor’s hypocrisy. The creature's acknowledgment for his need of affection is present throughout the entirety of the novel. By acknowledging that he lacks affection, he discovers he needs to search for it since Frankenstein suppressed him from it. It is because affection is unachievable for the creature, despite his efforts, which makes him the victim of this novel. Sympathy for the Devil Essay -- Literary Analysis, Frankenstein The gothic novel is previously associated with being a ‘rebellion against constraining neoclassical aesthetic ideals of order and unity, in order to recover a suppressed primitive and barbaric imaginative freedom.’ (Botting, 1996: 98) It is often considered a premature manifestation of the emerging values of Romanticism. Although the gothic genre is somewhat shadowy and difficult to define it can be seen as having a number of characteristics or conventions. This can be observed in Frankenstein including the ‘stereotypical settings, characters and plots, an interest in the sublime, the production of excessive emotion in the reader, an emphasis on suspense, the notion of the double and the presence of the supernatural.’ (Botting, 1996: 102) The genre develops more than an understanding of the various modes of destructive violence, social repressions, and disturbing sexual energies characterizing particular moments of modernity. It begins to be integral to the formation self-representation and maintenance of the modern world we inhabit. The degree in which the protagonist characters in the novel portrayed as either innately virtuous or evil and its contribution to their identity. The novel Frankenstein finds itself a victim of psychoanalytical criticism. The purpose of this essay is to investigate the identity of Frankenstein and his relation to the creature using the psychoanalytic theory. This essay will discuss the evidence showing the reason why the creature is a more appealing character by observing closely the relationship between Victor Frankenstein and his monster. In addition, the epistolary form used in the novel as well as character development will also be referenced. The monster represents a part of Frankenstein's fr... ... the horrific result of in her novel. Frankenstein is more than a ghost story; it is a social narrative and a political manifesto. Neither Victor nor his creation displays actions or attitudes that constitute â€Å"goodness† under this particular perception of human nature. Yet the creature continues to prove him more sympathetic than his creator does because he is far more aware of his own wrongness than Victor is. Victor is appallingly hypocritical; the monster is merely realistic, and indignant towards Victor’s hypocrisy. The creature's acknowledgment for his need of affection is present throughout the entirety of the novel. By acknowledging that he lacks affection, he discovers he needs to search for it since Frankenstein suppressed him from it. It is because affection is unachievable for the creature, despite his efforts, which makes him the victim of this novel.

Assessment of Product: The Refrigerator Essay -- Consumer Issues

Customer Expectation for a product changes from one customer to another and so does the definition of quality. In case of a refrigerator there isn’t a product that could satisfy every customers need therefore manufactures have to target their products in different segments. Even if the product caters for a certain customers need, it wouldn’t stop a rival company from bringing new features that customers never imagined and now customers have changed their quality definition. When assessing the quality of a product it is important to understand the thought process of a customer as sales are generated through them. A customer generally has a preconceived idea about the product or service, after consuming they would have perception on how the product or service performed; if the product or service does perform to expectation or even beyond, it would be perceived as a quality product. Evaluation of the LG Refrigerator (GL-M252VM) using the Garvin’s eight product dimensions framework. Dimensions of LG Refrigerator - GL-M252VM It is important to understand that quality varies when product evolves through time. Consider this, when refrigerators were introduced newly it contests on the level of performance and when all competitors are close enough to a certain level customers expect all products to perform (maintain a necessary temperature to keep bacteria away).then competition goes to the reliability stage where they compete on reliability, Durability, Conformance and Perceived Quality once these aspects are meet or even close to judge the completion moves on to convenience stage Features, Serviceability and Aesthetics will be their success factors and product is considered to be a commodity that is contested on price. G... ... Vogue type handle. Works Cited 1) Miner (2010) Re: 8 Dimensions of Product Quality according to Garvin. [online]. Last accessed 3 April 2012 at: http://elsmar.com/Forums/showthread.php?t=45292 2) Press Releases (2011) LG’s Linear Compressor Refrigerators: Technology that Preserves. [online]. Last accessed 3 April 2012 at: http://www.lg.com/za/press-release/article/lgs-linear-compressor-refrigerators-technology-that-preserves.jsp 3) Module 11: Quality Management (2010). [online]. From YouTube last accessed 4 April 2012 at: http://www.youtube.com/watch?v=QJNVrY_Z2NM&feature=related 4) Product Support for GL-M252VM.AMDQABN. [online]. Last accessed 3 April 2012 at: http://goo.gl/ziWk1 5) James R. Hood (1998) Consumer Complaints & Reviews [online]. Last accessed 3 April 2012 at: http://www.consumeraffairs.com/homeowners/lg_refrigerator.html

Who is to blame Essay -- essays research papers

Who Is To Blame? â€Å"Frankenstein†, one of the key texts in modern literature, was written by Mary Shelley in 1818 when she was only 21. The novel was first published anonymously, and the author was only later revealed to be Shelley. When she republished the book in 1831, with changes to the story, Shelley had finally answered the question she had been asked several times: how could such a young girl write about such horrible things? Her answer describes her literary sources, as well as a disturbing dream that was the kernel of inspiration for the story. â€Å"Frankenstein† is a tale about a man named Victor Frankenstein who creates life out of ‘raw materials’. As the story unfolds, the creature comes to life and ends up, out of revenge, killing several members of Frankenstein’s family. Although ...

A Student Survival Guide Education Essay

This Student Survival Guide is a resource that will be utile to me as an Axia College pupil. The Guide will assist me form and optimise my college experience. The lone manner I can accomplish my dreams is to follow the clip line and pull off my clip sagely. I need to put action programs, utilize time-lines and compare them to what I accomplish in a twenty-four hours. This will convey consciousness and assist me unbend my hebdomad countries. To-Do lists along with short and long-run ends are the best manner to carry through what I set out for ; draw a bead oning to finish the dream of a grade. The best manner I found to maturate as pupil is by developing my reading comprehension and breaking my apprehension of the stuff in the long-run. Using my ain personality in-to my survey wonts will assist me better my reading velocity and comprehension of the stuff ; this will do it easier to recognize educational achievements. This survival usher is a resource that is valuable to me. It will as sist me to form and optimise my college experience. This Guide is a resource that is a functional tool. This resource is accessible and gives practical attacks excessively jobs and the resources available to Axia college pupils along with resources from the web. I need to retrieve refering my surveies, personality counts. The manner I express myself is through my personal surveies and composing manner, this is my personality and learning manner. â€Å" It is no inquiry that everyone learns otherwise. Did you know that your personality can reflect the manner you learn? Knowing your personality and natural inclinations in idiosyncrasies and the absorbing of information can impact your success in college † quotation mark from ( â€Å" Personality & A ; larning manners. † ) Knowing my strengths will assist me along the route to my educational success. When I am cognizant of the strengths of the other pupils, even in the concern universe can assist organize a good squad with a balanced mix of intelligences for the undertaking at manus. I need continually to better these accomplishments, pattern to do betterments. Knowing that I am best at Intrapersonal accomplishments, I can utilize this to my advantage as an on-line pupil and expli cate action programs that accommodate my strengths and better my weaker countries of intelligences ; this information combined with the resource found and the universities website do my dreams possible. University of Phoenix offers many tools to me as a pupil. Get downing out in needed to cognize where the information was and how to entree it. I now know how to download and form all my school files and program to take all the PDF chapter files from my categories and set them on the Kindle I received for my birthday today. Traveling my papers to a portable reader will do it easier for to analyze my chapters anyplace. I think the most of import thing to make is do usage of the resources and workshops available for my advantage. The University ‘s library offers legion resources to pupils. Write-point and plagiarism-checker, for illustration, these two tools are in the Center for Writing Excellence along with workshops, they help me fix written assignments by giving advice and reviews on ways to better my paper. Plagiarism-checker gives me a similarity index, comparing my work excessively other articles and documents for similarities. Important note to self, these two resources ar e of import I need to utilize them to subject the best work I can. I have enrolled in a workshop â€Å" Time and Stress Management. † this is an country I need betterment believe I will profit from this workshop. I have read and understand the Axia ‘s academic honestness policy and take the information really earnestly. I need to follow the regulations to be successful as a pupil. Some information sing plagiarism can be found in the university ‘s library. I will adhere to the guidelines at all clip to guarantee my success. One illustration of plagiarism: â€Å" Paraphrasing statements, paragraphs, or other organic structures of work without proper commendation utilizing person else ‘s thoughts, informations, linguistic communication, and/or statements without recognition. † ( â€Å" Students ‘ rights and duties, † ) . The best manner to avoid plagiarism wholly is create original work. Do n't copy person else ‘s work. I can make something original and if I find information or resources I find peculiarly helpful or enlightening, I will mention the information right and to the best of my ability in APA format. Part of making the best work I can, I need to continually endeavor to develope my reading comprehension and retaining that information for longer periods of times with pattern. The University of Phoenix gives me all the tools I need to be a booming pupil. The SQ3R Method is a good method to better your reading and keeping rate. I need to work on this method. I know how to utilize it ; sometimes I merely fail to utilize it wholly. I have a alone method for analyzing. I study text-books is wholly different from the manner I would travel about reading a novel. I mark up the text, reappraisal words in bold and so seek to happen cardinal information. I make maps of the general construct and so organize back uping and of import information around the cardinal thought when I analyzing college text editions, particularly when fixing to compose an essay. This is the best method and I need to utilize this individualized method and better upon it. The brainstorming session allows me to prioritise the content and visualise the contextual flow of the essay. The best manner to better reading ability is to merely pattern. I do n't hold pattern brand perfect, it merely mak es me better. Reading all the stuff presented by the teacher will assist me better me reading ability and assist me maintain gait with the lessons. The best manner to make this is to put ends. Short and long-run ends are what I am progressively trusting on. The short-run ends assist me pave the manner to carry throughing bigger things. I need to his tool for personal success. I found a utile resource for pull offing personal action programs, the templet found at the following web reference, â€Å" hypertext transfer protocol: //www.healthkey.com/hive/healthwise/media/pdf/hw/form_zx3175.pdf † this web PDF papers can function as a templet I can utilize to pattern and better my end scene and clip direction accomplishments. I besides like the resources found at www.mindtools.com. This reputable resource along with the college ‘s resources can assist me through my educational experience in many ways, the chief focal point being on ends, clip direction, and life programs. Pull offing clip sagely is an of import accomplishment. I can equilibrate my instruction with my personal life by keeping end lists and puting timelines. Keeping path of my accomplishments gives me motive as I complete more of the challenges and acquire closer to my ends. Thingss will come approximately and decelerate me down. When I find myself overwhelmed I can sit a listen to new age piano music for a few proceedingss and clear my head. This will assist me concentrate and avoid cachexia clip. Lodging to the agenda is the most of import facet of pull offing my clip sagely. I am including several on-line resources that I believe will assist me better my accomplishments and finally impel me toward my grade.

Prejudice and Discrimination in Philadelphia Essay

Philadelphia is a movie which demonstrates not only the cold-blooded and hypocritical members of corporate society, but the indignities and prejudices that people living with AIDS have to go through. This movie was set in an era when homosexuality was not socially accepted and not many people were educated on the disease AIDS. Andrew Beckett, a Philadelphia lawyer who has been keeping his homosexuality, and his AIDS, hidden from his conservative bosses. He is a good worker and is respected in the workplace until one day he’s suddenly and inexplicably fired. Andrew suspects AIDS is the reason, and is determined to fight in court, even as he is losing his other battle, against the disease. Beckett hires attorney Joe Miller to represent him. Joe Miller is a homophobe and has to first overcome these fears of gays. Andrew Beckett’s ex Boss, Charles Wheeler, a sickening, prejudice man who resembles the most disgusting corporate boss there is: The corporate boss, who pretends to be friends with his coworkers or clients, only to stab them in the back later. He will do only anything to benefit himself and get to the top of the business. At the beginning, Wheeler pretends to be Andy’s friend, heck he even asks him for legal advice on a special antitrust case called †Highlight vs. Sander Systems†. Andy Beckett’s becomes fired, from the job, once they find out he has aids, but try to make it look he was fired for other reasons. The movie also greatly shows the prejudices, and misconception people have about aids. Another scene that shows people ignorance and prejudice towards AIDS and homosexuals is the library scene in which Andrew Beckett is conducting research for his AIDS case against the law firm that illegally fired him. The librarian first asks Andy Beckett, if he would be more comfortable in a study room, but then it becomes evident that the ignorant librarian is telling not asking Andy Beckett to go to another room because she is uneducated on the disease and fears she might catch it. Andrew being, a very proud man, refuses showing his true dignity even while having AIDS. At the time Andrew Beckett’s lawyer Joe Miller was there and saw this happening, although he was hiding behind a pile of books. He realised Andrew needed him to help protect his rights. The lawyer took the book Andy was holding out of his hand to show the librarian he was not afraid getting the disease by touching something Andrew had touched. During the court case, Joe Miller brings up the point of homosexuality against Andrew’s old company in defence, he brings up the points of how society don’t accept AIDS and homosexuals. In the end Andrew and Joe win the case and get money in damages, although Andrew is dying, he is happy to see that they won the case and raised awareness of AIDS.