Environmental Impact Of Leather Tanning Industry

Environmental Impact Of Leather Tanning Industry The global environment is gradually worsening as a result of the socio-economic activities of mankind. Leather tanning industry plays significant role in economy of a country through employment and export earnings; but resulting pollution from tanning process causing severe environmental degradation. Tanning is the process by which hides or skins are converted into leather. After removal of flesh and fur from the hide it is treated with chemicals which cross linked the microscopic collagen fibers to form a stable and durable leather product. A schematic diagram of tanning is presented and this indicates the type of waste stream generated from tanning process (Fig.1.1) (Harrison, 2001). Leather processing comprises of series of operations that can be classified as pre-tanning, in which hides or skins are cleaned; tanning process, which permanently stabilizes the hides and post-tanning or finishing operations, where final shape value is added for manufacturing of leather (Ramasami, Rao, Chandrababu, Parthasarathi, Rao, Gayathri and Sreeram, 1999). Production of leather from tanning of hides and skins has been an important activity since ancient times. For processing a ton of hide approximately 30-40 cubic meter (m3) of water is used (Suthanthararajan, Ravindranath, Chitra, Umamaheswari, Ramesh and Rajamani 2004). Currently, about 6.5 millions tons of wet salted hides and skins are processed worldwide annually. About 3.5 millions of various chemicals are used for leather processing. A considerable part of this amount is discharged into the effluent (Ludvik, 1996). Tanning of hides and skins by the usual tanning process is wholly a wet process from which a large volume of liquid waste is almost continuously discharged throughout the working hours of an industry. Usually soak waste, liming wastes and spent vegetable tan liquors are discharged intermittently (Song, Williams and Edyvean, 2000). It is approximated that 30-40 x 1010 liters of effluent is generated by worldwide annual processing of 9 x 109 kg hides and skins (Thanikaivelan, Jonnalagadda, Balachetran and Ramasami, 2004). Leather industry consumes a large amount of water so the availability of good quality water and the treatment of large amount of effluent are the two major issues. The tannery wastewater is a mixture of bio matter of hides and a large variety of organic and inorganic chemicals. Tanneries leave the wastewater usually contain organic and inorganic matter with high level of salinity, ammonia and organic nitrogenous pollutants and other toxic pollutants including sulphide and residues of chromium metal salt) (Ros and Gantar, 1998). Tannery effluents are characterized as highly colored, foul smelling with acidic and alkaline liquor (World Bank, 1998). Poor processing practices and use of unrefined conventional leather processing further aggravate the pollution problem. In tannery effluents presence of chromium and hydrogen sulfide formed due to sulfide are highly toxic to many living beings. Indiscriminate discharge of effluents into water bodies or open land causing contamination of surface and ground water in addition to degradation of flora and fauna of soil have direct impacts on agricultural land (Khawaja, Rasool, Fiaz and Irshad, 1995; Ramasami, Sreeram and Gayatri, 1997). The leather tanning industry significantly contributes to economy of a country. The major leather production centers in the world are found in Mexico, Brazil, Japan, South Korea, China, India and Pakistan. Leather tanneries generate three type of waste including wastewater, solid waste and air emissions. So far, wastewater is considered as the most important environmental challenge faced by Pakistans tanneries (Iqbal, 1998). In Pakistan, tanneries are established both in formal and informal sector presently over 596 tanneries are established in the formal sector and equally large number of tanneries exists in the informal sector (ETPI, 2001). Increasing number of tanneries in Pakistan is to be considered as the major cause of environmental degradation because untreated effluents from tanneries are released into environment. Kasur district has more than 350 tanning and it has become the mean livelihood of most of residents. The present study focuses on identification environmental problems related to tanneries wastewater in Kasur through participatory action and involve local communities for self managed collective actions for application of locally available and cost effective wastewater treatment technologies within their industry premises. In this process participants learn wastewater treatment technologies through social learning process which is based on the principle of à ¢Ã¢â€š ¬Ã…“learning by doingà ¢Ã¢â€š ¬Ã‚ . Participatory research allows researchers to gain a better understanding of problem. Participatory GIS approach is used for the purpose of involving community and development of GIS database. Participatory GIS is a spatial decision making tool designed to utilize GIS technology with participatory approach in the perspective of needs and capabilities of communities that are involved through and affected by development projects. Novel community mapping and modeling methods linked to GIS for implementing community-based planning, have been studied and developed since the 1990s (Dunn, Atkins and Townsend, 1997; Abbott, Chambers, Dunn, Harris, DeMerode, Porter, Townsend and Weiner,1998; Sieber, 2006) and began to spread into China through international development projects (Cai, Zhu and Dai, 2001; McConchie and McKinnon, 2002; Wang, 2003). Participatory GIS technique encourages community participation and involves community in the production of GIS (Cinderby, 1999). Participatory GIS generally resulted from the combination of participatory methods i.e. Participatory Learning and Action (PLA) and Participatory Rural Appraisal (PRA) with geo-spatial technologies (Rambaldi, Kyem, Mbile, McCall and Weiner, 2005). Within this broad range of approaches different techniques have been employed in specific locations and projects to investigate specific issues or encourage participation from particular groups or stakeholders. It has been a commonality of many participatory GIS that the process of participation (including the collection and collation of information) has often been emphasized in the process more than the technical utilization of GIS which requires access to specific expertise (McCall, 2004). Geographic information system (GIS) is a computer-based system for capturing, storing, manipulating, analyzing, and displayi ng geographic data for solving spatial complex resource planning and management problems (Densham, 1991). In GIS framework data is categorized into spatial data and attribute data. The data is stored in current GIS within two separate databases one for spatial data and one for attribute data. In most GIS representation of spatial data is in vector (points, lines, and polygons) and raster (pixels or grids) forms (Burrough, 1986). These conventional vector and raster representation of geographic features in GIS focus on database management including query and spatial analysis (Rhind, 1990). In the development of a GIS database, different features are processed and stored in separate data layers representing geographic themes. All data layers in the same GIS database are required to be geocoded to a standard coordinate system such as State Plane coordinate system. Therefore, a GIS database can be conceptualized as à ¢Ã¢â€š ¬Ã…“sandwichedà ¢Ã¢â€š ¬Ã‚  data layers containing different types of geographic features, registered to a common base map. GIS store, manage, and analyze geographically referenced data and devices that measure geographic location such as Global Positioning System (GPS) provides data on location in terms of latitude, longitude and altitude required for the GIS (Deichmann and Wood, 2001). Participatory action research combines aspects of popular education, community based research, and social action. Participatory action research is collaborative processes in which researchers work with community to identify an area of concern and community take part to generate knowledge about the issue, formulate plan and carry out actions meant to address the issue in substantial way (Brydon, 2001). Participatory research approach empowers community members to collaborate with researchers to better understand their own problems and to find effective and viable solutions. Participants in the research process can identify a problem, collect and analyze relevant information, and act upon it in order to develop solutions and to promote social and/or political transformation (Selener, 1997). Participatory research represents a distinct set of practices or approaches to generate knowledge, including a variety of quantitative and qualitative research methods (e.g., participant observation, personal interviews, focus groups, and participatory needs assessment surveys). Treatment of tannery effluents has been searched for physical, chemical and biological methods. The biological treatment, especially the use of microorganisms to improve polluted water quality is effective and widespread due to environmentally and economically as compared to chemical treatment. Effective Microorganisms or EM Technology is selected for the treatment of tannery wastewater. The concept of EM Technology was developed by Professor Teruo Higa, University of the Ryukyus, Okinawa, Japan. EM consists of beneficial naturally occurring microorganisms that have a reviving action on humans, animals, and the natural environment. EM is a mixed culture of selected species of microorganisms including predominantly lactic acid bacteria, yeasts, photosynthetic bacteria, actinomycetes and other types of organisms which are mutually compatible and can coexist in liquid culture (Higa, 1991; Higa and Wididana, 1991). The ultimate goal of this research is to break psychological, social, technical and economic barriers in technology adoption by tanneries owners and workers. So that tanneries owners and workers are enabled for self organized collective wastewater management within their working environment. Through this process community participation is anticipated in all stages of action research including problem identification, data collection, participatory GIS and application of wastewater treatment technology. AIMS AND OBJECTIVES The objectives of my study are as follows: Preparation of GIS database of small tanneries through participation of stakeholders in Kasur. Demarcation of small tanneries and wastewater channels discharging from tanneries through participatory GIS mapping. Identification and selection of locally available and effective wastewater treatment technologies. Laboratory experimentation to check the efficacy of selected wastewater treatment technology. Develop simplified methods to increase social acceptance of waste minimization techniques through community participation.

Culture Makes Better Future Essay

Culture is sort of like history or evolution. People make the mistake of assuming history has a purpose or that evolution has a purpose. But in reality, history is just an aggregate of facts and opinions about the past. History, or the march of civilization, has no direction, no goal. Yes, we seem to be â€Å"improving† ourselves by certain metrics but that isn’t an a priori requirement. Evolution is also not striving towards any particular direction. We are not at the cutting edge of evolution in any sense. If in a million years, the organism that can survive on Earth best is an amoeba, then amoebae will be the dominant species on the planet. It’s not a better or worse situation (except maybe for us), it just is. Similarly it is not culture’s job to create a better future. What does â€Å"better† even mean? Better for whom? At what cost for other entities? I imagine some cultures might like to take things slow and enjoy life, while others might believe in long work hours and competitiveness. Who’s the arbiter of better or worse here? Some culture might devalue women to the extent that it loses too many of them and isn’t able to effectively propagate itself, effectively dying out. I’m sure people from that culture wouldn’t be happy about that, although it’s â€Å"good† in some universal sense. Culture exists to propagate itself, not to do any good or bad for the people who follow it. My thoughts here are more or less para-phrasings of the discussion on ‘memes’ from ‘The Selfish Gene’. Culture at best, creates a feeling of societal cohesion, a generalized patriotism that can compel its members to perform better against other cultures. I don’t think it makes any sense in asking if culture is good for youth and country because that assumes that there is an alternative to culture, a state of diminished culture, or non-culture. That’s not going to happen ever. Culture doesn’t allow a vacuum to exist; something always rushes in to take up the empty space. You might mean instead mean to ask about the importance of a country’s indigenous culture for that country’s progress, in the context of foreign culture having undesired influences. To that I say, let the fittest survive. I don’t believe in feeling guilty or upset about, for example, Indian culture becoming westernized. If a culture is strong enough, it’ll adapt itself to new challenges. If not, too bad. Just like there have been millions of species that are now extinct, and also millions more than can arise given the appropriate conditions on Earth– culture, like life, will always be around in some form or the other. And just like you can’t say that any particular bird or animal or virus is â€Å"better† for nature, you really just can’t discuss how culture is â€Å"better† for our future.

Promote Good Practice in Handling Information Essay

1. Identify legislation and codes of practice that relate to handling information in health and social care. 2. Summarise the main points of legal requirements and codes of practice for handling information in health and social care. I have found 4 legislations that support handling information in health and social care. 1.Data Protection Act 2.Freedom of Information Act 3.Care Standards 4.Human Rights Act. Article 8 states of the Human rights act states 1. Everyone has the right to respect for his private and family life, his home and his correspondence. 2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others. This means that an individual’s wish to protect his or her privacy must be balanced against the needs of the relevant public authority to obtain or use specified information. Outcome 2:- Be able to implement good practice in handling information. 1.Describe features of manual and electronic information storage systems that help maintain security. *Ensuraing cupboards that contain personal informatio are locked at all times. *Creating passwords on computers and locking them when inactive. *Only giving out minimal information over the telephone unless im absolutely sure that i am speaking to the next of kin or a GP. *Checking other professionals ID’s on entering the building. *Ensuring each person signs in and out of the building so i know where they are are in the event of a fire. 2. Demonstrate practices that ensure seciruity when storing and accessing information. *Locking the file cupboard after use with a set of keys that only a senior members of staff and nurses have. This is good practice that ensures security. Also locking the drug trolleys through all rounds. 3. Maintain records that are up to date complete accurate and legible. *On all entries of paperwork weather it be in care plans, daily updates or food and fluid charts, it is vital that they must state a date, time and signature in black ink. All information must be clear, consice be truthful and to the point. Outcome 3 – Be able to support others to handle information. *I can do this by reminding my collegues of how impotant it is to lock cupboards immediately after use which store personal records and inforamtion, each person has there own folder with they’re information in. Making sure all stickers off blister packs and medicines are destroyed before disposal is also just as important. 2. Informing new members of staff and demonstrating completion of paperwork such as food and fluid charts for example makes people aware of the importance and security for the residents. I always tell my colleagues to ask if they are unsure and i will do my best to help and if i cannot help i will find some who can help and also learn from it myself.

Management of Resources Within the Public Sector - Free Essay Example

Sample details Pages: 9 Words: 2727 Downloads: 3 Date added: 2017/06/26 Category Economics Essay Type Report Level High school Did you like this example? Management of Resources within the Public Sector Table of Contents Executive Summary 1.Introduction 2.Results 2.1 NHS Spending 2.2 Spending Review 2010 2.2.1 Table 1: Department of Health Spending Review 2010 2.2.2 Efficiency Savings 2.3 Health and Social Care Act 2012 2.4 Funding Freeze 3.Discussion 4.Conclusion 5.References Bibliography 6.Appendices 6.1 Table 1 Department of Health Spending Review 2010 6.2 Recommendations Executive Summary Since the à ¢Ã¢â€š ¬Ã‹Å"Comprehensive Spending Reviewà ¢Ã¢â€š ¬Ã¢â€ž ¢ in 2010 the National Health Service (NHS) has experienced significant budgetary constraints. Whilst the UK Government has protected the NHS budget, it is still the tightest funding settlements the NHS has ever experienced. Demand is growing rapidly as the population ages and long-term conditions become more common. Along with more sophisticated and expensive treatment options are becoming available and the cost of medicines is growing by over  £600m per year. Don’t waste time! Our writers will create an original "Management of Resources Within the Public Sector" essay for you Create order The NHS must take decisive steps to remove the barriers in how patient care is provided between hospitals, physical and mental health along with social care. The NHS could save up to  £466m a year if doctors were less likely to prescribe multiple treatments of drugs to older people. Target resources on clinical interventions that optimise health outcomes and to identify procedures that can be made more efficient. The NHS could obtain over  £2bn over the next five years by selling off surplus land and buildings, according the Department of Health. 1. Introduction This report identifies the decisions made by the British Government to reduce its National Deficit and how this will affect its Public Services. Every finical year the UK runs up a large budget deficit. This is where the UK Government spends more money than it can collect through taxation. In 2010 the UK Coalition Government set out plans for its unavoidable deficit reduction. This was an urgent priority to secure the UKà ¢Ã¢â€š ¬Ã¢â€ž ¢s economic stability at a time of uncertainty in the global economy. This was to provide long term stability in its public services and its welfare Systems. According to a report published the à ¢Ã¢â€š ¬Ã‹Å"Spending Reviewà ¢Ã¢â€š ¬Ã¢â€ž ¢ (HM Treasury, 2010) the Coalition Government inherited one of the most ambitious and challenging fiscal positions in the world. The (Office of National Statistics, 2014) (ONS) commented that, Britainà ¢Ã¢â€š ¬Ã¢â€ž ¢s deficit was at its highest ever recorded in peacetime history. The state borrowed one whole p ound for every four pounds that it spent. The interest payments on UKà ¢Ã¢â€š ¬Ã¢â€ž ¢S National Debt cost the UK around  £45 Billion a year or 3% of à ¢Ã¢â€š ¬Ã‹Å"Gross Domestic Productà ¢Ã¢â€š ¬Ã¢â€ž ¢ (GDP). However, all the major political parties pledged to protect the National Health Service (NHS) from budget cuts in 2010, after a period of unprecedented growth there was a implementation of a à ¢Ã¢â€š ¬Ã‹Å"funding freezeà ¢Ã¢â€š ¬Ã¢â€ž ¢ in 2011 (House of Commons, 2010). This would be the most austere period for the NHS in over thirty years. Even with this constant funding, the rising demands from an ageing population, along with higher public expectations, meant that there was a substantial à ¢Ã¢â€š ¬Ã‹Å"funding gapà ¢Ã¢â€š ¬Ã¢â€ž ¢ to be met by improvements in productivity and efficiency. Efficiency savings are still needed. (Farrar, 2013), the chief executive of the NHS Confederation, commented on the à ¢Ã¢â€š ¬Ã‹Å"Spending Roundà ¢Ã¢â€š ¬Ã¢â€ž ¢: A lthough the health budget has been spared a reduction, it is important to remember that NHS organisations are facing significant pressures to meet growing demand and improve quality, and still need to find substantial efficiency savings. He also mentioned that: Maintaining the ring-fence for the NHS is vital, but it is also important that the health service gets to spend what is allocated to ità ¢Ã¢â€š ¬Ã‚  Therefore, long-term investment and innovation in healthcare must be seen as a key function of the UKà ¢Ã¢â€š ¬Ã¢â€ž ¢s growth strategy and not an anchor holding it down. 2. Results 2.1 NHS Spending Funding for the NHS comes directly from taxation and is granted to the Department of Health by Parliament. When the NHS was created in 1948, it had a budget of  £437 million (around  £9bn in current value). NHS spending has continued to increase significantly, in 2003/04 the NHS budget was  £64.173bn and this drastically increased to  £109.72bn in 2013/14. Statistics show that Net expenditure of the NHS has increased by  £45.54bn between the years 2003 and 2013. Government Statistics on public spending show that NHS spending increased from  £104.405bn in 2011/12 to  £105.254bn in 2012/13. This amounts to a 0.8% rise in real terms year-on-year. In 2011/12 health spending was 0.3% higher than the previous year. In recent years, the NHS has managed to spend slightly under budget. This was not because demand for its services was reduced, but because of the use of effective mechanisms in place not to spend. Public satisfaction within t he NHS, for its staff and for its quality of care received still continues to remain very strong (Dixon, 2014). All of this has been achieved while applying a significant reform programme following the Health and Social Care Act 2012. 2.2 Spending Review 2010 In agreement with the Governmentà ¢Ã¢â€š ¬Ã¢â€ž ¢s commitment to protect public health, spending in the NHS will increase by 0.4% in real terms over the course of the Spending Review period. This will include a 1.3% increase in the resource budget and a 17% decrease in overall capital spending. The administration budget will also be reduced by 33% and reinvested to support the delivery of NHS services. 2.2.1 Table 1: Department of Health Spending Review 2010 Sourced: (Department of Health , 2010) The health reform enabled the NHS to maintain the quality of services to patients. This settlement also included: Real term increases in overall NHS funding in each year to meet the Governmentà ¢Ã¢â€š ¬Ã¢â€ž ¢s commitment to protect public health spending, with total spending growing by 0.4% over the Spending Review period (see table 1). An additional  £1bn a year for social care, as part of an overall  £2bn a year of additional funding to support social care by 2014/15. New cancer drug fund of up to  £200m a year. Expanding Increasing access to psychological therapies Maintain funding for priority hospital schemes. Capital spending to remain higher in real terms than it has been on average over the last three Spending Review periods. 2.2.2 Efficiency Savings To sustain the rising costs of healthcare and the relentless increasing demand on its services, the NHS released up to  £20bn of annual efficiency savings over the recent four years, all of which was reinvested to meet rising levels of demand and to support the improvements in. This included: Constantly improving workforce productivity. Implementing best practice throughout the NHS in the management of long term condition. Reducing inconsistencies in admissions and outpatient appointments. A 33% cut in the administration budget, including a reduction in the number of armà ¢Ã¢â€š ¬Ã¢â€ž ¢s length bodies from 18 to a maximum of 10 by the end of 2014. 2.3 Health and Social Care Act 2012 A fundamental part of the Government reforms, was the Health and Social Care Act 2012 introduced substantial changes to the way in which NHS in England was organised, improvements in the quality of social care and reform its funding. The Health and Social Care Act introduced a variety of vital changes to the NHS in England. These changes came into force on 1 April 2013 (Parliment , 2013). These changes included: Providing groups of GP practices and other professionals, known Clinical Commissioning Groups (CCGs) real budgets to buy care on behalf of their local communities. Moving many responsibilities historically located in the Department of Health to a new, politically independent NHS Commissioning Board (NHS England). Implementation of a health specific economic regulator with a mandate to guard against anti-competitive practices. Relocating all NHS trusts to foundation trust status. 2.4 Funding Freeze Recent years have been extremely challenging for the NHS, a prolonged funding freeze in real terms, implementation of controversial reforms and the mistreatment of it users and the quality of care, in particular from the Mid Staffordshire NHS Foundation Trust (Robert, Francis. QC, 2013) . This NHS funding freeze will remain in place until 2015 and possibly further beyond. Regardless of the real term increase that is usually required to deal with the rising demand and the lack new treatments not readily being available. However, in 2011, the NHS has surprisingly succeeded to survive within its means, essentially as a result of curbing the wage bill. However, this may be difficult to continue because of rise in wages in the private sector. Meanwhile, there is a lot of engagement across the NHS to increase efficiency whilst protecting the quality of care (Dixon, 2014). 3. Discussion Since the implantation of the National Health Service (NHS) in 1948, the NHS has grown to become the worldà ¢Ã¢â€š ¬Ã¢â€ž ¢s largest publicly funded health service. It has also become one of the most efficient and comprehensive health services. The NHS was created out of a long-held ideal that good healthcare should be readily available to all, regardless of wealth. This is still a fundamental principle that remains at the NHS core. With the exception of some charges such as prescriptions and dental services, the NHS remains free to any UK resident. There are currently more than 63.2m people requiring this service. It covers everything from routine treatments, to transplants, emergency treatments and end-of-life care (NHS England, 2014). The NHS deals with over 1 million patients every 36 hours. The healthcare system is facing the challenge of significant financial pressures. As individual needs for services will continue to grow faster than the funding ità ¢Ã¢â€š ¬Ã¢â€ž ¢s al located. Therefore the Department of Health must innovate and transform the way in which they deliver their high quality services, within the resources available. To ensure that patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s needs, are always put first. The NHS has gone through several vital changes in recent years. Such as; Increased levels of investment and reduced waiting times. Ongoing developments include the expansion of patient choice and the introduction of academic health science centres (AHSCs), first of which is the Imperial College Healthcare NHS Trust (NHS Trust, 2013). The UKà ¢Ã¢â€š ¬Ã¢â€ž ¢s Government has identified a number of opportunities to cut costs in the NHS whilst protecting its frontline services. These include limiting its staffs pay and pensions, cutting back office management, the selling of assets, rationalising procurement and drugs purchasing. There are numerous discussions about value for money in the NHS (House of Commons, 2010). The Secretary Of State Jeremy Hunt (MP) (Department of Health , 2014) has overall responsibility for the function of the Department of Health (DH). According to Hunt the NHS must save up to  £10bn a year by 2020 by diminishing its use of agency staff and management consultants, selling off unused property and reducing clinical mistakes, the health commented: à ¢Ã¢â€š ¬Ã…“If we are to be truly financially sustainable we need to rethink how we spend money in a much more fundamental way.à ¢Ã¢â€š ¬Ã‚  A report published by Hunt the NHS Englandà ¢Ã¢â€š ¬Ã¢â€ž ¢s blueprint for the health service (National Health Executive , 2014), which identified the need for a greater use of technology and innovation to improve patient healthcare in the NHS whilst delivering cost savings the public sector. These reductions in the annual budget of  £110bn will be assisted by an increase in innovation, according to Hunt. The health secretary also commented that a reduction in prescription errors could save the NHS up to  £551m a year, whilst selling off some of the NHS unused land and buildings could create significant savings, including  £1.5bn in London alone. Targeting agency staffing bills which have significantly increase from  £1bn to almost  £2.5bn. Guidelines set out in the report à ¢Ã¢â€š ¬Ã‹Å"Everyone Counts: Planning for Patients 2014/15 to 2018/19à ¢Ã¢â€š ¬Ã¢â€ž ¢ illustrate how the NHS budget is invested, to drive continuous improvement, to maintain high standards of care for all. The NHS is driven by quality in all that they do. It can no longer accept a minimum standard of care as acceptable. According to the Chief Nursing Officer for England Jane Cummings, practical application of technology on the front line will enable NHS nurses and other health workers to concentrate on what is important, providing meaningful and compassionate care to its patients (NHS England, 2014). Becoming more efficient with data and technology could have the potentia l to create a substantial difference to patients, whilst enabling best value for taxpayers. 4. Conclusion The  £10bn of savings announced by Jeremy Hunt are realistic, however it will take up to five years to deliver these savings. It is imperative that the debate starts now and the NHS needs to look at where efficiency savings can be made, and to focus on clinical care and not just the back office jobs. The big question is whether these efficiencies can be made soon enough to reduce the requirement of unpopular cuts to health services. The NHS needs to ensure that accesses to all of its services are on an equal footing whether the patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s needs are mental or physical. They must innovate the way they in which they provide care for the most vulnerable users excluded from society. However, high quality is not just an aspiration. There is urgency to plan strategically and to start making these changes that are required to deliver models of care that will be sustainable in the longer term. Therefore, the discussion remains about how the NHS will cope with a contin ued freeze on its overall funding. There is tension between national co-ordination and local decision making in the NHS about value for money. The NHS should try an implement a top-down best practice or it should let innovation and efficiency come from local decision making and accountability, with an acceptance of locally diverse provision. 5. References Bibliography Department for Health , 2014. Everyone Counts: Planning For Patients 2014/15 to 2018/19, London : NHS England . Department of Health , 2010. Spending Review 2010. [Online] Available at: https://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/mediacentre/pressreleases/dh_120676 [Accessed 6 November 2014]. Department of Health , 2014. Secretary of State for Health, London : Department of Health . Dixon, J., 2014. How much longer can the NHS live within its means?. Guardian Professional, 1(1), pp. 01-02. Farrar, M., 2013. NHS Confederation and NHS Employers comment on the Comprehensive Spending Review, London: NHS Confederation . HM Treasury, 2010. SPENDING REVIEW 2010, London: Her Majestyà ¢Ã¢â€š ¬Ã¢â€ž ¢s Stationery Office. House of Commons, 2010. Key Issues for the New Parliament 2010, London: House of Commons Library Research. Imperial College Healthcare, 2014. About the NHS. [Online] Available at: https://www.imperial.nhs.uk/nhs60/about_the_NHS/inde x.htm [Accessed 5 Novemeber 2014]. John Appleby, J. T. J. J., 2014. How is the NHS, London: Department of Health. National Health Executive , 2014. NHS Finance. Hunt calls on NHS to deliver  £10bn a year efficiency savings, 14 November, pp. 1-3. NHS England, 2014. About the National Health Service. [Online] Available at: https://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx [Accessed 5 November 2014]. NHS England, 2014. Health and social care leaders set out plans to transform peopleà ¢Ã¢â€š ¬Ã¢â€ž ¢s health and improve services using technology. News, 13 November , VII(10), pp. 1-4. NHS Trust, 2013. Spending Review 2013 à ¢Ã¢â€š ¬Ã¢â‚¬Å" key points for the NHS, London : NHS . Office of National Statistics, 2014. EU Government Deficit and Debt, London: ONS. Parliment , 2013. Health and Social Care Act 2012, London : The Stationary Office. Robert, Francis. QC, 2013. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, Staff ordshire: The Mid Staffordshire NHS Foundation Trust. 6. Appendices 6.1 Table 1 Department of Health Spending Review 2010 Source: Department of Health , 2010. Spending Review 2010. [Online] Available at: https://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/mediacentre/pressreleases/dh_120676 [Accessed 6 November 2014]. 6.2 Recommendations The NHS must take decisive steps to remove the barriers in how patient care is provided between hospitals, physical and mental health along with social care. The future of the NHS will need to provide greater care, delivered locally, but with some services provided by specialist centres. This should be organised to support people with multiple health conditions. The NHS wastes around  £2bn a year and risk patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s health by giving them excessive x-rays and treatments they do not require. The NHS could save up to  £466m a year if doctors were less likely to prescribe multiple treatments of drugs to older people. This can create adverse drug reactions, which account for 6% of all hospital admissions, which amounts to 4% of all hospital bed being used. With future restrictions on NHS funding, another recommendation is to try to target resources on clinical interventions that optimise health outcomes and to identify procedures that could be made more efficient. The Kingà ¢Ã¢â€š ¬Ã¢â€ž ¢s Fund (John Appleby, 2014) has suggested money could be recovered by reducing the length of stay in hospitals and using lower cost drugs. The Department of Health estimates that nearly 8% of NHS land is underused, which could help to raise some  £2.5bn, equivalent to 50,000 nurses, between now and 2016.The Government has announced plans to sell off surplus land to boost health service funds. To modernise the NHS and to improve its efficiencies, the health service needs to be proactive and identify land that is no longer required or needed. This revenue raised from surplus land could be used to improve patient care. 1