Health Improvement And Innovation Health And Social Care Essay

Health advancement And Innovation Health And kindly Cargon EssayIn the former(prenominal) the wellness operate has been overly heightened on commissioning for wrong and volume rather than quality and outcome. There was too a good deal fierceness on treating illness rather than its prevention. Health inequalities flip alike been worsen and in England the rich can still expect to equal for prolonged than the poor. Now is a new era for existence wellness. The government is committed to closing the gap betwixt the closely advantaged and the least advantaged parts of familiarity (GBDH, 2010a GBDH, 2010b GBDH 2010c GBDH, 2010d). Health needs assessment (HNA) is a vital tool in this process be coif it targets services and erect to holds the just about disadvantaged. It is a method for examining the wellness needs of a terra firma leading to agreed priorities and resource apportioning in give to improve public wellness (Hooper and Longworth, 1998).The purpose of t his subsidisation is to be disorderedtake an HNA for the community that I presently work in as part of my Specialist Community Public Health Nurse (SCPHN) strength in health visiting. In fact HNA is a standard of technique in order to gain professional registration (NMC, 2004). Recent induction has increasingly demonstrated that the first few geezerhood of liveliness greatly influence future health, wealth and happiness (Tickle, 2011 Field, 2010 Marmot, 2010). The involvement of health visitors during this head is vital as they be experts in public health. The Health visitant Implementation Plan (2011) aims to expand the health visiting service with an sum totalal 4,200 health visitors to be in post by 2015. This leave behind apply the Governments commitment to improve health outcomes by developing an understanding of the health needs of children, families and communities enabling the commission of services that atomic number 18 base on need.The quintuplet- criter ion approach to HNA developed by Cavanagh and Chadwick (HDA, 2005) will be affaird as a framework for this assignment because it is simple, robust, flexible, and has been tested over some(prenominal) kindly classs. This five step process is base on the model outlined by Hooper and Longworth (2002). Due to time constraints and inadequacy of resources only steps atomic number 53 to lead of the five steps of HNA will be underinterpreted step 1 (my community), step 2 (identifying health priorities) and step 3 (assessing a health antecedence for action).All of the entropy used indoors this assignment is inside the public do primary(prenominal) however effort has been made to protect identity.Step 1 My CommunityAccording to Cavanagh and Chadwick (2005) the community for HNA can be identified as those sharing a geographic location like a admit estate a setting such as a school, prison or workplace a mixer experience like ethnicity or sexuality or an experience of a particular condition for drill mental illness or diabetes. The community has as well as been defined as a group of throng who share an interest, a neighbourhood, or a common set of circumstances. They whitethorn or may non bonk membership of a particular community (Smithies and Adams, 1990). It is the common interest of plenty that is particularly prodigious for public health. This is because even though people s cable carper as individuals, they may share characteristics or needs that can be assessed at a community level (Brocklehurst, 2004). However Naidoo and Wills (2000) state that individuals may be a part of different communities at various points in their lives rather than belonging to a single community. The community which is the focus of this HNA is a geographical area. It has been chosen because it is attached to a GP coiffe from which a team of health visitors are based and most work is with clients within this community. It consists of two covers in the borough of mag netic north Tyneside. They will be referred to as ward A and ward B and will be examined to regional and subject entropy lendable.Step 2 Identifying Health PrioritiesThis section will focus on the identification of the health priorities of my community by considering the ingredients which may stir health conditions. These factors can be grouped into five categories biological, companionable, economic, environmental and heartstyle. biologicThe population of wards A and B are shown in extension 1.1 use info from the census of 2001. Census entropy can be super useful however it has significant limitations. Its data rapidly goes out of get word and only provides a learn of the UK population decennially. For example, wards A and B make up experienced population change within the noncurrent ten years payable to new housing developments in that respectfore the 2001 census data may now be unrepresentative. For this reason a population estimate ( vermiform appendix 1.2) based on expected births and deaths is often a valuable tool al oneness must be used with caution as it is only a guide to what may happen if past trends continue. From the data it is clear that this borough has an maturation population but it is in addition notable that the destiny of the population under 5 years in both wards A and B is importantly higher than the regional and national partings. This perhaps underlines the importance of the role of the health visitor in these wards. appendage 1.3 illust grade that the combined male and female vitality foresight for wards A and B are significantly cut than the wedlock Tyneside and national figures. It is particularly alarming to note that some of those in ward A could potentially expect to live for seven years slight than some financial support merely a few miles away in separate parts of jointure Tyneside. The poor life expectancy of wards A and B may be due to the condition of their general health. These wards sed uce worse general health than northernmost Tyneside and England (appendix 1.4). That is, a greater percentage of those in wards A and B report poor health compared with topically and nationally. However Sen (2002) argues that there are complications in the self assessment of health because a persons own understanding of their health may differ from that of the healthcare professional. so attachmental statistics should be used to assess health status.The prevalence of long- marge health conditions in wards A and B as account by the Quality Outcomes mannequin (QOF) is also shown in appendix 1.5. hospital ward A has a higher prevalence of conditions such as coronary heart disease (CHD), diabetes, chronic obstructive pulmonary disease (COPD) and crab louse all of which contribute to debase life expectancy. so CHD is the biggest cause of preventable death in England (British Heart Foundation, 2010). In contrast ward B has a similar prevalence of long-term conditions to that of the national. However data from within the QOF has several limitations. For example QOF was not originally designed as a research tool and its data is not externally validated. It has also been suggested that QOF data may be much favourably presented with the aim of maximising practice income (Ashworth et al., 2008) yet Doran et al. (2011) found that financial incentives had little jolt upon the data. Further limitations include that prevalence data is not standardised for age and sex and that umpteen patients appear simultaneously on much than one disease memorialise (Ashworth et al., 2008).Mental health was seen as having equal importance to physical health for the first time in 2010 (GBDH 2010c). It was recognised that dissimilarity contributes to mental health and in turn mental health can cause progress inequality. Consequently tackling mental health is now a key precedence for the Government (GBDH, 2011b). It is delicate to determine the exact prevalence of mental health disorders but there are indicators to conjecture the situation in northbound Tyneside (appendix 1.6). For example benefit claims for mental health disorders along with hospital admissions due to self harm and mortality rates due to suicide are significantly greater in matrimony Tyneside than England.SocialThe Marmot Review (2010) accentuate the correlation between minusculeer hearty position and poor health. The social grade of those live in wards A and B is shown in appendix 2.1. Almost a quarter of those living in these wards are of final social grade compared with just 16% of people nationally. Marmot called for action to push down social gradients in order to improve the health of communities like those living in wards A and B. appurtenance 2.2 shows the measure of deprivation for wards A and B from the 2001 census. It is clear that both wards rank as some of most take in the country but as discussed earlier the census data is originally out of date. After the 2001 census local super take areas (LSOAs) were created to improve reporting of small area statistics as it was thought that wards deviate too much in size (ONS, 2011). The English Indices of Deprivation 2010 stratified LSOAs according to their deprivation level. It has undergone a range of procedures to assure its quality as well as being externally validated. According to the index northeast Tyneside is ranked as 113 out of 326 boroughs in England and is one of the least divest areas in the North East. However within the borough there are pockets of uttermost(a) deprivation which fall into the 10% most deprived areas in England (ONS, 2011). It is difficult to determine ward level deprivation using LSOAs because they do not fit exactly into ward boundaries. Nevertheless appendix 2.3 shows estimates of the deprivation levels of wards A and B using a best fit geographical conjunctive combined with averaging the LSOA scores. It shows that these wards stir been ranked as the m ost deprived wards in North Tyneside (North Tyneside Council, 2011). It has long been known that there is a relationship between deprivation and poor health (Marmot, 2010). In a social con textual matter of use this may be because a more deprived community is more likely to offer health guesss such as higher disgust rates (appendix 2.4) and poor housing.Research has shown that poor housing is associated with greater take chances of exposure of cardiovascular disease, respiratory disease and mental health conditions. The poorest communities are often made up from estates of mostly socially rented housing (Marmot, 2010). Indeed appendix 2.5 shows that wards A and B confine a significantly higher percentage of people living in socially rented accommodation than regionally and nationally. Those who live in social housing have been found to have increase unemployment rates, poor health and dis aptitude than the rest of the population (Clarke et al., 2008). There is also evidence to suggest that children living in social housing have a greater risk of disadvantage in adult life (Feinstein et al., 2008, Harker, 2006). Further, poor housing conditions like overcrowding can influence health. Appendix 2.6 illustrates the change magnitude problem of overcrowding in wards A and B relative to North Tyneside and England. frugalSocial gradient in communities is also affected by patterns of employment. Appendix 3.1 shows employment levels in wards A and B and it is clear that the percentage dismissed is significantly higher in these wards than in the rest of North Tyneside and England. prove suggests that the unemployed have intimately increase health risks including higher relative incidence of limiting long term conditions and mental health problems (Thomas et al., 2005 Gallo et al., 2006). In addition Jin et al. (1997) demonstrated a relationship between unemployment and decreased life expectancy although this research is dated. Perhaps it could be said that the poorer health and decreased life expectancy of wards A and B antecedently discussed may be cogitate to their high levels of unemployment. Physical and mental health is also affected by low paid, poor quality employment. Appendix 3.2 illustrates that the percentage of those in elementary, low level employment is greater in wards A and B than regionally and nationally. There are also less people working in managerial and professional roles in these wards. Further, those with few or no qualifications have the highest rates of unemployment and poor quality employment (Marmot, 2010). Appendix 3.3 clearly shows that wards A and B have a significantly greater proportion of people with no formal qualifications than figures for North Tyneside, North East and England.There is a well established link between income and poor health because those with put down incomes cannot buy items that maintain health and have to buy cheaper goods that could elevate health risks (Marmot, 2010). Appendix 3 .4 shows that the average weekly income is less in wards A and B than the average for the North East. Unfortunately there is no data available for North Tyneside or England to enable comparison.The data discussed above forms a picture of the economic factors that influence health in my community. The data is from the census 2001 and as previously stated it is ten years out of date. Consequently a greatly significant limitation of the data is that it will not reflect changes caused by the recent economic downturn. Therefore wards A and B could currently have worsened levels of unemployment and income however this cannot be confirmed until the results of the 2011 census are published.EnvironmentalAn important factor in reducing health inequality is creating an environment where people can live healthily. Those who live near areas of verdancy space such as parks can have alter health and wellbeing (Croucher et al., 2007). Green space may also upgrade social integration, physical ac tivity and improve quality of air. Appendix 4.1 shows a decreased percentage of green space areas in wards A and B compared to the borough.Another contributing factor to the creation of a healthy living environment is reducing cold housing. The cold is thought to be the main cause of extra deaths each year during the winter (Marmot, 2010). It is clear that the ability to afford to keep a warm home is crucial in the prevention of these deaths. Appendix 4.2 shows the percentage of households with underlying heating in wards A and B. Ward B has a significantly lower percentage of households with central heating than regionally and nationally. This data is again out of date and will not reflect recent rises in fuel costs. In November 2008 the increased price of fuel caused fuel poverty in more than one-half of single pensioners and two thirds of workless households (Bradshaw et al., 2008). This is important to note considering the ageing population of North Tyneside and the high unempl oyment levels of wards A and B.Finally appendix 4.3 shows information regarding car ownership. Wards A and B have a lower percentage of households without a car than North Tyneside and England. In fact the percentage of those with no car in these wards is double that of England. enthral is vital because it enables access to employment, education, services and social networks (GBDT, 2004). Transport also has an impact on health inequalities when considering deaths from road traffic accidents (RTAs). RTAs are thought to be particularly high among children who live in the most deprived areas in England (GBDT, 2009). However appendix 4.4 shows that the rate of injuries and deaths from RTAs is much lower in North Tyneside compared with England although data at ward level is unavailable.modus vivendiLifestyle choices have a huge impact on health. England has one of the highest obesity rates in Europe (WHO, 2012). It is linked with increased risk of conditions such as diabetes, cancer and mental health problems (GBDH 2011c). The percentage of round adults in North Tyneside is significantly higher than the national average and there are less healthy eating adults locally than nationally (appendix 5.1). This data is from the Health Survey for England (HSE) and is based on a sample of the population therefore estimates are subject to sampling error. In contrast to the findings above the Active People Survey found that the percentage of physically sprightly adults in North Tyneside is greater than that of England (appendix 5.1) but this data also has several limitations. Firstly it is not age standardised and it is likely that those who are jr. undertake the recommended levels of physical activity. Secondly the survey is self reported so may be subject to responder deviate. Finally the data does not include active recreation such as housework or active transport.There is great concern over the trends for puerility obesity in England and more than 20% of children are overweight or grave by the age of 3 (Rudolph, 2009). Appendix 5.2 contains data from the National electric shaver Measurement Programme (NCMP) which shows that wards A and B have higher percentages of grave children in year 6 than nationally. But the NCMP has a considerably low participation level therefore it is likely that some prevalence of childhood obesity figures are underestimated. Indeed there were a much lower number of children measured in the North East than any other region. There may also be an element of selection bias particularly with the year 6s where those who do not participate are those most likely to be obese. These limitations must be addressed in order to improve accuracy of the data.Smoking is the single greatest preventable cause of illness and premature death in England (GBDH 2011) but 1 in 5 adults remain smokers (Robinson and Bugler 2010). Appendix 5.3 shows that the prevalence of smokers is greater in North Tyneside than England. This data could be af fected by responder bias as it is self reported and therefore lead to underestimate of the prevalence of smoking. unfaltering heavy drinking has caused a huge increase in coloured disease and is currently the fifth biggest cause of death in England (GBDH 2011). Appendix 5.4 illustrates that the rate of alcohol related hospital admissions in North Tyneside is much higher than the national average. It also shows that the rate of alcohol specific hospital stays for those under 18 in the borough is double that of England. In addition 33% of people were found to binge drink in North Tyneside compared with just 20% in England. Clearly harm from alcohol is a huge concern for the borough.Appendix 5.5 demonstrates the higher rate of under 18 conceptions in North Tyneside than England. Teenage pregnancy is a major social concern as teen mothers are at increased risk of poverty, poor health and lower educational attainment. They are also considerably less likely to breastfeed and access ser vices (DfE, 2006). The evidence also shows that children born to teenagers have greater chance of experiencing a range of detrimental outcomes later in life (GBDH, 2008).Breastfeeding has a huge positive impact on the health of both mother and baby (Wilson et al., 1998 Horta et al., 2007 Quigley et al., 2012). But for the past fifty years the UK has had some of the lowest rates of breastfeeding in the world (WHO, 2010) even though UK policy clearly promotes breastfeeding (GBDH, 2003 NICE, 2008 GBDH, 2012). Breastfeeding is a huge factor in promoting public health and reducing health inequalities as there is increasing recognition that women from lower socio-economic groups have decreased rates of breastfeeding. Indeed appendix 5.6 shows breastfeeding statistics for North Tyneside and it is evident that both breastfeeding initiation and prevalence at 6-8 weeks are significantly decreased in the borough compared with nationally. It would be interesting to compare with ward level data however this is currently unavailable. The data is considered faithful however there remain some limitations. For example the initiation data is susceptible to observer and measurement bias because it based on watching by the midwives or nurses who record the data and interpret whether or not breastfeeding has been initiated. Similarly the number of infants who are totally or partially breastfed at the 6-8 week check is also based on observation so the same bias may arise. The method of data collection also assumes that all infants whose breastfeeding status is unknown are not breastfed resulting in underestimation of its prevalence. Even so it is obvious that low breastfeeding rates are of significant concern for the borough.Step 3This section will focus on the identification of a health need for action. The concept of need in relation to HNA can be discussed using the frequently quoted taxonomy of need by Bradshaw (1972) which considersNormative need perceptions of what profess ionals, experts or commissioners define as need based on available data.Felt need perceptions of what the profiled population feel that they need. evince need demand of the profiled population or felt need off-key into action.Comparative need the need found by those who receive a service.When selecting a precession for action HNA should balance these different needs (Thurtle, 2008 Cavanagh and Chadwick 2005). Therefore a significant limitation of this HNA is that only normative need is taken into account as only quantitative research is used. The incorporation of qualitative research would address felt, expressed and comparative need and greatly fortify this HNA.It is evident from step 2 that North Tyneside has some health needs. Those of highest priority appear to be mental health, adult and childhood obesity, smoking, alcohol intake, teenage conceptions and breastfeeding. As an aspiring health visitor the priority that if addressed could have the greatest impact and changea bility in my community is breastfeeding.As discussed previously breastfeeding is supported by much evidence for the short and long term health benefits for both mother and baby (UNICEF, 2012). The government recognises the importance of modify initiation and prevalence of breastfeeding and it has been included in the Public Health Outcomes Framework 2013-2015 to encourage the prioritisation of local breastfeeding support. Yet as illustrated in step 2 North Tyneside has extremely poor rates of breastfeeding. There are also more teenage mothers in the borough and wards A and B are areas of extreme deprivation. Research has found that females under 20 demonstrate the lowest incidence of breastfeeding (Infant Feeding Survey, 2010) and that there is a relationship between low rates of breastfeeding and socioeconomic deprivation (Dyson et al., 2010). Current services to promote breastfeeding in North Tyneside include breastfeeding support groups and a breastfeeding coordinator who visits the homes of breastfeeding mothers to provide one on one support. However the support groups are based mainly in more affluent areas and the coordinator has a massive caseload often failing to see many struggling mothers.Perhaps the supporting and influencing of disadvantaged younger mothers would be easier if the NHS embraced the technology that these people use on a daily basis. The proposed action of this HNA is to use social media to engage with hard to reach mothers to provide breastfeeding information and support. Social media is a modern, convenient and cost effective method of communication. Research from OFCOM (2012) showed that in the past year 50% of adults used the internet to access social networking sites such as Facebook and Twitter. In addition social networking has now overtaken text messaging as the most used method of communication among 16-24 year olds in the last two years. A study for the NHS Confederation (2012) recommended that health organisations should a ct immediately to avoid falling behind and to use social media to become communitarians that is, to engage, listen, respond and support communities. There is a significant lack of literature concerning social media and the NHS but Hawker (2010) suggests that some health organisations are starting to become more digitally connected. Still it is clear that a vast amount of further research in this area must be undertaken.In conclusion this HNA has identified breastfeeding as an urgent priority for intervention in my community. The proposed action is to take advantage of social media opportunities in order to engage with young or disadvantaged mothers who require breastfeeding support and advice. Indeed the Health Visitor Implementation Plan (2011) called for more sophisticated approaches to the profession. Incorporating such a change into health visiting practice would of dividing line be a huge challenge that would require planning, funding and readiness of staff. But now is the ti me to develop a new service vision and to embrace these opportunities. This will establish health visiting as a central part of community health, working with families to improve health equity and life chances.