Health Needs Assessment: Belmarshs Critical Review - Essay Example

?Health Needs Assessment: HMP Belmarsh’s Critical Review Primary Health Care professionals need to develop their skills and knowledge to provide the best and most appropriate care to patients. They need to plan their environment and services to meet the health needs and reduce the health inequalities in their registered practice population. In order to do this they need to have knowledge of the health needs and inequalities that exist in the community they serve through the utilization of health needs assessment method (National Institute for Health and Clinical Excellence, 2005). According to Heffernan, a health needs assessment (HNA) is a systematic method of identifying unmet health and health care needs of a population and making changes to meet those unmet needs. It provides information: (1) to improve health; (2) to enable service planning; (3) to have priority setting and (4) to have policy development. Health needs assessment is not health status of population assessment. It aims to improve health and it incorporates the concept of a capacity to benefit from an intervention. Health needs assessment is a new phrase to describe the development and refinement of well established approaches to understanding the needs of a local population. Health needs assessment has come to mean an objective and valid method of tailoring health services—an evidence based approach to commissioning and planning health service. HNA encourages strengthened community involvement in decision making, improves team and partnership working, promotes professional development of skills and experience and improves communication with other agencies and the public and provides better use of resources (Wright et al, 1998). Defining Needs An understanding of health needs assessment requires a clear definition of need. Need implies the capacity to benefit from an intervention (Heffernan). Needs had been defined as by Bradshaw (1972) into different types- the normative, expressed, comparative and felt needs. Comparative need is derived from examining the services provided in one area to one population and using this information as the basis to determine the sort of services required in another area with a similar population. In this case the comparative need regarding the health situation of the prisoners detained at Belmarsh compared to the health needs outside of the prison walls. However, when assessing comparative need the level of service provision in the reference area must be appropriate (Hawe et al, 1990). On the other hand, based on Maslow’s Hierarchy of needs (Montana & Chamov, 2008), health needs belong to the physiologic needs at the very base of the pyramid. According to the hierarchy the fulfilment of the needs from the lowest of the pyramid is significant to be able to move forward into a higher level. Even prisoners are basically captives; the responsibility of the government to restore social behaviours with the use of punishment by solitary exclusion from the society does not mean their needs are to be neglected. With the help of the study done at Belmarsh the basic needs for health of the prisoners are being monitored and assessed. Health and its Models Health is the state of complete physical, mental, social well-being and not merely the absence of disease (WHO, 1947). This definition of health integrates a person’s holistic being to be called as a healthy individual. It also connotes the mere absence of disease the counterpart of being healthy. The HMP Belmarsh Health Need Assessment study is governed by this theory believing in the concept of health as deemed vital and essential in a life of a person to be able to be function regardless if under conviction. The Prison Inspection introduced the concept of the Healthy Prison. This concept assesses and tests prison’s health against four criteria. The four criteria of a healthy prison answer to safety, respect, purposeful activity and resettlement. Safety- Prisoners are held safely (includes preventing bullying and self-harm). Respect- Prisoners are treated with respect. Purposeful Activity-Prisoners are able, and expected, to engage in activities that are likely to benefit them. Resettlement- Prisoners are prepared for their release into the community and helped to reduce the likelihood of re-offending. The conceptualities of the healthy prison concept also meets with the Needs – Fulfilment Health Model Health that holds that health is state in which needs are being sufficiently met to allow an individual to function successfully in life with the ability to achieve the highest possible potential. Prisoners of Belmarsh are being taken care of in terms of health prevention, health recovery and restoration of health if deemed necessary in preparation for the return to society (Petri, 2007). Belmarsh’s Health Need Assessment Approach. Health Needs assessment uses different approach. Comparative approach (Stevens & Gillam, 1998), the one used for the Belmarsh HNA, compared the level of services between different populations taking into account local population characteristic in this case the health level of the prison population was compared to the health level of the general male population of the outside counterpart. The demographic representation however between the two groups was not well defined- the age bracket of disease prevalence was not defined in the table of comparison of prevalence shown in the study. Other demographic data for the comparison group could have been of help like civil status, work status and location. The Comparative approach involves the comparison of levels of service provision between different localities. These could be cross-national comparisons of the levels of service provision or could be at a more local level for example, comparing the service provision in one town with another that has a similar demography just the way the study showed comparison of the prison populace and the general populace in terms of their health. Strengths of this kind of approach contribute to its fairly quick achievement and inexpensiveness. Moreover, using this kind of approach for Belmarsh gives its inmates society a fair chance of lifting the standards of health based on the quality that a normal person would be given. The Comparative approach in the study compares the prevalence of certain diseases in comparison with the general populace to know the percentage that the prisoners of Belmarsh are at risk of and to address the health concern that received highest rate of prevalence. On the other hand, disadvantages include the problems of finding a sufficiently similar locality for an accurate comparison. Unfortunately, the general populace in the study is of a broader context to be compared with Belmarsh. The manner the study was conducted should have been in comparison to another high maintenance prison under the healthy prison concept. In that way the similarities of in demographics would have given a better comparison and in relation to prison health and not against the general public which is very vast and broad. Also noticeable in the study that some survey date was from around year 2000 and the date the study was done was seven years after February of 2007. By the time the study was conducted significant changes in figures could have undergone over the years thus an updated list of data is of the essence to get an accurate presentation. The census increases even for just a short span of one year the remarkable increase in the figures would have changed the figures of the study. Criticizing the Belmarsh Study Every person is in need of healthcare, the provision of the government to give right of health to its people expands to every member of its sovereignty even those who are convicted of doing crimes against the society. Thus, the conduction of the health needs assessment in the facilities of a high maintenance prison such as Belmarsh can also be considered as the right of the prisoners. The aim of the HMP Belmarsh health care needs assessment is to assess the current situation with regards to achieving National Health Standards of care in Belmarsh Prison, and to clarify met and unmet health care needs. The Prison Service was formerly responsible for prison health care. The aim of the transfer of responsibility for health care in prisons from the Home Office to the Department of Health is to modernize prison health care, and to bring the standards of health care in prisons to the same level as within the National Health Service. This means that prisoners are to be treated as temporary residents of the Primary Care Trusts (PCT) in which the prison is located. The hallmark of the change is to describe the people under the responsibility of prison health care as patients not as prisoners (Petri, 2007). The target population, the inmates of the prison, were assessed and comparatively studied in the same way same age groups from outside of the prison would have been. By the use of the comparative approach the studies have shown figures and point as to where the present health situation of the prison is situated. At the same time the result of the study will show the degree of health program implementation’s efficacy and will then be used as guide for reorganizing the plan on how to properly target the desired outcome in the future. According to the assessment, prisoners overall disproportionately came from disadvantaged socio-economic groups, with more physical and especially more mental and social health problems than the general population. In addition, they are more frequently of high risk behaviours. Ten percent of prisoners had a psychotic episode in the year before admission, and depression and anxiety are very common whilst in prison. Over half of prisoners are drug dependent in various degrees, with one in four of the prison population currently or previously injecting drugs. Seven percent are severely alcohol dependent. Rates of hepatitis B and C infection among prisoners are increasing. The prison population is overall difficult to engage, with over half not registered with a GP. The prison setting provides an opportunity to engage with an often difficult-to-reach population. Though with difficulties in implementing programs within the kind of targeted population the study is a way to reassess and revise the program strategy repeatedly until desirable outcomes are met in the future. The good point of the study is that the criteria of health were based on the standards of the general male population, having equity and unbiased manner of levelling the prison health needs (Petri, 2007). With the use of Health Needs Assessment the present levels of health status of the prisoners are assessed and studied. It is important to note the current health situation of these prisoners to determine the strongest and weakest point of health implementation within the facility. The outcome of the study will then be the basis for the targeting health issues that dominate the prison populace that needs the most urgent attention and action. One problem encountered in the study was the limitations of information in table comparing the prison population with the national male UK population. The prevalence figures arising from studies among the general population are usually based on people aged between 16 - 65 years, and the prison population is overall younger. Also, prevalence for many conditions is higher in London than in the UK as a whole. By this reason comparative approach of study is not likely to succeed because there is discrepancy to the demographic profile of the two compared groups so the result of the study would be altered in some ways. The study could have used the epidemiologic approach following its three elements: First determining the incidence rate or prevalence of the health problems within the prison grounds supported by data collected accurately by means of record for the past years; second, identifying the effectiveness and cost-effectiveness of existing interventions regarding the health issues as identified in the study and addressed with the series of recommendation targeting the health issues with the highest prevalence rate; and last, by identifying the current level of service the study have shown how far as of the study was conducted the health of the prison have improved and still needs further improvement. This combination of health status assessments and evidence or effectiveness has also been described as the evidence based approach to needs assessment. While this is a systematic and objective approach carrying out new epidemiological work is costly and time consuming. The Belmarsh prison inmates are the primary stakeholders in the study. Which is very significant since it is the prisoner’s level of health are the objects of assessment. Pertinent data regarding the prisoner’s response to the concept of healthy prison- safety, respect, and purposeful activity- are vital in identifying improvement from all the data summarized. The Belmarsh study in totality achieved the purpose it was made. By analyzing the prevalence rate of health issues within the premises and comparing it against the prevalence rate of the general public a clear view of understanding that the high prevalence rate of certain diseases inside the prison walls versus of the outside is a significant figure of health that should be addressed by strengthening programs previously made and revising the ones that needs improvement through a series of recommendations backed up by facts of accurate data from the study. However a more demographic-specific data would have been achieved if the prevalence rate table has included other demographic data such as age, civil status, social status, offense made, years of stay in the prison etc the is deemed relevant into obtaining more specific conclusions regarding the prevalence of the disease within the prison grounds. These data could have answers to what specific age bracket have engaged more on alcohol and drug abuse or to what civil status does most of the prisoners with mental health belong to. These data could have narrowed the vast specs of the study which was rather not included due to time and financial constraint of the study. The accuracy of the study also depends on the credibility of the data collected. Information in the study was collected from the literature and from Belmarsh reports and a number of key informants were consulted. Also the report by the Chief Inspector of Prisons was accounted following the unannounced inspection which included an assessment of healthcare. On this case it is confessed that some data were missed as blamed on the non computerization of files that makes it inaccessible. The credibility of a written data is as accurate as the computerized entry provided that the data are written correctly and legibly and books and ledger as such should be kept in care and should be easily available for use because if there is a high tendency of inaccuracy and misinformation due to lack of credible sources. The ratio of nurses providing healthcare would have been a good point that could have contributed to the increase of prevalence of diseases in the prison- shortage in man power was mentioned in the study though it was not given emphasis. Health needs assessment plays an important role in Belmarsh prison. Its success requires a practical understanding of what is involved, the time and resources necessary to undertake assessments, and sufficient integration of the results into planning and implementation. It paves way for the assessment of the current health conditions of prisoners and evaluation of the efficacy of the programs implemented within the four guarded walls that aim for the promotion of health, prevention of sickness, and restoration of health for offenders to have a life within prison but never neglected of a healthy life. . Bibliography Hawe, P., Degeling, D. and Hall, J. (1990) Evaluating health promotion, a health worker’s guide. Sydney: Maclennan and Petty. Heffernan, C. (n.d.) Health Needs Assessment. Retrieved December 17, 2011, from http://www.drcath.net/toolkit/hna.html Montana, P. J., & Chamov, B. H. (2008) Management: Barron's Business Review Series (4 ed.). Barron's Educational Series. National Institute for Health and Clinical Excellence (2005, June 8) NHS. Retrieved December 2011, 2011, from NICE: http://www.nice.org.uk/aboutnice/whoweare/aboutthehda/hdapublications/health_needs_assessment_a_practical_guide.jsp Petri, A. (February 2007). HMP Belmarsh Health Care Needs Assessment. Stevens, A., & Gillam, S. (1998, May 9) Needs Assessment: from Theory to Practice. Retrieved December 17, 2011, from BMJ website: http://www.bmj.com/content/316/7142/1448 Wright, J., Williams, R., & Wilkinson, J. (1998, April 25). Development and importance of health needs assessment. BMJ Group. Retrieved December 16, 2011, from BMJ website: http://www.bmj.com/content/316/7140/1310.short Read More