Health Needs Assessment: Reading Borough, Berkshire, UK - Assignment Example

Health Needs Assessment: Reading borough, Berkshire, UK Health Needs Assessment (HNA) is a systematic method of identification of the inequalities and health needs in a given population (Pallant, 2002). It is one of the useful strategies that enhances professional development, identifies community needs, helps in the improvement of quality of data, contributes to evidence base and also improves outcomes of the patients. HNA also improves and develops links between local community and Clinical Government. It provides a base to improve team building opportunity. Ideally, HNA must be conducted with consultation with other agencies of the local community (Pallant, 2002). HNA gathers information that is critical to bring about a beneficial change as far as health of a population is concerned (Stevens, 1998). It identifies non-recipients of beneficial health care and recipients of ineffective, inefficient and inappropriate health care (Stevens, 1998). I have chosen to conduct HNA of Reading, Berkshire, UK. Description of the practice Account of the Community Reading is a large town in South East England. It is a Unitary Authority and hence is called the Borough of Reading. The town is an urban area in the county of Berkshire. The place lies at the confluence of two important rivers Thames and Kennet. It is located between Swindon and London city, off the M4 motorway. In terms of population, Reading is the largest settlement in the Home Counties (British Towns Network, 2009). The town is a house for Englands biggest music festivals. It is also an important commercial center, especially for information technology and insurance. It is considered the commercial capital of Thames Valley. Reading has two large universities. The local shopping center is The Oracle. The town is spread over 40.40 km2 with a population more than 143,700 (Census, 2001). Reading is a borough and though it had some local government autonomy initially, in 1998, the town became a unitary authority area. Reading also has a number of suburbs and other districts (Towns and Cities, 2009). The oldest ecclesiastical foundation is the Reading Minister which is the Minster Church of St Mary the Virgin. Another important Church is the St.James Church. The town also houses other religious centres of varying faiths and many other churches. There are many schools in Reading. There are 7 state secondary schools and 37 state primary schools in the borough (Encyclopedia, NationalMaster.com). The most popular school is the Reading school which is actually the tenth oldest school in England. There are also a number of other private schools, independent schools, kindergartens and nursery schools. The town also has an active Education- Otherwise home schooling network. The University of Reading is affiliated to the Oxford University and has its own three large campuses. There is a public library and a Central library. The town also has a three gallery- museum. Figure-1: Map of Reading, Berkshire (Encyclopedia, NationalMaster.com) The main National Health Service hospital in Reading is the Royal Berkshire Hospital. There are also two important private hospitals, the Berkshire Independent Hospital in Coley Park and the Dunedin Hospital on the A4 Bath Road (Berkshire Healthcare NHS Foundation, 2009). Prospect Park hospital is NHS hospital that takes care of patients with mental health problems and learning disabilities (Encyclopedia, NationalMaster.com). . Reading is also a good shopping center. There are many retail stores and companies which are also situated elsewhere in the country, hence it is also known as "clone town." The primary catchment area for non-bulky comparison goods includes Wokingham, Pangbourne, Goring-on-Thames and Henle-on-Thames. There is also a second catchment which includes Ascot, Camberley and other places. The main town centre shopping area is around Broad Street. There are many shopping malls and arcades too. There are many departmental stores in Reading, the most important of which are: House of Fraser, Debenhams and John Lewis Reading (Encyclopedia, NationalMaster.com). As far as utilities are concerned, Thames Water plc, a private company takes care of mains water and sewerage. The Environment Agency regulates Water abstraction and disposal. The water in Reading is hard because of water is mainly derived from underground aquifers (Encyclopedia, NationalMaster.com). The local electricity network is maintained by Southern Electric and the gas distribution is taken care off by Scotia Gas. The town has fixed land-line coverage and also ADSL broadband internet access to most of the areas. GSM and UMTS standard networks of mobile phone are available throughout the town. Reading has a significant position in Englands transport position by virtue of its location in the Thames Valley. There is a good network of local buses public transport and also buses to other cities by road. The railway lines from Reading link to both Paddington and Waterloo stations in London (Reading Borough Council, 2009). There is no airport in the town. But it is at reach of several international airports the nearest of which is London Heathrow which is 30 miles away by road. The town actually grew up as a river port, mainly at the confluence of the Thames and Kennet, both of which are navigable. However, the river transport in reading is mainly leisure- type now (Encyclopedia, NationalMaster.com). Demographics According to the 2001 census, Reading has 143,096 people with 72,076 males and 71,020 females. There are 27,392 people less than 15 years of age, 106,963 people between 16 to 74 years of age and 8,741 people above 75 years of age. In 2008, it was estimated that there are approximately 146,000 residents in Reading Borough. However, this figure is much lower than the estimated population of 205,000 registered with a General Practitioner. A good number of people are between the ages 20 and 29 years. According to the Office of National Statistics (Hughes, Mulhall and Saffin, 2008), the total population is expected to increase by about 5200 in the decade thereafter (2008- 2018). In 2006, there were approximately 2,246 live births. Housing As far as housing demographics are concerned, the number of households with residents are 57877. The number of people per hectare is 35.4. 6349 people lived in over crowded houses. At the nation level (Statistics of England and Wales), the number of people per hectare is 3.4 (National Statistics, 2001). Health related statistics According to the 2001 census data, 13.5% of the population suffers from limiting long-term illness and 6.5% suffers from not good general health. This is better when compared to the National statistics of 18.2% and 9.2% respectively. Only 7.7% of the people get unpaid care when compared to the national percentage of about 10% (Hughes, Mulhall and Saffin, 2008). Pollution Information regarding pollution was gathered from the Pollution Scorecard Organization of Berkshire county. The tests were done in 2002. According to the reports (Scorecard Pollution locator, 2002) of this organization, total environmental releases include 20- 30%. The cancer risk score was 10- 20% and the non-cancer risk score was 20 to 30%. Of these, air releases of recognized carcinogens was 50- 60% and air releases of recognized developmental toxicants was 70- 80%. The top ranked toxicant for cancer risk was formaldehyde and the top ranked toxicant in the non-cancer group was ammonia. Immigration After the enlargement of the European Union in the year 2004, many people emigrated from the “Accession 8" counties namely, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovenia and Slovakia (Hughes, Mulhall and Saffin, 2008). Ethnicity According to the 2001 census data, the majority of people residing in Reading are Whites and they constitute 86.82% of the population and non-Whites are 13.2% of population. About 4.14% of the population is Blacks, 5.21% Asians, 2.38% mixed and 0.72% Chinese. Of these, the majority are Christians, followed by Muslims and then Hindus. In terms of morbidity and mortality, ethnic status is an important cause of health inequality. Reasons for apparent health inequalities include cultural backgrounds and beliefs, genetics, lifestyle and environmental factors (Hughes, Mulhall and Saffin, 2008) Identified Needs 1. Education: According to the JSNA (Hughes, Mulhall and Saffin, 2008), general education achievement in the borough of Reading was much below the England average. The study also reported that a high proportion of those employed had minimal or no suitable qualifications. Also, the skills profile of the residents of Reading was much below the rest of Berkshire. 2. Housing: According to JSNA (Hughes, Mulhall and Saffin, 2008), 57% of the population of Reading is not in a position to afford housing at market rates. Thus there is a high demand for council housing outstrips. Also, when compared to the national average, non-decent proportion of housing is more in Reading. 3. Crime: Though crime rate decreased in Reading, there continues to be a rise in domestic violence. Domestic violence offences rose from 935 in the year 2006- 2007 to 1146 in the year 2007- 2008 (Hughes, Mulhall and Saffin, 2008). 4. Employment and deprivation: About 12% of Super Output Areas in Reading are severely deprived. Life expectancy in these areas is more than 5 years less when compared to other areas (Hughes, Mulhall and Saffin, 2008). 5. Environmental problems: In Central Reading, levels of nitrogen dioxide have actually exceeded target levels. There is a risk of floods in this borough (Hughes, Mulhall and Saffin, 2008) 6. Lifestyle factors: The use of tobacco and consumption of alcohol remains high in Reading. About 5.3% of the population above 16 years of age drink alcohol at harmful ranges. There are about 1750 problematic substance abusers. The most common pattern of abuse is opiate or poly drug use (Hughes, Mulhall and Saffin, 2008). 7. Problems in children: There is a high incidence of mental health and dental problems in children in Reading. 27% of the children are from severely deprived areas. Important factors discussed I have chosen domestic violence (crime) and substance abuse (life style factor) to discuss in detail. The reason I chose to discuss these factors is that there is a gradual rise in domestic violence and substance abuse in Reading and measures need to be taken to check them. Domestic violence Any incident of threatening behavior, violence or abuse, of any form, between individuals who are, or have been, intimate partners or family members, or share a relationship, is known as domestic violence (Hornor, 2005). The victims are usually women, children, elderly people, physically or mentally challenged persons and partners in gay or lesbian relationship. Domestic violence can be either physical - where there is danger of harm to any part of the victims body; psychological and emotional - where the offender abuses the victim verbally or criticizes her in front of others or causes embarrassment, despair, sadness or terror; sexual- where in the victim suffers rape or any other derogatory treatment; economical- the offender tortures the victim by causing financial tensions, not allowing her to spend or asking her penny-to-penny accounts of what is being spent; or social- where the victim is not given freedom to meet her friends and relatives or attend social gatherings. Other methods of harassment include blackmailing, following, unwanted mails and phone calls, etc. Children, elderly and the disabled may also suffer by sheer negligence like not giving food, shelter and clothes properly or not giving medical aid in time. Also, children may suffer by just looking at their mother being beaten up (Hornor, 2005). Domestic violence can cause many effects. Physical effects include bruising, fractures, burns, disability, loss of hair or tooth, choking and death. Psychological effects which can arise due to domestic violence are depression, anxiety, sleep disorders, eating disorders, post trauma stress disorder, suicidal tendencies, self harm, shame, insecure ness ,fear, terror, confusion, guilt, lost sense of self, isolation, despair, sadness and social phobia. The victim may resort to substance abuse as a means of solace. Role of nurses in Domestic Violence Nurses play a major role in helping victims of domestic violence. In most of the cases, they are the first point of contact. They have an advantage over other professionals due to their close relationship with the patients. Nurses and other professionals must be patient towards victims of domestic violence. They must listen to the victim and show that they are concerned and that the victim does not deserve this harassment and there is no need to put up with this (Steiner et al, 1996). The professionals must respond to safety issues immediately- encourage the victim to make her own safety plans. They must provide information about domestic violence and clarify about myths. They must also give information about the consequences that can occur and clearly mention that the responsibility of stopping the violence is that of the perpetrator. Also information must be given about local resources and nurses must make referrals to them. Nurses must record and document the information in the medical records in the victims own words and inform the victim about this. All injuries must be documented by mapping and if possible by photographs (Steiner et al, 1996). The nurses must schedule a follow-up appointment and encourage the victim to come. They must review medical records and enquire about what happened in between. Domestic Violence and Human Services Agencies Human Services Agencies are professional social workers who work for the cause of human rights and social justice. Their approach is to consider the individual within the social environment. They have access to various other resources like health and mental care, police, advocates, security personnel, etc. As far as domestic violence is concerned, dealing with the victims is a highly demanding job. The major issues of concern of these agencies are: 1. Identifying the target population: Not many women are open enough to express about intimate partner violence. They and their children are silent sufferers of the abuse. Children are abused directly or they may suffer by observing their mother being beaten up (Wolfe & Jaffe, 1999). Elders may not be able to complain about their care-takers. 2. There are many myths about domestic violence, like the victim triggering the incident or consumption of alcohol causing violence or poverty causing it. So women actually take up the responsibility of preventing the episodes. 3. In rural areas, the environmental characteristics, cultural practices and informal social controls make the victims resistant to outside help. There are low levels of anonymity and reporting. Also in these places, there are difficulties related to transport, housing, employment and safety (Eastman & Bunch, 2007). 4. In many situations, there is need to assume multiple roles while working, which is strenuous. The burden of arranging safety, getting medical service, consulting lawyer and informing police lies on the service providers. 5. Multiple appointments or visits are necessary to solve the problem. And the victim may drop the case in between. 6. Recidivism rates in domestic violence cases are high. Substance abuse Repeated and excessive use of certain chemicals to achieve certain effects is known as drug abuse or substance abuse (Helpguide.org). These substances are mostly categorized as “illicit drugs" because of their high potential for addiction and abuse. Drugs may be obtained with a prescription and then continued to be used for the purpose of pleasure rather than for medical reasons. The psychoactive substances can lead to dependence problems which are a cluster of cognitive, behavioral and cognitive phenomena. The dependence problems develop typically after repeated substance use. Dependence syndrome includes intense desire to take the drug addicted to, difficulty in controlling the intake of the drug, persisting in consumption of the drug despite devastating consequences, giving top priority to the consumption of the drug than other obligation, activities and work, increased tolerance to the drug and sometimes physical withdrawal state (WHO, 2009). Substance abuse is turning out to be a major problem in many developing and developed countries. The number of people resorting to substance abuse is gradually rising in Reading too. Role of nurses, other health professional and community agencies in tackling drug abuse in the community Risk focused approach is the most effective and promising route to prevent adolescent alcohol consumption and drug abuse. The approach involves identification of factors contributing to substance abuse and then identification and application of methods which effectively address risk factors (Hawkins et al, 1992). There are many intervention models to provide services for those with substance abuse problems. These include staged interventions, behavioral skills training, intensive care management (Jerrel, 1995), individual-based cognitive–behavioural therapy (CBT) combined with a family intervention programme (Haddock, 2003), motivational intervention (Drake, 2001), social support intervention (Drake, 1998) and comprehensive management or psychosocial approach (Green field 1995, Drake 2000). Which is the best model to deal with these clients is still under research. An ideal model would be that which produces positive outcomes, including substantial rates of stable remission of substance abuse, low cost (Clark, 2003) and helps the client lead a satisfying and fruitful life. Staged interventions involve delivering treatment in a staged manner (Jerrel, 1995). The client is first taken in to trust, is then motivated and then persuaded to gain recovery. In the process, the client is helped to acquire skills and supports for controlling illnesses and pursuing goals. Also, relapse prevention is aimed at. Through intensive care management (Jerrel, 1995), assertive outreach is aimed at. This may also involve meeting the client at home, providing him with daily needs and building a trustful relationship. This way, access to services is gained. Motivation helps those especially who are demoralized, symptomatic and confused (Drake, 2001). This method helps an individual identify his goals. Comprehensive approach is necessary to make the individual lead a symptom free and fruitful life. To achieve this, friends, activities and stress management must be included. Sometimes, it may be necessary to manage the finances and day-to-day needs of the client including housing and vocational rehabilitation. The main aspect of management of substance abuse is counseling. Nurses play an important role in counseling as they have good communication skills and are often close to the patients. Counseling helps develop positive coping patterns, as well as promotes cognitive and behavioral skills (Drake, 2001). Counseling can be in the form of individual, group, or family therapy or a combination of these. The integrated services must also consider elements of cultural sensitivity (Drake, 2001). Cultural considerations will benefit certain sensitive groups like African-Americans and Hispanics. Also, adequate competence will benefit those who are homeless and women with children. In these cases, services must be tailored to their particular racial and cultural needs (Drake, 2001). Nurses are in a position to enhance health in cases of drug abuse by applying addiction and nursing theory. They play a major role in prevention programs by strengthening bonds with parents and citizens, law enforcement, health agencies and schools and also various hospitals as a part of assistance to the community to design and implement a preventive program. Nurses must also provide the knowledge of abuse and addiction to the public and demonstrate research competencies and teaching skill when involved in community health enhancement (Finley, 1989). The first step in counseling is motivation for abstinence. The patient must be advised about the benefits in quitting like good health, good education and job, high self esteem and good social and partner relationships. Advise to stop-at-once than gradual withdrawal. Also, the client must be asked to stay away from peers, friends and others who indulge in drug abuse. If partner or family members are also drug dependent, they must be involved in de-addiction programme. Nurses must encourage the clients to go back to school or work and concentrate on good results. They must also be encouraged to use other modes of entertainment like watching movies and drama, playing games and attending family functions. With all these, the patient must also be advised to change his lifestyle (Astolfi et al, 1998). Regular exercise and balanced diet is a must for sound body and mind. The most important aspect of management in substance abuse is prevention of relapse. Education of client must be done in the early stages of abstinence when the risk of reverting back is high due to withdrawal symptoms (Astolfi et al, 1998). The way to success is mainly motivation and instilling confidence and positive attitude and not talking about failures. Doctors, nurses, attendants, care takers, friends and family members must get involved during this period in a positive manner. The client must be advised to delay the desire to smoke and distract his mind from smoking by getting involved in other activities like listening to music, watching movies or drama, attending family functions, playing games or indulging in any other hobbies like reading novels or gardening. Further, he should be advised to avoid places and people who trigger the desire to smoke. In Reading, there are many agencies which support and help drug addicts to come out of addiction. One such agency is the Youth Coalition. The South Berkshire Youth Coalition has taken up many drug deaddiction and anti- dug abuse projects. It has inspired high school youths to team up and undertake anti-underage drinking projects which also include prevention of stores selling alcohol to minors and prevention of adults buying alcohol to young ones (Smith, 2008). Conclusion Reading is a large town with borough status in South England. It is an important commercial center and an urbanized area with some super output areas. Health Needs Assessment in that area has revealed certain issues as far as pollution, overcrowding, education, crime and substance abuse is concerned. The main pollutant is nitrogen dioxide. Education and literacy levels are low when compared to the national average mainly because of super output areas and immigration. Ethnic mix has caused inequalities in financial status and health aspects. Domestic violence and substance abuse are in rise in the borough requiring the need of contribution from nurses, other health professionals and health agencies. References Astolfi, H., Keonard, L. & Morris, D. (1998). Cannabis dependence and treatment. GP Drug and Alcohol Supplement 10 Annette, M., Nkowane, R.N., & Saxena, S. (2004). Opportunities for an improved role for nurses in psychoactive substance use: Review of the literature. International Journal of Nursing Practice, 10 (3), 102–110. Berkshire Healthcare NHS Foundation (2009). Our Services. http://www.nationmaster.com/encyclopedia/Reading-Borough-Council British Towns and Villages Network. (2009). The Unitary Authority of Reading. http://www.british-towns.net/en/level_3_display.asp?GetL2=273 Clark, R.E, & Mueser, K.T. (2003). Progress in research on dual disorders. The British Journal of Psychiatry, 183, 81-92. Drake, R.E., Mercer-McFadden, C., & Mueser, K.T. (1998). Review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin, 24, 589-608. Drake, R.E., Essock, S.M., Shaner, A., Carey, K.B., Minkoff, K., Kola, L., et al. (2001). Implementing Dual Diagnosis Services for Clients with Severe Mental Illness. Psychiatric Services, 52. Retrieved Feb 21st, 2009 from http://www.ps.psychiatryonline.org/cgi/content/full/52/4/469 Drake, R.E., Mueser, K.T. (2000). Psychosocial approaches to dual diagnosis. Schizophrenia Bulletin, 26,105-118. Drug Abuse and Addiction. Helpguide.org. Retrieved Feb 21st, 2009 from http://www.helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatment.htm Eastman, J.B & Bunch, G.S. (2007). Providing Services to Survivors of Domestic Violence- A Comparison of Rural and Urban Service Provider Perceptions. Journal of Interpersonal Violence, 22(4), pp. 465-473. Encyclopedia. Reading Borough Council. NationMaster.com. Retrieved Feb 21st, 2009 from http://www.nationmaster.com/encyclopedia/Reading-Borough-Council Finley, B. (1989). The role of the psychiatric nurse in a community substance abuse prevention program. Nursing Clinics of North America, 24(1), 121- 136. Greenfield, S.F, Weiss, R.D, Tohen, M. (1995). Substance abuse and the chronically mentally ill: a description of dual diagnosis treatment services in a psychiatric hospital. Community Mental Health Journal, 31, 265-278. Haddock, G., Barrowclough, C., & Tarrier, N.,(2003) Randomised controlled trial of cognitive–behavioural therapy and motivational intervention for schizophrenia and substance use. Carer and economic outcomes at 18 months. British Journal of Psychiatry, 183. Retrieved Feb 21st, 2009 from http://bjp.rcpsych.org/cgi/content/full/183/5/418?ijkey=2dc92298d5f905f24e54bbb1621a88182a05ec9d Hawkins, J.D., Catalono, R.F. and Miller, J.Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112(1), pp. 64- 105. Hornor, G. (2005). Domestic Violence and Children. Medscape CME. Retrieved Feb 21st, 2009 from http://cme.medscape.com/viewarticle/508291_1 Jerrell, J.M., Ridgely, M.S.(1995). Comparative effectiveness of three approaches to serving people with severe mental illness and substance abuse disorders. J Nerv Ment Dis.,183(9),566-76. National Statistics. (2001). Reading UA: Census 2001. Retrieved on 19th Feb, 2009 from http://www.statistics.gov.uk/census2001/profiles/00MC.asp Pallant, J. (2002). Health needs Assessment Toolkit. National Health Service, Mid Hampshire. Reading Borough Council (2009). Transport and Streets. Retrieved Feb 21st, 2009 from http://www.reading.gov.uk/transportandstreets/ Room, R., Babor, T., & Rehm, J. (2005). Alcohol and public health. Lancet. 365, 519-530. Scorecard. Pollution Locator (2002). Environmental toxic chemical releases report: Berkshire County. Retrieved on 19th Feb, 2009 from http://www.scorecard.org/env-releases/county.tcl?fips_county_code=25003#major_chemical_releases Smith, J. (2008). Berkshire forums focus on teen substance abuse. Berkshire Eagle. Retrieved Feb 21st, 2009 from https://www.berkshireeagle.com/learning/ci_10971879 Steiner, P.R., Vansickle, K., Lippmann, B.S. (1996). Domestic violence-Do you know when and how to intervene? Postgraduate Medicine, 100(1). Retrieved on 19th Feb, 2009 from http://www.postgradmed.com/issues/1996/07_96/steiner.htm. Stevens, A. (1998). Health Needs Assessment. BMJ, 316, 1448- 1452. Towns and Cities (2009). Lovemytown. Retrieved Feb 21st, 2009 from http://www.lovemytown.co.uk/CityProfiles/TownPages.asp Hughes, Mulhall and Saffin (2008). Joint Strategic Needs Assessment (JSNA) for Berkshire West: Comparitive Summary. Retrieved on 19th Feb, 2009 from http://www.westberks.gov.uk/CHttpHandler.ashx?id=15856&p=0 WHO. (2009). Substance abuse. Retrieved Feb 21st, 2009 from http://www.who.int/topics/substance_abuse/en/ Wolfe, A.D & Jaffe, G.P.(1999). Emerging Strategies in the prevention of Domestic Violence. The Future of Children. Retrieved on 19th Feb, 2009 from http://www.thefutureofchildren.com. Read More