Northumbria University
School of Health, Community & Education Studies
Module PP0264
Assessing Need for Health
Assessing Need for Health
Victoria O'Neill
Word Count
3684
Tutor
Ann Robinson
Health Needs Assessment
The purpose of this assignment is to complete a health needs assessment within a defined community. It will seek to explore socio-economic factors and health issues to find what conditions are most prevalent within the ward and how they impact on the community. The assessment process will be guided by a framework which will explore all aspects of the community.
Health inequalities have existed in society for at least thirty years that we know of. The first report on health inequalities was the commissioned Black Report by the then Labour government. This was then brushed aside when the conservatives came into power in 1979 (Acheson 1998). Both the Black report (1980) and Acheson's reports (1998) where commissioned to look at health trends and trends in inequalities faced by the population of the time, and to see how government and social policy could work best to tackle and improve these outcomes.
The Acheson report looks at general health trends, socio-economic position, mortality, morbidity, income, education, employment, housing, homelessness, public safety, transport, health related behaviours and ethnicity (Acheson 1998). All of these issues will be explored as part of the process within this health needs assessment of the ward being discussed to build up a health profile of the community.
What is health?
' [Health is] the extent to which an individual or group is able on the one hand, to realise aspirations and satisfy needs and on the other hand to change or cope with the environment. Health is therefore seen as a resource for everyday life, not the object of living: it is a positive concept emphasising social and personal resources as well as physical capabilities...' (WHO 1984)
National Institute of Clinical excellence (Nice 2005) define a health needs assessment as
'..a systematic method for reviewing health issues facing a population, leading to agreed priories and resource allocation that will improve health and reduce health inequalities'
The framework used to complete this health needs assessment is based on guidance published by NICE (2005) which details a five step process. Step one defines who the population is, step two identifies health priorities which then builds a profile about the population group to target and benefit, step three looks at identifying conditions impacting on the community and identifies any gap in service provision which would lead to a proposed change ready for steps four and five, the development and implementation of and action plan and then evaluating its effectiveness (NICE 2005). Due to word constraint, only steps one, two and three will be explored.
For purpose of this assessment only information and data within the public domain has been used to maintain confidentiality (Nursing and Midwifery Council NMC 2008).
Evidence based research plays an enormous part in the way nurses practice and carry out tasks. It is ever changing so all research gathered and looked at has to be up to date and accurate. Gray, (2001) suggests that research is a process of enquiry that produces knowledge and can help us to understand and promote health care, through intervention, treatments and therapies. So by undertaking a health needs assessment on the population not only looks at prevalence of disease but can point out a gap in service provision and point out a way of meeting this need.
A health needs assessment rather than a focus needs assessment has been chosen for the purpose of this assignment. The reason for the choice of assessment come from the author being new to the practice area and new to the district with no knowledge of the community's issues and problems regarding health and social care.
Step one
Social Structure and Social Activity
The community is a small town in the North of England with a geographical area approx 9 square miles. In 1981 the ward was ranked 232 out of 678, by 1991 it had slipped to 176 putting it within the worst 25% of places to live in the north east. It has been difficult to find up to date data on where the ward ranks at present despite searching census and quality and outcomes framework (QOF) data bases.
The last census in 2001 shows the population in the ward at that time to be 11,222 people, with an approximate gender split between male and females (ONS 2001).
The wards community facilities include two nurseries, three primary schools and one senior school (Local Authority 2008), there are many local bakeries, one green grocer and two butchers but the community only has one small supermarket. The nearest large supermarket is roughly six miles away (AA route finder 2008). What is noticeable about the community's amenities is the large amount of fast food and takeaway businesses.
Since the closure of the mines in the 1980's there has been no industry within the town and the majority of those working of seeking to find jobs need to travel to the nearest city. When the mines closed many hundreds of people lost their jobs and were unable to find suitable or regular jobs due to poor education and the lack of qualifications to work in business. Unemployment within the community is higher than the nation average with most people having no qualifications to seek out permanent long term employment (ONS 2001).
There is one newly built community centre which houses a library, the local housing office, a café, gym and nursery. The Primary Care Trust (PCT) also use the facilities to provide communities services. Facilities can also be booked for individuals to use.
The ward itself is classifies as being in the most deprived 20% of the country (STPCT2006/07).
Age
The average age of the ward population is 45-54 years of age compared to the local and national average which is 35-44 years of age (ONS 2004).
The population of those aged ...
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There is one newly built community centre which houses a library, the local housing office, a café, gym and nursery. The Primary Care Trust (PCT) also use the facilities to provide communities services. Facilities can also be booked for individuals to use.
The ward itself is classifies as being in the most deprived 20% of the country (STPCT2006/07).
Age
The average age of the ward population is 45-54 years of age compared to the local and national average which is 35-44 years of age (ONS 2004).
The population of those aged 0-4 is 6.75% and the population of 0-14 is 22% in comparison to the nation average, this is 3.2% higher, a significant factor when looking at the health needs and future health needs of the population.
The proportion of those age 65 and over are 21.7%, 6.6% higher than the nation average which is 15.51%. With the population of those aged 65 and over being higher than the national average, this would suggest that health provision for those within this age group is well provided for and that the town is good place to retire to.
National target of life expectancy for the area is around 78-79 years of age (DH 2007) but as the figure show, this town has a significantly higher proportion of those aged over 65 in age and a slightly higher (0.8%) population of those over 80 years of age. (ONS 2004).
On the other hand due to the long liverty of the population, limiting long term illnesses maybe significantly higher. Hip fractures in those over 65 is shown to be significantly higher in the district than England (NEPHO 2008).
Ethnicity
The ethnic* population makes up just 2.3% of the population, an average of just over 2 in 100 people. The district also shows the ethnic population to be 4.79% compared with the national average 21.60% which equates to 1 in 5 people (ONS 2001). This shows a major difference in culture and provision of services which may need to be provided.
*For the purpose of this assignment ethnicity is anyone born outside of Great Britain and Ireland.
Health Care
The community serviced by one health centre which houses 7 general practitioners, 4 Health visitors and a nursery nurse. Midwifery service and district nursing service also share the same site. There are two Pharmacies in the ward, owned by the same company (no scope for choice), one dentist and one optician (Local NHS 2008).
The location of the health centre posses issues as to were it is situated (way back off the main street on an incline). Access up to the health centre is poor. The bus stop in the town centre and a main road has to be crossed before a long walk up to the health centre.
Children in the ward have higher than average tooth decay (NEPHO 2008). The district as a whole has the worst dental health care for children within north east. Is this lack of education or only having one dentist to services a population of almost 12000 people?
Data for the district shows Children are significantly more obese than in England, Child poverty is significantly higher, Obesity is higher in adults being significantly higher than the nation average for the ward (STPCT 2006/7) and Deprivation is higher. QOF data for the ward also shows that CHD, asthma, cancer, diabetes mellitus, blood pressure, Left ventricular dysfunction, mental health, cardio Vascular Accidents (CVA) and thyroid are all higher than the district average and the UK average (QOF 2005/06). The ward is among 10% of wards in England with the lowest percentages of adults eating five or more potions of fruit and vegetables a day (STPCT 2006.07).
What data does show about the area is how good an uptake of the immunisation programme there is within the trust of primary vaccinations, boosters and MMR vaccinations. It is almost 11% higher than the national average uptake (STPCT 2006/07).
General health
Within the ward there are 1693 people who report themselves to be in not so good health (15.09%), within England this figure is 9.06% a difference of 6.03% almost a third higher.
The percentage of those with limiting long tern illnesses is 29.01%, 11.08% higher than in national average. The district is also 6.12% above the national average.
The biggest mortality rates for the area are Cancers, CVA and Coronary heart disease (CHD) (NEPHO 2008, STPCT 2006/07). The north east over the last 25 years has always had a higher than average mortality rate, dating back to the 1981 census (Philimore et al 1994). In the period of 1981-1991 the north east had the highest mortality rates per ward than all of England and Wales (Philimore et al 1994).
In 2003-2005 deaths by lung cancer in the district was 5% higher than anywhere else in England and of all deaths by cancer, Lung cancer accounts for more than 60% of all respiratory diseases in woman. The figure for men is on average 10% lower accounting for an average 50% of all respiratory diseases in men (STPCT 2006/07).
Chronic obstructive pulmonary disease (COPD) prevalence is highest in the district by 0.4%, as well as being 1.37% higher than the national average (STPCT 2006/07). Asthma is another area the district's prevalence is higher (0.33) although a sister district does have a higher prevalence of 0.56% (STPCT 2006/07). As with the other respiratory problems it appears the north east far out weights the rest of England for prevalence of these diseases. Is there a gap in service provision here or could more be done locally to resolve these issues.
The ward has a significantly lower rate of low birth weight babies (STPCT 2006/07) this is a common occurrence throughout the north east. Smoking whilst pregnant is known to increase the chances of having a lower birth weight baby (NICE 2008)
The prevalence of smoking ranks it among the worst 20% of wards in England with the highest proportion of smokers, with 23% of the districts women smoking throughout their pregnancy (STPCT 2006/07). The number of girls aged 10-15 years old in the district who smoke is 3% higher than the national average, yet the number of boys aged 10-15 years old who smoke is 1% lower than the national average (STPCT 2006/07).
Binge drinking was also ranked within the worst 20% of wards in England with the highest proportion of individuals who binge drink weekly.
Mental health
Prevalence of depression in the ward was ranked among the best 10.5-21% of wards (STPCT 2006/07). People of the district received more incapacity benefit for mental health/behaviour disorders than in any other district within England (STPCT 2006/07. It is estimated that 1 in 10 children between the ages of 5 and 16 has a recognisable mental disorder, with boys being more prone to mental illness. It is also thought that children from single parent households are more prone to mental disorders (ONS 2004).
It was difficult to find accurate ward data when completing this part of the health needs assessment. By going on data for the district as a whole may not necessarily mean it's a common theme in this ward. Had data from GP's been in the public domain a more complete and accurate picture may have been given
Housing
From observed practice most people live in two bedroomed converted properties which were originally single story houses which have then been built upwards and extended out the back of the house. There are
4800 house holds in the ward with 41% of the population live in rented or council property 10.25% higher than the national average. Due to the type of properties on offer in the ward there is a lot of social movement in and out of the local towns surrounding the ward. Housing isn't offered on a point system from the council but on a swap for swap basis (Local Authority 2008).
Transport
The number of households with access to a car or a van is 34.7 percent. This is lower than the national average by 6.64%. The figure do however show that the percentage is higher than within the district and the north east by an average of 15.7%. Data from the 1991 census (Phillimore et al 1994) and 2001 census (ONS 2008) shows that they has been a 13.9% increase in car or van ownership. If up to data had been available it would have been interesting to see how different again this was after eight years.
Recorded percentage of household which do not have a car or van
Ward
District
North East
England
34.7
53.97
46.86
28.06
(Ons 2007)
991 Census
2001 Census
Improvement
48.6%
34.7%
3.9%
(Philimore et al 1994)
*Higher than national average
*Significantly higher than national average
*Lower than national average
Education
The local wards senior school shows an over 5% all increase in 15 year olds gaining a grade A*-C across all subject since 2005. The district also shows a staggering 12% increase in grades A*-C across all subjects since 2005 (DFES 2008). The north east shows no significant difference in 2008 for children attaining 5 of more GCSE's grade A*-C (NEPHO 2008) than anywhere else in England. Figures show that the ward senior school was already performing better than the national average for the period of 2005 and 2006 by an average of 5% (DFES 2008).
Local ward senior school
2005
2006
2007
2008
60%
64%
61%
65%
(DFES 2008)
District senior schools
2005
2006
2007
2008
52%
55%
59%
64%
(DFES 2008)
England's senior schools
2005
2006
2007
2008
56%
58%
61%
65%
(DFES 2008)
Recorded percentage of people with no qualifications
Ward
District
North East
England
28*
39*
29.11
32.78
(ONS 2004)
Recorded percentage of people with qualification level 1-5 and other
Ward
District
North East
England
72*
61*
70.89
67.22
(ONS 2004)
*Higher than national average
*Lower than national average
Employment
A rough estimate of ward figures for those of working age* from the census of 2001 and the employment census for the ward 2005, show roughly on 55% of the population are in employment (ONS 2001, ONS 2004). Job centre statistics show that the region is doing well with employment rates, with only 3.4% of the population in the district unemployed (DWP 2009). This may change quite drastically with the lay off of workers from the local car manufactures as this account for 22% of all jobs in the area (DWP 2009).
*Working age 16-65
Crime
The area is policed by two sergeant's with three community beat offers and three police community support officers (PCSO's). At present there is no local police base for officers to work from but they have regular beat times in the area (Northumbria Police 2008).
Within the town there is no close circuit television to monitor crime in the area.
Crime figures from the local district do show violent crime is not significantly different to England and within the local neighbourhood of ward that there had been a 10% reduction in crime since 2006/07 (Northumbria Police 2008).
Local census data for the ward doesn't show any crime rates although it does crime statistic for the district. These show the statistics from the fire brigade on how many incidents they attend within the period. The number attended was 34 be it does no report on what type of incidents these were i.e. accidental or non accidental, fires or the emergencies (ONS 2001).
Step Three
Identifying Health priorities
Three main areas of significantly high prevalence are of childhood and adult obesity, cancers, CHD and CVA. Within the practice area research suggests that 32.8% of the population are smokers, 6.8% higher than the national average which is 26 % of the population (STPCT, 2006/07) and 70% of all smokers questioned say they would like to stop smoking (Smokefreeengland 2008).
England went 'smoke free' after introducing the new Smokefree Law on the 1st July 2007, making it illegal to smoke in a public place (Health Act 2006). This was in an attempt to promote healthier lives, increase life expectancy and decrease the incidence rate of cancers and premature deaths within the population (STPCT 2006/07). Smoking cessation groups are set up for individuals or groups who wanted to stop smoking in a drive to beat cancers and improve general health through smoking prevention. Prior to this the government had ran several other stop smoking campaigns to help people quite smoking to improve their long term health. In 1998 the Department of Health published 'smoking kills' (DH 2008) this was the first real attempt to try and educate the public about the health risk associated with smoking giving them advice and support to quit, this was then followed by the ban on tobacco advertising. The country has also seen an increased in age from which cigarette could be bought from 16 to18 in an attempt to prevent younger people smoking. They are also looking at a ban on cigarettes machines in an attempt to stop those under age accessing cigarettes unlawfully.
At present it is up to the individual Primary Care Trusts and Strategic Health Authorities to provide or commission services for smoking cessation and to them what level they provide it (NICE 2008). With the introduction of these acts and new policy, the role of the health visitor was extended to provided smoking cessation as part of routine surveillance visits as well as and in some local areas health visitor began to run clinics (NICE 2008, STPCT, 2006/07). Specialist smoking cessation health visitors were also implemented in areas were smoking prevalence was highest.
The services local delivery plan intends to 'increase the focus on 'pregnant smokers' offering mothers and mothers to be one to one smoking cessation both anti natal and post natal by midwifes and health visitors with health visitors providing the smoking cessation sessions after going through a referral process (NICE 2008, STPCT 2006/07). At present the trust's target is to reduce levels of smoking during pregnancy to 15 % by 2010 (STPCT, 2006/07). Motivational questioning about Smoking cessation is used providing information on how to quit explaining service with an option to revisit at a time more appropriate to the mother (NICE 2008).
At present all smoking session is ran on a one to basis. A gap in services provision shows that there is no group ran smoking cession within the ward. The population target to benefit is parents and carers of children over the age of one but under school age (four or five).
Anti natally parents and carers are targeted for smoking cessation throughout the pregnancy as part of their health surveillance (NICE 2008). Post natally parents and carers are again targeted at babies health surveillance and development checks at the primary visit, 4-8 week visit, 12-16 week visit and 9 months (NICE 2008). From 1 year onward it becomes harder to target this population group as the health visitor visits less frequently.
Children are at an influential stage in their life. Less exposure to smoking could potentially reduce the risk of them becoming smokers in later life. 'If a child's parents smoke they are three times more likely to smoke themselves', (Cancer Research UK 2004). Potential places where parents or carers could be targeted are baby days (formally baby clinics), children's centre ran groups and parent and toddler groups.
Would a separate initiation need to be set up to target those who do not access these groups or this initiation be enough to target these parents and carers. One proposal would be smoking cessation coffee mornings with the addition of a crèche within an appropriate setting accessible to all.
The next step of the NICE framework is to look specifically at interventions, policies and strategies then to implement and evaluate there effectiveness. Due to time and word constraint it is not possible to undertake these steps at present.
This assignment was based on a health needs assessment. Had I worked in the community and known my population longer I may have undertaken a focused needs assessment. From this health needs assessment I feel I have learnt a lot about my community and services it provides. I now feel I have a greater understanding when talking to clients about how they must feel isolated and detached from the cities services due to education, work and health provision.
What is clear for this assessment is how deprived the ward is and how deprived the district is as a whole. The biggest indicators are the smoking prevalence, death by CVA, CHD and cancers and both childhood and adult obesity .
It is worth remembering that these figures are based on census data collected in 2001 and 2004. The population may have changed seeing an increase in migration from other countries as well as asylum seekers taking refuse, which in turn brings about new cultural health needs and problems.
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Victoria ONeill
U025244
