Health and Social Care Policies in Nursing

Discuss and examine the key health and social care policy in relation to the role of the nurse. Consider local, national and global trends in health and well-being and the factors that can impact upon these.

This assignment aims to discuss the key health and social care policies in relation to the role of a nurse, understanding local, national and international healthcare policies that can impact on, and the influences, of health and well-being. This essay will discuss the history and growth of the National Health Service (NHS) and its establishment in the United Kingdom (UK), its reforms and its influence on health and social care. This essay will also recognise the local, national and global health trends and health inequalities in illness and wellbeing. Emphasis will also be placed on the modern-day social, cultural and environmental aspects and their impact on health.

 Prior to the creation of the NHS, health services in England consisted of patch-work quilted public service, private and voluntary sectors (Derbyshire 2012). Derbyshire (2012) also emphasised how the general practices were already established, which were run by the medical officers of health and the local government. According Englander (2013) in 1834 a new Poor Law was introduced. The new Poor Law ensured that, there were workhouses to accommodate the poor, feed and clothe them (Nicholls, 2016). They gave children who came into the workhouse some form of education, all workhouse paupers would have to work for numerous hours every day in return for this care (Englander, 2013). Nevertheless, not all Victorians were happy with this idea. Richard Oastler, called the workhouses ‘Prisons for the Poor’ so he spoke against the new poor law (Crowther, 2016). It was not until after World War II that the NHS was created following the Beveridge report (Beveridge 1942). The Beveridge report was to help veterans returning from war and to cater for the poor people that were dying, because they could not afford to go to clinics and or afford medication (Englander, 2013).  The Beveridge report (1942) was presented to the British parliament and the aim was to banish poverty. William Beveridge predicted the government would fund most of the cost supported by the national insurance (Crowther, 2016).   A national scheme of welfares was also presented to deliver social security, so that the people would be protected ‘from the cradle to the grave’ (Beveridge 1942). The Beveridge report was to address society’s ‘Five Evil Giants’, this include want, squalor, idleness, ignorance and disease (Derbyshire 2012). However, the idea of an NHS was opposed by the doctors and consultants, particularly because this meant they would no longer profit by charging for their services (Peckham and Meerabeau, 2007). The NHS was formed on 5^th July 1948 by the minister of health Aneurin Bevan after Bevan’s Act was passed into law in 1946 (McNally, 2006). The Bevan’s Act was founded on three main beliefs, free healthcare for all at a point of delivery, same standard care for everyone and available on equal basis of care not the ability to pay (McNally, 2006). Nonetheless the new organisation soon faced financial crisis, so healthcare services like optical, dental, and prescriptions were to be paid for (NHS choices, 2017). Financial crisis has consistently plagued the NHS, and has left a question over its fitness for purpose ever since (NHS Choices, 2017).

The Francis Report (2013) condemned NHS’s capabilities after failings in the NHS, more reports of detailed cold-hearted treatment of patients in the health care system (Henry 2013). The Black Report (1980) presented huge gaps in health inequalities supported the Francis report (2013) findings (Gray,1982). The Black report evidenced the differences in mortality rates between many social classes due to the same motives acknowledged many eras ago during the Poor Law in Beveridge Report (Gray, 1982). Research suggests health inequalities are still in the health care services, such as the postcode lottery system, where the area you live in determines the kind of healthcare you receive (Mackenbach, 2000). However, there are positive reforms in NHS which has impacted on to today’s society, including improving people lives and increasing life span which was not so pre-NHS (Mackenbach, 2000).

Health means different things to different people (Dayer-Berenson, 2013). According to World Health Organization (WHO) health is define as a state of complete physical, mental, and social well-being and not just the non-appearance of disease or illness (WHO 2017). Therefore, health involves the feeling of physical, mental, emotional, spiritual and social wellbeing and satisfaction of an individual. For many, health means non-existence of illness (Hennessy, Spurgeon, 2000). However, someone with a chronic disease or terminal illness who manage it well may feel healthy with themselves (Brodersen et.al., 2011). Health trend is the tendency to continue at a certain rate or certain direction that used to define course of a warning signs in diseases (Medical Dictionary, 2009)

There were 56.4 million deaths globally in 2015, 54% of these deaths were due to the top 10 global killers (WHO, 2017). These global killers include Life Expectancy, Under 5 mortality rates, Pre-term birth mortality, Cardiovascular disease, HIV/AIDS, Pregnancy and child birth, Mental health, Tobacco, Diabetes and Road traffic (WHO, 2017). Cardiovascular disease and stroke are still, the leading causes of global death in the last 15years (WHO, 2017). 3.2 million lives were claimed in 2015 by Chronic Obstructive Pulmonary Disease (COPD), meanwhile lung cancer, trachea and bronchus cancers claimed 1.7 million deaths (WHO, 2017). These diseases are related to the use of tobacco, 7 million people die each year because of using tobacco. More than 6 million deaths are related to direct use of tobacco while 890,000 are related to non-smokers, having been exposed to second hand smoke (WHO, 2017). Tobacco is one of the huge public health dangers the world has ever confronted according to WHO (2017). 52% of all deaths in 2015 were caused by communicable diseases, maternal causes and nutritional deficiencies were in low-income countries while high-income countries with such causes were 7% (WHO, 2017). Across all the income classes, lower respiratory infections were among the major causes of death (WHO, 2017). According to WHO 70% of global deaths are non-communicable disease, with this in mind vulnerable and socially deprived people get ill and die sooner compare to   people of higher social class, this is because they are likely to be exposed to harmful products, including tobacco, and have restricted access to health facilities. (WHO, 2017).

Policy is any declaration made by the government for people to follow or obey, this can be guidelines, rules and regulations (Denny et al, 2016). The WHO Framework Convention on Tobacco Control (WHO FCTC) came to force in 2005, to promote health (WHO, 2017). In 2016 a conference was held in Barcelona to examine the performance of the WHO Framework Convention on Tobacco Control (WHO FCTC) specifically focusing on its achievement and reviewing the barriers and loopholes and future challenges (WHO, 2017).

Nationally, there is 1 in 6 deaths relating to tobacco use in England, the lowest death rate area associate with smoking is three times higher to the highest death rate areas (WHO, 2017). Department of Health (DOH, 2011) indicates that 21% of adults in England still smoke, since 2007 smoking prevalence has reduced a bit and new actions are being placed to take it down further. Healthy lives, healthy people came in to force to help reduce smoking prevalence (DOH, 2011). A tobacco control plan for England 2011 came into force to decrease smoking among young people and in pregnancy (DOH, 2011). The tobacco plan for England (2011) declared that using of tobacco continue to be the major outstanding public health challenges in communities, smoking is the most single cause of inequality in death rates between the rich and the poor (DOH, 2011).  National Institute for health and Care Excellence (NICE, 2017) stated that community pharmacies, local communities, NHS trusts and local authorities should examine policies regarding smoking termination and taking to account the advice of the NICE guidance.

Smoking in Bolton is higher than the national average, although statistics show that smoking in Bolton has reduced in the recent years (Bolton Council, 2012). Nevertheless, smoking remains the leading cause of diseases, premature deaths and health inequality in Bolton, fifth of the adult population still smokes and each week 10 people die in Bolton due to smoking related diseases (Bolton Council, 2012). Bolton Tobacco Control Strategy 2010-2015 is aimed to reduce smoking in young people by 2020, to assist and support everyone who wants to quit smoking, reduce smoking rate in pregnancy women and in most deprived areas by 2020 (Bolton Council, 2012). This strategy also wants to protect communities and families from harm due to tobacco use, looking forward to increasing the reduction of second hand smoke by 2020 (Bolton Council, 2012).

African American youths have shown safeguarding effects on risk factors with regards to tobacco use due to the levels of ethnic identity and religion (Brook, et al., 2007). African American descendants are less likely to smoke than the youths of other ethnic groups (Abuse, 2009). However, adults in other ethnic groups smoke lesser than African American adults (Abuse, 2009). African American youths with religious background are less likely to associate with their peers who smoke due to their religious beliefs and values (Fiala, et al., 2002). Environmentally, children in low-income and urban areas with uncontrolled asthma have a high rate contact to potential second-hand smoke and they lack resources to control for example education centre (Lewis-Land, et al., 2015). People in higher managerial and professional classes are less likely to smoke than people in manual social groups (Larkin, 2011). Therefore, people in lower socioeconomic classes are more risk and continue to be at risk of health problems due to smoking (Larkin,2011).

The National League for Nursing (NLN, 2016) has recognised global diversity as a crucial priority for nurses as migration is at its peak than ever before, notwithstanding of current technologies, there are still global nurse shortage, still caring for more diverse patient population and global health needs.

Life expectancy believed to be the number of years remaining at a given age. Mortality rates is likely to change through a lifetime but using trends, estimation can be made, Bolton life expectancy for men is 76.5 years and 80.6 years for women which is lower than North West 77years for men and 81.1 years for women and England is 78.6years for men and 82.6 years for women (Bolton Council, 2012). According to WHO (2016) life expectancy between the year 2000 and 2015 has increased by 5 years but health inequality continues. There is a substantial difference in life expectancy among people living in the richest and poorest areas globally, nationally as well as locally, and an even bigger difference in disability life expectancy (Bolton Council, 2012). Consequently, people in further disadvantaged areas not only die sooner, but believe to live more of their lives with infirmity.  The difference is not only among the richest and poorest in the society but it is a classified connection across all social situations (Bolton Council, 2012).  Poverty is a world situation, it extends from generation to next. People migrate in search of a better life or fleeing from poverty. People living in poor conditions and rural areas where there is lack of resources are prone to ill health, injury caused by violence, abuse, cognitive state and poverty related conditions (Dayer- Berenson, 2014). Nurses should be familiar with the unique needs of their patients by having knowledge of distinguishing mortality outlines among populations (Larkin,2011).

 Health inequalities are the spreading of health determinants among groups in a population while social determinants of health are the customary circumstances in a person’s life, thus where they are born, environment, education, work, assessing health care, housing and financial security (Royal College of Nursing (RCN), 2012). Social determinants are accountable for the substantial heights of discrimination whereas some health inequalities are the outcome of natural biological changes, free lifestyle choices (RCN, 2012). Policies are established to tackle inequalities, globally, ‘Leaving on one behind: Equity, gender and human rights to practice’ is a policy aiming to lecture ministry of health to commenced developments to analyse what method can improve health programmes to address injustices (WHO, 2017). Providing health professionals with training to pay attention to social determinants of health and discriminations at work places (WHO, 2017). The Marmot review was aimed to decrease health inequalities and to safeguard healthy strategies for all (Marmot, 2012). The Marmot review was to profit fair employment and enjoyable work for everyone, to give every child the best start in life and to allow adults and children access and control over their lives (Marmot, 2012).

In Bolton, there is Targeted Prevention Commission Strategy Adults which was produced in reply to the National Transforming Social Care Programme: ‘Putting People First’, the strategy is to confirm that health agencies, local authority and independent sector work together to encourage people’s choices and control, development in life results, decreasing discrimination and improving effectiveness (Bolton Council, 2013).

Sociology is the study of communication among groups and individuals in human society and includes the perilous scrutiny of everyday aspects of human life (Warwick, et.al., 2012). Whilst sociology is defined as the learning of human civilisation. Sociology inspires us to interpret everyday marvels in diverse way (Denny, et.al 2016). Sociology shows health and society are accurately related. Knowledge about health influences the society and vice versa (Wilkinson,1996).

Sociology enables nurses to reason above their own subjective, awareness and understanding of society (Mills, 1970), however thinking sociologically is the outcome of organised study. It is carried out tangibly and finally comprise of generalisation, examination and structure (Jenkins,1996). According to Warwick et al., (2014) many believe health promotion is about media campaigns, giving out leaflets and updating people around pros and cons on health associated lifestyle choices. However, health promotion is about health education, prevention, health protection and empowerment, health education includes communication to improve health and well-being and to avoid ill-health influencing views, information and attitude (Edelman and Mandle, 2014). Nevertheless, critics think health promotion relates to a feebler evidence base relate to biomedical training (Warwick et al., 2014). Empowerment helps individual to build up their confidence and develop holistically (Dossey et al., 2004). Nurses needs to be aware of attitudes and actions towards health promotion and prevention of diseases, to act as an advocate for patients and their families (Edelman and Mandle,2014). Nurse must deliver health education to patients and their families, help patients and relatives to resolve problems, making decision around health promotion and nurses need to assess, studied, plan implement and evaluate nursing events such as health promotion and education (Edelman and Mandle, 2014).

In conclusion, this assignment has discussed the history of NHS, its reforms and the influence on health and social care. It also points out global health killers, trends and policies. This essay recognised health discriminations and social factors of health, well-being and the imparts on health.

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