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Policies are relevant and essential as they allow health professionals whether employer or employee, to work within their remit and understand their responsibilities to their clients, patients and their colleagues (Baggott, 2007). Walt and Gibson (1994) identified that health policies are made through complex association of actors, processes and content. The health policy triangle was introduced by Walt and Gibson (1994) as an approach of methodically discerning the various factors that can affect or generate a health policy. Policy actors pertain to governments or individuals who can affect the policy, such as pressure groups and politicians (Walt and Gibson, 1994, cited in Buse et al, 2005). Policy process relates to the formulation or implementation of the policy and how it is communicated to the public or society (Walt and Gibson, 1994, cited in Buse et al, 2005). Policy content refers to material or substance within a policy which describes the issue or topic covered, such as social or political which may refer to national or local areas (Walt and Gibson, 1994. cited in Buse et al, 2005).
This essay will scrutinise and critique a health policy. It will demonstrate the development of a policy and critique the beneficial worth, stating whether the health policy is achieving the objectives for its initial implementation. It will similarly evaluate and assess the policy content and determine the benefit of this particular health policy within my nursing practice. Furthermore argue whether the health policy has strengths to enhance my practice or weaknesses which may hinder application to my role as a school nurse.
The Department of Health were the policy actors who published the National Service Framework for Children, Young people and Maternity services in 2004. This policy was instrumental in enabling health professionals to look at children’s services in a different manner and address the whole child rather than the child’s illness or problem they may have; and instead look at techniques to prevent the problem from initially occurring (DH, 2004). The national service framework for children, young people and maternity services (2004) brought to the attention of policy makers the necessity of action focusing on children’s services, which lead to more policies and strategies being formulated (Baggott, 2007). One of them being Healthy lives, brighter futures. The strategy for children and young people’s health (2009), which states that all children and young people should grow up healthy with specific attention directed to the vulnerable; which includes looked after children and children in low income families.
Healthy lives, brighter futures. The strategy for children and young people’s health was published in 2009, jointly by the Department of Health and the Department for Children, Schools and Families. This strategy was the Labour Government’s plan to improve children and young people’s health and wellbeing (Department of Health and the Department for Children, Schools and Families, 2009). (DH and DCSF, 2009). The Labour government’s aim through this Strategy was for children and young people to have more opportunities by using more easily accessible services, which would benefit them and diminish health inequalities leading to less strain on the country’s financial resources (DH and DCSF, 2009).
Healthy lives, brighter futures. The strategy for children and young people’s health (the Strategy) (2009) was the primary approach targeting all health professionals and children’s services, which preceded the Healthy Child Programme: From 5-19 years old policy; in addition was introduced later the same year together by the Department of Health and the Department for Children, Schools and Families. To achieve the goals set out in the Strategy which targeted health professionals in the community, hospitals and commissioners highlighting the importance of their part in reducing health inequalities (DH and DCSF, 2009). Child poverty is on a decline but in the United Kingdom (UK) one in four children are growing up in poverty (Department for Work and Pensions, 2009). Young people and children living in poverty additionally use and rely on more frequently, emergency services which can add unnecessary strain to health services (Centre for Excellence and Outcomes in Children and Young People’s Services, 2010). Health inequalities are still present, and policy actors such as the British Youth Council were there to add their voice to the areas, and problems which they felt still needs addressing for the young people of the UK (British Youth Council, 2012).
The section of the Strategy (DH and DCSF, 2009), which will be discussed/critiqued in great depth will be section five, titled ‘Young People’. I work with young people and can look at the strengths and weaknesses of the Strategy; and this area was also chosen as young people sometimes feel that their concerns are dismissed and their opinions are undervalued (British Youth Council, 2012).
Adolescence is seen as a vital stage where young people are leaving behind their childhood and stepping forward into adulthood; where they are gaining more independence and in some cases looking after their own health for the first time, rather than depending on their parents or carers (DH and DCSF, 2009). The Strategies established are directed to providing health services for young people which targets their health as well as their psychological wellbeing (DH and DCSF, 2009). Through this transitional period adolescents are developing neurologically, physically, emotionally in addition to psychologically (Moshman, 1999). While young people are testing the boundaries though they are gaining more independence, young people are more likely to listen and seek advice from their peers rather than adults (Moshman, 1999). In our locality to make school nursing services more accessible to teenagers we provide a drop in clinic, where teenagers can come and discuss health issues or concerns they may have on their own or with a friend.
The Strategy has recommended that health services adopt a more young people friendly service (DH and DCSF, 2009). You’re Welcome – Quality criteria for young people friendly health service published by the Department of Health, Children and Young People (DH and CYP, 2011). This policy was one of the follow on programmes to the Strategy which gave more in depth recommendations, for providing additional user friendly health services for young people and training for staff to have a more user friendly approach. A project directed by Randall and Hill (2012), noted that young patients wanted their nurses to be friendly; but still give them their privacy and dignity without drawing unnecessary attention (Randall and Hill, 2012).
Youth workers based in the community can break through barriers as they are mainly adult workers that can relate to young people as they may work with them daily, when young people attend youth groups or centres (Hilton and Jepson, 2012). Young people attending hospital appointments or in hospital can feel isolated, have low self-confidence or lose their individuality (Hilton and Jepson, 2012). Presently school nurses only work with young people mainly if they have health conditions, to promote health or have Child protection plans. If there were more resources available, in this case time, school nurses could work with youth workers to help distil fears in young people, in regards to being admitted onto a hospital ward or learning to live with a long-term health conditions. This would empower young people to have additional confidence in health workers, and enable them to feel undaunted about their transition into the adult world (Young, 2006).
Policy makers understand and recognise the importance of young people’s psychological wellbeing and mental health which is addressed (DH and DCSF, 2009). The issue to provide a service to tackle and deliver support for young peoples’ mental health is challenging, as insufficient funds is available to deal with this one particular area on its own (Child and Adolescent Mental Health Services, 2012). This is evident by my employment Council that provides an integrated child support service, which entails education psychology and education welfare, early intervention and behaviour (Southwark Council, 2012). If the child has a more serious emotional or mental health problem that cannot be dealt with by the integrated child support service, the child would be referred to Child and Adolescent Mental Health Services, generally referred to as CAMHS (Child and Adolescent Mental Health Services, 2012).
My employment Trust has CAMHS which provides mental health care for four Trusts and also a national and specialist team (Child and Adolescent Mental Health Services, 2012). Usually a referral to CAMHS can take from four to eight weeks before the child or young person would be given an appointment (Child and Adolescent Mental Health Services, 2012). This reveals how necessary and important the service which is provided by CAMHS is needed and required, but demonstrates the challenge to respond to the high demand of referrals in a sufficiently and effectively appropriate amount of time (Child and Adolescent Mental Health Services, 2012). CAMHS has a policy of if the child or young person misses their appointment due to any other reason than ill health, they will be put back onto the waiting list.
The Strategy recommends that young people should have more access to information regarding sexual health (DH and DCSF, 2009). Teenagers are known for trying unsafe behaviours whether it is sexually or experimenting with drugs or alcohol (DH and DCSF, 2009). Teenagers can access health services if they are still in school or may want to discuss things away from their usual environment by attending sexual health clinics (DH and DCSF, 2009). In my school nursing locality young people are offered a drop in service where they can discuss personal issues; presently the service is only offered once a month due to lack of school nurses to run the drop in clinic.
Southwark has the eighth highest rate of long term unemployment in England and Wales (Office for National Statistics, 2010). Southwark has 10% more deprived districts than the rest of England, in terms of income deprivation which affects children living in the borough (Southwark PCT, 2011). Priority is made to safeguarding children which is paramount, and as there are quite a few cases of children in Southwark who have child protection plans (Southwark Council, 2012). Health of children in Southwark is generally worse than the average in England (Association of Public Health Authorities, 2010). Promoting healthy eating can be challenging, when low income families are trying to provide a healthy meal for their family at a time when they are on a fixed income (Livingstone, 2007).
The Strategy recognises that young people are adept at using the internet, and other forms of modern technology to gain access to information (DH and DCSF, 2009). Young people 16 years and above can open a Health Space account, where they can keep their current health records and have more control over their health information (DH and DCSF, 2009).
Health space also gives young people guidance on healthy eating and information on different types of illnesses; and where teenagers can go to get necessary support if required (Health Space, 2012). As part of the recommendations our school nursing service uses mobile phones to text young people to remind them of upcoming appointments. The policy You’re Welcome – Quality criteria for young people friendly health services, identified that young people preferred to receive a text message rather than an appointment letter and to be given the option of attending their appointment with or without their parents (DH and CYP, 2011).
An effective approach mentioned by the Strategy is for health to be promoted through advertising. This can be through television or radio commercials and also through posters in prominent areas and campaigns (DH and DCSF, 2009). A campaign which referred to excess drinking was called ‘Know your limits’ encouraging young people not to get drunk as they are not in control of their faculties and emphasised the dangers of being drunk; such as getting alcohol poisoning to having unprotected sex (DH and DCSF, 2009).
The ‘Know your limits’ campaign ran from June to September 2009, which included advertising on television, radio and on the internet (Community Justice Portal, 2009). A survey conducted after the campaign revealed that young people did take notice of the anti-binge drinking campaign (Community Justice Portal, 2009). While 67% of young people said they would think more when out drinking with their friends, but none of the young people said that they would reduce the amount of alcohol they would consume (Community Justice Portal, 2009). This brings into question whether the campaign was effective, and whether another form of advertising would have been beneficial, productive and less costly.
Teenage pregnancy rates are decreasing and currently are at the lowest they have been for the last forty years (Office for National Statistics, 2010). In Western Europe England still has the highest rate of teenage pregnancy, with the majority of the pregnancies unplanned and half of them legally aborted (Swann et al, 2003). The Teenage Pregnancy Strategy launched in 1999, set out guidelines to reduce the amount of teen pregnancies in the UK (DCYPF and PH, 1999). The Strategy made clear and productive follow on guidelines to the Teenage Pregnancy Strategy, which involved methods and approaches on how to reduce teenage pregnancies and campaigns to promote effectual contraceptive techniques (DH and DCSF, 2009).
Young people aged between 16 years to 24 years old still has the highest amount of reported sexually transmitted infections (DH and DCSF, 2009). The Strategy has made clear procedures and techniques on how to decrease teenage pregnancy by gleaning evidence based information from countries such as America; where they have had an 86% reduction in their teenage pregnancy rate which they say was due to better quality use of contraceptives (DH and DCSF, 2009). Sex and relationship education is taught in schools by school nurses or by school teachers, but we are limited in some independent and religious schools by what we can teach the children. This would hinder and impede upon school nurses following the guidelines which the Strategy would like us to follow, as in some schools we have to negotiate with the head teachers what they will allow us to teach the pupils. For instance, in Catholic secondary schools if the pupils are taught sex and relationship education, it is limited to purity, abstinence and waiting till the students are married before having a sexual relationship (Catholic Education, 2012).
Childhood obesity is defined as weight gained to a significant amount which can affect the child’s health (Parliamentary Office of Science and Technology, 2003). The Strategy tried to put in place guidelines to help combat obesity in young people, but the government admitted that they were struggling to find effective ways to tackle the obesity in young people (DH and DCSF, 2009). The Strategy was not precise or adequate with beneficial and practical guidelines to encourage healthy eating in young people (DH and DCSF, 2009). Campaigns such as Change 4 Life were introduced in the same year as the Strategy, with the goal of targeting the whole family into eating healthier and exercising, and nothing directed just for young people (DH, 2009).
The Change 4 Life was effective to a certain extent, as it gave school nurses a worthwhile tool to go into schools and work with young children. Posters and leaflets were given to schools to promote the Change 4 life campaign; but as for teenagers they found it unrelatable. In addition to the Olympics being held in London, the follow on campaign is Games 4 life (DH, 2011). This was designed at encouraging families to take an active part in the games instead of just watching it all on the television set in their homes (DH, 2011). Games 4 life misses out on the opportunity of targeting young people to get them involved with the Olympics where they could have schools competing against each other.
“Our experts are examining the Government’s NHS reforms in detail and highlighting aspects of the legislation that merit greater scrutiny” Right Hon Stephen Dorrell MP, Health Select Committee (2011).
The announcement of the NHS reforms by the current Government will have a thought-provoking impact on patient’s care and the roles which health professionals presently hold. For instance, additional audits will be put in place and this can be questioned about the effectiveness of these audits, as it may perhaps mean more time being spent on completing these audits which would mean less time focusing on service users (Ham et al, 2011).
An adverse effect from the NHS reforms was the abolishment of the student education maintenance allowance scheme. (EMA) Young people in low income families relied on the EMA for funds for their books, and in some cases their travel expenses to college (British Youth Council, 2012). The distribution of the EMA bursary is now controlled by schools, training providers and colleges; young people feel that it is biased as they see it as another way for the Government to control their education when the young people should be making more decisions for themselves (British Youth Council, 2012). The NHS reforms will give 80% of the health budget to general practitioners to control and decide where they think health financial resources should be spent (DH, 2011).
The Strategy has a positive and negative influence on my practice as a school nurse. There are a number of areas for improvement which has been highlighted, such as promoting healthy eating in schools. This could happen by working more closely with school teachers but there would also need to have more resources put in place. These resources requires having a bigger budget to hire more school nurses, and also more funds to target young people to demonstrate to them, that they are not an age group which society undervalues and fails to appreciate as noted by the British Youth Council (British Youth Council, 2012). By means of additional resources, an increase in the amount school nurses could be hired and we would be able to offer a more effective service to young people and their families.
The Strategy recommended various ways of promoting sex and relationship education which is working, as records demonstrate the decreasing levels of teenage pregnancies and abortions for forty years (Office for National Statistics, 2010). This is advantageous as with the reduction of teen pregnancies the Government as one of the main policy makers, can implement more policies which should continue to highlight the needs of young people to help reduce health inequalities and promote their health and wellbeing (DH and DCSF, 2009). Young people attend and are admitted to hospitals all the time. The Strategy did not give enough information on how young people would be supported if they had to attend or be admitted to hospital; this could hinder my practice as not enough research has been conducted in this area.
The study conducted by Hilton and Jepson (2012), noted the importance of youth workers who could relieve some of the fears of young people and support them when and if they are admitted to hospital. More money spent towards the youth service signifies youth workers liaising and coordinating with school nurses working together to arrange schemes, work on leaflets or have an advice line for young people to contact school nurses. Presently we have a drop in clinic once a month but with more easily accessible contact services, young people would surely use the service if it was user friendly intended especially for their age group (British Youth Council, 2012).
The Strategy has recommended some valid points which can be implemented into my nursing practice as a school nurse; however there are some areas which have been demonstrated that are quite difficult to apply and facilitate without further resources and manpower to improve on the service which is presently in place for young people. Improvements have been noted and I am sure they will continue to improve while we have policy makers from different parts of the society such as the British Youth Council, who will continue to make society listen to the voice of young people.
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