The Contemporary Health and Social Care Policy Essay Example

common as all types of cancer combined. It Is fast becoming the 21st century's major public-health concern.

The risk of diabetes soars as the pounds pile on: a rise In IBM from 21 (healthy) to 35 (obese) means you are 50 to 80 times more likely to develop type 2. " (Henley, The Guardian).

The World Health Organization WHO) is the authority on health for countries in the united Nations, setting standards for the research agenda for these countries by gathering statistics and information that pinpoint the greatest health threats. The WHO collects and stores millions of pieces of data about health that help it to discover and forecast trends in diseases, helping spot developing epidemics.

The World Health Organization state that about 347 million people worldwide have diabetes, there is an emerging global epidemic of diabetes that can be traced back to rapid Increases in overweight, obesity and physical Inactivity. Diabetes UK are a leading charity that support people with diabetes, they Influence governments, pollen formers, healthcare professionals and health services to ensure that people with diabetes get the standards of care they deserve and that the wider public is aware of how to reduce diagnosed with diabetes in the UK has increased by more than 150,000 to 2.

Million in the past year. The data, collected from GAP practices, also show the nationwide figure of people registered as obese to have risen to over five and half million, an increase of more than 265,000. This now means one in 20 of the population is being rated for diabetes and one in ten for obesity. (Diabetes I-J 2012).

This massive increase in the population

of people newly diagnosed with type 2 diabetes is going to have a profound effect on the National Health Service (NASH) and health care provision.

Type 2 diabetes is a long term condition, (Matthews et al 2009) that is traditionally managed in the community in primary care setting, this is usually in general practice surgeries (Gaps) across the country. (Griffin& Kinkajou 2005). Beginning in the early sass's General Practitioners (Gaps) in the I-J developed diabetes clinics in their practices. This was followed by the 1990 GAP contract and the SST Vincent Declaration encouraging Gaps to take more responsibility for diabetes care.

The 1997 GAP contract provided further incentive for this, and primary care organizations were established gaining a realization that it was important to apply best evidence to primary diabetes care. The United Kingdom Prospective Diabetes Study was a stimulus for Gaps to improve care and moved the emphasis of care from merely blood sugar management to the broader cardiovascular risk assessment in people with diabetes. Following on from this the Scottish Intercollegiate Guideline

Network, National Institute for Clinical Excellence (NICE) and American Diabetes Association produced guidelines for diabetes management setting out best practice. The four nations in the I-J proceeded to publish National Service Framework (NSF) documents outlining best practice.

In 2003, Gaps voted for a new General Medical Services contract, announcing formalized payments for quality work in practice and encouraged Gaps and their practice nurses to follow protocols adapted from these guidelines and NSF and apply best evidence to their patients (Houghton 2011). The

Quality and Outcomes framework (GOFF) formed a positive impact on the number of people receiving diabetic care and testing

with measuring blood glucose, blood pressure and IBM. (20TH). This care included annual screening for complications associated with diabetes and achieving a certain percentage of people with diabetes who cholesterol is below the governments targets (Kenny 2004). This is Just one example of how the Government and its policies have a direct impact on practice delivery and service.

The National Institute for Clinical Evidence (NICE) in the United

Kingdom (I-J) is an independent organization that is responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. (NICE 2012). NICE develop and update various guidelines for diabetes care and produce resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice. Patients and healthcare professionals have rights and responsibilities as set out in the NASH Constitution for England - all NICE guidance is written to reflect these.

Treatment and care should take into account individual needs and preferences allowing individuals the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. Involved in the care of the newly diagnosed diabetic will given the best possible care, education and encouragement to be actively involved in managing her diabetes. Coupled with this will be National and International guidelines that set the standards of care that should be delivered (McDowell 2009).

However although standards of care are set for Marlene through policy and protocol t is important to remember that she has her own individual care needs, these must take into account for example her lifestyle and

her culture.

Tall times Marlene should be involved in her care and self-efficacy be prompted at all times, this should encourage Marlene to comply with treatment and become aware of the steps she can take to improve and control her Diabetes. (McDowell 2009). Diabetes mellitus is a chronic condition characterized by hyperglycemia due to deficiency or diminished effectiveness of insulin.

This can result in a disorder of carbohydrate metabolism. Irreversible tissue damage can be caused mainly due to or metabolic control. Type 2 diabetes is usually associated with obesity , and as such peoples body tissues becoming resistant to the effects of insulin, therefore causing an elevation of blood glucose (Ross and Wilson 2010), similarly The World Health Organization (WHO), 1999 state that Hyperglycemia is recognized by a chronic increase in blood glucose with disturbance of carbohydrate, protein and fat metabolism.

WHO 1999). In normal physiology the pancreas which is a small gland found in the abdominal cavity, Just behind the stomach, synthesize and secretes insulin for the beta cells found in the islets of Lanterns. It does this in response to an increase in blood sugar. Most cells in the body have insulin receptors which bind the insulin to the cell.

When a cell has insulin attached to it, the cell is able to activate the other receptors.

These receptors are designed to absorb glucose from the blood stream and move it to the inside of the cell for energy. Blood glucose levels are maintained within a tight range because there is a balance between glucose entering the blood stream from the liver and after intestinal absorption (after meals) and glucose uptake into the

muscles. Normally in homeostasis control, when glucose enters our blood stream the pancreas automatically produces the right amount of insulin to move glucose into our cells. Hugh et al 2001 .

Type 2 diabetes mellitus is characterized by the failure of the tissues to take up that glucose and this is called insulin resistance. Initially the pancreas manages and produces more insulin. Eventually over time the pancreas can no longer produce the amount of insulin needed to overcome the insulin resistance (Bullock et al 2010) People with Type 2 Diabetes may be unaware of their illness for many years because symptoms may take years to appear or be recognized.

During which time the body is damaged by excess blood glucose and other co-morbidity's may result if the condition is not controlled. (Hugh et al 2001) According to the Department of Health when initially diagnosed with diabetes, Marlene should be offered a full medical examination and be given information about her condition this should include information on available treatments as well as education from a specially trained nurse.

Additionally Marlene should be offered dietary advice from a registered dietician or a nurse specially trained in dietary advice.

Following her diagnosis, Marlene should be given the Asia facts necessary for the initial management of her diabetes and education to incorporating the basic supportive information on the nature, symptoms and outcomes of her diabetes and the risks associated with it (DOD 1996). In the (DOD) White Paper (1996), Primary care was described as the NASH most people see - the NASH, the family doctor and their team, community nurses, therapists as well as pharmacists, dentists and optometrists play

key roles in the treatments and care of people with type 2 diabetes.

Plans set in place by this paper have expanded the role of the nurse in learning further skills, such as prescribing medication, and also expanded the role of the practice nurse to take on referrals from people who would have ordinarily seen their GAP. (DOD 1996).

Marlene should receive information about how diabetes will affect her work and other areas of her life, for example her ability to drive, or her health insurance, Marlene should also be offered information on support groups who have in depth knowledge of diabetes and its accompanying issues. (DOD 1996).

Knowledge is one of the best tools for managing diabetes, for this reason, there are a number of structured education courses that have been set up to help Marlene understand and manage her diabetes. Histologist). In the I-J, the Department of Health (DOD) has set clear goals for diabetes care and who should be involved in its delivery.

Participating in the provision of Marten's care should be, the practice nurse at Marten's Gap's surgery who should carry out her routine blood tests, observations, monitor her height, weight and blood pressure as well as kidney function.

The nurse should also be able to offer health promotion education and advice. Marlene was also referred to the Help to Quit service and was prescribed blood pressure medication and lipid lowering drugs as per NICE guidance on diabetes treatment. The practice nurse should also refer Marlene to her GAP if her blood sugars are not controlled with diet alone and if Marlene needs to be offered some sort of glucose reducing

medication. (McDowell 2009).

Others involved in Marten's care will be the Podiatrist or Chiropodist who will offer Marlene foot checks every year, to check for a condition called diabetic enumerator, a condition that can cause damage to the nerves triggered by diabetes, which can lead to lack of sensation and poor skin healing (Fox 2009).

Marlene should be referred too dietician for dietary advice and help with her weight loss incorporating healthy eating plans.

Marten's practice nurse was a diabetic specialist nurse so she was able to offer Marlene all the advice she needed and help her with weight loss and healthy eating and so Marlene did not have to see the dietician. Marlene should also have annual eye screening from an optometrist, who would look for the signs of diabetic eye disease called reiteration which happens when the retina and small vessels behind the eyes get damaged by uncontrolled diabetes (Haughtier).

In Marten's surgery her Diabetes is monitored with a bi-annual review as set out by NICE guidance. NICE suggests that routine check-ups to should be carried out to determine if Marten's treatment is satisfactory and to look out for any evidence of longer-term complications developing. According to WHO, Marlene should be receiving checks of the following , weight, blood pressure, vision and eyes, legs and feet, urine for protein, Hibachi levels in her blood.

Unfortunately Marlene did not get a call from her doctors surgery for her bi-annual review and Marlene therefore thought that she had been right all along and they had discovered she did in fact not symptoms of her diabetes some fifteen months after her initial diagnosis that Marlene revisited

her GAP. By this time Marten's diabetes was not well controlled and her blood sugars were found to be 12. 6 at her fasting blood test. Diabetes I-J suggests that Marten's Hibachi should be less than 58 mol to prevent the risk of severe hypoglycemia.

Habit levels can be sought from a simple blood test and indicates your blood glucose levels for the previous two to three months. The Habit measures the amount of glucose that is being carried by the red blood cells in the body. (Diabetes I-J 2012). Marten's Hibachi result showed the Practice Nurse that her diabetes had not been controlled for some time. Marten's practice nurse helped to empower Marlene and encouraged her to control her diabetes by educating Marlene about what she could and should not eat. The practice nurse also offered Marlene the chance to enroll onto a structured education course called the x-pert patient programmer.

The X-PERT course is aimed at anyone diagnosed with diabetes. The course has been shown to improve long-term control of diabetes and gives you the confidence, tools and techniques to management your condition more effectively, teaching Marlene all aspects about diabetes. The programmer offered Marlene education on how be aware of carbohydrates, the benefits of physical activity, how to at well and how to reduce her alcohol intake. The course was run over 6 weeks with each session lasting two and a half hours in her local community centre.

The trouble for Marlene was that the sessions ran when she had to do her part time evening Job and she was unable to attend all of them.

Marlene managed to go to one

X-pert patient class only and felt that although this was a good idea, it did not fit into her lifestyle because of her difficulty in attending the classes. (Brine 2007) Marlene had not seen her practice nurse for over 15 months and was starting to feel unwell, she turned to her Gaps because she was extremely tired and suffering from blurred vision and tingling and numbness in her feet.

She had not received any foot or eye care and had not been called for her diabetic blood tests. It transpired that Marlene had been wrongly coded into her practice computer software database and therefore was not registered as a diabetic. This meant that no referrals or bi annual checks had been organized as the system used in her Gaps practice used an automated appointment system.

This structure of recall had failed Marlene as this wrong coding was a result of human error. In the future it might be wise if patients are even a pre-dated appointment so that they are not relying on databases to send out automatic appointments.

I feel Marlene was also a little let down by the Practice Nurse because I don't think she was able to make Marlene understand the importance of contacting her Dry's practice and maintaining regular reviews with the practice to help to keep Marlene well and control her blood glucose levels. Conclusion Diabetes is now of epidemic proportion, and despite all of the protocol, policy and procedure developed to help alleviate this epidemic, it seems that we are still failing people at the most basic levels.

Fundamentally Marlene was not made aware of the importance and seriousness

of her diagnosis of type 2 diabetes.

I feel that her doctor's surgery did not provide a thorough assessment of Marten's comprehension circumstances very thoroughly and seemed to lack some knowledge of how to help Marten's understanding. Although I appreciate It would be impossible for the practice to check and make sure that everyone on its practice list was followed up as they should perhaps be, some responsibility falls with the patient. It is important that people diagnosed with a chronic condition are made aware that they are equally expansible for their care as well as the health care professionals that they come into contact with.