What are the two most common causes of death?
Cancer and IHD
What is the name of the national action plan in Scotland for palliative care?
‘Living and Dying Well’
How do you know if a patient is at a palliative stage? (What tool is used?)
‘Supportive and Palliative Care Indicators Tool’
What is the overall goal of palliative care?
Emphasise quality of life
What should be considered when thinking about a patient’s palliative care and what they want?
Where do they want to be cared for?
Do they want resuscitation?
Who do they want informed of their care and changes in their condition?
Are they/their family fully aware of their prognosis?
Who is the palliative care team made up of?
Health and Social Care partnership
+ MacMillan nurses, CLAN, Marie Curie nurses
Religious groups
What might be considered ‘A Good Death’?
Pain-free
Acknowledgement of its imminence
At home with family and friends
No personal conflicts or unfinished business
In a manner that resonates with person’s individuality
What are possible different reactions to bad news?
Shock Anger Denial Bargaining Relief Sadness Fear Guilt Anxiety Distress
How is a patient’s current functional level in palliative care measured?
‘Palliative Performance Scale’
- has prognostic value
What are the social/socio-economic influences on our health?
Gender Ethnicity Housing Education Employment Financial security Health system Environment
How does the WHO define ‘Health Inequality’? What is the key determinant factor?
Differences in health status or in distribution of health determinants between different population groups
Deprivation is the key factor
What might you expect to see in the general health of children from deprived areas?
Low birth weight
Poorer dental health
Higher obesity
Higher rates of teenage pregnancy
What are some examples of ‘vulnerable groups’?
The homeless Those with learning difficulties Refugees Prisoners LGBT
What health challenges do the homeless face?
- Average age of death ~45
- Unnatural causes of death 4x more likely
- Suicide 35x
- Alcohol/drug problems increased
- Increased prevalence of infectious diseases
- Poorer oral health
- Decreased access to healthcare
What health challenges do those with learning difficulties face?
- Staff having poor understanding
- If learning disability hasn’t been formally identified
- Failure to recognise when those with learning difficulties are unwell
- Inadequate aftercare/follow-up
- Lack of joint working from different healthcare professionals
- Anxiety/lack of confidence
What health challenges do refugees face?
- Family integrity and social adjustments larger than medical issues
- Competing demands of distinct services such as social welfare, housing, education, transport, public health, mental health, primary care, specialty care
- Language barriers
- Previous poorly controlled chronic conditions
- exposure to violence/warfare
- prevalence of PTSD, depression, anxiety
What health challenges do prisoners face?
- High levels of alcohol use
- higher levels of smokers
- Less interest in socialising
- more drug use
What health challenges do LGBT face?
- Higher rates of depression - increased self-harm
What is the ‘Inverse Care Law’?
1971 - Julian Tudor Hart
‘Those who most need medical care are least likely to receive it, and conversely those with least need of health care tend to use health services more and more effectively
What range of factors can reduce health inequalities?
- Effective partnership across a range of sectors and organisations e.g. to promote health, improve patient education about health
- Evaluate and refine integration of health and social care
- Government policies and legislation e.g. smoking ban, Keep Well campaign
- Time to invest in the more vulnerable patient groups
- Improve access to health and social care services and professionals
- reduction in poverty
- social inclusion policies
- improved employment opportunities for all
- ensuring equal access to education in all areas
- improved housing in deprived areas
What is the difference between equity and equality?
Equality - everyone gets the same
Equity - everyone gets enough to bring everyone to the same level
What are the role of third sector organisations in health?
Provide a means of engaging effectively with communities and individuals
Deliver a range of services which may help to reduce health inequalities, including:
- promoting healthy living to groups of people who may not use mainstream services
- supporting people to access the relevant services of NHS Health Scotland
What are the benefits to individuals who volunteer?
Gain confidence Make a difference Meet people Be part of a community Learn new skills Take on a challenge Have fun
What factors may lead to global unsustainability? How might this affect healthcare?
Material inequality - rich getting richer Population and consumption - growing Resource depletion - oil, water Climate change Loss of biodiversity - animal depletion Crisis in healthcare - ageing population
