Community profiles are used and recognised as tools for development. They are found to be useful foundations for policy makers and also practitioners within a wide range of service and policy processes (Hawtin M, 2007, p1). These are most popularly used when identifying issues with crime figures or public health. However, they may also be used when identifying any geographical differences within certain areas and influencing local policies, procedures and resource development (Derbyshire County Council, 2014). In order to do this, community profiles contain a number of demographic characteristics such as; population and growth trends, age distribution, house hold size, unemployment rates, at risk groups, living arrangements and many more (Centre for Urban Transport Research, 2000, p4:2-4:3). For confidentiality reasons no names have been mentioned within this community profile therefore no consent was needed.
Smithies and Adams (1990, quoted in Jack K., Holt M: Community Profiling Article, 2008, p52) defined the community as ”people with a basis of common interest and network of personal interaction, grouped either on the basis of locality or on a specific shared concern or both.” This definition of a community demonstrates the variety within communities, therefore affecting how policy makers implement community profiles.
There are many reasons why a community profile is written. One of the main purposes is to enable service commissioners to target areas within communities that are most in need and make required improvements. This then benefits the local services and their users. In order to efficiently undertake in a community profile, it is firstly important to understand the reasons why it is been done, and what benefits it may essentially bring (Hawtin M, 2007, p12). By understanding the benefits a community profile may bring, and writing about these, it enables commissioners to understand health needs within their local area, therefore ensuring that the local community are able to deliver/provide relevant services to those most in need. In many cases, services may need reviewing and improving to provide better care and target areas most in need of the help. By doing this, service users are more likely to experience the benefits and this can be reviewed in future statistics or further community profiles.
Middlesbrough is a large town situated on the south bank of the River Tees only a few miles from the North Yorkshire National Park. From the 19th century, Middlesbrough was recognized as a major coal port and also a center for ironworks. Previously, it has also been known for its steelworks, and chemical plants (CSE, 2014).
According to census results in 2011 as shown in appendix three, Middlesbrough has an estimated population of 134,400 people. Of these, there were approximately 36,256 0-19year olds, and 28,222 people 60+. Overall, this was a 2% decrease from 2001 and this may have been influenced by many factors (Middlesbrough Council – Census 2011. 2014).
Middlesbrough has recently featured many times in the public eye for its high levels of alcohol misuse, and was recently named ”the worst area in the country for alcohol-related hospital admissions” (Mike Brown ‘ Gazette Live, 2014)
Due to the high levels of alcohol misuse within Middlesbrough, this will have an effect on local services such as hospitals, and rehabilitation centers etc. As a result, the town will then be disadvantaged due to financial implications.
Alcohol nationally causes approximately 22,000 preventable deaths per year and is costing the government ??7.3billion in alcohol related crimes and a further ??95million spent on specialist treatment. Within Middlesbrough alone, it has been estimated that 6,860 people are high risk drinkers, 3,773 are dependent drinkers, and there are 24,277 people becoming an increasing risk (Middlesbrough Council, 2014).
In circumstances like these where a health issue is having a considerable financial impact, a community profile may be beneficial if planned and written thoroughly and accurately. It enables service commissioners, and local authorities to explore services within the area in order to find out if the publics need are been met, assess the area’s most in need and make required improvements so that strategies can be put in place and implemented. Community profiles provide information so that resources can be proritised to make any funding or resources to the best advantage (Hawtin M, 2007, p13).
For Middlesbrough, a community profile in relation to alcohol would be beneficial in order to find out which services are most in need of improvement. Due to poor statistics in relation to alcohol misuse, the needs of the local community can also be assessed, ideas may be implemented, and new services introduced with an overall goal of improving statistics and reducing levels of alcohol misuse. A strategy for reducing the amount of alcohol misuse could be implemented and then reassessed over a period of time in order to track its progress. Community profiles help to build a better understanding of a subject. By having this greater knowledge, more precise and reliable improvements can be made within the community to contribute in combatting any issues. For Middlesbrough, these issues consist of high levels of alcohol misuse/dependency and alcohol-related hospital treatments required.
As stated previously, Middlesbrough has as estimated population of 134,400. Of these people 6.3% are of a different ethnic origin. Despite the high number of people living in Middlesbrough, from data in 2009 provided by Middlesbrough council, there were 58,100 households within the town. Looking back at the 2001 census, 61% of houses within Middlesbrough are owned by the occupier, 28% rent social housing and 7.1% private rent (Middlesbrough Council – Middlesbrough statistics. 2014).
From data collected in 2010 about the economy in Middlesbrough, 24% of people living in the area were benefit claimants 60.7% were in employment and 7.5% were receiving jobseekers allowance. Comparing the percentage of benefit claimants with Tees Valley at 20.4% and also the national average at 14.5% (as shown in appendix 4), Middlesbrough has a high level of unemployment which could be contributing to alcohol misuse within the town.
Looking at education results within Middlesbrough, 65% of students pass their GCSEs with 5 or more A*-C grades. In comparison with Tees Valley at 69% and the national average at 69.7%, Middlesbrough once again falls below these figures. (As shown in appendix 5). These results could further complement the alcohol misuse, but also the poor crime rates within Middlesbrough. Between 2010/11, there were a total of 108.5 crimes committed per 1,000 people in the town. Again, in comparison with Tees Valley at 0 and National crime statistics at 79.1 per 1,000 people, Middlesbrough comes out exceptionally high (Middlesbrough Council – Middlesbrough statistics. 2014).
Further exploring mortality rates and poverty, Middlesbrough once again shows poorer statistics compared to Tees Valley and the national average. Mortality rates under 100 suggest that individuals are likely to live longer. Both Middlesbrough at 106.8 and Tees Valley at 105.2 have poor results. The national average has a mortality rate of 100. This may be due to poorer living conditions/lifestyles. Middlesbrough is ranked 8th of all local authorities within England and Wales for being the most deprived, 1st being the worst. This will have an adverse effect on individuals’ health and their lifestyle (Middlesbrough Council – Middlesbrough statistics. 2014).
All of these factors together will contribute to Middlesbrough having poor statistics and change the way individuals living here are able to adapt their lifestyles for the better. Changes need to be made with the help of better services and increased knowledge in order to see a change within these numbers. This can be done through the use of a community profile. Each target area should be explored individually and improvements made accordingly.
Due to alcohol misuse being one of the main areas that is in desperate need of improvement within Middlesbrough, it is first essential to understand why and how alcohol leads to poor health, as well as what can be done to prevent its misuse. Often, individuals may use alcohol if they have any problems in their lives. Alcohol is a form of drug and can easily become addictive. Drug use is seen as a response to social breakdowns and a large factor for poor and/or worsening health (Wilkinson, R.G and Marmot, M.G. 2003. p24).
Alcohol has effects on the brain over a period of time with high consumption. Unfortunately, adolescents are more susceptible to the damage, however this is not to say that the adult brain cannot also be affected (Dasgupta, A. 2011. p10). It also has more noticeable effects often as the addiction takes over. This may include poverty, cravings. One of the most serious complications of alcohol misuse is often malnutrition. This is often due to the individual not eating enough to nourish their body. (Kessel, N and Walton, H. 1969. p30).
Chapter Two
According to statistics and media attention, alcohol misuse in Middlesbrough is currently at a high. This suggests that alcohol may be a local health improvement issue. With alcohol being such a large issue within Middlesbrough at the present time, local services and its users may benefit from a community profile in order to identify areas for improvement. Many people who misuse alcohol end up in hospital and within the last year out of every 100,000 of Middlesbrough’s population, 3,280 people were admitted to hospital. This is the highest statistic across England (Mike Brown ‘ Gazette Live, 2014).
A health improvement issue is an area that would benefit from health promotion and improving services provided. The World Health Organisation quoted ‘health promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.’ (WHO | Health promotion. 2014.)
With alcohol been such an issue, it has a large impact on services provided in Middlesbrough both physically and financially. There is strain on the services to provide affective care whilst in high demand. As a result of this, there are cost implications for use of treatments, equipment and time. If the level of alcohol misuse were to be reduced, this would create some relief for services working hard to accommodate. In order to reduce the levels, a community profile is beneficial in order to ascertain where the issues are within the local community and put strategies in place.
Yearly, across the country, alcohol misuse is causing the NHS approximately ??3.5billion (The National Treatment Agency for Substance Misuse. 2014.) Due to this, areas with high levels of alcohol misuse, such as Middlesbrough are forced to put into place and commission alcohol services in order to prevent/treat alcohol misuse.
Looking at the epidemiology of alcohol demonstrates why people may turn to alcohol and what effects it may have on them. Frequent heavy drinking can have many negative effects on the body and a person’s health and these may ne short or long term. Some impacts alcohol can have on a person are academic problems, social isolation, physical illnesses such as hangovers or illnesses, memory problems and an increased risk of mental health problems leading to suicide (Galanter, M et al. 1983. p1).
Alcohol starting becoming a rising problem in the 1800s, and the first self help groups were introduced. By the 1930s alcoholics anonymous had been founded and alcohol misuse has continued to grow since (Rose, M.E. and Cherpitel, C.J. 2011. p3)
Chapter Three
Within Middlesbrough, there are a number of services available to those within the community for suffer from alcohol misuse. With these in place, a long term goal is to reduce the amount of individuals reliant on alcohol, to change and improve their lifestyle for the better.
One of the services available to service users is the Middlesbrough Alcohol Treatment Service based in North Ormesby. This service aims to offer advice to its users, provide information and also treatment for alcohol misuse. They aim to do this by offering rehabilitation and detoxification referrals, as well as hepatitis vaccinations. Not only does this service provide care for the individual suffering from the alcohol abuse, but it also offers support to the families of those in need and dealing with the repercussions. This is affective because it takes a holistic approach to the care of the individual as well as their families (Middlesbrough Council – Help with alcohol. 2014.)
The Albert Centre in Middlesbrough are also specialists in providing treatment to those people who are experiencing addiction and struggling to manage it themselves (Middlesbrough Council – Help with alcohol. 2014.) In order to provide person centered care, the Albert Centre provides tailored packages within a community based intervention strategy. Initially, clients who are referred here will be assessed by the center in order to establish how much alcohol they drink, dependency levels and any reasons behind why they may drink. They are then allocated to a support worker who works one to one with the individual and starts to develop a recovery plan. From here, the support worker and the individual discuss and implement any interventions. These may consist of self-motivational tools, worksheets or other exercised to assist the recovery process. Along-side this, the Albert Center provides counselling sessions, alternative therapies, and peer led recovery groups on a support basis. Educational classes are also available to improve awareness around alcohol and the affects it has on stress, health, motivation, confidence and also differing behaviours. Upon reducing the alcohol to a safe level or completely cutting it out, services users are placed on an exit package which includes information and guidance about maintaining recovery (The Albert Centre. 2014).
For those younger individuals who suffer from alcohol misuse, there is a service called ‘Platform’ within Middlesbrough specifically for young people under 18 years. This demonstrates a clear understanding between the different types of treatment required for adults and adolescents. Often younger people are more vulnerable and need different methods of care for it to be effective. Platform aims to give help support and advice about alcohol misuse and works towards a harm reduction approach for the individual, their families and the community (Platform Middlesbrough. 2014).
A voluntary provider for alcohol misuse is the Middlesbrough Hospital based Primary Alcohol Drug Service, otherwise known as PADS. There are two full time substance misuse workers who are based in A&E of James Cook University Hospital and visit specific wards within the hospital to receive referrals. Both these workers are each trained in counselling and motivational interviewing. They are each able to offer every patient holistic patient centered approaches. Each individual will benefit from this greater than a general approach for someone who comes under the label of alcohol misuse. The substance misuse workers embark in a detailed assessment of the individual which can often identify the underlying causes resulting in the patient drinking. They both motivate the patient to get themselves help from community services but also refer and advocate on their behalf (Public Health England. 2014).
Within the hospital there is also an Alcohol Liaison Nurse who works with the patients specifically admitted to wards and experience alcohol withdrawal symptoms. They will often work in partnership with the community treatment agencies ensuring that any prescribed treatment in hospital compliments the treatment received in the community. This then makes the transfer between community and hospital setting a much easier one especially for the patient who is likely to be finding it hard enough (Public Health England. 2014).
Of these groups, some are volunteer led; such as the service for young people. This means that they are non-statutory. Non statutory services are service providing bodies that are not legal entities in their own right, however they are accountable for the care they provide (Non-statutory organisations | NHS Brand Guidelines. 2014). This, on the other hand means that a statutory service is one provided by the local authority. For individuals suffering from alcohol misuse and seeking help from one of these non-statutory service provisions, clients may often feel empowered as if they are in charge of their own recovery. This may be due to relationships being less formal and no direct authorative figure.
Chapter Four
The role of a nurse in facilitating health care and meeting the needs of each individual is very complex. There are many strategies in place, guidance, codes, laws and legislations. A nurse has to be extremely thorough in the care that he/she provides. As quoted by RCN, nursing is ‘the use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.'(Royal College of Nursing. 2014. p3)
The purpose of nursing is promote health, wellbeing, and to prevent disease, injury, illness or disability. When a person or their families require nursing interventions, the nurse’s role is to minimise distress, pain and suffering. It is also to provide information in a way that the patient can understand in order to help them understand and cope with their illness/disease. If death is inevitable, the nurse should maintain the best quality of life until the very end (Royal College of Nursing. 2014. p3).
Nursing interventions should empower their patients. This helps them to achieve or maintain independence and make the patient feel like they are involved in their care. Nursing is built up of intellectual skills, physical skills and emotion. Nurses need to provide personal care and therapeutic interventions. However, nursing isn’t just about personal care, it’s also about teaching, policy and knowledge development and management (Royal College of Nursing. 2014. p3).
There are many more characteristics of nursing including unique responses to health, illness. A patient’s response may be psychological, physiological, social, cultural or spiritual. Sometimes even a combination of these. Nurses need to be able to deal with all aspects of these. The focus of a nurse is the whole person, rather than just a specific illness or injury. Nursing is focused on ethical values, respecting dignity, being non-judgmental and having empathy. Nurses should also respect autonomy, confidentiality and always be accountable for their actions. Finally, a nurse must be committed to what their practice and partnership with patients, relatives, carers and as part of a multi-disciplinary team (Royal College of Nursing. 2014. p3).
In order to maintain these professional standards at all times, the Nursing and Midwifery council (NMC) put together a code of conduct. This is very similar to the points listed above about how a nurse should act by treating people as individuals, respecting people’s confidentiality, collaborate with those in your care, gain consent before doing anything and always maintain clear and professional boundaries (Nursing and Midwifery council. 2014). The code also states that nurses should share information with their colleagues, work effectively as part of a team, delegate and manage risk. All of this can be achieved by using the best available evidence, keeping skills and knowledge up to date and maintaining clear, accurate up to date records. Every nurse should act with integrity, deal with any problems that may arise, be impartial and uphold the reputation of nurses (Nursing and Midwifery Council. 2014).
Throughout the ages from birth to elderly, every individual will need caring for at some point. This means that care will have to be adapted to suit the requirements of this individual. Even if you aren’t directly caring for an individual, it is likely you will come across friends and family within nursing across the age continuum and it is essential that skills can be adapted appropriately.
In order to ensure care across the age continuum is implemented, the government introduced a strategy ‘making every contact count.’ This involved using every day opportunities to help improve people’s health and reduce inequalities. For example, a routine dental appointment could be an opportunity to offer advice about stopping smoking. Another example could be a visit from midwife/health visitor which then leads to a discussion about anxieties or fears the family may have and what sort of support is available (Shoni A and Bailey V. 2014).
Once an individual has a great understanding and knowledge of a subject, this then sets in motion change contemplation, even if they never act on it. Many models have been put into place about the stages of change, one of which being done by Prochaska and DiClemente (see appendix 6). This model suggests that each person goes through five stages before making a change.
The first stage of this model suggests pre-contemplation. An individual in this stage doesn’t see an issue; however others may not approve of their lifestyle and may offer suggestions. The second stage is contemplation. This is where the person starts weighing up the pros and cons of changing before coming to a decision about whether they are ready to make the change. Active changes are the next stage and this is where any decisions made are put into practice. Sometimes individuals find this too difficult initially and will often take an easy way out. In order to keep the change, it has to be maintained. For some, they will have changed their behavior and possibly never go back, however some will relapse and return to their previous behaviours. After this the cycle starts again.
Often, lifestyle may lead to poorer health and have effects on access to services. Approximately 1.2billion people round the world are living in extreme poverty. Ill-health is caused by poverty because people are forced to live in environments that make them ill. For example, damp and mold are bad for chests (WHO | Poverty and health. 2014). Not only this, but a person living in the country side with no method of transport may struggle to access services and therefore they may not seek the care or treatment they require.
Another method of ensuring patients get the correct level of care is through primary, secondary and tertiary prevention. Primary prevention is about educating the person in the hope of preventing the illness/disease occurring. Secondary prevention is implemented during the early stages of the disease and is the intervention to try and slow down or prevent the disease becoming worse. Tertiary prevention aims to reduce the impact the disease has on the person and aim to promote a good quality of life through rehabilitation (Department of Health – Publications. 2014).
Chapter Five
In conclusion it is clear that Middlesbrough has a high rate of alcohol misuse and that it is causing problems and strain within the local community and services. It is also having large financial implications. By doing a community profile, it makes it clear to recognise areas for improvement, and implement strategies in order to do so. Over a period of time, the aim would be to reduce the levels of alcohol misuse within Middlesbrough, therefore freeing up services, time and money.
Alcohol misuse has been on the rise since the 1800’s and was once seen as a social activity. As years have gone on, people have begun to misuse alcohol and have started using it as a form of release if they feel things aren’t going to well in their life and many other factors. An overall strategy to increase knowledge about the effects of alcohol and reduce the number of people misusing it is been set in place. Areas most in need can be reviewed using a community profile and make improvements to services accordingly.
There are a number of services within Middlesbrough to help raise awareness, increase knowledge and try prevent alcohol misuse. The services are aimed at a wide range of age groups and offer support to those suffering in the hope of cutting down the alcohol, or completely cutting it out of their lifestyle.
The role of a nurse plays a large factor in building relationships and maintaining trust when caring for individuals. Confidentiality, autonomy, empowering patients and many more interventions build up the bond between the nurse and the client so that care can be delivered more effectively and accurately.
Overall, the benefits of doing a community profile in order to establish areas of services most in need of improvement are highly beneficial to the local community.