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107 Cards in this Set
- Front
- Back
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In what year was the Beveridge report published? |
1942 |
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What is medical pluralism? |
More than one way of explaining and treating illness |
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What are the 3 sectors of healthcare?
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Professional, folk, popular
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What are the 2 levels of medical pluralism? |
State and non-state |
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When is non-state/folk medicine systematized? |
After the introduction of biomedicine |
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What was the Beveridge report? |
published in 1942 defined 5 areas needed to be supported by eventual welfare state squalor, ignorance, want, disease, idleness |
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What is the role of the Secretary of State for Health?
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Acts between department of health and PM |
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What portion of the budget goes to CCGs? |
65bn/100bn |
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What is the role of CCGs? |
200 of them, commission services locally Composed of GPs, nurses doctors and public improve health of their bit of pop commission/buy services from hospitals, mental health services, community health services, private and voluntary sectors all registered with CQC and monitor |
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Which bodies support the CCGs? |
Commissioning support units, about 20 of these, some contract management, technical things etc. contract negotiating clinical senates, containing hospital specialists to help GPs in commissioning complicated services |
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What is the role of NHS England? |
Separate to CCGs, offshoot to department of health Commission GP services specialist commissioning (services for small number of people) commissioned regionally/nationally |
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How many people employed in NHS England? |
4000 central office in Leeds 4 regional offices 25 area teams |
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Who controls public health and its budget? |
Local governments Public health england |
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What is another key role, aside from controlling public health budget, of local government in healthcare? |
Health and Wellbeing boards bring together local councillors and others key players in health and social care systems. talk to CCGs and electorate. SOCIAL Care |
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What is healthwatch? |
exist at national and local level responsibility of local government to set up represent views of patients and for people to engage in how services are planned |
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Which services are available in addition to A&E for urgent health care? |
Minor injuries unit walk in centre GP surgeries urgent care centres |
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NHS 5 year forward view: what are the key challenges faced by NHS? |
Cancer, mental health, care for frail elderly patients |
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NHS 5 year forward view: what is the first argument set out in the 5 year forward view? |
Big improvement in prevention to sustain NHS in future future health of millions of children affect how much Britain has to spend |
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NHS 5 year forward view: what adjustments have been made to ensure that same care is not used for everyone? |
local health communities choose from a small number of new care delivery options, given their own budget one option is multispecialty community provider; GPs, nurses, community health services, hospital specialists, and some mental and social care create out of hospital care another is Primary and Acute Care system; joined hospital and primary care system |
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NHS 5 year forward view: how will urgent and emergency care services be changed? |
GP out of hours A&E urgent care centres NHS 111 ambulance services all joined |
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NHS 5 year forward view: how will smaller hospitals be affected? |
Partnerships with hospitals further away partnering with specialist hospitals to provide local services |
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NHS 5 year forward view: how will midwives be affected? |
Options to take charge of maternity services they offer |
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NHS 5 year forward view: what was Derek Wanless' report? |
Written 12 years ago 'securing good health for the whole population' not focusing on prevention would increase avoidable illness |
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NHS 5 year forward view: how is prevention going to be improved? |
Hard hitting action on obesity, smoking and alcohol advocate for more public health power to local governments and local mayors develop and support new ideas in workplace to hel employees health and sickness related unemployment |
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NHS 5 year forward view: how will it affect carers? how will patients choice of care be affected? |
more support to 1.4m unpaid carers (NHS better partner with charities and local organisations) patients given greater control over their own care - shared money to join health and social care |
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NHS 5 year forward view: what is the second argument? |
break down barriers in how care is provided between family doctors and hospitals between physical and mental health and health and social care more care delivered locally specialist centres treat for multiple conditions |
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NHS 5 year forward view: how will budget change in next 2 and 5 years? |
in 2 years same amount of money to fund GP more money to fund primary care in next 5 |
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NHS 5 year forward view: how will role of CCGs change? |
More control over budget |
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NHS 5 year forward view: how much of a deficit has NHS England and Monitor predicted? |
30bn a year by 2020/21 |
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NHS 5 year forward view: what are the main ways by which the NHS intends to meet deficit? |
prevention new care models social care services |
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What is the 2014 Care Act? |
You have to pay for care and social support provided by council if you have enough money based on means testing |
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How does the experience of pain relate to the social gradient? |
Those in lowest income quintile (of equivalised household income) more likely to have more limiting chronic pain grades (3 and 4) and less likely to have lower intensity pain (grade 1) than those in highest quntile |
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What is arcus lipoides? |
white ring in front of iris due to hypercholesterolaemia |
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What are the major CVD risk factors identified by the Framingham heart study? |
High blood pressure high serum cholesterol obesity diabetes inactivity |
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What are related CVD risk factors? |
Blood HDL levels and triglyceride levels age gender psychosocial issues deprivation ethnicity |
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List the 10 social determinants of health. |
social gradient - life expectancy varies across different socieconomic grades addiction food security transport early life social exclusion (discrimination) social support stress work unemployment |
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What is the ecosocial theory? |
Explains distribution of health including health inequalities based on causal pathways operating at multiple levels and in historicla context emobied consequences of societal and ecological consequences manifest as population distributions how does social position affect health emobiment, pathways of embodiment cumulative interplay of exposure, susceptibility and resistance accountability and agency |
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What are the 2 models of social class? How do they differ? What was the Registrar General Classification? |
National statistics- socioeconomicc classification (NS-SEC) (1970s)
Great British Class survey (takes into account culture) (2011) 5 classes - was the gold standard - professional, etc. |
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Describe the NS-SEC model of classification. |
higher managerial and professional lower managerial and professional intermediate occupations small employers lower technical semi routine routine unemployed |
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Describe the GBCS model of classification. |
Elite established middle class technical middle class new affluent traditional working class emergent service worker precariat |
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What is DALY? What was associated with greatest loss in DALY in 2013? |
Disability adjusted life years - burden of disease based on years of life lost due to illness low back pain |
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What was associated with greatest loss in life years in 2013? |
Ischaemic heart disease |
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What does the cost-utility analysis of a treatment rely on? |
Look at improvement in quality of life over time (area is quality adjusted life years) treatment will improve quality of life and quantitiy of life, increasing number of QALYs |
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Describe life expectancy of those living in poorest areas of England compared to those in the richest? |
Die 7 yrs earlier |
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Describe difference in disability-free life expectancy between poorest and richest neighborhoods? |
17 yrs |
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Describe how the rate of multiple unhealthy behaviours has changed? |
Decreased overall not in poorest areas |
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How much more likely are those who engage in smoking, drinking too much, exercising too little and eating poorly to die within next 10 yrs? |
4x |
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What is the cause of 40% of loss of DALYs? |
tobacco overweight high BP little activity |
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What is cultural humility/sensitivity? |
Normalising culture of people that you treat |
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Describe how class affects prevalence of unhealthy behaviours. |
high class - better diet, less activity, more heavy drinking?, less smoking |
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Define an asylum seeker. |
someone fleeing persecution and applying to Home office for asylum |
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Define a refugee |
Asylum application granted after fleeing persecution |
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Define an irregular migrant. |
arrived in UK and not made themselves known to authorities or not complying with terms of leave |
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What is the difference between an irregular migrant and an illegal immigrant? |
Most irregular migrants havent broken criminal law, just havent followed administrative protocol |
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Describe the 2 parallel frameworks for legal protection of refugees. |
1951 Refugee Geneva convention: refugee is someone who due to fear of persecution based on race, religion, nationality, member of social group and unwilling to avail himself to country 1950 European convention on human rights no one subject to torture (article 3), right to respect for private and family life (article 8) |
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Describe the asylum application process. |
Application and screening to check for previous application - SCREENING interview SUBSTANSIVE interview - asylum discusses story successful - 5 years leave, full entitlement as UK citizen OR humanitarian prtoection based on ECHR granted discretionary leave (article 8) for 30 months, cant clame benefits indiscretionary leave, citizenship a year after if refused, right to appeal, forced removal, voluntary leave |
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What are the positive outcomes of asylum application? |
refugee status humanitarian protection discretionary leave indefinite leave |
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What are the negative outcomes of asylum application? |
Forced removal right to appeal voluntary return challenges to removal |
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Describe 8 problems in healthcare for migrants. |
language barriers cultural difference negative view from staff and other patients dont understand healthcare system social depravation no medical history no health care coverage |
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Describe 7 good practices in healthcare for migrants. |
good interpreting services positive attitudes among staff education about care entitlements for diff groups of migrants cultural humility organisational flexibility |
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Describe the migrant entitlement to healthcare. |
'no recourse to public funds' does not apply to NHS, so access to primary care is free secondary care charged for some migrants (not asylum seekers/refused seekers accessing support from national assistance act (s21), care act or s95/s4 STI, infectious disease, due to violence, family planning, torture, FGM dont charge if patient didnt come seeking treatment |
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Describe the attributes of effective physican-patient communication. |
effective questions lead to immersion in conversation lead to active listening lead to negotiating |
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Describe rate of Hep C in homeless compared to normal population. |
50x higher |
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Describe rate of TB in homeless compared to normal population. |
34x higher |
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Describe rate of HIV in homeless compared to normal population. |
2-20x higher |
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Describe rate of A&E attendance in homeless compared to normal population. |
5x higher |
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Describe rate of hospital admission in homeless compared to normal population. |
3x higher |
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Describe hospital cost of homelesscompared to normal population. |
8x higher |
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Describe average age of death in men and women in homeless compared to normal population. |
47 men 43 women |
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Describe rate of drug/alcohol death in homeless |
1/3 |
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Describe rate of suicide in homeless compared to normal population. |
9x higher |
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Describe rate of RTAs in homeless compared to normal population. |
3x higher |
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Describe rate of infections in homeless compared to normal population. |
2x higher |
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Describe likelihood of asthma in homeless compared to normal population |
2.5x |
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Describe likelihood of heart disease in homeless compared to normal population |
6x |
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Describe likelihood of stroke in homeless compared to normal population |
5x |
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Describe likelihood of epilepsy in homeless compared to normal population |
12x |
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Describe likelihood of co-morbidity in homeless compared to normal population |
5x |
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Describe onset of functional impairment in homeless compared to normal population. |
10-15yrs early |
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What % of homeless people receive Hep C treatment? |
3% |
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What is meant by the term 'trimorbidity' referring to homeless patients? |
Addiction, mental health, physical health |
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What has led to an increase in number of homeless? |
Increase in evictions (linked to bedroom tax, no longer get subsidy for spare room) Cuts in homeless hostel beds reduced housing stock in London |
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Give 4 examples of how homeless people "fall through the cracks" |
GP registration policy requires a home attitudes of staff to homeless communication difficulties formality of environment |
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What is the largest cause of disability in the UK? |
Mental health |
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How much more likely are people with mental issues to be in debt? |
3x |
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What % of people in problem debt thought that their mental health got worse? |
9/10 so 90% |
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What are the economic and social costs of mental health problems in England? |
£105bn/year |
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What is the difference between absolute and relative poverty? |
absolute: Severe depravation of basic needs - depends on access to services as well relative: living on less than X% of average UK income |
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What is the Marmot curve? |
Relationship between income deprivation and life expectancy, life expectancy decreases with income deprivation between 1993-2003 and 2006-2010 curve is flatter housing deprivation, employment, fruit and veg, binge drinking also linked to life expectancy |
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What is the public health outcomes framework? |
sets out indicators for trends in public health looks to improve wider determinants of health |
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What are 7 indicators which citizens advice can tackle? |
1. children in poverty 2. sickness absence 3. social isolation 4. digital inclusion 5. statutory homelessness 6. domestic violence 7. fuel poverty |
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What is Citizens advice? |
NAtional charity which provides advice/information |
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What are the top 4 enquire areas for citizens advice? |
Benefits, debt, housing and employment |
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What % of their time do GPs spend dealing with social issues? |
19% |
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What % of GPs felt adequately able to deal with social issues? What % signposted to external agencies? |
31% 84% |
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What are the 6 core principles of working with patients? |
people as assets building on existing capabilities facilitating rather than delivering mutuality and reciprocity peer support networks break down barriers between professionals and recipients |
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What are the 4 principles behind treating patients as partners and leaders? |
co-design --> patients involved in commissioning co-decision making --> allocation of resources co-delivery --> role of users in providing service co-evaluation |
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Describe the ladder of patient involvement in the NHS. |
patient leadership: co-produce, co-design patient influence: engage, consult, inform passive patient: educate, coerce |
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Describe how money can be linked to mental health. |
financial contributions improve depression, anxiety and sense of self |
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What was the whitehall study? |
established 1997 18k civil servants men inverse association between social class based on emplyment and motality men in lowest grade had 4* higher mortality than those in highest grade. gradient across all grades |
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What was the whitehall 2 study? |
20 yrs later, 1985-88 6900 men, 3414 women civil servants aged 35-55 investigate socioeconomic differens in physical and mental health (material pathway is exposure to hazardous chemicals, working conditions, shift work, psychosocial pathway is control over workload, HPA pathway, sympathetic overactivity 1 |
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What were the findings of the whitehall 2 study? |
No change in social class difference in morbidity inverse association betweeen social class and angina, ECG evidence of ischaemia and symptoms of chronic bronchitis self perceived health status worse in lower social grades clear employment grade differences in health risk behaviours |
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Describe the work/income insecurity and mental health status study |
2002 catalonian cross sectional health survey, 1474vmen and 998 women aged 16-64 analyse the impact of flexible emplyment on mental health status and on mens and womens partnership formation |
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Describe the results of the work/income insecurity and mental health status study |
fixed term temporary contract not associated with change in mental health among manual and non manual men with fixed term temporary contract they were less likely to have kids. non-manual men also more likely to be single non fixed term temporary contract associated with poor mental health in non manual female and manual male men and women manual with no conract have poor mental health and job satisfaction |
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Describe 7 indices for IMD. |
barrier to housing - measures geographical barriers and wider barriers (affordability) income - deprivation employment - number of unemployed living environment - indoors (quality of housing) outdoors (air quality and road traffic accident) crime (burglary theft criminal damage and violence) education skills training - flow (attainment of qualifications by children) and stock (skills and qualifications of adults) health and disabiility |
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What is the inverse care law? |
Availability of care varies inversely with need for it in population operates where medical care is exposed to market forces |
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Describe an incentive to combat the inverse care law. |
Simon stevens proposed revised GP funding for 2016-17 contract based on deprivation Carr-Hill formula (used for global sum allocation) is going to be revised to account for deprivation |
