Health Needs Assessment for Type 2 Diabetes in Chelmsford

This report discusses the high prevalence of Type 2 Diabetes in the Chelmsford area, including statistics, determinants, inequalities, and available healthcare services. The role of nurses in promoting health and supporting Type 2 diabetic patients is also discussed.

Health Needs Assessment

Table of Contents
INTRODUCTION...........................................................................................................................3
Identification of key area of public health concern.........................................................................3
Locality...................................................................................................................................3
Local Health and Social Care Data........................................................................................4
Determinants, Inequalities, and Barriers to Health ...............................................................6
Review of the Services and Health Care Available................................................................7
CONCLUSION AND RECOMMENDATIONS..........................................................................11
REFERENCES..............................................................................................................................12

INTRODUCTION
Health needs assessment can be defined as the process of systematically reviewing the
prevalence of a health issue or issues that the population residing in that area is facing.
Assessment of health needs aims at improving the health and for reduction of inequalities based
on access to health services. This assessment helps in identifying priorities and allow proper
allocation of resources for the identified priorities. This report will be considering the issue of
high number of cases of Type 2 Diabetes in the Chelmsford area. The report will include the
implications that are implemented for healthcare at district, national, and global level. The report
will also include discussion on the statistics relevant to the factors that have their impact on the
prevalence of Type 2 Diabetes in the area. It will also include the identification of healthcare
services provided by the health care settings to the residents of that area along with the
recommendations regarding improvement of health care practices.
The nursing staff at the health care settings play an elementary role in management of
any type of diseases. Diabetes being a complex disease to manage requires the assistance and
consultation of all the health care professionals in order to keep the blood sugar levels within the
normal ranges. Many people have been seen to not accept the administration of insulin injection
as there treatment regime because of various believes (Carroll, 2019). Here the nurses play an
important role in making the patients clear of their doubts and notions related to the insulin
administration. Also the nursing staff can give the patients detailed information about
importance of maintaining compliance with the medication in order to keep the disease in
control. Therefore the nurses play an important in promoting health in an area with high number
of cases of diabetes.
Identification of key area of public health concern
Locality
This report will emphasize on Chelmsford district of Essex county which is located in the
north- east region of the London, England. The city had a population of 1.1 million in the urban
area and the wider district has a population of around 1.7 million out if which around 49.2
percent were males and 50.8 % were females. Approximately 96 percent of the entire population
were White British (SPICER, 2019.). The health of people living in Chelmsford area in better

that the average health of England and the life expectancy rate of men and women both are
higher that the average life expectancy of people of rest of the England. However, the area has
high prevalence of diabetes among its population of both male and female (Essex JSNA, 2019).
Local Health and Social Care Data
Diabetes is a metabolic disorder which is linked with the failure of the body cells to
utilise the glucose available to them. Diabetes is of two types: Type 1 and Type 2 out of which
the prior one is acquired by an individual because of family history and the later one is acquired
due to bad lifestyle choices. The prevalence of Type 2 Diabetes is observed to be higher in
Chelmsford than Type 1. Out of the entire population around 19,000 people are having diabetes
and diabetes is considered to be a major health threat that is increasing at a very fast
pace(Diabetes UK, 2022). There are about 450 people in north east Essex who are below the age
of 30 and are suffering from diabetes. If this metabolic health issue is not managed in a correct
manner it can even result in serious health related complications including renal failure, stroke,
vision loss and can even result in loss of limbs (Tobin, 2021).
(Source: Essex County Council Public Health Team, 2017-18)
The cases of type 2 diabetes in north east Essex are high but as per the data it can be
concluded that around 58 % of the cases are in a condition where the health threat can be delayed
or can be brought under control by bringing changes in the lifestyle and diet related choices by
the individuals having type 2 diabetes (Birbeck, 2019).
The north east Essex diabetes service states a number of conditions that increases the
chances of an individual of acquiring diabetes. It states that the people over the age of 40 are at

higher risk of acquiring type 2 diabetes. Also the people who are in the category of overweight or
have BMI above the excepted range are also at major risk. The South Asians which are about 2
% of the population as well as the blacks which are around 1.3 % of the population and the
Caribbean are at comparatively higher risk. The population of entire Essex have high prevalence
of cardiovascular diseases which is also a reason that can result in people being more prone to
acquire another metabolic disorder. The NEEDS also mentions the women who are suffering
from polycystic ovarian syndrome also to be at higher risk of becoming diabetic. Also the people
who practice making poor lifestyle choices like alcoholism, smoking and not including physical
activities in daily routine are more likely to be obese which can be contributing factor to being
diabetic (Wainberg and et.al., 2019).
(Source: Essex County Council Public Health Team, 2017-18)
As per the statistics of diabetes in UK in present more people than ever are having
diabetes and if this rate of increase in diabetes patients continues then the toll of diabetes patients
will reach to 5.5 million by 2030 in UK. At present around 4.8 million people out if the entire
population of UK are having diabetes and out of this 4.8 million 90 % are having type 2 diabetes
and type 1 diabetes contributes 8 % to the total number. The rest 2 %are suffering from a rare
type of diabetes (Hicks, and James, 2020). Apart from this around 13.6 million people more are

at an increased risk of type 2 diabetes and 850,000 people are such that are living with type 2
diabetes but are not yet diagnosed.
Determinants, Inequalities, and Barriers to Health
Determinants of health are the factors that affect the health of the population of a
particular area. The social determinants are the factor elate dot social life, economic status and
the environment related factors. These factors are capable of regulating or causing disparities in
the access to health care services by the people of that area. These disparities are responsible for
further leading to inequalities related to health among the people residing in the same area. A
model of social determinants of health was designed by Whitehead and Dahlgren in 1991 which
describes the relation between the social ecological state if an individual to his health. This
model explains the concepts of major determinants of health with the age, gender and
constitution related factors concentrated in the centre as these can not be controlled by the
individual. But these factors does affects the ability of an individual to utilize the resources
provided to them. Outside the core lies a layer which mentions the factors that can be modified in
order to improve the health and well- being status of an individual (Dahlgren, and Whitehead,
2021). The layer just outside the core includes the lifestyle related factors such as the dietary

choices an individual makes and the choices regarding inclusion of exercise routines in their
daily lives. It is the result of poor lifestyle choices of the people of north east Essex that it has
such a high number of diabetes cases and along with that it also has high number of patients of
cardiovascular diseases. This all point towards the poor lifestyle choices of the people of
Chelmsford. Thus for maintenance of sound health people need to make healthy lifestyle
choices. Smoking, alcohol consumption, misuse of substances such practices should also be
avoided by the people as these are the major contributors to poor health of an individual. The
layer after this mentions the social and community networks which determine the health of the
individual. The presence of sound social and community networks act as a buffer to the stress
that has the potential to damage health in a number of ways. It is also seen that the people
belonging to ethnic minorities has a better family network but belonging from low income
groups and minority groups have comparatively poor social network. But this factor here does
not have much inclusion in the factors responsible for causing diabetes. But belonging from the
low socio-economic groups does impacts the access that an individual have to the health care
provision which would hinder that individual in receiving the required care for proper
management of diabetes.
Absence of these social and community networks result in chronic feeling of loneliness
which can have ill effects on the mental health of an individual by elevating the release of stress
hormones and then causing damage to the physiological health by having damaging effects on
the immunity of the person resulting in easy acquiring of other diseases by him. The last layers
mentions the factors of working place, living conditions, education, agriculture and food
production capacity of the area and the care services available in the area (Nutbeam,and Lloyd,
2020). These factors are also modifiable according to the needs of the people and have major
impact on the health of the population of that area. Sufficient evidences are available to prove the
fact that people working in good living conditions and working in good working conditions have
better health status in comparison to those who do not have proper working and living
conditions.
Review of the Services and Health Care Available
Identification of local, national policy, services, charities available for adults with type-2
diabetes:

The UK government has started a program called NHS Diabetes Prevention Program
which is a joint commitment of NHS England, Public health England and Diabetes UK with an
aim to deliver evidence based intervention who are at high risk of developing type 2 diabetes. At
national level in UK, X-PERT was one of the services that started with aim to manage type 2
diabetes. Whereas, DAFANE service was started with aim to manage type 1 diabetes. Other
course that started in regards of diabetes control was DESMOND, to manage and control type 2
diabetes. X- PERT programme for diabetes management runs in three different formats to
provide long term control of diabetes, to facilitate optimum resources to user and to provide a
cost effective help to such people. The aim of X-PERT is to enhance use of X-PERT services
among people with diabetes and to promote referrals. The guidances it provides include
information about diabetes, awareness regarding carbohydrate, importance of physical activities
and food labels, complications related with diabetes, avoiding the hypothesis and taking advices
from health professionals (Diabetes self- management education, 2020). Another one, Mid Essex
clinical commissioning group (CCG) which is a part of national health services, looks for
planning and organising local health services in UK. It provide services in the area of Maldon,
Braintree and Chelmsford city. Their health services include nursing, language therapy, mental
health services, patient support, diabetes management, etc. Diabetes UK and Mid Essex clinical
Commissioning Group (CCG) organised a free support and educational event in Mid Essex for
people suffering from Type 2 diabetes on Diabetes day. The event aims to provide essential
information to people with type 2 diabetes (Free support event in Mid Essex for people with
Type 2 diabetes, 2018). The NICE guideline NG28 provide the care and management to the
adults with the type 2 diabetes.
At local level, Provide which is a community interest company or called as social
enterprise delivers a range of health and social care services among area of Chelmsford, UK. The
“Chelmsford Health and Well being plan (2019)” is strategies which are working for improving
the health and reducing the inequalities. The enterprise provides specialist care for people with
type 2 diabetes and to some with type 1 diabetes. The services are for adults with diabetes,
registered with GP in NHS mid Essex area. It excludes patient who need pre conceptual
counselling, who are diagnosed newly with type 1 diabetes, who have complications with
diabetes, and who require insulin pump (Provide, 2022). NHS Long term plan will support local
and ensure availability of national program and focus on reducing the health inequility.

Diabetes UK aims to fight against prevalence of diabetes in UK by sharing knowledge
among general public. Diabetes UK provide supporters to help general public to fight against
diabetes. Their support include local support groups, events regarding type 1 and type 2 diabetes
disease prevention and management. Online learning zone and even insurance a few times. Their
services include, providing education to people regarding diabetes as well as proving resources
and support to them (Diabetes UK, 2022). There are a lot of private and government authorities
working for people suffering from type 2 diabetes in order to support them and to provide them
knowledge about the same. Support and advices on type 2 diabetes and its contributing health
conditions are not required to be found among community as there are multiple online resources
which can provide required knowledge to the general public, but services provide support in
terms of resources, funds, health check ups and improvement management. For this MECC
approch should be considered which make positive changes in in physical and mental well being
by making every contact count. In addition to these, online resources require an access to internet
and computer literacy. Some primary prevention strategies have been developed by government
and some communities for disease management but they require some support from health
workers.
The role of the nurses in health promotion, screening and in supporting type -2 diabetic patients:
Health promotion involves spreading awareness among general public health regarding
health and hygiene as well as prevention of diseases that may cause severity in future. Promotion
of health in general public prevents prevalence of disease so it is essential to understand about
the determinants of health that are responsible for diabetes type-2 among public. Nursing and
Midwifery Council facilitate essentiality of nurses in providing dietary requirements to patients
as well as in advising general public regarding their life style especially to people who are at risk
of progression of type 2 diabetes. Nurses play a key role in spreading awareness regarding early
sign and symptoms of disease to manage acute disease and to eliminate chronic disease
progression. Nurses conduct such management via self monitoring the blood glucose levels of
patients and educating patient for taking care of their own needs (Świątoniowska and et. al.,
2019). Regular monitoring of blood glucose levels of patient help in eliminating future
possibilities of disease progression and reduces chances of risk conditions. In addition, nurses
give preventive advices to patient including health coaching techniques. They promote self care,
assess and meet patient's nutritional needs, they monitors urine and blood glucose level of patient

and provide them appropriate therapies. Nurses identify hypo and hyperglycaemic conditions and
assess risk progression of patients (Duffy and Gillies, 2018). Nurses work with principle of 6C's
that is care, compassion, courage, communication, commitment and competence which is
important for looing after a patient.
The nurses can choose the NHS health check screening program to check up the elderly
patients. This program is will help in spotting early sign of type 2 diabetes. However UK NSC
does not recommend screening for type 2 diabetes as there is no such evidence found that finding
of early symptoms through screening will result in more health benefits. With the NHS England
Diabetes Prevention Program the nurse will implement several patient care management in order
to monitor the patient with type 2 Diabetes. Nurses can give health promotion services in type-2
diabetes by educating the general public, they provide help and support to people in preventing
their complications. Nursing assessment involves assessing Patient's history, physical conditions
and laboratory examinations. Further, when patient is diagnosed to be suffering from diabetes
the nurses are required to plan goals and achieve timely implementation. Priorities of nurses in
such scenario is to restore patient's fluid balance, reverse metabolic abnormalities, identification
and management of disease, prevention of complication and informing treatment needs. Nursing
interventions involves educating patient and their family about home glucose monitoring, review
patient's common situations and encouraging them to read labels prescribed, checking sites of
injection periodically. Duty of nurses continue till the patient is discharged. Nurse's key duty is
planning such goals for treating patient with diabetes which includes treatment to normalise the
blood glucose levels and reduction of complications (Azami and et. al., 2018). Health promotion
and sickness prevention is the part of nurse's role. Approaches that nurses can contribute for
health promotion includes medical approaches, behavioural approach, educational approach,
empowerment and social change. Medical approaches involve prevention, such as vaccinations
and screenings. Behavioural approaches says that healthy lifestyle is essential for good health
and nurses play a key role in assessing the needs of patients. Educational approaches involves
increasing patient's knowledge. Empowerment approaches give people a control over their
health. Social approaches alters social structure to influence healthy behaviour. For example,
maintaining a healthy diet with regular medication if more likely to stop progression of diabetes.

CONCLUSION AND RECOMMENDATIONS
One in ten people from UK of age over 40, are diagnosed with type 2 diabetes, overall
7% of UK population is living with diabetes and among which one million people have type 2
diabetes. The project is based on identification of key area of public health concern within the
area of Chelmsford, UK and tendering the data of type 2 diabetes. The project in brief concluded
that health inequalities are responsible for unfair differences within the groups of people and
different social determinants have effect on different areas of UK. Therefore, one approach will
not be suitable for all. Social determinants like unhealthy choices, poor diet, smoking, drinking
are responsible for increased risk of Type 2 diabetes. In addition to this, people in poverty don't
have many options as comparison to the wealthy people. Living in such condition is responsible
for high stress level of people and poor diet which is responsible for diabetes. Government and
community health services are taking action in regards to control the prevalence of disease.
Nurse's role in such is to identify the key roles and support the patients. With the correct
approach nurse can address and discuss patients unhealthy habits and can take desirable action to
reduce mortality due to type-2 diabetes.
Recommendations may include that dependency on single area for determining the cause
and severity of disease may not give required estimation as social determinants of different area
have different effect on people in regards to Diabetes type 2. In addition, Government and
communities should evaluate the responsible causes for type-2 diabetes and educate people more
regarding the same using advertisement methods such as mass media, social media, newspaper,
TV channels, radio etc. Healthcare workers are required to show their voluntarily involvement in
educating and motivating people for their good health (Azami, G. and et. al., 2018). Nurse's play
a key role in management, promotion and screening of type-2 diabetes, so their involvement is
required for effective management as well as treatment for type-2 diabetes.

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