Inequitable Provision Research Articles

Inequitable provision of optimal health services for patients with chronic heart failure: a national geo‐mapping study

Inequitable provision of optimal health services for patients with chronic heart failure: a national geo‐mapping study

The (un)‐certainties of district nurses in the context of cultural diversity

This paper is a report of part of a study exploring district nurses' understanding and practices in relation to discrimination and inequalities issues. Clients from minority ethnic groups continue to experience inequalities in health status and care provision. District nurses work with a wide range of clients, yet research has demonstrated inequities in service provision to clients from minority ethnic groups due to organizational, professional and personal constraints. A qualitative methodology was used to explore district nurses' understanding of discrimination and equalities issues in the context of their work. Semi-structured interviews were undertaken during 2003 with 18 district nurses employed in two primary care organizations in England providing healthcare services to a large and culturally diverse population. District nurses' accounts were marked by uncertainty, suggesting that many lacked confidence when discussing issues of ethnicity and cultural difference. There were marked differences in the extent to which they appeared to recognize or engage with clients' experiences of discrimination or inequalities, or to recognize inequitable service provision to clients from minority ethnic groups. Key issues were a lack of provision of district nursing services to some clients, and failures to meet clients' language and communication needs, and although reflecting organizational constraints, such continuing inequities were largely unquestioned. There is a need for further educational and practice developments to enable district nurses to provide more equitable care to clients from culturally diverse communities, ensuring that the key professional discourse of individual care and advocacy are fully realized in their work with all clients.

Inequitable provision of optimal services for patients with chronic heart failure: a national geo‐mapping study

To compare the location and accessibility of current Australian chronic heart failure (CHF) management programs and general practice services with the probable distribution of the population with CHF. Data on the prevalence and distribution of the CHF population throughout Australia, and the locations of CHF management programs and general practice services from 1 January 2004 to 31 December 2005 were analysed using geographic information systems (GIS) technology. Distance of populations with CHF to CHF management programs and general practice services. The highest prevalence of CHF (20.3-79.8 per 1000 population) occurred in areas with high concentrations of people over 65 years of age and in areas with higher proportions of Indigenous people. Five thousand CHF patients (8%) discharged from hospital in 2004-2005 were managed in one of the 62 identified CHF management programs. There were no CHF management programs in the Northern Territory or Tasmania. Only four CHF management programs were located outside major cities, with a total case load of 80 patients (0.7%). The mean distance from any Australian population centre to the nearest CHF management program was 332 km (median, 163 km; range, 0.15-3246 km). In rural areas, where the burden of CHF management falls upon general practitioners, the mean distance to general practice services was 37 km (median, 20 km; range, 0-656 km). There is an inequity in the provision of CHF management programs to rural Australians.

From Beveridge to Turner: Demography, Distribution and the Future of Pensions in the UK

SummaryThe paper outlines the recommendations of the UK Pensions Commission, and the data and analysis on which they were based, including projections of demographic change, trends in private pension saving and evolution of the State pension system. The Commission concluded that, without reform, structural problems with UK pensions would lead to increasingly inadequate and inequitable provision by 2020–2025. It recommended reforms which would lead to a more generous, more universal and less means-tested State system than would otherwise evolve, and the establishment of a low cost national pension savings scheme, into which employees without good employer provision would automatically be enrolled. The proposals, which have now largely been adopted by the UK Government, imply eventual increases both in state spending on pensions as a share of national income and in State pension age, but accompanied by measures to facilitate later and more flexible retirement.

Truly advanced practice

It is staggering how inequitable service provision can be across the UK

Participation in continuing professional education in nursing: findings of an interview study

The evidence suggests that enrolled nurses and those working part-time and on night duty consistently attend less continuing professional education than their more senior, full-time and day duty colleagues. This was substantiated in the findings of this study which also highlighted the paucity of opportunities for continuing education among unqualified practitioners. In the light of recent developments within the health services, this inequitable provision of continuing professional education to all nursing practitioners will need to be addressed and resolved. Continuing professional education provided on an arbitrary and random basis will not afford maximum positive outcomes for clients, the service and practitioners and has the potential to increase the levels of frustration among disadvantaged groups of nursing staff.

Hospital Provision before the NHS: Territorial Justice or Inverse Care Law?

ABSTRACTIt is often claimed that before the NHS areas with the highest need for health care had the least provision. In other words, it is asserted that the so-called ‘inverse care law’ (Hart, 1971) existed. This claim is empirically tested for the hospital sector, using needs and provision data from a number of sources. It is found that, for the voluntary hospital sector, both beds and staff were inequitably distributed. However, for the municipal hospital sector, it appears that high need areas tended to have more beds and staff than low need areas. When both sectors are aggregated to produce total provision there is little association between need and bed provision, but inequitable provision for staffing. Thus, it is concluded that municipal provision was successful to some extent in rectifying the inequitable nature of voluntary provision.