Student Study Section

STUDENT STUDY SECTION Review questions Study the timeline above and then read the following quotation. The nation that political problems could more naturally be solved by violence than by debate was firmly entrenched in a country in which for a thousand years civil war has been if not exactly the norm then certainly no rarity. From Paul Preton, The Spanish Civil War: Reaction, Revolution and Revenge, 2006 1. Looking at the timeline above showing events in Spain in the 19th and early 20th centuries, what evidence is there for Preston’s argument? 2.What factors were causing tension in Spain during this time? (Economic, military, religious, political? ) 3. What example of foreign intervention was there in Spain in the 29th century? STUDENT STUDY SECTION Review questions 1. Draw a mind map or spider diagram of the key issues dividing Spain by 1931 2. Explain the events that led to the fall of Kind Alfonso in 1931. 3. Looking at the long-term issues in Spain and the political even ts of the 19th century, what problems was the Second Republic likely to face? Do you consider that war was inevitable by mid 1931? STUDENT STUDY SECTIONReview questions How did the actions of the Second republic create more tension? In what way did they, in Paul Preston’s words, ensure that Spain’s underlying conflicts ere transmitted into national politics? STUDENT STUDY SECTION Research activity Research the Asturian miner’ uprising of 1934. In Paris, discuss the extent to which you agree that this was an attempted revolution. STUDENT STUDY SECTION Review questions 1. To what extent did economic issues lead to a civil war? 2. What was the impact of international events to the growing divisions in Spain Class debateDivide the class into three groups. Each group needs to argue one of the following: * The right wing was responsible for the Spanish Civil War * The left wing was responsible for the Spanish Civil War * Both left and right were equally responsible fo r the Spanish Civil War STUDENT STUDY SECTION Review activity Look back at the timeline on pp. 235-36. Identify key points where foreign intervention plays a significant role in the fighting. STUDENT STUDY SECTION Document analysisWhat civisms does Salvodo make of the Non-intervention Committee (p. 238)? Research activity In small group, research the different countries, groups and famous individuals that went to Spain to fight in the international Brigades; for example, the Abraham Lincoln Brigade from USA. STUDENT STUDY SECTION Review activities Summarize the key points made in the text in grid: | Nationalists | Republicans | Political strengths/weaknesses| | | Military strengths/weaknesses| | | Economic advantages/ Disadvantages| | | Foreign assistance| | | Class debate Divide the class into two groups.One side will argue that the Nationalists’ strengths won the Spanish Civil War, the other will argue that it was due to Republican weaknesses. The motion is: The strengths o f the Nationalists won the Civil War. Each side must have a series of thematic and coherent arguments. To gain a point, they have to support arguments with clear evidence. STUDENT STUDY SECTION Read the following sources and answer the questions: Document A The nationalists maintained that Guernical had been blown up by the Basques themselves, in order to discredit the blameless Nationalists.A later version said that Republican planes dropped bomb to detonate charges dynamite placed in the sewers. Twenty years later it was still a crime in Franco’s Spain to say that Guernical had been destroyed by the Nationalists. Document B Our consciences were uneasy about it. After living through the raid we knew only too well that the destruction had come from the air. The Reds had hardly any planes, we knew that too. Amongst our own, we’d admit the truth: our side had bombed the town and it was a bad thing. But what can we do about it now? We’d say. It was simply better to keep quite.From a statement by Juan Sangroniz, a Nationalists, quoted in Ronald Fraser, Blood of Spain Document C The Germans said the wind caused the bombes to drift eastwards [the target had been a bridge on the river]. In fact Guernica was a military target, being a communications centre close to the line. Retreating republican soldiers could only escape with any ease through Guernical because the bridge over the river was the last one before the sea. But if the aim of the Condor Legion was destroy the bridge why did they not use their supremely accurate stuka bombers?At least part to aim must have been to cause maximum panic and confusion among civilians as well as soldier. The use of incendiary bombs proves that some destruction of buildings and people other than it bridge must have been intended From Hugh Thomas, The Spanish Civil War, 1977 Questions 1. In what ways are the views expressed in Document A supported by the views in Document B 2. What reasons are identified in Do cument C for the bombing of Guernica? STUDENT STUDY SECTION Essay work Planning essay in an essential way to revise topics as you approach examinations. In pairs or groups, plan out the essays below.Your plan should include: * An introduction written out in full * The opening sentence for each paragraph setting out your ‘topic’ * Bullet points setting out the evidence to go in each paragraph * A conclusion written out in full Each group should present it essay plan to the rest of the class. How much overlap of content is three between the different essay plans? Some hints are given for your planning in the first 3 essays Essay 1 Analyze the causes of the Spain Civil War. You could structure this essay thematically, and consider the key issues in the long term and the short term.Your analysis should then explain why there was tension that intensified over time. Remember to include the ‘trigger’ of the civil war, as this explains why the war broke out when it did. * Themes: 1898-1931 –Economic/Social/Polical/Empire * Themes:1931-36 –Land reforms/Church reforms/Social unrest /Reaction of right/Popular Front * Trigger:1936 –The attempted coup. Essays 2 What were the key effects of the Spanish Civil War? You might want to include material from this chapter on the ‘nature’ of the war in this essay, as well as focusing on the more general results.It might be helpful for you to structure your essay in two parts: effects of the war internally on Spain, and then effects of the war external on the other countries. Remember to attempt to adopt a thematic approach. Essay 3 What was the impact of foreign intervention in the Spain Civil War? You could discuss this question in terms of how the ‘nature’ of the war was affected by foreign intervention: * Polarizing the complex political divisions in Spain * Increasing the brutality and casualty rate * Protracting the war. You could then discuss this questi on in terms of how the ‘outcome’ of the war was affected by foreign intervention† * Germany/Italy/Portugal: Strengthening the military capabilities of the Nationalists * USSR: Weakening the political unity of the Republic, and then undermining its ability to wage war by withdrawing support * NIC and Neutrals benefited the Nationalists Now attempt to make detailed plans for the following essay questions: * In what ways and to what extent, did social and religious divisions lead to war in Spain in 1936? * To what extent was the Spanish Civil War caused by division in Spain and in Spain society? Assess the impact of political and constitutional developments in Spain between 1930 and 1939 * Why did the Constitutional Monarchy in Spain collapse in 1931? * Carlism is a political movement in Spain that looks to establish a separate line of the Bourbon family on the Spanish throne. This line is descended from Carlos V ( 1788-1855). * The Civil Guard was founded in 1844. I ts purpose was to control the peasantry, maintain the status quo and stamp out any anti-monarchist, revolutionary sentiment. It was particularly active in the Basque Provinces and was hated by the peasantry.It was later to play a role in supporting the conservative downers in resisting the reforms of the Second Republic. * The destabilization of the Spanish electoral system is the worth nothing that the Spain electoral system ensured that only a small swing in the number of votes cast had a huge effect on the parliamentary system. Thus, although there was only a minor shift of votes from the left to the right, there was a big change in parliamentary power. The same was ro happen in 1926 when the Popular front gained control. The instability created by the electoral system was a contributory factor to the breakdown of the Second Republic.

In What Ways do Gender Relations Affect Work Organization and Management? Essay

With the influx of women into the workforce during the last 20 years, there has been increased attention to comparisons between men and women on a number of work-related attributes and behaviors. With this increased attention, there has also been some confusion about whether women and men differ to a significant degree, how much they differ, and whether these differences truly are meaningful regarding behavior at work. The principal goal of this work is to consider gender issues that affect work organisation and management. The discussion of gender and work which is included in this paper is selective in focusing mainly on recent research, in which the topic has been considered explicitly. The cases considered provide useful examples of the role of gender in work. The discussion uses definition of gender as ‘a system of culturally constructed identities, expressed in ideologies of masculinity and femininity, interacting with socially structured relationships in divisions of labour and leisure, sexuality and power between women and men’ (Nicolson, 1996. p. 54). Although women and men have always engaged in purposeful activity, the set of activities that many people consider work or employment is not always clear. Historically, men and women worked side by side together in the fields. Today, however, a distinction is made between paid, public work external to the family and unpaid, private work in the home. Each of these spheres of work has come to be sex-typed, with paid work being viewed by many as the domain of males and unpaid work in the home the domain of females. These perceptions are changing but are still deep-seated in many respects (Nicolson, 1996). Stereotyping involves generalizing beliefs about groups as a whole to members of those groups. For example, if you believe that older people are more likely to resist change than younger people, you may infer that an older person you have just met is likely to be rigid and to have a hard time adapting to changes. Through stereotyping, we can categorize people into groups on numerous demographic bases, including gender, race, age, religion, social class, and so forth, and our perceptions of specific individuals will be influenced by what we know or think we know about the group as a whole. Gender stereotypes are socially shared beliefs about the characteristics or attributes of men and women in general that influence our perceptions of individual men and women (Nicolson, 1996). The stereotype literature suggests that our general beliefs about groups of people can affect our assessments of individual group members (Biernat, 1991). Stereotypes can contribute to shared misperceptions of coworkers, job candidates, performance, and credentials (Haworth 90). Stereotypes not only affect the decisions we make about men and women but also affect self-perceptions, decisions, and choices made by those men and women. Furthermore, gender stereotypes can create a self-fulfilling prophecy, in the sense that both men and women may feel pressure to behave in ways that correspond to gender stereotypes. Thus, stereotypes can affect both how men and women behave in the workplace and how their behavior is perceived. In recent years, the influx of women into the workforce in general, and into nontraditional occupations in particular, has led to increased attention in the popular media. One result of the recent profusion of books, magazine articles, and newspaper stories dealing with these topics is an increasing level of confusion about whether there are, in fact, sex or gender differences between women and men; or if there are such differences, in what ways (i.e., personality, skills, leadership, intelligence, etc.) men and women differ, how much they differ, and whether the differences really mean anything (Nicolson, 1996). Given our social expectations of men and women based on gender stereotypes, it is not surprising to observe some differences between men and women in numerous domains at work. For example, men and women differ in their expectations for success on specific tasks, and these expectations are related to achievement motivation on the task. This finding has been interpreted as meaning that women have lower expectations for success than men, and that is why they do not attempt new tasks or perform as well as men on subsequent tasks. However, an equally plausible explanation is that women face more barriers than men on the job, especially sex discrimination, and are less likely to be successful due in part to biased evaluations. Furthermore, women may take this into account when forming their expectations about occupations that do not require lengthy training programs or extensive time commitment. That is, success expectations for a woman may include an implicit assessment of the sexism within her current environment as well as an assessment of her ability to perform a given task (Haworth, 2004). There is evidence (from studies conducted in the 1970s and again in the 1990s) suggesting a small but consistent impact of gender stereotypes on work-related decisions and on men’s and women’s self-perceptions of their behavior, performance, and worth (including expectations for pay).However, the observed differences must be interpreted with much caution. One conclusion drawn from these differences is that women are deficient in some ways compared to men. It is easy to attribute the cause of such differences to internal, skill, personality, or biological explanations. The reliance on internal or person-based explanations inhibit and often precludes the search for equally compelling external, situation-based explanations for gender differences. Most behaviors that reflect gender differences are learned behaviors, and by labeling them as masculine and feminine, scientists may reinforce the association of that behavior with gender (Haworth, 2004). The positive expectations associated with physical attractiveness generalize beyond interpersonal relationships such as dating and marriage into the work setting. Perceptions of attractiveness have a moderate effect on perceptions of the person’s intellectual competence. The link between attractiveness and perceptions of intelligence appears to be similar for both men and women. However, attractiveness appears to have a stronger effect for women than for men on perceptions of job performance (Lewis & Bierlys, 1990). Applicants and employees with higher physical attractiveness are expected to do better work. Once completed, their work is evaluated more positively than identical work by less attractive individuals. In one study, highly attractive authors were evaluated as having better ideas, demonstrating better style, being more creative, and generally producing higher quality work. In the interviewing setting, if an interviewer believes that physical attractiveness is an important job attribute, then being attractive is an advantage. There is extensive research evidence that attractiveness positively influences entry-level employment decisions. Other research has shown few significant effects. Although there is some evidence to the contrary, physical attractiveness appears to interact with the sex-type of the job to influence work evaluations (Crompton, 1996. p. 8). Physical attractiveness is a positive feature for women when applying to lower level positions (e.g., clerical) but not for higher level positions (e.g., management), whereas physical attractiveness is advantageous for men in a wider range of positions. These advantages and disadvantages are similar for such work decisions as evaluations of applicant qualifications, hiring recommendations, starting salary, and rankings of hiring preferences (Nicolson, 1996. p. 68). At work, physical attractiveness is usually an advantage for women and men, but for women, there are limits to these positive consequences. Attractiveness is most beneficial for women working in traditional feminine areas or just entering an organization. However, when women enter more traditionally masculine work, physical attractiveness can be a liability (Biernat & Wortman, 1991. p. 4). One interpretation of these findings is that because women who are physically attractive are also perceived as more feminine (Aaltio, 2002, p. 55), the negative female stereotype of being less intelligent or competent may be activated or salient. Especially in masculine occupations where competence is of great perceived importance, attractive women may face discrimination. Workplace romance can influence organizational effectiveness in a number of ways, including the breakdown of the legitimacy of organizational promotions and structure, excessive transfers, and more terminations (Pierce et al., 1996). Especially when a romantic relationship involves a supervisor and a subordinate, it is likely to result in perceptions of favoritism and inequity concerning promotions among coworkers. When coworkers perceive such favoritism they can become both alienated from the work group (Pugh, 1997) and envious which can result in an imbalance of power within the organization (Grint, 2005). Furthermore, when the power structure within an organization breaks down, channels for advancement become closed off and promotion and raise decisions become distorted and unpredictable. When one investigates the basis for promotions and who is promoted, it is important to examine the values, informal guidelines, and norms surrounding such decisions. Therefore, the relationship between workplace romance and promotion decisions may depend, in part, on the culture of the organization. Should employees participating in a workplace romance be transferred or relocated? Managers appear to perceive job relocation as a reasonable intervention to workplace romance (Pierce, Byrne & Aguinis, 1996. p.7) especially when employees engage in such behavior against formal organizational policy. Furthermore, employees might expect such transfers as a consequence. Some experts (Andrews & Knoke, 1999) suggest that management should offer relocation as one option for couples to consider. However, female participants are more frequently relocated than males, and fewer of these women occupy top-level management or higher status positions. Therefore, organizational relocation decisions in situations of workplace romance may be discriminatory based on the employees’ gender or organizational positions. The decision to terminate or dismiss an employee because of his or her involvement in a workplace romance may also be viewed as a detrimental managerial action, one representing a punitive form of organizational intervention. Yet employees are often dismissed for participating in a workplace romance. Furthermore, a female participant is more likely to be terminated than a male participant, the participant who is lower in status or less â€Å"valuable† to the organization is more often terminated, and extramarital affairs are more likely to result in employee termination as compared to other types of affairs. However, there is a need to identify managerial prejudices and inequitable decisions based on gender, so that if terminations are made within the context of workplace romance, an employee is terminated based on poor performance rather than gender or organizational status (Haworth, 2004). Our personal physical attractiveness plays a tremendous role in our interactions with others in our work lives. There is evidence that attractiveness influences what people expect from us, how people respond to us, and what decisions we make are made about us. Yet many organizational texts do not address this topic. We believe that physical attractiveness is a pivotal factor in the development of relationships, friendships, and romances in the workplace. Furthermore, these relationships greatly shape men’s and women’s experiences of work (Haworth, 2004). The physical attractiveness stereotype is generally, â€Å"What is beautiful is good.† This view appears to hold for younger and older persons and for men and women. Yet the stereotype is subtle, and often we deny its influence on our behavior. Attractiveness appears to influence the expectations we have about each other including intelligence, interpersonal skills, honesty, and guilt or innocence of a crime. Furthermore, attractiveness appears to influence a number of work-related decisions including hiring decisions, work evaluations, interview ratings, and salaries (Pierce, Byrne & Aguinis, 1996). Physical attractiveness is a key factor in interpersonal attraction and liking as well as in the development of romantic relationships at work. Although such factors as propinquity, familiarity, attitude similarity, and reciprocity of liking are important, an attractive individual is more likely to engage in interpersonal relationships than a less attractive individual. Furthermore, interpersonal attraction is one antecedent of sexually intimate relationships including romantic relationships at work. Workplace romances appear to be increasing among American workers. The rise seems to be associated with greater acceptance of office dating, especially among coworkers (less so between a manager and subordinate), and organizational cultures that convey more liberal attitudes about the appropriateness of such behavior. There are numerous outcomes or consequences of workplace romances, and such outcomes may depend, in part, on the type of romance occurring: true love, the fling, or a utilitarian relationship. More negative coworker and organizational reactions occur with utilitarian relationships, followed by flings and true love. Although workplace romances can promote perceptions of inequity among coworkers and increased legal liability for the organization, these reactions are usually is associated with manager-subordinate romances and perceptions of sexual harassment (Pierce, Byrne & Aguinis, 1996). The central argument of this paper is that gender relations are constitutive of the structure and practices of organizations and that this is key to understanding how men define and dominate organizations. These gendered processes operate on many levels, from the explicit and institutional to the more subtle, cultural forms that are submerged in organizational decisions, even those that appear to have nothing to do with gender (Crompton, 1996. p. 60). They include the way men’s influence is embedded in rules and procedures, formal job definitions and functional roles. For example, the structure of a management career, based on men’s experiences, needs and life-cycle patterns, assumes a history of continuous, full-time employment. Or the way in which gender is mapped onto organizational authority resulting in a sexual division of labor whereby it is prescribed that women are better suited to personnel management than other management functions. References Aaltio, Iiris. (2002). Gender, Identity and the Culture of Organizations. Routledge: London. Andrews, S.B. & Knoke, D. (eds) (1999). Networks in and around Organizations, Stamford, Conn.: JAI Press. Biernat M., & Wortman C. B. (1991). â€Å"Sharing of home responsibilities between professionally employed women and their husbands.† Journal of Personality and Social Psychology, 61. Crompton, Rosemary. (1996). Changing Forms of Employment: Organisations, Skills, and Gender. Routledge: New York. Grint, K. (2005). The Sociology of Work, 3rd edn, Cambridge: Polity Press. Haworth, John T. (2004). Work and Leisure. Routledge: New York. Lewis K. E., & Bierly M. (1990). â€Å"Toward a profile of the female voter: Sex differences in perceived physical attractiveness and competence of political candidates†. Sex Roles, 22. Nicolson, Paula. (1996). Gender, Power, and Organization: A Psychological Perspective. Routledge: New York. Pierce C. A., Byrne D., & Aguinis H. (1996). â€Å"Attraction in organizations: A model of workplace romance†. Journal of Organizational Behavior, 17. Pugh, D.S. (1997). Organization Theory: Selected Readings, 4 edn, thLondon: Penguin.

Barriers to Accessing Health Care Services

In this essay I am going to critically analyse diversity within the National Health Service (NHS. I will briefly focus on barriers to accessing health care services in relation to age, race, disability, gender and culture and sexual orientation. I will consider the barriers which have unintentionally been put into place within different health services for both service users and members of staff, and the measures that have been taken in order to redress these issues by the government, NHS and Department of Health (DOH). Diversity is the inclusion of all irrespective of an individual’s age, race, capabilities, cultural background, gender or sexual orientation. The St. Helens and Knowsley NHS trust affirm this ideal describing diversity as, â€Å"Different individuals valuing each other regardless of skin, intellect, talents or years. † This is a quote the St. Helen’s and Knowsley trust have used from the Equality Act 2000 on their website to show their beliefs surrounding diversity. In society every individual is born differently, such as hair colour, skin colour, male or female, sexual orientation (depending on your belief that sexual orientation is genetic and not environmental), born into different religious and cultural backgrounds. As the U. K. has become ever more a multi-cultural society, issues such as diversity and anti-discriminatory practices have become ever more significant within our society. An individual who has been treated differently or received an unequal quality of service based on a preconceived idea due to a minority group they may identify themselves with have been discriminated against. Within the NHS these minority groups are known as characteristics, as in characteristics which help build an individual’s idea of their own self-concept. Since the Equality Act was up-dated in 2010 the NHS have not only included race, culture, gender, capabilities, religious beliefs and sexual orientation but also now include, pregnancy/ maternity, marriage/civil partnerships and carers as part of their protected characteristics policy. (http://www. nhs. uk). For the first time the law also protects people who are at risk of discrimination by association or perception. This could include, for example, a carer who cares for a disabled person† (http://www. nhs. uk) There are two forms which discrimination can take place the first is called direct discrimination. Direct discrimination is when an individual is treated differently usually negatively or unfairly compared to others based on the individual identifying themself with one of the above protected characteristics. Indirect discrimination is when a law, policy or procedure has been put into place, which applies to everyone, but this law, policy or procedure will disadvantage individuals who associate or identify themselves with the above protected characteristics. However due to organisations focusing too much on anti-discriminatory practice a new controversial concept of positive discrimination has begun to emerge, this is also being called positive/ affirmative action. Positive discrimination is where minorities or individuals, who associate or identify themselves with the protected characteristics, are given preferential treatment to others. An example of this would be two candidates who are both equally qualified for a job, however one candidate is a white, heterosexual male and the other candidate is a black, homosexual female, by positive discrimination the second candidate would receive the position. Positive discrimination can be due to pressure felt by the organisation to employ a diverse work force, to fill a quota to ensure the organisation cannot be accused of being discriminatory or historical guilt for issues such slavery. â€Å"The idea of positive discrimination came from the US where an ‘affirmative action’ programme has been used to try and ensure the make-up of certain workplaces reflects that of society. † (http://www. findlaw. co. uk) It has been suggested that the root cause of discrimination is due to prejudice. Prejudice is a stereotyped, pre-conceived idea of the way an individual or social group should portray themselves within society (Walsh et al, 2005). For example all Irish people drink alcohol excessively. â€Å"Prejudices can be a result of your own beliefs and values, which can often come into conflict with work situations. † (Pg. 194, Nolan et al, 2005). There are no laws in place against being actively prejudice, this is why the law concentrates against discriminatory practices. (Walsh et al, 2005. ) Ageism is commonly thought of as discrimination against the elderly; many nursing and health and social care textbooks affirm this belief, Kydd et al (2009, Pg. 49) state that â€Å"Ageism is the generalisation of old age as a social problem, this has contributed to the negative stereotyping and ageist practices in relation to older people. † However this is a false perception. Ageism can affect individuals of all ages, for example in 2004 the upper age limitations of free breast screening were 69, (http://www. imsersomayores. sic) however due to a growing older population this age restriction was raised to 73 in 2010 and the lower age limitation remained at 47. (http://www. cancerscreening. nhs. uk). Studies carried by the cancer research charity show â€Å"The 5 Most Commonly Diagnosed Cancers in Females, Average Percentages and Numbers of New Cases, by Age, UK, 2007-2009† (http://www. cancerresearchuk. org). Breast cancer is highest in both categories of women aged 2 5-49 and 50-74, however in the group 25-49 breast cancer was more prevalent by 10% (43%) compare to the 34% in the group of women aged 50-74. These figures show there is a need for the lower age restriction to be reduced. This NHS policy for age restrictions on breast screening needs to be reviewed as it can be viewed to be discriminatory towards women in the UK under 47 who are proven to be in need of this health service. Racism is the belief that one race is superior to another; (walsh et al, 2005) throughout history millions have faced discrimination and persecution due to this belief the most prevalent examples of this is in the Jewish community and the Black community. As the UK continues to become a more diverse, multi- cultural society racism continues to plague Britain. Penketh (2000, Pg. 7) affirms this by stating, â€Å"Black people are more likely to be ‘stopped and searched’, arrested, imprisoned and even to die in custody than whites. † Studies carried out by Unison, the UK’s largest healthcare trades union found that 70% of their non-Caucasian client’s employed by the NHS had experienced ‘racism or racial discrimination’ at work, some employees had experienced verbal abuse and physical abuse in relation to their race. (http://www. unison. org. uk). From this study the NHS have brought out an initiative to help eradicate racism within the NHS, part of this initiative is to have a better complaints and redress system in place, as three quarters of the employees in this study who experienced racism or racial discrimination were unsatisfied with the outcome when the incident was reported to their management. Disablism refers to prejudices against individuals who have suffered ‘mental, physical or sensory impairments’. In the past words such as lunatic, spastic and cripple were acceptable words used within health care settings as a way to describe an individual with specific needs. These terms are still rife within society today. (Walsh et al, 2005). Goodley (2011, Pg. 24) states â€Å"People with some form of impairment are likely to experience social disadvantage, a lack of opportunities and unfair discrimination. † Barton (2002) agrees with this as Barton theorises that individuals with a sensory, physical or mental impairment will at some stage in their life experience oppression in both institutional and individual forms, this can be due to absence of choices, barriers to funding, unforeseen deterioration in their impairment or general ignorance. Within the NHS discriminatory practices occurs on a regular basis despite programmes such as ‘Valuing People Now’ being released by the DOH in 2009, this was a three year strategy to help improve the quality of life for individuals with learning difficulties. This year MENCAP have released a report called ‘Death by Indifference: 74 deaths and Counting. ’ This report highlights the failings within the NHS to provide an equal quality of care for those with specific needs and learning difficulties. The main areas of failing that subsequently lead to the needless deaths of many patients with learning difficulties are failure to recognise pain, poor communication, diagnostic overshadowing, and delayed treatments, inappropriate DNR’s and lack of basic care. Throughout the report it is emphasised the lack of compliance not only to the Equality Act but also the Mental Capacity Act, in relation to DNR’s being allocated to patients without the consent or the knowledge of the patient’s family, friends or advocate. Again a major issue within the report is the NHS complaints and redress system in place. MENCAP,2012) â€Å"In this report we deal with the inadequacies of the NHS complaints process. On average it can take 18 months- 2 years to reach the Local stage, and between 2 years- 4 years to complete the ombudsman stage. † (MENCAP,2012, Pg. 7). Sexism is the belief that one gender is superior compared to the opposite sex, it is generally felt that women tend to be sexually discriminated against within society more so than men. (Walsh et al 2005). Within the health care profession a patient may express a preference in the gender of the health care practitioner (HCP) who provides their personal care (Smith t al, 2011). This is not to be seen as sexual discrimination against the HCP, by noncompliance with the patient’s request this can be viewed as discrimination against the patient’s religious and cultural beliefs. However due to under funding and under staffing with the NHS the ability for HCP to fulfil these requests has been compromised. â€Å"Modesty in dress and a requirement to be treated by a doctor/nurse of the same sex is also important in some religions. NHS staff should consider these requirements in order to preserve the dignity of the patient. However, it is not always possible or feasible to provide same-sex attendance, particularly without adequate notice that this might be an issue, and this should be made clear at the time of making appointments† (DOH, 2009) The Royal College recognise the need for a review within staffing levels within their 2011 report Mandatory Nurse Staffing levels, they also acknowledge the impact staffing levels have on a patient, they state, â€Å"There is a growing body of evidence which shows nurse staffing levels makes a difference to patient outcomes, patient experience, quality of care, and the efficiency of care delivered. (RCN, 2011). Within a female dominated profession such as nursing it is felt that males tend to be more so discriminated against sexually than females. A recent example of this on a national news level is the case of Andrew Moyhing, a male student nurse who won a sexual discrimination case against the NHS. He was told by a female staff nurse that he would need to be chaperone by a member of staff as he attached an electro-cardio machine to a female patient, due to ‘intimate care’ required . Mr Moyhing felt this was unfair as female students on the same ward were unsupervised when carrying out personal hygiene and intimate care on male patients. The Equality Opportunities Commission supported Mr Moyhing releasing this statement, â€Å"The Employment Appeal Tribunal was right to find that it was not acceptable to have a chaperoning policy based on lazy stereotyping, Male nurses are still seen as a bit of an oddity simply because there are so many more women in the profession than men despite the fact that so many doctors are male. † (www. ews. bbc. co. uk/1/hi/health). The charity ManKind this year released a report presenting the ‘Seven Challenges Male Victims Face’, it highlights various forms of sexism especially within statutory service such as the NHS, â€Å"Practically all training with in the police, NHS and local authorities is aimed at women as the victims, men as the perpetrators. † (See appendix 2). Cultural discrimination is when a s ociety does not accommodate or recognise the needs of an individual or group of people from a different religious or cultural background. As a society there will be expectations of what the ‘social norms’ are, what is acceptable and what is not acceptable. When an individual or social group show beliefs or needs that do not fit in with our own social norms they can be met with hostility and intolerance. (Walsh et al, 2005). â€Å"Cultural barriers can prevent, for example consideration of spiritual, relational or dietary needs that do not conform to traditional expectations. † (www. bridgingthegap. scot. nhs. uk). There are many areas of patient care which are can be jeopardised due to ignorance of cultural beliefs, examples of these which are emphasised in the NHS guidelines for cultural and religious beliefs are: Diet- many religions are restricted as to what types of food they can eat, and how the food was prepared, for example an orthodox Jew will not eat pork or any meal that has come into contact with a pork product, Muslims also have similar beliefs surrounding food preparation. Personal Hygiene- as mentioned before patients often express preference to the gender of the HCP who assist with their personal care. An orthodox Muslim will only wash in running water, therefore offering a basin of water to wash in may be seen as offensive. Palliative care and Dying- each religion has different views are to how a body should be ‘laid out’, when a patient dies the patient is given the Last Offices, if a patient is Christian a bible is also usually set in the room, however some religions find it offensive for anyone except the family to ‘lay the body out’. http://www. bfwh. nhs. uk). This is why more importance needs to be emphasised on patient admissions and filling in the ADL forms to the best of our ability, as it can prevent any future offence or discriminatory practices. As you can see in the Activities of Daily Living (ADL) (see appendix one) spiritual needs are mentioned, however the contents of the ADL will vary from trust to trust an d all trusts do not include religion or spiritual needs. In the caring profession patients have shown signs of frustration, confusion and anger as their cultural beliefs are not met, over looked or ignored. (Leininger, 1991). Discrimination based on sexual orientation, Roper, Logan and Tierney identify sexuality as one of the ADL (Mckenna et al, 2008), within each NHS trust it varies as to what is recognised as an ADL. As you can see (appendix one) the trust I work for have not included sexuality. Many people within society see sex as a taboo subject and therefore find it a difficult topic to approach and discuss openly, however sexual health is a part of holistic health and should be taken as seriously as any other aspect of health such as mental, emotional or physical. The World Health Organisation defines health as, â€Å"a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. †(WHO, 1948). Studies have shown that the homosexual community are greatly disadvantaged and are the least likely group that identify with the protected characteristics to access health services. There are a variety of reasons due to this such as, a patient may not be openly gay, when they do access health services a majority of the time assumptions are made the reason for accessing that health service is related to the patients sexual health, also when homosexuals do access sexual health services they feel a stigma of promiscuity has been attached to the homosexual community. (Dunn et al, 2010). In conclusion from this essay I have realised barriers to health service access are a key factor in differential health outcomes among population groups within society. WHO, 2001) Although policies and procedures have been put in place by governing bodies to decrease the occurrence of discriminatory practice, these policies are not always effective; they are only effective when they are enforced by the organisation. Within the health care profession we must always strive to respect an all aspects of an individual’s identify and self-concept (Walsh et al, 2005). Simple measures such as filling in an ADL to the best of your ability can be a preventative method to causing future offence, or discrimination to a patient.

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