HEALTH IMPROVEMENT CLINICS
Healthcare professionals working with adults with learning disabilities have been increasingly concerned with their interface with primary and secondary health care over the last decade. Notably, the ‘Survey of GPs’ Views of Learning Disability Services’ (Marshal et al. 1996) highlights the disappointing attitudes of GPs toward adults with learning disabilities who attempt to access a service from the Primary Care Trust. Our Healthier Nation (Department of Health 1998) acknowledges that adults with learning disabilities are a ‘vulnerable group’ and set out to make vast improvements before 2010. Since the time of these publications, much has been written about the problem and, consequently, many initiatives within services for adults with learning disabilities have been undertaken, with varying degrees of success. One initiative that has certainly had a positive impact for adults with learning disabilities is the ‘Health Improvement Clinic’.
The clinic provides an opportunity for those who experience access problems for a variety of reasons to receive a comprehensive health assessment and, if required, an action plan aimed at meeting their highlighted health needs. It is important to note that the intention of these clinics is not to replace primary care or secondary care services for adults with learning disabilities, but instead to support them. Valuing People (Department of Health 2001a) identifies primary care services as the first point of contact for adults with learning disabilities.
However, Gates (2003) identifies a variety of issues from a service user’s perspective which may act as ‘barriers’ to receiving a good service from a GP surgery. Many of these are based on the ‘fear’ or ‘anxieties’ which exist amongst many adults with learning disabilities. These include being fearful of the environment of the GP surgery, which has been described as a very ‘serious’ and ‘unwelcoming place’, and, also, the doctors themselves may appear quite authoritarian and very often are a complete stranger to their learning-disabled patients. Additionally, difficulties occur with communication, as, often, the GP is extremely time-constricted and cannot take the time to learn to understand the patient and too often communicates via an accompanying carer to save time, which can leave the patient feeling undermined.
It is for these reasons that the Health Improvement Clinic will usually take place in a location which is familiar to the user, such as day centers, colleges, places of work and their homes. The clinic is usually led by two learning disability nurses, who are usually familiar with the location and the users within it. However, it is not unusual to see the same people on a number of occasions within the clinic to help them get used to the idea of the clinic and the nurses. The clinic utilizes a referral system whereby service users are encouraged to self-refer and highlight areas of health need which may require closer attention. For each referral, an appointment lasting approximately an hour is allocated. It was found that this was a reasonable time span in which to complete a thorough health check. Generally speaking, the ‘OK’ Health Check (Matthews 2004) or similarities are utilized. Matthews and Hegarty (1997) explain that the ‘OK’ Health Check is designed to systematically assess areas of health in which adults with learning disabilities are particularly vulnerable; they are listed in Table 1.
Table 1 The areas of health assessed by the ‘OK’
Health Check (source: Matthews 1998)
________________________________________________
• Current medication and side effects
• Circulation and breathing
• Perception of pain
• Digestion and elimination
• Skin condition
• Feet
• Ears and hearing
• Private issues
• Lifestyle risks
• Body dimension and measurement
• Epilepsy
• Urinary system
• Physique and mobility
• Oral hygiene
• Eyes and vision
• Mental health
• Sleep
________________________________________________
learning disability services. McKenzie and Powell (2004) emphasize the need for primary care teams to work with learning disability teams to provide good quality health care for adults with learning disabilities.
The action plan is often diverse in nature and could be a referral to an appropriate agency or professional. This referral may be internal, i.e. to another member of the learning disability team, such as a psychiatrist or therapist. Alternatively, it may be an external referral perhaps to a member of the primary care team, such as a chiropodist or a dentist, as appropriate. In all instances, the nurses would allow for time to discuss the most suitable way to support the referred agency and the service user, as, often, support and a certain amount of creativity are required, enhancing the chances of success. For some, using the clinic is a desensitization process to eventually utilizing GP surgeries and therefore may need to return to the clinic in a GP surgery. The information recorded can also be transferred on the service user’s Health Action Plan.
Additionally, the clinic acts as an advisory service on health issues and aims to promote health. Powrie (2003) highlights the need for health promotional information in general to be more ‘user friendly towards adults with learning disability’, stating that a recent analysis of leaflets held in GP surgeries showed there was very little that could be described as educationally informing to those with difficulties in reading and understanding. The learning disability nurses are in constant liaison with health promotional agencies that provide ‘user-friendly’ material; this is made available at the clinics.
