HEALTH FACILITATION

Valuing People (Department of Health 2001a) clearly states the existence of inequalities in health and in healthcare delivery for adults with learning disabilities. It sets out guidance that incorporates key principles of rights, independence, choice and inclusion for adults with learning disabilities. The emphasis is very much on social inclusion, and this extends to the areas of health care and healthcare delivery. Adults with learning disabilities should expect to have the same support in relation to their health needs as anyone else. Historically, the health experience and life expectancy of people with these additional complications were potentially poor. However, improvements in health care have meant that people can now expect to live longer with appropriate healthcare intervention, and hence the need to ensure that equal access to such health care is facilitated for adults who have learning disabilities.

To achieve this, an inter-agency approach is proposed and adopted. Partnership Boards were established within each local authority area, consisting of public, private, community and voluntary sector representatives, with a clear remit to involve adults with learning disabilities and their carers in the planning and implementation of the health agenda for adults with learning disabilities within their areas.

Through Partnership Boards, the implementation of the Health Action Plan process began and continues to address the issues of healthcare needs for adults with learning disabilities.

Health Action Plans are individual plans adopted within the concept of a person-centered approach to care. Health Action Plans identify the health needs of an individual and clearly indicate the support necessary to address those needs and optimize the health experience of the individual.

The person who has a learning disability, with a health facilitator(s), devel ops these plans. Health facilitators are identified within each Primary Care Trust; these individuals work as a bridge between the adult with a learning disability, mainstream healthcare services and specialist learning disability services, as appropriate. Their role is to ensure that each person has a Health Action Plan, and subsequently the opportunity to access appropriate health-care support.

As noted above, the emphasis within accessing health care is based within the principle of inclusion. Where possible, adults with learning disabilities are facilitated to utilize mainstream health services, such as local GP services, rather than feeling segregated within ‘specialist’ services. It is hard to believe that not all adults with learning disabilities have been registered with a GP in the past. This fact in itself highlights the inequality that people have historically experienced. Indeed, the Department of Health’s Good Practice Guidance (2002b), relating to Health Action Plans and health facilitation, clearly states that there has been a reluctance in some mainstream healthcare services to support improving health for adults with learning disabilities. This reluctance can often relate to concerns about lack of time, skills or adequate resources. However, this resistance is now being addressed through the work of health facilitators, providing information, education and support to enable greater identification of the health needs of adults with learning disabilities within our community.

Who might these health facilitators be? Within the White Paper (Department of Health 2001a), the community learning disability nurse (CLDN) is identified as a key professional who may be well placed (though not exclusively) to take on the health facilitation role. The CLDN often works within a multidisciplinary context in a community-based team, with access to the advice and support of a variety of professionals, such as consultant psychiatrists, clinical psychologists, speech and language therapists, occupational therapists, social workers and counsellors. They have a broad knowledge base in respect of the potential health needs of adults with learning disabilities. They may have established networks liaising in an inter-professional capacity with the primary healthcare team, for example. The facilitation of optimum health for the adults with whom they work will already form part of their portfolio of expertise.

A key role for the health facilitator is close working with local GPs, enabling them to identify the healthcare needs of the people with learning disabilities registered within their practice. Ensuring that people with learning disabilities have access to GP care and enabling people with learning disabilities to complete Health Action Plans and be involved in the decisions made in respect of their health care is also part of their role.

It is important to note the issue of inclusion here once again. Though every effort should be made to facilitate the individual to access mainstream ser vices, Valuing People (Department of Health 2001a) also notes that there are times when specialist services may be better placed in terms of knowledge, skills, experience or appropriateness of care to support adults with particular aspects of their healthcare needs. As carers or students supporting people with learning disabilities, you need to be conscious that a person’s experience of health and healthcare provision is an individual one. In your work with adults with learning disabilities, you will need to be aware of the local health facilitators and related resources, to enable people to access appropriate support. Facilitating the achievement of optimum health should be everyone’s aim. Including the person in his/her Health Action Plan, and ensuring that the most appropriate service provides that care, be that specialist or mainstream services, will enable this to happen.

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