VOL: 97, ISSUE: 08, PAGE NO: 39
At the time of writing, Kay Graham, RNMH, was community nurse (learning disabilities). She is now health project facilitator, The Yorkshire Wolds and Coast Primary Care GroupThe need to raise the profile of learning disability services has been highlighted by health minister John Hutton in the document Once a Day (1999).
The need to raise the profile of learning disability services has been highlighted by health minister John Hutton in the document Once a Day (1999).
As a community nurse for people with a learning disability in east Hull, I have, over the past five years, helped to identify the specific health needs of people with a learning disability that have not previously been addressed. As a result, new services have been developed in partnership with other interested agencies, in particular, primary health care teams.
Our work has been based on the evidence from the Royal College of General Practitioners (1990), which expressed the concern that the health needs of people with a learning disability were in danger of being ignored.
We were also guided by Our Healthier Nation (Department of Health, 1998), which outlined some basic aims. These include improving the health of the population as a whole by increasing life expectancy and the number of years people spend free from illness, as well as improving the health of the worst-off in society.
In addressing health issues for people with learning disabilities we considered how, as health providers, we should promote and develop a programme of care that would include health promotion, health surveillance and health care at a level and pace that would be of benefit to people with learning disabilities and their carers.
Our programme of support, which is linked to Our Healthier Nation targets for people with learning disabilities, focuses on helping people with learning disabilities to:
- Choose a healthy way to live;
- Find out if they have an illness so that it can be treated early;
- Access good care if they are ill.
As a direct result of local research into why people with learning disabilities did not use primary health services, we began supporting them to do so.
Where people accessed primary health care independently, this was encouraged, but recognition was given to those who needed practical help to do so. This was achieved by developing a tailor-made well person clinic in the client's own GP practice.
These clinics were offered to assess, promote and monitor the physical health of adults with a learning disability. The aims and objectives for the clinics include:
- Being staffed by community learning disability nurses;
- Focusing on the prevention of ill health;
- Raising awareness of the benefits of health promotion among all clients;
- Facilitating health screening;
- Developing criteria for annual screening;
- Providing an opportunity and a challenge to familiarise reluctant clients with the benefits of health checks.
We started the clinics as part of a pilot study at three GP practices in the west of Hull before extending the programme to all those applicable clients known to the West Community Team. The clinics offer an open referral to clients and are developing links with primary health care teams.
We have been able to measure their effectiveness in a systematic way by monitoring clinic attendance, referrals and subsequent contacts. We routinely seek the views of service users. The effectiveness of this health-screening programme is now being formally audited as we have been given funding by our trust to enable us to assess the effectiveness of the actual screening tool we use.
We also offer health promotion workshops covering a whole series of health-related topics. The workshops, held in local community facilities, such as community centres, youth centres and church halls, are well attended, beneficial and enjoyed by all. They aim to enable participants to:
- Review and improve their general health and well-being;
- Discuss and explore health issues in a supportive environment.
The information given at each workshop has been adapted to be relevant to the groups' specific level of understanding. This is possible because there is a close partnership between the facilitators of the groups. Regular facilitators include a senior programme worker from social services day care, myself and fellow community learning disability nurses, and a client who has experienced a number of years of health care support. The health promotion workshop covers a number of topics in a 10-week programme, including:
- Accessing your GP;
- Healthy eating;
- Oral hygiene;
- Care in the sun;
- Breast and testicular self-examination;
- Not smoking;
- Drinking in moderation;
- The importance of exercise.
As the programme has been so successful, it has been expanded to include a health and art workshop.
The city of Hull is a health action zone with an implementation plan covering health strategies and health improvement programmes that aim to achieve better health and reduce health inequalities. Five different agencies, including the health service, social services, voluntary and youth service and the private sector, work together, alongside our clients and their families, towards the targets set for the health action zone.
One positive outcome of the programme is exemplified by Denise Hull who, as a result of being a client facilitator for the health promotion workshop, has become more confident. Ms Hull has asked to learn Makaton to help her to facilitate the course and she has applied to Mencap for assistance and funding for videos of the health workshop.
Ms Hull's aim is to teach and encourage other people with learning disabilities who may wish to become facilitators. She has always believed passionately that people with a learning disability should be afforded equitable health care. Her role as health facilitator has given her the chance to channel these beliefs.
Clients attending the workshops are now beginning to influence their content. We have also encouraged them to participate in local health initiatives together with the general population, such as the Health Garage (an MOT for the body).
The Health Garage offers health checks to adults living locally. The community team learning disability nurses are the 'mechanics' for the clients who have a learning disability and require additional support. This development has been enhanced by a grant from East Riding Health Authority.
The opportunity to research and develop specific health services has enabled nurses to plan for the future in developing health care packages that can be flexible and responsive to the complex needs of this group of clients.
It has also allowed attention to be focused on specific problems. It is estimated that about a third of the learning disabled population have epilepsy. Corbett (1981) states that the prevalence of epilepsy increases with the severity of the learning disability.
Signpost for Success in Commissioning and Providing Health Services for People with Learning Disabilities (NHS Executive, 1998) highlights epilepsy as being a wider problem than having seizures. It recommends that services should focus on quality-of-life issues, that treatment should be long term and that information, counselling and careful monitoring are required.
With these factors in mind, we are committed to improving the care of adults with learning disabilities and epilepsy. Recent projects to improve care include:
- Developing an epilepsy assessment tool;
- Developing an epilepsy management tool;
- Adopting standards of care through protocols and policies;
- Establishing greater liaison with epilepsy specialist nurses;
- Providing education to clients and carers, and to private sector, social services and other health professionals;
- Improving links with general practitioners;
- Joint working with other learning disability teams to audit current services.
This work has been carried out without additional staffing and nurses have maintained active community nursing duties and the benefits are evident.