Healthcare for all?
This post is not about universal healthcare – at least not in the American political sense. That is a different topic for a different blog, albeit a very interesting one.
This post is about the healthcare system in the UK, although it undoubtedly applies to most other healthcare systems throughout the world as well. In the UK, the National Health Service (NHS) is available and free to everyone, including me as a non-UK citizen who lives here. Although there are certainly problems with the NHS, the healthcare professionals working within the system generally provide excellent care to all patients who walk through the hospital doors.
But what about people who have a hard time communicating their needs and/or understanding what they are told, or who may be difficult to interact with or examine because of behavioural problems? In a healthcare setting where time is extremely limited, are patients with learning disabilities being given an equal standard of care?
Unfortunately, in most hospitals, the answer is no.
I had a job interview a couple of weeks ago for a job which involved working with adults with learning difficulties, and in order to prepare for my interview, a friend who works in the NHS recommended that I read a review which was conducted in 2008 to assess the healthcare provided to people with learning disabilities. The review is called ‘Healthcare for All‘ and it highlights many important issues which need to be addressed.
I know that the NHS provides mandatory training to all new staff, and I am fairly certain that it includes training in equal opportunities and disability discrimination (I will find out soon!). However, I think that the most important point of the ‘Healthcare for All’ review is that providing equal care doesn not mean treating everyone in the same way. Unfortunately I think this is often mis-understood, and medical professionals believe that by treating someone with a learning disability the same way they would treat anyone else, they are providing equivalent care.
However, there are many problems with this. Some of the most crucial of which include:
1) People with learning disabilities are not always able to communicate their symptoms, their wishes, or their questions verbally, or to be understood by the healthcare professionals. Instead, these individuals may communicate through acting out or mis-behaving, which can then be mis-interpreted by healthcare professionals as stemming solely from the disability rather than being a means of communication. Therefore, these attempts to communicate are often brushed aside.
2) The family members/carers of the people with learning disabilities are often better able to interpret the words and actions of the person with a learning disability than the healthcare professionals. However, healthcare professionals do not always take the concerns of family members/carers seriously and may ignore their input in spite of them being an incredibly useful and important source of information.
3) Many healthcare professionals, particularly those working in general healthcare, have limited knowledge and understanding of learning disabilities and the applicable legislative framework. It is particularly problematic that general practitioners (GPs) and general healthcare staff lack knowledge in this area because they are the single point of access for treatment. In other words, in the NHS, if someone has a health concern, all referrals are made through the GP. Therefore, if the GP does not understand or take a concern seriously, the necessary tests and appointments – i.e., the next steps in care – will not be provided.
Sadly, these issues lead to very large discrepancies in care for people with learning disabilities as compared to people without learning disabilities. This means that even when controlling for all other health problems, people with learning disabilities have shorter average lifespans than people without learning disabilities, at least in the UK.
People with learning disabilities, as well as their carers, often feel misunderstood and ignored by healthcare professionals, and family members/carers are often expected to provide care which is beyond their personal means and should be provided by the healthcare system.
Clearly these issues need to be addressed and resolved, primarily through further education of staff, and I would hope that all new and existing staff members at all hospitals are required to read the ‘Healthcare for All’ report and any follow-up reports which are conducted.
I am certainly glad I read it. I believe that I have always been sensitive to issues surrounding equality and disabilities, but I will definitely be even more sensitive/empathetic now that I have read this report.