Enhancing Care Delivery for Clients with Learning Disability and Diabetes in London

Complex Health and Social Care Needs

How Is Participation And Collaboration Across Professional Groups And Sectors To Enhance Care Delivery For This Client Group Developed?

What Recommendations Do You Have? What Could Nurses Do To Respond To Local Health/Social Issues To Support The Health Of The Local Community?

An increasing number of people are residing with complex care need that is being characterised by mental health issues, multi-morbidity, and social deprivation. According to Kuluski et al. (2017), illness has found to have a predominant impact on the lives of people and management of treatment and medicines that involves a number of factors such as social participation, societal contribution, and relationships. Even though a large number of people have presented with complex health and social needs, the health system is focused in offering care and treatment for one illness at one time or prioritising it orienting care on medical or social aspects by providing attention to involve the quality of life as well as social support. A long-term condition is found to be one that is not cured; however, it can be managed with the use of drugs and other therapies. It can also be stated as a chronic condition or life-limiting condition for individuals suffering from it. The occurrence of such conditions is found to be strongly associated with people that are suffering from multiple long-term diseases in England that had arisen to 2.9 million by 2018 (Assets.publishing.service.gov.uk, 2020).

The essay aims to explore a group of the client with complex health and social care needs, which is learning disability and diabetes within a specified geographical community in the UK that was chosen to be London. The use of varied literature, policy documents and other information will be reviewed for discussing the health and social needs of the specified groups and promotion of access to health care and holistic nursing interventions for enhancing the health of the clients.

The rationale behind choosing this group of clients from London is because due to various reasons, the population with complex health and social care was increasing, which pose pressure on the health system and the healthcare professionals in the city. Thus, the study will be conducted to evaluate the barriers and challenges associated and mitigate them for the proper functioning of the health system.

The learning disability is stated to be a reduced intellectual ability and there is a difficulty in conducting activities on a daily basis. Therefore, people with this disorder tend to take a longer time to learn and require support in the development of new skills, understanding of complex information, interacting and developing relationships with other people. As per the report, men with learning disabilities die on an average 14 years earlier than others, whereas, in the case of women, it is 18 years (Ninnoni 2019). The reason for the early death of people suffering from learning disabilities is stated to be a lack of healthcare services and the avoidance of good health outcomes. According to Chambers and Campbell (2019), people with a learning disability are likely to have diabetes than the general population. It can be stated that adults with learning disabilities are found to have a high rate of multi-morbidity, as they tend to develop health issues at an earlier age. The prevalence of diabetes with people having a learning disability is not known; however, in the recent data, it is found to be 10% and the rate is doubling at a quick rate among the general population. In most of case, diabetes is observed to be type 2 diabetes (Baines and Hatton 2018). The risk factors for type 2 diabetes include obesity and a sedentary lifestyle and in the UK, there are 40% of the adults are found to have a learning disability and obese. The situation in London is more grave in nature and the quality of life of such people is negatively affected. According to Mason and Williams (2017), people with learning disabilities have a reduced ability to assimilate new and complex information and learning new skills. They are unable to cope up with the situation on an independent basis. This worsens the scenario of management of diabetes, as they require external support for the management of the complex situation. Therefore, the need for developing local community needs assessments and strategic plans which seek to enhance the wellbeing and health and social care for people with learning disabilities who have complex and multiple needs were required (Ninnoni 2019). Over time, both governmental and non-governmental agencies have understood the importance of addressing the complex health and social care needs of the affected people in London as a result of which, assessment of the scenario on an annual basis, and development of strategic plan were established. According to the study of Powell and Jefferies (2019), the biochemical perception of health is characterised by highlighting the mechanism and disease progression and include a reductionist viewpoint that defines health as an absence of disease. This has been long ago replaced with a view that focuses on the role of sociocultural factors in shaping the psychological and health-related experience. The sociocultural environments help in shaping the psychology with respect to illness and health as it involves the way of thinking, feeling and the physical state.

Barriers and Challenges to Proper Functioning of the Health System

As stated by Mafuba et al. (2018), the needs of people with learning disabilities are critical and complex in nature. One of the major factors that pose difficulty in assessing the needs of such people is the multitude of conditions that are included in the umbrella of learning disability. The conditions include dyslexia, dyspraxia, and attention issue, genetic issues such as Down syndrome, challenging behavioural issue, or Asperger’s syndrome. In an occasional manner, the people are found to have a sensory or physical impairment that is considered a learning disability and thus, there is no single assessment that helps in identifying or distinguishing between these conditions (Intellectualdisability.info 2020). The target population, specifically in London as well as in other locations, experience issues such as memorising, recalling, merely telling the time, conceptualising, conducting day-to-day activities, or learning new things. Three criteria need to meet in order to be considered to have a learning disability. These include impairment of intellectual function, impairment of social and adaptive functions and the condition that occur before the onset of adulthood. Bates, Goodley and Runswick-Cole (2017) opined that identification of various difficulties utilises the evidence-based approach for addressing various needs of the individual. It is important to address the issue as they have a potential impact on the social and economic aspects. Even though the people in London are well to do; however, the economic stress, in this case, sometimes becomes unbearable in nature. The use of early intervention policies by various organisations has been implemented. These include the World Health Organisation, Department of Health, World Bank, Department of Education and Graham Allen MP of early intervention (Rcn.org.uk 2017). The approaches are found to work well among people with learning disabilities (LD) that involve drawing on knowledge of behavioural research. This indicates the potential advantages of offering behavioural interventions. The robust evidence in case of early behavioural interventions has a positive effect on both children and parents as per the NICE guidelines. The Triple P Parenting Programme is one of the most well-known examples that was designed for the parent having children of 2-8 years with LD. It is one of the multilevel systems in term family intervention that helps in preventing the emotional and behavioural aspect (Robinson, Moore and Hooley 2018). This helps in promoting as well as nurturing the relationship between the two target populations. In addition to this, community intervention or support care is useful in aiding people with learning disabilities. The complex health and social care of people are challenging to treat simultaneously using medical intervention; therefore, the community care plan needs to be applied. In this case, the risk factors need to be identified by the professionals at an initial stage by considering the difference between the population with specific health needs (Hines et al. 2019). In addition to this, integrated care approach needs to be done by recognising the behaviours and emotional factors, the use of continued inputs that include referral and re-referral over time, systematic screening process, Positive Behavioural Support (PBS) that can be used as a framework and family-centered care approach. Individually or combined utilisation of approaches can be used for enhancing recovery and coping of the disorders suffered by the individual.

Strategies for Enhancing Care Delivery

As stated in the study of Hardy, Chaplin and Tolchard (2018), one of the strategies that can be used for the implementation of appropriate and timely addressing care among the people, those who have learning disabilities and diabetes, is communication. People with learning disabilities are found to have poor physical and mental health as compared to the general population. As per the report, a number of barriers that do not allow the people with the complex disorder from accessing good quality healthcare services (Cnwl.nhs.uk 2020). The barriers include transportation issue, failure of diagnosing the condition, inability of identifying people with a learning disability, stigma, ineffective or untrained staffs, and identification of diabetes among people with learning disability, limitation in joint efforts of different organisations, less involvement of carer provider and inadequate follow-up or aftercare. In this particular field, communication is not only about talking; however, but it also involves listening. By communicating with a person suffering from learning disabilities, the tone, body language, and word used are considered to be critical in nature (Morris, Oshita and Stransky 2019). Healthcare professionals need to be an excellent communicator for offering care and support to the individual with complex physical and social care needs. Since the brain function of such people is not developed and the metabolism pathway is affected; thus, the use of accessible language needs to be done. A language programme is known as Makaton that uses signs, symbols and speech in order to commute emotion, thus, offering different options while offering treatment to the individual. Another important aspect that needs to be taken into consideration understands that each individual is unique and thus, communication needs to be done based on his or her need that will best suit the person (Kurpas et al. 2018). The foremost criteria that need to be evaluated are the cause and severity of the condition because, without proper assessment of the disorder, it is not possible to implement care strategy. Thus, thorough evaluation and assessment, both the physical and mental status of the individual need to be done. Healthcare professionals have a legal duty that needs to make reasonable adjustments as per the individual (GOV.UK 2016) and it includes easily accessible information, longer appointment times and avoidance of any medical errors. Patients with a learning disability have various issues that affect their brain function as a result of specific interpersonal communication for establishing a strong relationship between the patient. (Haegdorens, Monsieurs and Van Bogaert 2018) opined that the use of interpersonal communication in treating people with learning disabilities will help in gaining more information about the case study and, thus, the development of the care plan. As stated by Jones (2016), timely management of escalation and early identification of learning disability with other health issues is effective in offering treatment. One of the barriers to accessing health settings and equal healthcare service is the lack of reasonable adjustment. This involves accessing to investigations and appointments that can be contributory factors in various cases of avoidable deaths. Therefore, communication is stated to be an important intervention strategy that helps in understanding the needs and demands of the clients and offering them person-centric care to support them in leading a normal and independent life.

Recommendations for Nurses to Respond to Local Health and Social Issues

In a study conducted by Anderson et al. (2017), the barrier to engagement and accessing healthcare service among people with learning disabilities having diabetes in London is less concern or attention provided to them. This is because in most case, the situation remains undetected as learning disabilities in the early childhood is not considered to be critical as a result of which, it is detected at a level where it becomes untreatable. Diabetes is a health issue that is related to insufficient or no production of insulin. This develops commonly among patients with learning disabilities because of the fact that the health condition of such people is not given importance. In addition to this, the focus is given on treating the mental issue; as a result, neglect to the physical condition is applied. This leads to obesity, which is considered to be a major factor in the development and progression of diabetes. According to Liljas et al. (2017), independence is stated to be an important barrier for such individuals in involving and accessing the appropriate services. The individuals cannot conduct day-to-day activities on their own in most of the cases; as a result, they need to depend on others. Alshammari, Doody and Richardson (2018) opined that the aspect of dependence poses various kinds of barriers in accessing healthcare services. For example, the care worker did not show up one day as a result; in that case, the appointment with the doctor needed to cancel because the individual is unable to visit the doctor alone. Other barriers involve a lack of appropriate information that is required, such as knowing the treatment options, referrals, and administration of medication or exercise used for management or controlling the symptoms of intellectual disability and diabetes. Therefore, solutions need to be applied for effectively addressing the issues or challenges faced by the vulnerable group of people. The first solution is to the identification of the issues that are learning disability and diabetes, which can affect the quality of life to a large extent. Crook et al. (2016) opined that early identification is useful in treating the patient at a primary stage; thus, the chance of management or curing increases. The second solution is to offer qualitative and quantitative information in all possible manner that suits the need of the patient; therefore, person-centred care consisting of an evaluation of the needs and demands of the patient and offering care is significant. Moreover, the support system needs to be strengthened that allows in leading a better life. The use of social care workers and referrals in case of community care or other purposes need to be given that help in upgrading the quality of care as well as life. From the opinion of Vogan et al. (2017), the guidelines of various national and local authorities need to be taken into account while offering care to people with learning disabilities and diabetes. As the individual suffers from such varied health and mental care needs that are complex in nature, therefore, holistic and comprehensive care approach needs to be adopted for addressing the needs as well as catering to the disabilities that affect the health and social wellbeing. In addition to this, the support of the family and community is also important in nature. The support needs to be in the form of physical, mental, emotional and physiological states that will allow the individual to have a positive environment. This is vital for the mental wellbeing of the people that have allowed in management of the complex disorder in an effective manner.

Early Intervention Policies and Behavioral Interventions

The role of the learning disabilities nurses is critical in the promotion of holistic healthcare and wellbeing of the client that is suffering from multiple and complex health and social care needs. Dickens, Large and Browning (2019) opined that the nurses offer care and support to the vulnerable people and help them in living independently. The nurses need to ensure that the need of the patient, either child or adults, are met and thus, support them to maintain the physical and mental health as well as supporting them to conduct daily activities. These nurses also help in teaching them the skills that are required to work in an independent manner at a pace that is optimised for them. The community and support living setting is stated to be maintained by the learning disability nurse as they conduct critical responsibilities. Mafuba et al. (2018) states that the nurses assess and plan the care requirement on both a general and individual basis, advice organisations to organising services and resources. This is related to offer appropriate care and benefits, assist in the learning of basic skills, liaising the family members and other healthcare professional and meeting the client in follow-up cases to discuss the progress. In London, the employers that offer to learn disability-nursing care include the NHS, day centres social services, residential homes, charities and specialist schools. Since the learning disability nurses work in a range of settings; therefore, it is important to offer governmental support (Gray and Watson 2017).

From the essay, it can be summarised that clients with learning disabilities and diabetes pose a challenging issue in the healthcare setting in London. The individuals that have such critical conditions are found to have several issues with respect to their daily life and conducting simple activities. The communication skill is also hampered in addition to other basic skills that are acquired during the initial phases of childhood. Diabetes is a complex issue in the kidney that affects health as a result of which prolonged treatment needs to be given. Many underlying factors need to be investigated in the assessment process subjected to critical analysis. London is one of the most prevalent cities in Europe, where the population of people suffering from learning disabilities and diabetes is high. Therefore, it is chosen for conducting the study in an in-depth manner. There are barriers in terms of engagement and accessing healthcare service among the target population; as a result, the health outcomes are deteriorating at a considerable rate. The complex health and social care needs were analysed and in response to it, solutions are proposed in order to overcome them. The examination of the needs of such people is critical in nature; as a result, various kinds of interventions in terms of health, social and psychosocial aspects have been assessed that allows in improving the recovery and coping rates specifically in the chosen geographical location. In addition to this, the role of learning disability nurse is critical that is responsible for promoting the universal health and wellbeing among clients with multiple and complex health needs. The importance of communication and local community needs assessments and strategic plans were assessed in a critical manner.

Community Intervention and Support Care

References

Alshammari, M., Doody, O. and Richardson, I., 2018, June. Barriers to the Access and use of Health Information by Individuals with Intellectual and Developmental Disability IDD: A Review of the Literature. In 2018 IEEE International Conference on Healthcare Informatics (ICHI) (pp. 294-298). IEEE.

Anderson, J.K., Howarth, E., Vainre, M., Jones, P. and Humphrey, A., 2017. A scoping literature review of service-level barriers for access and engagement with mental health services for children and young people.

Assets.publishing.service.gov.uk. 2020. Long Term Conditions Compendium of Information [online] Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216528/dh_134486.pdf [Accessed 13 Mar. 2020].

Baines, S. and Hatton, C., 2018. CQC inspection reports for acute NHS trusts: are there relationships between the comments in inspection reports regarding people with learning disabilities and CQC hospital/trust ratings?. Tizard Learning Disability Review.

Bates, K., Goodley, D. and Runswick-Cole, K., 2017. Precarious lives and resistant possibilities: the labour of people with learning disabilities in times of austerity. Disability & Society, 32(2), pp.160-175. 

Chambers, D. and Campbell, S., 2019. Common and Assistive Technology to Support People with Specific Learning Disabilities to Access Healthcare. Everyday Technologies in Healthcare, p.109.

Cnwl.nhs.uk. 2020. History :: Central and North West London NHS Foundation Trust. [online] Available at: https://www.cnwl.nhs.uk/about/history [Accessed 14 Mar. 2020].

Crook, B., Tomlins, R., Bancroft, A. and Ogi, L., 2016. ‘So often they do not get recruited’: exploring service user and staff perspectives on participation in learning disability research and the barriers that inhibit it. British Journal of Learning Disabilities, 44(2), pp.130-137.

Dickens, J., Large, M. and Browning, M., 2019. The Role of a Learning Disability Practitioner in Birmingham Liaison & Diversion Team.

GOV.UK. 2016. Public Health England. [online] Available at: https://www.gov.uk/government/organisations/public-health-england [Accessed 14 Mar. 2020].

Gray, J. and Watson, V., 2017. Evaluation of a learning disability liaison nurse service. Learning Disability Practice (2014+), 20(5), p.35.

Haegdorens, F., Monsieurs, K. and Van Bogaert, P., 2018. Standardizing care processes using evidence-based strategies: implementation of a rapid response system in Belgian hospitals. In The Organizational Context of Nursing Practice (pp. 239-257). Springer, Cham.

Hardy, S.E., Chaplin, E. and Tolchard, B., 2018. Working with Children and Young People with Learning Disabilities and Comorbid Mental Health/Autism/Challenging Behaviour Conditions: A Workforce Development Project.

Hines, M., Bulkeley, K., Dudley, S., Cameron, S. and Lincoln, M., 2019. Delivering Quality Allied Health Services to Children with Complex Disability via Telepractice: Lessons Learned from Four Case Studies. Journal of Developmental and Physical Disabilities, 31(5), pp.593-609.

Intellectualdisability.info. 2020. The health needs of people with learning disabilities: issues and solutions. [online] Available at: http://www.intellectualdisability.info/how-to-guides/articles/the-health-needs-of-people-with-learning-disabilities-issues-and-solutions [Accessed 14 Mar. 2020].

Jones, I., 2016. De-escalating Interventions for Troubled Adolescents.

Kuluski, K., Ho, J.W., Hans, P.K. and Nelson, M.L., 2017. Community care for people with complex care needs: bridging the gap between health and social care. International journal of integrated care, 17(4).

Kurpas, D., Gwyther, H., Szwamel, K., Shaw, R.L., D’Avanzo, B., Holland, C.A. and Bujnowska-Fedak, M.M., 2018. Patient-centred access to health care: a framework analysis of the care interface for frail older adults. BMC geriatrics, 18(1), p.273.

Liljas, A.E., Walters, K., Jovicic, A., Iliffe, S., Manthorpe, J., Goodman, C. and Kharicha, K., 2017. Strategies to improve engagement of ‘hard to reach’older people in research on health promotion: a systematic review. BMC public health, 17(1), p.349.

Mafuba, K., Forster, M., Kupara, D. and Gates, B., 2018. Improving the health of people with a learning disabilities: a public health nursing approach final literature review report. 

Mason, V. and Williams, V., 2017. Enabling good emotional support for and with people with learning disabilities. Tizard Learning Disability Review.

Morris, M.A., Oshita, J.Y. and Stransky, M., 2019. Advancing the delivery of communication sciences and disorders services through research: The promise of health services research. Perspectives of the ASHA Special Interest Groups, 4(1), pp.16-26.

Ninnoni, J.P.K., 2019. A qualitative study of the communication and information needs of people with learning disabilities and epilepsy with physicians, nurses and carers. BMC neurology, 19(1), p.12.

Powell, S. and Jefferies, R., 2019. Development of training programme to manage behaviour that challenges in children and young people with learning disabilities. Learning Disability Practice, 22(6).

Rcn.org.uk 2017. The Needs of People with Learning Disabilities [online] Available at: https://www.rcn.org.uk/professional-development/publications/pub-005769 [Accessed 14 Mar. 2020].

Robinson, D., Moore, N. and Hooley, T., 2018. Ensuring an independent future for young people with special educational needs and disabilities (SEND): a critical examination of the impact of education, health and care plans in England. British Journal of Guidance & Counselling, 46(4), pp.479-491.

Vogan, V., Lake, J.K., Tint, A., Weiss, J.A. and Lunsky, Y., 2017. Tracking health care service use and the experiences of adults with autism spectrum disorder without intellectual disability: A longitudinal study of service rates, barriers and satisfaction. Disability and Health Journal, 10(2), pp.264-270.