If you’ve been following my series of blogs about this project you'll know I was getting excited about a forthcoming ‘Roundtable’ meeting which I had organised for commissioning staff and community groups and leaders, to come together to discuss and agree what needs to happen over the next few months.
The desktop research report which I wrote initially was considered as a good starting point, but the consensus was that action needed to be guided at a local level. Those around the table agreed with the themes I had outlined:
- Equalities and protected characteristics frame NHS guidance and other documents
- The onus is placed on local primary care to get it right not central Government
- Minority groups and those with learning difficulties are seen as predominantly the ones who need to change
- ‘One-size-fits-all’ solutions are preferred by NHS guidance which tend to be too narrow
- IT solutions to this problem are being considered without understanding that minority groups and those with learning disabilities can be digitally excluded
It was emphasised that in Middlesbrough and Stockton minority groups were so diverse that any attempt to introduce overarching policies would not be successful. Communities from all parts of the world exist in this area and have very different experiences of disability, health provision and expectations from services. Barriers to accessing AHC’s will be varied and will be understood by asking appropriate questions and also asking for appropriate solutions.
However, a key message was that reasonable adjustments (making changes, providing support, allowing certain behaviours) have to be considered on the individual level, not the (primary care) organisation. This is crucial if AHCs are to be taken up more than they are now.
Also thought to be key was the involvement of VCOs in supporting individuals to access their AHC, handhold them through the process and empowering others to know of their rights to this type of service. VCOs are by their very nature engaging with community groups and individuals and can offer a link to those eligible for AHCs and their families.
The growing disadvantage of digital exclusion (where people either do not have or cannot use the internet or specifically computers, phones, or tablets) in NHS services can be tackled by working with these organisations. There are important VCO’s in both Middlesbrough and Stockton who although don’t work specifically with those with learning disabilities do work, for example, with young people and asylum seekers. Furthermore, community venues and services where target groups are can provide information about AHC’s and it was suggested that there could be supportive advocacy provided by these VCOs to ensure satisfactory reasonable adjustments made.
Those around the table also saw no reason why community venues and providers premises could not be places where the actual AHC’s could take place. Liaison with local GP surgeries would have to take place to make this happen.
This involvement of VCOs and community groups will need to be thought through because there are certain things which need to be clarified against legalities and national policies and procedures. The provision of interpreters, for example, at appointments such as AHC’s at the GP surgery need to be free from any bias. So, parent/carers and other family members cannot be involved and independent, paid for interpreters have to be used.
The final discussion point was on the role and actions of commissioners to help GP surgeries to ensure they understand and implement appropriate reasonable adjustments on an individualised basis. Ultimately VCOs, community groups and leaders can understand and support individuals and families in Middlesbrough and Stockton to access health services, but ultimately the responsibility is on commissioners of these services. A mechanism either formal or informal needs to be developed to ensure commissioners are held to account for the progression AHC’s being taken up by people with learning disabilities across the board.
Summary of key action points
- Consider proposals for additional support
- GP’s hold AHCs in community centres of VCO premises
- Promote digital inclusion, ensure services do not digital exclude
- Use of existing VCO services to empower communities
- Ensure reasonable adjustments are understood by GP surgeries and implemented on an individual level.
A final report is being planned along with at least one follow-up meeting with the commissioners of this project. The report along with any further information on actions being taken will be made available to all those involved and wider to service providers and GP practices. It is also envisaged that further meeting(s) will be arranged with community groups, leaders and VCOs to solidify recommended actions or activities. Watch this space!
In February 2007 Craig joined the Planning & Partnership team with a focus on Health & Social Care. He left MVDA in 2010 and re-joined us in August 2014 as Strategic Development Officer. He is currently acting as the partnership manager for both the Middlesbrough Carers Partnership and Middlesbrough Mental Health Partnership as well as leading MVDA’s work around VCS intelligence and supporting the Health and Wellbeing VCS Forum.