When the National Health Services (NHS) was founded in 1948, one of the principles was to provide complete services to all and free at the time of need in UK (nursing times.net 2009). Access to healthcare services is based on clinical needs of an individual and not the ability to pay the services. This means everyone has the rights of accessing to health and social care, although it is still a major problem for low social group and ethnic minority who are facing personal, socio economic, cultural and problems happening as results of the structure of health and social care processes (POSTNOTE 2007).

In this essay, a case study will be used to demonstrate a patient with learning disability who faces various problems during his access to health and social care services and factors that contributed to these problems. Also it will focus on how nurses could support these individuals to make decisions about their care. The meaning of learning disability will be explained. The assignment will also look at major cultural and social economic influencing the health and health choices of individuals. Also it will analyze the differences between health education and health promotion and with their importance in individual in accessing health and social care. The challenges inherent in meeting the needs of people of varying abilities and social backgrounds will be look at as well as the factors that trigger the accessing of multi-professional health and social service. The essay will also discuss the understanding of the legislation related to the provision of health and social care, as a nurse why are we needed to be aware of the inequalities in provision. A name mentioned in the case study has been changed in order to comply with the code of NMC (2008) and consent was obtained from the patient and the name Anil will be used in stead.

Anil is a boy of eighteen years old who came to UK from South East Asia seven years ago. He lives with his parents in the housing estate of East London where majority are ethnic from South Asia. His father who earns minimum wages works in a food factory in six days a week, speaks English and his mother is a fulltime housewife and does not speak English, only Hindu.

Anil was born with Asperger syndrome, a lifelong disability that affects how a person makes sense of the world, processes information and relates to other people. People with Asperger can find difficult to communicate and interacts with other (NAS 2010). Anil had never been to hospital in India and he was treated by traditional healers. He only started seeks medical assistance when he moved to UK. Anil physical condition has deteriorated recently. He does not eat well; look tired, sometimes suffered headache and finding difficult in sleeping. Since he came to UK, he had been to school for three years only and he never had friends. He does not mix well with other people and his parents do not bother about this. At times he lets himself become a little neglected.

Anil represents a small and vulnerable group in a society who find difficulty in accessing and using health and social care because of the greater health care needs they have than general population. Motor and sensory disabilities, Epilepsy, hypertension and Alzheimer’s disease are some of the conditions that are common in this group (NURSING STANDARD 2010). The MENCAP report (DEATH IN DEFFERENCES 2007) states that people with learning disability are being treated wrongly in all part of healthcare provision and they are not equally valued in the health services. The government also revealed that people with learning disabilities are poorer particularly uptake of invitations on primary care and hospital provisions such as access screening services (ALD 200/01). Because of their greater needs of healthcare, they are more prone to a wide variety of additional physical and mental health problems as it shows to Anil. According to Tudor- Hart (cited in Hart 1985) there is an increasing in evidence of an ‘inverse care law’ where those who needs are greatest get the least.

Learning Disability is a life long condition which has a significantly reduced ability to understand new or complex information and it is vary from one person to another. The World Health Organization (WHO) defines learning disability as impairment of the body function which limits the activity of an individual in performing a task or action (WHO 2010)

According to Thomas and Woods in their book ‘Working with people with learning disabilities 11(2003), a learning disability is a terminology used to label people with lower level of intellectual that is lower than the average to normal people in the society. The term itself was widely accepted in England following a speech in 1996 to MENCAP by Stephen Dorrell, the then secretary for Health. From time to time the title and labels have changed and this has been driven by several influences. The term used to cover children with specific learning problems that may arises from a number of different things like emotional problems, medical problems and language impairment (BILD 2004). In the past, many people with learning disability were lived in institutions and have been labeled differently by their generations. Many different forms of terms have been used before. Terminology such as menace, sub- human organism, unspeakable objects of dread, holy innocent, diseased organism, eternal child and many more (WOLFENSBERGER,1972). There are about 1.5 million people with learning disability in UK who require different levels of support (MENCAP). It has been identified that approximately 26.5% of people who have learning disability as being associated with genetic factors (Craft et al 1985).

Learning Disabilities is caused by problems during brain development before, during and after birth (RCSLT 2009). There are different types of learning disabilities some of which are Asperger syndrome (a specific type of Autism) which affect a person the way interact to the world, reading disabilities, writing disabilities, non verbal learning disabilities (NVLD) and many more (ALD 2000-2010), reading disability (dyslexia), speech and listening disability, and auditory processing disorder. It is often detected in early childhood.

In UK there are laws and policies which describe how the needs of people with learning disabilities should be met. The purpose of these laws and policies is to improve quality of life and based on empowerment, making choices and decision, having the same opportunity and rights as other people and social inclusion. Policy such as` valuing people’ which explain how the government will provide same opportunity and choice for people with learning disabilities and their families to live full and independent lives as part of their local communities and to ensure they gain maximum life chance benefit ( DOH 2010).

The Disability Discrimination Act 1995 which is a piece of legislation promotes the rights of people with learning disabilities to access healthcare and other care services. Healthcare providers must respect, support them and their families and conforms to professional standard (NHS 2006). It is the NHS duty to make sure they provide an equal service that can be easily accessed by anyone according to this Act.

Most of the people with learning disabilities have sensory and physical impairment that make it hard to make their choices and to understand by others. A piece of legislation which protects them in England is Mental Capacity Act 2005 which is empowers and protects vulnerable people who are not able to make their own decision. People with learning disability will still have the right to give their consent for daily living and accessing the services despite of having significantly reduced ability to understand new learning skills (NURSING STANDARD 2010). If the person lack a capacity of giving or refusing consent, it is still possible for care providers to provide care and treatments for the best interest of the person (DOH 2003). A survey showed that nearly 62%of all people with learning disabilities depend on their parents and other caregivers (EMERSON et al 2005).

However, healthcare providers have a duty to understand and recognize the needs of a person with learning disabilities and make sure their needs are met. It is a nursing role to work in partnership with the clients to overcome barriers by identifying what management and decision to represent the person mostly professionally although clients and their cares may make their own decision.

People with learning disabilities in lower social classes are particularly disadvantage relative to the higher social classes in accessing healthcare services because of physical, social, psychological and economic barriers that limit their full participation in society. Acheson (1998) identified the links between inequalities and poor health. He noted that health inequalities were widening with the poorest in society being more affected than those who are well off. The post code lottery which depends on where you might live is a big issue in NHS. The availability of better treatment, drugs and waiting time in a deprived area where people depend on state healthcare provisions will carry on experience poor access to services and treatment than those who have the power of buying services in private services (GUARDIAN 2000).

People from ethnic backgrounds experience healthcare service differently due to their lack of knowledge which can be limited by the ability to communicate in English. They may find challenge to enter healthcare services because it may require, for example making a telephone call, appointment, coping with a queuing system and complex procedures ( NHS 2006). Different in culture’s attitude and stigma between where they came from and UK can impact Anil’s health. It is believed that South Asian parents don’t have positive attitudes towards disabilities because religious and superstitious beliefs (ROYAL COLLEGE OF PSYCHIATRIC 2003). Anil’s parents might not take his problem seriously because of their background and social stigma of having a child with disability (AUTISM-INDIA 2008).

According to the report of Department of Health (2009) a review in development in tackling health inequalities of Acheson, recommended the improvement of living standards of people with lower income than average. Among the people in this group are people living in a deprived area and depend on social housing. Also people with learning disability may fail to get the necessary services because of lack of understanding about health issues articulating their needs based on their poor experiences of education system (Mathews 1996).

Research carried out by Cartwright & O’brien1976 found that General Practitioners spend far less time with their patients from lower classes ( cited in Hart 1985,p59). The situation may be more complex for service users who have little or no verbal communication and those with learning disability. A learning disability person may be unable to identify and describe the signs and symptoms requiring accurate medical attention. The information may not be presented in accessible format and the staffs may ask questions which can not understand (NURSING STANDARD 2010).

Unavailability of an experience interpreter in the healthcare settings can be barrier. It can affect the sensitivity of patient’s values and attitudes. To use a professional interpreter can reassure patients to communicate and feel freer when describing their religious beliefs and unsatisfactory environment conditions but to healthcare professionals may feel disempowerment and may depend on interpreters in order to carry out their roles (ROYAL COLLEGE OF PSYCHTRIC 2003).

Sometimes physical access may be an issue for people with learning disability; they find their appointment times are often too short to understand the system because of their difficulties and transport needs to access healthcare facilities are more distant. Practitioners may be given job in deprived areas with all facility available but they may be in the risks of vandalism, theft and anti social behavior (Thomson J et al 2003 p59).

The aims of the government today in UK is convince individuals to be more involved in their health. But the problems with availability of health promotion services and involvements are some of concern due to the restructuring of health and social care for people with learning disabilities has been accelerated by NHS and community care Act (DOH 1990, Emerson Et al 1996 chap 11). For example, most of the health promotion discussion and activities to accessing suitable primary healthcare is focus on medical involvements such as immunization (Stanley et al 1998 p71). Some of this medical approach can lead to reinforced dependency for people with learning disabilities. Those with severe learning disabilities, their needs are becoming known to service providers through secondary and tertiary care after being referred by primary care. Among health promotion is prevention which is focusing on decrease of risk occurrence of diseases, disabilities and handicap. These activities occur in health care settings. Primary prevention is to prevent from risk factors such as obesity through education, exercise and diet. Primary prevention produces information on various health issues in pictorial and easily understandable format such as cancer. On secondary prevention, it involves identifies early signs of diseases occurring such as cancer screening and tertiary prevention is involves reducing the impact of the disease and promoting quality of life through active rehabilitation (Thomson et al 2003).

Anil’s state of confusion may be caused a number of factors which might need further investigation. It is the duty of his General Practitioner (primary prevention) to refer him to hospital (secondary prevention) for investigation. A consultant may decide whether Anil has physical or mental illness.

To deal with and removing barriers such as difficulty with interpersonal communication, health promotion will need to promote inclusion and reduce inequalities in service provision (Thomson et al 2003 p129). World Health Organization (2010) has made it clear that health promotion is the process of enabling individual to improve and increase control of their health. Many primary healthcare professional do not have skills to overcome this problem as results those people who have learning disabilities are less likely to receive lifestyle advice than those who do not have learning disabilities (Fitzsimmons & Barr 1997). Learning disability nurses have a variety of skills in communication and observations which could be useful to teach other healthcare professionals in health and social care settings (Thomson et al 2003 p131)

Health education as a part of health promotion is defined as a planned communication activities designed to attract well being and ill health in individuals and group through influencing the knowledge, belief, attitudes and behavior of those in power of the community at large (Tannahill 1985p167-8). For people with learning disabilities, health education might promote social inclusion through decreasing negative stereotyping by valuing and respecting their needs. On a more individual level, people who receive health education messages have a choice to decide whether to follow or not the message given (Thomson J et al 2003).

Building partnerships between nurses, careers, other professional and people with learning disabilities is essential in order to promote and educating health by identifying their physical and mental health condition (DOH 1995). A partnership is not only the way to bring up to date statutory services but also is about developing and acknowledging the collective responsibility for the health and wellbeing of the community which they belong (Thomson J et al 2003, p102).

Having the opportunity to make choice about their healthcare is critical to their sense of inclusion in society. It is also a key factor in allowing individual like Anil to feel in control of his life. The NMC (National Midwifery Council) code of 2008sets out number of responsibilities on nurses to promote choice and respect the decisions of those they care. Nurses need to help them making their choice by making some simple adaptations. The first step can be taking a little more time to explain something and giving the person with learning disability more time to understand what is being said (NURSING STANDARDS 2010, P53).

Other approach could be the involvement of relative or paid career not to make choice on behalf of the person with learning disability but to use their knowledge of the person to help the care professional interpret or to explain treatment options. In all this processes, nurses need to ensure that they obtain consent before they begin assessment and treatment. Any decision to be taken by the staff must be in the interests of the person and must regard to his or her human rights.

To conclude, the essay has set out key difficulties experienced by people with learning disabilities in accessing healthcare services and the gap between rich and poor who are accessing healthcare appear to be widening. People who have learning disabilities are generally underestimated and find themselves failure to succeed their expectation. They experience more health problems than any other group in a society but use healthcare services less than the general population (RODGER 1996). Inequalities in health for people with learning disabilities must be dealt with by healthcare providers in health care provision with the aim of closing the division between the general public experiences and this group. By using good quality of health care and respecting people’s rights to access, and making reasonable adjustment, the lives of people with learning disabilities can be changed. Healthcare providers have a duty to ensure that people with learning disabilities are offered regular checking and are included in health screening program.