Facilitation of access to services. L/O – To know the different types of barriers that prevent service users accessing services.

Facilitation of access to services

L/O – To know the different types of barriers that prevent service

users accessing services

How can we access services?Self Referral

- This is where individuals suspect that they have a health problem or recognise they have a social problem. They make themselves an appointment with their GP or can self-refer to social services by the telephone.

Professional referral- This is where individuals are already in contact with a health

professional. If the professional suspects that there are underlying or other problems they can referral the individual on for specialist help (Hospital consultants, psychiatric services or social services)

Third party referral- This is where an non-professional person such as a relative

friend or neighbour contacts the services on someone else’s behalf. Maybe the person themselves are unable to access the service for themselves, or maybe a person is suspicious of child abuse or domestic violence or mental health problems.

Types of barriers to services

Physical barriersPsychological barriers

Financial barriersGeographical barriersCultural and language

barriers

Physical barriers

• The Disability discrimination act states that all buildings must be accessible to people with disabilities, including mobility problems and sensory difficulties (sight and hearing).

• The level of accessibility can vary depending according to the focus of the service user, as well as the limitations posed by financial constraints - -– voluntary services tend to have small budgets, which are

only provided on year by year basis can’t make long term plans for alternations,

– Statutory services have larger budgets and have greater financial stability)

Difficulties faced by particular providers with regards to physical

accessHospitals– Many are old buildings, some were built as work houses– Range of services provided is much greater and most

hospital exceed the capacity of their original buildings– Hospitals do not have a consistent layout or design, with

newer buildings being added over the years.– Modern technology requires much more equipment for

both diagnosis and treatment – MRI Scanners, mammography equipments need lots of space.

– Wheelchair bound people have their needs catered for in most hospitals, but people with sensory difficulties may be less-served

– Where hospitals are brand new most of the accessibility problems have been overcome with the design stage.

Health centres and GP surgeries

• These buildings are the first point of call for anybody who is seeking health care (primary care services)

• If access is poor then initial contact can’t be made, leading to difficult or impossible diagnosis

• These buildings are getting better as Family Health Authorities (manage GP’s on behalf of NHS) have been helping GP’s to upgrade their premises to meet requirements of DDA.

Voluntary organisations• Many are registered charities (therefore

have different governance than statutory services)

• Much of their income may be derived from charitable donations and there are rules as to how the money can be spent, the majority going to the specific uses the charity is working for, leaving very little for building costs

• These also tend to be housed in older or listed buildings making it difficult to make accessible.

Activity• Visit your local GP Surgery/Health Care Centre/Hospital

– What physical barriers do you anticipate?– Are there any facilities to enable access?

• (wheelchair bound, blind, deaf, disabled, pushchairs)

• Write a report for the practice manager/centre manager/hospital management about barriers to access to the surgery/centre/hospital.– The report should be based on your observations

and include:• An identification and description of the types of barriers

service users may face when trying to access the surgery/centre/hospital

• Possible means of removing or reducing the barriers and thus facilitate access to the service.

Psychological Barriers• This is very dependent upon peoples on attitudes

towards their own health and illness.• DoH research shows that:-

– Men are less likely to see a doctor and therefore the extent of their health problems, particularly mental health difficulties, is hidden.

– Doctors are less likely to diagnose men with mental health problems than a woman

• The Men's Health Forum (Registered Charity) has found that:-– Young men were reluctant to use any kind of service and

displayed stereotypical male attitudes towards help seeking

– Services showed little or no understanding of young men or have to work with then effectively

• Men see illness as weakness and incompatible with what it means to be a male in our society, whereas maleness is associated with strength.

• These attitudes are formed as part of gender socialisation.

• People understand their health in different ways– Some people see their body as a machine, which is

liable to break down, particularly men– Stereotypical attitudes amongst male doctors can

sometimes prevent women from accessing services. E.g. Women may feel that their concerns are minimised by a patronising attitude, which undermines their self esteem and prevents them from asking questions.

• Some individuals feel that their health is a matter of willpower and determination, dependent on choosing a healthy lifestyle, these people also see illness as a weakness

• Some people may feel guilty if they become ill, or experience denial, attributing symptoms of ill-health to other things such as tiredness or stress

• Attitudes to health and illness behaviour are shaped through socialisation and many people lack knowledge and understanding of how their bodies work.

• Other people may feel that they have no control over whether they become ill or not, illness is seen as a matter of fate, and they are not worried about the long term risks to health.

• For some people the link between lifestyle choices and ill-health is denied or minimised because it may not be borne out by their own life experience, and they are resistant to health promotion and health education campaigns

• Some illnesses have a stigma attached to them. E.g. cancer, which is seen as life threatening and mental ill health.

• Fear of confirming such illnesses, and the implications for individuals and their families may prevent people from accessing services

• People with mental health difficulties may not recognise they have a problem, until there is a crisis.

Financial Barriers• Health and Social services are usually free at the point of

delivery, however there are sometimes charges attached to certain types of treatment, examples:-– Dental treatment– Cost of travelling if people live in rural areas– People of low incomes who are not eligible for free

prescriptions, the cost of treatment maybe considered to be too high – this may deter people from taking medication, especially if a person needs to take more than one type of medication

– Children's services, such as day nurseries, or childminders charge

– Residential day services and care services for the elderly also charge, as they are run by large private organisations

• The government does provide some assistance in the form of tax credits, particularly for working families requiring childcare.

• It is important that individuals have access to information about the type of financial help that is available for health, social and childcare services– Leaflets available at Post office– Citizens advice bureau offer guidance– Welfare rights organisations

Geographical Barriers• Services are not distributed throughout the country, and this is

particularly apparent for health and childcare services.• The numbers of GP’s vary across regions. There are twice as

many GP’s in Oxford than in Salford. • Children's services are provided by private organisations and

individuals and are therefore likely to be located in more affluent areas.

• People living in rural areas often have trouble accessing services due to having to rely on public transport.

• Public transport offers frequent services in areas with high density populations, therefore rural areas have very infrequent services as they are not cost effective to the company.

• Working people often have difficulty in accessing GP services, for example because appointments are only made during working hours.

• Therefore people have to take time off work to attend appointments, they may not get paid if this is the case, so they don’t go to the doctors.

• Where appointments are made centrally appointments or pre arranged, they may not be made at times that are convenient.

• Parking can also be difficult and limited, especially in hospitals. Car parks also charge for parking, this can add to the expense.

• Geographical aspects should be taken into account when plans services are being made.

Cultural and language barriers

• Accessing services for people whose first language is not English can be a particular problem

• In areas with high ethnic minority populations, information needs to be provided in more than one language.

• It can be hard to provide information in the appropriate languages.

• Signs and directions in most services are written in English.

• Many organisations provide translation services• Medical terms are often hard to translate.

• Individuals from certain cultures that have particular strict gender roles may feel uncomfortable in being seen or treated by health professionals.

• Other cultural issues include information about dietary requirements of a particular group.

• These issues can cause psychological barriers as well as cultural barriers.

• It is important for health and social care professionals to understand them and think about ways of providing culturally sensitive services.

Ways of facilitating Services

• Adapting premises

• Raising awareness and changing attitudes

• Promoting self-advocacy

• Identifying additional funding

• Joint planning and funding for integrated services and effective care

Group work – Case studies