Facilitation of access to services

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

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Types of barriers to services

• Physical barriers
• Psychological barriers
• Financial barriers
• Geographical barriers
• Cultural and language barriers

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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
  cant make long term plans for alternations,
• Statutory services have larger budgets and have
  greater financial stability)

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Difficulties faced by particular providers with
regards to physical access

• Hospitals
• 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.

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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 cant be
  made, leading to difficult or impossible
  diagnosis
• These buildings are getting better as Family
  Health Authorities (manage GPs on behalf of NHS)
  have been helping GPs to upgrade their premises
  to meet requirements of DDA.

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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.

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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.

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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

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• 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.

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• 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.

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• 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.

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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

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• 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

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Geographical Barriers

• Services are not distributed throughout the
  country, and this is particularly apparent for
  health and childcare services.
• The numbers of GPs vary across regions. There
  are twice as many GPs 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.

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• 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 dont 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.

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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.

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• 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.

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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

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Group work Case studies