Exploring Complex Health Needs: LD and Diabetes in London Essay

This essay examines the complex health and social care needs of individuals with learning disabilities and diabetes within the London community. It explores the challenges faced by this client group, including reduced intellectual ability, difficulties with daily activities, and a higher prevalence of diabetes, particularly type 2. The essay reviews relevant literature, policy documents, and community profiles to identify specific health and social care needs, such as the need for early intervention and community support. It analyzes barriers to accessing healthcare, including communication challenges, lack of reasonable adjustments, and stigma. The essay proposes evidence-based and holistic nursing interventions, such as improved communication strategies (e.g., Makaton), tailored care plans, and integrated care approaches, to enhance clients' health, well-being, and coping abilities. The importance of addressing sociocultural factors, implementing early intervention policies, and the role of the learning disabilities nurse in managing these complex conditions are also highlighted, with a focus on promoting access to appropriate healthcare and overcoming barriers to engagement.

Running head: LEARNING DISABILITY AND DIABETES IN LONDON
LEARNING DISABILITY AND DIABETES IN LONDON
Name of the Student:
Name of the University:
Author’s Note:

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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.

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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

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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.
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

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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.

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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

6LEARNING DISABILITY AND DIABETES IN LONDON
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.
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

7LEARNING DISABILITY AND DIABETES IN LONDON
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

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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.
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

9LEARNING DISABILITY AND DIABETES IN LONDON
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.

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