BARRIERS TO ACCESS
Financial barriers
NHS and social services are seen as free but there are costs for some i.e. dental treatment
Not enough funding = not enough resources = delays in getting appointments.
Staff shortages or shortages of beds can cause delays in receiving treatment and surgery causing multiple cancellations for some individuals.Individual service users cannot do anything about this other than to opt for private health care (if they can afford it).
Individuals on low incomes may not access a service because of the cost.
May be unaware of the benefit entitlement.
The cost of travelling to a service may be very high – deter them from seeking treatment or prevent them from taking medication which could have serious long-term effects.
Private organisations charge e.g. day nurseries, childminders, and residential care services – too expensive.
To improve:
Identification of additional sources of funding i.e. government tax credits to help with childcare services.
Easily accessible info about the type of financial help available i.e. leaflets at the post office, department of health website, citizens advice bureau or welfare rights organisation.
Promotion of self-advocacy
Some conditions/illnesses are exempt from prescription charges
There is financial assistance for some people with chronic, and long-term conditions.
Physical Barriers
When one is physically unable to access services
When the existing premises and facilities have been designed on the assumption that all service users are able-bodied.
Mobility problems – cannot use public transport and no help nearby.
Limitations are posed by financial constraints to make adaptations.
Hospitals – old workhouses, therefore not designed with special needs in mind. Newer buildings have been built, therefore not a consistent design or layout.
People with sensory difficulties are less well served i.e. blind people will have difficulty with the addition of new buildings in hospitals.
It will be some time before all hospital buildings are fully accessible and usable by disabled people.
Health centres and GP surgeries – if buildings are physically inaccessible, basic forms of healthcare i.e. diagnosis becomes difficult/impossible.
Some small outlying clinics are still housed in unsuitable premises.
Voluntary organisations – much money raised is put back into the charity. Little money for making alterations to the premises.
Voluntary and charitable organisations may be housed in older/listed buildings – difficult to make accessible.
Reducing this barrier has been helped by:
Many health centres are now housed in purpose built buildings – designed to ensure they are accessible to people with disabilities.
Most hospitals make their buildings and services accessible to people with mobility problems.
Hospital car services – volunteers (day centres also)
Motorised scooters for elderly people
Walking sticks, frames or other mobility aids
Adaptation of existing premises and facilities
Under the Disability Discrimination Act, all services should be accessible.
Some GP’s do not work for the NHS – sell their service to them. The family Health Services Authority has been helping GP’s to upgrade their premises in order to meet the Disability Discrimination Act. They also help them to move into other purpose built premises which may house other facilities.
Cultural/language barriers
Different languages for carers and service users
If the first language is not English it is a problem in this society.
Difficult to fill out forms in for a second language
Where several languages are spoken in an area it can be difficult for service providers to target the appropriate language.
Illiterate people will not be able to read – embarrassment factor also
On premises signs are only often in English.
Receptionists (sources of help and assistance) may only be able to speak English.
Medical terms are often difficult to translate – important to have professionally trained translators!
Cultural barrier = some people are not allowed to be treated by the opposite sex – both male and female professionals are needed to provide each service.
Unless a health professional is fully aware of the cultural and dietary requirements of a particular group, it may not be possible for the service user to make appropriate changes.
Religious beliefs relating to sex and sexuality = family planning and sexual health services are hard to access.
Reducing the above barriers has been helped by:
Information in more than one language.
Picture boards
Translation services are provided (need to be arranged in advance).
Family members can translate for somebody. However, a child could not translate something about a parent that they would find distressing i.e. the mum thinks she has breast cancer.
Provide culturally sensitive services.
Psychological barriers
Service users are frightened of a diagnosis
Frightened of the stigma attached to the illness
Service users with mental health problems may not recognise they need a particular service until there is a crisis.
Men are less likely to see a doctor, therefore health and mental health problems are hidden (inequalities in health, 1998).
Doctors are less likely to diagnose men with mental health problems than women (Inequalities in health, 1998)
Gender socialisation – for men illness is seen as weak. Maleness is associated with strength.
Women may feel that their concerns are minimised by a patronising attitude, which also undermines their self-esteem and prevents them from asking questions.
Some feel that their health is a matter of willpower and determination, dependant on choosing a healthy lifestyle – ill-health is seen as a weakness – lack of willpower. They feel guilty if they are ill or denial.
Attitudes are shaped through socialisation – many people lack knowledge and understanding of how their bodies work.
Some think illness is fate and accept the long-term consequences of it. Often have more pressing problems i.e. financial hardship.
We need to:
Use of campaigns and awareness to raise attitudes
Promotion of self-advocacy
We need to see our body as a machine and that it is liable to break down – help people to take responsibility for their health (especially men), by providing information to dispel fear and myths about health and illness.
Men’s health book – uses humour and factual infoto inform men about how their body works, the warning signs and symptoms of illness and when to see a doctor.
Women often have a lot more contact with doctors as a result of pregnancy and childbirth.
Geographical/location barriers
Limited public transport
Services are not distributed evenly around the country e.g. GP’s are not employed by the NHS. They are contracted and therefore are free to choose where they practice.
Children’s services are usually private, therefore located in more affluent areas
Insufficient outreach provision
Postcode lottery – regional differences – the level of services available, depends on where you live.
Rural people have problems – services are too far away.
Low income families = the cost is a barrier.
Elderly have mobility problems, therefore need to get taxis and the cost becomes a barrier again.
Full-time workers have problems – appointments are often in working hours, may need to take annual leave or may lose money going to the appointment.
People with small children have difficulties – have to find childcare.
Pre-arranged appointments i.e. letters from a hospital are not always made at convenient times.
Parking at hospitals etc is expensive and limited. There is a charge and this cost is a barrier, if the doctor is running late, the car parking may run out and then the service user is fined/clamped!
Helped by:
Use of campaigns to raise awareness e.g. made aware of local bus services
Awareness of voluntary organisations e.g. ‘dial a ride’
Identification of additional sources of funding.