Table 2 Checklist of possible needs and barriers to good healthcare requiring adjustment
Example of impairment or deficit | Example of adjustment (enabler of good healthcare) |
 Intellectual disability/reduced mental capacity |  Staff training in capacity assessment and inclusive practice |
 Memory problems |  Prompts, support for appointments |
 Literacy/reading skills deficit |  Accessible materials, communication skills |
 Vision/hearing impairment |  Visual aids |
 Speech problems |  Time, trained staff |
 Mobility difficulties, physical symptoms or restrictions |  May need OT/physio assessment/mobility aids |
Attitudinal barriers | Â |
 History of lack of dignity/respect in services |  Staff training |
 Threat to safety including bullying |  Safeguarding protocols |
 Overcoming stigma |  Advocacy |
 Instrumental barriers |  |
 Transport to services |  Funding, safe provision |
 Finance |  Personal budget |
 Lack of access to personal pleasure/R+R activities |  Planning meeting with supporter |
 Treatment burden—timing, side-effects |  Support with adherence, modified regime |
Social barriers | Â |
 Lack of social support/networks |  Identify, train and support carers; advocacy; third sector |
 Talking with professionals |  Staff training + supervision |
 Communicating needs |  LD register; Health Action Plan |
 Understanding—health risks, necessary actions |  Accessible information |
 Low self confidence |  Social engagement activities |
Mental Health | Â |
 Challenging behaviour |  Pacing of change; staff training |
 Distress + mental disorder |  Mental health review with learning disability team |