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Health services

The GP is the first point of contact for community health services, most of which are provided on a GP’s recommendation. Home visits can be arranged if you are unable to get to the surgery or if it is an emergency. If you are dissatisfied with your GP you can change doctor without having to give a reason and you can register with any GP who will accept you. There is, however, no absolute right to specific treatment under the NHS, it is up to the health professionals concerned as to whether a course of treatment or service is appropriate for, and available to, you. The Patients Charter outlines your general rights and copies are available from the Department of Health, Health Literature Line (Tel: 0800 555 777).

Your GP can also refer you to a health visitor or community nurse. Health visitors are nurses employed by district health authorities or health trusts and they can give advice and assistance on all family health and associated welfare issues. Community nurses visit people at home to give nursing care, such as changing dressings, and to assist with the provision of home nursing aids and equipment such as incontinence pads.

Help with Costs

Some people are entitled to free NHS prescriptions, dental treatment and sight tests, wigs and fabric supports, vouchers towards the cost of glasses or contact lenses, and repayment of reasonable travel costs to hospital for NHS treatment. You may be entitled to some or all of these things if you are under 16 (under 19 if in full time education), or over retirement age, pregnant, in receipt of a war pension or if you have a specified condition which requires long-term medication. You may also be entitled to them if you get Income-based Jobseeker’s Allowance, Family Credit, Income Support or Disabled Person’s Tax Credit (within £70 of the maximum award).

If you do not fit these categories but are on a low income, you may still be able to get some help with health costs under the NHS Low Income Scheme. Complete form HC1, available from your local social security office or hospital to apply for assistance under this scheme. Leaflet HC11 ("Are you Entitled to Help with Health Costs?") gives full information and is available from post offices, social security offices, hospitals and the Department of Health.

Treatments

Chiropody
Chiropody (often also called podiatry) concerns the care of the feet. This is far more than cosmetic, and for people with conditions such as diabetes it is frequently essential. Elderly people also find their mobility enhanced by chiropody treatment, as do people with foot deformities. Disabled people, children, pregnant women and pensioners are entitled to free chiropody treatment under the NHS. Most chiropodists/podiatrists will treat people at home if they are unable to get to a clinic. Disabled people can obtain chiropody treatment by self-referral or via a referral from their GP or health visitor.

Continence Advice
Many people are understandably embarrassed about discussing any problems they may be having with incontinence, although it might help to know that it is very common and that there are many discreet ways of managing it. Help with management, which might include the choice of equipment, can be given by a continence advisor or district nurse. The availability of equipment on the health service will vary from area to area: some may be free of charge, some available on prescription, some may have to be privately purchased. In some areas a laundry service is provided by either the health or local authority, and in some areas a waste collection service for disposable products may be available. Help to identify the cause of incontinence can be given by a GP or continence advisor.

Hearing Therapy

 Hearing therapists provide advice, support and counselling to anybody who experiences difficulty in communicating effectively because of a hearing problem. They can help people use their residual hearing more effectively and suggest ways of improving communication skills, including teaching lip reading. Hearing therapists also offer advice and practical help to people with tinnitus, and specialised rehabilitation to people who have had cochlear implants. Referral is usually after attendance at an Ear, Nose and Throat Department or a Hearing Aid Clinic.

Occupational Therapy
Some occupational therapists (OTs) work with social services, while others work in the NHS. OTs use practical means to promote independence. They can assess your ability to undertake everyday activities such as bathing, dressing, eating and getting around your home, and advise on suitable adaptations to your home and aids and equipment. OTs can also suggest ways of assisting people to get back to work, including the use of special equipment or adaptations to the workplace. In addition, OTs can be helpful in assisting people to participate in social activities and to use their leisure time constructively. You can refer yourself to your local social services department or you can be referred by your GP. In hospital, your consultant will do the referral for occupational therapy.

Orthoptics
Orthoptics is the diagnosis and treatment of squint and other disorders of binocular vision and eye movement. When children have a mental or physical disability the incidence of squint is approximately 40%. Older people can have vision disorders following, for instance, a stroke, thyroid disorders and accidents. Most orthoptists work in the NHS as part of the ophthalmic team, although some also work in the community providing vision screening in schools, mobile units and health centres. People may be referred to an orthoptist by their GP or consultant.

Physiotherapy
Physiotherapy aims to improve movement, strength and function by using a range of treatments such as exercise and manipulation, heat, light and sound. People receiving in-patient treatment in hospital may be referred to the physiotherapy department by their consultant. For people not in hospital, or who have been discharged from hospital without having been offered out-patient physiotherapy, their GP or social services staff (an occupational therapist, for example) can make a referral. Alternatively, people may refer themselves to physiotherapy departments. Some areas have domiciliary physiotherapists who can visit people at home, and there are also physiotherapists in private practice.

Rehabilitation
In addition to the rehabilitation work done in hospitals, there are a number of purpose-built or specially adapted rehabilitation centres throughout the country which provide facilities for the rehabilitation of patients who have fairly substantial disabilities as a result of injury or illness. Referral to one of these centres is via your consultant or GP. Alternatively, you can pay for rehabilitation at a private centre.

Speech Therapy
Speech therapists are specialists in helping with speech and language difficulties of all kinds: speaking, reading and writing. They will assess and diagnose the communication disorder, and provide treatment and advice on how to manage the condition, including the provision of communication aids. You can be referred for speech therapy by your GP or consultant, health visitor, occupational therapist, etc, or you may refer yourself.

Further Information

The Association of Community Health Councils for England and Wales publishes a summary of your rights under the NHS. Singles copies are available free of charge with a stamped, self-addressed envelope. Local Community Health Councils can also give advice and support if you have a complaint against the health service.

Carers association

We are indebted to RADAR for providing the information for this section.