Everyday Healthcare

Cleaning teeth

Teeth should be brushed twice a day. This should be every night before bed and then on 1 other occasion throughout the day. It does not matter if this is in the morning.

Teeth should be brushed for around 2 minutes, using an adult fluoride toothpaste. People should try to clean every surface of all teeth.

After cleaning teeth, people should not rinse straight away. Leaving some toothpaste on the teeth helps prolong the positive effect of fluoride.

People also should not use mouthwash straight after cleaning teeth for the same reason as above. It is OK to use mouthwash at a different time of day. For example, after eating. You shouldn’t eat or drink for 30 minutes after using a mouthwash.

Flossing is encouraged, as it can remove plaque from along the gumline, where brushing is less effective. It is best to floss before brushing teeth.

If people get food stuck between their teeth, this should be removed using floss or an interdental brush. Toothpicks are discouraged as they can damage the gum and cause infection.

Denture care

Some people will have dentures. These are removable false teeth. Dentures can be partial (used to replace 1 or just a few teeth) or complete (a whole upper or lower set).

It is important to remove plaque and food deposits from dentures regularly. Unclean dentures can lead to bad breath, gum disease, tooth decay and oral thrush.

Dentures should be cleaned as often as teeth should be cleaned:

Step 1. Brush dentures with toothpaste or soap and water.

Step 2. Soak the dentures in a fizzy solution of denture cleaning tablets (follow manufacturer's instructions).

Step 3. Brush them again with toothpaste.

Visiting the dentist

Routine visits to the dentist should take place in line with the recommendations of the dentist. Some people will need to visit more often than others.

The time between check-ups can be as little as 3 months or as long as 2 years.

Most people should have an eye test every 2 years. However, this should be more frequent if someone:

1. Has diabetes;
2. Is over 70;
3. Is over 40 and there is a history of Glaucoma in the family.

If someone is unable to travel to the Optician, a home eye test can be arranged.

Most people under the age of 40 should have a hearing test every 2 years.

People over the age of 40 should go every year.

Hearing tests can be carried out by the NHS, but a lot of Opticians now offer this service, meaning people can use the same service for their hearing and eye tests if they want to.

If someone is unable to travel to the Optician, a home hearing test can be arranged.

It is important not to put off having a hearing test, because if hearing deteriorates too much, things like hearing aids may be less effective.

Contraception

Contraception is a way of preventing pregnancy. Condoms can also prevent the transmission of STI’s (see below).

If someone being supported is known to be having sex without using contraception, they should be encouraged to get contraceptive advice from their GP, a contraception clinic or a sexual health clinic.

For further information, see:

NHS: What is contraception?

STI’s 

STI’s (sexually transmitted infections) can be very painful and, if left untreated, can have a detrimental effect on other areas of health.

If a person is known to be sexually active, and has any of the following symptoms they should be encouraged to have a STI test:

STI tests can be carried out at a sexual health clinic. Some GP surgeries, contraceptive clinics and other sexual health services can also do tests.

For further information, see:

NHS: Find a sexual health clinic

NHS: Visiting an STI clinic

The NHS offers a range of screening tests to different people.

A screen negative result means that a person is at low risk of having a condition.

A screen positive result indicates a higher risk. Diagnostic tests are then carried out to confirm whether the condition is present. If it is, early treatment can be provided.

Diabetic eye screening

Anyone with diabetes should be offered an annual diabetic eye test to screen for signs of diabetic retinopathy.

Cervical screening

Cervical screening is offered to all women and people with a cervix aged 25-64. It checks the health of cells in the cervix to look for signs of cancer.

Those aged 25-49 are offered a test every 3 years.

Those aged 50-64 are offered a test every 5 years.

Breast screening

Breast screening if offered to women aged 50-70 to detect early signs of breast cancer. Women over the age of 70 can self-refer for further tests if they want them.

Bowel cancer screening

Bowel cancer screening is a self-administered test that takes place at home. Anyone aged 60-74 is offered the test every 2 years. From the age of 75, people can request a kit every 2 years if they want to.

Abdominal aortic aneurysm screening

AAA screening is offered to men once, during the year they turn 65. An AAA is a dangerous swelling in the aorta that is life threatening. Men over the age of 65 can self-refer for further tests if they want them.

NHS Health checks

NHS health checks are offered to most adults between the ages of 40-74 every 5 years.

The health check assesses the risk of heart disease, stroke, kidney disease, diabetes and dementia.

Anyone that already has any of the following will not be offered a NHS health check:

• Heart disease;
• Chronic kidney disease;
• Diabetes;
• High blood pressure (hypertension);
• Atrial fibrillation;
• Transient ischaemic attack;
• Inherited high cholesterol (familial hypercholesterolemia);
• Heart failure;
• Peripheral arterial disease;
• Stroke.

Respiratory checks

People who have a diagnosed respiratory issue such as asthma or chronic obstructive pulmonary disease (COPD) should receive a yearly health check to make sure they are managing the condition and still on the correct medication type and dose.

Annual health check (people with a learning disability)

Anyone with a diagnosed learning disability should be offered an annual health check, normally by their GP.

This involves:

• A physical check-up (weight, heart rate, blood pressure);
• Sometimes a urine sample or blood test;
• Advice and information about staying well;
• A review of medication, particularly whether the person is taking any medication they do not need;
• Checking vaccinations are up to date.

For further information, see: Annual health checks

People that are overweight are at increased risk of developing conditions such as heart disease, type 2 diabetes, stroke and certain types of cancer.

The NHS offers a range of weight management services and support for people that are overweight.

For further information, see: Managing your weight

Good foot and nailcare can help prevent common nail conditions:

As a person gets older, their nails become thicker or more brittle. If it becomes difficult to manage nail care, a podiatrist can help. A person’s GP can make a referral on the NHS. Alternatively, services can be arranged and funded privately.

Eating a healthy, balanced diet is an important part of maintaining good overall health and reducing the risk of developing certain conditions.

Most people should try to:

• Eat at least 5 portions of a variety of fruit and vegetables every day;
• Base meals on higher fibre starchy foods like potatoes, bread, rice or pasta;
• Have some dairy or dairy alternatives (such as soya drinks);
• Eat some beans, pulses, fish, eggs, meat and other protein;
• Choose unsaturated oils and spreads, and eat them in small amounts;
• Drink plenty of fluids (at least 6 to 8 glasses a day).

For further guidance and advice, see: Eat well

Poor hygiene can cause discomfort, skin complaints and infections, and can lower self-esteem. Keeping clean is therefore essential.

The basics

• Wash hands after going to the toilet;
• Wash the genitals and bottom area every day;
• Wash the face every day;
• Have a bath or shower at least twice a week.

There is a chapter of this Handbook dedicated to providing personal and intimate care:

See: Personal and Intimate Care

As many as 1 in 3 people have difficulty with continence itself, or with getting to the toilet in a timely way because of reduced mobility.

Continence problems can cause skin irritation and infection but can also impact on dignity because they can be embarrassing.

A person’s GP can refer them to a continence care specialist, who can help someone access the right kind of continence aids and advice to enable them to maintain dignity and independence.

For example:

• Covers to protect bedding;
• Waterproof underwear;
• Disposable or washable continence pads.

Occupational Therapy services from the local authority can also help with things like rails, commodes and raised toilet seats.

Some local authorities can help with laundry services if someone is finding this difficult to manage.

Women may need support to manage health needs relating to their menstruation cycle (period) or the menopause. Some women may also need support if they are pregnant.

Menstruation (periods) 

Most women have a menstrual cycle (period) every 3-5 weeks, although this can vary.

As their period approaches, make sure that the person has sufficient sanitary products of their choice available. Some people will want to use pads, and some will prefer tampons. If the person has no preference, pads are normally easier to use.

If someone needs direct support to change their sanitary wear, a pad should be used. Tampons are not appropriate as they would require you to have inappropriate contact with the person’s genitalia.

Sanitary care should be carried out with full regard to dignity and in line with the persons wishes about who should support them.

Ask the person regularly if they are comfortable or need their sanitary product changing. Be aware of anyone that has a heavy flow of blood and offer to change it more often. This will reduce the risk of an accidental leak. If the person is managing their own period care, they may require prompts to change their sanitary wear.

If someone has an accidental leak into their underwear or bedding, this should be managed sensitively. Provide reassurance and do not draw unnecessary attention to what has happened - this can cause embarrassment.

If menstruation is heavy or painful, it may be beneficial for the person to seek medical advice about measures that can help. For example, some contraceptives can lighten the flow, improve mood, or prevent periods altogether.

Support to understand periods

Mencap have developed some easy read guidance to support women to understand and manage their periods as independently as possible.

See: Menstruation. 

Menopause

Menopause happens when a woman’s periods stop because their body is no longer producing the hormones that make them happen.

Menopause usually happens between the ages of 45-55 but can sometimes happen earlier or later.

Symptoms of menopause can start years before periods stop and can continue for years afterwards.

Common symptoms can include:

• Mood swings;
• Anxiety;
• Brain fog;
• Hot flushes;
• Irregular periods.

Note: Not all people will experience all symptoms, and some will experience different symptoms to those listed above.

Perimenopause describes the period before menopause, when the woman is still having periods but is experiencing other signs and symptoms of menopause.

Symptoms of menopause and perimenopause can have a significant impact on mental and physical health and wellbeing, including relationships and work. The person may need our support to access medical advice or treatment to help manage the symptoms they are experiencing.

Support to understand menopause

Mencap have developed some easy read guidance to support women to understand and manage the menopause.

See: Menopause.

Pregnancy 

All pregnant women are entitled to pre-natal and ante-natal care. As part of this support, they should be provided with information and advice to help them understand pregnancy and to make any pregnancy-related decisions.

If someone we support is pregnant, we may need to support them to access this care. This could mean contacting the GP on their behalf (with consent) or supporting them to attend an appointment or seek urgent medical advice or attention.

Individual care and support plans may need to be reviewed and updated to reflect any change in support needs, for example if the person can no longer take a prescribed medication, or if their mobility reduces.

Some people will be at increased risk of pregnancy complications, such as miscarriage or premature birth. Where this is the case, health professionals should ensure that the person and anyone supporting them is aware of signs that what action to take (for example, to seek medical advice or to go to A & E).

If there are safeguarding concerns for an unborn child, a referral should be made to the local children’s services so that any support or other intervention can be explored.

Following the birth, the person may need support with parenting. Being able to carry out caring responsibilities for a child is one of the outcomes listed in the Care Act 2014, and the person may be eligible for additional support from the Local Authority.

The person may experience mental health issues (perinatal or postnatal depression), which could have an impact on their motivation to engage in support or self-care. The service may need to support them to access an appropriate mental health service.

Support to understand pregnancy 

The health professional providing pre-natal care should provide the person with information and advice about pregnancy. The following are links to some additional resources that may be helpful:

NHS: Pregnancy webpages 

Birthrights: Disability and long-term health conditions and maternity care

University of Bristol: Pregnancy and Me From Bump to Baby

Constipation can be a life-threatening issue for someone with a learning disability because they are at increased risk of health complications. Knowing when someone with a learning disability has constipation (and therefore being able to seek appropriate support) can be challenging for staff, because people with a learning disability often don’t recognise the symptoms or communicate them to others.

NHS England have developed a range of resources to help staff and others have conversations with the people they support to better prevent, recognise and treat constipation.  

See: Constipation resources for carers.

Support should only be provided if the person needs it or asks for it.

Support should be provided in line with the individual care or support plan.

Support should promote independence and maximise choice and control at all times.

Consent must be sought before doing anything to, or on behalf of a person.

Dignity and respect must be always upheld.

Often, people that need support to carry out everyday healthcare tasks will need some gentle encouragement. We all have times when we don’t feel in the mood to do something we know we should. For example, eat well, drink enough or clean our teeth.

Staff should make sure that they are supporting the person in line with their individual care or support plan, their preferences, in a dignified way and using appropriate methods of communication.

They should remind people of the benefits of doing a particular activity (or the potential consequences of not doing it) and think of ways in which they can perhaps make it a little more enjoyable/bearable.

For example:

• Getting someone involved in choosing and preparing a healthy meal for themselves;
• Going somewhere like a café after a health appointment;
• Using scented lotion after a bath;
• Painting nails after cutting them.

Despite our best efforts, sometimes people that need support with everyday healthcare will decline it and the activity or task will go uncompleted.

If they have the mental capacity to do so, they can make this choice and it must be respected.

See: Mental Capacity

If they routinely make this choice and doing so puts them at risk of harm, a self-neglect safeguarding concern should be raised to reduce the risk of serious harm occurring.

See: Disclosure and Raising a Concern

If a person lacks the mental capacity to make decisions about carrying out a healthcare task, a decision will need to be made under the best interests principle of the Mental Capacity Act 2005. This decision will be whether to carry out the task, and, if so, what the best way of doing so is. Depending on the nature of the healthcare task, this decision may need to be made by a relevant healthcare professional e.g., a dentist or a GP.

Some people decline to attend scheduled health appointments because they are afraid of the clinical environment, the health professional (or their uniform), the procedure (e.g., a dental examination or blood test) or the potential outcome (e.g., a diagnosis).

Any anxiety the person has should always be recognised. Never downplay what is clearly worrying them or tell them they have nothing to worry about.

It may be necessary to ask a health professional to speak to the person about what is worrying them. They may be able to explain step by step what is going to happen, why and what the potential outcomes may be. This can allay fears.

It may also be necessary to ask a health professional to consider other ways in which any necessary health intervention can take place. For example, at the person’s home.

Health professionals should be open to any reasonable requests to adapt how they do things in order to engage the person and enable them to access the healthcare they need.

Regulation 9A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires that, unless there are exceptional circumstances, hospitals are required to allow people to be accompanied by a family member, friend or other person providing support to them.