Stuart is a 60 year old man who has Down's syndrome. Stuart lives in supported living accommodation. He experiences severe anxiety about most health interventions and travelling in vehicles. This means he only accesses the community as far as he can walk.

Stuart had been experiencing unexplained pain, weight loss, and recent blood test results were abnormal. The GP was concerned that Stuart might have cancer and wanted to refer Stuart for a CT scan. Stuart was assessed and was found to lack capacity to make a decision for himself about having a CT scan so Stuart's GP referred him to POhWER for an Independent Mental Capacity Advocate (IMCA) to support with a best interest decision. 

Terry, a POhWER IMCA met with Stuart and his key worker at his supported living accommodation. Terry explained the role of an advocate and why he had been asked to support Stuart. They then discussed the possibility of Stuart attending a hospital appointment for a CT scan. Stuart’s key worker explained that, in spite of his health anxiety, Stuart had walked to the local hospital for a previous appointment and had enjoyed stopping for a cake and cup of tea at the café.  Terry asked Stuart if he would like to visit the hospital café again before speaking with a doctor and Stuart responded with enthusiastic clapping.

Terry explained that Stuart had the right to have reasonable adjustments. They discussed what reasonable adjustments might minimise Stuart’s anxiety. Stuart’s key worker said that Stuart had needed to have chemical sedation with lorazepam before any previous medical interventions, including routine blood tests, so he would expect that some form of sedation would be necessary before the CT scan. 

Terry spoke with Stuart's GP who summarised his discussion with a consultant at a hospital which is considerable distance away who had recommended that the CT scan should be carried out there. Terry raised the issues of Stuart's health and transport phobias and the GP agreed that it could be extremely difficult for Stuart to travel that far as he would have to go by car. The GP agreed that a reasonable adjustment would be to investigate whether the CT scan could be done at Stuart’s local hospital.

The GP contacted Terry to confirm that the CT scan could be done at Stuart’s local hospital.

A best interest meeting was held to discuss whether further adjustments could be made to support Stuart with attending a scan appointment. Learning disability liaison nurses arranged to meet with Stuart and his key worker before the scan appointment to show them around the unit and introduce them to the staff. It was also agreed that it would be in Stuart's best interest to be given lorazepam at home before he set off for the hospital and then further sedation once he arrived at the hospital for the procedure. 

The extensive planning around Stuart’s appointment enabled him to access medical treatment with minimal anxiety. The scan result indicated that his pain and weight loss was not due to cancer but instead urinary retention which was corrected by the insertion of a catheter.

Stuart tolerated both the CT scan and catheterisation appointments very well. Stuart was very happy not to be in pain any more following his hospital treatment.