Blood tests in Barnet

This report examined how accessible blood testing (phlebotomy) services in Barnet were for people with learning disabilities and autism. The research was carried out by Healthwatch Barnet, Barnet Mencap and the Expect the Best project in response to concerns that some people with learning disabilities were experiencing difficulties accessing blood tests, which are an important part of maintaining good health and identifying illness. The study included surveys of 61 patients and carers, a survey of 20 GP practices, case studies and a quality check of Barnet General Hospital’s phlebotomy service. 

Overall, the findings were positive. Ninety-four per cent of patients surveyed described their experience of blood testing services as either good or acceptable, and 95% were satisfied with where they had received their blood test. Most respondents had been referred by their GP, and the majority had their blood tests in hospital settings, although one-third received tests at their GP surgery.

The report found that GP practices often provided a better experience for people with learning disabilities, particularly those with higher support needs. People with severe or profound learning disabilities and those with autism were more likely to have blood tests carried out at their GP surgery, where familiarity with staff and surroundings appeared to reduce anxiety. Patients who attended GP services reported uniformly positive experiences, while all negative experiences identified in the survey occurred in hospitals or community clinics.

A key finding was the importance of staff attitudes and communication. Patients valued staff who were friendly, patient, reassuring and able to explain clearly what would happen during the procedure. Positive experiences were linked to staff taking time to talk through the process, providing reassurance and understanding individual needs. Conversely, poor experiences were associated with staff lacking confidence, awareness or preparation for supporting people with learning disabilities. 

The study identified shortcomings in the provision of accessible information. More than half of respondents reported receiving no information before their blood test, and only a minority received information in easy-read formats. This suggested that services were not fully complying with the NHS Accessible Information Standard, which requires healthcare providers to identify, record and respond to communication needs. 

The report also highlighted weaknesses in appointment booking and flagging systems. Many people with learning disabilities relied on carers or family members to arrange appointments, and researchers found that services did not consistently identify or record patients’ additional needs when appointments were booked. As a result, staff were sometimes unaware that reasonable adjustments might be required until the patient arrived.

GP survey findings showed that 65% of responding practices offered some form of blood testing service, but only half provided it to all patients. Many practices that did not offer blood testing relied on hospital referrals and had limited alternatives for people who struggled to attend hospital appointments. Several GPs suggested that additional funding would be required if more practices were expected to provide phlebotomy services locally. 

The case studies demonstrated that people with the most complex needs could face significant barriers. One individual with profound learning disabilities waited 17 months for a blood test because services disagreed about whether reasonable adjustments, including community-based testing, could be provided. Other families reported failed attempts to obtain blood tests because distress and anxiety prevented the procedure from being completed. These cases raised concerns that important health conditions could go undiagnosed. 

The quality check of Barnet General Hospital found many examples of good practice. The service was found to be welcoming, accessible and willing to make reasonable adjustments, including offering longer appointments, quieter environments, use of children’s nurses experienced in distraction techniques, and prioritisation of patients with additional needs. Staff were friendly and knowledgeable, and learning disability awareness training was available. 

However, the quality check also identified areas for improvement. The hospital’s appointment system included flags for some additional needs but not specifically for learning disabilities. Easy-read information about blood tests was not available, there were limited opportunities for patients to provide feedback, signage could be improved and staff did not always explain procedures clearly during appointments. 

Overall, the report concluded that blood testing services in Barnet worked well for most people with learning disabilities, but that those with the highest level of need were at greater risk of poor experiences or missing out on blood tests altogether. The report recommended improving accessible information, introducing stronger flagging systems, increasing learning disability awareness training, expanding GP-based blood testing services, reviewing funding arrangements, improving community provision for people unable to attend hospitals, and ensuring that reasonable adjustments are routinely considered and implemented. 

Relevant images from the report: