'Destined' to be a physio, Alistair Beverley speaks out for people with learning disabilities: a Q&A
The death toll among people with learning disabilities triggered by Covid-19 has been raising huge concerns for months, as a PhysioUpdate article highlighted last November.
In this exclusive article, you can read what Alistair Beverley, a committed learning disability physiotherapist, has to say about the issues and how physios in other areas of practice can play their part in delivering appropriate support.
Does the pandemic raise concerns for you, given your area of practice?
Covid-19 poses a very real risk for people with learning disabilities. Irrespective of your field of practice, the figures from the first wave tell a harrowing story: people with learning disabilities are more likely to die from coronavirus than people without by a ratio of six to one.
Death rates in young men aged 18-34 are 30 times higher than the general population. We already know that people with learning disabilities have significantly reduced life expectancy (from 17-20 years less before comorbidities are taken into account) and this gap has widened through this pandemic.
Statistics aside, people with learning disabilities are people – family members, friends – and their untimely deaths will, no doubt, leave huge holes in many lives.
The pandemic has caused a transformation in how healthcare is provided and if you believe (as I do) that not enough was being done to prevent people with learning disabilities becoming ill in the first place, then I shudder to think about what is happening around the UK at present.
Yes, we need to balance the risk of contact but – and this applies particularly to those with physical health needs – we need to be at the very least keeping an eye on people and engaging with and supporting people in a meaningful way.
The use of technology is all well and good for those who have access to it, but for those with learning disabilities who can’t access screens, or don't engage with them, the effectiveness of telehealth may be reduced.
When poverty levels are taken into account – and we know that poverty levels are higher among this group – there is an awful lot of ‘privilege’ in suggesting people with learning disabilities may have the financial resources to have a piece of technology sufficient to engage with telehealth.
What advice would you give to physios who haven’t got much experience in the field?
It's no exaggeration to say it's a tough time for everyone. But people with learning disabilities need us now more than ever and are dying at rates never seen in the modern age.
We need you to engage, find ways to connect with people who are likely afraid, unsure of what to do and isolated. Please be aware that legal obligations around reasonable adjustments and the Mental Capacity Act still apply – if someone in clinic who has a disability asks to be escorted, do not deny this request so long as infection control and social distancing are not compromised.
People with learning disabilities may still experience the same physiotherapy needs as the general population – whether it’s back pain or knee pain, for example – and will still require physiotherapy support.
I suggest you engage with family members or carers if the person can't tell you what their problem is, otherwise give extra time and treat the session as you would any other. Learn some quick and simple communication methods to enhance your contact by searching #makatonforhcps on social media.
Also, remind people to move, engage in physical activity or move positions during the day, many people will be spending increased time in static positions which we know can be detrimental to physical health.
Any resources you can recommend?
There is a useful resource from the Association of Chartered Physiotherapists for People with Learning Disabilities, titled ‘So your next patient has a learning disability’:
Another useful resource is the complex care in lockdown web video series:
For advice on ‘getting it right in hospital’, see:
Tell us about a typical day
I work in a busy specialist further education college near Mansfield, Nottinghamshire, with a team of nine staff whose job it is to help the students (who have learning and/or physical disabilities or autism) who attend the college.
I divide my time between clinical sessions, managerial duties and time working on advocacy. We also operate a private physiotherapy service to members of the public with neurological impairments.
We offer a wide variety of treatment modalities including, exercise prescription, strength and conditioning, gait rehabilitation, orthotic clinics, rebound therapy, virtual reality sessions and hydrotherapy amongst others.
It takes great skill to pitch your engagement and energy levels sufficiently to match the individual, and I really thrive on connecting with people
Most mornings start about 8.15, catching up with the team and emails before clinic begins at 9am (sometimes earlier). Pre-Covid, the team would then work between classrooms, the gym and hydrotherapy facility to provide high-quality physiotherapy support and rehabilitation. At present, we work in the gym with young people still attending college and through telehealth for those who are able to engage with it.
Our days are very varied clinically – depending on who we are seeing – and give us a great range of people to work. We base all our sessions around building engagement and rapport. It takes great skill to pitch your engagement and energy levels sufficiently to match the individual, and I really thrive on connecting with people.
My morning is usually punctuated with meetings or time on social media (I am rather prolific on Twitter) and then at lunch some of the team enjoy taking a woodland walk, exploiting the college's wooded position to get some fresh air.
The afternoon clinic starts from 1pm and follows a similar, hourly pattern to the morning, with staff members usually working across the college. Again, meetings and advocacy work may be slotted in somewhere there before our clinics conclude around 5pm.
Judging by a short video I saw of you at work, you and the students have fun as well as 'work'?
As I mentioned earlier, we really focus on engaging with the individual, whatever that means for the person. It may mean we have to pretend to be a warrior princess to engage someone, we may need to know about the latest developments in gaming, football or pop music – we need to keep our finger on the pulse.
Why? Because exercise, in its most fundamental form is hard work, challenging, tiring and painful for some. I exercise quite a bit, because I understand the secondary benefits to my physical and mental wellbeing. If you remove that understanding, as is the case for some people we work with, then you are just left with the hard bit. Therefore, we need to have a positive therapeutic relationship so that when we ask someone to do something out of their comfort zone they are willing to engage.
So, is fun/meaningfulness at the heart of all we do? Yes! And that's the way I think it should be for every clinician, regardless of clinical setting.
What drew you into this field?
I originally wanted to go into law, but a work experience placement at a law firm as a 14 year old put paid to those ambitions. ‘Too much paperwork!’ I thought. I needed to find a job that involved the things I enjoyed: being active and connecting with people.
My older brother Jonathan, who sadly passed away last year, had Down syndrome and so we spent lots of time as children at various health appointments. Physio was a big part of his life and I think that helped my development too.
Added to that, a good friend had cystic fibrosis at school and I had a mildly successful run at chucking an egg-shaped ball around a pitch. In short, I guess physio was something I was always destined to do.
How do you relax away from work and how can readers keep in touch with you?
Outside work, I enjoy socialising (remember that?), spending time with my wife and daughter and getting active: exercising, running, mountain biking, listening to music, most of the things other people do, I guess. I also spend time volunteering for Special Olympics Great Britain as physiotherapist for Team GB and clinical director for health and wellbeing.
I am contactable on Twitter: @theldphysio, Instagram: @_theldphysio_ and by email: email@example.com
Author: Edited by Ian A McMillan