Traditionally, little attention has been paid to the menopause as it affects women with learning disabilities. Consequently, older women with learning disabilities have rarely been adequately prepared for, or supported through, what for most women is a significant 'change of life'. None of the existing literature focuses on the women's perspectives, but rather, looks at menopause from a medical angle, in particular focusing on the timing of onset. The research study described in the present paper is an attempt to gain some insights into the ways in which women with learning disabilities perceive the menopause. The main informants were women with learning disabilities themselves, but also general practitioners, staff in learning disability services and parents who still cared for their middle-aged daughters at home. The research project also involved the non-disabled researchers working alongside two groups of women with learning disabilities, who acted as advisors and consultants to the project, and who were paid for their time.

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During its first twenty years the Polish health service represented a neglected sector of government activity, as the development of heavy industry remained the predominant economic goal, with social policy regarded as a "nonproductive" sphere. When Edward Gierek came to power in 1970, the promise of reform extended throughout society to include health. However, despite a fundamental organizational reform, the health service has remained in a state of crisis, currently worsening as a result of mounting economic dislocation and political tension. Inadequate access to treatment, lack of continuity of care, poor quality of care, profound shortages of drugs and supplies, and the absence of preventive medicine are some of the manifestations of this crisis. Its main causes lie in the political weakness of the Ministry of Health, with consequent underfunding and the nonfulfillment of its plans. This situation is exacerbated by continuing organizational fragmentation, the neglect of primary care, the existence of conflicting aims in health policy, and the dominance of an ideology of clinical specialism.

Faced with staff shortages and a recognition that the core health surveillance system in schools could not be sustained, school nurses in one area decided to pool their skills and target surveillance to children with identified needs. Following completion of a pilot programme in October 2002, the school health nursing service has been restructured and now operates in teams who manage a corporate caseload. The core programme includes a targeted health surveillance programme, a programme of health promotion and a referral system that were modelled on the pilot project.

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