Patient safety
because without them some people would be “completely lost”. The conversations also highlighted that people with a learning disability may have particular needs when it comes to communication. For example, one person interviewed had to talk through each part of their body before they could identify where they were feeling pain. To understand how challenges in providing
care to those with a learning disability could be met at a system level, HSSIB looked at and gathered evidence in five other areas. l Assuring delivery of high-quality care l Information sharing and accessibility l The learning disability specialist workforce in acute hospitals
l Supporting the wider hospital workforce l Societal beliefs and values.
The report sets out eight key findings and makes four safety recommendations. These are focused on providing guidance on: the learning disability liaison workforce, how to assess mental capacity in practice, and standard information for the health and care passport. Continuing to assess care provision via the annual learning disability survey is also advised. There are three suggested actions for Integrated Care Boards to aid improvement at a local level.
Safety recommendations
1. NHS England should develop and issue learning disability liaison nursing service best practice and workforce guidance to all acute hospitals. This will help local decision making about specialist learning disability provision and enable appropriate support for people with a learning disability and the staff who care for them.
2. NHS England should ensure that the national learning disability improvement standards annual benchmarking survey for the care of people with a learning disability is continued for acute hospitals in order to help assure that local population needs are met.
3. NHS England should commission the development and dissemination of guidance on the practical assessment of the mental
Findings in full The health and care system is not always designed to effectively care for people with a learning disability. People with a learning disability who are admitted to an acute hospital are often cared for by staff without specialist training, skills and experience in
capacity of people with a learning disability in acute hospitals. This is to ensure that appropriate decisions are made about the person’s care.
4. NHS England, with support from key stakeholders including the Professional Record Standards Body, should work collaboratively to develop and publish a set of guidelines on information to be included in a health and care passport (which could be paper based, digital, or both) for people with a learning disability with consideration of the reasonable adjustments that people may need. This is to ensure the most current and accurate information about reasonable adjustments to the person’s care is accessible when and wherever it is needed.
working with people with a learning disability. These staff often have limited support and are unable to take the time they would like to meet the person’s needs. There is no standard model or national
guidance for an acute learning disability liaison service (that is, teams that are specifically trained in caring for people with a learning disability). Consequently, there is variation in how these services are funded, their availability, the size of teams and what they are expected to do. The quality of learning disability services is
currently monitored via the learning disability improvement standards annual benchmarking survey which is only being funded until the end of 2023/24. Decisions on future years have yet to be made. Staff in acute hospitals may lack confidence and support in assessing the mental capacity of people with a learning disability, in line with the Mental Capacity Act (2005). There is no national shared system with a single point of access for storing and managing information about the needs of people with a learning disability and the reasonable adjustments required for each individual. Current mechanisms for sharing information about a person – such as ‘care passports’ (a document that gives staff helpful information about the person’s health and social needs, including their preferred method of communication, likes and dislikes) and alert flags (a way to highlight key information to staff) on the electronic patient record – can be unreliable. Instead, information is often gathered from friends and family.
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www.clinicalservicesjournal.com I January 2024
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