The National Survey of Reasonable Adjustments by NHS Trusts 2010

Results and recommendations

Hazel Roberts, Chris Hatton and Sue Turner

The National SurveySurvey sent to all NHS Trusts in England in October 201030% response rate (119 Trusts)Trusts answered questions about reasonable adjustments in 8 areas and were also asked to provide evidence

Accessible informationMajority of Trusts provide Easy Read info (78-86%), while audio (18-24%) and DVD/film (9-30%) formats less commonNot always clear that accessible info is routinely provided – 25% stated was available on request, 40% on website and 18% on intranet 20% said info was personalised by specialist learning disability staff.

What should happenProvision of accessible info should be common practice – throughout patient pathway – and in a range of formatsServices should include people with learning disabilities in the provision of accessible information and get feedback from them.

Working in partnership with familiesReasonable adjustments mentioned by Trusts include:

Involving carers in care planning (13%) or key meetings (6%)A carers policy (10%)Facilities for carers to stay (11%)

Was not always clear if specific information for carers of people with learning disabilities is made available

What should happenFamily carers need to be involved from pre-admission stage onwards. Should be a policy which details support for carers and a protocol on the provision of extra personal care.

Consent, capacity and advocacy

Nearly all Trusts have a policy, and provide training – but unable to tell from survey how many staff had been trained.Reasonable adjustments in this area often reliant on specialist learning disability staff.Information re use of IMCA and ICAS was patchy with many Trusts unable to provide this

What should happenPolicies/procedures and training to support use of MCARegular check of treatment decisionsPeople with learning disabilities/family carers should receive info on their rights as a matter of course.

Service delivery – making and attending an appointment

Most frequently named adjustments:

First, last or longer appointments (22%)Easy Read appointment letters (10%)Pre-visits (8%)

What should happenRecord systems should identify the person with learning disabilities.There should be accessible appointment systems in placeHealth checks and health action plans

Service delivery-receiving a serviceDiagnosis/ identification

Collaboration between liaison staff and other services, inc. partnership working (9%)Support by liaison staff (8%)Easy Read info/ leaflets (8%)Hospital passports/ Health Action Plans (7%)

Clinical/ professional intervention

Individualised RAs (13%)Adapted care plans (7%)Liaison with carers (5%)

What should happenUse the health passport or similarUnderstand how people communicate pain and distressAccessible information about food

What should happenSafe swallow guidanceRisk assessmentsPeople with learning disabilities identified in incident reports and lessons learned

Service delivery-discharge arrangements

11% of Trusts described links between Trust staff and Community Learning Disability Teams for discharge/ follow up

What should happenPlan for discharge on admission or beforeInvolve the right peopleUpdate health passport or similarAny onward referrals clearly communicatedPeople with learning disabilities identifiable in readmission data

Monitoring and reporting69% of Trusts had a method of flagging patients with learning disability63% used a set of clinical codes agreed with other TrustsOnly 20% could provide specific information about the number of people with Learning disabilities who had used Trust services in the last year.

What should happenAgree and use clinical codingHave a flagging systemShare information about use of services with people and their familiesUse hospital passports/health action plans

Patient and public involvement

86% of Trusts reported that views of people with learning disabilities were represented at Trust Board level67% reported people with learning disabilities and/or carers acting as trainers within the Trust17% of Foundation Trust responders could give the no./% of Trust members with learning disabilities.

What should happenAn accessible complaints procedureInvolvement in trainingExperience of people with learning disabilities/family carers included in service reviewsRepresentation at Board and on Foundation Trusts.

Employment13% of responding Trusts reported people with learning disabilities undertaking voluntary work, and 12% paid work93% of Trusts reported appraisal/PDP procedures as appropriate for people with learning disabilities, but few gave specific examplesThis section had a low response rate

What should happenAccessible recruitment and appointment proceduresPeople with learning disabilities employed within the Trust given the same opportunities as other employees

Equality Impact Assessments

38% of Trusts reported that people with learning disabilities were involved in planning/ review of EIAs Relatively low response rates for this section

What should happenInvolve people with learning disabilities/family carers in Equality Impact Assessments.

So….Lots of good examples but still a long way to goTrusts possibly rely on specialist learning disability staff rather than use them to help embed good practiceImplementation of reasonable adjustments will also support other vulnerable groups in a wide range of health service settings

The Reasonable Adjustments Database

www.ihal.org.uk/adjustments Contains examples of evidence returned for NHS surveyA work in progressYou can upload your own examples of reasonable adjustments in order to share examples of good practice- for guidance see www.ihal.org.uk/projects/reasonableadjustments/database