The National Survey of Reasonable Adjustments by NHS Trusts 2010

1. The National Survey of Reasonable Adjustments by NHS Trusts 2010 Results and recommendations Hazel Roberts, Chris Hatton and Sue Turner

2. The National Survey • Survey sent to all NHS Trusts in England in October 2010 • 30% response rate (119 Trusts) • Trusts answered questions about reasonable adjustments in 8 areas and were also asked to provide evidence

3. Accessible information • Majority of Trusts provide Easy Read info (78-86%), while audio (18-24%) and DVD/film (9-30%) formats less common • Not 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.

4. What should happen • Provision of accessible info should be common practice – throughout patient pathway – and in a range of formats • Services should include people with learning disabilities in the provision of accessible information and get feedback from them.

5. Working in partnership with families • Reasonable 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

6. What should happen • Family 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.

7. 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

8. What should happen • Policies/procedures and training to support use of MCA • Regular check of treatment decisions • People with learning disabilities/family carers should receive info on their rights as a matter of course.

9. 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%)

10. What should happen • Record systems should identify the person with learning disabilities. • There should be accessible appointment systems in place • Health checks and health action plans

11. Service delivery-receiving a service • Diagnosis/ 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%)

12. What should happen • Use the health passport or similar • Understand how people communicate pain and distress • Accessible information about food

13. What should happen • Safe swallow guidance • Risk assessments • People with learning disabilities identified in incident reports and lessons learned

14. Service delivery-discharge arrangements • 11% of Trusts described links between Trust staff and Community Learning Disability Teams for discharge/ follow up

15. What should happen • Plan for discharge on admission or before • Involve the right people • Update health passport or similar • Any onward referrals clearly communicated • People with learning disabilities identifiable in readmission data

16. Monitoring and reporting • 69% of Trusts had a method of flagging patients with learning disability • 63% used a set of clinical codes agreed with other Trusts • Only 20% could provide specific information about the number of people with Learning disabilities who had used Trust services in the last year.

17. What should happen • Agree and use clinical coding • Have a flagging system • Share information about use of services with people and their families • Use hospital passports/health action plans

18. Patient and public involvement • 86% of Trusts reported that views of people with learning disabilities were represented at Trust Board level • 67% reported people with learning disabilities and/or carers acting as trainers within the Trust • 17% of Foundation Trust responders could give the no./% of Trust members with learning disabilities.

19. What should happen • An accessible complaints procedure • Involvement in training • Experience of people with learning disabilities/family carers included in service reviews • Representation at Board and on Foundation Trusts.

20. Employment • 13% of responding Trusts reported people with learning disabilities undertaking voluntary work, and 12% paid work • 93% of Trusts reported appraisal/PDP procedures as appropriate for people with learning disabilities, but few gave specific examples • This section had a low response rate

21. What should happen • Accessible recruitment and appointment procedures • People with learning disabilities employed within the Trust given the same opportunities as other employees

22. 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

23. What should happen • Involve people with learning disabilities/family carers in Equality Impact Assessments.

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

25. The Reasonable Adjustments Database • www.ihal.org.uk/adjustments • Contains examples of evidence returned for NHS survey • A work in progress • You 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