document type: unique identifier: guideline corp/guid/450

Document Type: GUIDELINE

Unique Identifier: CORP/GUID/450

Title: Guidelines for the Care of People with Learning Disabilities when accessing Trust services

Version Number: 1

Status: Ratified

Target Audience: Trust Wide

Divisional and Department: Learning Disabilities

Author / Originator and Job Title: Andrew Heath, Patient Experience and Engagement Lead Alison Fairbairn, Learning Disability Liaison Nurse Chris Upton Integrated Service Leader Lancashire Care Foundation Trust

Risk Assessment: Not Applicable

Replaces: CORP/PROT/056, Version 1, Blackpool Learning Disability Partnership Board - Agreement To Fund Additional Personal Care And Support Needs Of Individual With A Learning Disability Whilst In Patient CORP/GUID/039, Version 3, Caring for People with Learning Disabilities

Description of amendments: Merged documents

Validated (Technical Approval) by: Adults Community Services and Long Term Conditions Procedural Document Validation Group

Validation Date: 06/05/2016

Which Principles of the NHS Constitution Apply? 1 - 4

Ratified (Management Approval) by: Equality and Diversity Committee

Ratified Date: 04/12/2015

Issue Date: 06/05/2016

Review dates and version numbers may alter if any significant changes are made

Review Date: 01/05/2019

Blackpool Teaching Hospitals NHS Foundation Trust aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that they are not placed at a disadvantage over others. The Equality Impact Assessment Tool is designed to help you consider the needs and assess the impact of your policy in the final Appendix.

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/GUID/450


Revision No: 1 Next Review Date:

Do you have the up to date version? See the intranet for the latest version

of 20

CONTENTS

1 Purpose ....................................................................................................................... 3

1.1 Philosophy and Health Need ................................................................................... 3

2 Target Audience .......................................................................................................... 4

3 Guideline ..................................................................................................................... 4 3.1 What Is Learning Disability? .................................................................................... 4 3.2 Roles and responsibilities of staff ............................................................................ 5

3.2.1 Integrated Community Learning Disability Teams .......................................... 5 3.2.2 Liaison Nurse .................................................................................................. 5 3.2.3 Community Learning Disability Nurse ............................................................. 6

3.2.4 Health Facilitators and Carers ........................................................................ 6 3.3 Consent ................................................................................................................... 6 3.4 Communication ....................................................................................................... 8 3.5 Out Patient Attendance ........................................................................................... 9 3.6 Unplanned admission .............................................................................................. 9

3.6.1 Immediate Discharge from the Emergency Department or Urgent Care Centre ........................................................................................................... 10

3.6.2 Transfer from the Emergency Department to an admitting ward .................. 10

3.6.3 Admission to a Receiving Ward .................................................................... 10 3.7 Planned Admission ............................................................................................... 10 3.8 Discharge .............................................................................................................. 12

4 Attachments .............................................................................................................. 12

5 Procedural Document Storage (Hard and Electronic Copies) ................................... 12

6 Locations this Document Issued to ............................................................................ 12

7 Other Relevant / Associated Documents ................................................................... 12

8 Supporting References / Evidence Based Documents .............................................. 13

9 Consultation / Acknowledgements with Staff, Peers, Patients and the Public ........... 14

10 Definitions / Glossary of Terms ................................................................................. 14

11 Author / Divisional / Directorate Manager Approval ................................................... 14

Appendix 1: Core Principles ............................................................................................... 15

Appendix 2: Out Patient Attendance .................................................................................. 16

Appendix 3: Hospital Passport ........................................................................................... 17

Appendix 4: Person Centred Health Action Plan ............................................................... 18

Appendix 5: Equality Impact Assessment Form ................................................................. 19





of 20

1 PURPOSE 1.1 Philosophy and Health Need People with learning disabilities have higher levels of ill health and are admitted to hospital much more frequently than the general population. They also have much higher rates of premature death than the population as a whole, and die on average 16 years sooner. In recent years there has been growing evidence from a series of reports and inquries that the health service is not commissioning or providing services in a way that adequately meets people with learning disabilities health needs and that people with a learning disability will die from a cause which could have been prevented (CIPOLD, 2013). This is due to:

A lack confidence when caring for people with learning disabilities.

Negative attitudes towards people with learning disabilities.

Limited knowledge and understanding of the client group’s needs the assumption that learning disability liaison nurses should remain with the patient throughout their hospital admission.

A habit of segregating people with learning disabilities from other patients.

These barriers contribute to preventable ill health, poor quality of life and at worst premature deaths. People with learning disabilities have a right to the same flexible and responsive level of health care as that provided to the general population. The aim of this procedure is to ensure that people with learning disabilities are able to access high quality health care when attending Blackpool Teaching Hospitals NHS Foundation Trust for diagnostic investigations or treatment. It will enable staff at the Trust to have a better understanding of people with learning disabilities and equip them to deal more effectively with the particular needs of each individual. Ensuring diagnostic overshadowing doesn’t take place when presented with reports of physical ill health or unusual behaviours from learning disability patients, viewing them by their illness and health needs rather than their long term condition. It will also enhance understanding of the duties and boundaries of Trust’s learning disabilities staff so staff across the organisation are aware of the appropriate caring and supportive role in which to take.





of 20

2 TARGET AUDIENCE These guidelines apply to the practice of Blackpool Teaching Hospital Trust staff in the provision of services to people with a learning disability who access acute and community services. This strategy also applies to all volunteers; patients; families, carers and service users of Blackpool Teaching Hospitals NHS Foundation Trust as it is their individual and collective experiences and knowledge of care and treatment that will influence the way we provide services to people with a learning disability. 3 GUIDELINE 3.1 What Is Learning Disability? The term learning disability is used to describe a person who has a developmental delay or intellectual disability which is usually evident from birth or childhood. There is a three core criteria which must be met for the term learning disability to apply (DH 2001):

A significantly reduced ability to understand new or complex information, to learn new skills (impaired Intelligence).

A reduced ability to cope independently (impaired social functioning).

The age of onset before adulthood which has had a lasting effect on development.

Within this definition there are a wide and varying range of needs, from those with the most profound learning disability; those with associated physical or sensory disabilities through to those with milder learning disability who may present unaccompanied and may not have a health facilitator / carer. Possible indicators to make you aware of the presence of a learning disability include:

Difficulty following instructions.

Difficulty understanding and processing information.

Difficulty understanding abstract concepts such as time or directions.

Repetition of phrases in conversation without expanding on the content.

The guidelines cannot outline the actions required for all people with learning disability as each person’s needs will differ. An individual, flexible approach to establishing the person’s support needs whilst accessing the Trust’s services is required by all.





of 20

3.2 Roles and responsibilities of staff People with learning disabilities have the right to the same level of medical and nursing care as that provided to the general population. However, due to their complex needs, they may require additional staffing support to meet their particular needs. The responsibility for providing medical and nursing care remains with Trust staff. Trust staff should ensure they receive all relevant information regarding the support needs of the patient when they come into contact with them. This may include support with eating and drinking, communication, taking medication, managing behaviour, reducing stress and anxiety and orientating the carer to the routine of the service. Trust staff to ensure people with learning disabilities support needs are met, where specialist equipment is required transferred the hospital will make reasonable adjustments to accommodate this e.g. use two bed spaces / side room. 3.2.1 Integrated Community Learning Disability Teams Learning Disability Services can provide advice and support to all areas of Blackpool Teaching Hospitals NHS Foundation Trust when providing care to people with learning disabilities. 3.2.2 Liaison Nurse

Manage the interface between mainstream general hospital services, Community based Health Services and specialist community learning disability services.

Facilitate open and easy access to the hospital services for people with a learning disability.

Identify and meet staff training needs with regard to raising awareness of patients with a learning disability.

Provide advice and support relating to keeping policies and procedures up to date with relevant up to date information regarding this vulnerable client group.

Work closely with Learning Disability (LD) Partnership Board and Health sub group around responses to meeting the needs of this population.

The Liaison nurse is based within the Blackpool Community Learning Disability Team. The team operates Monday to Friday, between the hours of 09.00hrs to 17.00hrs. To contact the team, please call 01253 477803. For Fylde and Wyre patients contact the Adult Community Learning Disability Team on 01253 956179 (same operating hours).





of 20

3.2.3 Community Learning Disability Nurse Patients with multiple / complex health needs may have an allocated Community learning Disability Nurse involved. Their role may include the following:

In Liaison with Mental Capacity Act (MCA) Lead provide advice and support around MCA assessment, best interest decisions and Deprivation of Liberty Safeguards (DOLS).

Provide advice and support on the ‘do not attempt resuscitation’ (DNAR) process for this vulnerable patient group and support with robust completion of protocols relating to this to ensure due process is followed.

Provide de-sensitisation / graded exposure to support patients with heightened anxieties to access healthcare safely.

Develop in conjunction with patient, their family, carers and relevant health professionals an admission plan with details of adjustments required.

Advise and recommend reasonable adjustments within the hospital to facilitate fair access to care and treatment including bespoke accessible information.

3.2.4 Health Facilitators and Carers Health facilitators are referred to throughout this policy. This refers to the people who know the patient well and provide support around managing health needs. This may include family members, Support workers or Community Learning Disability Nurses. Where appropriate and with consent of the patient Health Facilitators should be involved in care planning discussions. Some people with a learning disability may be supported by a carer. This could be a family member or a support worker if the person lives in a residential service. Informal carers are not expected to provide the ‘main support’ during a hospital stay although may be happy to remain involved. Support Workers who have been commissioned to provide a service and are therefore paid staff, will be expected to provide a level of support to the person during their hospital stay that is commensurate with the package of care commissioned. The roles and responsibilities of Hospital staff, Support workers/ Carers should be negotiated and agreed prior to or on admission. Any issues or concerns around the level of support that a person is receiving or requires should be discussed by the organisation with the Community Learning Disability Team. 3.3 Consent Consent can present ethical dilemmas for health care professionals. Careful consideration needs to be given when obtaining informed consent from any patient (refer to CORP/PROC/102 in Section 7). The fact that a patient has a learning disability does not alter the need to obtain informed consent for treatment. This may cause concern when the health professional is unclear whether the person with the learning disability has the





of 20

capacity to understand the implications of the procedure they are being asked to consent to, and indeed the whole notion of giving or withholding consent. The Trust’s Mental Capacity Act Lead is available to provide specialist support when assessment is required to decide whether the person with a learning disability has capacity to consent. Generally a person is considered able to make a decision if they are able to:

Understand the information relevant to the decision.

Retain that information.

Use or weigh that information as part of the process of making the decision.

Communicate their decision whether by talking, using sign language or other means.

Most patients with a learning disability do have the capacity to give informed consent - it should not be assumed that they cannot. It is not acceptable or legal for a parent or carer to give consent on behalf of an adult with a learning disability. Except if the person with a learning disability does not have capacity and their family member or carer has a Lasting Power of Attorney or Court Appointed Deputy for Health and Welfare and authority to approve medical treatments.-You MUST Check. Approval of medical treatment by the completion of Consent Form 4. Staff in the Trust should make every effort to help and support the person with learning disabilities to maximise their potential to make their own decisions. They should consider how much information to convey to the person, and how to make the most of the abilities that the person has. This may involve contacting people who have a detailed knowledge of the patient, allowing the person sufficient time to become familiar with the issues and communicating in a simple language or through the use of pictures and photos. If the patient does not have capacity(is not competent) to give consent, treatment is lawful providing it is in their best interest. It is the responsibility of the department/ professionals providing the treatment to co-ordinate a best interest meeting. Relatives and carers should be consulted with about the patient’s best interests though only where this is commensurate with the duty of confidentiality and the patient’s wishes. Family members may have a different view and perspective of the patient’s wishes and views to that of paid carers so it is important to consult all those closely involved with that person and consider all views. If there is not a close relative who can support in the best interest process the individual is entitled to the services of an independent mental capacity advocate (IMCA). The Mental Capacity Act Lead may be contacted for guidance if required to arrange this. The position regarding consent in an emergency situation is no different for a person with a learning disability - ultimately the attending doctor makes the decision to proceed in the patient’s best interest. A flow chart outlining the core principles for the care of a patient with a Learning Disability in Blackpool Teaching Hospitals NHS Trust is provided at Appendix 1 and 2.





of 20

3.4 Communication For some people with Learning Disabilities their behaviour can be their most powerful or only method to communicate with others what their needs are and whether they are suffering or in pain or in distress. The patient or their carer may request that the Registered nurse documents the outcome of their consultation in their Health action plan.. Many barriers to health care to a patient with learning disabilities can be overcome with effective communication, with the patient themselves and with paid carers, family members, advocates, care managers and learning disability team staff. People with learning disabilities have difficulties understanding complex sentences and abstract concepts with time being a particularly difficult concept to understand this should be considered when discussing future appointments or treatments. They also have difficulty understanding written communication and this should be taken into consideration when arranging appointments, particularly if pre-appointment instructions are included. There is a range of easy to understand information available to enable people with learning disabilities to better understand clinical appointments, medical procedures and admissions. The learning disability service can advise on resources available. Some patients with a learning disability may bring their hospital passport (see Appendix 3) with them to appointments or when admitted, which will contain important information about how to effectively communicate with them. For people who have limited communication, liaise with their family / carers around the most effective means to communicate. Consider use of alternative means of communication such as sign language, symbols, photos, objects of reference. The Hospital Communication Book may be helpful and will be in the Learning Disability resource pack held at ward level. You can also liaise with the health facilitator/carer, relatives and others who know the patient about what the patient was usually like before they became ill. Listen to the carer’s opinion about any changes in behaviours normal for the patient and take appropriate action. If the patient is admitted and there are any specific changes or developments in the patient’s condition during the duration of hospitalisation the health facilitator/carer should be contacted as soon as possible (with the patient’s agreement). A dependency assessment should be undertaken at regular intervals throughout the period of hospitalisation in order to review the nursing resource needed and to make appropriate adjustments to the communication method. Remember to always include the patient in conversations and consultations with carers and relatives regardless of their level of verbal communication.





of 20

3.5 Out Patient Attendance Where a patient is to attend an out-patient appointment, they or the health facilitator/carer should be invited to make advance contact with the clinic nursing staff to discuss details of the appointment and consider any reasonable adjustments required. Where it is ascertained that a reasonable adjustment is required, this will be marked on the Patient Record in order that this can be considered in future outpatient appointments. If a patient presents in outpatients who has extreme anxiety or challenging behaviour precautionary measures should be taken to meet their health needs including:

A full risk assessment should be completed in advance with learning disability and medical staff so they can jointly plan how to manage the situation. It should not be assumed the learning disability staff will manage this situation independently.

First appointments should be offered if the clinic is quiet as lengthy waits can exacerbate stress levels.

Single rooms or suitably quiet waiting areas should be offered to minimise anxiety levels and risks to other patient’s safety.

Following the out-patient consultation a Registered Nurse should see the patient and their health facilitator/carer to ensure that they have understood the information and/or instructions given to them during the consultation and to determine any further care requirements before they leave. Appendix 1 provides a flow chart outlining Outpatient attendance. 3.6 Unplanned admission During an emergency admission, it may be suspected that the patient has learning disabilities due to their presentation or communication abilities. Speak to them or their health facilitator/carer (if present) to establish if they have any additional needs. Where a learning disability is confirmed, an assessment should be made by the triage nurse to establish if the patient needs fast tracking through the system. It should be acknowledged however that some people with learning disabilities are able to wait and capable of managing their own health care needs either with or without support and should be encouraged to do so. If a patient with learning disabilities is admitted unaccompanied, and there is an identified need for additional support the named/triage nurse should attempt to identify a health facilitator / carer or relative and make contact with them as soon as possible. Where no other person can be identified local Learning Disability teams should be contacted. To assist in obtaining information, the patient with a learning disability may have brought some valuable information with them e.g. Hospital Passport. Ask for this and use the information it contains to support decision making. Where possible try to keep waiting time to assessment to the minimum.





of 20

Pay attention to the provision of privacy as some patients with learning disabilities have associated physical and personal care needs. 3.6.1 Immediate Discharge from the Emergency Department or Urgent Care Centre When discharging a patient with a learning disability, the co-ordinator may have assessed that follow up is required due to concerns such as the patient’s safety, mental health and/or challenging behaviour, the patient’s ability to comprehend instructions or follow medication regimens. This information should be shared verbally and followed up in writing with the health facilitator/ carer. In the absence of either, the nurse should consider contacting the Community Learning Disability Team. 3.6.2 Transfer from the Emergency Department to an admitting ward Where a patient with a learning disability is to be transferred to an admitting ward the Named Nurse in Accident and Emergency should advise the nurse in charge of the receiving ward that the patient has a learning disability and provide their initial assessment of the patient’s care needs. If the person requires an additional staffing support contact the local learning disability team to ascertain whether any existing support can be transferred. If this is not available liaise with the Clinical Matron for the admitting area so a need and resource can be identified. 3.6.3 Admission to a Receiving Ward When a patient with a learning disability has been admitted via the Accident and Emergency Department, the Nurse should attempt to identify a health facilitator/carer and make contact with them as soon as possible in the patient’s admission to the acute hospital. The patient needs to be welcomed and introduced to their local environment, including the other patients. If the patient is unable to provide information regarding their health facilitator/carer, or does not have a health facilitator/carer and there are concerns, the Nurse should contact the the Learning Disabilities Team or Social Services Details of the health facilitator/carer and contact numbers should be clearly documented in the patient’s nursing notes. The protocol for planned admissions for patients with learning disabilities should be followed. 3.7 Planned Admission Many people with learning disabilities are very anxious about medical treatment and hospital environments. When a patient with a learning disability is identified as requiring an admission, this should act as the trigger for an assessment to be completed at the earliest opportunity in order to establish the person’s individual needs in advance of the admission.





of 20

Where information is available in advance, the Sister/Charge Nurse of the respective ward/department should be informed in advance by medical or secretarial staff that a patient with a learning disability is to be admitted, they need to be informed of the admission date and given a contact name and number for the patient’s health facilitator / carer (if available). If a health facilitator/carer is not identified and additional support is required, the Sister/Charge Nurse can contact the Learning Disability Team for information on whether the person is known to services. The Sister/Charge Nurse of the respective ward/department should identify a Registered Nurse for the patient who will be on duty on the day when the patient is admitted. There are identified staff with a Link role (Learning Disability Guides) within the Trust who have received additional training around caring for a patient with learning disabilities. Contact details with these staff within the Learning Resource Pack. Where possible, the patient and the health facilitator/carer should be asked to attend the ward prior to the admission date, in order to undertake an assessment of the patient’s care needs and to identify if any reasonable adjustments are required and agreed. The patient may bring their Hospital Passport (see Appendix 3) to assist with the assessment and provision of their care needs. The patient or the health facilitator / carer should also be asked to bring a copy of the patient’s current Health Action Plan / care plan (where these are in place) and medication. The patient and the health facilitator/carer should be made aware that this assessment can sometimes be a lengthy process. Preparations for discharge planning and any predicted discharge needs should also be discussed during the visit. Where other agencies are identified as required at this point referrals should be made. A full assessment of the patient’s nursing needs should be undertaken. This will assist to identify the specific nursing resource required and should be done, if possible in conjunction with the health facilitator/carer. Any resource requirements should be communicated initially to the Community Learning Disability Team (CLDT) and appropriate Matron as soon as possible and appropriate support instituted without delay. Upon admission to hospital any care needs that the patient has are the responsibility of hospital staff. Consideration should be given for the health facilitator/carer to accompany the patient on the day of admission and to take part in the admission process (with the patient’s consent). The patient must be flagged, ‘learning Disability’ on the electronic patient tracking system unless otherwise stated in the patient notes. Where at all possible transfer of a patient with a learning disability in order to accommodate other admissions (emergency or elective) should be avoided to ensure a consistent environment is maintained.





of 20

3.8 Discharge Discharge planning should be discussed with the patient and the health facilitator / carer at the time of admission. In the first instance all patients with a learning disability should be considered to have complex discharge planning needs. The policy on discharge planning should be adhered to at all times. Where cases are particularly complex a Multi-Disciplinary Team (MDT) or Best Interest meeting should be held ensuring relevant parties are invited. This may include Community Learning Disability Team. On the day of discharge the health facilitator/carer should be issued with a copy of the patient’s discharge plan detailing the patient’s care needs on discharge and arrangements for support in the community. Where the Community Learning Disabilities Team are involved, this should be copied to them. If the patient is to be discharged with medication the discharging nurse must ensure that the patient is able to administer their medication independently. If there are concerns that the patient may have difficulty taking their medication as prescribed contact the Community LD Team or pharmacy services for further guidance. The patient may have a health action plan that they ask the discharging nurse to complete.

4 ATTACHMENTS

Appendix Number Title

1 Core Principles

2 Out-Patient Attendance

3 Care of a Patient with a Learning Disability in Blackpool Teaching Hospital Trust (Hospital Passport)

4 Prior to hospital admission assessment and health action plan

5 Equality Impact Assessment Form

5 PROCEDURAL DOCUMENT STORAGE (HARD AND ELECTRONIC COPIES)

Electronic Database for Procedural Documents

Held by Procedural Document and Leaflet Coordinator

6 LOCATIONS THIS DOCUMENT ISSUED TO

Copy No Location Date Issued

1 Intranet 06/05/2016

2 Wards, Departments and Service 06/05/2016

7 OTHER RELEVANT / ASSOCIATED DOCUMENTS

Unique Identifier Title and web links from the document library

CORP/GUID/083 Implementing the Mental Capacity Act 2005 and Apply the Supporting Code of Practice http://fcsharepoint/trustdocuments/Documents/CORP-GUID-083.docx

http://fcsharepoint/trustdocuments/Documents/CORP-GUID-083.docx

http://fcsharepoint/trustdocuments/Documents/CORP-GUID-083.docx





of 20

7 OTHER RELEVANT / ASSOCIATED DOCUMENTS

Unique Identifier Title and web links from the document library

CORP/PROC/003 Do Not Attempt Cardiopulmonary Resuscitation (Adults, including Community Services) http://fcsharepoint/trustdocuments/Documents/CORP-PROC-003.docx

CORP/PROC/102 Consent to Examination or Treatment http://fcsharepoint/trustdocuments/Documents/CORP-PROC-102.docx

CORP/PROC/469 Applying for a Deprivation of Liberty Safeguards (DoLS) Authorisation and the Trusts Responsibilities as a Managing Authority http://fcsharepoint/trustdocuments/Documents/CORP-PROC-469.docx

PL/0981 Hospital Information - for people with Communication Difficulties http://fcsharepoint/trustdocuments/Information%20Leaflets/PL0981.docx

8 SUPPORTING REFERENCES / EVIDENCE BASED DOCUMENTS

References In Full

Barr, O. (2004) Nurses for People with Learning Disabilities within the United Kingdom: an Overview and Some Challenges for the Future. International; Journal of Nursing in Intellectual and Developmental Disabilities. 1 (1) 5-12

Cumella, S. & Martin, D.M. (2000) Secondary care for people with learning disabilities. Report completed for DH. British Institute of Learning Disabilities

DH (2001) Valuing People: A New Strategy for Learning Disability for the 21st Century. London. HMSO

DH(2009) Valuing People now a new three-year strategy for people with Learning Disabilities. Making it happen for everyone. HMSO

Heslop, P et t al (2013) CIPOLD(Confidential Enquiry into Premature Deaths of People with Learning Disabilities)

Disability rights Commission (2006) Equal treatment: Closing the gap. A formal investigation into the physical health inequalities experienced by people with learning disabilities and /or mental health problems. DH London

Emerson et al (2011) Health and inequalities & People with Learning Disabilities in the UK.

Glasby, A.M. (2003) Access all areas. Learning Disability Practice. 6 (2) 10-12

Hatton et al (2003) Key Highlights in the Health of People with Learning Disabilities. www.valuingpeople.gov.uk/documents/KeyHighlights.pdf (last accessed February 13 2004)

Mencap (2010) Getting it Right. London. Mencap

Mencap (2004) Treat me right: Better health care for people with a learning disability .London. Mencap

Mencap (2007) Death by indifference. London. Mencap Mencap (2012) Death by Indifference: 74 Deaths and Counting. A progress report 5 years on. London. Mencap

NPSA (2004) Understanding the patient safety issues for people with learning disabilities. London. NPSA

http://fcsharepoint/trustdocuments/Documents/CORP-PROC-003.docx






http://fcsharepoint/trustdocuments/Information%20Leaflets/PL0981.docx


http://www.valuingpeople.gov.uk/documents/KeyHighlights.pdf





of 20

8 SUPPORTING REFERENCES / EVIDENCE BASED DOCUMENTS

References In Full

Michael J (2008) Healthcare for all: report of the Independent inquiry into access for healthcare for people with Learning Disabilities. London Department of Health

NHS England (2015) Independent review of deaths of people with Learning Disability or Mental Health Problems in contact with Southern Health NHS foundation trust April 2011- March 2015

9 CONSULTATION / ACKNOWLEDGEMENTS WITH STAFF, PEERS, PATIENTS AND THE PUBLIC

Name Designation Date Response Received

Robert Ward MCA / DOLS Lead September 2015

Emma O` Kane Adult Safeguarding Practitioner 29/04/16

Mr. Mrs F Parent carers September 2015

Lynn Atcheson Clinical Improvement Lead May 2016

Anders Coleman Quality Manager May 2016

Patricia Cross Infection Prevention May 2016

Maggy Heaton RCN Rep May 2016

Julie Hollingworth Lead Pharmacist May 2016

Lisa Littler Deputy Head of Blackpool Locality May 2016

Michael Reid Clinical Librarian May 2016

10 DEFINITIONS / GLOSSARY OF TERMS

DOLS Deprivation of Liberty Safeguards

DNAR do not attempt resuscitation

LD Learning Disability

MCA Mental Capacity Act

MDT Multi-Disciplinary Team

11 AUTHOR / DIVISIONAL / DIRECTORATE MANAGER APPROVAL

Issued By Andrew Heath Checked By Simone Anderton

Job Title Patient Experience and Engagement Lead

Job Title Deputy Director of Nursing and Quality

Date 09/03/16 Date July 22nd 2015





of 20

APPENDIX 1: CORE PRINCIPLES

Principles of Informed Consent

All patients must be treated as equal, having the same rights to care

Patient consent is required in all areas of care / treatment.

It should not be assumed that patients with a learning disability cannot give informed consent

Patient consent cannot be given by another adult on behalf of an adult patient

Medical and nursing staff should assess the capacity of the patient to give consent along with people who know them best

All care given must clearly be in the patient’s best interests; ultimately the attending doctor may make a decision to proceed without consent

Liaise with people who know the patient e.g. health facilitator/carer or parent

Assess the need to involve the CLDT

Patients with a learning disability should not be excluded from treatment unless clinically indicated

Patient referred for treatment or admission

Elective

Investigations

Outpatients

Accident and Emergency and other Receiving Areas

Pre-admission Planning – Consider liaison with:

Patient and their carer

Health Facilitator

CLDT

Patient’s community supports

Other agencies e.g. Social Work

Primary Care Team

Admission / Investigation / Treatment as an Out

Patient

Discharge Planning Refer to Trust Discharge Planning Policy and follow appropriate flow chart Consider involvement of

Patient

Health facilitator/carer

CLDT

Other agencies e.g. social work

Primary care team

Complete Nursing Assessment

Discuss need for additional nursing resources with CLDT

Ensure carer involvement at the level they desire

Ensure Good Communication between all parties by using

the patient’s Prior to admission document

Hospital Communication Book

Talking to the patient about their care

Keep the health facilitator/carer informed of patient progress

Hospital Passport

Care delivered according to care plan and protocols

Review care plans on a daily basis





of 20

APPENDIX 2: OUT PATIENT ATTENDANCE

Invite the patient or health facilitator/carer to make contact with Clinic Nursing Staff.

Discuss details of the appointment and any specific needs/ resources required

If the patient’s needs indicate that a specific appointment time on the clinic list is preferable, enter the detail on the Patient Record

NOTE - if ambulance is the required mode of transport it may not be possible to guarantee the

appointment time

A Registered Nurse must see the patient prior to them leaving the department. Ensure patient and carer understand the outcome of the consultation

and document as required in the Health action Plan if the patient has one

If follow up appointments required, establish

further care requirements

Does the outcome of the appointment indicate that investigation or admission to the acute care

setting is required? Yes

Liaise with staff in the relevant department

Consider a referral to the CLDT if support and assistance with preparation of the patient will be

complex

Flexibility of Clinic Appointments

For the safety and comfort of both the patient and other patients attending the clinic it may be necessary

to alter the patient’s appointment time in order to minimise any patient anxiety that might be induced by

lengthy waiting in an unfamiliar environment

The Nurse-in-Charge of the clinic has the authority to take a flexible approach based on patient needs

No

No further Action





of 20

APPENDIX 3: HOSPITAL PASSPORT







of 20

APPENDIX 4: PERSON CENTRED HEALTH ACTION PLAN

Health Action Plan

Health Issues Actions

John is having difficulty reading the news paper.

The Optician has referred John to the hospital to see

Dr. Jones

The appointment is on Monday 25

th May at 2.30p.m

John will attend the appointment with Susan Brown.

Susan will meet John at the outpatients department at

2.15p.m.

John will bring his glasses with him and a list of his medication.

Who What Happened (outcome)

John was supported by his community nurse,

Susan Brown.

John met clinic nurse Joan Green

Joan gave John an information leaflet about cataract surgery

John was seen by Dr. Jones in clinic.

John has cataracts that need to be removed.

John is to come into hospital. John will receive a letter asking him to arrange a date to come

for surgery. Susan will help John make this

appointment





of 20

APPENDIX 5: EQUALITY IMPACT ASSESSMENT FORM Department Learning and

Disabilities Service or Policy CORP/GUID/450 Date Completed:

GROUPS TO BE CONSIDERED Deprived communities, homeless, substance misusers, people who have a disability, learning disability, older people, children and families, young people, Lesbian Gay Bi-sexual or Transgender, minority ethnic communities, Gypsy/Roma/Travellers, women/men, parents, carers, staff, wider community, offenders.

EQUALITY PROTECTED CHARACTERISTICS TO BE CONSIDERED Age, gender, disability, race, sexual orientation, gender identity (or reassignment), religion and belief, carers, Human Rights and social economic / deprivation.

QUESTION RESPONSE IMPACT

Issue Action Positive Negative What is the service, leaflet or policy development? What are its aims, who are the target audience?

See Purpose

Does the service, leaflet or policy/ development impact on community safety

Crime

Community cohesion

Yes

Is there any evidence that groups who should benefit do not? i.e. equal opportunity monitoring of service users and/or staff. If none/insufficient local or national data available consider what information you need.

Yes

Does the service, leaflet or development/ policy have a negative impact on any geographical or sub group of the population?

Yes

How does the service, leaflet or policy/ development promote equality and diversity?

Yes

Does the service, leaflet or policy/ development explicitly include a commitment to equality and diversity and meeting needs? How does it demonstrate its impact?

Yes

Does the Organisation or service workforce reflect the local population? Do we employ people from disadvantaged groups

Yes

Will the service, leaflet or policy/ development i. Improve economic social conditions

in deprived areas

ii. Use brown field sites iii. Improve public spaces including

creation of green spaces?

Yes

Does the service, leaflet or policy/ development promote equity of lifelong learning?

Yes

Does the service, leaflet or policy/ development encourage healthy lifestyles and reduce risks to health?

Yes

Does the service, leaflet or policy/ development impact on transport? What are the implications of this?

Yes

Does the service, leaflet or policy/development impact on housing, housing needs, homelessness, or a person’s ability to remain at home?

Yes

Are there any groups for whom this policy/ service/leaflet would have an impact? Is it an adverse/negative impact? Does it or could it (or is the perception that it could exclude disadvantaged or marginalised groups?

Yes

Does the policy/development promote access to services and facilities for any group in particular?

Yes





of 20

APPENDIX 5: EQUALITY IMPACT ASSESSMENT FORM Does the service, leaflet or policy/development impact on the environment

During development

At implementation?

Yes

ACTION:

Please identify if you are now required to carry out a Full Equality Analysis

Yes No (Please delete as appropriate)

Name of Author: Signature of Author:

Date Signed:

Name of Lead Person: Signature of Lead Person:

Date Signed:

Name of Manager: Signature of Manager

Date Signed: