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2nd November 2023
A set of safety observations and recommendations relating to the care of adults with a learning disability in acute hospital settings in England have been outlined in a new report by the Health Services Safety Investigations Body (HSSIB).
The report found the needs of patients with learning disability are ‘not consistently met’ when in hospital and that this is ‘a widespread and persistent issue’.
This is due to current systems and processes within the NHS not always being designed to enable non-specialist staff to deliver effective care to people with a learning disability, and the availability of learning disability liaison services being inconsistent, it said.
As a result, general staff are often not equipped with the skills, information, support or sufficient time to make reasonable adjustments to their care and meet the needs of these patients.
The HSSIB’s four recommendations are therefore aimed at reducing the safety risks, tackling care inequity and supporting the delivery of safe care to vulnerable people through the development of guidance and standard procedures.
This includes encouraging NHS England to develop best practice guidance for the learning disability liaison workforce to standardise support for patients and non-specialist staff, as well as issuing guidance on how to assess mental capacity in practice to improve staff confidence and what information should be included in a health and care passport.
Extending funding for the national learning disability improvement standards annual benchmarking survey for the care of people with a learning disability in acute hospitals beyond 2024 is also recommended.
Other considerations outlined in the report include optimising local configuration of electronic patient record systems, ensuring training curricula align with the upcoming national code of practice on statutory learning disability and autism training, and clinicians advocating for all people with a learning disability to have an up-to-date care passport.
Three safety actions for integrated care boards to support patient safety are also included, which centre on working with acute hospitals to share good practice and learning and provide cross-sector peer support to ensure equitable care.
Clare Crowley, HSSIB senior safety investigator said: ‘In the UK it is estimated over 900,000 adults have a learning disability. Each person with a learning disability will have their own experiences, their own way to communicate and will come into hospital with unique needs, which will require a tailored set of reasonable adjustments.
‘What our investigation shows is that where systems and processes do not support staff overall, an ‘unrealistic reliance’ is placed on individual staff members working within hospital wards. We heard from staff that they are trying their best for their patients but don’t always have the time to meet needs in the way they would like and are not always equipped with the specialist skills and knowledge they need to assess and care for people with a learning disability.
She added: ‘If needs are not met, it can cause distress and confusion for the patient and their families and carers, and raises the risk of poor health outcomes and in the worst cases, harm.’
Responding to the report, Saffron Cordery, deputy chief executive at NHS Providers, said: ‘This report bolsters longstanding concerns over the gaps in care provided to patients with learning disabilities.
‘Trust leaders are committed to stamping out health inequalities and improving quality of care for all, but operational pressures and the lack of available data on health inequalities within the NHS have slowed progress significantly.
‘Investing in training programmes would help equip hospital staff with the skills, knowledge and confidence needed to provide effective care to patients with learning disabilities.
‘We agree that rolling out standardised national guidance for acute learning disability liaison services could also help ensure consistent and equitable care across the country.
‘Getting care right for patients with learning disabilities will mean getting care right for everyone.’
Earlier this year, it was found that a programme intended to improve care for patients with learning disabilities in acute and elective settings was limited by a poor working relationship with primary care.