RQIA Calls for Improvements in Caring for People with a Learning

18 December 2014
RQIA Calls for Improvements in Caring for People with a Learning
Disability in General Hospital
Today, RQIA has published the findings of its Review of Implementation of GAIN
Guidelines on Caring for People with a Learning Disability in General Hospital
Settings.
The Guideline on Caring for People with a Learning Disability in General Hospital
Settings was published by GAIN in June 2010. The guideline details specific
requirements for people with a learning disability who use general hospital settings.
These include: communication; training for hospital staff; attendance at emergency
care services; discharge planning; and support for carers.
Each HSC trust should have arrangements in place to specifically identify if a person
has a learning disability. The likely impact of a person’s understanding and
cooperation in an emergency department should be established and factored into
any assessment, alongside determining their priority for treatment.
RQIA Chief Executive, Glenn Houston stated: “People with learning disabilities
are very clear that healthcare staff should look at, and speak to them first, and
focus on them, rather than directing attention to carers or parents. Service
users who contributed to the review expressed their negative experiences of
staff talking around the person with learning disabilities.”
Using terminology that does not devalue or stigmatise individuals is an important
element in ensuring that people with learning disabilities feel included and valued
when they are in receipt of services. During the review, this was raised frequently by
service users and carers as a problem that immediately creates barriers to good
therapeutic and respectful relationships. The only acceptable term is “person with a
learning disability”.
Mr Houston continued: “Concerns were raised by the review team around
misunderstanding and poor practice in relation to consent, capacity
assessment, best interest decisions and resuscitation orders. While the
review team was satisfied that there is sufficient guidance, policy and
professional codes to inform and guide clinical practice, on many occasions
these were not followed.”
The review team found that linkages and liaison between general hospital services
and learning disability services was variable and dependent on the insight of
individual members of staff, rather than a structured and formalised process. RQIA
recommends that each HSC trust should ensure that there are clear lines of
communication and robust linkages between learning disability services and general
hospitals.
Mr Houston continued: “All health and social care trusts have processes in
place to implement GAIN guidelines. However, the review team considers that
trusts need more robust procedures for monitoring progress, ensuring there
are appropriate reporting mechanisms in place at director and trust board
level.”
Health passports were identified by all trusts as an important mechanism to improve
communication and patient safety for people with learning disabilities, during their
journey through general hospital services, but evidence of their use was limited.
Glenn Houston concluded: “In this review, RQIA makes 19 recommendations,
which, if implemented we believe will improve the level of care experienced by
people with a learning disability in general hospital settings.”
END
For further information, please contact Malachy Finnegan:
Tel:
email:
website:
Twitter:
028 9051 7485
[email protected]
www.rqia.org.uk
@RQIAnews
The Regulation and Quality Improvement Authority (RQIA)
RQIA is the independent body responsible for monitoring and inspecting the
availability and quality of health and social care services in Northern Ireland, and
encouraging improvements in the quality of those services.
Background to Review
The GAIN Guideline on Caring for People with a Learning Disability in General
Hospital Settings was launched and published in June 2010, and disseminated by
GAIN to health and social care trusts for implementation.
The guideline has since been referenced in two DHSSPS policy documents.
Section 19 of The Learning Disability Service Framework (DHSSPS 2011) states: “all
acute hospitals should have an action plan for implementing the GAIN guidelines
and be able to demonstrate a clear commitment to the implementation of such a
plan”.
The 2012 -2015 Bamford Action Plan (DHSSPS 2012) commits to the need for
services to “improve the experience of people with learning disability using acute
general hospitals based on the GAIN Guidelines on Caring for People with a
Learning Disability in General Hospital Settings.”
Terms of Reference
The terms of reference for the review were agreed as follows:



Evaluate the arrangements that have been put in place to implement the GAIN
Guidelines on Caring for People with a Learning Disability in General Hospital
Settings.
Assess the current position in relation to the best practice statements within the
GAIN guidelines.
Identify any lessons learned from the implementation, report on the findings and
make recommendations as appropriate.
Membership of the Review Team
Professor Owen Barr
Maurice Devine
Dalrene Masson
Siobhan Rogan
Head of School of Nursing, University of Ulster
Review Lead, Assistant Head of Clinical Education
Centre and Nursing Officer for Mental Health and
Learning Disability Nursing, DHSSPS
Auditor, GAIN, DHSSPS
Mental Health and Learning Disability Inspector, RQIA
Anne McKibben
David Philpot
Project Administrator, RQIA
Project Manager, RQIA

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