Hospital handovers 'failing' patients with learning disabilities
Posted 02 November 2023 - 15:34
Nursing shift handovers for such patients are hugely varied, lack structure and are failing patients, a safety watchdog says
Nursing shift handovers for patients with learning disabilities at acute hospitals are hugely varied, lack structure and are failing patients, a safety watchdog has said.
The Health Services Safety Investigations Body (HSSIB) report calls on NHS England to publish a national guide for best practice for disability liaison nursing for all acute hospitals to enhance decision-making and improve reasonable adjustments for patients.
The report, published on 2 November, said hospitals must do more to provide effective care for people with learning disabilities as the system can cause distress and confusion for patients, and elevate the risk of harm.
Reasonable adjustments may take more than a day to put in place, investigators told
It gave the example of a 79-year-old man with a learning disability who was admitted to hospital and died after a cardiac arrest two weeks later. The HSSIB found that his needs in hospital ‘were not consistently documented or met’, including a hearing impairment not being addressed, meaning staff were unable to communicate with him.
The HSSIB probe also found that record-keeping of patient needs was inconsistent and trusts often only have one ‘over-stretched’ learning disability liaison nurse available on site, with their role being unfilled during annual leave or sickness.
One liaison nurse told the investigation: ‘Capacity is beyond stretched, and reasonable adjustments for a person may take more than one day to put in place.’
‘Unrealistic reliance’ is being placed on individual staff members, says senior investigator
HSIBB senior safety investigator Clare Crowley said an ‘unrealistic reliance’ is placed on individual staff members.
‘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 said.
They also found some hospital staff may lack confidence in assessing the mental capacity of patients with a learning disability in line with the Mental Capacity Act (2005).
Lack of learning disability nurses and national guidance on standards ‘a doubled-edged sword’
RCN professional lead for learning disability nursing Jonathan Beebee said the government must invest in the workforce and deliver an impact assessment for where future learning disability nurses are needed.
‘The double-edged sword of a lack of learning disability nursing staff and national guidance on service standards has created an unacceptable level of care,’ said Mr Beebee. ‘People with learning disabilities are being denied the quality specialist support they deserve.’
He added: ‘Since 2009, the number of learning disability nurses working in the NHS in England has fallen by nearly half. Coupled with the absence of standard models for learning disability care, the result is a postcode lottery of care.’
NHS plans to add new digital flag in patient records from next April
An NHS spokesperson said it ‘remains committed to increasing support for people with a learning disability’ and will be rolling out a new digital flag in patient records from April 2024.
The Reasonable Adjustment Flag will ensure staff are aware if a patient is autistic or has a learning disability and the reasonable adjustments they need.
The Department of Health and Social Care has been approached for comment.
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