The National Survey of
Reasonable Adjustments by NHS
Trusts 2010
Results and
recommendations
Hazel Roberts, Chris Hatton and Sue
Turner
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
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.
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.
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
What should happen
Family carers need to
be involved from preadmission stage
onwards.
Should be a policy
which details support
for carers and a
protocol on the
provision of extra
personal care.
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
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.
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%)
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
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%)
What should happen
Use the health
passport or similar
Understand how
people
communicate pain
and distress
Accessible
information about
food
What should happen
Safe swallow
guidance
Risk assessments
People with learning
disabilities identified
in incident reports
and lessons learned
Service delivery-discharge
arrangements
11% of Trusts
described links
between Trust staff
and Community
Learning Disability
Teams for discharge/
follow up
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
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.
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
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.
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.
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
What should happen
Accessible recruitment
and appointment
procedures
People with learning
disabilities employed
within the Trust given
the same opportunities
as other employees
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
What should happen
Involve people with
learning
disabilities/family
carers in Equality
Impact Assessments.
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
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/reasonableadjustme
nts/database