Using simulation to learn how to meet the needs of people with more complex issues

1

• Using simulation to learn how to meet the needs
  of people with more complex issues
• Neil James
• Unit for Development In Intellectual Disability
• Faculty of Health, Sport and Science

2
DRC Report (2006)

• Equal Treatment Closing the Gap
• Some findings
• Reasons for health inequalities are complex
• Attitudes of reception staff
• Focusing on learning disability
• Inflexible appointment systems
• Inaccessible information
• Inaccessible communications
• Less likely to receive appropriate treatment
• Face barriers to accessing services

3
Death by Indifference

• MENCAP, March 2007
• 6 stories that are shocking and tragic that
  demonstrate, Indifference, Lack of Training and
  Poor understanding in respect of the needs of
  PWLD
• Institutional discrimination leading to neglect
• Failure to tackle unequal access

4
Death by Indifference

• Families recount the words that health
  professionals have said to them
• If she had been a normal young woman we would
  not hesitate to treat her
• Wouldnt it be better for everyone if we just
  let him go?
• In my opinion there is nothing wrong with him
  and I am not usually wrong. Its just the way he
  is
• (Mencap, 2007)

5
Martins story

• Martin died on 21 December 2005, aged 43 years
  old, allegedly of a stroke. He had a severe
  learning disability and no speech. In the 26
  days he spend in hospital following a stroke he
  went without food. The hospital failed to use a
  nasal feeding tube at the critical time to
  prevent his condition from deteriorating
  dangerously. This left him too weak to undergo
  surgery to have a PEG feeding tube inserted into
  his stomach.
• (Mencap, 2007)

6
Death by Indifference

• Some of the contributing factors
• People with a learning disability are seen to be
  a low priority
• Many health professionals do not understand much
  about learning disability
• Many healthcare professionals do not properly
  consult and involve the families and carers of
  PWLD
• Many healthcare professionals do not understand
  the law around capacity and consent to treatment

7
The MCA (2005) - 5 Principles

• A person is assumed to have capacity. Lack of
  capacity has to be determined
• No-one should be treated as unable to make a
  decision unless all practicable steps have been
  taken and shown not to work
• A person can make an unwise decision. This
  doesnt mean they lack capacity
• If it is determined that a person lacks capacity,
  any decisions taken on their behalf must be in
  their best interests
• Any decisions taken on their behalf must take
  into account their rights to freedom of action.
  Any decision must show that a least restrictive
  option or intervention is achieved

8
The MCA (2005) - Assumption of Capacity and
Supported Decision Making

• Act sets out an assumption of capacity
• Obligation to take all practicable steps to help
  the person take his or her own decision
• Act makes it clear that a persons age,
  appearance, condition or behaviour does not by
  itself establish a lack of mental capacity
• Must give information in a clear and easy way to
  understand
• Must help the person who lacks capacity to
  communicate

9
The Cornwall Report (2006)

• AT centres had become long stay homes
• Over-reliance on PRN medication to control
  behaviour
• Record keeping was generally poor that affected
  care delivery
• Resident finance management concerns
• Some individuals have suffered abuse, physical,
  emotional and institutional

10
David Brindle, Wednesday January 17, 2007 The
Guardian

• Sutton Merton Primary Care Trust London
  Hospitals
• People with learning disabilities had been
  subjected to physical and sexual abuse at a
  hospital in London, according to an investigation
  by the Healthcare Commission. One member of staff
  was jailed for six years last summer after being
  charged with rape of a woman resident who was
  considered unable to give consent due to her low
  mental age. A second staff member had been given
  a suspended sentence for a sex offence against
  the same woman a year earlier.
• Living conditions were impoverished, routines
  arranged for the convenience of staff and
  organised activities at the hospital provided for
  less than five hours a week.

11
Some closing comments

• TRAC Teaching Research Advisory Committee
• A family carers video for use in CFP
• Student stories from practice
• Multidisciplinary working
• Student participation
• Preventing marginalisation
• Support the use of communication skills in a
  difficult environment
• Teaching to see someone as a person first
• Developing the scenarios and why

12
The scenario demonstration

• 2 volunteers
• University of Glamorgan staff will be
  participating
• Audience participation
• Take notes
• Provide positive and constructive feedback at end
  of scenario
• My role as a facilitator

13
The Scenario

• A 34 year old gentleman with moderate learning
  (intellectual) disability, who has been admitted
  after experiencing a tonic clonic seizure at his
  work placement. During the seizure cyanosis of
  the lips and frothing at the mouth were observed.
  His seizure is reported to have lasted for
  approximately 2-3 minutes after which he was
  reported to be drowsy and confused. His family
  carer has reported that this is the 5th tonic
  clonic seizure that he has experienced in the
  last 48 hours. They also reported that an
  average rate of occurrence of this type of
  seizure is normally one every 2-3 months usually
  lasting between 30 seconds to 1 minute. He
  has been admitted for assessment and observation
  due to this increase in seizure activity. No
  investigations other than blood monitoring have
  been arranged since his admission and transfer to
  the general medical ward.

14
References

• Commission for Healthcare Audit and Inspection.
  (2006). Joint investigation into the provision
  of services for people with learning disabilities
  at Cornwall Partnership NHS Trust. Commission
  for Healthcare Audit and Inspection, London.
• Disability Rights Commission. (2006). Equal
  Treatment Closing the Gap. A formal
  investigation into physical health inequalities
  experienced by people with learning disabilities
  and/or mental health problems. Disability Rights
  Commission, Stratford upon Avon.
• Mencap. (2007). Death by indifference
  following up the Treat me right report. Mencap,
  London.
• Prasher, V. P. and Janicki, M. (2002) Physical
  health of adults with intellectual disability.
  Blackwell Publishing, Oxford.
• RCN. (2006). Meeting the health needs of people
  with learning disabilities Guidance for nursing
  staff. RCN, London.
• Turner, S. (2001). Health needs of people who
  have a learning disability Meeting the health
  needs of people who have a learning disability.
  J. Thompson and S. Pickering. Edinburgh,
  Bailliere Tindall 63-88.