Contemporary Issues in Learning Disabilities

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Contemporary Issues in Learning Disabilities
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Definition of learning disability

• Learning disability is characterised by
• IQ lt70
• Significant deficits in two or more areas of
  adaptive functioning
• Onset must be present before the age of 16
• As defined by World Health
• Organisation etc.

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Increased health needs of those with Learning
Disabilities

• People with learning disabilities have poorer
  health than the rest of the population and to a
  large extent these health problems are avoidable.
• Particular health conditions are more common in
  people with learning disabilities.
• These health inequalities are compounded by
  barriers people with learning disabilities face
  in accessing timely, appropriate and effective
  healthcare.
• (NHS Health Scotland, 2004 Emerson Baines
  2012).

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Communication Issues in Learning Disability
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He understands everything we say.
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Communication Difficulties

• People with learning disabilities may
• Have difficulty understanding complex sentence
  structures.
• Display literal understanding of language. E.g.
  how much do you drink.
• Be easily overloaded with verbal language, which
  increases anxiety.
• Show unreliable use of yes/no.
• People will often say yes because they think it
  is what
• you want to hear, not because they understood the
• question.

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What you need to do.

• Keep sentence structures simple.
• Use concrete language, most people with learning
  disabilities will struggle with abstract language
  and concepts.
• Consider using closed questions and visual aids.
• Break information into small manageable chunks.
• Use gesture to support your language.
• Use visual aids to explain patient journey
• Think about what you are saying, and be specific.
  
• Some people with learning disabilities will not
  have the cognitive
• ability or language skills to formulate and
  construct an answer

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What is out there to help?

• The Pink Box
• Contains a range of resources including
• Pain charts
• Easy read leaflets
• Choice board
• Information about learning disabilities

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Adults with Incapacity (Scotland) Act 2000

• The Act provides ways to help safeguard the
  welfare and finances of people who lack capacity
• It protects adults ( people aged 16 or over) who
  lack capacity to take some or all decisions for
  themselves because of a mental disorder or an
  ability to communicate because of a physical
  condition
• It allows a person such as a relative, friend
  or partner to make decisions on someone's
  behalf (subject to safeguards)

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Capacity to consent

• Capacity to consent is variable and should be
  assessed in relation to the particular patient,
  at the particular time, with regards to the
  particular treatment proposed.
• Temporary factors can reduce or remove capacity
  e.g. confusion, fear, fatigue, pain, drugs

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Checking indicators of capacity can the
person use

• Communication receiving and processing
  information, communicating decisions
• Memory recalling new information, consistency
  of decisions, distinction between short-term
  memory loss and long-term memory deficit
• Understanding Try to increase understanding by
  repeating information back/checking out/use of
  language/advocacy

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Principles of Adults with Incapacity Act
(Scotland) 2000

• Benefit
• Minimum intervention
• Must take account of wishes and feelings
• Consultation with others
• Encourage the adult to exercise residual capacity

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Adults with Incapacity Act ( Scotland 2000)

• Part 5 of the Act gives general authority to
  treat a patient who is incapable of consenting to
  the treatment in question, on the issuing of a
  certificate of incapacity and a treatment plan
  being implemented.
• The general principles of the Act must be applied
  by a medical practitioner or health professional
  issuing such a certificate and giving treatment
  under it.

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Equality Act 2010

• The act replaced previous anti-discrimination
  laws with a single act to make the law simpler
  and to remove inconsistencies. protection in some
  situations.
• The act covers nine protected characteristics,
  which cannot be used as a reason to treat people
  unfairly. Every person has one or more of the
  protected characteristics, so the act protects
  everyone against unfair treatment. The protected
  characteristics are
• age
• disability
• gender reassignment
• marriage and civil partnership
• pregnancy and maternity
• race
• religion or belief
• sex
• sexual orientation

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What reasonable adjustments do you have to make
for disabled people?

• Service providers are required to make changes,
  where needed, to improve service for disabled
  customers or potential customers.
• There is a legal requirement to make reasonable
  changes to the way things are done
• such as changing a policy
• changes to the built environment (e.g. to improve
  access)
• to provide auxiliary aids and services (such as
  providing information in an accessible format, an
  induction loop for customers with hearing aids,
  special computer software or additional staff
  support when using a service).

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Why should you think about what we have been
discussing.

• The following slides show some of the reports and
  research completed highlighting the need for
  improved healthcare for the learning disabled
  patient
• NHS Highlands responses

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Death by Indifference

• This is a report produced by MENCAP
• MENCAP found that some people with learning
  disabilities died because of inadequate medical
  treatment.
• MENCAP talked about 6 people with learning
  disabilities who died.

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Subsequent reports about the care of people with
learning Disabilities

• Six lives (Parliamentary and Health Service
  Ombudsman, 2009)
• Tackling Indifference (NHS QIS, 2009)
• Meeting the health needs of people with learning
  disabilities (RCN, 2011)
• Death by indifference 74 deaths and counting. A
  progress report 5 years on. (Mencap, 2012)

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Tackling Indifference in Scotland

• The Tackling Indifference report identified areas
  for development in relation to
• Awareness training around issues related to
  learning disabilities and autism
• The provision of advice and support for staff in
  hospital services
• Availability of communication supports for people
  with learning disabilities

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NHS Highland Response

• Establishment of Tackling Indifference Steering
  Group
• Development of local (CHP) action plans
• Ensuring local accountability structures are in
  place to monitor progress
• Co-ordinate Highland wide initiatives

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Support available from NHS Highland Learning
Disability services
Assessment Treatment Unit
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We may be able to help!

• Community Learning Disability Nurses based
  throughout Highland
• Fort William Health Centre
• Kyle of Lochalsh
• Poolewe
• Thurso
• Golspie
• Invergordon
• Conan Bridge
• Inverness
• Nairn
• Aviemore

• Acute Liaison Nurse (Raigmore)
• and based at New Craigs.
• Speech Language Therapists
• Occupational Therapists
• Physiotherapist
• Accessible Information Officer
• Additional Support Team (Challenging Behaviour)
• Psychologists
• Psychiatrists
• Epilepsy Nurses Specialist
• Dietician
• Assessment Treatment Unit (Willows)

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Any Questions?

• Thank you for your time.