Reasonable adjustment flag pilot

August 19, 2019

NHS Digital has announced a 'reasonable adjustment flag' pilot to support people with learning disabilities to receive better care from health services.

The pilot will see a reasonable adjustment flag added to patient records, which will let doctors, nurses and other health and care staff know that a person has a learning disability and might require adjustments to the services provided so they get the best care.

In the trial, staff will access the information through a patient’s record on the Summary Care Record application, a program designed to share key information about patients. In the longer term, it will be integrated with clinical systems so that staff will be able to see it on their own screens as soon as they search for the patient.

The reasonable adjustment flag can alert a practitioner to a patient’s need for a longer appointment or a quiet waiting area as well as how to communicate with them or who to involve in decisions about their health and care.

The reasonable adjustment flag pilots will run in Gloucestershire and Devon until the end of September. Various care settings will be involved, including GP surgeries, hospitals and community services for learning disability. They will look at how care is impacted when that information is readily available to staff from the first point of contact onwards. The trials will seek to test the technology behind the flag and gather feedback from staff, patients and carers. NHS Digital will then explore a potential expansion, including widening the geographical area, giving access to more care settings and trialling integration with clinical systems.

Susan Hanley, Chief Executive of Leeds People First and leading learning disability campaigner, said, '1.5 million people in the United Kingdom have a learning disability but it can’t always be seen.

'For me, if the hospital had a system that told them that I wanted easy-read information and for the doctor to speak clearly with no jargon, it would be really useful as I don’t always have my health passport on me. Some people don’t want to repeat themselves to everyone they meet so this information on a computer would help.'

Brendan Chivasa, member of Mencap’s Treat Me Well campaign steering group and who has a learning disability, said, 'People with a learning disability, like me, can have bad experiences in hospitals because doctors and nurses don’t understand our learning disability or don’t make the reasonable adjustments we need. This can lead to people with a learning disability dying earlier. That’s why Mencap started it’s Treat Me Well campaign.

'I think it’s a really good idea to highlight someone with a learning disability via their health records so that both nurses and doctors are aware of their condition. However, there’s a lot more that can be done. Personally, health professionals understand me because I’m able to express myself verbally, but for someone who is non-verbal it’s much more difficult for them to explain their symptoms and emotions. Therefore, I think the doctors and nurses should have access to more specialist training in this field, on top of this flagging system trial.'

Dr Rob Jeeves, Clinical Lead for the project at NHS Digital, said, 'By helping staff to recognise their patients’ needs earlier, we can help those patients access the best possible care while reducing pressure on the NHS.

'This pilot will explore how flagging vital information can influence the experience of care for people with a learning disability.

'This will help to drive real improvement for a patient group that is disproportionally affected by poor health outcomes. I welcome this step and look forward to the results of the pilot.'


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