Helpful Health Care Advice

Information and advice when providing health care for people with learning disabilities

Communication

The physical health needs of people with learning disabilities are often overlooked because of communication difficulties. People with learning disabilities also have 80% greater risk of sensory impairment which can have a major impact on communication.

Points to consider:

Encourage a culture where staff see the person, not the disability.

Talk directly to the person and involve the carer if it seems the person has not fully understood.

Check that you have understood what the person has said to you and that they have understood you.

Use plain language with familiar words and short sentences. Avoid the use of jargon.

Use normal tone, intonation and grammar. Do not shout.

Explain what is going to happen to help reassure and avoid anxiety.

Keep a pen and paper handy to write or draw things

Listen and look out for facial expressions, body language, pointing etc.

Make sure any further information is available in an appropriate format, such as easy read. Some examples of easy read documentation.

Provide time and opportunities for questions

Training of staff on issues around learning disabilities may be appropriate and should consider recommendations from the QIS Best practice Statement (2007) – Promoting access to healthcare for people with a learning disability – a guide for frontline NHS staff

Adults with Incapacity(Scotland) Act 2000

Top Ten Tips

1) Consent: a patient of or over the age of 16 years is presumed under Scottish law to have legal capacity to consent to treatment unless he or she:

  • Is unable to take in and retain the information material pertaining to the decision, especially as to the likely consequences of having or not having the treatment.
  • Is unable to weigh the information in the balance as part of a process of arriving at the decision. 
  • 2)   Principles of the Act: The treatment should;

  • benefit the person
  • be the minimum necessary intervention
  • take account of past and present wishes of patient
  • restrict the patient’s freedom as little as possible

and

  • the patient should be encouraged to exercise any residual capacity
  • relevant others (e.g. GP, relatives, carers) should be consulted.

3) Capacity: In order to give informed consent, the patient needs to be capable of:

  • acting on decisions
  • making decisions
  • communicating decisions
  • understanding decisions
  • retaining the memory of decisions

Remember, a patient may have capacity in relation to simple treatments, but not understand complex treatment (e.g. surgery). Also, capacity may change depending on the patient’s health status.

4) Assessment: Work as a team and aim for a consensus of opinion and consult relevant others. Consider the patient’s level of comprehension and be aware of suggestibility and acquiescence. Remember, you may need to adapt your communication, use communication aids or seek the help of other professionals.

5) Section 47 Certificate: Completed following assessment. This gives a general authority to treat. The certificate is treatment specific, time limited (for the expected period of treatment, normally for up to 1 year, however in specific circumstances this can be for up to 3 years), and completed by a senior doctor. A nurse or dentist may complete a certificate for treatment they are specifically trained to deliver if they have undertaken the prescribed training.

6) Documentation and Treatment Plans: Conversations with the patient and relevant others and the decision to treat under a Section 47 certificate should be documented in the patient’s notes. It is good practice to complete a treatment plan, detailing what treatment is being carried out under the certificate.

7) Power of Attorney, Welfare Guardian or Intervention Order: Does the patient have a court appointed proxy. If so, then the proxy may be able to consent to medical treatment for the patient. However, it should be confirmed that this is permitted under e.g. the guardianship order. Any decisions made on the patient’s behalf by a proxy should be in the patient’s best interests, and comply with the principles of the Act. A Section 47 certificate should still be completed as above.

8) Dispute resolution: Local resolution of disputes is encouraged. However, if this is not achievable, then a second opinion can be sought from the Mental Welfare Commission. Failing this, court proceedings can be undertaken to seek a judges decision.

9) Emergencies: Authority to treat in an emergency remains

10) More support and information: The Mental Welfare Commission and professional organisations (GMC, BMA, NMC and RCN) all provide guidance on consent and assessment of capacity. For specific advice about patient’s with learning disabilities, please contact the Learning Disability Liaison Service (0131 537 4220).

Links to further information:-

The use of the Mental Health & Adults with Incapacity Law in General Hospitals

Adults with Incapacity (Scotland) Act 2000

Last Reviewed: 01/06/2011