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Nursing Times Awards 2010

Patient Pathway Award

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WINNER: Improving care in an acute hospital for people with learning disabilities, Pamela McCarthy, Carol Edwards, Stephanie Read and Ben Mills, Norfolk and Norwich University Hospitals Foundation Trust

Background

Norfolk and Norwich University Hospital (NNUH) believes that acute health services must be accessible and equitable for all people, including those with a learning disability. To this end an initiative was developed to ensure that these people received care and treatment that is appropriate for their special requirements when receiving medical, surgical or emergency interventions.

Since 2006 the trust has developed the care pathways for people with learning disabilities through staff education, working with advocacy groups, Norfolk learning disabilities services and carer organisations. The work was originally based on the Department of Health document Valuing People and the Disability Discrimination Act. However, other key policy documents have since been incorporated.

The Trust has been awarded the Care Services Improvement Partnership Award for Best Equality Project in the Eastern Region in 2008 and has taken part in the pilot work to develop the Care Quality Commission Standards for Learning Disabilities.

Throughout the initiative people with learning disabilities and their families inspired the drive for change and improvement with their stories and experiences, and their desire for the same life chances as everybody. They have become valued members of our team and their input and expertise have been welcome.

The process

The initiative involved collaborative working with primary care learning disabilities service, before, during and after admission of a patient with learning disabilities. The trust appointed a senior nurse to champion the project, developed a champion/link practitioner system, so a network of nurses could act as sources of information for staff and a point of contact for families and carers. It also employed two registered learning disability nurses and set up a steering group involving representatives from local learning disabilities advocacy groups.

Nine hundred staff have received training on learning disabilities each year, while signage has been improved, with input from people with learning disabilities. We use personal health information books to assist in the integrated delivery of care and treatment, while online resource documents offer staff clear information on subjects such as communicating with people who have learning disabilities; epilepsy; challenging behaviour; and consent/capacity issues. The resource also gives useful contact details and web links.

A DVD about the hospital was planned, acted and produced by and for people with learning disabilities, to help them to understand what to expect if admitted for treatment.

Advice to other organisations

Partnership working across health and social care is crucial, and it is vital to listen to and involve people with learning disabilities in all activities. They can be involved both individually and through local and national advocacy groups. Patient satisfaction should be assessed regularly through surveys using easy read/picture book materials

In terms of staff issues, it is useful to introduce learning disabilities champions in all areas and these staff need training and development; a trust champion at a senior manager level is also helpful. Employing a learning disability liaison nurse is useful, even on a temporary basis to prove the case for a similar initiative, or preferably as a permanent member of staff.

Once the initiative is established it should become part of the governance and safeguarding agenda.

Benefits of the initiative

The initiative has had a range of benefits including:

  • Reduced length of stay — in one area an average of 41 days was reduced to 11;
  • Improved client/carer satisfaction and reduced PALs referrals and reduced complaints;
  • Improved health outcomes and safer and timely admission for patients undergoing elective surgery;
  • Safer and more effective discharging processes;
  • Individualised pathways (meeting reasonable adjustment under the DDA);
  • Increased staff and student awareness/understanding of LD issues (training);
  • Reduced risk and support for the trust clinical governance agenda.

Financial implications

The costs associated with the project were £50,000 per annum to employ a band 7 learning disabilities acute liaison nurse and £50,000 for a practice development learning disabilities nurse, and £2,500 for the production of a DVD (total £102,500). Over a six month period it has reduced bed days by 235.5, resulting in savings of £114,099.

Contact

For more information on this initiative please contact Tristan.johnson@nnuh.nhs.uk or Stephanie.read@nnuh.nhs.uk

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