Improving care for patients with learning disabilities


08 / 04 / 2011

The organisation

Mid Cheshire Hospitals NHS Foundation Trust (MCHFT) was established as an NHS Trust in April 1999, and licensed as an NHS Foundation Trust from 1 April 2008.  The trust provides a comprehensive range of acute, maternity, child health services and intermediate care to a population of almost 300,000 people living in Alsager, Crewe, Congleton, Knutsford, Nantwich, Northwich, Sandbach and Winsford.  Services are provided from Leighton Hospital in Crewe, Victoria Infirmary in Northwich and Elmhurst Intermediate Care Centre, Winsford.

Employing around 3,300 staff, the trust provides clinical services through four clinical divisions:

  • diagnostic and clinical support
  • emergency care
  • surgery and cancer
  • women, children and sexual health

What we did and why

The board at MCHFT discussed the issues relating to the care of patients with learning disabilities in June 2009.  The Care Quality Commission (CQC) has since commenced their own review looking at how physical healthcare is provided for people with a learning disability and people who use mental health services.  This review looks at:

  • access
  • assessment
  • care delivery
  • communication with patients and their carers. 

The trust has taken these themes as its focus for improvements. Working with Cheshire and Wirral Partnership Trust (CWP) three key work streams have been identified that will help to improve care in the acute setting:

  • communication / information for patients and carers
  • training to highlight awareness amongst staff of specific needs for this client group
  • development of a care pathway relating to admission, inpatient stay and discharge.

How we did it

A Learning Disabilities Development was set up.  The group is led by the director of nursing and members include:

  • the trusts privacy and dignity matron
  • ward and department nurses
  • patient experience manager.
  • representatives from CWT including their consultant nurse for learning disabilities

The group began by holding a process mapping exercise led by the service improvement team, whereby carers and staff looked at gaps and bottlenecks within the patient’s journey and from that determined the work streams.

Development of flagging system

MCHFT and CWP developed a flagging system within the acute trust that highlights, on admission, patients who are admitted to the trust and have a learning disability.

The system is mostly dependent upon information from primary care and helps to streamline services and promote joined up working.  This system also alerts staff that patients with more complex needs have a care plan in place. 

Electronic care pathway
The electronic care pathway highlights to staff the importance of patients with learning disabilities receiving regular holistic health checks and asks if this can be included as a recommendation on their discharge letter.  The pathway is available on the hospital intranet. It provides medical and nursing staff with prompts and guidelines to ensure patients with learning disabilities are cared for appropriately, including guidance on their roles and responsibilities. The rollout of the pathway is being led by the privacy and dignity matron and is included as part of the ongoing learning disability awareness training.

Patient passport

The trust has a patient passport that highlights patients’ communication needs, for example, how to relieve their anxiety.

The trust has used a local drama group, all of whom have learning disabilities, to present a short play to over 200 staff about the right and wrong ways to communicate with people who have a learning disability.

Results and next steps

The patient passport was recognised as excellence in practice and the trust received a North West Positive Action award.

The following case study highlights the impact of the project and its effect on patient satisfaction and health outcomes.

 A young girl aged 8 with severe learning disabilities had been missing appointments due to her distress and anxiety at having to wait in the outpatient department.  The Privacy and Dignity Matron went to visit the child and her mum at home and completed a care plan which was shared with healthcare professionals at the hospital. This liaison enabled the trust to plan the child’s appointments to ensure that the she was given the first clinic appointment and therefore would not need to wait in the department.

A bleep was given to the child’s grandmother so she could take the child for an ice cream in between having eye drops put in and seeing the ophthalmologist. This meant she did not have to wait in a very busy and intimidating department whilst the eye drops took effect, and when her grandmother was bleeped, they could go straight into the consulting suite. 

Since the introduction of the care plan, staff understand the need to prioritise the child when organising clinic lists and there is a supply of her favourite biscuits and drink within the Emergency Department should she actually need to be admitted. She has not missed an appointment since the care plan was introduced.

The trust's work has been:

  • shared with the Learning Disability Partnership Board
  • showcased at external conferences
  • formed part of in-house training and education
  • received coverage in external publications, such as  the FT Members magazine. 

Evaluation and progress is monitored by the Learning and Disability  Development Group and there is an action plan to highlight timescales and responsibilities.

Further information and contact details

Philippa Pordes, Privacy and Dignity Matron
Tel: 01270 278080

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