Learning Disability examples of good
practice
NHS England and NHS Improvement
System examples of best practice for learning disabilities
and autism
Joined Up Care - Derbyshire
DHCFT Hub LD Days
• Working closely with carers/family members to ensure a calm and considered experience pre/during/post the vaccination.
• Desensitization and planning work prior to the vaccine. What works for the person and their Carers’?
Using feedback from our service users to design the
experience
• LD specific days at the hub
• Morning or afternoon extended time slots
• Reducing the stages e.g. going straight to one room
• Access friendly setting
• LD peer support workers as greeters
• Using or not using uniforms
• Using sensory objects / sounds to relax patient
• Reduced Flow through hub
Is the GP aware of any reason for not having the vaccine?
• Appendix 1
• LPA for health and welfare or Court of Protection appointed attorney for health and welfare? • Had previous severe allergic reaction (anaphylaxis) after other vaccine?
• If have a problem with bleeding or bruising or if you are taking blood thinning medications (anticoagulant - if latest INR is within right range – GP)?
• If their immune system does not work properly (immunodeficiency) or they are taking medicines that weaken the immune system (high doses corticosteroids, immunosuppressant’s or cancer medicines) – GP
• If pregnant - GP
• Phobia needles - Do they have annual flu vaccination?
Is there any reason to believe the patient does not have
capacity to consent?
• Firstly, the starting position is we must assume a person has capacity unless we have evidence that individual lacks capacity (capacity is decision specific). If you conclude the individual lacks capacity, you should be able to provide evidence and demonstrate practicable steps to support the individual to make the decision. People may and can refuse and make an unwise decision
• The Mental Capacity Act requires a two-stage test in the assessment of capacity;
• Is there an impairment of the mind or brain? Whether the person has the capacity to make a particular decision (needs to be decision specific)
• Is the individual unable to understand information about the decision made e.g., the reason why the vaccine is needed and the likely outcome of not having the vaccine. The person doesn’t need to know everything, only the salient points.
• The individual is able to retain the relevant information long enough (can be supported with the use of visual aids, if required) to use the information as part of the decision making process about having the vaccine.
• The individual is unable to use the information as decision making process e.g. weighing up the pros and cons to the decision • COVID-19 Vaccine Best interest decision process; once established that the individual doesn’t have capacity the identified health
professional will contact next of kin, carers and GP (this can be done separately) to establish the individuals’ view on the client having the vaccine as well as attempting to establish the clients view wishes, feelings beliefs & values. We would need to document (1) decision made (2) reason for the decision (3) who was consulted (4) What particular factors were taken into account e.g. Covid-19 pandemic which has disproportionally affected individuals with learning disability (6 x times more likely to die as a result of Covid-19 than the general
population). Therefore, the need prioritise this group for the vaccine is seen as being important, however in order to do this in a timely manner under lockdown condition has required a flexible approach.
• Though all this information and decision may gather prior to the vaccine appointment, the person administering the vaccine is the final ‘decision maker’.
Example of tools to support decision making
• Beyond words – empowering people through pictures • Down’s Syndrome Association – vaccination easy read
• NHS reasonable adjustments - supporting people with a learning disability and autistic people to get the COVID-19 vaccination • Suffolk Learning Disability Partnership – what happens at your appointment?
• PHE – easy read – a guide to your appointment • PHE – what to expect when having your vaccination • A guide to having your vaccine – videoclips, photos etc
• Guidance and practical resource pack in preparation for COVID-19 vaccination programme in disability services • Easy read Covid-19 vaccination black and white symbols
Reasonable adjustments considerations
• Preparing in advance will help
• It may be necessary to hold the person supportively when the injection is given to ensure safety of the service user and the vaccinator (would this be in their best interest).
• Some people may be hypersensitive to medication.
• Family members may be anxious about their relative having the vaccine and these factors should be considered as a high priority when deciding best interest.
• Do they have a hospital or communication passport?
• Do we need to consider de- sensitisation – visit centre meet vaccinator? • Will they need extra time allocated for appointment?
• Where is the best place e.g. clinic, car, home etc • Who will bring/support during the vaccine.
System examples of best practice for learning disabilities
and autism
Coventry & Warwickshire
Speech Therapists produce video to encourage people with learning
disabilities to get their COVID-19 vaccine
• People with learning disabilities are being encouraged to get the covid-19 vaccination in a video produced by the Coventry and Warwickshire Vaccination programme.
• The video was produced in response to feedback from local people with learning disabilities who told staff that one of the main reasons they didn’t want to get a vaccine is because of a fear of needles. • The video explains why it is important for them to get the COVID-19
vaccine and that the process is quick; it only takes a few minutes for health professionals to administer the vaccine. It explains that if people are worried, they can tell staff that they are scared of needles who will put them at ease.
• Filmed and signed by Speech and Language Therapists Sam and Louise from Coventry and Warwickshire NHS Partnership Trust, the video uses Makaton - a unique language programme that uses symbols, signs and speech to help people who have learning disabilities to understand information and communicate.
