Abstract
BackgroundChildren and young people (CYP) with learning disabilities (LD) are a vulnerable population with increased risk of abuse and accidental injury and whose parents have reported concerns about the quality, safety and accessibility of their hospital care. The Care Quality Commission’s (CQC) view of best practice for this group of patients includes: access to senior LD nurse provision; a clearly visible flagging system for identifying them; the use of hospital passports; and defined communication strategies (Glasper, Comp Child Adolesc Nurs 40:63-67, 2017). What remains unclear is whether these recommendations are being applied and if so, what difference they are making. Furthermore, what we do not know is whether parental concerns of CYP with LD differ from parents of other children with long-term conditions. The aims of this study were to 1) describe the organisational context for healthcare delivery to CYP with LD and their families and 2) compare staff perceptions of their ability to identify the needs of CYP with and without LD and their families and provide high quality care to effectively meet these needs.MethodsIndividual interviews (n = 65) and anonymised online survey (n = 2261) were conducted with hospital staff working with CYP in 15 children’s and 9 non-children’s hospitals in England. The majority of interviews were conducted over the telephone and recorded and transcribed verbatim. Health Research Authority was obtained and verbal or written consent for data collection was obtained from all interview participants.ResultsThe nature and extent of organisational policies, systems and practices in place within hospitals to support the care of CYP with LD differs across England and some uncertainty exists within and across hospitals as to what is currently available and accessed. Staff perceived that those with LD were included less, valued less, and less safe than CYP without LD. They also reported having less confidence, capability and capacity to meet the needs of this population compared to those without LD.ConclusionFindings indicate inequality with regards the provision of high quality hospital care to children and young people with LD that meets their needs.There is a pressing need to understand the impact this has on them and their families.Trial registrationThe study has been registered on the NIHR CRN portfolio 20461 (Phase 1), 31336 (Phases 2-4).
Highlights
Children and young people (CYP) with learning disabilities (LD) are a vulnerable population with increased risk of abuse and accidental injury and whose parents have reported concerns about the quality, safety and accessibility of their hospital care
Trial registration: The study has been registered on the NIHR CRN portfolio 20461 (Phase 1), 31336 (Phases 2-4)
For example, the moment a young person with learning disability (LD) is transferred to adult services or sometime earlier? Consideration of their circumstances suggests that children and young people (CYP) with LD are a vulnerable population who face a greater risk of abuse and accidental injury than CYP without LD: due to factors such as their receipt of intimate, personal care from multiple caregivers; restricted ability to communicate; and impaired capacity to identify or avoid danger [5]
Summary
Children and young people (CYP) with learning disabilities (LD) are a vulnerable population with increased risk of abuse and accidental injury and whose parents have reported concerns about the quality, safety and accessibility of their hospital care. Consideration of their circumstances suggests that children and young people (CYP) with LD are a vulnerable population who face a greater risk of abuse and accidental injury than CYP without LD: due to factors such as their receipt of intimate, personal care from multiple caregivers; restricted ability to communicate; and impaired capacity to identify or avoid danger [5]. That can arise when the little things that are important to these patients are unrecognised or overlooked” Key to delivering these ‘little things’ was being able to identify CYP with LD to find out what reasonable adjustments were needed and for that information to be communicated effectively to whoever needed to know
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