Learning disabilities

Discrimination

Contents

Introduction

This page looks at some practical ways to reduce the likelihood of discriminating against people with learning disabilities.

Our experts suggest ways to ensure you don’t make assumptions about your patients that could lead to discrimination.

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Avoiding discrimination

Our experts suggest ways to ensure you don't make assumptions about your patients that could lead to discrimination.

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Learning points

  • Beware of diagnostic overshadowing - ask yourself what investigations you would carry out for a non-disabled patient and do the same
  • Make reasonable adjustments – some patients may benefit from having a consultation in a different environment
  • Flagging or tracking systems and notifying a named member of staff when a patient with a learning disability arrives in a hospital can help stop vulnerable patients from falling through the gaps
  • Assumptions about a patient’s lifestyle based on the disability are unhelpful and can lead to decisions which are not in the patient’s best interests and which may also be discriminatory
  • A physical examination must be carried out if indicated – don’t avoid it because of difficulties in communication or assessing capacity. Instead try to gain the patient’s trust and persuade them to agree to be examined.

You can see these points brought to life in our Interactive learning section of the website.

Reasonable adjustments you could make

Increase first appointment times, and offer first or last appointment of the day if possible

Waiting in a healthcare environment can be stressful for anyone.  Managing the stress of the environment by reducing patients’ waiting time, and offering appointments at a time of day when there are fewer people around will all help to make things run more smoothly. 

For a patient with a learning disability who might display challenging behaviour under stress, these adjustments could improve that patient and other patients’ experience of the healthcare service.

Make patient information accessible - from leaflets to appointment and referral letters

Providing more accessible information for people with learning disabilities doesn’t have to be complicated.  Websites such as CHANGE and easyhealth have helpful documents on how to make information accessible.

NHS Fife has an Accessible Information Database where you can download lots of accessible health-related information.

The Scottish Accessible Information Forum (SAIF) provides a range of tools such as publications, training, consultation and advice, to help public bodies and others improve the accessibility of their information.

 The University of Birmingham has produced easyread leaflets and audio recordings (mp3) about common medication.  

There are lots of helpful resources out there and most people are willing to share them. Make contact with Janet Cobb’s UK network to connect with other healthcare workers and find out what information is already available in your area.

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Adjustments can make a difference

Jim Blair describes how making a reasonable adjustment changed healthcare workers’ attitudes towards a patient with a learning disability.

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Department of Health guidance

The Department of Health (England) has produced guidance on how to ensure healthcare services provide better access with practical suggestions for reasonable adjustments.

Download Equal access? - A Department of Health publication (pdf)

Change unhelpful attitudes through training

“All of us have prejudices but we perhaps don’t know what they are…We aren’t aware of the ways in which we are prejudicial and the risk that we might discriminate against somebody because of that lack of awareness…it’s about being vigilant and constantly trying to learn…to get feedback from patients and staff…reflective practice”
Professor Baroness Sheila Hollins

People with learning disabilities say that negative or unhelpful attitudes of healthcare workers deter or stop them from seeking help.  Staff training sessions led by people with learning disabilities can make an enormous difference not just in terms of awareness of the issues but in changing attitudes, teaching people not to make assumptions.

This can be particularly effective if the training involves or is carried out by people with learning disabilities.  The Scottish Consortium for Learning Disabilities run co–training with people with learning disabilities for healthcare staff across  NHS Greater Glasgow and Clyde Health Board and CHANGE delivers training for health professionals, medical students and others on communication and ways to support people with learning disabilities to look after their own health. 

Dr Paula Manners is part of a multidisciplinary team teaching undergraduate medical students at St George’s University of London.  Read about the training course - which was praised in Sir Jonathan Michael's report, Healthcare for all - in this GMC Today article (pdf).

 

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The importance of training

Dr Banks discusses how training early on in a doctor’s career can encourage a positive attitude towards people with disabilities.

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Case study: Dr Roger Banks describes the Conwy Connect project

We know that positive attitudes and better practice towards people with learning disabilities can be nurtured in doctors through contact with them and their families early in their training.

Although in North Wales we welcomed the requirement from Cardiff Medical School for students to meet people with learning disabilities in a context other than outpatient clinics, the idea that we might regularly send students to view people in their own homes was inconsistent with engendering attitudes of respect and seeing people as individuals rather than “case examples”.

Using SIFT money, we established an agreement with Conwy Connect a voluntary organisation in Conwy who have been able to organise regular sessions in which people with learning disabilities and their families meet students in the ordinary setting of the local cricket club and have a facilitated discussion about the issues that they feel doctors in training need to know in order to improve their future practice.

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Encouraging positive attitudes

A short film looking at the Conwy Connect project, which gives medical students the opportunity to meet the parent-carers of people with learning disabilities.

Download the transcript (PDF)