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This page was written by
Sue Turner
Frequently asked questions - family carers
- What are reasonable adjustments’?
- Can you give some examples of reasonable adjustments'?
- How can I get a health check for my relative?
- What is included in a health check?
- How can I find out how well my area is doing about making sure people with learning disabilities have health checks?
- What is a health alert/flag, and how can I make sure my relative has one?
- How can I find out how my area compares with others in terms of health services for people with learning disabilities?
- How can I find out more about the Mental Capacity Act?
- What should a 'best interest' meeting look like?
What are 'reasonable adjustments'?
In law, all public sector services have a legal duty to make ‘reasonable adjustments’ to the way they make their services available to people with learning disabilities, to make them as accessible and effective as they would be for people without disabilities. Reasonable adjustments include removing physical barriers to accessing health services, but importantly also include making whatever alterations are necessary to policies, procedures, staff training and service delivery to ensure that they work equally well for people with learning disabilities. We have undertaken a survey of what reasonable adjustments NHS Trusts are making and host a searchable directory of adjustments.
Can you give some examples of reasonable adjustments'?
Reasonable adjustments are about making services accessible and effective for disabled people. This may mean having accessible information and appointment letters, longer appointment times or appointments at quiet times when people don't have to wait long. Health checks are a reasonable adjustment for people with learning disabilities, as we know they detect unmet health needs. There is guidance on reasonable adjustments which gives more detail. There are lots of examples of reasonable adjustments on our searchable directory of adjustments.
How can I get a health check for my relative?
Annual health checks for people with learning disabilities are currently provided as part of a Directed Enhanced Service (DES). The DES is voluntary, and participating GPs get paid for doing health checks if they meet the criteria set out in the DES. All people with learning disabiliites known to social services primarily because of their learning disabilities are eligible to have a health check. If the person is registered with a GP practice participating in the DES, they should receive an invitation to have a health check, and you should raise it with the practice if your relative does not receive an invitation. If the practice is not part of the DES, you can ask if your relative can get a health check elsewhere. You can also ask the practice why they are not part of the DES as research shows that health checks detect unmet health need. Because of this, some areas are offering all people with learning disabilities health checks, whether they are known to social services or not. There is guidance about health checks which will give you more information.
What is included in a health check?
As a minimum, the health check should include:
a review of physical and mental health with referral through the usual practice routes if health
problems are identified, including:
* health promotion
* chronic illness and systems enquiry
* physical examination
* epilepsy
* dysphagia
* behaviour and mental health
* specific syndrome check
* a check on the accuracy of prescribed medications
* a review of coordination arrangements with secondary care
* a review of transition arrangements where appropriate.
Many areas use the Cardiff Health Check, or another Health Check that is similar. The Step by Step Guide includes a copy of the Cardiff Health Check, and has some examples of syndrome specific checks. Some areas are auditing health checks to see how well they are being done. There is an audit tool available on the website.
How can I find out how well my area is doing about making sure people with learning disabilities have health checks?
You can find out how well your area is doing at making sure people have annual health checks by checking the map. You can also look at the Improving Health and Lives report about numbers of health checks.
What is a health alert/flag, and how can I make sure my relative has one?
In order to identify who needs reasonable adjustments and to alert staff to any specific needs a person may have, record systems should identify people with a learning disability in both primary and acute care. Records should also detail any reasonable adjustments that are known to be helpful to the individual. There is an example of an alert in the Step by Step guide. Some health services are better at identifying people with learning disabilities than others. You will need to check what your local health service is doing. You could also ask your local Partnership Board about this.
How can I find out how my area compares with others in terms of health services for people with learning disabilities?
Each Primary Care Trust area does a health self-assessment. You can look at the website to find out how your area compares with others. You can also see how well your area is doing at providing health checks.
How can I find out more about the Mental Capacity Act?
hft have produced a guide for family carers and friends about the Mental Capacity Act. The hft website also has some helpful video clips.
What should a 'best interest' meeting look like?
The hft guide has information about best interests meetings. there are also some helpful video clips on the website which cover capacity, best interest decisions and challenging decisions.