Quality statement 5: Hospital admissions

Quality statement

People growing older with a learning disability meet hospital staff before any planned hospital admission to agree arrangements that make the stay easier for them.

Rationale

Hospital admissions can be particularly distressing for people with a learning disability. Hospital staff may also find it difficult to provide good quality care if they do not understand the care and support needs of the person with a learning disability. A pre-admission meeting gives everyone involved the opportunity to discuss the level of support needed by the person, any reasonable adjustments to support them during their hospital stay, complete the pre-admission documentation, and share and discuss the person's hospital passport. Going through this process ensures that the person with a learning disability receives the support they need throughout their hospital stay.

Quality measures

A specific age limit is not used to define older people with a learning disability in this quality standard (see the definitions section). For measurement purposes, commissioners may wish to define a specific age group or range of age groups based on their local population.

Structure

a) Evidence of local arrangements to ensure that a learning disability is recorded in hospital case notes and electronic health records.

Data source: Local data collection, such as review of service level agreements.

b) Evidence of hospital protocols to ensure that reasonable adjustments are put in place for people growing older with a learning disability before a planned hospital admission.

Data source: Local data collection, such as review of service level agreements.

c) Evidence of team structure including learning disability liaison nurse.

Data source: Local data collection, such as hospital audit.

Process

Proportion of planned hospital admissions for people growing older with a learning disability that had a pre-admission planning meeting.

Numerator – the number in the denominator that had a pre-admission planning meeting.

Denominator – the number of planned hospital admissions for people growing older with a learning disability.

Data source: Local data collection, such as review of hospital admission records.

Outcome

Proportion of people growing older with a learning disability who felt satisfied with the support provided during their planned hospital stay.

Numerator – the number in the denominator who felt satisfied with the support provided during their planned hospital stay.

Denominator – the number of people growing older with a learning disability who had a planned hospital stay.

Data source: Local data collection, such as post-discharge patient survey.

What the quality statement means for different audiences

Service providers (such as GP practices, community learning disability teams and hospitals) follow agreed protocols when people with a learning disability may need hospital admission. This includes organising a pre-admission meeting for planned admissions. This meeting should include the hospital liaison team or liaison nurse, a representative of the community learning disability team, the person and relevant people from their support network (family, friends, carers, advocates or others who provide emotional and practical help to the person). Services ensure that the learning disability liaison nurse has the skills and knowledge to support people growing older with a learning disability before, during and after the admission, and ensure that their needs are being met and any agreed arrangements are put in place for their hospital stay. Service providers also have arrangements in place for a family member or carer to stay overnight, if agreed with the person with a learning disability.

Healthcare professionals (such as members of the hospital liaison team) participate in the pre-admission meeting with the person growing older with a learning disability and support them in a way that meets the person's needs. They put any agreed arrangements in place before and during the admission to ensure that the person's experience of their hospital stay is as positive as possible. Healthcare professionals also ensure that all staff involved in care of the person growing older with a learning disability are aware of their needs and have access to a hospital passport that includes information relevant to their care.

Commissioners (such as clinical commissioning groups) put processes in place to ensure that GP practices, community learning disability teams and hospitals work together to agree protocols to be followed when people with a learning disability may need hospital admission. They monitor whether pre-admission planning meetings are undertaken to agree specific arrangements and complete pre-admission documentation. They also ensure that a sufficient level of support is available to people with a learning disability and arrangements are in place for a family member or a carer to stay overnight if agreed.

People growing older with a learning disability meet with hospital staff before they stay in hospital. They can ask about what will happen during their stay and talk about their needs and worries. Hospital staff can explain what will happen and explore how they can make the hospital stay easier for them, including if they want someone to stay with them overnight. People should also have an opportunity to talk about hospital admissions before the need for the admission arises.

People from the person's support network (family, friends, carers, advocates or others who provide emotional and practical help to the person) take part in a meeting with hospital staff and make sure the hospital staff understand the person's needs before the person with a learning disability stays in hospital. They can stay overnight in the hospital if the person they support wants them to.

Source guidance

Care and support of people growing older with learning disabilities (2018) NICE guideline NG96, recommendation 1.5.26

Definitions of terms used in this quality statement

People growing older with a learning disability

A specific age limit is not used in this quality standard to define people growing older because adults with a learning disability typically experience age-related difficulties at different ages, and at a younger age than the general population.

[NICE's guideline on care and support of people growing older with learning disabilities, terms used in this guideline]

Meeting with hospital staff

Participants should include the hospital liaison team or liaison nurse, a representative of the community learning disability team, the person with a learning disability, and their family members, carers or advocate. At this meeting:

  • the pre-admission documentation is completed, including information from the person's hospital passport

  • any reasonable adjustments needed are discussed, for example, arranging for the person to visit the hospital before their admission to meet the learning disability liaison nurse who will be their contact.

[NICE's guideline on care and support of people growing older with learning disabilities, recommendation 1.5.26]

Equality and diversity considerations

Some people with a learning disability may find it difficult to communicate their needs, anxieties and concerns about being admitted to hospital. Hospital staff need to work with the person and their family members and carers to find ways to communicate effectively. Without mutual understanding, admission may be distressing for the person with a learning disability and for the hospital staff.