national guidelines on accessible health and social care ......guidelines. we hope that the national...

National Guidelines onAccessible Health andSocial Care Services

people caring for people

A guidance document for staff on theprovision of accessible services for all

Title: National Guidelines on accessible health and social care services - aguidancedocumentforstaffontheprovisionofaccessible services for all

Document reference number: V.1

Approvaldate: June2014

Revisiondate: June2016

Documentdevelopedby: NationalAdvocacyUnit, HSEinpartnershipwiththeNationalDisabilityUnit, HSEandtheNationalDisabilityAuthority

Contact details: Caoimhe Gleeson NationalSpecialistinAccessibility NationalAdvocacyUnit Email: [email protected]

ISBN: 978-1-906218-80-5 Thisdocumentissubjecttoreviewandmaychangeatanytime

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NATIONAL GUIDELINESAccessible Health and Social Care Services

Contents

Acknowledgements 1 Foreword 2

1. Introduction 4 1.1 Providingresponsivecareforserviceusers 4 1.2 SomekeyfactsaboutdisabilityinIreland 4 1.3 Arangeofsolutions 62. Purpose 7 2.1 Purposeofguidelines 7 2.2 Structureofguidelines 7

3. Scope 9

4. Legislation and related policies, procedure and guidelines 10 4.1 Overviewoflegislationandotherrelatedhealthcarepolicy 10 4.2 TheNationalHealthcareCharter,YouandYourHealthService 10 4.3 FutureHealth,AStrategicFrameworkforReformoftheHealth

Service2012–2015 11 4.4 IntegratedCareGuidance:Apracticalguidetodischargeand

transferfromhospital 12 4.5 TheEqualStatusActs2000–2008 12 4.6 Part3,DisabilityAct2005 13 4.7. NationalDisabilityAuthorityCodeofPracticeandGuidance 13 4.8 NationalConsentPolicy 14 4.9 TheNationalEmergencyMedicineProgramme 15 4.10 Other 15

5. GlossaryofTerms/Definitions 16 5.1 Glossary 16 5.2 AppropriateTermstoUse 18 5.3 Abbreviations 19

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6. RolesandResponsibilities 21 6.1 AllStaff 21 6.2 Seniormanagementrole 21 6.3 AccessOfficerrole 23

Part One: Guidelines for all Health and Social Care Settings1. Guideline One:Developingaccessiblehealthandsocialcareservices 26 1.1 Ask,Listen,Learn,Plan,Do 26 1.2 Examplesofpolicies,proceduresorguidelinesforstaff 29

2. Guideline Two:Developingdisabilitycompetence 30 2.1 Buildingcapacityandunderstandingforallstaff 30 2.2 Onlinetrainingresource 31 2.3 Tailoreddisabilitytraining 31 2.4 Professionaleducation,trainingandprofessionalstandards 31

3. Guideline Three:Accessibleservices-generaladvice 32 3.1 Donotassume-ask 32 3.2 Makinganappointment 32 3.3 Showflexibilitywhenschedulingappointments 33 3.4 Missedappointments 34 3.5 Planvisitsforroutinecheck-upsorsurgeryinadvance 34 3.6 Queuingtobeseen 35 3.7 Fillingforms 35 3.8 Informationandnotices 36 3.9 Mobilityaids 36 3.10 Focusontheperson 36 3.11 Concurrenttherapeuticorcareneeds 36 3.12 Maintainconfidentiality 37 3.13 Health Promotion 37 3.14 IntegratedDischargePlanning 38

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4. Guideline Four: Communication 42 4.1 Generalprinciplesofgoodcommunication 42 4.2 Establishhowthepersonpreferstocommunicate 43 4.3 Notifyrelevantstaffofthepreferredmethodofcommunication 43 4.4 Communicatingwiththeperson 43 4.5 Communicatingwithapersonwhoisunabletostandorwhousesawheelchair 45 4.6 Communicatingwithapersonwithspeechdifficulties 45 4.7 Communicatingwithapersonwhohasavisualimpairment 46 4.8 CommunicatingwithapersonwhoishardofhearingorDeaf 48 4.9 Communicatingwithapersonwholipreads 50 4.10 CommunicatinginwritingwithaDeaforhardofhearingperson 51 4.11 CommunicatingwithapersonwhousesIrishSignLanguage 52 4.12 IrishSignlanguageinterpreters 53 4.13 Deafinterpreters 54 4.14 IrishRemoteInterpretingService(IRIS) 54 4.15 DeafPeerAdvocates 54 4.16 Communicatingwithapersonwhoisdeafblind 55 4.17 Communicatingwithapersonwithanintellectualdisability 55 4.18 Othercommunicationchallenges 57 4.19 Communicationboards 59 4.20 Communicationpassports 59 4.21 Lámhsigns 60 4.22 Inductionloops 60 4.23 Communicationaidsaspartofcommunicationstrategy 60 4.24 Provideinformationaboutcommunicationaidsavailable 60

5. Guideline Five:Accessibleinformation 61 5.1 Whyprovideinformationinanaccessibleformat? 61 5.2 Informationaboutaccessibilityofpremisesandservices 61 5.3 Providinginformationindifferentformats 62 5.4 Sometipsonwritteninformation 62 5.5 Largeprint 63

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5.6 Usepicturesandsymbols 63 5.7 EasytoRead 63 5.8 Website 63 5.9 Videoandaudio 64 5.10 Braille 64 5.11 Furtherinformation 65

6. Guideline Six:Accessiblebuildingsandfacilities 67 6.1 Generalinformation 67 6.2 Providinginformationaboutaccessibilityofpremisesandfacilities 68 6.3 Pointstoconsider–Achecklistforaccessiblebuildingsandfacilities 68 6.4 Furtherinformation 75

7. Guideline Seven: Consent 77 7.1 Generalprinciplesofconsent 77 7.2 Whatisvalidandgenuineconsent? 77 7.3 Importanceofindividualcircumstances 78 7.4 Informingthepersonbeforegettingconsent 78 7.5 Howandwheninformationshouldbeprovided 79 7.6 Howshouldconsentbedocumented? 80 7.7 Capacitytoconsent 81 7.8 Emergencysituations 82 7.9 Consent,childrenandyoungpeople 82

8. Guideline Eight:Roleoffamilymembersandsupportpersons 83 8.1 Roleoffamilymembersandsupportpersons 83 8.2 Righttoprivacy 84 8.3 Discharge 84 8.4 Carerneeds 84 8.5 Advocacy 84

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PartTwo:Guidelinesforspecificservices9. Guideline Nine: AccessibleGPsurgeries,healthcarecentresandprimarycarecentres 86 9.1 Planservicesforall 86 9.2 Yourpremises 87 9.3 Appointments,openinghours,waitingrooms 89 9.4 Waitingtobeseen 90 9.5 Fillingforms 91 9.6 Examinationandtreatment 91 9.7 Consent 92 9.8 Communicationwithpatientsandserviceusers 92 9.9 Information 95 9.10 Continuityofcare 95 9.11 Homevisits 96 9.12 Familymembersandcarers 96 9.13 Referral and sharing of information 97

10. Guideline Ten:Accessiblehospitalservices,includingout-patientdepartments 98 10.1 Ask,listen,learn,plan,do 98 10.2 Whototalktowhendevelopingthecareplan? 99 10.3 Identifyexistingcareprotocols 100 10.4 Prepareinadvance 100 10.5 Inthehospital 101 10.6 Dischargefromhospital-integrateddischargeplanning 105

11. Guideline Eleven:Accessibleemergencydepartments 106 11.1 Onarrival 106 11.2 Communication 108 11.3 Accessibilityrequirements 109 11.4 Waitingtobeseen 111 11.5 Familyorcarersupport 112 11.6 Assignedstaff 112 11.7 Explainmedicalproceduresclearlyandaccessibly 112 11.8 Integrateddischargeplanningfromtheemergencydepartment 113

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12. Guideline Twelve:Accessiblematernityservices 115 12.1 Introduction 115 12.2 Non-judgmental 116 12.3 Planningforspecificrequirements 116 12.4 Antenatalservices 122 12.5 Givingbirth 123 12.6 Careintheward 124 12.7 Post-natalcareandafterdischarge 125 12.8 Dischargeandfollow-up 126 12.9 Post-nataldepression 127 12.10Goodpracticeguidelinesforwomenwithspecificdisabilities 127

References 133

AdditionalUsefulResources 159

Appendix 1:Accessibilitychecklist 165 Appendix 2: Coreprinciplesofaqualityservice 166 Appendix 3:Disability-thenumbers 168 Appendix 4: MembershipoftheHSEUniversalAccessSteeringCommittee 173

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Acknowledgements

Wewouldliketotakethisopportunitytothankallofthosewhogavetheirtimesogenerouslyindevelopingthisdocument.Wewouldliketoacknowledgeinparticularthehardwork,guidanceandpatienceofthemembersoftheHSEUniversalAccessSteeringCommitteeandallthosewhoseexpertiseandexperiencewascriticaltothedevelopmentofthisdocument.

Thanksalsotoallofthestaffandserviceuserswhomadesubmissionsduringtheconsultationphaseofthisworkandwhoweresignificantstakeholdersinthedevelopmentoftheseguidelines.

Wewouldalsoliketothankinadvanceallthosewhowill,inthecomingmonths,readandimplementtheguidelines.WehopethattheNationalGuidelinesonAccessibleHealthandSocialCareServiceswillbeausefulguideforstaffand,inturn,willmakearealdifferencetotheserviceuser’sexperienceofhealthandsocial care services in Ireland.

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Foreword

The DisabilityAct2005isapositiveactionmeasure,whichprovidesastatutorybasisformakingpublicservicesaccessible.Itgiveseffecttotheunderlyingprinciplethatmainstreampublicservicesprovidedtothegeneralpublicmustalsoservepeoplewithdisabilitiesasanintegralpartoftheservicetheyprovide.

Thehealthserviceisobligedtoensurethatitsbuildings,itsservices,theinformationitprovides,andhowitcommunicateswithpeople,areallaccessibletopeoplewithdisabilities.TheseGuidelinesofferthepracticalguidancetomakethatareality.

Thisdocument,theNationalGuidelinesonAccessibleHealthandSocialCareServiceshas been writtentogivepracticalguidancetoallhealthandsocialcarestaffabouthowtheycanprovideaccessibleservices.Whiletheseguidelinesrefertospecificdisabilities,ifwetakestepstoroutinelyprovideaccessibleservicesforall,wewillpositivelyinfluencetheexperienceofeverybodywhousesourservices.

TheethosofaccessibilityisreinforcedbyAFutureHealth,AStrategicFrameworkforReformoftheHealthService2012-2015,publishedbytheDepartmentofHealthinNovember2012;bylegislationsuchas the DisabilityAct2005,theEqual Status Acts 2000 – 2008,bytheNational Healthcare Charter ‘You and Your Health Service’andthemanyotherhealthandsocialcarepoliciesandprocedures.

Theguidelinesdescribeastandardtowhichwecanaspire.Theydetailwhatobligationsareinstatutetoprovideaccessibleservices.Theyalsoserveasaresourceforhealthandsocialcareprofessionalswhomaybeplanningservicesinthefuture.

Manyofthekeyinitiativesoutlinedintheguidelinestomakeservicesmoreaccessiblearecostneutral.Consideration,compassionandopencommunicationarefree.Timespentidentifyingaperson’sneedsisaninvestmentinsafe,effectivecarewhichcanpreventunnecessaryriskstotheindividualandthestaffmember,andnegativefeedback.

Wehopethattheguidancewillhelpallstafftobuildontheirexistingknowledgeandtorecognisethatpeoplewithdisabilitiesareoftenexpertsinwhattheyneed.ThekeymessagereinforcedthroughouttheguidelinesisAsk,Listen,Learn,PlanandDo.

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WelookforwardtoservicesworkinginpartnershiptoensurethattheNationalGuidelinesonAccessibleHealth and Social Care ServicesmakeapositivedifferencetotheexperienceofallthosewhouseIreland’shealthandsocialcareservices.

TonyO’Brien SiobhanBarronDirector General Director HealthServiceExecutive NationalDisabilityAuthority

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1. Introduction

1.1 Providing responsive care for service users

Itisimportantthathealthandsocialcareservicesprovideappropriateandresponsivecareforallserviceusers.Inthecourseoftheirlives,somepeoplewillhaveregularinteractionwiththehealthandsocialcareservices.Theymayhaveadisabilityoraprolongedillness,orbecauseofapre-existingconditionmaybemorevulnerabletootherillnesses.Manypeoplewhohavecontinuouscontactwithservicesdonotconsiderthemselvesill.

AnunderstandingoftheneedsofserviceuserswithdisabilitiesisimportantforeverypersonemployedorcontractedbytheHSE.1Thisunderstandingwillhelpensurethatpeoplewhoworkinthehealthandsocialcareservices,inwhatevercapacity:

• areequippedwiththeknowledgeandskillstoidentifyandwherepossiblemeettheneedsofpatientswithdisabilities

• designpremisesandsystemswiththoseneedsinmind • communicatewithserviceusersinwaysthatareappropriatetotheirneeds

1.2 SomekeyfactsaboutdisabilityinIreland:

TheNationalDisabilitySurvey2006reportedthatbetweenoneinfiveandoneintenpersonshasalong-termdisability.Mostpeoplewillexperiencesomedegreeofdisabilityoverthecourseoftheirlife;however,aspeoplegetolder,theproportionofpeoplewithadisabilityrises.Basedonthefollowingstatistic,thenumberofpeoplewithadisabilitywillincreaseinthecomingyears:

“Eachyearthetotalnumberofpeopleovertheageof65yearsgrowsbyaround20,000personsandthepopulationover65yearswillmorethandoubletooveronemillionby2035.Peoplearelivinglonger–thoseagedover65yearsincreasedby14%since2006.”2

Disabilitymaybeclassifiedintoanumberofgroupings,forexample: • physicaldisability • sensorydisability–impairedsight,impairedhearing,orimpairedspeech • intellectualdisability • mental health conditions

1 TheHSEisintheprocessofreformandwilltransitionintoanewcommissioningagency.Theseguidelineswillbesubsumedbythisnewagency.2 HSEAnnualReportandFinancialStatements2012.www.hse.ie

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The NationalDisabilitySurvey2006showedthatthemostcommonformsofdisabilityinIrelandare,inorderoffrequency:

1. Difficultieswithmobilityordexterity 2. Pain 3. Mentalhealthdifficulties 4. Memorydifficulties 5. Breathingdifficulties 6. Hearingloss 7. Impairedvision 8. Intellectualdisability

Disabilitiesvaryintermsofthenatureanddegreeofdifficultyexperiencedforeachindividual.Somepeopleexperiencemorethanonekindofdisabilityatthesametime.Ingeneral,the numberofpeoplewithsomedegreeofimpairmentismuchlargerthanthenumberswithtotal loss of function.

Weneedtobeawarethattherearebothvisibleandhiddendisabilities • Visibledisabilities:Sometimes,itisveryobviousthatapersonhasadisability,suchasablind

personwhousesawhitecaneorsomeonewhousesawheelchair • Hiddendisabilities:Itisnotimmediatelyobviouswhensomeonehasahiddendisability.

Notallpeoplewhohaveavisualimpairmentneedawhitestickoruseaguidedog.Someone’sappearancewillnottellyouiftheyhaveepilepsy,oriftheyarelikelytogetpanicattacks

Extractfrom:NDAdocument“Providingpublicservicestopeoplewithdisabilities.

ASelf-StudyGuide” • ThemostcommontypesofdisabilityinIrelandaremobilitydisabilities • About184,000peoplehavedifficultywalkingmorethan15minutes • About31,000peopleuseawheelchair.Manymorepeople–about83,000–usewalkingaids,

or a stick • OthercommondisabilitiesinIrelandaredealingwithpain,difficultyrememberinginformation,

orhavingmentalhealthdifficulties • Somepeoplearebornwithadisability • Manymorepeopledealwithatemporarydisabilitybecauseofinjuriesorillness

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1.3. A range of solutions

Wherepossible,itisimportanttoofferarangeofsolutionsthatmeettheindividualneedsofpeoplewithdisabilities.Somethingthatworkswellforapersonwithapartiallossoffunctionmaynotbethebestsolutionforsomeonewithamoreseveredifficulty.Forexample,someonewhowalkswithdifficultymayfinditeasiertomanagestepsthanaramp,oncethereisahandrail,whileawheelchairuserwouldneedaramptonegotiateachangeinlevel.

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2. Purpose

2.1 Purpose of guidelines

The purpose of these guidelines is to: • assisthealthandsocialcareproviderstocomplywithlegalobligationsundertheEqual Status

Acts,theDisabilityAct2005,theassociatedstatutoryCodeofPracticeonAccessibilityofPublicServicesandInformationprovidedbyPublicBodies,andhealthandsocialcarepolicyandprocedures

• assisthealthandsocialcareproviderstomeettheprinciplesoftheNational Healthcare Charter, You and Your Health Service

• assisthealthandsocialcareproviderstomeettheprovisionsoftheNational Standards for Safer Better Healthcare 2012 (HIQA)

• providearesourceforAccessOfficerstosupporthealthservicestaffrespond totheaccessrequirementsofpeoplewithdisabilitiesinallhealthandsocial care settings

• provideaguidancedocumentforuseineducationandtraininginrelationtodisability,accessibilityandcustomercare

• provideareferencemanualforallstaffinallhealthandsocialcaresettings

2.2 Structure of guidelines

Theguidelinesaredividedintotwosections–PartOneincludesguidelinesforuseinallhealthandsocialcaresettingsandPartTwoincludesguidelinesforspecificserviceareas.

Whileeachguidelinecanbeusedasastand-alonedocument,agreaterunderstandingcanbeachievedbyreadingalloftheguidelinedocuments.

Part One: Guidelines for all health and social care settings

Guideline One: Developingaccessiblehealthandsocialcareservices Guideline Two:Developingdisabilitycompetence Guideline Three: Accessible services - general advice Guideline Four: Communication Guideline Five: Accessible information Guideline Six: Accessible buildings and facilities Guideline Seven: Consent Guideline Eight: Roleoffamilymembersandsupportpersons

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PartTwo:Guidelinesforspecificservices Guideline Nine: AccessibleGPsurgeries,healthcarecentresandprimarycarecentres Guideline Ten: AccessibleHospitalServices Guideline Eleven:AccessibleEmergencyDepartments Guideline Twelve:Accessiblematernityservices

The guidelines contain links to further information and resources, as well as contact details fordisabilityorganisations.

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3. Scope

TheseGuidelinesweredevelopedinapartnershipbetweentheNationalDisabilityAuthorityand the Health Service Executive, and with input from an Advisory Group, drawing on:

• research evidence • focusgroupsandinterviewswithpeoplewithdisabilitiesandtheirorganisations • feedback on drafts

Abackgroundpaper,commissionedbytheNDA,setsoutthematerialthatunderpinsthisguidance.Thispapersummarisesresearchfindings,reviewsotherguidanceonhealthservicesanddisability,andconsidersthepointsraisedintheconsultationwithIrishdisabilityorganisations.

TheGuidelinesareavailableinpaperandelectronicformat,andhavelinkstoothersourcesofguidanceandinformation–seeResourcessection.

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4. Legislation and related policies, procedure and guidelines

4.1 Overview of legislation and other related healthcare policy

Itisalegalrequirementtoprovideaccessiblehealthandsocialservicesforserviceusers.Thefollowingsection,whilenotexhaustive,setsoutthekeypiecesoflegislationandpolicywhichareimportantinprovidingaccessibleservicesforpeoplewithdisabilities.

The NationalGuidelinesonAccessibleHealthandSocialCareServicesarewrittento

complementexistingpolicies,proceduresandlegislationgoverninghealthandsocialcareinIreland.TheguidelinesdonotreplaceotherpoliciesoftheHSEorindeedcontraveneexistinglegislationinanyway.

TheseguidelinesshouldbereadinconjunctionwithothergoverningdocumentsoftheHSEandthelegislationsothatstaffcanprovidethebestpossibleservicetoallpatientsandserviceusersofhealthandsocialcareservices.Mattersappropriatetootherprocedureswillcontinuetobetreatedinthesamemannerandinaccordancewiththeseagreedprocedures.

Examplesofrelevantdocumentsinclude:National Consent Policy; National Healthcare Charter; Equal Status Acts 2000 – 2008; Integrated Care Guidance: A practical guide to discharge and transfer from hospital; Your Service Your Say – Policy and Procedure for the Management ofConsumerFeedbacktoincludeComments,ComplimentsandComplaints;OnSpeakingTerms;theMedicalCouncilGuidetoProfessionalConductandEthicsforRegisteredMedicalPractitioners;theDisabilityAct2005andtheHealthAct2004.

The NationalGuidelinesonAccessibleHealthandSocialCareServiceswillbereviewedatregularintervalstoensurethatthecontentofthedocumentisinlinewithnewpolicychangesordevelopmentsinhealthcare.

Thefollowingaresomeofthekeydocumentsforyourinformation.

4.2 The National Healthcare Charter, You and Your Health Service

The National Healthcare Charter, You and Your Health ServicewasdevelopedfollowingwideconsultationwithandinputfromtheIrishpublic,serviceusers,staff,thevoluntaryandstatutorysector,patientadvocacygroupsandindividualadvocates,themanagementteamoftheHSE,theDepartmentofHealth,theHealthServicesNationalPartnershipForumandregulatorybodies.

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Theresultofthisconsultationisacharterdocumentwhichsetsouteightprinciplesofexpectationandresponsibilitywhichunderpinhighquality,people-centredcare.Thefirstprincipleofthecharter“Access”setsoutourcommitmenttoprovidehealthandsocialcareserviceswhichareorganisedtoensureequityofaccesstoallwhousethem.Thecharteralsoclearlyacknowledgesthatpatientsandserviceusershaveresponsibilitiestomeetsothattheyareactiveparticipantsintheircare.

4.3 FutureHealth,AStrategicFrameworkforReformoftheHealthService 2012 – 2015

Future Healthwillallowthehealthandsocialcareservicestomovetowardsanewintegratedmodelofcarethattreatspatientsatthelowestlevelofcomplexitythatissafe,timely,efficient andasclosetohomeaspossible.Inprovidingaccessiblecare,asoutlinedintheseguidelines,serviceswillsupportthegoalsofFuture Healthtoprovidecarethatispreventative,plannedandwell-coordinated.

Extractfrom:FutureHealth,AStrategicFrameworkforReformoftheHealthService 2012 – 2015

Keeping People Healthy:Thesystemshouldpromotehealthandwellbeingbyworking acrosssectorstocreatetheconditionswhichsupportgoodhealth,onequalterms,forthe entirepopulation.

Patient-centredness:Thesystemshouldberesponsivetopatientneeds,providingtimely,proactive,continuouscarewhichtakesaccount,wherepossible,oftheindividual’sneeds andpreferences.

Lack of Integration:“Weneedmuchbetterintegrateddeliverysystemsbasedonmulti-disciplinarycare.Thiswillreducecostsandimprovequality.”

“Achievingintegratedcaremeansthatservicesmustbeplannedanddeliveredwiththepatient’sneedsandwishesastheorganisingprinciple.Itispreferablethatthetermintegratedcareratherthan“integration”beusedsothatitisclearthatthefocusiswhereitshouldbei.e.onpatientsandfamiliesandtheservicestheyneedratherthanonfundingsystems,organisationorprofessionals.Eachofthesewillbeimportantleversinenablingandfacilitatingintegratedcare–buttheyinthemselvesarenottheobjectives.”

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Inpracticalterms,thismeansthatservicesmustrecognisethatpeoplewithdisabilitieshaveadegreeofexpertiseintheownrequirementsandthat,bytheapplyingtheguidelines“Ask,Listen,Learn,Plan,Do”,servicescanprovidemoreintegratedcare.(SeeGuidelineOne:DevelopingAccessibleHealthandSocialCareServicesformoreinformation).

Differenthealthservicesettingsorspecialtiesshouldnotoperateasindividualsilosunlessthereisgoodreason.Liaisonbetweenprofessionalsisimportanttoidentifytheservicesneededforindividualsandtoenableprofessionalstodeliverintegratedcarethatiscentredontheindividualandtheirneeds.Thisshouldhappeninwhateversettingthoseneedsaremetfromtimetotime.Forexample,whereappropriate:

• Teamsworkinginprimary,specialist,rehabilitationandhospitalcarecansharetheirknowledgeandexperiencesothatperson-centredcarebecomesthenorm

• Thosetreatinggeneralillnessescanliaisewiththoseprovidingspecialistcareorsupportfortheunderlyingdisability;and

• Hospitalscanputinplacedischargeplanningandfollow-upwiththeperson’sGPandspecialistdisabilitysupport,toensurecontinuityofcareandsupportondischarge.Thisisessential,especiallyforthosewithasevereandprolongeddisability

4.4 Integrated Care Guidance: A practical guide to discharge and transfer from hospital

Professionals should refer to the Integrated Care Guidance: A practical guide to discharge and transfer from hospital.3

4.5 The Equal Status Acts 2000 – 2008

TheEqualStatusActs2000-2008 4applytoallservicesinthepublic,voluntaryandprivatesectors.TheseActsmakediscriminationongroundsofdisabilityillegal.

TheActsalsorequirereasonableaccommodationsofpeoplewithdisabilitiesandallowabroadrangeofpositiveactionmeasures.Servicesandpremisesmustreasonablyaccommodatesomeonewithadisability.However,theyarenotobligedtoprovidespecialfacilitiesortreatmentwhenthiscostsmorethanwhatiscalledanominalcost.Whatamountstonominalcostwilldependonthecircumstances,suchasthesizeandresourcesofthebodyinvolved.

3 Thispracticalguidetointegratedcareisdesignedtosupporthealthcareproviderstoimprovetheirdischargeandtransferprocessesfromtheacutehospitalsettingbackintothecommunityandthereby,supportthedeliveryofhighqualitysafecare.TheNationalIntegratedCareGuidancehasbeendevelopedbytheNationalIntegratedCareAdvisoryGroupundertheauspicesoftheQualityandPatientSafetyDivision.http://www.hse.ie/eng/about/Who/qualityandpatientsafety/safepatientcare/integratedcareguidance/IntegratedCareGuidancetodischargefulldoc.pdf

4 TheEqualStatusActs2000–2008promoteequality,makessexualharassmentandharassment,victimisationandcertainkindsofdiscrimination(withsomeexemptions)acrossninegroundsillegal.Oneofthesegroundsisdisability.

http://www.hse.ie/eng/about/Who/qualityandpatientsafetysafepatientcare/integratedcareguidance/IntegratedCareGuidancetodischargefulldoc.pdfhttp://www.hse.ie/eng/about/Who/qualityandpatientsafety/safepatientcare/integratedcareguidance/IntegratedCareGuidancetodischargefulldoc.pdfhttp://www.hse.ie/eng/about/Who/qualityandpatientsafety/safepatientcare/integratedcareguidance/IntegratedCareGuidancetodischargefulldoc.pdf

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Thedefinitionofdisabilitycoversthebroadrangeandkindsofdisability,andisnotlimitedtopeoplewithmoreseriousdifficulties.Itisbroadlydefined,includingpeoplewithphysical,intellectual,learning,cognitiveoremotionaldisabilitiesandarangeofmedicalconditions.FurtherinformationontheEqualStatusActs2000–2008isavailablefromtheEqualityAuthorityhttp://www.equality.ie/en/Publications/Information-Publications/Your-Equal-Status-Rights-Explained.html.

4.6 Part3,DisabilityAct2005

Part3,DisabilityAct2005(AccesstoBuildingsandServicesandSectoralPlans)coversthepublicsector,anditsfocusisonthosewhoexperiencemoresignificantdifficulties.5Itsetsoutwhatpublicbodiesmustdowherethisispracticableandappropriate,asfollows:

• Mainstreamservicesmustincludepeoplewithdisabilities • Whereapersonwithadisabilityrequestsit,theymustbegivenassistancetouseaservice • Publicservices,incommunicatingwithpeoplewithdisabilities,mustuseappropriateformsof

communicationwhencommunicatingwithpeople;forexample,withpeoplewhohaveproblemswithvision,problemswithhearing,orthosewhohaveanintellectualdisability

• Publicareasmustmeetminimumstandardsofaccessibility.Byend2015,theymustmeetthestandardssetoutinPartMoftheBuildingRegulations2000and,byJanuary12022,theymustmeetthestandardssetoutinPartMoftheBuildingRegulations2010;and

• Thegoodsandservicesprocuredmustbeaccessibletopeoplewithdisabilities Underthelegislation,asapublicbody,thehealthservicemusthaveatleastoneAccessOfficerto

provideorarrangetheprovisionofassistanceandguidanceforpeoplewithdisabilitieswhentheyare accessing its services.

TheHealthServiceExecutivehasaNationalComplaintsOfficer(referredtoasanInquiryOfficerintheact)whodealswithappealsandcomplaintsaboutfailuretoprovideaccessibleservices,premises,informationorcommunication.ThereisafurtheravenueofappealtotheOmbudsman.

4.7 NationalDisabilityAuthorityCodeofPracticeandGuidance

ThereisastatutoryCodeofPracticeonAccessibilityofPublicServicesandInformationprovidedbyPublicBodies6whichgivesguidanceonhowtocomplywiththeDisabilityActrequirements.CompliancewiththeCodeofPracticeistakenascompliancewiththeAct.

5 Thelegaldefinitionofdisabilityinrelationtoapersonmeans“asubstantialrestrictioninthecapacityofthatpersontocarryonaprofession,businessoroccupationintheStateortoparticipateinsocialorculturallifeintheStatebyreasonofanenduringphysical,sensory,mentalhealthorintellectualimpairment”

6 http://nda.ie/Good-practice/Codes-of-Practice/Irish-Code-of-Practice-on-Accessibility-of-Public-Services-and-Information-Provided-by-Public-Bodies-/

http://nda.ie/Good-practice/Codes-of-Practice/Irish-Code-of-Practice-on-Accessibility-of-Public-Services-and-Information-Provided-by-Public-Bodies-/

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Forfurtherinformation,seetheGuidetotheDisabilityAct2005 (http://www.justice.ie/en/JELR/Pages/Guide_to_Disability_Act_2005).

TheNationalDisabilityAuthority’saccessibilitytoolkit(http://accessibility.ie)containsgeneralinformationonhowtomakeservices,buildings,informationandwebsitesmoreaccessibletopeoplewithdisabilities.Thiswebsiteisupdatedregularly.

4.8 National Consent Policy

Extract from the National Consent Policy: “Consentisthegivingofpermissionoragreementforanintervention,receiptoruseofa

serviceorparticipationinresearchfollowingaprocessofcommunicationinwhichtheserviceuserhasreceivedsufficientinformationtoenablehim/hertounderstandthenature,potentialrisksandbenefitsoftheproposedinterventionorservice.”7

TheneedforconsentextendstoallinterventionsconductedbyoronbehalfoftheHSEonserviceusersinalllocations.Theethicalrationalebehindtheimportanceofconsentistheneedtorespecttheserviceuser’srighttoself-determination(orautonomy)–theirrighttocontroltheirownlifeandtodecidewhathappenstotheirownbody.

Itincludessocial,aswell,ashealthcareinterventionsandappliestothosereceivingcareand

treatmentinhospitals,inthecommunityandinresidentialcaresettings.Howtheprinciplesareapplied,suchas,theamountofinformationprovidedandthedegreeofdiscussionneededtoobtainvalidconsent,willvarywiththeparticularsituation.Exceptinemergencysituations,aninterpreterproficientintheserviceuser’slanguageisrequiredtofacilitatetheserviceuseringivingconsentforinterventionsthatmayhaveasignificantimpactonhisorherhealthandwell‐being.Wherepracticable,thisisbestachievedinmostcasesbyusingaprofessionalinterpreter.

Knowledgeoftheimportanceofobtainingconsentisexpectedofallstaffemployedorcontractedbyhealthandsocialcareservices.Toensurethattheyareawareoftheirobligationswhenseekingconsentandforguidanceonobtainingvalidconsentfrompeoplewithdisabilities,staffshouldreadthe National Consent Policy.

7 NationalConsentAdvisoryGroup,HSE.NationalConsentPolicy.May2013HSE

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4.9 The National Emergency Medicine Programme Professionals should refer to The National Emergency Medicine Programme – A strategy to

improve safety, quality, access and value in Emergency Medicine in Ireland. This document giveshelpfuladvicespecifictotheEmergencyMedicineprogrammerelevanttoaccessibility.

4.10 Other

The UNConventionontheRightsofPersonswithDisabilities(CRPD),whichwasadoptedon13December2006andsignedbytheIrishGovernmentinDecember2007,hasnotyetbeenratified.Thisandemerginglegislation,suchastheAssisted Decision Making (Capacity) Bill and the HealthInformationBill,mayimpactonthecontentofguidelinesandrequirethemtobereviewedattheappropriatetime.

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5. Glossary of Terms / Definitions

5.1 Glossary

IntheseGuidelines,theterm‘accessible’meansuser-friendlyforpeoplewithdisabilities.

Accessiblebuilding Anaccessiblebuildingisonethatpeoplewithdisabilitiescanreadilyenter,movearound,use

comfortablyandexitsafely.

Accessiblecommunication Accessiblecommunicationmeanscommunicatingwithpeoplewithdisabilitiesinwaystheycan

readilyfollow.

Accessibleinformation Accessibleinformationmeansthatpeoplewithdisabilitiescanreadilyaccessandunderstandit.

Accessibleservice Anaccessibleserviceisonewhichisgearedtoservepeoplewithdisabilitiesalongsideother service users.

Disability Thelegaldefinitionofdisability,assetoutintheDisabilityAct2005,usedinrelationtoaperson

means“asubstantialrestrictioninthecapacityofthatpersontocarryonaprofession,businessoroccupationintheStateortoparticipateinsocialorculturallifeintheStatebyreasonofanenduringphysical,sensory,mentalhealthorintellectualimpairment”

Easy to read EasytoReadisthetermforverysimplifiedtextwithpictures,whichisimportantforpeoplewith

literacyproblemsorlimitedEnglish.

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Health and Social Care Professional Healthandsocialcareprofessionalisgenerallyusedasanumbrellatermtocoverallthevarious

healthandsocialcarestaffwhohaveadesignatedresponsibilityandauthoritytoobtainconsentfromserviceuserspriortoanintervention.Theseincludedoctors,dentists,psychologists,nurses,alliedhealthprofessionals,socialworkers.

Plain English Awayofpresentinginformationthathelpssomeoneunderstanditthefirsttimetheyreadorhearit.

Service user Weusetheterm‘serviceuser’toinclude: • Peoplewhousehealthandsocialcareservicesaspatients • Carers,parentsandguardians • Organisationsandcommunitiesthatrepresenttheinterestsofpeoplewhousehealthandsocial

careservices;and • Membersofthepublicandcommunitieswhoarepotentialusersofhealthservicesandsocial

care interventions

Theterm‘serviceuser’alsotakesaccountoftherichdiversityofpeopleinoursociety,whetherdefinedbyage,colour,race,ethnicityornationality,religion,disability,genderorsexualorientation,andwhomayhavedifferentneedsandconcerns.

Weusetheterm‘serviceuser’ingeneral,butoccasionallyusetheterm‘patient’whereitis mostappropriate.

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5.2 Appropriate Terms to Use

Whenwritingorspeakingaboutpeoplewithdisabilities,itisimportanttoputthepersonfirst.Catch-allphrases,suchas‘theblind’,‘theDeaf’or‘thedisabled’,donotreflecttheindividuality,equalityordignityofpeoplewithdisabilities.

Listedbelowaresomerecommendationsforusewhendescribing,speakingorwritingaboutpeoplewithdisabilities.

Some examples of appropriate terms:

Term no longer in use: Term Now Used: thedisabled peoplewithdisabilitiesordisabledpeople wheelchair-bound personwhousesawheelchair confinedtoawheelchair wheelchairuser cripple,spastic,victim disabledperson,personwithadisability thehandicapped disabledperson,personwithadisability mentalhandicap intellectualdisability mentallyhandicapped intellectuallydisabled normal non-disabled schizo,mad personwithamentalhealthdisability suffersfrom(forexample,asthma) has(forexample,asthma)

ReproducedfromtheNDA Guidelines on Consultation Source:MakingProgressTogether,2000-PeoplewithDisabilitiesinIrelandLtd.

18 19


5.3 Abbreviations

ASL AmericanSignLanguage BSL BritishSignLanguage CD CompactDisc DCSP DirectorateofClinicalStrategyandProgrammes DHSSPS DepartmentofHealth,SocialServicesand

PublicSafety

DVD Digital Versatile Disc ECN EmergencyCareNetwork ED EmergencyDepartment EDD Estimated Date of Discharge EDIS EmergencyDepartmentInformationSystems ELOS EstimatedLengthofStay EM EmergencyMedicine EMA EmergencyMultilingualAids EMP EmergencyMedicineProgramme GAIN GuidelinesandAuditImplementationNetwork GP General Practitioner HIQA HealthInformationandQualityAuthority HSE HealthServiceExecutive IRIS IrishRemoteInterpretingService ISL IrishSignLanguage IT InformationTechnology LIU LocalInjuryUnit MRI MagneticResonanceImaging MRSA Methicillin-resistantStaphylococcusaureus NALA NationalAdultLiteracyAgency NCBI National Council for the Blind of Ireland NDCS NationalDeafChildren’sSociety NDA NationalDisabilityAuthority NECS NationalEmergencyCareSystem NHS National Health Service NICE National Institute for Health and Clinical

Excellence

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NPSA NationalPatientSafetyAgency PA Personal Assistant PDD Patient Discharge Data PHN Public Health Nurse PPG Policy,ProcedureorGuideline SCIE SocialCareInstituteforExcellence SDU SpecialDeliveryUnit SLIS SignLanguageInterpretingService UK UnitedKingdom UN UnitedNations US UnitedStates UNCRPD UnitedNationsConventionontheRightsof

PersonswithDisabilities WC WaterCloset

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6.1 AllStaff

Eachmemberofstaffworkinginhealthandsocialcareserviceshasaresponsibility,relevanttotheirownrole,toensurethatservicesareaccessibletopeoplewithdisabilities,andthattheirinteractionsandcommunicationwithpeoplewithdisabilitiesareappropriate,respectful,andaredeliveredinwaysthatpeoplewithdisabilitiescanreceiveandunderstand.

Medical,nursing,andotherprofessionalandtherapystaffhavearesponsibilitytolistenandtocommunicateappropriately,andtotakeaccountofconcurrentissuesinrelationtotheperson’sdisabilityintheirtreatmentprogrammes.

Receptionistsandadministrativestaffhavearesponsibilitytoensurethatpeoplewithdisabilitiesareinformedofappointmentsandarecalledfortheirturninwaysthatcanbereceivedandunderstood.

Careassistants,porters,cateringandcleaningstaffwhointeractwithpatientsandserviceusersinthecourseoftheirworkhavearesponsibilitytocommunicateinwaysthatcanbeunderstood.

Maintenanceandcleaningstaffmaymaintainaccessibilityofbuildingsandfacilitiesbyensuringthattherearenoobstructionswhichcouldhinderaccessibilityorcauseahazard.

Frontlinestaffshouldseektoresolve,atalltimes,concernsandqueriesfrompatientsandserviceusersatthefirstpointofcontactwiththepatient/serviceuserand/ortheiradvocate.Wherethisisnotpossible,theyshouldseekadvicefromtherelevantlinemanagerorfromaspecialistdisabilityorganisation,dependingontheissue.Iftheissuecannotberesolvedatthislevel,furtheradvicecanbesoughtfromtheAccessOfficer.

6.2 Seniormanagementrole

Seniormanagershavearesponsibilitytosupportandpromotetheprovisionofaccessibleservicesforallserviceusers.Allhealthandsocialcaremanagementshouldaimtoensurethatthecapacityoftheserviceisdevelopedtofullysupportpeoplewithdisabilitiesinmainstreamhealthservices.Thefollowingarekeytasks/responsibilitiesforseniormanagers: Tocomplywithallpolicies,proceduresandlegalobligations:

• EnsurecompliancewithlegalresponsibilitiesundertheEqual Status Acts 2000 – 2008 and the DisabilityAct2005.

6. Roles and Responsibilities

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Toprovideleadershiptootherstaff: • Setoutrolesandresponsibilities • Ensureallotherstaffaccessappropriatedisabilitytraining • Ensureaccessofficer(s)areinplaceandarereleasedforandhaveaccessedappropriatetraining;

and • EnsurethatstaffareawareoftheNationalHealthcareCharterandthe8principlesof

Access,DignityandRespect,SafeandEffectiveServices,CommunicationandInformation, Participation,Privacy,ImprovingHealth,Accountability,theavailabilityoftheseguidelines andotherrelevantpolicies

Toensurethatallmainstreamserviceplanning,servicedeliveryorperformanceevaluationsystemsaredevelopedsothatservicesareaccessibleforallserviceusersandsupportcompliancewiththerelevantpolicies,procedures,guidelinesandlegislation:

• Integrateaccessibilityintoserviceplanningineachservice;forexample: – Build-insystemstoensuretheindividual’sneedsareco-ordinatedacrossdifferentlevelsor

centres of care – Developpatientandserviceuserinformationsystemsthatensurethattheaccessibility

requirementsofserviceusersandinformationonmanaginganypre-existingconditionscanfollowthroughtheirpatientjourneyacrossdifferenthealthservices

• Ensurethatdeliveringonaccessibilityrequirementsisbuiltintosystemsformanagingandmonitoringperformanceofstaffanddepartments;and

• Budgettomeetaccessibilitycommitments

Toensurethat,aspartoftheregularplanningcycle,seniormanagerssetgoalsandclearprioritieswhichwillallowthemtomeetlegalrequirementsandenhanceaccessibility:

• Setgoalsandclearprioritiesforachievingaccessibility • Setkeyperformanceindicatorsorcomplywiththeprovisionofdataforexistingnational

performanceindicatorsonaccessibility • Ensuretherearepoliciesand/orprotocolsthatsetouthowaccessibilityistobeachievedin

eachlocalarea;and • Putinplaceasystemforreportingandreviewingwhathasbeenachievedandforplanningand

agreeingthenextsteps

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6.3 AccessOfficerrole

TheappointmentofAccessOfficersisalegalobligationunderPart3oftheDisabilityAct2005. TheActrequiresthatAccessOfficersbeappointedtoallsiteswherethegeneralpublicusehealthandsocialservices.TheActalsoextendstoorganisationsthathaveaserviceagreementwith theHSE;forexample,thoseorganisationsthatarefundedunderSection38and39oftheHealth Act 2004.

Section26(2)oftheDisabilityAct2005requireshealthandsocialcareservicestoauthoriseatleastonememberofstafftoactasan‘AccessOfficer’,toprovideorarrangeforandco-ordinatetheprovisionofassistanceandguidancetopersonswithdisabilitiesinaccessingitsservices.Pleasenote,thisisnotspecificallytheroleofstafffromDisabilityServices,andstafffromanybackgroundshould be considered.

GiventhattheHSEprovideshealthandsocialcareservicesinhundredsoflocationsthroughout

thecountry,accessofficersarenecessarywherethereareserviceusers,patientsandclients;forexample,hospitals,primarycarecentres,healthandsocialcareclinicsand/orlocationswherehealth and social care is delivered.

Theroleisnotlimitedtophysicalaccess,suchascarparking,rampsorwheelchairaccess,butextendstoallaspectsofthepatient/serviceuserjourneyincludingtheprovisionofaccessibleinformation,consultationsandprocedures,appointmentsandapplicationsforserviceprovision.

Itisthedutyandroleofallhealthandsocialcareprofessionalsatalllevelstoattendtothe accessneedsofpeoplewithdisabilities.AccessOfficerswillnotreplacethisduty.Rather,AccessOfficerswillprovideadditionalsupporttofrontlineservicestoattendtotheaccessneedsofpeoplewithdisabilities.

Mostaccessanddisabilityissuesarealreadybeingmanagedeffectivelybyfrontlineservicesonaday-to-daybasis.Thisrolewillnottakefromthisexistingpractice.Ininstanceswhereanissuecannotbedealtwithlocally,thismattercanbereferredtotheNationalSpecialistinAccessibilityforfurthersupport.TheHSEappointedaNationalSpecialistinAccessibilityin2010whoseroleistoprovideguidance,adviceandstrategicsupportinthepromotionofaccesstomainstreamhealthservicesforpeoplewithdisabilities.

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Peoplewithdisabilitiesfacemanybarriersinaccessinghealthandsocialcareservices.Someofthesebarriersareowingtoapoorphysicalenvironment.However,mostoftheexistingbarriersareowingtoalackofunderstandingofhowtoaccommodateaperson’sdisability.AccessOfficerswillplayakeyroleinsupportingtheorganisationtoaddresssomeofthesebarriersand,indoingso,inensuringgreateraccessibilityforpeoplewithdisabilities.Theroleisdesignedtosupporthealthservicestaffrespondtotheaccessrequirementsofpeoplewithdisabilitiesinallhealthandsocialcaresettings.Accessofficerswillbeprovidedwithon-goingcomprehensivetraining,informationandresourcesmaterialstoenablethemcarryoutthisrole.

TheroleofanAccessOfficerinhealthandsocialcareservicesistosupporthealthservicestafftorespondtotheaccessrequirementsofpeoplewithdisabilitiesinallhealthandsocialcaresettings.ThemaindutiesofanAccessOfficerareto:

• Respondtoanddealwithrequestsfromhealthservicestaffforassistanceregardingaccessissueswheresuchrequestshavenotbeendealtwithorcannotbemanagedatthefirstpoint of contact

• Advisehealthservicestaffontheprovisionofinformationinanaccessibleformat • Developprotocolsforrespondingtospecificrequestsforassistanceanddocumenthowsuch

assistance can be sourced • Disseminateinformationonbestpracticeregardingaccessibility • Liaisewithrelevantdisabilityorganisationsifnecessaryand/orsupportfrontlineservicestodo

soasappropriate • Logandappropriatelyrecordresponsestorequestsandqueries • Promoteawarenessoftheroleofaccessofficerasappropriate • LiaisewiththeNationalSpecialistinAccessibilityand ItisnottheroleofanAccessOfficerto: • Provideone-to-oneadvocacyforpeoplewithdisabilities • Relievefrontlinestaffoftheiraccessresponsibilitiestopatients/clients/serviceusers • Beaonestopshoponallmattersofdisability;and • Dealwithcomplaints(theseshouldbedirectedthroughYour Service, Your Say).Iftheissue

cannotberesolvedorthepatient/serviceuserisnotsatisfiedwithhowtheissuehasbeendealtwith,s/hecanreferthemattertotheHSEcomplaintssystem,‘Your Service, Your Say’ormayrefertheissueonwardstotheOfficeoftheOmbudsmanortheOfficefortheOmbudsmanforChildren.Furtherdetailsof‘YourService,YourSay’areavailableonwww.hse.ie

Title

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25

Part One

Guidelines for all Health and Social Care Settings

Theguidelinesdescribeastandardwhichwecanaspireto.Theyarewrittenintheknowledgethatservicesmaynothavefinancialresourcestoimplementallmeasuresoutlined;however,thereisanobligationonindividualstoensurethattheyknowwhatisrequiredofthembylaw.Theyalsoserveasaresourceforhealthandsocialcareprofessionalswhomaybeplanningservicesinthefuture.

Manyofthekeyinitiativesyoucantaketomakeservicesmoreaccessiblearecostneutral.Consideration,compassionandopencommunicationarefree.Timespentidentifyingaperson’sneedsisaninvestmentinsafe,effectivecarewhichcanpreventunnecessaryriskstotheindividualandthestaffmember.

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Developing accessible health and social care services 1.1 Ask, Listen, Learn, Plan, Do

Mainstreamsystemsandpracticesshouldbedesignedtoensurethattheyareaccessibleforallservicesusers.Whendevelopingaccessibleservices,thefollowingapproachmaybeofassistancetoyou:Ask,Listen,Learn,Plan,Do.Figure1isacirculardiagramwhichisavisualrepresentationoftheAsk,Listen,Learn,Plan,Doprocess.Italsodemonstratesthecyclicalorrecurringnatureofthisprocess.

Ask Listen

Learn

Plan

Do

Fig. 1: Developing

accessible services

1. Guideline One

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Ask

Consultwithindividuals,advocates,disabilityorganisationsandstaffworkingcloselywithindividualstoidentifypatientandserviceuserneedsinyourarea.8

• Asksimplequestionstofindoutifserviceusershaveanyspecificrequirementsthatmustbeaccommodated;forexample,“Isthereanythingwecandotoassistyou?”

• Becomeawareofwhatcouldconstituteobstaclesordifficultiesforpeoplewithdisabilitiesusingyourservices

• Withtheconsentofthepersonwithadisability,familymembers,carersorsupportworkersmayalsobeabletoguideonanyspecificneeds

Listen

Recognisethatpeoplewithdisabilitiesandstaff,familymembers,personalassistants,advocatesanddisabilityorganisationsworkingcloselywithindividualsareoftenexpertsinpatientandserviceuser needs.

• Listenattentivelytotheirfeedback • Listentoanysuggestionsmadeforaddressingtheirrequirements

Learn

Ensurethatyouhavesufficientinformationtohelpyoutoimproveserviceprovision. • Completeanynecessaryresearchsothatyoucanlearnabouttherequirementsofindividuals • Readtherelevantpolicies,procedures,guidelinesandlegislation

8 TheNationalAdvocacyUnitprovidesguidanceonserviceuserinvolvementandparticipation.

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Plan

Whileitwillnotalwaysbepossibletomeetpatientorserviceuserrequirements,healthandsocialcareservicescanstrivetounderstandserviceuserneedsand,wherereasonable,practicalandappropriate,theycanmakepositivechangestohowservicesareprovided.Whereappropriate:

• Setoutaprogrammeofactiontoaddressidentifiedissues • Developaplaninconsultationwithrelevantpeopletosupportyoutomaketheservicesyou

providemoreaccessible • Setoutclearprotocolsandguidanceforstaff • Buildincoordinationacrossdifferentlevelsofcare • Setoutrolesandresponsibilities • Establishandembedpolicies

Do

Adoptpoliciesandprotocolsthat: – setoutthestandardstepstofollowtoachieveaccessibleservices;and – integrateaccessibilityintoyourgeneralprotocolsforserviceprovision • Implementtheadoptedpoliciesandprotocols • Provideclearleadership • Provide training and mentoring • Establishsystemstomonitorandreviewdeliveryinpractice • Offerafeedbackandcomplaintsmechanism • Ensurefeedbackinformsreviewofpoliciesandpractices • Afteraperiodoftimeitwillbenecessarytobeginthecycleagain

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1.2 Examplesofpolicies,proceduresorguidelinesforstaff

Whenanagreedstandardpolicy,procedureorguideline(PPG)isinplaceandimplemented,staffareawareofwhattheycandolocallytomakeservicesmoreaccessible.PleasenotethattheHSEPPGs are available on the intranet site.

Examplesofpolicies,proceduresorguidelines(PPGs)whichareadvisableforservices,orwheretherearepre-existingnationalhealthandsocialcareservicePPGswhichstaffshouldadoptandapplylocally,aredetailedbelow:

• Identifyingaperson’saccessibilityrequirements • Reviewingpre-admissionplanning,in-patientcareanddischargeplanningtoensurethatthey

areaccessible(SeeIntegrated Care Guidance: A practical guide to discharge and transfer from hospital)

• Co-ordinationofcareacrossGeneralPractice(GP)andhospitalservicesandliaisonwiththeteamdealingwiththeperson’sprimarydisability,whereappropriate,andmaintainingconfidentialityasisrequireddependentonthecase

• Patientconsent(SeeNational Consent Policy)anddecision-making • Evacuationinanemergencyfromhealthorsocialcaresettings • Ensuringthatbuildingsarewell-maintained,thatallaccessibilityfeaturesareoperatingcorrectly • Ensuringthattherearenoobstructionswhichcouldhinderaccessibilityorcauseahazard

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Developing disability competence 2.1 Buildingcapacityandunderstandingforallstaff

Allhealthandsocialcarestaffshoulddisplayapositiveattitudetowardsserviceusers.Appropriatetrainingiskeytoensuringthatstaff:

• areawareofthepatientandserviceusersneedsintheareaofaccessibilityandspecificaccessibilityconcernsforpeoplewithdisabilities,and

• developthecompetenceandconfidencetoaddresstheseeffectively

Peoplewithdisabilitiescanfacearangeofaccessibilityproblemsorbarriers.Forexample: • buildings • transport • equipment • failuretocommunicateinappropriateways • lack of accessible information • attitudes • ignorance • discrimination

Disabilitytrainingcanhelpstaffrecognisethesebarriersandlearnpracticalwaysinwhichtheycanbe addressed.

Localmanagersshouldfacilitatecapacitybuildingforstaff.Thiscanbedonebyarrangingawarenesstrainingwhichincludesgeneralmaterialonaccessibleservicesandcommunication,aswellastailoredtrainingrelatingtothespecificroleandsetting.

2. Guideline Two

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2.2 Online training resource

TheNationalDisabilityAuthority’sDisabilityEqualityTraininge-learningisavailableonlineat elearning.nda.ie,andalsoonHSELand.ie,theHSE’sonlineresourceforLearningandDevelopment(www.hseland.ie)under“PersonalDevelopment”.Thiscourseisfreeofcharge;ittakesaboutanhourandahalftocompleteandprovidesageneralintroductiontocustomerserviceforpeoplewithdisabilities.

2.3 Tailoreddisabilitytraining

Insomeinstances,itcanbehelpfultohavetrainingwhichistailoredtoinformparticipantsaboutaparticulardisability.Forexample,DeafawarenesstrainingcanexplorecommunicatingwithDeafpeopleinmoredepth.

2.4 Professional education, training and professional standards

Professionaleducationandtrainingandcontinuousprofessionaldevelopmentofhealthandsocialcarepersonnelshouldroutinelyincludetrainingonaccessibilityasanintrinsicpartof their curriculum.

Medical,nursingandtherapyschools,professionaltrainingbodies,suchasthecollegesofprofessionalspecialties,andregulatorybodies,suchastheIrishMedicalCouncil,havearoletoplayinthisregard.Standardssetbyprofessionalbodiesshouldmakeprovisionforaccessibilityissues.

Staffprovidinggeneralhealthandsocialcareneedtoreceiveappropriatetrainingtoallowthemtocompetentlysupportpatientsandserviceuserspresentingfortreatmentofmedicalconditionsotherthantheirdisability.

Clinical,nursingandalliedhealthprofessionalsshouldreceivetraininginmanagingtheinterplayofdifferentmedicalconditionsand,inparticular,whereaperson’sdisabilitymayimpactontheircareplan;forexample,howtocarefor:

• Apatientwithaspinalinjurywhentheyareinhospitalwithanunrelatedcondition,astheymayneedadditionalsupportsregardingposture,bowelcareandavoidanceofpressuresores;or

• Apatientwithacognitiveimpairmentwhopresentswithafracturedhip,whentheymayforgetthattheyneedtoimmobiliseit;or

• ApatientwhoisinlabourwhentheyareDeaf

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Accessible services - general advice 3.1 Donotassume-ask

Peoplewithdisabilitiesaregenerallyexpertsontheirspecificaccessibilityrequirements.Noteveryonewithadisabilityneedsassistanceandanaccessibilityneedmaynotbeapparent,soitisimportantto:

• Askeachpersoniftheywouldlikeassistanceandaboutanyspecialrequirementstheymayhave • Askforinstructions,ifanofferofhelpisaccepted • Listenattentivelytowhattheirrequirementsareandhowtheycanbeaddressed • Allowthepersontohelpanddirectyou,ifyoudonotknowwhattodo.Thepersonwillindicate

thekindofhelpthatisneeded • Notbeoffendedifyourhelpisnotaccepted,asmanypeopledonotneedanyhelp;and • Documentanyrelevantaccessibilityorcommunicationresourcesorrequirements

Donotassumethatapersonwithadisabilitywouldbeunabletoanswerquestionsabouttheirhealthortheirsymptoms.Askthepersonthemselvesinthefirstinstance.

3.2 Making an appointment

Identifyanyaccessibilityrequirements Whenbooking,forexample,appointmentsorprocedures,contactthepersonandprovidethemwith

anopportunitytoinformyouofanyaccessibilityrequirements.

Primarycontactforappointmentsisusuallybyletter.However,whereservicesareawareofadisability,primaryand/orfollow-upcontactshouldbeappropriatetotheperson’sneeds,andmaybemadebyletter,telephone,email9ortextmessage.

Establishfromserviceuserstheirpreferredmethodofcommunication,takingintoconsiderationtheirlevelofdisability;forexample,itmaybenecessaryforapersonwithavisualimpairmenttoreceivecommunicationviaemailortelephoneinsteadofletter.

Itisimportanttonotethatthemethodofcommunicationmaybedifferentforeachpersondependingontheirdisability.Also,twopeoplewiththesamedisabilitymayhavedifferentcommunication needs.

3. Guideline Three

9 ItisimportantthatwhereelectroniccommunicationcontainspersonalconfidentialinformationthatitisencryptedinaccordancewiththerelevantHSEInformationTechnology(IT)PolicyandProcedures.

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Two way appointment systems Manyappointmentsystemsareone-wayonlyorrequireapersontotelephoneiftheywantto

changetheirappointment.TheseareinaccessibletopeoplewhoareDeaforhaveimpairedspeech.Itisessentialtohaveatwo-waysystemsothatallserviceusersmayrespond;forexample,tocancelorchangeanappointment.Thismaymeanreviewingtheexistingresponsemethodsinanarea.Haveasysteminplacetoensurethatsuchmessagesarerespondedtopromptly.

Using text messages Whereavailable,useamobilenumberoratelephonelandlinethatacceptstextmessages.(Please

notetextmessageservicesarenotavailableinallareasatpresent). • Publicisethenumberinyourserviceuserinformation;forexample,onyourwebsiteandinyour

hospital,GPsurgeryorhealthcentre • Iftextisthemethodused,alwaysgiveaquickacknowledgmenttoatextmessage,evenif

youdonotknowtheanswertothequestionthatisasked,sothatthepersonknowsyouhavereceived their message

3.3 Showflexibilitywhenschedulingappointments

Pleasenotethatthefollowingsectiondoesnotmeanthatpreferentialtreatmentwillbegiventopeoplewithdisabilities,butratherthatservicesshouldexerciseconsiderationforthecircumstancesofacasewhereappropriate.

Setting an appointment time Wherepossible,servicesshouldbeflexibleaboutappointmenttimesandvisitinghourswherethey

impactontheprovisionofaccessibleservices.Forexample: • Earlymorningappointmentsmaybeunrealisticforpeoplewhoneedmoretimetogetreadyor

whoneedacarerorPersonalAssistanttohelpthem • Findingaccessibletransportmayalsobemoredifficultearlyinthemorning • Alaterappointmentmayfacilitatefamilymembers,personalassistants,orsupportpersons

toaccompanyapersonwithadisabilitytoattendanappointmentortobetheretoassistwithfeeding,drinking,orusingthetoiletasnecessary

Minimising the waiting times for an appointment Itmaybeappropriate,whenpossible,tominimisewaitingtimesforapersonwithadisability

whentheyareattendingforappointmentswheretheirdisabilitymaycausethemtoexperience

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unnecessaryanxiety,distressorpain.Forexample,apersonwithacognitivedisabilitymaybecomeagitatedordistressedinanewenvironmentorfindremaininginoneplaceforalong timedifficult.

Itcanbehelpfultotakethisintoconsiderationwhenschedulingappointments;forexample, thefirstappointmentafterlunchmayhavetheshortestwaitingtime.Itcanbehelpfulto scheduleappointmentswithaninterpretersothatwaitingtimesandcostofinterpretiveservices are minimised.

Allow additional time for appointments where necessary Someserviceusersmayneedmoretimetocommunicateeffectivelywithyou.Schedulelonger

appointmentswherenecessary;forexample;incaseswherethepersonhasacognitiveimpairmentorimpairedspeech,orthepersoncommunicatesthroughlip-readingorviaaninterpreter.

Allowenoughtimeforapersonwithadisabilitytogetfromoneplacetoanotherather/his ownpace.

3.4 Missed appointments

Whenapersonwithadisabilitymissesanappointment,itcanbehelpfultocheckwhether thiswasduetoinaccessibleinformationortoaninaccessiblebuildingorservice.Actonthefeedbackprovided.

3.5 Planvisitsforroutinecheck-upsorsurgeryinadvance

Wherethereisapre-plannedvisit,suchasaroutinecheck-uporpre-plannedsurgery,itispossibletoidentifyandplaninadvancetomeetanyaccessibilityrequirements.

Contactthepersonbeforeadmissionandprovidethemwithanopportunitytoinformyouofanyaccessibilityrequirementstheywillhaveontheday.

Apre-visitmaybehelpfulinsomesituationstofamiliarisethestaffandpatient.Forexample, pre-visitstoahospitalorcliniccanhelpbuildtrustforapersonwithanintellectualdisability,sothattheyaremorecomfortableandincontrolwhentheyareadmittedtohospitalorwhentheyattend for treatment.

Letotherstaffknowwhenandwherethepersonisarrivingandwhattheplanis.

34 35


3.6 Queuingtobeseen

VisualDisplayUnitsinwaitingroomsandpublicareascaninformpeopleofappointments,directions,informationorqueuinginformation.Avisualsystemcouldbeaticketmachine,avisualdisplayorawhiteboard.

Ifpossible,havebothanaudibleandvisualsystemforlettingpeopleknowtheirturn.ThisistoensurethatpeoplewithimpairedvisionandpeoplewhoarehardofhearingorDeafareawarethattheyarebeingcalledfortheirturn.

Ifyouuseaticketsystemforthequeue,ensurethattheticketmachineisataheightwhereawheelchairuserorapersonofshortstaturecanreachit(andthatthereisanalternativeforpeoplewhoareblind).

Informpeoplehowtheywillbecalledandthelocationofthevisualdisplayunits,sothattheycansitwheretheycanseeorhearwhentheyarecalled.

Intheabsenceofavisualdisplayunitinthewaitingroom,makesurethatpeoplewithimpairedvisionorthosewhoareDeaforhardofhearingareinformedwhenitistheirturntobeseen.

3.7 Filling forms

Askifthepersonneedsassistancefillinginaform. Servicesshouldalsoconsiderhavingeasy-grippensavailableforthosewithmanual

dexterityproblems.

Ifthereceptionist’scounteristoohigh,forexample,forawheelchairuser,youmayneedtosteparoundittocompleteyourbusinesswiththepatient/serviceuser.

Aclipboardcanbehelpfulforpeopleunabletoreachthecounterwhenfillingoutformsor signing documents.

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Ifpossible,itmaybehelpfultoprovidetheoptionfortheformtobeaccessedandcompletedon-lineinadvanceofanappointment.

3.8 Information and notices

Provideinformationabouthowyoucanaccommodatesomeone’sdisability;forexample: • Contactdetailsforthepersonwhowilldealwithqueriesaboutaccessibilityifyoucannotanswer

theirquery • Thesymbolforahearingloop,ifavailable • AnoticeaboutyourpolicyonGuideDogsandAssistanceDogs;and • AnoticeontheprovisionofanIrishSignLanguageInterpreteronrequest

3.9 Mobilityaids

Manypeoplewithphysicaldisabilitiesrelyonmobilityaids,suchasmanualandelectric wheelchairsormobilityscooters,andwalkingaids,suchascrutches,walkingframesandwalkingsticks. Do not:

• movemobilityaidswithoutpermissionfromtheowner(unlesstheyarecausinganobstructionwhichurgentlyneedstobemoved)

• pushaperson’swheelchairortakethearmofsomeonewalkingwithdifficulty,withoutfirstaskingifyoucanbeofassistance

• leanagainstaperson’swheelchairwhentalkingtothem.Forawheelchairuser,theirchairispartoftheirpersonalspace

3.10 Focus on the person

Duringaconsultation,focusontheperson,nottheirdisability.Therecanbeariskthatclinicianscouldattributesymptomstoaperson’sunderlyingdisability,andthusmisssomesignsofanunrelated health condition.

• Taketheperson’spresentinghealthcondition/clinicalneedsintoconsideration. • Giveconsiderationtotheirunderlyingdisabilityandthepotentialimpact(ifany)ofthesameon

thepresentinghealthconditionand/ortheircareplan • Beflexibleinordertoaddressindividualneeds

3.11 Concurrent therapeutic or care needs

Anindividual’sprimarydisabilityorotherpre-existingconditionmayinvolvespecifictreatmentorcareprotocols.Itisimportanttoknowaboutthesewhendiagnosingandtreatinganothercondition.

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• Talktotheperson,theircarer,GP,consultantorkeyworkerintheirdisabilitysupportserviceasappropriate,astheyareimportantsourcesofinformation

• Identifyanyspecificcareortherapeuticrequirementsrelatedtoexistinghealthconditionsortotheirdisability,suchasrequirementsinrelationtopersonalcare,feeding,lifting,posture,preventionofpressuresoresorbowelcare

3.12 Maintainconfidentiality

Confidentialityisabasicprincipleintheprovisionofhealthandsocialcare.

Aperson’sprivacycouldbecompromisedifthereisintimateorsensitiveinformationbeingconveyedordiscussedwiththirdpartieswithouttheirconsent.

Healthandsocialcareprovidersshouldbemindfulofthiswhencommunicatingwiththirdparties,suchasfamilymembers,personalassistants,staff,advocatesetc.Staffshouldusetheirdiscretiontoensurethattheydonotcompromisetheindividual’srighttoconfidentiality.

Relyingonchildrenandfamilymemberstointerpretortranslateisnotrecommendedonethicalandlegalgrounds.Thedocument‘On Speaking Terms’(http://www.hse.ie/eng/services/publications/)givesmoreinformationonthis.However,theremaybesomesituationswherethisisunavoidable;forexample,anemergencysituationwhereafamilymemberisaskedtotranslateforaDeafserviceuser.However,thisshouldbetheexception.Childrenshouldnotbeaskedtointerpretortranslatefortheirparents.

3.13 Health Promotion

Allpatientsandserviceusersshouldbeconsideredinthedevelopmentofanyhealthpromotionstrategy:

• Providehealthpromotioninformationandguidanceinarangeofaccessibleformats • Ensurepeoplewithdisabilitiesareincludedinanypopulationscreeningprogrammesandhealth

checksasdeemedclinicallyappropriate;forexample,amammogram

Healthscreeningpremisesandequipmentshouldbedesignedsothatallpatientsandserviceuserscanusethem.Ifthisisnotthecase,effortsshouldbemadetoofferanalternative.Forexample,aMagneticResonanceImaging(MRI)scanrequiresapatienttoremainstillforaperiodoftime;somepatientsmayneedsedationpriortoundergoingthisscan.

http://www.hse.ie/eng/services/publications/

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3.14 Integrated Discharge Planning

“Toensureserviceusersaredischargedortransferredsafelyandontimerequiresfullassessment

oftheirindividualhealthcareneeds,planningandco‐operationofmanyhealthandsocialcareprofessionals.”10

MakeaplanforcontinuityofcareandsupportafterdischargeinaccordancewiththeIntegrated Care Guidance: A practical guide to discharge and transfer from hospital.Thefollowingninestepsaretakenfromthedocument“Discharge and transfer from hospital—The nine steps quickreferenceguide”.

“Dischargeandtransferfromhospital—Theninestepsquickreferenceguide”.

Step one:Beginplanningfordischargebeforeoronadmission Pre‐admissionassessmentsconductedforplannedadmissionstohospital,suchaselective

procedures,oralternativelyatfirstpresentationtothehospitalforunplannedadmissions. • Mostaccuratepre‐admissionmedicationlistshouldbeidentifiedpriortoadministrationof

medicationinthehospital • Priorhistoryofcolonisationwithamulti-drugresistantorganism,example,Methicillin-resistant

StaphylococcusAureus(MRSA)orhealthcareassociatedinfectionshouldberecordedinhealthcarerecord,andhealthcarestaffinformedasperlocalhospitalpolicy

• Timelyreferralsaremadetomultidisciplinaryteamandreceiptofreferralsrecordedonintegrateddischargeplanningtrackingformwithin24hoursofreceivingreferral NOTE: this includes referrals from hospital to primary care services

• Eachserviceusershouldhaveanestimatedlengthofstay(ELOS)/estimateddateofdischarge(EDD)identifiedwithin24hoursofadmissionanddocumentedinthehealthcarerecord,relatedtotheestimatedlengthofstayrequired(SpecialDeliveryUnit,2013)

Step two: Identify whether the service user has simple or complex needs Theserviceuser’sneedsareassessedeitherpriortoadmissionoronfirstpresentationand

indicatewhethertheserviceuserhassimpleorcomplexneeds. • TheELOS/PredictedDateofDischarge(PDD)isdeterminedbywhethertheserviceneedsare

simpleorcomplex • Theserviceuserisplacedonanappropriateclinicalcareprogrammecarepathway,relevantto

theserviceuser’sdiagnosis,tosupportseamlesscareandmanagement

10ExtractfromIntegratedCareGuidance:Apracticalguidetodischargeandtransferfromhospital.

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Step three: Develop a treatment plan within 24 hours of admission Allserviceusershaveatreatmentplandocumentedintheirhealthcarerecordwithin24hoursof

admission,whichisdiscussedandagreedwiththeserviceuser/familyandcarers. • Thetreatmentplanincludesareviewofpre‐admissionagainstadmissionmedicationlist,witha

viewtoreconciliation • Changestothetreatmentplanarecommunicatedtotheserviceuserandrelevantprimarycare

servicesasappropriate,anddocumentedinthehealthcarerecord

Step four: Work together to provide comprehensive service user assessment and treatment Themultidisciplinaryteamcomprisesoftheappropriatehealthcareprofessionalstoproactively

planserviceusercare,setgoalsandadjusttimeframesfordischargewherenecessary. • Regularmultidisciplinaryteammeetingsorcaseconferencesforcomplexcarecasesareheld

whereappropriate • Rolesandresponsibilitiesforproactivemanagementofdischargeareclarified

Stepfive: Set a predicted date of discharge / transfer within 24 – 48 hours of admission TheELOS/PDDisidentifiedbytheadmittingconsultantinconjunctionwiththemulti‐disciplinary

team,duringpre‐assessment,onpostadmissionwardroundorwithin24hoursofadmissiontohospital(forsimpledischarges)and48hours(forcomplexdischarges),anddocumentedinthehealthcare record.

• TheELOS/PDDisagreedbyspecialtyandproactivelymanagedagainstatreatmentplanbyanamedaccountableperson(SDU,2013)

• TheELOS/PDDisdisplayedinaprominentposition • ChangestothetreatmentplanandELOS/PDDaredocumentedinthehealthcarerecord

(SDU,2013)

Step six: Involve service users and carers so they make informed decisions and choices Thetreatmentplanissharedwiththeserviceusers,andtheyareencouragedtoaskquestions abouttheplan. • Developinformationpackforserviceuser/carer,example,medicationslist,careofany

indwellingdevicessuchasintravascularlinesorurinarycatheters,woundcareand instructionsfortheserviceusertosharewiththeirGP,communitypharmacistandotherrelevanthealthcareprovider

• Counselandeducatetheserviceuser,consideringtheneedsofserviceuserswithpoorvision,hearingdifficulties,cognitivedeficits,culturalandlanguagebarriers.

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Step seven:Reviewthetreatmentplanonadailybasiswiththeserviceuser Practitionerstalktotheserviceuserdailyaboutprogress. • Thetreatmentplanismonitored,evaluatedandupdated(wherenecessary)andchangestothe

treatmentplanandELOS/PDDaredocumentedinthehealthcarerecord(SDU,2013) • Anyproblemsoractionsrequiredareidentifiedandareescalatedorresolvedasnecessary

Step eight: Useadischargechecklist24–48hoursbeforedischarge Thefamily/carers,PrimaryCareTeam/GP,PublicHealthNurse(PHN)andotherprimaryand

communityserviceprovidersarecontactedatleast48hoursbeforedischargetoconfirmthattheserviceuserisbeingdischargedandtoensurethatservicesareactivatedorre‐activated.

• Dischargearrangementsareconfirmed24hoursbeforedischarge(SDU,2013) • Clinicalteamsconductdischargingwardroundsatweekends(SDU,2013) • Processinplacefordelegateddischargingtooccurbetweenclinicalteamsortoother

disciplines,withinagreedparameters(SDU,2013)

Step nine: Make decisions to discharge / transfer service users each day Eachserviceuserdischargeiseffectednolaterthan11amonthedayofdischarge(SDU,2013). • Dischargemedicationreconciliationanddevelopmentofthedischargemedication

communicationtakesplaceinaplannedandtimelyfashion,preferablyonthedaybeforetheserviceuserleavesthehospital

• PrimaryCareservicesandhomelessnessservicesshouldbenotifiedwhenaserviceuserwhoishomelessorlivingintemporaryorinsecureaccommodationisduefordischarge

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Helpful tips

• Whileitisimportanttorespecttheperson’sprivacy,itisalsoimportantthatfamilymembers,carers,supportpersonsorthoseassistingthemunderstandkeyinformationfortheirsafety;forexample,whatmedicationshouldbetakenandwhen,andunderwhatconditionsthepersonneedstoreturntothehospital

• Liaisewiththepersonandothersasappropriate(theirfamily,carers,relevantserviceproviders,includingdisabilityservicesorthemedicalteam)arounddischargearrangements,aftercareandfollow-up.Confirmdischargearrangementsasappropriate

• Prepareaninformationpackandprovideinformationandeducationtotheserviceuserandthefamily/carerintheappropriatelanguage,verballyandinwrittenform.Thisshouldbeprovidedinaformatthatisaccessibletothem,wherepossible.Seepage37-38inthe“IntegratedCareGuidance”forwhatinformationtoincludeinaninformationpack.

– Iffollow-upisrequired,ensurethatacommunicationmethodappropriatetotheserviceusersaccessibilityneedsisidentifiedpriortodischarge

– Signpostapersontowardsdisabilityorganisationsforsupport,informationaboutbenefitsandservicesthattheycanavailofinthecommunityand,wherepossible,tellthemwhotocontactinspecialistdisabilityservices

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Communication

4.1 General principles of good communication

Figure 2: Albert Mehrabian’s Communications Model

Communicationismadeupof7%verbalcommunication(whatwesay),38%vocalcommunication(howwesayit),and55%non-verbalcommunication(bodylanguage).Whenapersonhasadisability,itcanimpactsignificantlyonhowtheycommunicate.Thiscouldinclude,forexample,someonewithimpairedspeechorhearing,someonewithlimitedornolanguage,orsomeonewhosecommunicationisimpairedbecauseofdementiaorbraininjury.

Failuretomakeappropriateprovisionforaperson’scommunicationdifficultymayresultinavoidableseriousrisksanderrorsforboththepatientandhealthcareprovider.

Thissectionprovidesguidanceoncommunicationunderthefollowingheadings: • Communication skills • Communicatingwithapersonwhohasadisability • Communicationaidsandappliances

Remembercommunicationshouldbenon-judgmental,unbiasedandrespectful.Treatanadultwithadisabilityasyouwouldanyotheradult.

4. Guideline Four

7%verbal

(wordsonly)

38%vocal

(includingtoneofvoice,inflectionand othersounds)

55%nonverbal

(bodylanguage)

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COMMUNICATION SKILLS

4.2 Establishhowthepersonpreferstocommunicate

Establishtheperson’spreferredmethodofcommunication.Thiscanbedonewhencontactisfirstmadewiththeservice.

Apersonwithasignificantdisabilitymayhaveafamilymember,carerorsupportpersonwhocanprovideguidanceontheappropriatemethodsofcommunicationinsituationswherethepersoncannotdosothemselves.Thismightincludeinformationonaspecificcommunicationaidanddevicewhichmakescommunicationwiththepersonpossible.

IncaseswhereEnglishisnottheperson’sprimarylanguage,itmaybenecessarytoarrangeforaprofessionallytrainedinterpreter.Itmaybehelpfuliftheinterpreterhasanunderstandingofhowthechosenmethodofcommunicationworksorifnecessarytotaketimetounderstand.

4.3 Notifyrelevantstaffofthepreferredmethodofcommunication

Informationonaperson’spreferredmethodofcommunicationshouldbepassedontorelevantstaffsothatpeopledonothavetorepeattheirrequirementsateachstageoftheserviceuserjourney.Thisinformationshouldbeincludedinthepatient’schartor(withtheperson’sconsent)inasignattheirhospitalbed.

4.4 Communicating with the person

Active Listening • Communicationisatwo-wayprocess.Wherepossible,alwayscommunicatedirectlywith

theindividual,ratherthantheircarer,supportpersonorinterpreter.Beawareofindividualdifferencesanddiverseneeds

• Itisimportanttonotonlylisten,buttohearthemessage • Givecommunicationthetimeneededsothatstaffandthepatient/serviceusercan

communicateandunderstandwhatisbeingcommunicatedbytheother.Apersonwhoisunabletospeakortohear,whohasdifficultyprocessingorretaininginformation,orwhocannotreadmayrequiremoretime.Aswithallinteractionswithpatientsandserviceusers,moretimemayalsoneedtobefactoredintocommunicatebadnewsinasensitiveway

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Verbalcommunication • Speakclearly,conciselyandslowly • Useplainlanguagethatiseasytounderstand.Ifyoumustuseamedicalterm,explainwhatit

meansfirst • Give accurate information

Effectivequestioning • Askonequestionatatime(avoidbombardment) • Givethepersontimetorespondwithoutunnecessaryinterruption • Givethepersontimetoaskquestions • Donotbeafraidtoaskthesamequestiontwice.Repeatwhatyouhavesaidwhenapersonis

havingdifficultyunderstanding,andverifythattheyhaveunderstood • Phrasingquestionsinawaythatapersoncangiveasimple“yes”or“no”answercanbehelpful

in some situation

Non-verbalcommunication-positivebodylanguage • Facethepersonyouarecommunicatingwith • Maintaineyecontact(althoughthismaynotbepossibleorcomfortableforsomepatients/

serviceusers) • Non-verbalcommunication,suchasgestures,facialexpressionsandappropriatetouch,canbe

importantwhencommunicatingwithpeoplewhoareexperiencingcommunicationsdifficulties • Gesturesandfacialexpressionscanbeusedtoexpressanemotion.Forexample,athumbs-up

canbeanacceptablewayofreassuringapersonthatthingsareallright

Use visual aids • Drawings,diagramsorphotographsareausefultoolincommunicatinginformation.Theycanbe

particularlyusefulincommunicatingwithsomeonewhoisDeaforhardofhearing,orsomeonewithanintellectualdisabilityorabraininjury

Give information to take away • Peoplewithdisabilitiescanfinditusefultohavetheinformationyouhavecommunicatedtothem

orallygiventotheminaformattheycanreviewlater;forexample,apersonwithacognitiveimpairmentmayneedwritteninformationtohelpthemrememberanyinstructionstheyreceived.Thisisparticularlyimportantforinformationaboutfollow-upcare,exerciseormedication

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• WritedownwhatyouhavesaidinplainEnglishclearly,conciselyandaccurately • Avoid using jargon and technical medical language • Alwaysexplainanyabbreviations • Remembertypedinformationiseasiertoreadthanhandwriting • Wherepossible,provideinformationinanaccessibleformatsuitabletotheindividual’s

needs.Thiscouldbeinlargeprint(changethefontsize),bye-mail,bytextmessageorwherepracticableinaudioformat

COMMUNICATINGWITHAPERSONWHOHASADISABILITY

4.5 Communicatingwithapersonwhoisunabletostandorwhousesawheelchair

Positionyourselfateyelevelbysittingbesidetheperson.Ifthisisnotpossible,standastepbacksothatthepersondoesnothavetostraintheirnecktoseeyou,orcrouchdownifappropriate.

4.6 Communicatingwithapersonwithspeechdifficulties

Talktothepersonasyouwouldtalkanyoneelse,andlistenattentively.

Askthepersontohelpyoutocommunicatewithherorhim.

Ifthepersonusesacommunicationdevice,suchasamanualorelectroniccommunicationboard,askthepersonhowbesttouseit.Thesedevicescanprovidevisualinformationthatmakeslanguageaccessibleforpeoplewithspeechimpairments.

Allowtimetogetusedtoaperson’sspeechpattern.

Allowtimetoreplyasitmaytakethepersonawhiletoanswer.Waitforthepersontofinish,ratherthancorrectingorspeakingfortheperson.

Askshortquestionsthatrequirebriefanswers,oranod“yes”or“no”.

Neverpretendtounderstandifyouarehavingdifficultydoingso.Ifyoudonotunderstandwhatthepersonissayingtoyou,letthemknowthis.Askthepersontorepeatthemessage,tellyouinadifferentway,orwriteitdownifpossible.

46

Repeatwhatyouhaveunderstoodandallowthepersontorespond.Theresponsewillguideyourunderstanding.

Makeeyecontactwiththepatientorserviceuserevenwhensomeoneelseisinterpretingforthem.

4.7 Communicating with a person who has a visual impairment

Bepunctual.Lackofpunctualitycancauseapersonwithsightlossunnecessarystress.

Rememberalsothatthepersonmaynotbeabletoseewhetheryouhavearrived. • Alwaysletapersonwithsightlossknowwhenyouareapproaching.Asuddenvoiceatclose

rangewhentheydidnothearanyoneapproachcanbeverystartling • Speakfirstfromalittledistanceawayandagainasyoudrawcloser.Saytheirnamesothatthey

knowyouarespeakingtothem • Greetapersonbysayingyournameandwhatyourroleis.Donotassumetheyknowwhoyou

are,eveniftheyknowyou

Talkdirectlytotheperson,byname,ratherthanthroughathirdparty.

Dotrytospeakclearly,facingthepersonwithsightlosswhileyoudoso.

Donotassumewhathelptheyneed.Beforegivingassistance,alwaysaskthepersonfirstiftheywouldlikehelpand,iftheydo,askwhatassistanceisneeded.

Apersonwithavisualimpairmentmayrequest‘sightedguide’assistancesothatthepersoncanfindher/hiswayaroundtheemergencydepartmentortothetoilet.Ifapersonwithsightlosssaysthattheywouldliketobeguided:

• Offerthemyourelbow • Keepyourarmbyyourside,andthepersonwithsightlosscanwalkalittlebehindyou,holding

yourarmjustabovetheelbow • Whenassisting,itishelpfultogivecommentaryonwhatisaroundtheperson;forexample,“the

chairistoyourright” • Ifyouhavebeenguidingablindpersonandhavetoleavethem,bringthemtosomereference

pointthattheycanfeel,likeawall,tableorchair.Tobeleftinanopenspacecanbedisorientatingforapersonwithnovision

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• Ensurethattheyknowwhatisaroundthem.Describewhatisintheroom,includingequipment,anddescribetheroomfromlefttoright.Giveclearinstructionsaboutthelocationoftoilets,drinksmachines,anystepsorotherfeatures,suchaschangesinfloorsurfaces

Donotassumethatapersonusingawhitecaneorguidedogistotallyblind.Manypeoplewithsome remaining vision use these.

Donotassumethat,becauseapersoncanseeonething,theycanseeeverything.Ifnecessary,askthepersoniftheycanseeaparticularlandmarkorobject.

Neverdistractaguidedogwheninharness.

Donotpointifyouaregivingdirections.Giveclearverbaldirections;forexample,“thedooristoyourleft”.

Ifyouhavebeentalkingtoapersonwithsightloss,tellthemwhenyouareleaving,sothattheyarenot left talking to themselves.

Explainprocedurestosomeonewhocannotseewhatyouaredoing. • Clearlyexplainalltheproceduresandwhatwillbedonestep-by-step • Ifapersonisaskedtolieonanexaminationcouch,giveclearverbalinstructionsaboutwhatwill

happen,wherethecouchisandwhatthepersonshoulddo • Tellthepersonwhatpartsoftheirbodyyouwillexamineandwhereyouwilltouch • Ifyouaregivinganinjectionoraneedleprick,explainwhereyouwillputtheneedleandwhatwill

happen(forexample,drawingblood,insertingadriporgivingsedation) • IfapersonishavinganMRIscanorx-ray,explainallproceduresclearlyandletthepersonknow

whenyoumovebehindascreenorintoanotherroom

Whenservingfood,staffshould: • Tellpeoplethatthemealhasarrivedandhasbeenplacedinfrontofthem • Identifythefoodontheplateusingtheclocksystem,ifapersonhasavisualimpairment;for

example,“themeatisatsixo’clock,beansatthreeo’clockandpotatoatnineo’clock”

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Helpful hints • Iffoodisservedonatraythathasagoodedge,anythingspilledwillstayonthetray • Agoodcolourcontrastbetweenadrinkanditscontainerisusefultoavoidaccidents-brightly

colouredcupsmaybeseenmoreeasily.Forexample,aglassofwatermaynotbeeasilyseen;teainawhitemugiseasiertoseethaninabrownmug

TheNationalCouncilfortheBlindofIrelandhasdevelopedspecificinformationresourcesforhealthcareprofessionals,whichcanbeaccessedathttp://www.ncbi.ie/information-for/health-professionals.Thetopicscoveredinclude:

For All Health Professionals • GuidingaPersonWithaVisionImpairment • GettinginTouchWithourServices

NursingStaff • AssistingAdultsWithSightLossinHospital • AssistingChildrenWithSightLossinHospitalandatthe

Doctor’sSurgery CareStaff • PracticalTipsforCareStaff • LeisureActivitiesforDayCentres

PublicHealthNurses • OlderPeopleWithSightLoss–LivingatHome • PracticalTipsforCareStaff

Occupational Therapists • OlderPeopleWithSightLoss–LivingatHome • PracticalAdviceforEverydayLiving • ChangesinYourOwnHome

4.8 Communicating with a person who is hard of hearing or Deaf

Aperson’shearingmaybeaffectedatanystageoftheirlife,fromthetimeofbirthorintheirlateryears.Lossofhearingmaybeaninvisibledisability.

PeoplewhohavegrownupwithhearinglossmayhaveIrishSignLanguage(ISL)astheirprimarymeansofcommunication,andthesearetermedtheDeafcommunity.AsEnglishisconsideredtheir

49


secondlanguage,somehavedifficultywithwrittenEnglish.ItisimportanttouseplainEnglish,andtoprovideinformationinsimple,concreteterms.Visualaidsarealsohelpful.

Peoplewhoexperiencehearinglossastheygrowoldermayrelyonhearingaids,onlip-readingoronwritteninformation.TheygenerallywillnothavelearnedIrishSignLanguage.

LearningafewbasicsignsofIrishSignLanguagecanhelpDeafpeoplefeelathomeandwelcome.The Irish Deaf SocietyhasproducedaDVDcalled“Everydaysignedvocabularyinmedicalsettings for service user care”,andabookletof“Basic Medical Signs for Irish medical institutions on common medical sign language for service user care”.YoucanfindbasicsignsandinformationaboutIrishSignLanguageclassesonwww.IrishDeafSociety.ie

InthePalliativeCaresetting,thetypeofinformationthatneedstobeconveyedcanbedifficult.Manypatientswishtoknowabouttheirdiagnosisorprognosis;however,othersmayprefertonegotiateagradualdisclosureofinformation.Muchofpalliativecarepracticeisaboutsymptommanagement,requiringaccuratehistorytaking.ThiscanbemoredifficultwhenaserviceuserisDeaf.Inthisregard,itisimportanttoensurethatanISLInterpreterisavailabletointerpret.

Itisthoughtthat,whenapersonisdying,thepersonmaystillbeabletoheardespitebeingveryweakandmainlysleeping,andmanyhealthcareprofessionalscontinuetospeakwiththepersontoprovidethemwithreassuranceandsupport.WhenapersonisDeaf,itisimportanttobemindfulthatotherformsofcommunication,suchastouch,mayconveyemotionalsupport.However,itcanbehelpfultocheckwiththepersonortheirfamilyinadvanceastowhetherornottheywouldbecomfortablewithtouch.

General points

• Askifsomeonecanhearyouclearly;donotassumethattheycan • Askthepersonwithahearingdifficultyhowtheywanttocommunicate.Thiscouldbespoken

English,writtenEnglish,IrishSignLanguageorcommunicationappropriatetosomeonewhoisdeafblind

• Youmayneedtotaptheperson’sarmgentlytogettheirattention.Iftouchisnotappropriate,youmayneedtouseanotherapproach;forexample,inthecaseofaburnvictimyoumightwaveyourhandintheirlineofsightorswitchalightonandoff

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• Wherepossible: - provideinductionloopsystemsforhearingaidusersoraportablelisteningdeviceforhardof

hearingserviceusers,andtestthemregularly - providewrittenversionsofanyaudionoticesandcommunications - supporttheinformationgiveninconversationwithwrittenhandouts - andprovidediagramsorpictureswhichmaybeusefulinsupportingtext. • Makesurethatonlyonepersonspeaksatatime • Usegestures,bodylanguageandfacialexpressionstoemphasisethesenseofwhatyouare

tryingtocommunicate;forexample,nodratherthansaying“hmmm”toshowyouarelistening.Takecarethatthesedonotappearover-exaggeratedorpatronising

4.9 Communicating with a person who lip reads

Get and keep the person’s attention • Gaintheperson’sattention;forexample,taptheperson’sarmgentlytogettheirattention,wave

yourhandintheirlineofsightorswitchalightonandoff • Talkdirectlytotheperson

Position yourself well • Positionyourselfthreetosixfeetfromthepersonandatthesamelevelasthem • Makesureyourfaceisingoodlightwhileyouspeak.Donotstandwithalightorawindow

behindyouasshadowsmaymakeitdifficulttoreadyourlips • Checkwiththepersonthattheycanseeyouclearly • Minimiseanybackgroundnoise

Assist the person to see your face and lips • Makesuretheyhaveaclearviewofyourfaceandlips • Donotcoveryourmouthorhaveanythinginorcoveringyourmouth;forexample,chewinggum,

pen,paper,hands • Keepyourheadstillwherepossible • Stoptalkingwhenlookingdownoraway

Speak clearly • Letthepersonknowthetopicofconversationandsignalanychangeintopicbypausing • Speakatamoderatepaceandmaintainanormalrhythmofspeech

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• Donotshoutbecausethiscandistortyourlippatterns • Donotover-emphasisemouthmovementsasthiswilldistortyourlippatterns • Sentencesorphrasesareeasiertounderstandthansinglewords • Ifawordorphraseisnotunderstood,usedifferentwordswiththesamemeaning

Assist the person to understand • Knowthatlipreadingistiring • Allowtimeforthepersontotakeinwhatyouhavesaid • Usenaturalbodylanguageandfacialexpressionbutavoidexaggeratedgestures • CheckwiththeDeaforhardofhearingpersonregularlytoensuretheyunderstand.Some

healthcareprovidersmakethecommonmistakeofpresumingDeaforhardofhearingpeoplecanlipread.Thisisnotalwaysthecase.Evenifthepersoncanlipread,accuracyinlipreadingisestimatedat30%,resultingindisproportionatelyhighratesofmiscommunicationandmisunderstanding.Thismayhaveveryseriousimplicationsformedicationmanagementorinthefollowupcareofacondition

• Someofwhatyousaymaybemissed–supplementwhatyousaywithwritteninformation,notesanddiagrams.Whenyouwritesomethingdown,useplainEnglish

4.10 Communicating in writing with a Deaf or hard of hearing person

• Askthepersonhowtheywouldprefertocommunicate • Penandpaper,textmessaging,e-mail,speedtextandwrittenhandoutsofinformationprovided

areusefulwaystocommunicatewithsomeonewhoisDeaforhardofhearing • Ifusinge-mailortextmessagestoarrangeanappointment,ensureanye-mailsystemortext

messageservicecanreceivereplies(ratherthanano-replynumberore-mailaccount)sothatpeoplecanrespondandcandiscussaccessrequirementsforanupcomingappointment.Ifnot,makealternativearrangementstoenableareply

• Alwaysfollowclearprintguidelines.(Seethewww.ncbi.ieforfurtherinformation) • Ifthepersonwantstocommunicatebynote-writing: - Bepatient,itmaytakelonger - AlwaysuseplainEnglish - Ensureyourhandwritingisclearandlegible - Allowthepersontokeepownershipofthenotes - Asktheperson’spermissionifyouwanttousethenotesaspartoftheirtreatmentplan;and - Treatallhandwrittencommunicationsasyouwouldaprivateconversation

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4.11 Communicating with a person who uses Irish Sign Language

SomeDeaforhardofhearingpatientsandserviceusersuseIrishSignLanguage(ISL)astheirfirstlanguageandpreferredmethodofcommunication.NoteveryonewhosignswilluseISL;forexample,someonefromEnglandwhoisonholidaywilluseBritishSignLanguage(BSL),anAmericanwilluseAmericanSignLanguage(ASL),andtheyareallverydifferent.

Patientsandserviceusersareentitledtorequestandbeprovidedwithaqualifiedsignlanguageinterpreter.Whiletheonusisontheserviceusertorequestaninterpreter,itistheresponsibilityofstafftomakethearrangements.Staffshouldroutinelyletserviceusersknowthat:

• theyhavetherighttoaninterpretertoassistincommunication • thereisnocosttotheserviceuser;and • staffwillarrangefortheinterpreter

Itisconsideredgoodpracticeforservicestoarrangeaninterpreterwithoutbeingpromptedincaseswhererepeatvisitsarenecessaryorwhereitisknowninadvancethattheserviceuserneedsone.

Notprovidingaqualifiedsignlanguageinterpreterwhendeliveringcaretoapatientorserviceuserplacesthehealthorsocialcareproviderinaprecarioussituation:

• informationmaybemisinterpretedormisunderstoodwhichmayleadtoapotentialadverseoutcomeforthepatientorserviceuser;or

• thelackofprovisionofaqualifiedsignlanguageinterpretermayresultininvalidconsentforinvasivemedicalorsurgicalprocedures

Aninterpretermayalsobenecessaryiftheprimarycareroradvocateofapatient/serviceuserisDeaf;forexample,Deafparentswithachildwhocanhear.

TheHSEguidancedocumentonusinglanguageinterpreters,‘On Speaking Terms’,isavailableonwww.hse.ie

IfitisnotpossibletogetanIrishSignLanguageinterpreterinanemergencyoronshortnotice,itcanbehelpfultohaveastandardpre-preparedlistofwrittenquestions,picturesandsymbolsthatyoucanusetocommunicatewithapersonwhoisDeaf.Thequestionsorpictu

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