National Guidelines on Accessible Health and Social...

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: Caoimhe.Gleeson@hse.ie

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

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

ii iii

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: Developing disability competence 30 2.1 Buildingcapacityandunderstandingforallstaff 30 2.2 Onlinetrainingresource 31 2.3 Tailoreddisabilitytraining 31 2.4 Professionaleducation,trainingandprofessionalstandards 31

3. Guideline Three: Accessible services - general advice 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

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

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: Accessible hospital services, including out-patient departments 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

12. Guideline Twelve: Accessible maternity services 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

Acknowledgements

Wewouldliketotakethisopportunitytothankallofthosewhogavetheirtimesogenerouslyindevelopingthisdocument.Wewouldliketoacknowledgeinparticularthehardwork,guidanceandpatienceofthemembersoftheHSEUniversalAccessSteeringCommitteeandallthosewhoseexpertiseandexperiencewascriticaltothedevelopmentofthisdocument.

Thanksalsotoallofthestaffandserviceuserswhomadesubmissionsduringtheconsultationphaseofthisworkandwhoweresignificantstakeholdersinthedevelopmentoftheseguidelines.

Wewouldalsoliketothankinadvanceallthosewhowill,inthecomingmonths,readandimplementtheguidelines.WehopethattheNational Guidelines on Accessible Health and Social Care Serviceswillbeausefulguideforstaffand,inturn,willmakearealdifferencetotheserviceuser’sexperienceofhealthandsocial care services in Ireland.

Foreword

The Disability Act 2005isapositiveactionmeasure,whichprovidesastatutorybasisformakingpublicservicesaccessible.Itgiveseffecttotheunderlyingprinciplethatmainstreampublicservicesprovidedtothegeneralpublicmustalsoservepeoplewithdisabilitiesasanintegralpartoftheservicetheyprovide.

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

Thisdocument,theNational Guidelines on Accessible Health and Social Care Services has been writtentogivepracticalguidancetoallhealthandsocialcarestaffabouthowtheycanprovideaccessibleservices.Whiletheseguidelinesrefertospecificdisabilities,ifwetakestepstoroutinelyprovideaccessibleservicesforall,wewillpositivelyinfluencetheexperienceofeverybodywhousesourservices.

TheethosofaccessibilityisreinforcedbyAFutureHealth,AStrategicFrameworkforReformoftheHealth Service 2012 - 2015,publishedbytheDepartmentofHealthinNovember2012;bylegislationsuchas the Disability Act 2005,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.

WelookforwardtoservicesworkinginpartnershiptoensurethattheNational Guidelines on Accessible Health and Social Care ServicesmakeapositivedifferencetotheexperienceofallthosewhouseIreland’shealthandsocialcareservices.

Tony O’Brien Siobhan Barron Director General Director HealthServiceExecutive NationalDisabilityAuthority

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 Some key facts about disability in Ireland:

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

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.

We need to be aware that there are both visible and hidden disabilities • Visible disabilities:Sometimes,itisveryobviousthatapersonhasadisability,suchasablind

personwhousesawhitecaneorsomeonewhousesawheelchair • Hidden disabilities: Itisnotimmediatelyobviouswhensomeonehasahiddendisability.

Notallpeoplewhohaveavisualimpairmentneedawhitestickoruseaguidedog.Someone’sappearancewillnottellyouiftheyhaveepilepsy,oriftheyarelikelytogetpanicattacks

Extract from: NDA document “Providing public services to people with disabilities.

A Self-Study Guide” • ThemostcommontypesofdisabilityinIrelandaremobilitydisabilities • About184,000peoplehavedifficultywalkingmorethan15minutes • About31,000peopleuseawheelchair.Manymorepeople–about83,000–usewalkingaids,

or a stick • OthercommondisabilitiesinIrelandaredealingwithpain,difficultyrememberinginformation,

orhavingmentalhealthdifficulties • Somepeoplearebornwithadisability • Manymorepeopledealwithatemporarydisabilitybecauseofinjuriesorillness

1.3. A range of solutions

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

2. Purpose

2.1 Purpose of guidelines

The purpose of these guidelines is to: • assisthealthandsocialcareproviderstocomplywithlegalobligationsundertheEqual Status

Acts,theDisability Act 2005,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

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 for disability organisations.

3. Scope

These Guidelines were developed in a partnership between the National Disability Authority and 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.

4. Legislation and related policies, procedure and guidelines

4.1 Overview of legislation and other related healthcare policy

Itisalegalrequirementtoprovideaccessiblehealthandsocialservicesforserviceusers.Thefollowingsection,whilenotexhaustive,setsoutthekeypiecesoflegislationandpolicywhichareimportantinprovidingaccessibleservicesforpeoplewithdisabilities.

The National Guidelines on Accessible Health and Social Care Servicesarewrittento

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 of Consumer Feedback to include Comments, Compliments and Complaints; On Speaking Terms;theMedicalCouncilGuidetoProfessionalConductandEthicsforRegisteredMedicalPractitioners; the Disability Act 2005 and the Health Act 2004.

The National Guidelines on Accessible Health and Social Care Serviceswillbereviewedatregularintervalstoensurethatthecontentofthedocumentisinlinewithnewpolicychangesordevelopmentsinhealthcare.

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.

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.”

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

The Equal Status Acts 2000 - 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.

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

Part 3, Disability Act 2005(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 National Disability Authority Code of Practice and Guidance

ThereisastatutoryCode of Practice on Accessibility of Public Services and Information provided by Public Bodies6whichgivesguidanceonhowtocomplywiththeDisabilityActrequirements.CompliancewiththeCodeofPracticeistakenascompliancewiththeAct.

5 Thelegaldefinitionofdisabilityinrelationtoapersonmeans“asubstantialrestrictioninthecapacityofthatpersontocarryonaprofession,businessoroccupationintheStateortoparticipateinsocialorculturallifeintheStatebyreasonofanenduringphysical,sensory,mentalhealthorintellectualimpairment”

6 http://www.nda.ie/Website/NDA/CntMgmtNew.nsf/0/3DB134DF72E1846A8025710F0040BF3D/OpenDocument

Forfurtherinformation,seetheGuidetotheDisability Act 2005 (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

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.

5. Glossary of Terms / Definitions

5.1 Glossary

IntheseGuidelines,theterm‘accessible’meansuser-friendlyforpeoplewithdisabilities.

Accessible building Anaccessiblebuildingisonethatpeoplewithdisabilitiescanreadilyenter,movearound,use

comfortablyandexitsafely.

Accessible communication Accessiblecommunicationmeanscommunicatingwithpeoplewithdisabilitiesinwaystheycan

readilyfollow.

Accessible information Accessibleinformationmeansthatpeoplewithdisabilitiescanreadilyaccessandunderstandit.

Accessible service Anaccessibleserviceisonewhichisgearedtoservepeoplewithdisabilitiesalongsideother service users.

Disability Thelegaldefinitionofdisability,assetoutintheDisabilityAct2005,usedinrelationtoaperson

means“asubstantialrestrictioninthecapacityofthatpersontocarryonaprofession,businessoroccupationintheStateortoparticipateinsocialorculturallifeintheStatebyreasonofanenduringphysical,sensory,mentalhealthorintellectualimpairment”

Easy to read EasytoReadisthetermforverysimplifiedtextwithpictures,whichisimportantforpeoplewith

literacyproblemsorlimitedEnglish.

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.

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: Making Progress Together, 2000 - People with Disabilities in Ireland Ltd.

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

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

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 Disability Act 2005.

6. Roles and Responsibilities

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

6.3 AccessOfficerrole

TheappointmentofAccessOfficersisalegalobligationunderPart3oftheDisability Act 2005. TheActrequiresthatAccessOfficersbeappointedtoallsiteswherethegeneralpublicusehealthandsocialservices.TheActalsoextendstoorganisationsthathaveaserviceagreementwith theHSE;forexample,thoseorganisationsthatarefundedunderSection38and39oftheHealth Act 2004.

Section26(2)oftheDisability Act 2005 requireshealthandsocialcareservicestoauthoriseatleastonememberofstafftoactasan‘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.

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

Part One

Guidelines for all Health and Social Care Settings

Theguidelinesdescribeastandardwhichwecanaspireto.Theyarewrittenintheknowledgethatservicesmaynothavefinancialresourcestoimplementallmeasuresoutlined;however,thereisanobligationonindividualstoensurethattheyknowwhatisrequiredofthembylaw.Theyalsoserveasaresourceforhealthandsocialcareprofessionalswhomaybeplanningservicesinthefuture.

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

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

Fig. 1: Developing

accessible services

1. Guideline One

Consultwithindividuals,advocates,disabilityorganisationsandstaffworkingcloselywithindividualstoidentifypatientandserviceuserneedsinyourarea.8

• Asksimplequestionstofindoutifserviceusershaveanyspecificrequirementsthatmustbeaccommodated;forexample,“Isthereanythingwecandotoassistyou?”

• Becomeawareofwhatcouldconstituteobstaclesordifficultiesforpeoplewithdisabilitiesusingyourservices

• Withtheconsentofthepersonwithadisability,familymembers,carersorsupportworkersmayalsobeabletoguideonanyspecificneeds

Listen

Recognisethatpeoplewithdisabilitiesandstaff,familymembers,personalassistants,advocatesanddisabilityorganisationsworkingcloselywithindividualsareoftenexpertsinpatientandserviceuser needs.

• Listenattentivelytotheirfeedback • Listentoanysuggestionsmadeforaddressingtheirrequirements

Ensurethatyouhavesufficientinformationtohelpyoutoimproveserviceprovision. • Completeanynecessaryresearchsothatyoucanlearnabouttherequirementsofindividuals • Readtherelevantpolicies,procedures,guidelinesandlegislation

8 TheNationalAdvocacyUnitprovidesguidanceonserviceuserinvolvementandparticipation.

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

• Setoutaprogrammeofactiontoaddressidentifiedissues • Developaplaninconsultationwithrelevantpeopletosupportyoutomaketheservicesyou

providemoreaccessible • Setoutclearprotocolsandguidanceforstaff • Buildincoordinationacrossdifferentlevelsofcare • Setoutrolesandresponsibilities • Establishandembedpolicies

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

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

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

2.2 Online training resource

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

2.3 Tailored disability training

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

Accessible services - general advice 3.1 Do not assume - ask

Peoplewithdisabilitiesaregenerallyexpertsontheirspecificaccessibilityrequirements.Noteveryonewithadisabilityneedsassistanceandanaccessibilityneedmaynotbeapparent,soitisimportantto:

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

thekindofhelpthatisneeded • Notbeoffendedifyourhelpisnotaccepted,asmanypeopledonotneedanyhelp;and • Documentanyrelevantaccessibilityorcommunicationresourcesorrequirements

Donotassumethatapersonwithadisabilitywouldbeunabletoanswerquestionsabouttheirhealthortheirsymptoms.Askthepersonthemselvesinthefirstinstance.

3.2 Making an appointment

Identify any accessibility requirements 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.

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

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 Plan visits for routine check-ups or surgery in advance

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

Contactthepersonbeforeadmissionandprovidethemwithanopportunitytoinformyouofanyaccessibilityrequirementstheywillhaveontheday.

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

Letotherstaffknowwhenandwherethepersonisarrivingandwhattheplanis.

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.

Ifpossible,itmaybehelpfultoprovidetheoptionfortheformtobeaccessedandcompletedon-lineinadvanceofanappointment.

3.8 Information and notices

Provideinformationabouthowyoucanaccommodatesomeone’sdisability;forexample: • Contactdetailsforthepersonwhowilldealwithqueriesaboutaccessibilityifyoucannotanswer

theirquery • Thesymbolforahearingloop,ifavailable • AnoticeaboutyourpolicyonGuideDogsandAssistanceDogs;and • AnoticeontheprovisionofanIrishSignLanguageInterpreteronrequest

3.9 Mobility aids

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.

• 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’(seewww.hse.ie/eng/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.

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 quick reference guide”.

“Discharge and transfer from hospital—The nine steps quick reference guide”.

Step one: Begin planning for discharge before or on admission 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.

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.

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

treatmentplanandELOS/PDDaredocumentedinthehealthcarerecord(SDU,2013) • Anyproblemsoractionsrequiredareidentifiedandareescalatedorresolvedasnecessary

Step eight: Use a discharge checklist 24 – 48 hours before discharge 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

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

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%non verbal

(bodylanguage)

COMMUNICATION SKILLS

4.2 Establish how the person prefers to communicate

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

Verbal communication • 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-verbal communication - positive body language • 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

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

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

COMMUNICATINGwITHAPERSONwHOHASADISABIlITY

4.5 Communicating with a person who is unable to stand or who uses a wheelchair

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.

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

• 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”

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

Public Health Nurses • 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

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

Peoplewhoexperiencehearinglossastheygrowoldermayrelyonhearingaids,onlip-readingoronwritteninformation.TheygenerallywillnothavelearnedIrishSignLanguage.

LearningafewbasicsignsofIrishSignLanguagecanhelpDeafpeoplefeelathomeandwelcome.The Irish Deaf SocietyhasproducedaDVDcalled“Everyday signed vocabulary in medical settings 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

• 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

• 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

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.Thequestionsorpicturesshouldreflecttheusualquestionsyouaskwhensomeoneisadmittedtohospital,suchas“wheredoesithurt?”,“doyouhaveprevioushealthconditionsthatweshouldknowabout?”,or“areyouonany

medication?”MakesurethatthequestionsarewrittenclearlyandinplainEnglish.

TobookandISLinterpreter,seewww.slis.ieore-mailbookings@slis.ie.Youmayneedtobookaninterpreteruptotwoweeksinadvance.

4.12 Irish Sign language interpreters

SignlanguageinterpretersaretheretotranslatebetweenIrishSignLanguageandEnglish.TheyinterpretforboththeDeafpersonandhealthandsocialcarestaff.

ProfessionalIrishSignlanguageinterpreters: • WorktoaCodeofEthicsandProfessionalConductwhereconfidentialityisacorevalue • Translatenotonlythewordsbutalsotheculturalmeanings;and • Aretrainedtobeimpartial.Donotexpectthemtogiveapersonalopinionofapatient

Theinterpreterisnotacaseworkeroranadvocate.Theymayintervene,forexample,toasksomeonetosignorspeakmoreslowly,toclarifyunderstandingortoaskthatinformation berepeated.

WiththeconsentoftheDeafpersonandwherepossible,providetheinterpreterwithbackgroundnotesandinformationinadvance.Thiswillenabletheinterpretertocarryouthigherqualityinterpretation.

Allowextratimewhenworkingthroughaninterpreterespeciallyinmedicalsettingswheretermsmaynotbeeasilyunderstood.

MakesurethattheinterpretersitsnexttoyouandthattheDeafpersoncanseebothofyouclearly.

DirectwhatyousayandmakeeyecontactdirectlywiththeDeafperson,notwiththeinterpreter.

Givetheinterpretersufficienttimetotranslatewhatiscommunicated.RememberthataninterpreterhastointerpreteverythingthatbothaDeafpersonandahearingpersonsayduringthecourseofaninterpretingsession.

4.13 Deaf interpreters

DeafinterpretersareDeaforhardofhearingpeoplewhohavebeenprofessionallyrecognisedasaccreditedinterpreters.Contactviabookings@slis.ie.

• TheyhavefluencyinIrishSignLanguageandworkintandemwithIrishSignLanguageinterpretersorDeafadvocates

• Theyareskilledintechniquesofinterpretationandtranslatingmeaningbetweenlanguages and cultures

• Theyhavein-depthknowledgeoftheDeafcommunityandcaninterpretforDeafforeignnationals,forvulnerableDeafindividuals,inmentalhealthsettingsandforDeafindividualswithanintellectualdisability

• Theyworktothesameguidelines,ethicsandstandardsasIrishSignLanguageinterpreters

4.14 IrishRemoteInterpretingService(IRIS)

TheIrishRemoteInterpretingService(IRIS)usesaweb-basedprogrammetoconnecttoacentralinternetserverwhereaninterpreteractsonbehalfofthepractitionerandtheDeafperson.

• Thisison-screenvideointerpretationoveraninternetconnection • Thewebbasedprogrammedoesnotreplacefacetofaceinterpretationandshouldonlybeused

forgenericappointments;forexample,bookinganappointment,checkingtimesordetailswiththeDeafperson

• Ifanappointmentbecomesmoreseriousorrequiresmorein-depthdiscussions,afacetofacemeeting should be booked

• Aserviceproviderorserviceuserwillneedaccesstobroadband,amicrophone,speakersandacamera/videofacilityontheirPCorlaptop

• Contact www.slis.ie

4.15 Deaf Peer Advocates

DeafPeerAdvocatescanassistinbreakingdown,understandingandmakingsenseof information received.

• Theyarenotsocialworkers,carersorsignlanguageinterpreters • Theirroleistoensurethepatientorserviceuser’srightsareupheld.Theyareimpartialandwork

for the best for the client.

4.16 Communicatingwithapersonwhoisdeafblind

Apersonwhoisdeafblindhascombinedsightandhearingloss. • Awhitecanewitharedbandsignifiesthatsomeoneisdeafblind • Apersonwhoisdeafblindneedsaspecialisedinterpreter.Thispersonworksintandemwiththe

deafblindpeeradvocatetoensurethepersonisunderstoodandunderstandswhatisbeingsaid • Apeeradvocateisapersonwhosetouchandcommunicationstyleisknowntothepersonwho

isdeafblindandwhocanrelayinformationtothehealthcareworker • Howtocommunicatewithapersonwhoisdeafblindisanindividualmatter.Thepractitioner

adjuststheirstrategytotheperson’sneedforsupport • Thedeafblindalphabetisasystemtofingerspellwordsontothehandofapersonwho

is deafblind

4.17 Communicating with a person with an intellectual disability

Peoplewithanintellectualdisabilitymayhavedifficultyunderstandinglanguagethatiscomplex,containsabstractconceptsortechnicaljargon.Itisthereforeimportantwhentalkingwithsomeonewithanintellectualdisabilityto:

Speakdirectlytothepersonconcerned. • Ifitisnecessarytoobtaintheinformationfromacarerorfamilymember,maintainthefocuson

thepersonwiththedisabilitythrougheyecontactandbodylanguage

SpeakclearlyandmoreslowlyusingsimpleplainEnglishandshortsentences. • Addressthepersonanduseatoneofvoiceconsistentwiththeirage–sospeaktoanadultas

another adult • Pausefrequentlytoenablethepersontoprocesswhatyouaresaying • Chooseaquietplacewithfewdistractionsifpossible • Giveonlyonepieceofinformationatatime,inshortsentences • Checkyouhavebothunderstood • Don’tpretendtohaveunderstoodwhenyouhaven’t • Usewordsandphrasesfamiliartoall • Makeitclearifyouarechangingthesubject • Don’tignorethepersonorwalkawayifyoudon’tunderstand.Tellthemyoudon’tunderstandso

youaregoingtofindhelp

Somepeoplewithanintellectualdisabilitymayhavetroubleexpressingtheirthoughtsorfeelingssoitisimportanttoprovideenoughtimeforthepersontoreply,commentandformulatetheirquestionsoranswers.

• Askonequestionatatimeandprovideadequatetimeforthepersontoformulateandgive theirreply

• Usevisualcues–suchasobjects,picturesordiagrams–andfacialexpressionandbodylanguagetoconveyinformation,andtotryandunderstandwhatsomeoneistryingtosay

• Ifthepersonusesacommunicationdevice,thenensuretheyhaveaccesstoit,readthedirections(usuallyonorinthedeviceorbook)anduseitwiththem

Somepeoplewithanintellectualdisabilitycanfindithardtorecogniseandcommunicatetheirsymptoms,painordiscomfort.Asaresult,healthandsocialcarestaffmayrelyonfamilymembersorsupportworkerstobringhealthproblemstotheattentionofhealthcarestaffandtoprovideagoodmedicalhistory.

• Itisimportanttoremember,however,thatsupportworkersmayalsobeunawareofsymptomsand,withaturnoverinsupportstaff,maynotalwaysknowthepersonwell

Recognisethatdifficultbehaviourmaybebecausethepersonisinpain,anxious,confused. Theremaybetimeswhenyoudonotunderstandwhatthepersonissaying.Inthissituation,itmaybehelpful:

• Toaskthepersontorepeatwhattheyhavejustsaid • Ifyoucouldaskanaccompanyingsupportworker/familymembertohelpyouunderstandorto

showyouhowthepersonsays“yes”and“no”,andthenaskyes/noquestionstoidentifywhatitistheyaresaying;or

• Ifyoustillcannotunderstand,showrespectforthepersonandacknowledgetheimportanceoftheirmessagebyapologisingforfailingtounderstandthem11

Physicalexaminationmayalsotakelongerduetoacombinationofdifficultieswithcommunication,withaccuratehistory-takingorwithphysicalexaminationduetoanxietyorchallengingbehaviours,andthismeansthatlengthierassessmentsshouldbeplannedfor.

11Someofthismaterialwastakenfromhttp://www.cddh.monash.org/assets/documents/working-with-people-with-intellectual-disabilities-in-health-care.pdf

4.18 Other communication challenges

Patientsandserviceusersmayhaveanumberofdifficultieswhichimpactontheircommunicationskills;forexample:

• Problemsanddifficultieswithsocialinteraction,suchasalackofunderstandingandawarenessofotherpeople’semotionsandfeelings

• Impairedlanguageandcommunicationskills,suchasdelayedlanguagedevelopmentandaninabilitytostartconversationsortakepartinthemproperly

• Unusualpatternsofthoughtandphysicalbehaviour.Thisincludesmakingrepetitivephysicalmovements,suchashandtappingortwisting.Aserviceusercanbecomeupsetifthesetroutines of behaviour are broken or disturbed

• Thecurrentstageofaperson’swellnessmayimpactcommunication.Challengesexperiencedmayreferencetheindividual’sdesireandcapacitytoengageinarecoveryfocussedprocess.Whenapersoniswellthesamechallengesmaynotexist

• Yearsofinstitutionalcarewithinmentalhealthorintellectualdisabilityservices,wherebypeoplemayhavebeendependentonothersbynecessityorbychoice,mayhaveanimpactonhowapersonengageswithstaff.Theymayneedadditionalsupportinastagedandappropriatewayforaperiodtoinitiategreaterparticipationandenablethemtoassumeresponsibilityfordirectingand/ormanagingtheirowncaretothegreatestextentpossible

Patientsandserviceusersmayalsohaveadisabilitywhichresultsinadversereactionstonoise,crowds,waiting,food,andsmellsamongothers.Thismaycausedifficultywhenaccessinghealthorsocialcareservices.Recognisethatpeoplewillhavedifferentlevelsofcomprehension,dependentontheindividualandcircumstances.Inviewofthis,thefollowingaregeneralguidelinesmaybehelpful.

• Considerusingvisualaidstohelp;forexample,pictures,pointing,pictorialtimetables • Explainwhatisgoingtohappenbeforestarting • De-cluttercommunication–beawareofbackgroundnoiseandnothavingoverstimulation • Useclearsimplelanguagewithshortsentences • Usefewwordsinsteadofmanyanduseaslittleabstractlanguageaspossible • Makeyourlanguageconcreteandavoidusingidioms,irony,metaphorsandwordswithdouble

meanings;forexample,“It’srainingcatsanddogsoutthere”.Thiscouldcausethepersontolookoutsideforcatsanddogs.Somepatientsandserviceusersmayinterpretlanguageliterallywhichcancauseconfusion

• Givedirectrequests-suchas“Pleasestandup”ratherthan“Canyoustandup?”-asthismayresultinthepersonstayingseatedoranswering“yes”,asthepersonmaynotunderstandwhatyouareaskingthemtodo

• Giveonecommandatatimeandcheckthatthepersonhasunderstoodwhatyouhavesaid–somepeoplemayspeakclearlybutcanlackfullunderstanding

• Donotoverdependonusingnon-verbalcommunication–beasconcreteaspossible • Allowforextraprocessingtime–somepeopleneedtensecondsormoretoprocesswhatthey

are being asked or told • Ifnecessary,youmayneedtorestatethemessageinanotherwayandemphasisethemost

importantaspectsofthemessage • Donotinsistoneyecontact.Lackofeyecontactdoesnotnecessarilymeanthatthepersonis

notlisteningtowhatyouaresaying • Rememberthatwhenapersonisquitestressed,heorshemaynotlistenorprocessyourwords

until he or she is calm • Donotbepersonallyoffendedifthepersondoesnotappeartoengagewithyou. • Apersonwithsignificantcommunicationchallengesmaybenefitfromahomevisitorapre-visit

tothehealthandsocialcaresettingpriortoascheduledappointmentwherepossible

Thefollowingtableprovidesalistofquestionsthatstaffcanasktohelpthemidentifyaservicesusers communication needs.

Ask yourself: 1. Howmuchlanguagecanthepersonunderstand? 2. Howwelldoesheorsheunderstandthenonverbalaspectsofcommunication? 3. Doesthepersonneedmoretimetoprocessinformation;forexample,willyouneedtoslow

yourrateofspeech,shortensentences,orallowtimeforthepersontoabsorbinformation? 4. Doesithelptowordyourmessageinaparticularfashionordeliveritinaspecificstyle?

Willtheperson“tune-out”peoplewhouseaparticularcommunicationstyle(forexample, assertiveandloud,soft-spokenetc.)?

5. Whatisthebestwayofgettingandkeepinghisorherattentionotherthaneyecontact? (Forsomeindividuals,eyecontactisdifficult).

6. Willbackgroundnoise,otherstimuli(suchaspeople,food,movement,etc.)impactonthe person’sabilitytoprocessamessage?

7. Isthepersonabletoprocessamessagewhenupset?Howdoyouknowthepersonis upsetandwhatcanyoudointhiscase?

8. Willgestures,visualaidsortexttoaidinthecomprehensionofmessages? 9. Doesthepersonhavepersonalspaceboundariesthatshouldnotbeviolated?Thismay

mean no touching or not standing too close. 10. Doesthepersonfindithardtounderstandsubtlereferencesorhiddenmeanings? 11. Hasthepersonbeenininstitutionalcarewithinamentalhealthorintellectualdisability

settingforanextendedperiodoftime?Ifso,theymaybemoredependentonothersby necessityandsometimeschoice.

COMMUNICATION AIDS AND DEVICES

4.19 Communication boards

Manualorcomputerisedcommunicationboardsprovidevisualinformationthatmakeslanguageaccessibleforpeoplewithspeechimpairments.Theydisplaywrittenwords,photographsandsymbols.Asymbolshowingacupcommunicates“I want a drink”,orletterscanbespeltout usingafinger,handorfoot.Theyareportable.Theycanbefittedtoalaptrayforusebyawheelchairuser.

4.20 Communication passports

Communicationpassportsaresometimesusedbypeoplewithanintellectualdisabilityorpeoplewhohavedifficultyinspeakingtorecordtheirviews,preferencesandcommunicationrequirements.

• Theycanoftenhelpstafftounderstandthepersonwithadisabilityandpromotesuccessfulcommunications.Communicationpassportsareawayofmakingsenseofformalassessmentinformationandrecordingtheimportantthingsaboutaperson,inanaccessibleandperson-centredway,inordertosupportaperson’stransitionsbetweenservices

• Theyaimtodescribetheperson’smosteffectivemeansofcommunication,andhowotherscanbestcommunicatewithandsupporttheperson

• Theycandrawtogetherinformationfrompastandpresentandfromdifferentcontextstohelpstaffandothersunderstandthepersoninordertohavesuccessfulinteractions

Forfurtherinformationandtemplatesforcommunicationpassports,referto: http://www.communicationpassports.org.uk/Home/

4.21 Lámh signs

ProvisionofLámhsignscanbeusedtosupportcommunicationswithpeoplewhohaveanintellectualorcommunicationsdisability.LámhisamanualsignsystemusedbychildrenandadultswithintellectualdisabilityandcommunicationneedsinIreland.LámhsignsarebasedonIrishSignLanguage(ISL)andspeechisalwaysusedwithLámhsigns.Forfurtherinformation,refertowww.lamh.org

4.22 Induction loops

Hearinginductionloopsystemsforhearingaidusersaredevicesthatcanbeprovidedinafixedlocationorwornaroundaperson’sneckasaportabledevice.

4.23 Communication aids as part of communication strategy

Itcanbehelpfultousecommunicationaidsaspartofanoverallstrategyforcommunicatingwithpeoplewithspecificdisabilities.Forexample,Lámhsignscanbeusedalongsidecommunicationpassportsandothervisualsupports,suchaspicturesandsymbols,toassistcommunicationswithpeoplewithanintellectualdisability.Assistivetechnology,audioandlargeprintdocumentscanbeusedtocomplementinformationprovidedverballyforpeoplewithimpairedvision.

4.24 Provide information about communication aids available

Letpeopleknowhowtoaccesscommunicationaidsandadaptivetechnology. • Provideinformationaboutthecommunicationaidsyouprovideonyoursectionofthewebsite

andinyourpatientorserviceuserinformationbookletsorleaflets,wherepossible • Providesignsindicatingwhereahearingaidusercanuseaninductionloop • Placeanoticeatreceptionabouthowandwhotocontactinthehealthandsocialcareservice

sothatthestaffmembermaybookanIrishSignLanguageinterpreterinadvance

5. Guideline Five

Accessible information

5.1 Why provide information in an accessible format?

Publicbodiesareobligedbythelegislationtoensure,asfaraspracticable,thatinformationprovidedtopeoplewithahearingimpairment,avisualimpairmentorwhohaveanintellectualdisabilityisprovidedinaformthatisaccessibletothepersonconcerned.

Itisimportanttoprovideinformationinanaccessibleformatwhichisclearandeasytounderstand.Itenablesandempowerspeopleto:

• Findtheservicestheyneed • Makeinformedchoicesanddecisions • Understandmedicalprocedures,treatmentsandafter-care;and • Avoid medication errors

5.2 Information about accessibility of premises and services

Informationaboutaccessibilityofyourpremisesandyourservicesshouldbereadilyavailableandinarangeofformatsonrequest(wherepracticable).

Provideinformationinaccessibleformats-forexample,inyourpatientinformationbookletoronyoursectionofthewebsite-aboutyourhealthandsocialcarefacility.Thefollowinginformation ishelpful:

• Detailsofthelocationofyourpremises,publictransportaccess,carpark,set-downandpick-uparrangements,andofwheretheentranceis

• Thelocationofspecificservicesandfacilities,includingreceptionandwaitingareas,andaccessibletoiletsandzoneswhichhaveanaudioloopsystem(forhearingaidusers)

• Detailsofopeninghours • Detailsofhowtomakecontactorappointments,andofanyaccessibilityarrangements,suchas,

thefacilitytomakeappointmentsviatextmessage;and • Informationaboutwhotocontactforspecificassistanceandhowtocontactthem

5.3 Providinginformationindifferentformats

Askthepersonwithadisabilityhowshe/hewouldlikeinformationtobeprovided.Somepeoplemayneedinformationtobetransmittedinanaccessibleformat;forexample,viae-mailoratextmessageinthecaseofablindpersonwhocannotreadletterssentviapost.

Incaseswherethepatientorserviceuserwillhaveregularcontactwiththeservice,arecordiskeptofthepreferredmethodforinformationprovision.

Whenpreparingprintedinformation,suchasaleaflet,orpostinginformationtoyourwebsite,consideralsohowthiscanbeprovidedinwaysthatareaccessibletopeoplewithdisabilities.Thiscouldincludelargeprint,informationonyourwebsitethatisaccessible,EasytoRead,audio,videoorBrailleoroncolouredpaper.

5.4 Some tips on written information

Getyourkeymessagesacrosswithwritteninformationthatisclear,conciseandsimple.

Ask yourself: Who is your audience? What is your key message to them? Thefollowingguidancewillhelpalso: • WritesimplyandclearlyinplainEnglish • Keepanythingyouwriteaccurate • Avoid using jargon and technical medical language • Alwaysexplainanyabbreviations • Usingaminimumof12-pointfontindocuments(orasadvisedintheHSENationaltemplatesfor

Policies,ProceduresandGuidelines) • Providealarger-printversionforthosewhoneedthis • Aligntexttotheleft(thisisimportantasthespacingofjustifiedtextcancausedifficultiesfor

peoplewithdyslexiawhoaretryingtoassimilatetheinformation) • Provide clear headings • Highlightimportantwordsinbold.Avoidusingallcapitals,italicsorunderlining,asthismakesit

harderforpeoplewithsightdifficultiestomakeouttheshapeoftheword • Keepsentencesshort.Keeponepointtoeachsentence • Useshortparagraphs.Usebulletedlists • Havegoodcontrastbetweenthetextandbackgroundcolours.Donotusepalecolourprint • Usenon-reflectivepaper(forexample,amattfinish);and

• Testthedocumentbeforeyougotoprinttoseeifpeoplewhouseyourservicecanunderstand iteasily

5.5 Large print

Peoplewithimpairedvisionmaybemorecomfortablewithdocumentsinlargeprint,from14pointfontandupwards.

• Largeprintversionsofkeypublicationsandinformationcanbeproducedsimplybychangingthefontsizeinyourwordprocessingsoftware

• Youcanproducelargeprintversionsofleaflets,forms,prescriptions,hospitalmenusorotherdocumentsasrequired

• Askthepersoniftheyrequireinformationinlargeprintandifthereisaparticularfontsize theyrequire

Ensurethatlinksontheinternetsitecanbeaccessedbyvisuallyimpairedpeoplewhohaveareaderontheircomputer.

5.6 Usepicturesandsymbols

Picturesandsymbolscanhelppeoplewhohaveintellectualdisabilitiesandpeoplewhohavedifficultyinreading,orindealingwithsituationsthataredifficulttodiscuss.

Accesstopicturestoexplainsymptomsmaybehelpfulinsomesettings;forexample, amobilephone.

5.7 EasytoRead

‘EasytoRead’meansprovidinginformationthroughverysimpletext,withaccompanyingpictures.Thismakesiteasierforsomepeoplewithintellectualdisabilitiesandpeoplewithliteracydifficultiestofollow.

5.8 Website

Informationonyourwebsiteshouldbeaccessibletopeoplewithsightproblemswhousetechnologytoreadtothemwhatisonthescreen.

Somesimpleguidance: • Makeyourwebsiteeasytonavigate(easytofindtheinformationyouarelookingfor) • Structureyourdocumentsusingheadingsstylesfromyourwordprocessingpackage • Provideatextdescriptionofanyimages–howyouwoulddescribethemtosomeoneoverthe

phone • Makesurepeoplecangetalltheimportantinformationfromyourvideosandaudio,evenifthey

cannot see or cannot hear them • Provideenoughcolourcontrastbetweenwritteninformationanditsbackground;and • Itcanbehelpfultosubtitlevideoclips

TheNationalDisabilityAuthorityhasdetailedadviceonhowtomakeawebsitefullyaccessible. http://www.universaldesign.ie/useandapply/ict or http://accessit.nda.ie.Yourwebmasterandwebdevelopershouldbefamiliarwiththesestandardsandthisadvice.

• EnsureeverythingonyourwebsitemeetstherecognisedaccessibilitystandardwhichisLevelAAconformancewiththeWebContentAccessibilityGuidelines2.0

• Allyourcontent,includingwordandpdfdocuments,maps,audio,videoandhtmlcontent,should meet these standards

• Itispossibletohavetheaccessibilityofyourwebsiteindependentlychecked

5.9 Video and audio

KeepCDsorDVDsandonlinevideosoraudiosshortsothatpeoplecanfinditeasiertoabsorbandremember the information.

Provideavoice-over(audiodescription)sosomeonewithimpairedvisioncanfollowavideo.

Providesubtitles,tohelppeoplewhoarehardofhearing.

AvideoinIrishSignLanguageisagoodwaytoprovideinformationtotheDeafcommunity.

ConsiderincorporatingLámhsigns.

5.10 Braille

Brailleisawritingsystemofraiseddotsthatarereadbytouch.Withnewertechnologiesavailable,thedemandforBrailledocumentsisrelativelylow.HaveanarrangementinplacetoconvertdocumentsintoBraillewherepracticableifthisisrequested.

5.11 Further information

Guidelines on accessible information and accessible formats

Making health information easier to understand and guidance for using plain English

Accessible information using symbols and pictures

Accessible information for Deaf or Hard of Hearing people

AccesstoInformationforAll,CitizensInformationBoard www.citizensinformationboard.ie/publications/social/social_access_info_contents.html

NationalDisabilityAuthorityguidancewww.accessibility.ie/MakeYourInformationMoreAccessible/

Forinformationonhowtowrite,prepareanddesigndocumentsinplainEnglish,see:www.simplyput.ie

MakeitEasy:aguidetopreparingeasytoreadinformationhasbeenpreparedbytheAccessibleInformationWorkingGroup,whoworkwithadultswithintellectualdisabilitiesinIreland.Available at: www.walk.ie

TheNationalAdultLiteracyAssociationhasinformation onmakinghealthinformationeasiertofollow: www.citizensinformationboard.ie/publications/social/downloads/AccessToInformationForAll.pdf

EasyInfohasresourcestohelpmakeaccessibleinformationforpeoplewithintellectualdisabilities,includingguidanceonhowtousesymbolsandpicturesandmakingdocumentsEasy-to-Read: www.easyinfoforus.org.uk

Organisationsthatprovidesymbolsinclude: • Change Picture Bank (www.changepeople.co.uk); • Photosymbols(www.photosymbols.co.uk);and • Boardmakercommunicationsymbols (www.mayer-johnson.com)

Further information Reference

Accessible information for blind people

Accessible information where Englishisnotafirstlanguageand translation is required

ContacttheNationalCouncilfortheBlindofIreland’smediacentreforfurtherguidanceonhowtoprovidealternatives,includingBrailleandgoodqualityaudio,forpeoplewithimpairedvision: www.ncbi.ie

TheIrishDeafSocietyhasfacilitiesforproducingsignedvideosand DVDs: www.irishdeafsociety.ie

www.lenus.ie/hse/bitstream/10147/207010/1/Lostintranslation.pdf

Accessible buildings and facilities

6.1 Generalinformation

Publicbodiesareobligedbythelegislationto“…ensurethatitspublicbuildingsare,asfaraspracticable,accessibletopersonswithdisabilities”

Peoplewithdisabilitiescanfaceparticularchallengesgettinginto,movingaroundandusingthefacilities of some buildings.

Thechallengesmaybesomewhatdifferentforpeoplewhowalkwithdifficulty,thosewhousewalkingaids,wheelchairusers,peoplewithavisualimpairment(peoplewhohavedifficultyseeingorpeoplewhoareblind),peoplewithhearingdifficultiesorpeoplewithintellectualdisabilities.Therearearangeofdifferentfeaturesthatarerequiredifabuildingistobefullyaccessible.

Buildingmanagersshouldensurethatthepremisesaredesignedtobeaccessibleandthataccessibilityismaintained.

Thoseresponsibleforcommissioningequipmentshouldensurethatthewiderangeofneedsandcircumstancesiscateredfor,includingpeoplewithdisabilities.

Askpeopleabouttheirphysicalaccessrequirementssothatanindividual’srequirementcanbemetwherepracticable.

Provideinformationaboutthephysicalaccessibilityofyourpremisesandyourservice,includingaccessibleaidsandequipment,inanypatientinformationmaterialoronyourwebsite.

DetailedtechnicalguidanceondifferentaspectsofphysicalaccessibilitycanbefoundintheNationalDisabilityAuthority’sBuildingforEveryonehttp://www.universaldesign.ie/buildingforeveryone

6. Guideline Six

6.2 Providinginformationabouttheaccessibilityofpremisesandfacilities

Informationabouttheaccessibilityofyourpremisesandyourservicesshouldbereadilyavailableandinarangeofformatsonrequest(wherepracticable).

Provideinformationinaccessibleformats;forexample,inyourpatientinformationbooklet,oronyoursectionofthewebsiteaboutyourhealthcarefacility.Thefollowinginformationishelpful:

1. Detailsofthelocationofyourpremises,publictransportaccess,carpark,set-downandpick-uparrangements,andofwheretheentranceis.

2. Thelocationofspecificservicesandfacilities,includingreceptionandwaitingareasandaccessibletoiletsandzoneswhichhaveanaudioloopsystem(forhearingaidusers).

3. Detailsofopeninghours. 4. Detailsofhowtomakecontactorappointments,andofanyaccessibilityarrangements,suchas

thefacilitytomakeappointmentsviatextmessage. 5. Informationaboutwhotocontactforspecificassistanceandhowtocontactthem.

6.3 Pointstoconsider–Achecklistforaccessiblebuildingsandfacilities

Thefollowingtableisachecklist.Itprovidesalistwhichservicescanusetosupporttheprovisionofaccessiblebuildingsandfacilities.Itshouldbenotedthatthisisnotanexhaustivelistandcanbeaddedtoforeachareaasrequired.

Thelistdescribesastandardtoaspireto.Itiswrittenintheknowledgethatservicesmaynothavefinancialresourcestoimplementallmeasuresoutlined;however,thereisanobligationonindividualstoensurethattheyknowwhatisrequiredofthembylaw.

Points to consider A checklist for accessible buildings and facilities Yes No

General points

1. Canpeoplewithdisabilitiesgetintoyourbuildingeasily?2. Canpeoplewithdisabilitiesmovearoundthebuildingeasily,andfindtheirwayto

wheretheyneedtogo?3. Canyouevacuatepeoplewithdisabilitiessafelyinanemergency?4. IsthereawarningsysteminplaceforDeafpeoplewhocannothearanyalarms?

A checklist for accessible buildings and facilities Yes No

5. ArethereaccessibleWCswherepeopleneedthem?6. Isyourfurnitureandequipmentsuitableforpeoplewithdisabilities?7. Haveyousystemsinplacetoensureaccessibilityofyourpremisesandfacilities

ismaintained?

Entrance and approach

8. Isthereaset-downandpick-uppointthatisclearlysign-postedclosetotheentrancetothebuilding?

9. Arethereaccessibleparkingbaysclosetotheentrance?10. Isthereoneormoreparkingmeterorpaymentmachinewhichcanbeoperated

whenseated?11. Isthereanunobstructedroutefromparkingorpublictransporttotheentrance?12. Isthereanon-slippathwaywithdishedkerbsandwithtactilesurfacesat

crossingpoints?13. Istherealevelstep-freeentrancetothebuilding?Otherwise,thereshouldbe

bothstepsandagentlerampattheentrancewithcontinuoushandrails.Acontrastintextureofthepavingwillletsomeonewithavisualimpairmentknowtheyareattheentrance.

14. Arerampsnosteeperthan1:20,andpreferablynolongerthan10meters?15. Arestepsnon-slipandmarkedalongtheedges?Isthereclear,well-litsignage

withgoodcolourcontrast?16. Aretheentrancedoorseasytoopenordotheyopenautomatically?17. Ifthereisadoublesetofdoorstominimisedraughtsatanentrance,isthere

enoughspacebetweentheouterandinnerdoorsforsomeonewithlimitedmobilityorawheelchairusertonegotiate?

18. Aredoorhandlesvisibleandeasytouseandataheightwhichawheelchairusercanaccess?

19. Ifthedoordoesnothaveaself-lockingdevice,aretherepull-handlestoclose thedoor?

20. Aretheredoorentrycontrolsystems,suchasintercoms,wherenecessarythathavefeaturesthatworkforpeoplewhohavevisionorhearingimpairments?

21. Isthereadesignatedareaoutsideforaguidedogtorelievehimself? Foyer,receptionandwaitingareas 22. Isthereclearsignageshowingwheretofinddifferentservicesandfacilities?23. Isthereceptiondeskclosetotheentranceandinalocationtominimiseinternal

andexternalnoise?24. Isthereatwo-tierheightreceptiondeskthatcanserveboththosewhoare

standingandthosewhoareseated(includingwheelchairusers)withadequatekneespace?

25. Isthereachairatthereceptiondeskforthepersonmakinginquiries?26. Isthereasuitable-heightsurfaceforsigninganyforms?27. Istherealoopsystematreceptiondeskstofacilitatethosewithhearingaids?28. Isthereaportableloopsothataserviceusercantakealoopfromoneroom

toanother?29. Istheregoodlightingonthereceptionist’sfacetofacilitatelip-reading?Avoid

lightingbehindthereceptionistwherepossible.30. Isthereadequatespaceforbothmanualandpoweredwheelchairstoenterand

turnaround?31. Isthereadequateseatinginanywaitingarea?Wherepossible,providesome

witharmreststhatareeasiertostandupfrom.32. Doesthelayoutoftheseatingenableawheelchairusertositbeside

acompanion?33. Arewrittennoticesinlargeprint,inacleartypeface,withgoodcolourcontrast

andonamattbackgroundtoreduceglare?34. Areleafletdisplaystandsaccessibletopeoplewhoarestandingorwho

usewheelchairs?35. Canpeoplewithlimiteddexteritytakealeafletfromaleafletdisplaystandeasily?36. Istherespaceforaguidedogclosetotheseatinginwaitingareasandawater

bowlifrequired?

General areas and circulation

37. Aretherenon-slipfloorsurfacesthataredry,well-maintainedandeasytousebysomeoneoncrutches,withawalkingaidorinawheelchair?

38. Aretherecontrastsincolourandtextureforfloorcoveringstodefinedifferentareasofthebuildingortomarkaroute?

39. Aredoorways,corridorsandcirculationspaceswideenoughforpoweredormanualwheelchairuserstonavigateandturn?

40. Arecorridors,waitingroomsorwardsfreeofanyobstaclesthatcouldrestrictmobilityorcauseinjury?Checkthattrolleys,cleaningequipmentorwall-mountedobjectslikefireextinguishersorothermaterialsdonotprotrudeand/orarenotplacedwheretheycouldbeanobstructionorahazard.

41. Aretherehandrailsandseatinginallwaitingareasandalongcirculationroutestoenableapersonwithawalkingdifficulty,apersonwhohasbalancedifficultiesorapersonexperiencingchronicpaintogetaroundthebuildingandtakeabreakiftheyneedit?

42. Aretherehandrailswheretherearechangesinfloorlevelsandwheretherearestepsorramps?

43. Isthereaglazedvisionpanelsondoorssothatonecanseewhatisbeyond thedoor?

44. Aretheremarkingsonglassdoorssothattheycanbeclearlyseen?45. Aretheedgesofanystepsmarkedsothattheyarevisible?46. Isthereanalternativeforthosewhocannotusesteps,suchasaliftoraramp?47. Areallcontrols,suchasliftcontrols,doorhandlesorswitches,ataheightwhich

peoplewhoareseatedorstandingcanuse?48. Istheliftatalkingliftthatspecifieswhichflooryouareon?49. Isthereaminimumclearopeningof900mminthelift?50. Arethecontrolsintheliftaccessible?51. Istheregoodlighting,withoutglare?52. Canawheelchairuserpositionthemselvesalongsideanyseatingtoenablea

companiontotakearest?53. Istheresufficientspaceforawheelchairusertoaccessandgrabrailsinkeyparts

ofthebuilding,suchasalongcorridors,alongsiderampsandintoilets?

Toilet facilities

54. Aretoiletfacilitiesaccessible?Theseshouldbelargeenoughapersonusingapoweredwheelchairtouse.

Fortechnicaldetails,seeBook5(SanitaryServices)in“BuildingforEveryone”:www.universaldesign.ie/buildingforeveryone

55. Isthereanaccessibletoiletneartheexaminationroomsothatapersoncangive aurinespecimen,ifrequired?

56. Aredoorhandles,wash-handbasins,tapsandthetoiletfullyaccessible? Doorhandlesandtapsshouldbeusablebypeoplewithrestricteddexterity.

57. Arethereappropriatelyplacedgrabrailsandaccessiblehandlesforentry andexit?

58. Areaccessibletoiletsmaintainedandrepairedpromptlyifoutoforder?Accessible toilets should be maintained free of obstruction and not used as a storage area for cleaning or other materials.

Consulting and treatment rooms

59. Indesigningandbuildingtreatmentrooms,havetherelevantprofessionalstakenaccountoftheacousticpropertiesofroomswhereconsultationstakeplace?Choosematerialsthatdampensound.Avoidnoisyventilationorairconditioningsystemsthatcanmakeitdifficultforapersontohear.

60. Aretreatmentroomsofasufficientsizetoenableamanualorpoweredwheelchairusertoturn?

61. Canthetreatmentroomaccommodatealiftinghoisttoenableapersontotransfersafelyandcomfortablyontoanexaminationortreatmenttableorchair?

62. Areexaminationcouchescentrallylocatedwithaccessfrombothsides(orcantheybemovedeasilysothattheyare)?Aretheyheight-adjustablesothatapersoncanbeexaminedinarangeofpositions-lying,standingorseated?

63. Isdiagnosticequipment,suchasamammographymachine,capableofbeingaccessedbyapersoninaseatedposition?

64. Arehandgripsprovidedtohelppeoplewithmobilityorvisionimpairmentstohavesupportwhenstandingbesideadiagnosticmachineoronweighingscales?

65. Arethereaccessibleweighingmachinessothatpeoplewhoarenotabletostandontheweighingscalecanbeweighedsafelyandcomfortably?Forexample,thereshouldalsobeaccessibleweighingscalesthatallowindividualstobeweighedinawheelchair.

66. Isatleastonedressingroomaccessibletomanualandpoweredwheelchairusersandpeoplewithlimitedmobility?Aretherehandgripsandseatinginthedressingroomandacallbellifapersonrequiresassistance?

67. Atleastoneconsultationortreatmentroomshouldhaveahearingloopsystemavailableforapersonwhoisahearingaiduser.Provisionshouldalsobemadeforaportableloopsystemtobeavailableifapersonisrequiredtomovebetweenconsultationortreatmentrooms.

Hospital wards

68. Arethereaccessibleandautomaticheight-adjustablebedsavailableifaserviceuserneedsone?

69. Arehoistsandmonkeypolesavailabletoenablepeoplebeliftedortoliftthemselves,inparticulartoenabletransferbetweenbedandbathroomorintoandoutofabedsidechair?

70. Istheresufficientspacearoundabedforamanualandpoweredwheelchairusertoturnbesideabed?

71. Isthereafullyaccessibletoiletandbathroomadjacenttotheward,withachoiceofshowerorbathfacilitiesandwithsuitablehoistsavailableasrequired?

72. Isthereasingleroomavailableonallwards,whichcanhelpinfectioncontroloroffermoreprivacyorquietforthosewhorequireitbecauseoftheirillnessordisability,wherepossible?Somedisabilitiesmayresultinapersonbeinguncomfortableorfinditdifficulttocommunicateinanoisyorbrightenvironment.

73. Istherearangeofchairsinthedayroomtosuitpeoplewithlimitedmobilityandwitharmreststoassistthemwhentheygotostand?

74. Istheenvironmentfreeofobstaclesorhazards?75. Isthereatelevisionprovided?Ifyes,istheoptionofsubtitlesavailable?

Signs and notices

76. Isthereaclearway-findingsystemaroundthebuilding?77. Isthereclearsignageatanappropriateheightabovefloorlevel?78. Arethesignsmadefromamaterialthatdoesnotreflectlight?Glarecanmake

themdifficulttoread.79. IsplainEnglishusedinsignsandnotices?80. Dothesignsuseclearandconsistentlanguageandimages?81. Isthereacolourcontrastbetweenletteringandbackgroundoninformation

noticesandsigns?82. Arepicturesignsandsymbolsusedthatcanbereadilyunderstoodbyall;for

example,peoplewithliteracydifficulties,peoplewithintellectualdisabilitiesandpeoplewhodonotreadEnglish?

83. Isthereanoticewhereyouhaveahearingloop?84. Arenoticesinaminimumof18ptfont?Dotheyuselargesymbolswitha

combinationofupperandlowercaselettering?85. Dosignsmeettherecommendedguidelines?SeetheHSESignagePolicy2005

for more information.

• Internal signs: - Therecommendedsizeforinternallocationidentificationanddirectionalsigns

isatleast60mmheightandviewingdistanceupto20metres(m) - Therecommendedheightofasignisbetween1300-1600mmabove

floorlevel - Theheightofthesignsshouldbechosenforcomfortinreading;thatis,as

closetoeyelevelaspossibleforinternalsignsandexternalpedestriansigns.Ingeneral,eyelevelisconsideredtobeapproximately1500mmfromground.ThisisalsotherecommendedheightfortactileandBraillesigns.(NationalCouncilfortheBlindofIreland–RecommendationsforSignage)

• External signs: - Externallocationidentificationandmotoristdirectionalsignsshouldbe90mm

highandlegiblefromapproximately45m - Wherepossible,provideBrailleorraisedletteringsothatpeoplewithimpaired

visioncanreadthembytouch

Safe evacuation

86. Isthereanappropriateplaninplaceforthesafeevacuationofeveryone,includingpeoplewithdisabilities,inthecaseofanemergency?

87. IsthefirealarmbothaudibleandvisiblesotheycanbeperceivedbypeoplewhoareDeaforhardofhearing?

Compliance with Part M of the BuildingRegulations

Guidance on accessible buildings

Guidelines on designing accessible environments

TheDepartmentofEnvironment’sTechnicalGuidanceDocument: www.environ.ie/en/Publications/DevelopmentandHousing/BuildingStandards/FileDownLoad,24773,en.pdf

TheNationalDisabilityAuthority’sBuildingforEveryone:www.universaldesign.ie/buildingforeveryone

TheIrishWheelchairAssociationhavedevelopedBestPracticeAccessGuidelines-DesigningAccessibleEnvironments,followingextensiveconsultationwiththeirmembersandexternalorganisations:www.iwa.ie/services/housing/iwa-housing-advocacy/designing-accessible-environments

6.4 Furtherinformation

Guidance on safe evacuation TheNationalDisabilityAuthorityGuidanceonSafeEvacuationfor All. www.nda.ie/Website/NDA/CntMgmtNew.nsf/0/BC5E9F0E705C006C8025784F003B42EE/$File/Safe_Evacuation_for_All.pdf

Consent

“Consentisthegivingofpermissionoragreementforanintervention,receiptoruseofaserviceorparticipationinresearchfollowingaprocessofcommunicationinwhichtheserviceuserhasreceivedsufficientinformationtoenablehim/hertounderstandthenature,potentialrisksandbenefitsoftheproposedinterventionorservice.”

National Consent Policy, HSE, May 2013

Pleasenote,thefollowingsection“Guideline Seven: Consent”shouldbereadinconjunctionwiththeNationalConsentPolicy,HSEwhichisavailableonwww.hse.ie. These guidelines are also subjecttochangependingforthcominglegislation.

7.1 General Principles of Consent

Theneedforconsentextendstoallhealthandsocialcareinterventionsconductedbyoronbehalfofhealthandsocialcareservicesonpatientsandserviceusersinalllocations(forexample,hospitals,community,residentialcaresettings).

Itisabasicruleatcommonlawthatconsentmustbeobtainedformedicalexamination,treatment,serviceorinvestigation.Consentmustalsobesoughtforapersontotakepartinahealthandsocialcareserviceresearchproject.

Therefore,otherthaninexceptionalcircumstances,treatingserviceuserswithouttheirconsentisaviolationoftheirlegalandconstitutionalrightsandmayresultincivilorcriminalproceedingsbeingtakenbytheserviceuser.

No other person such as a family member, friend or carer and no organisation can give or refuse consent to a health or social care service on behalf of an adult service user who lacks capacitytoconsentunlesstheyhavespecificlegalauthoritytodoso.

7.2 What is valid and genuine consent?

Consentisthegivingofpermissionoragreementforanintervention,receiptoruseofaserviceor

7. Guideline Seven

participationinresearchfollowingaprocessofcommunicationabouttheproposedintervention.Theprocessofcommunicationbeginsattheinitialcontactandcontinuesthroughtotheendoftheserviceuser’sinvolvementinthetreatmentprocess,provisionofsocialcareorresearchstudy.Seekingconsentisnotmerelygettingaconsentformsigned;theconsentformisjustonemeansofdocumentingthataprocessofcommunicationhasoccurred.

Thehealthcareworkershouldaimtomaximizethecapacityoftheserviceuserasfaraspossibletoprovideorrefuseconsent.Gettingconsentisaprocessinvolvingeffectivecommunicationbetweentheserviceuserandhealthcareprofessional.Theprovisionofappropriateandaccessibleinformationtotheserviceuserwillbecriticalinfacilitatingandsupportingthemtomakeaninformedchoice.Insomesituations,involvinganappropriatethirdpartytofacilitatetheexchangeofinformationandcommunicationbetweenthehealthcareprofessionalandserviceuserwillbenecessary(forexample,wheretheserviceuserisnon-verbalorrequiressignlanguageinterpretation).

Fortheconsenttobevalid,theserviceusermust: • Havereceivedsufficientinformationinacomprehensibleandaccessiblemanner(inawaythat

theycanunderstand)aboutthenature,purpose,benefitsandrisksofanintervention/serviceorresearchproject(forexample,proposedtreatment,diagnosticprocedure)

• Notbeactingunderduress,and • Havethecapacitytomaketheparticulardecision

7.3 Importance of individual circumstances

Howmuchinformationserviceuserswantandrequirewillvarydependingontheirindividualcircumstances.Discussionswithserviceusersshouldasmuchaspossiblebetailoredaccordingto:

• Theirneeds,wishesandpriorities • Theirlevelofknowledgeabout,andunderstandingof,theircondition,prognosisandthe

treatmentoptions • Theirabilitytounderstandtheinformationprovided/languageused • The nature of their condition

7.4 Informing the person before getting consent

Theamountofinformationtobeprovidedaboutaninterventionwilldependontheurgency,complexity,natureandlevelofriskassociatedwiththeintervention.

Itisimportantto: • Communicateandprovideinformationatalevelandinaformatwhichisappropriatetothe

needsofeachpatientorserviceuser.(SeeGuideline Four: Communication for guidance and Guideline Five: Accessible information for guidance respectively)

• Investthetimeandeffortneededtoensurethatpatientsorserviceusers: • understandthenatureoftheprocedureortreatment • understandtheconsequencesofrefusingtreatment • have enough information to make an informed decision • haveanopportunitytoaskquestionsabouttheirconditionandtheprocedureortreatment

Informationaboutriskshouldbegiveninabalancedway.Serviceusersmayunderstandinformationaboutriskdifferentlyfromthoseprovidinghealthandsocialcare.Thisisparticularlytruewhenusingdescriptivetermssuchas‘often’or‘uncommon’.Potentialbiasesrelatedtohowrisksare‘framed’areimportant:a1inathousandriskofacomplicationalsomeansthat999outofathousandserviceuserswillnotexperiencethatcomplication.

Inordertobestsupportserviceusersinassessingtheriskandbenefitsofvariousinterventions/courseofactionconsiderationshouldbegiventoprovidingtheinformationinanaccessibleandunderstandableformatusingplainlanguage.

7.5 How and when information should be provided

Themannerinwhichthehealthandsocialcareoptionsarediscussedwithaserviceuserisasimportantastheinformationitself.Thefollowingmeasuresareoftenhelpful:

• Discussingtreatmentoptionsinaplaceandatatimewhentheserviceuserisbestabletounderstandandretaintheinformation.Sensitiveissuesshouldbediscussedinanappropriatelocationtoensurethattheserviceuser’sprivacyisprotectedtothegreatestdegreepossibleinthe circumstances

• Providingadequatetimeandsupport,including,ifnecessary,repeatinginformation • Useofsimple,clearandconciseEnglishandavoidanceofmedicalterminologywherepossible • Supplementingwrittenorverbalinformationwithvisualdepictions,forexample,pictures • Askingtheserviceuserifthereisanythingthatwouldhelpthemrememberinformation,ormake

iteasiertomakeadecision;suchasbringingarelative,partner,friend,careroradvocatetoconsultations

Serviceusersshouldbegiventhetimeandsupporttheyneedtomaximisetheirabilitytomakedecisionsforthemselves.Itisparticularlyimportanttoensurethisisthecaseforthosewithlimitedliteracyskillsorwhomaylackcapacityduetoacondition.However,itshouldnotbeautomaticallyassumedthatserviceuserswithcertaintypeofdisabilities(forexample,intellectual,cognitive,communicationdifficulties)lackcapacitytounderstandinformationormakeadecision.Aperson’scapacitycanbeimprovedandmaximisedwithappropriateandaccessibleinformationandsupportssoallpracticablestepsshouldbetakeninthisregard.

Forthosewithcommunicationdifficulties,speakingtothoseclosetotheserviceuser,toanadvocate,apersonalassistantortootherhealthandsocialcarestaffaboutthebestwaysofcommunicatingwiththeserviceuser,takingaccountofconfidentialityissues,maybehelpful.Forexample,additionalmeasuresmayberequiredforpeoplewithlimitedEnglishproficiency,peoplewhoaredeafandhardofhearingandblindandvisuallyimpairedserviceusers.

7.6 Howshouldconsentbedocumented?

Itisessentialforthosewhoprovidehealthandsocialcare,todocumentclearlyarecordofboththeserviceusers’agreementtotheinterventionandthediscussionsthatleduptothatagreementif:

• Theinterventionisinvasive,complexorinvolvessignificantrisks • Theremaybesignificantconsequencesfortheserviceuser’semployment,orsocialor

personallife • Providingclinicalcareisnottheprimarypurposeoftheintervention,forexample,clinical

photographsorvideocliptobeusedforteachingpurposesorbloodtestingfollowingneedlestickinjurytostaff

• Theinterventionisinnovativeorexperimental,or • Inanyothersituationthattheserviceproviderconsidersappropriate

Thismaybedoneeitherthroughtheuseofaconsentformorthroughdocumentingintheserviceuser’snotesthattheyhavegivenverbaland/ornonverbalconsent.

Ifaconsentformisusedandtheserviceuserisunabletowrite,amarkontheformtoindicateconsentissufficient.Itisgoodpracticeforthemarktobewitnessedbyapersonotherthantheclinician seeking consent and for the fact that the service user has chosen to make their mark in this waytoberecordedinthehealthcarerecord.

Writtenconsentformsshouldbeclearandeasytounderstand.

7.7 Capacity to consent

Has the service user the capacity to make the decision? Bestpracticeandinternationalhumanrightsstandardsoperatefromthepresumptionthatall

adultserviceusershavecapacitywhenmakingdecisionsunlessthecontraryisshownandalladultserviceusersshallnotbeconsideredasunabletomakeadecisioninrespectofthematterconcernedunlessallpracticablestepshavebeentaken,withoutsuccess,tohelpthepersonto do so.12

Wherethedecision-makingcapacityoftheserviceusermaybeindoubt,bestpracticefavoursa‘functional’orissue-specificapproachtodefiningdecision-makingcapacity.Accordingtothis,theserviceuser’scapacityistobejudgedinrelationtoaparticulardecisiontobemade,atthetimeitistobemade-inotherwords,itshouldbeissuespecificandtimespecific–anddependsupontheabilityofanindividualtounderstand,retainandtouseorweighthatinformationaspartoftheprocessofmakingthedecision.Theserviceusermustalsobeabletocommunicatethedecisionbyanymeans(forexample,usingsignlanguage,assistivetechnology)tothehealthcareprofessional.

Duty to maximise capacity Bestpracticeandinternationalhumanrightsstandardsfavour“supporteddecision-making”where

possible.Thisrequiresthatallpracticablestepsmustbetakentomaximisetheserviceuser’sdecisionmakingcapacitytoallowthemtomaketheirowndecisionswherepossible.

Mostserviceuserswillbeabletomakesomedecisions,butmayfinditdifficulttomakeother

decisionswhichmay,forexample,bemorecomplexandinvolvechoosingbetweenanumberofoptions.Fluctuationsinaperson’sconditionsuchasconfusion,panic,shock,fatigue,painormedicationmaytemporarilyaffecttheperson’sdecisionmakingcapacitysoasfaraspossible,seekingconsentshouldbedelayeduntilthepersonhasregainedcapacitytodoso.

Itisimportanttogivethosewhomayhavedifficultymakingdecisionsthetimeandsupporttheyneedtomaximisetheirabilitytomakedecisionsforthemselves.

For further information on assessing capacity see the National Consent Policy and forthcoming legislation.

12SeeAssistedDecisionMaking(Capacity)Bill2013

7.8 Emergency situations with service users who lack capacity

Inanemergencysituationwhereaserviceuserisassessedtolackcapacity,thehealthandsocialcareprofessionalmaytreattheserviceuserprovidedthetreatmentisimmediatelynecessarytosavetheirlifeortopreventaseriousdeteriorationoftheirconditionandthatthereisnovalidadvancerefusaloftreatment.Thetreatmentprovidedshouldbetheleastrestrictiveoftheserviceuser’sfuturechoices

Whileitisgoodpracticetoinformthoseclosetotheserviceuser–andtheymaybeabletoprovideinsightintotheserviceuser’swillandpreferences-nobodyelsecanconsentonbehalfoftheservice user in this situation.

For further information see the National Consent Policy.

7.9 Consent, Children and Young People

Bestpracticeandinternationalhumanrightsstandardsfavouranapproachwhichprovidesthatachild’soryoungperson’swishesaretakenintoaccountand,asthechildgrowstowardsmaturity,givenmoreweightaccordingly.Wherechildrenareunabletogiveavalidconsentforthemselvesowingtothelegalageofconsent,theyshouldnonethelessbeasinvolvedasmuchaspossibleindecision‐makingaschildrenmayhaveopinionsabouttheirhealthcareandhavetherighttohavetheirviewstakenintoconsiderationbygivingtheirassenttotheproposedtreatmentorservice.

For more detailed information see the National Consent Policywhichalsoaddressestheissueofwhenitmaybenecessarytoobtaintheconsentofbothparents/guardiansand/orwhentheconsentofoneissufficient.

8. Guideline Eight

Role of family members and support persons

8.1 Roleoffamilymembersandsupportpersons

Familymembersandothersupportpersonsoftenplayacriticalroleinenablingaccesstohealthandsocialcareforpeoplewithdisabilities,navigatingthehealthandsocialcaresystemwiththemandsupportingthemwhileinhospitalorinotherhealthandsocialcarefacilities.

Ifapersonwithadisabilitydoesnotwanttobeaccompaniedbyacarerorfamilymember,thisshouldberespected.

Thefamilymember,carerorsupportpersonwillgenerallyunderstandtheperson’sdisabilityandcanprovideinformationandinsightsintoaperson’saccessibilityrequirements.Thisisimportantwherepeoplewithdisabilitiesareunabletocommunicatetheirrequirementseasily.Staffshouldbeawareoftheirimportantroleandfacilitateit.

Aninterpretermaybenecessaryiftheprimarycareroradvocateofapatient/serviceuserisDeaf;forexample,Deafparentswithachildwhocanhear.Whiletheonusisontheserviceusertorequestaninterpreter,itistheresponsibilityofstafftomakethearrangements.Itisconsideredgoodpracticeforservicestoarrangeaninterpreterwithoutbeingpromptedincaseswhererepeatvisitsarenecessaryorwhereitisknowninadvancethattheserviceuserneedsone.

Collaborationbetweenfamilycarersorothersupportpersonsandhealthandsocialcarestaffcanhelptoensurethatthebasicneedsandaccessibilityorcommunicationrequirementsofapatientwithadisabilityaremet.

Familyorothercaresupportpersonsmaybeabletoprovideassistancewithactivitiesofdailyliving(suchasassistingthepersontoeatordrink,dressorundress,movearound,orusethetoilet)wherethisisrequiredandiswhatapersonwithdisabilitywishes.However,familycarersandothersupportpersonsshouldneverbeusedtoreplacegeneralnursingormedicalcarestaff.

8.2 Righttoprivacy

Peoplewithdisabilitieshavethesamerighttoprivacyandconfidentialityasanyotherperson. The National Healthcare Charter, You and Your Health Servicestatesthateveryonehastherighttohavetheirprivacyrespectedandthat,asstaff,“Wewilldoourbesttoensurethatyouhaveadequatepersonalspaceandprivacywhenyouuseourhealthservices.Wemaintainstrictconfidentialityofpersonalinformation”.

8.3 Discharge

See “Guideline Three: Accessible services - general advice, Section 3.14, Integrated Discharge Planning”,formoreinformationondischargeplanning.Alsosee“Integratedcareguidance:Apracticalguidetodischargeandtransferfromhospital”.

Makeaplanforcontinuityofcareandsupportafterdischarge.Ondischargefromhospital,those

playingasignificantcaringandsupportroletothepersonwithadisability,includingtheGP,shouldalsobeinformedaboutandunderstandtheperson’smedicalanddrugregime,anyspecificissuesofcaremanagement,andunderwhatconditionsthepersonmayneedtoreturntothehospital.Whereappropriate,maketimetodiscussadiagnosisandtreatmentplanwithfamilymembers,carerorsupportperson.

8.4 Carer needs

Familycarersmaythemselvesbeelderlyorfrailandmayhavedifficultiesinprovidingphysicalassistance.Healthcarestaffshouldbealertforsignsofdistressinthecarerandlimitsonassistancetheywouldbeabletoprovidetothepatient.Staffmaybeabletoadvisethepersonortheirfamilyaboutimportantsourcesofsupportandwherefurtherinformationisavailable.

Healthcarestaffinpolicyandmanagementpositionscangiveconsiderationonsupportswhich

mightbeofferedtorelativeswhoneedtovisithospitalsorhealthcentresfrequently. 8.5 Advocacy

Anindependentadvocatecanrepresenttheinterestsofvulnerablepeopleandplayaroleinassistingpeoplethemtoaccessservices,rightsandentitlements.Anadvocatecanhelp themtoidentifyandarticulateaccessibilityrequirementsandassisttheminmakingchoices. Wherethissupportisindicated,healthstaffshouldfacilitateapersonwithadisabilitytoaccess anindependentadvocate.

Anyformofadvocacyusedmustbeagreeabletoboththeserviceuserandthehealthandsocialcare service.

Guidelines for specific services

Theguidelinesdescribeastandardwhichwecanaspireto.Theyarewrittenintheknowledgethatservicesmaynothavefinancialresourcestoimplementallmeasuresoutlined;however,thereisanobligationonindividualstoensurethattheyknowwhatisrequiredofthembylaw.Theyalsoserveasaresourceforhealthandsocialcareprofessionalswhomaybeplanningservicesinthefuture.

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

Part Two

Accessible GP surgeries, health care centres and primary care centres

ThefollowingsectionshouldbereadinconjunctionwithPartOne: 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

9.1 Plan services for all

Peoplewithdisabilitiesaremorelikelytodrawonprimarycaresupportaswhiletheyenjoygeneralgoodhealth;onaverage,theyhavepoorerhealththanthepopulationatlarge.

Primarycareplaysacriticalroleinsupportingpeoplewithdisabilitiesandchronicconditionstomanagetheircondition,recoverafteranillnessandstaywell.

Itisessentialthatprimarycareservicesareplannedanddeliveredsothattheyareaccessibletoallpatientsandserviceusers.

Theuptakeofpreventativescreeningprogrammesisoftenverypoorbypatientsandserviceuserswithamentalhealthillnessordisability.Researchalsoshowsthatpeoplewithintellectualdisabilitieswhoarelivinginthecommunityarelesslikelytoaccessprimarycarethanothermembersofthepopulation.

ThefollowingtableincludesaGeneralPointsChecklisttohelpstaffandservicesidentifyiftheirservices are accessible.

9. Guideline Nine

Whenreadingthetablesinthefollowingsections,pleasenotethattheguidelinesdescribeastandardwhichwecanaspireto.Theyarewrittenintheknowledgethatservicesmaynothavefinancialresourcestoimplementallmeasuresoutlined;however,thereisanobligationonindividualstoensurethattheyknowwhatisrequiredofthembylaw.Theyalsoserveasaresourceforhealthandsocialcareprofessionalswhomaybeplanningservicesinthefuture.

Top Tips

• ApositivemeasureintroducedintheUKhasbeenanautomaticannualcheck-upforpatientswithanintellectualdisability–thisisconsideredgoodpractice.

• Ensurepreventiveandscreeningprogrammesaredesignedtobeaccessibletoandinclusiveofpeoplewithdisabilitieswhereappropriate;forexample,mammograms,cervicalsmears,fluvaccinationsetc.

9.2 Your premises

Thefollowingtableisachecklistwhichwillhelpstaffidentifyiftheirpremisesareaccessible.Itshouldbenotedthatthisisnotanexhaustivelistandcanbeaddedtoasrequired.Moreinformation is available in Guideline Six: Accessible buildings and facilities.

General points Yes No

1. Arethepremisesandequipmentaccessibletopeoplewithdisabilities?2. Isinformationandcommunicationtailoredtoparticularrequirementspeoplewith

disabilitiesmayhave?3. Areinvestigations,treatmentsandprescribedexercisestailoredtomeettheneeds

ofpeoplewithdisabilities?4. Isapersonwithadisabilitytreatedonthebasisoftheclinicalconditionthey

presentwith?Therecanbeariskthatsymptomsofanillnessareattributedtotheperson’sdisabilityratherthantoanothercondition.

5. Dopeoplewithintellectualdisabilitiesinyourcommunityaccessprimarycare?6. Arepeoplewithdisabilitiesactivelyincludedinpreventiveandscreening

programmes?7. Woulditbehelpfultokeeparegisterofpatientswithdisabilitiestoenableauditof

theircare?

Points to consider A checklist for your premises Yes No

General points

1. Isyourpremisesphysicallyaccessibletopeoplewithdisabilities?2. Isthereanalternativeforpatientswhohavedifficultiesinnegotiatingstairs;for

example,thattheycanbeseeninadownstairsconsultingroom?3. Isthereaccessibleparkingclosetotheentrance?4. Isthereapathwayfromtheentrancetotheparkingarea?5. Isthemainroadfreefromobstructionsorsteps?6. Isthereclearexternalandinternalsignagewithlargewell-litsignssothatpeople

canfindtheirwayeasilytothebuildingandaroundthebuilding?7. IfyouhaveanintercomsystemattheentrancetotheGPsurgeryorhealthcentre,

isitusablebysomeoneseatedinawheelchair,bysomeonewhohasavisualimpairmentandbysomeonewhoishardofhearingorDeaf?

8. Istherearampiftheentranceisnotlevel?Wheelchairuserscannotnegotiatesteps,whereaspeoplewhowalkbutwithsomedifficultygenerallypreferasmallnumberofstepstoaramp.

9. Isthereahandrailtoassistpeoplewhoarenotsteadyontheirfeet?10. Isthereahearingloop?Ifso,arepeoplewhousehearingaidsroutinelyinformed

thatitisavailable?Alternatively,consideraportablehearinglooporlisteningdevice that can be taken from one treatment room to another.

11. Isthereanaccessibletoiletlocatedattheentrancelevelandsignposted?12. Isthereceptionistdeskataheightwheresomeonewhoisseatedcantransact

theirbusiness? • Isitpossibletoputachairatthereceptiondeskforsomeonewhohasa

walkingdifficultytositdown,ifneeded? • Whenapersonisseated,dotheyhaveanunblockedviewofthereceptionist?13. Istheresufficientspaceinthewaitingroomforawheelchairusertoturnaround,

andalsosothatthepersoncansitinthemainwaitingareanexttoaseatedcompanion?

14. Ifyourpremisesisnotphysicallyaccessibletosomeone,areyoupreparedtoarrangeanappropriatealternative;forexample,provideahomevisit?

Top Tips

• Ifthereisnofixedramp,servicesmightconsiderifitispossibletoprovideamobileramporprovidetheoptionofbothstepsandaramp

• Ifthereisaloopsystemoraportablelisteningdevice,checkthatitistestedregularlyandthatstaffknowhowtouseit

9.3 Appointments, opening hours, waiting rooms

See Guideline Three: Accessible services - general advice for more information on making appointments.

Pleasenotethatthefollowingsectiondoesnotmeanthatpreferentialtreatmentwillbegiventopeoplewithdisabilities,butratherthatservicesshouldexerciseconsiderationforthecircumstancesofacasewhereappropriate.

• Wherepossible,beflexibleinmakingappointments,takingintoconsiderationthatsomepeoplewithdisabilitieshavedifficultieswithearlymorningappointmentsbecauseofmedicationortheadditionaltimeneededtogetready

• Wherepossible,beflexibleaboutsurgery/healthcentreopeninghourstoenableafamilymember,personalassistantorsupportpersontoaccompanypeoplewithdisabilitiestoattend anappointment

• Somepeoplewithdisabilitiesmaygetagitated(forexample,inanunfamiliarenvironment)orfinditdifficulttoremaininoneplaceforlong.Forthesepatients,considerappointmenttimesthatmayminimisewaitingtimes;forexample,thefirstappointmentafterlunch

• Ifappointmentscanbemadebytextmessageoremail,ensurethereisatwo-wayprocesssothatapersoncanrespondtoatextmessageoremail,andcancelorchangeanappointmentif

A checklist for your premises Yes No

15. Inthecaseofanemergency,isthereanappropriateplaninplaceforthesafeevacuationofeveryone?Hasconsiderationbeengiventosafeevacuationofthosewithdisabilities;forexample,peoplewhoareDeaf,blind,hardofhearingorwhohavemobilityissues?

necessary.Itisimportantthatreceptionstaffrespondtotextmessagesandemailsinatimelyway.Letpeopleknowofalternativemethodsofcommunication;forexample,includeanumbertotextonpublicitymaterialandheadedpaper

• Peoplewithdisabilitiesmayrequiremoretimethanthestandardconsultingappointment(forexample,toallowforadditionaltimetointerpretsignlanguage)andconsiderationshouldbegiventobookingalongerappointmentordoubleappointment

• Itcanbehelpfultoscheduleappointmentswithaninterpretersothatwaitingtimesandcostofinterpretiveservicesareminimised

9.4 Waiting to be seen

Formoreinformation,seeGuideline Three: Accessible services - general advice. VisualDisplayUnitsinwaitingroomsandpublicareascaninformpeopleofappointments,

directions,informationorqueuinginformation.Avisualsystemcouldbeaticketmachine,avisualdisplayorawhiteboard.

Ifpossible,havebothanaudibleandvisualsystemforlettingpeopleknowtheirturn.ThisistoensurethatpeoplewithimpairedvisionandpeoplewhoarehardofhearingorDeafareawarethattheyarebeingcalledfortheirturn.

Ifyouuseaticketsystemforthequeue,ensurethattheticketmachineisataheightwhereawheelchairuserorapersonofshortstaturecanreachit(andthatthereisanalternativeforpeoplewhoareblind).

Informpeopleofhowtheywillbecalledandofthelocationofthevisualdisplayunitssothattheycansitwheretheycanseeorhearwhentheyarecalled.

Intheabsenceofavisualdisplayunitinthewaitingroom,makesurethatpeoplewithimpairedvisionorthosewhoareDeaforhardofhearingareinformedwhenitistheirturntobeseen.

Ifyouhavealeafletstand,makesureitcanbereachedfromawheelchair.

Ifyourreceptiondeskisnotatanaccessibleheight,bepreparedtomeetawheelchairuserawayfromthereceptiondesk,inaplacewhichwillenablethemtodiscusstheirrequirementswiththesamedegreeofprivacyaffordedtoothers.

Apersonwithawalkingdifficultyorbalanceproblemsmayneedassistancesittingorstanding.Peoplewithimpairedvisionmayneedassistanceinfindingaseatinthewaitingroomoraconsultation/treatmentroom.

Offertoguidesomeonetothetreatmentroomifthisisneeded;forexample,someonewithimpairedvisionorwhoisunsteadyontheirfeet.

Somepeoplewithdisabilitiesmayfinditdifficulttowaitinacrowdedreceptionorwaitingareawithoutbecomingagitatedoranxious.Wherepossible,provideaquietplaceforpeoplewhoaredistressedoranxioustosit,awayfrombrightlightsandnoise.

9.5 Filling forms

Itmaybehelpfultomakelargeprintformsavailablethatareaccessibletopeoplewith impairedvision.

Itmaybehelpfultoprovidetheoptionfortheformtobeaccessedandcompletedon-lineinadvanceofanappointment,ifpossible.

Askifthepersonneedsassistancefillinginaformandprovidethatassistanceifnecessary.Approximately25%ofadultsinIrelandhaveliteracydifficulties.Theyaresometimesembarrassedbythis,andcanbeveryadeptatcoveringuptheirproblem.Allstaffshouldbeparticularlymindfulofthisgroup.

Ifthereceptionist’scounteristoohigh(forexample,forawheelchairuser),youmayneedtosteparoundittocompleteyourbusinesswiththepatient/serviceuser.Ensurethereisaprivateareawherepeoplecangivepersonalandmedicaldetailswithoutbeingoverheard.

Aclipboardcanbehelpfulforpeopleunabletoreachthecounterwhenfillingoutformsor signing documents.

9.6 Examinationandtreatment

Itisimportanttoliaisewiththespecialistservicesthataretreatinganyunderlyingdisabilityorchroniccondition,andensurethatanyappropriatetreatmentprotocolsarefollowedintheprimarycaresetting.Forexample,someonewithaspinalinjurymayneedtokeepaparticularposture,andthisshouldbefactoredintoanyexaminationorprimarycaretreatment.

Ensurethatyourtreatmentanddiagnosticfacilitiesareaccessibletowheelchairusersandpeoplewhoareunabletostandforlongperiodsoftime;forexample,itmaybehelpfulto:

• Equipyourpremiseswithanexaminationcouchthatcanberaisedorlowered,andwithahoistormonkeybarsthatcanassistsomeonewithmobilityproblemstosafelytransferonandoff

• Providewheelchairweighingscales;and • Providehandgripstohelppeoplewithmobilityorvisionimpairmentstohavesupportwhen

standing,forexample,onweighingscales

Ifthepatientisnotabletotransfertoanexaminationcouchwithassistance,conducttheexaminationintheperson’schairorwheelchairifappropriate.

9.7 Consent

Youshouldseektheconsentofthepersonwithadisabilityaswithanyotherpatient.SeeGuideline Seven: Consent.

Alwaysaskforconsenttoshareconfidentialinformationaboutanindividual’saccessibilityrequirements.

9.8 Communication with patients and service users

See Guideline Four: Communication for more information on communicating with a patient or service user in a way that meets their needs.

Communicatedirectlywiththeperson,ratherthantheirfamilymember,carerorinterpreter.

Ifyouhaveapatientwithadisability,askwhattheirpreferredmethodofcommunicationistoenabletwo-waycommunicationwiththeservice;forexample,orally,inwriting,bye-mailorotherwise.Textandemailmaybeappropriateformakingappointments/administrativetasks;however,theyshouldneversubstituteforafacetofaceclinicalorprofessionalconsultation.Itisrelativelyeasytohaveanemailrelationshipwithapatientwithadisability,butthiscanbeasourceoferrorandpoorclinical management if it is the sole means of communication.

Ensurethatcommunicationisappropriatetotheperson’sneedssothatthepersoncanreceiveandunderstandcommunicationaroundappointmentsorreferrals,adiagnosis,prescribingmedications,exercisesetc.

Recordtheirpreferredmethodofcommunicationontheirfileandensurethat: • Relevantstaff,suchasreceptionistswhomakeappointments,areawareofitand • Asystemisinplacetoalertotherrelevantstaffwhomayhavecontactwiththepatientorservice

useraspartoftheircareplan

Wherethepersonhasasignificantdisability,familymembersorcarersmaybeabletoofferguidanceonhowbesttocommunicate.

Wherepossible,usetheperson’spreferredformofcommunication,forexample,textingore-mailing,inrelationtoappointments.

Givethepatientorserviceuserrelevantinformationtotakeaway,clearlytypedandinplainEnglish.Aservicemaytakestepstotranslatetheinformationintootherlanguageswherenecessary;however,thisshouldalsobewritteninastylewhichiseasytounderstand.

Itmaybenecessarytoprovideadditionaltimeorcommunicationsupporttoenableapersontounderstandthetreatmentandpossibleoutcomesandtoaskquestions.Aservicemaytakestepstotranslatetheinformationintootherlanguageswherenecessary;however,thisshouldalsobewritteninastylewhichiseasytounderstand.

Generalprinciplesofgoodcommunicationinclude: • Facethepersonyouarecommunicatingwith • Maintaineyecontact • Nevercarryoutanothertaskwhenlisteningtosomeone • Speakclearly,conciselyandslowly • Usestraightforwardlanguage • Askonequestionatatimeanddonotinterruptunlessnecessary • Givethepersontimetorespondandaskquestions • Repeatwhatyouhavesaidwhenapersonishavingdifficultyunderstandingandverifythatthey

haveunderstood;and • Phrasequestionsinawaythatapersoncangiveasimple‘yes’or‘no’answer

Explaintheproceduresyouwillundertake,stepbystep.

Forapatientwhoisunabletosee,gothrougheachprocedureortestbeforeyoudoit.Tellthemwhatpartsoftheirbodyyouwillexamineandwhereyouwilltouch.Ifyouaregivinganinjectionoraneedleprick,explainwhereyouwillputtheneedleor,ifyouaretakingbloodpressureorusingastethoscope,explaintheprocedure.

Somepatientsorserviceusersmayneedextratimetounderstandwhatisbeingsaidtothemandtoaskquestions(forexample,apersonwhoisunabletospeakortohear,whohasdifficultyprocessingorretaininginformationorwhocannotread,orapersonwhohasanintellectualdisability,anacquiredbraininjuryordementia).Useverysimplelanguage.Astheymayhavedifficultiesprocessingorrememberinginformation,takeitslowly,stepbystep.

Donotoverloadthepatientorserviceuserwithinformation.Whereappropriate,usepictures,signsandsymbols.

Ifsomeonehasdifficultyinhearing,facethemdirectlyandmakesureyourfaceisinthelight,toenablethemlip-read.Speakclearly,donotexaggerateyourmouthmovementsanddonotcoveryourmouth.Usegesturesanddiagramsandprovideinformationinwritingtoreinforcewhatyou aresaying.

Ifyouhavedifficultyunderstandingwhatapersonissaying,telltheminarespectfulway.Thepersonmaybeabletorespondwithagesturetoquestionsthatrequirejusta“yes“or“no”answer.

IfrequestedbyaDeafperson,bookanIrishSignLanguageinterpreterinadvanceofanappointment.TakeallreasonablestepstoensurethataDeafpersoncanaccessaqualifiedIrishSignLanguageinterpreteroftheirchoice.Theabsenceofaprofessionalinterpretercanresultinmisdiagnosis,clinicalriskandcompromisesafety.Wherethereisanunplannedvisitoranemergency,youmaybeabletocommunicatethrougharemotesignlanguageinterpreterviavideolink.Thisrequiresawifi-enabledcomputerwithacamera,microphoneandspeakers,asfoundonmodernlaptops.

Besensitivetothestressitmaycauseifsomeonehasdifficultyincommunicatingclearlyorinunderstandinginformation.Facilitatethemingivingitextratimeandinexplainingasclearlyasyoucan,usinggesturesanddiagramstosupplementthespokenword.

9.9 Information

For further information see Guideline Five: Accessible information.

Provideinformationonaccessibilityfeaturesofyourpremisesandservices.Includethisinformationonyourcommunicationmaterials;forexample,onawebsite,informationleaflets,bookletsetc.

Providetake-homeinformationtosupplementwhatyousaytoyourpatientsorserviceusers.Peoplemaynotbeabletoabsorbeverythingyousayduringaconsultationortreatmentsession.InformationshouldbewritteninplainEnglishandtypedinclearprint.Usesimplelanguagetoexplainmedicalterms.Provideappropriatediagrams,forexample,forphysicalexercises.

Provideinformationtoyourpatientsonotherrelevantcommunitysupportservicesandentitlements;forexample,ifapatienthasrecentlydevelopedadisability,youmaybeabletoreferthemtotheappropriatesupportgroupforthatcondition.TheCitizensInformationBoardpublishesinformationonentitlementsforpeoplewithdisabilities.

Provideserviceuser/patientinformationforms,informationaboutafter-care,prescriptions,medicalcertificatesandotherinformationleafletsinalargeprintformatwhenrequired.

SomepeoplewithanintellectualdisabilitymayrequireinformationinEasytoReadformat,whichconsistsofshortsimpletextandillustrations.Thereareanumberofresourcesyoucandrawon,suchaspicturebanksandpicturebooksthatareusedbysomepeoplewithanintellectualdisabilityinhealthsettings.Usepicturesandsymbolstoexplaintreatmentsorhealthconditions

Donotpresumethatapersoncanreadorunderstandthewritteninformationyouprovide.Alwaysverballyexplainanywritteninformationaboutmedication,treatmentorafter-care,forexample.Checkthattheserviceuserunderstandswhatyouhavesaidandwrittendown.Ifthisisnotclearrepeattheinformationandbepatient.

9.10 Continuity of care

ItwillhelpsomepeoplewithdisabilitiestoseethesameGPorotherrelevantprofessionaleachtimetheyvisit.Forexample,apersonwithanacquiredbraininjuryorapersonwithanintellectualdisabilitymayexperiencelessdistressiftheyaredealingwithamemberofstaffthattheyknow.

Ensurethateverymemberofstaffistrainedsothattheymayrecognisetheaccessibilityandcommunicationneedsofpatientsandserviceusersand,inturn,communicatewithandassistthemas needed.

9.11 Home visits

SomepatientsmayfinditphysicallydifficulttogettoaGPsurgeryorprimarycarecentre.Others,suchasapersonwithanintellectualdisabilityordementia,maybelessdisorientatedoranxiousiftheyareseenathomebyaGPorothermemberoftheprimarycareteam.Wherepossible,arrangehome visits in these circumstances

Ifyouarevisitingapersonwithimpairedvisionintheirownhome,letthemknowifyoumovesomethingandletthemknowifyoureplacetheitemsothatshe/hecanfinditwhenyouleave.

9.12 Family members and carers

Familymembers,carersandsupportpersonsplayakeyrole,particularlyforpeoplewithsignificantlevelsofdisability.Theyareoftenaninvaluablesourceofexpertiseaboutaperson’sdisability,healthandwell-being.Theycanhelpachievebetteroutcomesincommunication,understandinganddecision-making.Withtheconsentofthepersonwithadisability,involvetheirfamily,members,carersandsupportpersonsincareplans.

Primarycommunicationmustbewiththepatientandnotwiththeirfamilymemberor personalassistant.

Wherethepersonsoconsents,givefamilymembers,carersandsupportpersonsinformationthatiseasytofollowaboutthetreatment,diagnosis,medicationandfollow-upappointments,toenablethemtoprovideappropriatecareandsupport.

Publichealthnurses,socialworkersandothermembersofprimarycareteamscanplayakeyroleinsupportingfamilycarersandingivingtheminformationonthehelpandtheentitlementsopentothem.TheCitizensInformationBoardwebsiteisalsoausefulsourceoninformationonentitlementsandsupports.

9.13 Referralandsharingofinformation

Itisessentialthatpatientsandserviceusersexperienceintegratedcareinprimarycare,specialistcare,rehabilitationandhospitalcareserviceswhichiscentredontheindividualandtheirneeds.Whereappropriate,teamscansharetheirknowledgeandexperiencesothatpersoncentredcarebecomes the norm.

Themultidisciplinaryteaminprimarycarecanmeetdifferentaspectsofanindividual’sneeds;forexample,thepublichealthnurse,physiotherapist,occupationaltherapist,socialworkerorspeechandlanguagetherapist.

Theprimarycareteamplaysanimportantroleinsupportinganindividualwithadisabilitywhoisawaitingarehabilitationserviceorhasbeendischargedfromrehabilitationbacktothecommunity.

Theindividual’sfamily,carersordisabilitysupportservicealsohaveakeyrole.Theprimarycareteammayneedtoliaisewithothersinvolvedintheperson’scare,includinghospitalspecialistsorthecommunitymentalhealthcareteam,whereappropriate.

Itisimportanttohavegoodcommunicationbetweendifferentindividualsandteamswhicharelookingafterdifferentaspectsofaperson’smedical,careandsupportneedssothattheseareaddressedinaco-ordinatedway.

Itisalsoimportanttoensurethatparticularaccessibilityrequirements,forexample,preferredformsofcommunication,aresharedbetweendifferentprofessionalsandservicesinvolvedintheperson’scare,sothatthesedonotneedtobenegotiatedagaineverytime.

Askfortheperson’sconsentfortheiraccessibilityrequirementsbeingnotedintheirfileandpassedontootherpractitioners

Includethepersonandtheirfamily(withtheperson’sconsentwhereappropriate)inanymulti-disciplinarycaseconference.

Primarycareteamservicesandspecialistdisabilitysupportservicesmaybenecessaryaftertheonsetofadisability;forexample,ifapersonacquiresabraininjuryfromanaccident.Oftenthereisawaitinglistforrehabilitation,whichmeansthatthereisakeyroleforcommunitysupportandinformationforthepersonduringthisinterimperiod.

Accessible Hospital Services, including Out-Patient Departments

ThefollowingsectionshouldbereadinconjunctionwithPartOne: Guideline Three: Accessible services - general advice Guideline Four: Communication Guideline Five: Accessible information Guideline Six: Accessible buildings and facilities Guideline Seven: Consent GuidelineEight:Roleoffamilymembersandsupportpersons

10.1 Ask, Listen, Learn, Plan, Do

Peoplewithdisabilitiesareoftenexpertsinwhattheyneed.SeeGuideline One: Developing accessible health and social care servicesformoreinformationonAsk,Listen,Learn,PlanandDo.

• Askallpatients:Doyouhaveanyspecificrequirementsthatmustbeaccommodated?Isthereanythingwecandotoassistyou?Remembermanydisabilitiesarenotvisible

• Withtheconsentofthepersonwithadisability,familymembers,carersorsupportworkersmayalsobeabletoguideonanyspecificneeds.

Listen

• Listenattentivelytowhattheirrequirementsareandhowtheycanbeaddressed.

10. Guideline Ten

• Usebookingvisitsorpre-admissionclinicstoidentifyanyaccessibilityneedsbeforeaperson

attendsforelectiveorpre-plannedtreatment • Ifaccessibilityrequirementshavenotbeendeterminedatpre-admissionstage,makeaplan

whenthepersonfirstvisitsthehospital

• Planthesupportrequiredfor: 1. Admission 2. Hospitalstay 3. Discharge

• Puttheplanintoaction

Thefollowingsectionswillgiveyoumoreinformationonplanningthesupportforeachofthesestages.

10.2 Who to talk to when developing the care plan?

Discussanyoptionswiththeindividual. Involve,withtheconsentofthepersonwithadisability,theirfamily,members,carersandsupport

personsinthedrawingupofcareplans. • Familymembers,carersandsupportpersonscanplayakeyroleinsupportingandcaringfor

peoplewithdisabilitiesandareaninvaluablesourceofexpertiseaboutaperson’sdisability,healthandwell-being

• Insofaraspossible,facilitateapersonwithadisability,wheretheysowish,toreceivecareandsupportfromfamilymembers,carersorpersonalassistantswhileinhospital.However,familycarersandothersupportpersonsshouldneverbeusedtoreplacegeneralnursingormedicalcarestaff

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• Familymembersorothercarersmayneedtobegiveninformationaboutdiagnosis,medication,treatment,exercises,careandanyoutpatients’appointments,inordertoprovideeffectivesupportafterdischargefromhospital

Organiseamulti-disciplinarycaseconferencewherethisisrequired;forexample,wherethepersonhascomplexconditionsorhighsupportneeds.Cross-disciplinarysupportmaybeinvaluableintreatingsomeonewithdementia,withintellectualdisability,withmentalhealthdifficulties,withspinalinjuriesorothercomplexneeds.

• Liaisewithothermedicalteamsinvolvedintheperson’scareandtreatmentasappropriate • Drawontheexpertiseofstafffromacrossthehospital,suchasphysiotherapists,socialworkers

andspeechandlanguagetherapists,whowillassistwithplanningservicesandinformationforpeoplewithdisabilitiespriortoadmissionandondischarge

• Liaiseasrequiredwithdisabilityserviceproviders,theperson’skeyworkerorclinicalspecialistsindisability.Thisshouldalsoassistwhenco-ordinatingcareandplanningbetweenthehospitalandthecommunity

• Liaiseasrequiredwitholderpeople’sspecialistsinthehospitalandwithspecialistservices,primarycareteams,voluntaryorganisationsandkeyworkersinthecommunity

10.3 Identify existing care protocols

Identifyifthereareanycareprotocolsassociatedwiththeperson’sprimarydisabilityorpre-existingcondition.Forexample:

• Peoplewithspinalinjuriesmayhaveparticularrequirementsaroundposture,toileting,andavoidanceofpressuresores

• Peoplemayneedhelpwiththeirtoiletingandbathingrequirements,eatinganddrinking,regularturningtopreventpressuresoresorinprovidingaccessiblecommunication

10.4 Prepare in advance

Bookanyequipmentorarrangeassistanceoradaptationsbeforethepersonisadmittedtohospital.Forexample,aliftinghoistmaybeneededinatreatmentroominorderforsomeonetomovesafelyfromtheirwheelchairontoanexamination.

Placeanaccessibilitychecklistintheperson’sfilesothatallaccessibilityrequirementscanbenoted.(SeeAppendix 1forasamplechecklist.Anonlinechecklistmaysuitsomepeople).Usethelistatfollow-upappointmentsorwhenreferredtootherdiagnosticortreatmentservicesin

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thehospital,ortocommunitybasedservices.Checkifanyrequirementshavechangedateachsubsequentvisit.

Enableaccesstoanindependentadvocate;providethepersonwithcontactdetailsforindependentadvocacyservicestohelpthepersonavailoftheirentitlements.

Arrangewherepossibleforcontinuityofcaresothatsomeonewithadisabilitycanbenefitfromseeingsamehealthpractitionereachtimetheyattendanoutpatientappointment.Factorthis intotheschedulingofappointments.Forexample,someonewithanacquiredbraininjuryorapersonwithanintellectualdisabilityislikelytoexperiencelessdistressifthepersontheyseeifknowntothem.

10.5 In the hospital

Admission - In reception • Wherealowreceptiondeskisavailable,makesurethatthelowspaceiskeptclearandis

notblockedwithofficeequipment,toallowface-to-facecontactwithamanualorpoweredwheelchairuserandpeopleofshortstature

• Peoplewithmentalhealthdifficultiesoranintellectualdisabilitymayprefertositandwaitinaquietareaifavailable

Informing people of their turn to be seen • Besensitiveabouthowyoucallaperson;donotshoutorcompromisetheperson’sprivacy.If

thereisnotadualspokenandvisualannouncementofsomeone’sturn,peoplemayrequireareceptionisttoalertthemwhentheirappointmentiscalled.Forexample:

– Peoplewithimpairedvisioncanbealertedbyagentletapontheirshoulderorarm – PeoplewhoareDeaforhardofhearingcanbealertedvisuallybyahandmovement,suchas

adiscreetwaveorbytappingthepersongentlyontheirshoulderorarm Getting to the appointment / ward • Peoplewithwalkingdifficultiesorbalanceproblemsmayneedassistanceingettingtoan

outpatientclinicorward.Forexample: – Portersshouldbeavailabletoassistapersonifrequested,forexample,tositdownor

standfromaseatedposition,and/orprovideawheelchairandaccompanyapersonwithamobilitydifficulty

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– Iftheoutpatientclinic,consultingortreatmentroomisinapartofthehospitalwhichthepatientcannotaccess(forexample,upstairs),arrangetoseethepersoninanalternativelocationthatisaccessibletothepatient.Putinplaceaplansothatthiswillberectifiedin the future

• Apersonwithimpairedvisionmayrequesta‘sightedguide’.Again,porters,receptionistsandotherstaffcanalllearnhowtoaccompanyandguidepeoplewithimpairedvisionappropriatelywhenrequested

In the ward • Accommodatetherequirementsofapersonwithadisabilitywhentheyareadmittedtoaward.

Forexample: – allocateabedclosetoanaccessibletoiletandwashingfacilities – ensurethatthereisafacilityforpeoplewhoareDeaforhardofhearingtoaccesssubtitles,

if there is a television in the room • Wherepossible,apersonmayprefertobeinaquietpartofthewardorinasingleroom;

forexample: – apersonwithmentalhealthdifficultiesmayprefertobelocatedinaquietpartofthewardor

inasingleroom,ifpossible,awayfromloudnoisesandbrightlights.Asingleroommaybeimportantforsomeonewhoneedstogetagoodnight’ssleeptomanageaparticularcondition(forexample,bipolardisorder)

– apersonwhoishardofhearingmayfinditeasiertocommunicatemoreeffectivelyinaquietpartofthewardorasingleroom.Wherepossible,positiontheirbedsothattheycanseewhensomeonecomesintotheroom

– apersonwithimpairedvisionmayfinditeasiertocommunicateinaquietpartofthewardorin a single room

– apersonwithanintellectualdisabilityorcognitiveimpairmentmaybelessanxiousiftheyareinafamiliarandquietenvironment

– apersonwithdementiaorothercognitiveimpairmentmaybenefitfrombeinginaquiet partofthewardorinasingleroom.Thismayhelptoreduceconfusionandanxiety.Avoidmovingpeoplewithdementiafromoneroomtoanotherwherepossible,asthatcangiveriseto distress

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Meal times • Whenservingameal,cateringstaffshouldtellapersonwithimpairedvisionthatthemealhas

arrivedandhasbeenplacedinfrontofhim/her • Adaptedcutleryanddrinkingaidsshouldbemadeavailabletothosewhoneedthem • Servefoodonatraythathasagoodedge–anythingspilledwillstayonthetray • Helpthepersonidentifywherethefoodisonadinnerplatebyusingaclocksystem.For

example,“themeatisat12o’clock,thepeasareat3o’clockandthepotatoesareat6o’clock” • Forsomeonewithlowvision,providinggoodcolourcontrastbetweenadrinkanditscontainer

canavoidaccidents.Forexample,waterinaclearglassmaynotbeeasilyseen;insteadplacethewaterinabrightlycolouredcup.Anotherexampleistopourteaintoawhitemugwhereitiseasiertoseethaninabrownmug

• Sometimesapersonalassistantorsupportpersonisabletoassistwithfeeding;forexample,wherethepersonhasswallowingdifficulties.Thisshouldonlybecarriedoutwiththeconsentofthepersonwithadisability,andshouldneverreplacegeneralcareprovidedbyhospitalstaff

• Makespecialprovisionforpeoplewithdisabilitieswhodonothaveacarerorsupportpersontoassistthem.Itisveryimportanttoprovideassistancewithmealsandhydration

Care from family or carer • Wherepossible,provideflexibilityinvisitingtimessothatpeoplewithdisabilitiescanreceive

supportfromtheirfamilymember,carer,supportpersonorpersonalassistant,ifrequested.Thisisimportantforpeoplewithsignificantdisabilities

• Makespecialprovisionforpeoplewithdisabilitieswhodonothaveacarerorsupportpersontoassistthem.Itisveryimportanttoprovideassistancewithmealsandhydration,usingthetoiletandwashing

• Carefromfamilyoracarershouldneverreplacegeneralcareprovidedbyhospitalstaff

Disability-specificcareneeds • Beawareofspecificdisability-relatedhealthsupportneeds.Beingawareoftheneedforspecific

carecanavoidtheonsetofmorecomplicatedhealthproblemsForexample: – Apersonmayrequireregularturningtoavoidtheriskofthebuild-upofpressuresores – Apersonmayrequiretheuseofahoist,wheelchairorotherspecialisedequipment – Apersonwithaspinalcordinjuryorparalysismayrequiretimelyandrespectfulbowelcare

procedurestobeimplementedatspecifiedtimes.

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Where people cannot articulate their needs • Itisparticularlyimportantthathospitalstaffbeawarethatsomepeoplewithdisabilities,suchas

peoplewithanintellectualdisabilityorpeoplewithanacquiredbraininjury,maynotbeabletoarticulatetheirrequirementsclearly;forexample,askingforwaterorusingthetoilet

• Thisisalsoimportantbecauseapersonmaynotbeabletoarticulatechangesintheirsymptomsorpainlevels.Thefollowingmaybehelpful:

– ahigherlevelofclinicalobservationandthebuildingofagoodrelationshipandcommunications

– sensitivityandgoodcommunicationstoassistthepersonincommunicatingpainanddiscomfort;and

– theuseofpicturesandsymbolsoraskingapersontotouchthepartoftheirbodythathurts

Familiar objects • Encouragepeoplewithintellectualdisabilitiesandpeoplewithdementiatobringsomefamiliar

objectssuchasphotographsoffamilymembersontheirbedsidetable

Television • Ensurethatthefacilityforsubtitlesisswitchedonasthiswillmeanthatthetelevisionis

accessibleforpeoplewhoareDeaforhardofhearing • Manypeoplewithsightlossenjoytelevision,sodon’tbeembarrassedtoaskthepersonifthey

wouldlikethetelevisionswitchedon

Hearing loop / Listening Devices • Wherepossible,provideafacilityforapersonwhoisahearingaidusertohaveaportable

inductionloopsothattheycancommunicatewithstafforvisitorsduringtheirstayinhospital.Listeningdevicesthatamplifysoundcanhelpimprovecommunicationwithpeoplewhoarehardof hearing

Explain medical procedures clearly and accessibly • Ifapersonisundergoinganoperationoranyprocedure,itisimportantthatwhatisgoingto

happenisclearlyexplainedinadvance • Itisparticularlyimportanttoletsomeonewhoisblindorhaslowvisionknowwhatishappening

verbally,astheywillnotbeabletoseeit.Explainclearlyandstep-by-stepwhatishappeningateachstage.Forexample:

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– Ifananaesthetistisgoingtoapplyanoxygenmask,thisshouldbeexplainedinadvance – IfapersonishavinganMRIscan,mammogramorx-ray,explainallproceduresclearlyandlet

thepersonknowwhenyoumovebehindascreenorintoanotherroom – Ifdiagnosticequipmentisbeingused,suchasanechocardiogram,describeclearlywhatison

thescreen,asthismaynotbeseenbyapersonwithimpairedvisionorunderstoodbypeoplewithcognitiveimpairments

– Ifpeoplewithimpairedvisionareaskedtowearahaltermonitororbloodpressuremonitor,pointoutwherethemonitorwillbelocatedbeforeitisputon

• Alwaysaskpeoplewithdisabilities,“Isthereanythingwecandotoassistyou?”

10.6 Dischargefromhospital-integrateddischargeplanning

“Toensureserviceusersaredischargedortransferredsafelyandontimerequiresfullassessment

oftheirindividualhealthcareneeds,planningandco‐operationofmanyhealthandsocialcareprofessionals.”13

Makeaplanforcontinuityofcareandsupportafterdischargeinaccordancewiththe“Integratedcareguidance:Apracticalguidetodischargeandtransferfromhospital”.

Seesection3.14foranextractfromthe“Discharge and transfer from hospital - The nine steps quick reference guide”andsomehelpfulguidance.

• Step one: Beginplanningfordischargebeforeoronadmission • Step two: Identifywhethertheserviceuserhassimpleorcomplexneeds • Step three: Developatreatmentplanwithin24hoursofadmission • Step four:Worktogethertoprovidecomprehensiveserviceuserassessmentandtreatment • Stepfive:Setapredicteddateofdischarge/transferwithin24–48hoursofadmission • Step six: Involveserviceusersandcarerssotheymakeinformeddecisionsandchoices • Step seven: Reviewthetreatmentplanonadailybasiswiththeserviceuser • Step eight:Useadischargechecklist24–48hoursbeforedischarge • Step nine: Makedecisionstodischarge/transferserviceuserseachday

13ExtractfromIntegratedCareGuidance-Apracticalguidetodischargeandtransferfromhospital.

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Accessible Emergency Departments

StaffshouldalsorefertoThe National Emergency Medicine Programme – A strategy to improve safety, quality, access and value in Emergency Medicine in Irelandwhichisreferencedthroughoutthesectionbelow.

Emergency Sign Language Interpretative Service

OnceEmergencyDepartmentstaffidentifythatapersonisDeafandusesIrishSignLanguage (ISL)astheirprimarylanguage,theyshouldfollowthelocalpolicyinplacetoarrangeaninterpreter.

TheemergencycontactnumberfortheSignLanguageInterpretativeServicesis0876725179.

Emergency Multilingual Aids (EMA)

EMAsareavailabletoassiststaffandpatientsinanemergencywhereEnglishisnottheirfirstlanguage.Theseareavailableon:http://www.hse.ie/eng/services/Publications/services/SocialInclusion/EMA.html

11.1 On arrival

ExtractfromtheNationalEmergencyMedicineProgramme(EMP)Strategy:Section16.8.2.10Vulnerable adults:

Adultswithaphysicalorintellectualdisability,cognitiveimpairmentormentalill-health diagnosesmayrequireadditionalsocialsupportsduringandfollowingtheirEmergency Department(ED)presentation.

11. Guideline Eleven

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The National Emergency Medicine Programme (EMP) – A strategy to improve safety, quality, access and value in Emergency Medicine (EM) in Ireland(referredtoastheNational EMP Strategyinthefollowingsection)notesthatsomepeoplehaveadditionalorparticularcareneedswhentheypresenttoemergencyservices.Thestrategymakesspecificreferencetopatientswithcomplexpsycho-socialproblems,peoplewithanintellectualdisability,peoplewithaphysicaldisability,andpeoplewithlanguageorcommunicationproblems.Alloftheseserviceusersmayhaveaccessibilityneeds.Itis,therefore,importanttobesensitivetotheneedsofpatientsandserviceusers,andtoidentifyasearlyaspossibleinthepatient/serviceuserexperiencewhatneedsapersonmayhavesothattheycanbemanagedaccordingly.Forexample:

Thereceptionistmayduringthecheckinprocessidentifyiftheserviceuserortheircarerhasanyobviousaccessibilityneedsand,whereappropriate,informclinicalstaff.Localproceduresshouldbedevelopedtosupportstaffwhoidentifyaccessibilityneeds;forexample,howtoarrangeaninterpretativeserviceinanemergency.

WhiletheNational EMP StrategyidentifiesthemostimportantcomponentofEmergencyMedicineworkasthe“prioritisedevaluationandtreatmentofpatientswithtime-criticalhealthcareneeds”,itmaytakeadditionaltimetoassessaperson’simmediatecommunicationorothersupportrequirementswheretheyhaveaccessibilityneeds.

Assignednursesordoctorsmayroutinelyidentifyanyaccessibilityneedwhenaskingaboutthepast

historyofnoteorattheendofatriageprocess,whenasking“Isthereanythingelseyouneedtotellus?”.However,inordertoevaluateandtreatsomepatients,itcanbehelpfulforstafftotailorquestionstospecificallyidentifyaccessibilityneedsor,alternatively,howtomeetthem.

Top Tips

• Remembersomeformsofdisabilityarenotvisible • Provideassistancetopeopletomeettheiraccessibilityrequirementswherepossible.However,

donotassumethatyouknowbest.Justbecausepeoplehavethesamedisability,itdoesnotmeantheirneedsarethesame.Alwaysaskiftherearespecificrequirementstoaccommodateaperson’sdisability.Apersonwithadisabilityisnormallyanexpertinwhatisrequiredtoensurethattheiraccessibilityneedsaremet

• ThetriagenurseshoulddocumentanyidentifiedaccessibilityneedsonthefrontoftheEmergencyDepartmentcardandhighlightitinhandover.Thisnotonlyimprovestheexperience

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forthepatientortheirfamily/carer,butalsosavesstaffcriticaltime • Forsomepatients,itcanbehelpfultohavethesamestaffmemberinvolvedintheircare

throughouttheEmergencyDepartmentjourney;however,thisisnotalwayspossible

11.2 Communication

ExtractfromNational EMP Strategy, Section 21.7 People with Language or Communication Problems

ExcellentcommunicationisessentialtothesuccessfulinteractionwithallpatientsandtheirfamiliesattendingEmergencyCareNetworks(ECN)14units.Clearinformationisrequiredonaccessroutestothehospital;therefore,effectiveroadandhospitalsignagedetailingthetypeofECN unit is essential.

Communicationbarriersthatcanimpedesuccessfulinteractioninclude: • Literacydifficulties • Notspeakingthesamelanguage • Communicationbarriersintheenvironment,includingpoorsignageandanoisyenvironment • Theinabilitytoaccessand/oruseservicesorequipment • Physicaldisabilityrestrictingcommunication,suchasdifficultieswithwriting • Avisualorhearingimpairment;and • Alackofabilitytoconcentrateandfocusoncommunication

PatientsmaypresenttotheECNwithoneoravarietyoftheabovebarrierstoeffectivecommunication.ResourcestoassistwithremovingandreducinglanguageandcommunicationbarriersarelistedintheReferencesandResourcessectionoftheNationalEMPStrategy.SpeechandLanguageTherapistscanalsoprovideassistancewithreducingcommunicationbarriersasoutlinedinChapter16ofthestrategy.Whereapatientdoesn’thaveadequateEnglishskills,theHSErecommendstheuseofprofessionalinterpretingservicesforclinicalexaminationsorobtainingconsenttoensurepatientconfidentiality.

14EmergencyCareNetworks(ECN’s)willinclude: •24/7EmergencyDepartments(ED’s); •LocalInjuryUnits(LIU’s)wherepatientswithnon-lifethreateninginjuriescanreceivecare; •ThepotentialroleofLocalEmergencyUnits(LEU’s)providingdaytimeonlyemergencyservicesmaybeconsideredonalimitednumberofsites.

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Effectivecommunicationisessentialtotakeagoodcasehistoryandidentifysymptoms.Difficultiesincommunicationcanincreasetheriskthathealthconditionsorsymptomspassundetected.

Provideforaccessiblecommunicationandinformationateverystageofthepatient’sjourney.Establishifthereareanyspecificcommunicationaidsthatthepersonwantstouseandtheirpreferredformofcommunicationsothattheiraccessibilityneedsaremet.Forexample:

• Somepeoplewithanintellectualdisabilityhaveacommunicationpassport;somepeoplewithspeechimpairmentsuseacommunicationsboard.Communicationaidswillnormallycontaininformationabouttheperson’sdisability,communicationneeds,medicationorhealth.15 The patientpassport,wherepossible,shouldbeusedtoinformtheAcuteNeedsAssessment

• Iffundingbecomesavailable,itmaybehelpfultoprocureaportableinductionloopforhearingaidusersoraportablelisteningdeviceforhardofhearingserviceusers

Building trust is essential to good communication.

Alwayscommunicatewiththepersonwithadisabilityinthefirstinstance.Ifthisisnotpossible,involvetheperson’scarerorsupportperson.

Youmayneedtoallowadditionaltimetocommunicatewithserviceusersdependingontheirneeds.Providingthetimemaybeimportantindetectingahealthproblemthatisnotobvious,makingacorrectdiagnosisandexplainingthisandfollowuptreatment.Apersonwithanintellectualdisability,forexample,mayneedmoretimeinordertounderstandthediagnosisandthetreatment.

For more details see Guideline Four: Communication and Guideline Seven: Consent

11.3 Accessibility requirements

Asattendanceinanemergencydepartmentisnotplanned,peoplewithdisabilitieswillnothaveletthehospitalknowinadvanceofanysupportneeds.

“TheinfrastructureofeachfacilityintheECN(EmergencyCareNetwork)mustmeettheneedsofpatientswithaphysicaldisability,thusensuringtheyarecaredforinasafeenvironment.EmergencyDepartmentinfrastructureshouldalsoaccommodatepatients’familymembers,carers,EmergencyDepartmentstaffandotherhospitalstaffwhohavephysicaldisability.”16 In addition toanaccessibletreatmentspace,equipmentcanalsobehelpful.Examplesincludeaheight-

15SeeTheNationalEmergencyMedicineProgramme–Astrategytoimprovesafety,quality,accessandvalueinEmergencyMedicineinIreland-Section21.5.1.1,PatientPassportandSection21.5.1.2,Acuteneedsassessment.

16SeeTheNationalEmergencyMedicineProgramme–Astrategytoimprovesafety,quality,accessandvalueinEmergencyMedicineinIreland-Section21.6PeoplewithPhysicalDisability

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adjustabletrolleyorexaminationcouch,andhoiststoassistawheelchairusertosafelymoveontoanadjustabletrolley/examinationcouchfromtheirwheelchair.

Itispartofessentialcaretoensurethatpatientsarehydrated,thatbasiccomfortneedsaremetandthatanyadditionalinterventionsareundertakentopreventtheriskofbuild-upofpressuresores,particularlyiftheyhavetowaitonatrolleyformorethantwohours.

Apersonwithadisabilitymayhavespecificsupportneedsaroundbasicactivities,suchaseating,drinking,turningtopreventpressuresoresorgoingtothebathroom.Forexample,ifapersonisintheemergencydepartmentforlongperiodsoftimeonatrolley,theymayneedtobeturnedregularlytopreventtheriskofpressuresores,ortheymayneedassistancewithanyfeedingandhydrationrequired.

Thissupportisespeciallyimportantifthepersondoesnothaveafamilymember,personalassistantorcareworkerwiththem.However,eveniftheyareavailableandmaywishtoassistintheprocess,familycarersandothersupportpersonsshouldneverbeusedtoreplacegeneralnursingormedicalcarestaff.

Whilemanyofthesupportneedsaroundbasicactivitieswillberoutinelymetaspartoftheprofessionalstandardsadheredtobystaffprovidingessentialcare,staffmayneedtobemadeawareofspecificneedsduringhandoverprocesses,andotherdisciplinesofstaffmayneedguidanceontheirrole.Inabusyemergencydepartment,itisimportanttoensurethatspecificrequirementsofsomeonewithadisabilityarenotoverlooked.

• Ensurethatrelevantstaffhavereceivedappropriatetrainingtoassist • Handoverbetweenstaffindifferentdisciplinesshouldroutinelyincludeabriefingonspecific

accessibilityneeds • Wherenecessary,developanagreedapproachtoensurethatspecificcareneedsaremanaged

atappropriateintervalsasrequired

Theemergencydepartmentstaffmayneedtoliaisewithappropriateservicestoidentifyspecificneeds.Thismightincludetheperson’sGPorspecialist(forexample,thepsychiatricteamorcommunitymentalhealthteam)ortheirdisabilitysupportservice.SeeSection16oftheNational EMP Strategyforinformationontherolesoftherapyprofessionalsandmedicalsocialworkersinemergencycareincludingphysiotherapists,occupationaltherapists,orthoptists,speechandlanguagetherapists,dieticians,podiatristsandmedicalsocialworkers.

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See Guideline 4: Communication for more information on communicating with patients and serviceuserswithspecificdisabilities.

Ifadmittedtohospital,itisessentialthataperson’saccessibilityrequirementsarepassedontoallrelevantstaff,includingreceptionists,portersandcateringstaff.Informthepersonwithadisabilityofanyinformationthatisbeingpassedontootherstafforserviceproviders.

11.4 Waiting to be seen

“EmergencyDepartmentcliniciansandhospitalshaveadutyofcaretopatientswhomayneedtobeaccommodatedinawaitingroomarea.”SeeSection19.9.2.RecommendationsforPatientCareinEmergencyDepartmentwaitingRoomsoftheNationalEMPStrategy.

Usethistimeasanopportunitytofindoutifthereareanyspecificrequirementswhiletheperson iswaiting.

Thetriageprocesswillidentifythepriorityinthetreatmentofpatients,basedontheseverityoftheirconditionwhichcanleadtodelaysforotherpatients.

Somepatientsandserviceusersmayexperiencesignificantdistressoranxietyinunfamiliar,crowdedornoisyenvironments;forexample,apersonwithamentalhealthdifficulty,anacquiredbraininjury,anintellectualdisabilityorapersonwithdementia.IftheEmergencyDepartmenthasthespaceand/orcapacity,thefollowingmeasuresmaybehelpfulforserviceusersinthissituation.However,itshouldbenotedthatthesesuggestionsarenottoprovideapersonwithadisabilityapreferentialserviceoveranyotherpatientorserviceuser,butrathertoensurethatcompassionisshowninasituationwhereaperson’sdisabilitydirectlyleadstosignificantdistressoranxietywhichcouldbealleviated.Pleasenote,thefollowingsuggestionsaredependentonlocalresources:

• Askapersoniftheywouldprefertowaitinaquietroom/elsewhereandcallthemwhentheirturn is near

• Informapersonifthereistobealongwaitandhowlongitwillbe,ifthisisknown.Thismayallowthemanopportunitytogoawayandgetacupofteaorameal.Sendatextmessageorcallthemontheirmobilephoneiftheyarenearthetopofthequeue

MakesurethatsystemsareinplacetoensurethatpeopleareinformedappropriatelywhenitistheirturntobeseeniftheyhaveimpairedvisionorareDeaf,hardofhearingordeafblind.

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• Wherepossible,plantohavebothspokenandvisualannouncements • Ifthisisnotpossible,peoplewithimpairedvisioncanbealertedbyagentletapontheirshoulder

or arm • PeoplewhoareDeaforhardofhearingcanbealertedvisuallybyahandmovement,suchasa

discreetwave,orbytappingthepersongentlyontheirshoulderorarm

Ifthereisatelevisionintheemergencydepartmentwaitingroom,makesurethatitdisplayssubtitlesandcanbeaccessedbypeoplewhoareDeaforhardofhearing.

11.5 Family or carer support

Apersonwithadisabilitymayneedsupportwhilewaitingtobeseen,aswellasincommunicatingtheirmedicalhistory,makinginformeddecisionsandgivingconsenttocare.Inanaccidentoremergencysetting,familymembers,carersorpersonalassistantscanassistthepersonwithadisabilityandbeaninvaluablesourceofexpertiseaboutaperson’sdisability,healthandwell-being.

Facilitatethepersonwithadisabilitytobesupportedbyafamilymember,carer,personalassistantoradvocate,wheretheysowish.Thetriagenursemaybethepersonwhomakesthisdecision,whichshouldbecommunicatedtootherstaff

11.6 Assignedstaff

Itmaybehelpfultoassignakeymemberofstafftoassistapersonwithadisabilitytoensurethather/hisrequirementsaremet.Thiscanbeveryimportantforapersonwhohassignificantdisabilitiesorsomeonewhohasnoaccompanyingpersontosupportthem.However,itisrecognisedthatitisnotpossibletofacilitatethisineverysetting.

11.7 Explain medical procedures clearly and accessibly

Ifapersonisundergoinganyprocedure,itisimportanttoexplainwhatisgoingtohappenclearlyand in advance.

Itisparticularlyimportanttoletsomeonewhoisblindorhasimpairedvisionknowwhatishappeningastheywillnotbeabletoseeit.Tellthemaboutanyprocedureyouaregoingtodo,suchastakingbloodorgivinganinjection,andwheretheneedlesitewillbe.

Ifperformingaphysicalexamination,explaininadvancewhereyouplantoexamine(i.e.,touch).

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Explainclearlyandstep-by-stepwhatishappeningateachstage.

Explainalldiagnosticproceduresclearly,suchasanultrasound,rectalexamination,electrocardiogram,anx-rayorMRIscan.Letthepersonknowwhenyoumovebehindascreenorinto another room.

Ifperforminganintimateexaminationaspartofstandardprotocol,ensureachaperoneispresent.

11.8 Integrated Discharge Planning from the Emergency Department

Healthandsocialcareprofessionalsshouldreferto: • Guideline Three: Accessible services-generaladvice,Section3.14,Integrated

Discharge Planning • Guideline Ten: Accessible Hospital Services,Section10.6,Dischargefromhospital-

integrateddischargeplanning • Integrated Care Guidance: A practical guide to discharge and transfer from hospital • Chapter 19. The Emergency Medicine Patient Pathway, The National Emergency

Medicine Programme – A strategy to improve safety, quality, access and value in Emergency Medicine in Ireland

Extract from the National Emergency Medicine Programme Strategy, Section 19.17.4 RecommendationsforPatientDischargeandDeparture

• AllpatientsshouldhaveanappropriatebriefdischargesummarysenttotheirGP • TheEmergencyMedicineProgrammewilldevelopatemplateforEmergencyDepartment

dischargesummariesincollaborationwiththeDirectorateofClinicalStrategyandProgrammesPrimaryCareProgramme

• ThetimeofEmergencyMedicaldischargeandthetimeofEmergencyDepartmentdepartureshouldberecordedforallpatients

• Follow-upcarearrangementsforallpatientsshouldberecordedinthepatient’sEmergencyDepartmentrecords/EmergencyDepartmentInformationSystems

• StandardNationalEmergencyCareSystemsdatasetswillincludefollow-uparrangementsforEDpatients

• Patientsshouldbeprovidedwithself-careinformationaspartofthedischargeprocess(forexample,headinjuryadvice)

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WhereappropriatetotheEmergencyDepartment,makeaplanforcontinuingcareandsupport after discharge.

Safedischargemaymeanthatstaffwillliaisewithotherdisciplines,suchasthePublic HealthNurse,theirGP,thespecialisttreatingtheirprimarydisabilityorotherconditionortheirdisabilitysupportservice.“Multidisciplinaryassessmentisparticularlyvaluableinsupportingthesafedischargeofpatientswithcomplexcareneeds.”:Section19.19.4,PatientDischarge, National EMP Strategy.

AllGPsshouldbeinformedfollowingaserviceuser’sattendanceattheEmergencyDepartmentaspartofstandardprocesses.Wherethispostexists,thismaybethetaskofaGPliaisonnurse.

Assessifanyadditionalsupportsareneededwhenthepersongoeshome,followingtheirEmergencyDepartmentvisit.

Whenapersonisdischargedfromhospital,explainallfollow-upprocedures,medication,after-careorwhenfurtherappointmentsareneeded.Printthisinformationoffinclearprintsothepersonhasittokeep.

Itisimportantthatfamilymembers,carersorsupportpersonsalsounderstandthemedicationregime.Whileitisimportanttorespecttheperson’sprivacy,itisalsoimportantfortheirsafetythatthoseassistingthemknowwhichmedicationshouldbetaken.Carersalsoneedtobetoldwhenandunderwhatconditionsthepersonneedstoreturntothehospital.

Signpostapersontowardsrelevantdisabilityorganisationsforsupportandinformation ifappropriate.

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Accessible maternity services

12.1 Introduction

Theguidelinesarewrittenintheknowledgethatservicesmaynothavefinancialresourcestoimplementallmeasuresoutlined.However,manyoftheguidelinesarecostneutral,andthey alsoserveasaresourceforhealthandsocialcareprofessionalswhomaybeplanningservicesinthe future.

Theseguidelinesareforallhealthandsocialcarestaffandshouldbereadinconjunctionwiththerelevant Code of Professional Conductandwiththeexistingguidelinesforstaff,includingtheClinical Guidelines of the Institute of Obstetricians and Gynaecologists at the RoyalCollegeof Physicians in Ireland and Midwifery Practice Standards (2010) from An Bord Altranais agus Cnaimhseachais.

An Bord Altranais midwifery practice standardsstatethathealthprofessionalsshouldenhancetheirknowledgeofservicesandsupportsavailabletowomenwithdisabilities,inlinewiththe RoyalCollegeofNursing’s(2007)guidelines.TheRoyalCollegeofNursingguidelines,entitledPregnancyandDisability:RCNGuidanceforMidwivesandNurses,canbeaccessedathttp://www.rcn.org.uk/.

MoredetailisavailableonaccessibleservicesinGuideline Three: Accessible services - general advice; Guideline Four: Communication; Guideline Five: Accessible information; Guideline Six: Accessible buildings and facilities and Guideline Seven: Consent.

12. Guideline Twelve

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Clinicalstaffneedtobeknowledgeableaboutparticularneedsandissuesconnectedwithdisabilityandtohavecorrespondingclinicalskills.Forexample,relevantcliniciansshouldknowaboutepiduralanaesthesiaforsomeonewithspinabifidaorspinalcordinjury.

Itshouldbenotedthatthissectionisprimarilyaboutaccessiblematernityservicesfromthewoman’sperspective.However,patientsandserviceusersmaywishtohaveapartner,familymember,friendoranadvocateaccompanythem,whomayhaveanaccessibilityrequirement.Inthisregard,servicesmayneedtogiveconsiderationtotheirneedsalso;forexample,ablindparentattendingthebirthoftheirbaby.

12.2 Non-judgmental

InaccordancewiththeCode of Professional Conduct,benon-judgmentalandprofessionalincaringforwomenwhoarepregnant.

• Donotqueryherdecisiontogetpregnantnorhercapacitytocareforandnurtureherbaby • Donotassumethatshehasordoesnothaveanyspecificrequirements–ask.Peoplewith

disabilitiesmayhavealotofexpertisearoundspecificneedstheyhaveandhowtheycouldbemet

12.3 Planningforspecificrequirements

Birth or Care plan Abirthorcareplanshouldtakeaccountofanyspecificneedsaserviceusermayhave,andthis

includesaccessibilityrequirementsassociatedwithawoman’sdisability.Ideallyanassessmentoftheseneedsshouldbeconductedatthefirstantenatalbookingvisit.

Participationincareisimportant.Activelyinvolvethewomanintheassessmentandbirthorcareplan.Enablehermakeinformedchoicesateverystep–aboutantenatalcareandclasses,aboutthebirthofherchild,aboutbabyfeeding,aboutsupportwithparentingskillsetc.

Whereappropriate,furtherinformationmayneedtobesoughtfromtheperson’sGP,otherhealthprofessionalsorspecialistservices.Wherecarerequirementsaremorecomplex(forexample,awomanwithmultipledisabilities,intellectualdisabilityorsignificantmentalhealthdifficulties),involvingamulti-disciplinaryteamcanaddressdifferentaspectsofcare.Itmaybenecessarytoholdacaseconferencetohelpformulateacomprehensivebirthorcareplan.

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Ensurethatrelevantstaffareawareofanyrequirementsinrelationtocareortreatmentthatareassociatedwiththeunderlyingimpairment;forexample,theneedtomaintainaparticularpostureforsomeonewithaspinalinjury.

Planahead.Forexample: • Bookaccessibleaidsandequipment,suchasaheight-adjustableexaminationcouchorahoist

forawomanwithaphysicaldisability • Ensurethedeliverysuiteisaccessible

Somewomenwithdisabilitieswillbenefitfromseeingthesamehealthpractitionereachtimetheyattendanantenatalclinic.Wherepossible,factorthisintotheschedulingofappointments.

Appointastaffmembertoakeyworkerroleinsituationswhereitisrequired;forexample: • Whereawomanhassignificantdisabilitiesor • Awomanwithdisabilitieswhodoesnothavethesupportofapartneravailable.Thiskeyworker

shouldhavereceivedappropriatetraining

Sharerelevantinformationwiththecareteamandotherstaff Itisessentialthatrelevantinformationissharedwithstaffinvolvedinthewoman’scareatdifferent

stagesofthecarejourney;forexample,inantenatalcare,duringbirthandduringpostnatalcare.Thiscanminimisetheneedforawomanwithadisabilitytonegotiatethesameissuesatdifferentstagesofhercareorwhenshemeetsdifferenthealthpersonnel.

• Includerelevantinformation;forexample,communicationpreferencesonherchartandanITsystemforbookingquestionnaires,whereavailable

• Clinicalstaff,includingmedical,nursingandtherapystaff,shouldbeinformedofspecificelementsofthebirthorcareplan

• Informationrelevanttocareandsupportondischargeshouldbepassedontorelevantstaff,suchasthewoman’sGP,publichealthnurseorsocialworker

• Relevantstaff,suchascatering,housekeepingandreceptionstaffinthehospital,shouldbeinformedofanyindividualrequirementsrelevanttotheirroles;forexample,anyspecialrequirementsaroundmanagingmeals

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Accessible premises See Guideline Six: Accessible buildings and facilities for more information.

Ensurethatbuildingsareeasytoaccessandgetaround: • Providehandrailsandseatingwherepeoplehavetowalksomedistancebetweendepartments • ProvideclearsignageinplainEnglishtoenablepeoplefindtheirway

Provideopenaccessibletoiletstoservewaitingareas,thedeliverysuiteandthewards.Maintainingoodworkingorder.

Provideaccessibleshowerandbathfacilitiesonthewards.SeeNationalDisabilityAuthority’sBuilding for Everyone www.universaldesign.ie/buildingforeveryone,SanitaryServicesfortheappropriatetechnicalstandards.

Ensurethatthebedlayoutinthedeliverysuiteandthematernitywardfacilitatesawomanwhousesamanualorpoweredwheelchairorawomanwhohasimpairedvisiontomovearoundeasily.

Providegoodlightingeverywhere:inreception,theantenatalclinic,thedeliverysuiteandonthepostnatalward.Thisbenefitseveryone,includingthosewhoarepartiallysighted.

Ensurethatwaitingrooms,corridors,consultationroomsandwardsarefreeofobstaclesthatcouldimpedemobilityorbeahazardforsomeonewhocannotsee.Forexample:

• Donotstoreequipmentinacorridorwhereitcouldblockcirculationorpresentahazard • Do not store cleaning materials in an accessible bathroom and • Ensurethatleadsandwiresfromequipmentorvacuumcleanersarenotlefttrailingonthefloor

wheretheyareahazardandmaytripsomeone

Accessible equipment Ensurethatequipmentisaccessibleorthatanappropriatealternativeisoffered.Forexample: • Provideheight-adjustableexaminationcouchesorbeds,withahoistavailable,sothatawoman

cantransfersafelyonandoff • Provideweighingscalesthataresuitableforawheelchairuser • Provideheight-adjustablebabycotsincubatorsandbabybathingfacilitiessothatwomenwith

physicaldisabilitiescanfeed,lift,holdandbathetheirbabies;and

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• Ensurethatappropriateequipmentandaidscanbeusedwhetherthewomanisstanding,seatedorlyingdown

Appointments and waiting room See Guideline Three: Accessible services – general adviceforinformationonappointmentsand

waitingrooms.

Communicateaboutappointmentsinthewaythatisaccessiblefortheindividual;forexample,bye-mailortextmessageforsomeonewhoisDeaforhardofhearing,orbyphoneore-mailforsomeonewhoisblindorvisionimpaired.Asktheindividualwhattheircommunicationneedsare.

Letpeopleknowapproximatelyhowlongtheyhavetowaitandwheretheyhavetogowhentheyare called.

Haveasystemwhichenableswomenwhohavedifficultyseeingorwomenwhohavedifficultyhearingtoknowwhentheyarebeingcalled.TicketingsystemswithvisualelectronicdisplaysareaccessibletosomeonewhoisDeaf.However,thereneedstobeanaudiocomponentforsomeonewhocannotsee.Ifthisisnotpossible,someonewhohasavisionorhearingimpairmentcouldbeinformedthatitistheirturnbyagentletapontheshoulder.

Ifyouhaveatelevisioninthewaitingroomforantenatalappointmentsoronthematernityward,makesurethatithasafacilityforsubtitlesandisaccessibletopeoplewhoarehardofhearing or Deaf.

Itcanbehelpfultoscheduleappointmentswithaninterpretersothatwaitingtimesandcostofinterpretiveservicesareminimised.

Information Provideinformationabouttheaccessibilityofyourpremisesandservices;forexample,inan

informationbookletoronyourwebsite.Thiscouldcoverinformationaboutaccessibleparking,accessibilityfeaturesofyourbuildingandanycommunicationaidsorothersupportsavailable.

Provideinformationonwhattodoandwhotocontactifcomplicationsemergeorincase ofemergency.

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Yourinformationformothersshouldcoverissuesaroundpregnancyandmentalhealth,includingpost-nataldepression.

• Encouragewomentodiscloseiftheyhavementalhealthissuesorareonmedicationsothattheycangetappropriatesupportbotharoundtheirpregnancyandtheirmentalhealth

• Provideinformationoncounsellingsupportsavailable,supportthatcanbereceivedbytelephone,andprovideinformationfornewmothersaboutpost-nataldepressionsupportgroupsand counselling services

Ensurethatinformationonthematernityservices,childbirthandinfantcarecanbeprovidedindifferentformatsonrequestandwherepracticable.Youmaybeaskedtoprovideinformationinlargeprint,onaudio,bye-mail,throughyourwebsiteorinBraille.

AllinformationshouldbeinplainEnglish.Aservicemaytakestepstotranslatetheinformation intootherlanguageswherenecessary;however,thisshouldalsobewritteninastylewhichiseasyto understand.

Ensurethereisatextdescriptionofanypicturesordiagrams,thatcanexplainthemto someonewhocannotsee:thisisessentialwhereadocumenton-lineisbeingreadusingscreen-readertechnology.

MakeuseofEasy-to-Readhealthleafletsonspecificproceduresthatareavailable.EasytoReadisthetermforverysimplifiedtextwithpictures,whichisimportantforpeoplewithliteracyproblemsorlimited English.

Ante-natalclassescanusevisualteachingaidswithsubtitlestocommunicatewithwomenwhoarehard of hearing or Deaf.

Videoclips,audioclipsandDVDscanenhancetheaccessibilityofinformationtowomenwithdisabilities.Keepinformationinaudioandvideoshortasitcanbedifficulttoretainalotofinformationfromsuchsources.Womenwhohavedifficultyretaininginformationcangoovertheseagain and again.

For more see Guideline Five: Accessible information.

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Consent Please read Guideline Seven: Consent and the National Consent Policy for further information

on consent.

Toenableawomantogiveinformedconsenttoanyprocedure,appropriateinformationneedstobegivenandcommunicatedinawaythatmeetstheaccessibilityneedsofthewoman.Staffshouldexplaininaclearandaccessiblewaywhatwillhappenifawomanneedsaninterventionofanytype.Someserviceusersmayneedadditionaltimeandsupport,including,ifnecessary,repeatinginformationtohelpthemunderstand.

Itmustnotbeassumedthataserviceuserlackscapacitytomakeadecisionsolelybecauseoftheirage,disability,appearance,behaviour,mentalcondition(includingintellectualdisability,mentalillness,dementiaorscoresontestofcognitivefunction),theirbeliefs,theirapparentinabilitytocommunicate,orthefactthattheymakeadecisionthatseemsunwisetothehealthorsocialcareprofessional.Youshouldpresumethatallwomenhavethecapacitytoconsenttoaparticularprocedureorintervention,unlessthereisanadequatetriggerindicatingotherwise.

Allserviceusersmayexperiencetemporarylackofcapacityduetosevereillness,lossofconsciousness or other similar circumstances.

Alwaysgetconsenttopassonanyconfidentialinformationaboutaccessibilityrequirementsortopassoninformationtoothermedicalorsupportstafforthewoman’sfamily.

Flexibility Servicesmayneedtobeflexiblesothattheycanmeettheneedsofaserviceuserwithadisability. Whenmakingappointmenttimes,takeintoconsiderationthatawomanwithadisability: • Mayfindearlymorningappointmentsdifficulttoattendduetomedication,additionaltime

neededtoprepareetc;and • Mayneedextratimetogettoanantenataloroutpatientappointment

Beopentoprovideone-to-onesupporttoenableawomanwithadisabilitytoparticipateinantenataltrainingandtosupportbabyfeedinganddevelopmentofparentingskills.

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Wherepossible,beflexibleaboutofferinghomevisitsasanalternativetocomingtothehospital orbabyclinicwhereawoman’sdisabilitywouldmakethatparticularlychallenging.Thismightincludeprovidingantenatalvisitsathome,teachingandsupportingawomanwithparentingskillsathome,orhavingthebabyweighedathomeratherthaninthebabyclinic.Thismaynotbefeasiblein some settings.

Allowflexibilityinvisitingtimessothatthewoman’spartnerorcarersupportpersoncanassistandsupportherwithheractivitiesofdailylivingandwithbabycare.

12.4 Antenatal services

Antenatal care Factorinlongerappointmentswherenecessary.Itmaytakelongertocommunicatewithsomeone

withaspeechorhearingdisabilityorsomeonewithanintellectualdisability.Thereshouldbesufficienttimegiventohearanyconcerns,toexplainwhatishappeningandtoensurethewomanunderstandswhatisbeingsaid.

WhereantenatalcareissharedbetweentheGPandthehospital,itisessentialtoensurethereisgoodcommunicationaboutanyaspectofthewoman’srequirementsthatmaybeassociatedwithherdisability.

Explainthestepsinvolvedinanyprocedureortestinadvance,inclearandsimplelanguage.Theseprocedurescanincludebloodtests,urinetests,bloodpressureandweightchecksorultrasoundexaminations.Forsomeonewithahearingdifficultyormentalhealthimpairment,usingdiagramsisagoodwaytoexplain.Explaininadvancewhatishappeningtosomeonewhocannotsee.

Awomanwithamobilitydisabilitymayneedtositdownorliedownduringanx-rayorotherdiagnosticexamination.Ifthisisnotpossible,discusswiththewomanandtakeanyguidanceshemayhaveonhowtoproceedintoconsiderationwhenexaminingalterativeoptions.

Provideasafeandsupportiveenvironmentforwomenwithmentalhealthdifficultiestodiscloseanddiscusstheirconcerns.Whereneeded,makeareferraltothementalhealthteamortothementalhealthsupportmidwifeifthereisoneavailable.

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Antenatal classes Antenatalclassesshouldbeheldinplacesthatarephysicallyaccessible.

Wherepossible,ante-natalclassesshouldbedesignedtobeinclusive,whereclass content,informationandpresentationmethodsareaccessibletoeveryoneincludingmothers withdisabilities.

Exercisesandtechniquesshouldbeadaptedasappropriatewhereawomanhasa physicaldisability.

• Awomanwhocannotseewillneeddiagramsorexercisesexplainedorally • AwomanwhoishardofhearingorDeafmayneedtositclosetothefacilitatorsothatshecan

hearorlipread • Informationtotakeawayshouldbeavailableinarangeofaccessibleformatstosuittheneedsof

individuals

Antenataltutorsshouldbeabletotellwomenwithphysicaldisabilitiesaboutadaptivetechniquesoraids.Itmayalsobehelpfulforthemtoliaisewithstaffinthedeliverysuitewhereappropriate,toensurethattheyalsohavethisinformation.

Itisnotalwayspossibletocaterforawomanwithadisabilityinamainstreamante-natalclass,andone-to-onesessionsmayberequiredinparticularcases.

Womenwithintellectualdisabilitiesmayalsobenefitfromone-to-oneantenatalsessionswherematerialcanbeexplainedinasimplewayatanappropriatepace.Forexample,ifawomanwithanintellectualdisabilityisundergoingaplannedcaesarean,theprocedureshouldbecarefullyexplainedinsimplelanguage.

12.5 Giving birth

Itisimportantatthisstagetospendextratimewithawomanwithadisabilitytolistenandrespondtoanyconcernsshemayhave.

Ensurethatthemidwifeandclinicalteamarefamiliarwiththespecificrequirementsofawomaninrelationtoaccessiblecareand/oranyspecialcommunicationissuestheymayhave.

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Ensurethattheteamhavedevisedwaystocommunicatewiththeserviceuserappropriately. Forexample:

• Awomanwithahearingimpairmentoranintellectualdisabilitymayfinddiagramsandgesturesauseful aid to communication

• AwomanwhoisDeaforhardofhearingcanagreesomesignsorgestureswhichcanactasalternativesifsheisunabletolipreadduringlabour

• Awomanwhoisvisuallyimpairedorwhohasanintellectualdisabilitymayneedverbalexplanationstounderstandwhatishappening

• Awomanwithanintellectualdisabilitymayneedamidwifeormidwiferyassistanttostaywithherandgivereassurancetoreduceanxietyorfear.Keepinformationshortandsimple,nottoomuchto take in

• Awomanwithaphysicaldisabilitymayneedtohaveassistancetomovesafelyandchangeherpositionduringlabour,andmayrequireanadditionalmemberofstafftoassist

Explainclearlyandstep-by-stepwhatishappeningateachstageduringanexamination,andthenwhatwillhappendependingonthefindings;forexample,ifthewoman’scervixisdilated,ifherwatershavebroken,ifsheisbeingreferredforanemergencycaesareansectionorifsheneedsaforcepsdelivery.

Explaininformationaboutchoicesinpaincontrolclearlyandthenwhatishappeningwhenpaincontrolisinstituted.Explainthatusinggasandairmaymakesomeonefeeldisorientated.

Duringlabour,ask‘Whatcanwedoforyou?”and“HowcanImakethepaineasierforyou?”.

12.6 Careintheward

Ifitispossible,itmaybehelpfulforawomanwithadisabilitytohaveaprivateroom.Thisdoesnotmeanthatapersonwithdisabilitiesreceivespreferentialtreatmentaboveotherserviceusers,butratherthattheirspecificneedsaretakenintoconsiderationaspartoftheprovisionoftheircare. Forexample:

• Providingquietcanbeimportantforawomanwithmentalhealthdifficultiesorawomanwithhearingdifficulties

• Someonewithavisionimpairmentmayfinditeasiertoorientthemselvesinasingleroomthanonabusyward

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Forawomanwithhearingdifficulties,ifpossible,thebedshouldfacethedoorsothatthewomancanseewhenacateringassistantornurseenterstheroom.Ifthisisnotpossible,thestaffmembershouldmaketheirpresenceknowntothewoman.

Whereawomanwithadisabilityissharingaward,trytoensureherbedisplacedclosetothewashingandtoiletfacilities.

Helporientatewomentothelayoutandfacilities.Showthemthelocationoflightswitches,toiletsandshowers,otherfacilitiesonthewardforthebabyandhowtheycansummonhelp.Whilethisshouldbedoneforallpatientsandserviceusers,itisparticularlyimportantforserviceuserswhohaveavisualimpairmentoranintellectualdisability.

Provideheight-adjustablecotsforwomenwhorequirethistoenablethemcarefortheirbabyasindependentlyaspossible.

12.7 Post-natal care and after discharge

Communicateinformationtoassistwomenwithdisabilitiesintheirrecoveryfrombirthandindevelopingthepracticalskillsofparentingandself-care.Communicateinawaythatisaccessibletotheserviceuser.Thismaytakeadditionaltimedependingontheneedsofthewoman.SeeGuideline Four: Communication for more information.

Provideinformationinasuitableformattotakeaway.Forexample,thiscouldbeinlargeprint,bye-mail,onaudioorinpictorialEasytoReadformat,asrequiredintheparticularcase.SeeGuideline Five: Accessible information for more information.

Giveadequateinstructionsonpostnatalexercisesandrecoveryafterbirthtowomenwithdisabilities.Aphysiotherapistmaybeabletoassistwomenwithphysicaldisabilitiesaboutappropriatepelvicfloororotherexercisesthatarerecommendedforrecovery.

Providesupport,assistanceandguidanceonthepracticalaspectsofbabycare.Forexample,thephysiotherapistcanassistthewomanwithtechniquesforliftingandholdingherbaby,provideadvice on useful aids etc.

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Communicatesensitivelyandinwaysthewomancanreceiveandunderstand,onanyareasofdifficultyordistress,suchasifitisacrisispregnancy,ifthebabyisillorhasadisabilityoronthedeathofthebaby.Ensurethereiscounsellingavailablethatiscapableofcommunicatingwiththewomanandherpartnerinwaystheycanreceiveandunderstand.

ManywomenwhoareDeafseedeafnessnotasadisabilitybutasanintrinsicpartoftheiridentity.Respectthisperspectivewheninformingherabouttheresultsofanyhearingtestsonherbaby.

12.8 Discharge and follow-up

Itisimportanttoplanforawoman’saccessibilityrequirementsandhermedicalandsupportneedsondischarge.Preparationfordischargemayneedtoincludeacaseconferencebetweenthematernitystaffinthehospitalandpublichealthnurse,occupationaltherapist,socialworkerandGPstoensuretheneedsofmotherandchildaresupportedwhenshereturnshome.Withthewoman’sconsent,ensurethatthedetailsofawoman’saccessibilityrequirementsareincludedinaplanforpostnatalcareandfollow-upappointments.

Explainclearlywhenandwherefollow-upappointmentswilltakeplace,andwhenshewillseethe

publichealthnurseandattendthebabyclinictogetthebabyweighed.Providethisinformationonappointmentsinanaccessibleformattotakeaway,suchaslargeprint,bye-mail,inaudioortextformat,asrequired.

Additionalsupportsmayberequireddependingonthecircumstancesofthiscase.Ensurethatthewomanisfullyinvolvedandinformedaboutplans.Forexample:

• Itmaybenecessarytoorganiseadditionalparentingsupportathome,suchasahomehelporapersonalassistant

• Specificsupportmayneedtobeorganisedfromapublichealthnurseinbreastfeedingathome • Specificsupportmaybeneededforpostnataldepression

Publichealthnursescanhaveaveryimportantroletoplayintheprovisionofadvice,informationandsupportduringthepostnatalperiod.Itisimportantthatfollow-upvisitsareputintotheirschedulesothatthenewmothersreceivethissupport.

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12.9 Post-natal depression

Ensurethereisaplanfortheprevention,earlydetectionandmanagementofperinatalmentalhealthproblemsandpostnataldepression.Identifywomenatrisk,facilitateappropriatesupportandaccessarangeofsupportsforthem.

Explainclearlyandinnon-judgmentalwayshowtoaddresspostnataldepression.

Provideaccessiblewritteninformationaboutpostnataldepressionandavailablehealthandsupportservicesforwomenexperiencingpostnataldepression.

12.10 Goodpracticeguidelinesforwomenwithspecificdisabilities

A woman with physical disabilities Discusswithawomanwithaphysicaldisabilityadditionalsupportthatcanbeprovidedbya

physiotherapistincarryingoutexercisesandbreathingasherpregnancydevelopsandinpreparingforchildbirth.Aphysiotherapistmayalsoassistthewomanindevelopingtechniquesforliftingandcarryingherbaby.

Planaheadforanoccupationaltherapisttovisitawomanathomepriortothebirthtoseeifthereisanyequipmentoradjustmentstothewoman’shomethatneedtobemadeinadvanceofbringingababyhome.Thiscouldincludeaccessiblebabybathsorchangingareas.

Womenwithphysicaldisabilitiesmayexperiencedifficultiesintheirmobilityasaresultofweightgainduringpregnancy.Apregnantwomanwhoisawheelchairusermayneedalargerwheelchair,orawomanwithawalkingdisabilitymayneedtoavailofamobilityaid.

Aheight-adjustablebabycotortabletochangeababy’snappycanhelpanewmotherto beindependent.

Putplansinplacetoprovidesupportathomewhereappropriateandpossible. • Anewmothermayneedhomehelp/anassistanttoassistherinthecareofherbaby,suchasin

nappychanging,liftingherbabyfromthecotorbathingthebaby • Homevisitsmayalsoberequiredifitisdifficultforawomanwithaphysicaldisabilitytoattenda

babyclinic

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Awomanwithmentalhealthdifficulties Staffinvolvedinmaternitycareshouldprovideasafeandsupportiveenvironmentwhereamother

candiscloseanddiscussanymentalhealthissuesandbereferredtosourcesofsupportandcareinrelationtoanymentalhealthissues.

Ifavailable,offerawomanwithmentalhealthdifficultiesaccesstoaspecialistmentalhealthserviceormentalhealthsupportmidwifeinthehospital.

Liaisonbetweenstaff,suchasmaternitystaff,physiotherapists,occupationaltherapistsetc.,andacommunitymentalhealthteamormentalhealthnurseshouldtakeplacewhereappropriate,withthewoman’sconsent.

Midwivesanddoctorsinvolvedinmaternitycareshouldbecomefamiliarwithawoman’smedicationandmentalhealthhistorywhereappropriate.Discusswithapregnantwomantheuseorwithdrawalofmedicationsduringherpregnancyandbirth,particularlyifmedicationthatsheistakingcouldbeharmfultothefoetusorababywhoisbreastfed.

Ifawomanistransferredfromapsychiatrichospitalorward,shewillneedtobesupportedbyamentalhealthnurseandanymedicationmanagedappropriately.

Womenwithmentalhealthdifficultiesoftenexperienceanxietyattendinganappointment. • Taketimetolistentotheconcernsoranxietiesexpressedbywomenwithmental

healthdifficulties • Taketimetoexplainwhatwillhappenduringanexaminationandatdifferentstagesofthe

birthprocess • Givereassuranceandsupportwherethisisneeded • Toalleviatesignificantanxiety,ifappropriateandwherepossible,tryandensurethatthewoman

canwaitinaquietplaceandthatshedoesnothavetowaittoolongfortheappointment

Ifthewomanhasgivenbirthbefore,askherifshehadexperiencedanxietyordifficultyandfindoutwhathelpedherandwhatdidnothelp.Askherwhatwouldhelpherduringhercurrentpregnancyand forthcoming birth.

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Itisimportanttoplanwiththewomanthesupportthatcanbeprovidedbythewoman’sGP,thepublichealthnurse,andthecommunitymentalhealthteamaftersheisdischargedfromhospital.

Provideinformationonadvocacyservices,supportgroupsandservicesforpost-nataldepression.

A woman with a vision impairment Whenyoutalktoawomanwithavisionimpairment,giveyournameandexplainyourrole.Lether

knowwhensomeoneelseentersorleavestheroom.

Allowaguidedogtoaccompanyawomantothehospitalforantenatalappointmentsandclasses,anddiscusswithherwhattheoptionsareregardingbringingaguidedogwithherwhensheisaninpatientandduringthebirth.

Explainallexaminationsandproceduresinadvance,stepbystep,tosomeonewhocannotseewhatyouaredoing.

Providewritteninformationinanaccessibleformatwhichtheserviceusercanaccess;forexample,largeprint,e-mailorBraille.

Explainthelayoutoftherelevantpartsofthehospital,suchasthereception,waitingroomandtoiletfacilities.Inthebirthingsuiteorintheward,explainwherethedifferentfacilitiesare,includingthelocationofthetoiletandshowerandthecallbellforassistance.

Offertoguideawomanwithimpairedvisiontowheresheisgoing;forexample,toaseatinthewaitingroom.

Provideaprivatespacewhereshecangiveoralanswerstofillinanyform,withoutbeingoverheard.

Ensureawomanwithavisionimpairmentisletknoworallywhenitisherturntobecalled.Offerherassistancetogototheexaminationortreatmentroom.

Ifawomanwithimpairedvisionishavingafoetalultrasoundorexamination,explainclearlyandstep-by-stepwhatishappeningonthescreen.Facilitateawomantohearherbaby’sheartbeatthrough vibration.

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Itisimportanttoexplainclearlyanycomplicationswhererepeatedscanstakeplace.Wherepossible,arrangefortheultrasoundtobeprintedinlargeprintformatandarrangeforittobeemailedtothewomanifrequested.

Explainproceduresclearlyandstepbystepduringthebirth.

Provideclearguidanceonhowtocareforherbabytakinghervisualimpairmentintoconsideration.Forexample,giveguidanceonhowtoexpressmilkortomakeupformulafeeds.

A woman who is Deaf or hard of hearing Ahearingloopenhanceshearingforsomeonewhousesahearingaid.Aportableloopsystemcan

enhancecommunicationatdifferentlocations;forexample,inthewaitingroom,thebirthingsuiteandtheward.

• Letserviceusersknowifyouhaveoneavailable • Checktheloopsystemregularlytoseethatitisworking

SomepeoplewhoareDeaforhardofhearinglip-read. • Positionyourselfface-to-faceinfrontofthewomanwhenspeakingandwithgoodlighton

yourface • Donotspeakwhenwalkingawayorfrombehindatheatremask • Speakclearlyandmakeeyecontact • Rememberthatshemaynotfullycatchorunderstandwhatyouaresaying,sousediagrams,

gesturesandprovidewritteninformationaswell.Forexample,ifthereisatestbeingconductedonthemotherorbaby,athumbs-upcansignalthatalliswell

IfaDeafwomanhasrequestedanIrishSignLanguageinterpreter,putaplaninplaceforthistobeprovidedatsubsequentvisitsandwhenshecomesintohospitaltogivebirth.Plansmayalsoneedtobeputinplaceinadvanceofanunplannedoremergencyadmission.

Wherepartnersareattendingantenatalclassesoratthebirth,makearrangementsforaccesstoIrishSignLanguageInterpretationwherethepartnerisDeaf.

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Unlessthewomanrequestsitorinanemergencywhenthereisnoalternative,avoidrelyingonthewoman’spartnertoactastheinterpreter.Ifheisneededbyhertosupportherthroughlabourpainorchildbirth,itisdifficulttoalsoactasinterpreter.Inadditiontothis,IrishSignLanguageInterpretersarequalifiedtointerpretalloftheinformation.Apartner,familymemberorfriendmaynotdosoforanumberofreasons;forexample,inanefforttoprotectaserviceuserfromworry,etc.

Duringlabour,itmaybedifficultforawomantolipread.Ifthisisthecase,anadditionalmemberofstaffmaybeneededtohelpwithcommunication.Priortolabour,agreewiththewomansomevisualsignsorgesturesthatstaffcanusetohelpcommunicate.

ProvidewomenwhoarehardofhearingorDeafwithbabyalarmsthatvibratewhenthebaby cries.Itisbestifsheislocatedinasingleroomonthewardasthealarmmaypickupthecries of other babies.

A woman with an intellectual or cognitive disability Awomanwithanintellectualorcognitivedisabilitywillneedinformationexplainedtoherinvery

simplelanguageandsimpletermsthatshecanfollow.Useofdiagramscanbehelpful.Rememberthelevelofunderstandingmayvaryforeachserviceuser.

Awomanwhohasothercommunicationdifficulties,othermedicaldifficultiesoranotherconcurrentdisability(forexample,mobility,visualimpairment,ormentalhealthdifficulties,etc.)willneedadditionalsupportduringpregnancy,childbirthandafterwards.

Awomanwithanintellectualorcognitivedisabilitymayrequireadditionalsupportfromaphysiotherapisttosupportherbreathingduringpregnancyorbirth.

Awomanwithanintellectualorcognitivedisabilitymayexperiencedifficultiesincommunicatingpainduringlabour.Itisimportanttoanticipatethisandtoensureshehasassistanceincommunicatingandmanagingpain;forexample,beingaccompaniedbyafamilymemberorcarerduringlabourmayprovideadditionalreassuranceforher.

Itisimportanttoexplainsimplyandclearlyinadvanceaboutanyprocedurestobeundertaken,suchasvaginalexaminations.

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Thechoicesandpossiblecomplicationsofdifferentwaysofgivingbirth(naturalbirthorcaesareansection)oruseofepiduralpainreliefshouldbeexplainedsimplyandclearlytoenableinformedconsent to be obtained. See Section Fifteen: Consent for more information.

Informationmayneedtoberepeatedseveraltimes,asawomanwithanintellectualdisabilitymaynotunderstandthefirsttimesheisgiveninformation.Checkthatwhathasbeensaidisunderstood.

Informationmaynotbewellretainedfromonevisittothenext,soensureitisrepeated.

Maternityservicesshouldliaisewiththewoman’ssupportnetwork,includingherfamilyandserviceprovider,whereappropriate,toensurethatherneedsareunderstoodandmet.

Amulti-disciplinarycaseconferencemayneedtobeorganisedwhenawomanwithanintellectualdisabilitybecomespregnanttoplanappropriatecareandsupportforherduringpregnancy,duringthe birth and on discharge.

Goodcoordinationisrequiredtoprovideappropriatecareandsupportafterdischargeincludingsupportincaringforthebaby.

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Specialist disability organisations

Thereareanumberofdisabilityservices,serviceproviders,advocacyservicesandcarersupportorganisationsavailabletosupportserviceusers.TheCitizensInformationBoard,DisabilityManagersintheHSEandotherumbrellabodieswillbeabletoguideyouintherightdirection.

Specialistdisabilityorganisationscanhaveawealthofpracticalinformationonmatterslikecommunication,accessibility,andday-to-daymanagementandlivingwithaparticularcondition.

Whileitisnotpossibletolisteverydisabilityorganisationinthisguidance,theCitizensInformation Boardpublishesalistofnationalvoluntaryorganisations,includingdisabilityorganisations. www.citizensinformationboard.ie/publications/voluntary_sector/downloads/directory_of_volunteers2008.pdf.

Foralistofvoluntarymentalhealthorganisations,seewww.citizensinformation.ie/en/health/mental_health/voluntary_mental_health_organisations.html

Manyorganisationsworkingwithpeoplewithspecificconditionscanbefoundviaoneoftherelevantumbrella bodies.

Additional Useful Resources

General guidance

Guidance on accessible buildings and places

TheNationalDisabilityAuthority’saccessibility toolkitwww.accessibility.ieprovidesgeneralinformationonhowtomakeservices,buildings,information,andwebsitesmoreaccessibletopeoplewithdisabilities.Thiswebsiteisupdatedregularly.Guidanceonaccessiblebuildingsandplaces

TheDepartmentoftheEnvironment,HeritageandLocalGovernment: BuildingRegulations2010.TechnicalGuidance Document M Access and Use

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Guidance on accessible buildings and places

Guidance on safe evacuation

Guidelines on accessible information and accessible formats

www.environ.ie/en/Publications/DevelopmentandHousing/BuildingStandards/FileDownLoad,24773,en.pdf TheNationalDisabilityAuthority’sBuildingforEveryone:www.universaldesign.ie/buildingforeveryone.

TheIrishWheelchairAssociationhavedevelopedBestPracticeAccessGuidelines-DesigningAccessibleEnvironments,followingextensiveconsultationwiththeirmembersandexternalorganisations:www.iwa.ie/services/housing/iwa-housing-advocacy/designing-accessible-environments

TheNationalDisabilityAuthorityGuidanceonSafeEvacuationforAll:www.nda.ie/Website/NDA/CntMgmtNew.nsf/0/BC5E9F0E705C006C8025784F003B42EE/$File/Safe_Evacuation_for_All.pdf

CitizensInformationBoard,Access to Information for All: www.citizensinformationboard.ie/publications/social/social_access_info_contents.html

National Disability Authority guidance: www.accessibility.ie/MakeYourInformationMoreAccessible/

Information for all: European standards for making information easy to read and understand – Inclusion EuropeDo not write for us without us: Involving people with intellectual disabilities in the writing of texts that are easy to read and understand–InclusionEurope

Both the above available at: http://inclusion-europe.org/en/projects/pathways-ii

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Making health information easier to understand and guidance for using plain English

Accessible information using symbols and pictures

Accessible information for blind people

Forinformationonhowtowrite,prepareanddesigndocumentsinplainEnglish,see:www.simplyput.ie/

Make it Easy: a guide to preparing easy to read information hasbeenpreparedbytheAccessibleInformationWorkingGroupwhoworkwithadultswithintellectualdisabilitiesinIreland.Itisavailableat:www.walk.ie

TheNationalAdultLiteracyAssociationhasinformationonmakinghealthinformationeasiertofollow:www.citizensinformationboard.ie/publications/social/downloads/AccessToInformationForAll.pdf

EasyInfohasresourcestohelpmakeinformationaccessibleinformationforpeoplewithintellectualdisabilities,includingguidanceonhowtousesymbolsandpicturesandmakingdocumentsEasy-to-Read:www.easyinfoforus.org.uk/Organisationsthatprovidesymbolsinclude: • ChangePictureBank(www.changepeople.co.uk) • Photosymbols(www.photosymbols.co.uk) • Boardmakercommunicationsymbols (www.mayer-johnson.com)

ContacttheNationalCouncilfortheBlindofIreland’smediacentreforfurtherguidanceonhowtoprovidealternatives,includingBrailleandgoodqualityaudio,forpeoplewithimpairedvision:www.ncbi.ie.

TheIrishDeafSocietyhasfacilitiesforproducingsignedvideosandDVDs:www.irishdeafsociety.ie.

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Accessible information where Englishisnotafirstlanguageand translation is required

Hospital care for people with dementia

www.lenus.ie/hse/bitstream/10147/207010/1/Lostintranslation.pdf

http://www.rcn.org.uk/development/practice/dementia/commitment_to_the_care_of_people_with_dementia_in_general_hospitals/commitment_to_dementia

Information on entitlements

Name: Citizens Information Board Address: GroundFloor,George’sQuayHouse,43TownsendStreet,Dublin2 Website: www.citizensinformation.ie Telephone number: 0761079000 Fax number: 016059099 Service provided: TheCitizensInformationBoardprovidesinformationonpublic

services and entitlements in Ireland. Sign Language Interpreters

Name: Sign Language Interpreting Service Address: DeafVillageIreland,RatoathRoad,Cabra,Dublin7 Website: www.slis.ie Email: bookings@slis.ie Telephone number: 0761078440ormobile0879806996 Emergency out of hours: 0876725179 Fax number: 018380243 Service provided: TheSignLanguageInterpretationServiceisthenationalagency

fortheprovisionofsignlanguageinterpreters,andprovidescontactdetailsforanyonewishingtobookaninterpreter.Italsoorganisesalimitedremoteinterpretationserviceviavideolink.

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Ifyouwishtobookasignlanguageinterpreteroutsideofficehours,pleasecalltheSignLanguageInterpretingService(SLIS)EmergencyHelplineon0876725179.Onlyasmallnumberofpeoplecaninterpretmedicalinformation,buttheywilldotheirbesttoarrangeaninterpreterforyou.

Umbrella bodies - service providers

Name: Disability Federation of Ireland Address: FumballyCourt,FumballyLane,Dublin8 Website: www.disability-federation.ie Email: info@disability-federation.ie Telephone number: 014547978 Fax number: 014547981 Service provided: Thisisthenationalsupportorganisationforvoluntarydisability organisationsinIrelandwhoprovideservicestopeoplewith

disabilities and disabling conditions. It serves as an umbrella bodyfororganisationsservingpeoplewithphysical,sensoryor

neurological conditions. Name: Inclusion Ireland Address: UnitC2,TheSteelworks,FoleyStreet,Dublin1 Website: www.inclusionireland.ie Email: info@inclusionireland.ie Telephone number: 018559891 Fax number: 018559904 Service provided: InclusionIrelandprovidesinformationandadvocacysupportto peoplewithanintellectualdisability,andparentsandfamily membersofchildrenwithanintellectualdisability.Themembership ofInclusionIrelandincludesindividualswithintellectualdisabilities,

parentsandcarersandserviceproviders.

164 165

Name: National Federation of Voluntary Bodies Address: OranmoreBusinessPark,Oranmore,Galway Website: www.fedvol.ie Email: info@fedvol.ie Telephone number: 091792316 Fax number: 091792317 Service provided: Thisistheumbrellabodyforintellectualdisabilityserviceproviders. Name: NotforProfitBusinessAssociation Address: UnitG9,CalmountPark,Ballymount,Dublin12 Website: www.notforprofit.ie Email: info@notforprofit.ie Telephone number: 014293600 Fax number: 014600919 Service provided: Thisistheumbrellabodyforserviceprovidersforpeoplewith physicalorsensorydisabilities.

Name: The Wheel Address: 48FleetStreet,(entranceParliamentRow),Dublin2 Website: www.wheel.ie Email: info@wheel.ie Telephone number: 014548727 Fax number: 014548649 Service provided: TheWheelisasupportandrepresentativebodyconnecting communityandvoluntaryorganisationsandcharitiesacross Ireland.Establishedin1999,TheWheelhasevolvedtobecomea resourcecentreandforumforthecommunityandvoluntarysector.

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Accessibility checklist

Thefollowingtableisachecklistwhichstaffcanusetohelpthemidentifyifthereareanyspecificrequirementsrelatingtoaperson’sdisability.

Appendix 1

Aretherespecificrequirementsrelatingtotheperson’sdisability?Does the person need: Yes No

1. Tomakeappointmentsbytextmessageore-mail?2. Helptoknowwhenitistheirturntobecalled?3. Supportwithcommunicationorspecificcommunicationaids?4. Assistancewithmobility?5. Consultationstotakeplaceonthegroundfloor?6. Specificequipmentsuchasaliftinghoist,aheight-adjustableorexamination

couchoraccessibleweighingscales?7. Adapteddiagnosticequipment,suchasanMRIormammogram,adaptedto

accommodatetheirimpairment?8. Specificsupportorcareneedsrelatedtoapre-existingconditionorprimary

disability?9. Specialistnursingstaff,akeyworkerorsocialworkertoassistwithadisability?10. Arrangementsinplaceforafamilymember,carer,supportperson,personal

assistantorindependentadvocate?11. Specificassistancerequiredtogiveinformedconsenttocare?12. Accessibilityrequirementsinrelationtofollow-upappointments,referralstoother

servicesorservicesinthecommunity?13. Doesthepersonhaveanyotheraccessibilityrequirements?14. Doesthepersonneedaninterpreter?Ifso,whatlanguage?

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Appendix 2

Core principles of a quality services

The National Healthcare Charter, You and Your Health Service,isaStatementofCommitmentby theHSEdescribingwhatserviceuserscanexpectwhenusinghealthservicesinIreland,and

whattheycandotohelpIrishhealthservicestodelivermoreeffectiveandsafeservices.Itis basedoneightprincipleswhichunderpinhighquality,people-centredcare.Theseprincipleshave

beenidentifiedthroughareviewofnationalandinternationalpatientchartersandthroughwideconsultationwiththeIrishpublic.

TheNationalHealthcareCharteraimstoinformandempowerindividuals,familiesandcommunitiestoactivelylookaftertheirownhealthandtoinfluencethequalityofhealthcareinIreland.

You and Your Health Service - what does it do?

Itoutlinessupportingarrangementsforapartnershipofcarebetweeneveryoneinvolvedinhealthcare:patients/serviceusers,families,carersandhealthcareproviders.

Itsupportsahealthcareculturethatdelivershealthandsocialcareservicesinapredictable,preventative,personalandparticipatoryway.

Itrecognisesthattherearedifferentrolesandresponsibilitiesforbothserviceusersand healthcareproviders.

Itpromotestheimportanceofserviceusersasindividualswithdiverseneedsandnotjustamedicalcondition to be treated.

Itappliestoallpublichealthandsocialcareservices,includingcommunitycareservicesandacutehospitalservices.

ThefollowingtablesetsoutthecoreprinciplesofprovidingaqualityserviceassetoutintheNational Healthcare Charter, You and Your Health Service.

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Access

DignityandRespect

SafeandEffectiveServices

Communication and Information

Participation

Privacy

Improving Health

Accountability

Ourservicesareorganisedtoensureequityofaccesstopublichealth and social care services.

Wetreatpeoplewithdignity,respectandcompassion. Werespectdiversityofculture,beliefsandvaluesinline withclinicaldecision-making.

Weprovideserviceswithcompetence,skillandcareinasafeenvironment,deliveredbytrustedprofessionals.

Welistencarefullyandcommunicateopenlyandhonestly,andprovideclear,comprehensiveandunderstandablehealthinformation and advice.

Weinvolvepeopleandtheirfamiliesandcarersinshareddecisionmakingabouttheirhealthcare.Wetakeaccountofpeople’spreferencesandvalues.

Wewilldoourbesttoensurethatyouhaveadequatepersonalspaceandprivacywhenyouuseourhealthservices.Wemaintainstrictconfidentialityofpersonalinformation.

Ourservicespromotehealth,preventdisease,andsupport andempowerthosewithchronicconditionstoself-managetheir condition

Wewelcomeyourcomplaintsandfeedbackaboutcareandservices.Wewillinvestigateyourcomplaintsandworktoaddressyourconcerns.

8 Principles What patients and service users can expect

ExtractfromNational Healthcare Charter – You and Your Health Service.

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Disability - the numbers

TheCensusandtheNationalDisabilitySurveygiveanindicationofhowmanypeopleexperiencedifferentkindsofimpairment.Thiscanbeusefulforserviceplanning.

Therearedifferentdegreesofdisabilityfromtotalandseveretomoderateandmild,andthenumberofpeoplewithdisabilitiesisverysensitivetowherethelineisdrawn,whatexactquestionisaskedandhowitisasked.

BasedontheNationalDisabilitySurvey2006,betweenoneinfiveandoneintenofthepopulationhadalong-termdisability.InCensus2011,13%ofthepopulationstatedtheyhadalong-termdisability.Inaddition,therearepeoplewhomaybeexperiencingshort-termimpairment,becauseofabrokenlimb,forexample,andolderpeoplewhohavesomedifficultiesineverydayactivities,butdonotdescribethemselvesashavingadisability.

Sothedatapresentedinthissectionisindicativeandnotprecise.

Mobilityisthemostfrequentlyencountereddisability.Ofthe160,000peoplewhohaddifficultyinwalkinganydistance,83,000usedwalkingaidsand31,000werewheelchairusers.

Peoplewithalotofdifficultyinseeing(withglasses)greatlyexceededthenumberswho werecompletelyblind.Sothereislikelytobeawidespreaddemandforlargeprintbutfewer Braille users.

Thefiguresalsosuggestthathealthservicestaffarelikelytoencounterpeoplewhoarehardofhearingmorefrequentlythanthosewithoutanyhearing.Census2011showedtherewereabout2,600peopleforwhomIrishSignLanguagewasthelanguageofthehome.

Peoplewithdisabilitiesbytypeofimpairmentandseverity:NationalDisabilitySurvey2006

ThisisatablewhichisbasedonthosepeopleinterviewedintheNationalDisabilitySurvey2006whohaddisclosedadisabilitybothinCensus2006andintheNationalDisabilitySurvey.Itincludesthetypeofimpairmentandseverity.

Appendix 3

168 169

Total % of population Seeing 50,600 1.19 -moderatedifficulty 27,600 0.65 -alotofdifficulty 20,700 0.49 -cannotsee 2,300 0.05

Hearing 57,600 1.36 -moderatedifficulty 35,200 0.83 -alotofdifficulty 20,600 0.49 -cannothear 1,800 0.04

Speech 35,300 0.83 -moderatedifficulty 16,800 0.40 -alotofdifficulty 12,200 0.29 -cannotspeak 6,400 0.15

Mobility and dexterity 184,000 4.34 -moderatedifficulty 57,000 1.34 -alotofdifficulty 62,200 1.47 -cannotdo 64,900 1.53

Moving around home 101,200 2.39 -moderatedifficulty 50,200 1.18 -alotofdifficulty 38,400 0.91 -cannotdo 12,700 0.30

Going outside of home 128,900 3.04 -moderatedifficulty 53,700 1.27 -alotofdifficulty 49,900 1.18 -cannotdo 25,300 0.60

Walking for about 15 minutes 160,000 3.77 -moderatedifficulty 47,200 1.11 -alotofdifficulty 52,900 1.25 -cannotdo 60,000 1.42

170 171

Total % of population Usinghandsandfingers 79,000 1.86 -moderatedifficulty 33,900 0.80 -alotofdifficulty 30,900 0.73 -cannotdo 14,300 0.34

Remembering&concentrating 113,000 2.67 -moderatedifficulty 54,900 1.29 -alotofdifficulty 43,800 1.03 -cannotdo 14,300 0.34

Rememberingimportantthings 77,600 1.83 -moderatedifficulty 39,100 0.92 -alotofdifficulty 27,600 0.65 -cannotdo 10,900 0.26

Forgetting where I put things 85,800 2.02 -moderatedifficulty 44,600 1.05 -alotofdifficulty 30,400 0.72 -cannotdo 10,800 0.25

Concentrating for 10 minutes 77,900 1.84 -moderatedifficulty 35,000 0.83 -alotofdifficulty 29,800 0.70 -cannotdo 13,100 0.31

Intellectual functions 27,700 0.65 -alittledifficulty 4,000 0.09 -moderatedifficulty 9,100 0.21 -alotofdifficulty 10,300 0.24 -cannotdo 4,300 0.10

170 171

Total % of population Intellectual & learning 71,600 1.69 -alittledifficulty 12,000 0.28 -moderatedifficulty 25,900 0.61 -alotofdifficulty 24,800 0.58 -cannotdo 8,900 0.21

Interpersonal skills 22,300 0.53 -alittledifficulty 4,600 0.11 -moderatedifficulty 7,200 0.17 -alotofdifficulty 7,200 0.17 -cannotdo 3,400 0.08

Learning everyday skills 55,000 1.30 -alittledifficulty 10,200 0.24 -moderatedifficulty 19,500 0.46 -alotofdifficulty 18,700 0.44 -cannotdo 6,700 0.16

Diagnosed with intellectual disability 50,400 1.19 -alittledifficulty 14,000 0.33 -moderatedifficulty 24,200 0.57 -alotofdifficulty 9,000 0.21 -cannotdo 3,200 0.08

Emotional, psychological & mental health 110,600 2.61 -alittledifficulty 25,300 0.60 -moderatedifficulty 46,300 1.09 -alotofdifficulty 35,100 0.83 -cannotdo 8,900 0.21

172 173

Total % of population Pain 152,800 3.60 -moderatedifficulty 74,900 1.77 -alotofdifficulty 73,100 1.72 -cannotdo 4,700 0.11

Breathing 71,500 1.69 -moderatedifficulty 45,000 1.06 -alotofdifficulty 25,200 0.59 -cannotdo 1,300 0.03

Total persons with a disability 393,785 9.29

172 173

Membership of the HSE Universal Access Steering Committee

TheHSEUniversalAccessSteeringCommitteewasestablishedin2011toadvise,makerecommendationsandsupportthedevelopmentofastrategicapproachtouniversalaccessinhealthandsocialcareservices.Itisapartnershipofkeyinternalandexternalstakeholdersandexperts.

Greg Price Director,NationalAdvocacyUnit,HSE Cate Hartigan AssistantNationalDirector,HSE(untilJuly2013) Paul Defreine ChiefArchitecturalAdviser,HSEEstates Diane Nurse NationalLeadforSocialInclusion,HSE Michael Shemeld NationalDisabilityUnit,HSE williamReddy AcuteHospitalsProgramme,HSE(untilJune2012) Tony Leahy MentalHealthSpecialist,HSE Enda Saul Communications,HSE RosalieSmithlynch AreaManager,ConsumerAffairs,HSE ChrisRudland AreaManager,ConsumerAffairs,HSE Helen Lahert CitizensInformationBoard Elaine Howley NotforProfitBusinessAssociation John Hannigan NationalFederationofVoluntaryBodies Deirdre Carroll InclusionIreland(untilJune2012) Jim Winters Inclusion Ireland Jacqueline Grogan DisabilityFederationofIreland Shane Hogan NationalDisabilityAuthority(untilJune2013) Donie O’Shea NationalDisabilityAuthority Dr. Shari McDaid MentalHealthReform Marie Prendergast PrimaryCare,HSE Michele Guerin EqualityOfficer,HSE Marian Murray EqualityOfficer,HSE Sinead Burns AreaManager,ConsumerAffairs,HSE Deborah Keyes AreaManager,ConsumerAffairs,HSE

Appendix 4

174 175

Gerry Mulligan PrimaryCareReimbursementServices,HSE Helen Valentine PrimaryCareReimbursementServices,HSE Phil Garland AssistantNationalDirector,ChildrenandFamilies,HSE(until

September2012) Caoimhe Gleeson NationalAdvocacyUnit,HSE Angela Kennedy NationalAdvocacyUnit,HSE Juanita Guidera NationalAdvocacyUnit,HSE

174 175

ISBN: 978-1-906218-80-5

Quality and Patient Safety Division HealthServiceExecutive OakHouse MillenniumPark Naas CountyKildare Tel: 045880400 Fax: 1890200894 Email: yoursay@hse.ie Website: www.hse.ie National Disability Authority 25ClydeRoad Dublin4

Tel: 016080400 Fax: 016609935 Email: nda@nda.ie Website: www.nda.ie

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