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A tale of two trusts

Very recently I heard two stories, both delivered with a true passion for good care and a commitment to ensuring all people have their needs met. The stories were about two very different patient experiences at two NHS trusts.

One trust serves an affluent community and has a good reputation. It has a strong local support and access to greater amounts of charitable funding and sponsorship of various projects. The other faces much greater demographic and reputational challenges.

Shall we call the first 'Richmouth Hospitals NHS Foundation Trust? Maybe the second could be 'Poorside NHS Trust'? The finances aren't the issue though - except to help understand that good care is not always about money.

A young man with a learning disability was admitted for surgery to Poorside hospital. Their learning disabilities team was made aware of the admission and co-ordinated care and consents to allow the young man to have his surgery under the care of a specialist learning disabilities anaesthetist and a specialist learning disabilities theatre practitioner. The patient was provided with care whilst under anaesthetic that would not be provided when the chap was conscious and aware because he became too distressed. That planning allowed for a physical health check and care that included blood tests, vaccination, chiropody and even a haircut. He not only looked better and was more comfortable, but was protected from other potential harms and the trauma of trying to fight off people he probably perceived as trying to hurt him with scissors and needles. No restraint was necessary, there was no lack of dignity, less stress on staff and much less distressed and potentially violent behaviour.

The young man with a learning disability who was taken by ambulance to the accident and emergency department of Richmouth Hospital did not fare as well. There were restrictions in place because of Coronavirus. The rule was that patients were not permitted to be accompanied in the department. This non-verbal young man was not allowed to have the two people who could keep him calm and enable care with him. He became very distressed to the point where he became very unsettled, banging his head to the point of drawing blood and throwing things around. His behaviour frightened staff and meant they couldn't carry out the diagnostic tests necessary to determine the cause of his sudden onset ill health. He had to leave without a diagnosis or treatment plan. The sudden, serious ill health recurred. This time the young many was too frightened to even enter the department. He'd been calm in the ambulance, he'd co-operated with paramedics on the journey, but couldn't face going into the place where he had been so frightened before. He remains undiagnosed and untreated for a potentially life threatening condition.

Undoubtedly, there was guidance in place to restrict visitors to emergency departments, quite rightly so, but that guidance does not negate the need to comply with the Equality Act 2010 and make reasonable adaptations for people with a protected characteristic. The NHS even offer a COVID-19 Grab and Go guide for people with learning disabilities. There is a section on the form that records what support is needed for people with learning disabilities, "This is the help I need to understand what is happening and the support I may need with any treatment". That support is likely to include the need for an advocate or supporter.

Poorside hospital policy was that visitors were only considered in exceptional circumstances. The exceptional circumstances included where a patient had additional needs, e.g. dementia, mental health or learning disabilities. Richmouth hospital website shows video's of the emergency department pathway but doesn't mention people with additional needs.

The care differences these two young men received was not about funding, it was about staff attitudes. In one case, fairly short sighted attitudes which dealt with the immediate perceived risk of the virus, but not the possibly greater risk of an undiagnosed and untreated serious condition or even an avoidable death.

What about the staff?

Which group went home with a smile on their face feeling they had served their patient well? Which hospital team were helping build a positive culture, for themselves as much as their patients?

Who were less likely to suffer violence or to have a complaint made about them?

Do you and your team find solutions or use policy and guidance as barriers to personalised care delivery?

Do you tell those who ask that you have passports, and assume that is sufficient? Do you audit use of the passports? Do you engage with people with disabilities, staff, carers and family about how useful they are in practice?

Do you ever join up services and offer holistic care?

Does your own or your team's attitude enable good care or prevent it? Are there simple changes that you could make to usual practice to improve the care you provide for people with a learning disability or other cognitive impairment?

Could you reduce fear-induced, distressed behaviours through a change to how you provide care?

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