National Guidelines on Accessible Health and Social Care Services: Part Two

Part Two: Guidelines for specific services

The guidelines describe a standard which we can aspire to. They are written in the knowledge that services may not have financial resources to implement all measures outlined; however, there is an obligation on individuals to ensure that they know what is required of them by law. They also serve as a resource for health and social care professionals who may be planning services in the future.

Many of the key initiatives you can take to make services more accessible are cost neutral. Consideration, compassion and open communication are free. Time spent identifying a person’s needs is an investment in safe, effective care which can prevent unnecessary risks to the individual and the staff member.

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9. Guideline Nine
Accessible GP surgeries, health care centres and primary care centres

The following section should be read in conjunction with Part One:

  • Guideline Three: Accessible services - general advice
  • Guideline Four: Communication
  • Guideline Five: Accessible information
  • Guideline Six: Accessible buildings and facilities
  • Guideline Seven: Consent
  • Guideline Eight: Role of family members and support persons

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9.1 Plan services for all

People with disabilities are more likely to draw on primary care support as while they enjoy general good health; on average, they have poorer health than the population at large.

Primary care plays a critical role in supporting people with disabilities and chronic conditions to manage their condition, recover after an illness and stay well.

It is essential that primary care services are planned and delivered so that they are accessible to all patients and service users.

The uptake of preventative screening programmes is often very poor by patients and service users with a mental health illness or disability. Research also shows that people with intellectual disabilities who are living in the community are less likely to access primary care than other members of the population.

The following table includes a General Points Checklist to help staff and services identify if their services are accessible.

When reading the tables in the following sections, please note that the guidelines describe a standard which we can aspire to. They are written in the knowledge that services may not have financial resources to implement all measures outlined; however, there is an obligation on individuals to ensure that they know what is required of them by law. They also serve as a resource for health and social care professionals who may be planning services in the future.

General Points

  1. Are the premises and equipment accessible to people with disabilities?
  2. Is information and communication tailored to particular requirements people with disabilities may have?
  3. Are investigations, treatments and prescribed exercises tailored to meet the needs of people with disabilities?
  4. Is a person with a disability treated on the basis of the clinical condition they present with? There can be a risk that symptoms of an illness are attributed to the person’s disability rather than to another condition.
  5. Do people with intellectual disabilities in your community access primary care?
  6. Are people with disabilities actively included in preventive and screening programmes?
  7. Would it be helpful to keep a register of patients with disabilities to enable audit of their care?

Top Tips

  • A positive measure introduced in the UK has been an automatic annual check-up for patients with an intellectual disability – this is considered good practice.
  • Ensure preventive and screening programmes are designed to be accessible to and inclusive of people with disabilities where appropriate; for example, mammograms, cervical smears, flu vaccinations etc.

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9.2 Your premises

The following table is a checklist which will help staff identify if their premises are accessible. It should be noted that this is not an exhaustive list and can be added to as required. More

information is available in Guideline Six: Accessible buildings and facilities.

Points to consider:
A checklist of your premises

General points

  1. Is your premises physically accessible to people with disabilities?
  2. Is there an alternative for patients who have difficulties in negotiating stairs; for example, that they can be seen in a downstairs consulting room?
  3. Is there accessible parking close to the entrance?
  4. Is there a pathway from the entrance to the parking area?
  5. Is the main road free from obstructions or steps?
  6. Is there clear external and internal signage with large well-lit signs so that people can find their way easily to the building and around the building?
  7. If you have an intercom system at the entrance to the GP surgery or health centre, is it usable by someone seated in a wheelchair, by someone who has a visual impairment and by someone who is hard of hearing or Deaf?
  8. Is there a ramp if the entrance is not level? Wheelchair users cannot negotiate steps, whereas people who walk but with some difficulty generally prefer a small number of steps to a ramp.
  9. Is there a handrail to assist people who are not steady on their feet?
  10. Is there a hearing loop? If so, are people who use hearing aids routinely informed that it is available? Alternatively, consider a portable hearing loop or listening device that can be taken from one treatment room to another.
  11. Is there an accessible toilet located at the entrance level and signposted?
  12. Is the receptionist desk at a height where someone who is seated can transact their business?
    • Is it possible to put a chair at the reception desk for someone who has a walking difficulty to sit down, if needed?
    • When a person is seated, do they have an unblocked view of the receptionist?
  13. Is there sufficient space in the waiting room for a wheelchair user to turn around, and also so that the person can sit in the main waiting area next to a seated companion?
  14. If your premises is not physically accessible to someone, are you prepared to arrange an appropriate alternative; for example, provide a home visit?
  15. In the case of an emergency, is there an appropriate plan in place for the safe evacuation of everyone? Has consideration been given to safe evacuation of those with disabilities; for example, people who are Deaf, blind, hard of hearing or who have mobility issues?

Top Tips

  • If there is no fixed ramp, services might consider if it is possible to provide a mobile ramp or provide the option of both steps and a ramp
  • If there is a loop system or a portable listening device, check that it is tested regularly and that staff know how to use it

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9.3 Appointments, opening hours, waiting rooms

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

Please note that the following section does not mean that preferential treatment will be given to people with disabilities, but rather that services should exercise consideration for the circumstances of a case where appropriate.

  • Where possible, be flexible in making appointments, taking into consideration that some people with disabilities have difficulties with early morning appointments because of medication or the additional time needed to get ready
  • Where possible, be flexible about surgery/ health centre opening hours to enable a family member, personal assistant or support person to accompany people with disabilities to attend an appointment
  • Some people with disabilities may get agitated (for example, in an unfamiliar environment) or find it difficult to remain in one place for long. For these patients, consider appointment times that may minimise waiting times; for example, the first appointment after lunch
  • If appointments can be made by text message or email, ensure there is a two-way process so that a person can respond to a text message or email, and cancel or change an appointment if
  • necessary. It is important that reception staff respond to text messages and emails in a timely way. Let people know of alternative methods of communication; for example, include a number to text on publicity material and headed paper
  • People with disabilities may require more time than the standard consulting appointment (for example, to allow for additional time to interpret sign language) and consideration should be given to booking a longer appointment or double appointment
  • It can be helpful to schedule appointments with an interpreter so that waiting times and cost of interpretive services are minimised

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9.4 Waiting to be seen

For more information, see Guideline Three: Accessible services - general advice.

Visual Display Units in waiting rooms and public areas can inform people of appointments, directions, information or queuing information. A visual system could be a ticket machine, a visual display or a white board.

If possible, have both an audible and visual system for letting people know their turn. This is to ensure that people with impaired vision and people who are hard of hearing or Deaf are aware that they are being called for their turn.

If you use a ticket system for the queue, ensure that the ticket machine is at a height where a wheelchair user or a person of short stature can reach it (and that there is an alternative for people who are blind).

Inform people of how they will be called and of the location of the visual display units so that they can sit where they can see or hear when they are called.

In the absence of a visual display unit in the waiting room, make sure that people with impaired vision or those who are Deaf or hard of hearing are informed when it is their turn to be seen.

If you have a leaflet stand, make sure it can be reached from a wheelchair.

If your reception desk is not at an accessible height, be prepared to meet a wheelchair user away from the reception desk, in a place which will enable them to discuss their requirements with the same degree of privacy afforded to others.

A person with a walking difficulty or balance problems may need assistance sitting or standing. People with impaired vision may need assistance in finding a seat in the waiting room or a consultation/treatment room.

Offer to guide someone to the treatment room if this is needed; for example, someone with impaired vision or who is unsteady on their feet.

Some people with disabilities may find it difficult to wait in a crowded reception or waiting area without becoming agitated or anxious. Where possible, provide a quiet place for people who are distressed or anxious to sit, away from bright lights and noise.

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9.5 Filling forms

It may be helpful to make large print forms available that are accessible to people with impaired vision.

It may be helpful to provide the option for the form to be accessed and completed on-line in advance of an appointment, if possible.

Ask if the person needs assistance filling in a form and provide that assistance if necessary. Approximately 25% of adults in Ireland have literacy difficulties. They are sometimes embarrassed by this, and can be very adept at covering up their problem. All staff should be particularly mindful of this group.

If the receptionist’s counter is too high (for example, for a wheelchair user), you may need to step around it to complete your business with the patient / service user. Ensure there is a private area where people can give personal and medical details without being overheard.

A clipboard can be helpful for people unable to reach the counter when filling out forms or signing documents.

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9.6 Examination and treatment

It is important to liaise with the specialist services that are treating any underlying disability or chronic condition, and ensure that any appropriate treatment protocols are followed in the primary care setting. For example, someone with a spinal injury may need to keep a particular posture, and this should be factored in to any examination or primary care treatment.

Ensure that your treatment and diagnostic facilities are accessible to wheelchair users and people who are unable to stand for long periods of time; for example, it may be helpful to:

  • Equip your premises with an examination couch that can be raised or lowered, and with a hoist or monkey bars that can assist someone with mobility problems to safely transfer on and off
  • Provide wheelchair weighing scales; and
  • Provide handgrips to help people with mobility or vision impairments to have support when standing, for example, on weighing scales

If the patient is not able to transfer to an examination couch with assistance, conduct the examination in the person’s chair or wheelchair if appropriate.

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9.7 Consent

You should seek the consent of the person with a disability as with any other patient. See Guideline Seven: Consent.

Always ask for consent to share confidential information about an individual’s accessibility requirements.

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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.

Communicate directly with the person, rather than their family member, carer or interpreter.

If you have a patient with a disability, ask what their preferred method of communication is to enable two-way communication with the service; for example, orally, in writing, by e-mail or otherwise. Text and email may be appropriate for making appointments / administrative tasks; however, they should never substitute for a face to face clinical or professional consultation. It is relatively easy to have an email relationship with a patient with a disability, but this can be a source of error and poor clinical management if it is the sole means of communication.

Ensure that communication is appropriate to the person’s needs so that the person can receive and understand communication around appointments or referrals, a diagnosis, prescribing medications, exercises etc.

Record their preferred method of communication on their file and ensure that:

  • Relevant staff, such as receptionists who make appointments, are aware of it and
  • A system is in place to alert other relevant staff who may have contact with the patient or service user as part of their care plan

Where the person has a significant disability, family members or carers may be able to offer guidance on how best to communicate.

Where possible, use the person’s preferred form of communication, for example, texting or e-mailing, in relation to appointments.

Give the patient or service user relevant information to take away, clearly typed and in plain English. A service may take steps to translate the information into other languages where necessary; however, this should also be written in a style which is easy to understand.

It may be necessary to provide additional time or communication support to enable a person to understand the treatment and possible outcomes and to ask questions. A service may take steps to translate the information into other languages where necessary; however, this should also be written in a style which is easy to understand.

General principles of good communication include:

  • Face the person you are communicating with
  • Maintain eye contact
  • Never carry out another task when listening to someone
  • Speak clearly, concisely and slowly
  • Use straightforward language
  • Ask one question at a time and do not interrupt unless necessary
  • Give the person time to respond and ask questions
  • Repeat what you have said when a person is having difficulty understanding and verify that they have understood; and
  • Phrase questions in a way that a person can give a simple ‘yes’ or ‘no’ answer

Explain the procedures you will undertake, step by step.

For a patient who is unable to see, go through each procedure or test before you do it. Tell them what parts of their body you will examine and where you will touch. If you are giving an injection or a needle prick, explain where you will put the needle or, if you are taking blood pressure or using a stethoscope, explain the procedure.

Some patients or service users may need extra time to understand what is being said to them and to ask questions (for example, a person who is unable to speak or to hear, who has difficulty processing or retaining information or who cannot read, or a person who has an intellectual disability, an acquired brain injury or dementia). Use very simple language. As they may have difficulties processing or remembering information, take it slowly, step by step.

Do not overload the patient or service user with information. Where appropriate, use pictures, signs and symbols.

If someone has difficulty in hearing, face them directly and make sure your face is in the light, to enable them lip-read. Speak clearly, do not exaggerate your mouth movements and do not cover your mouth. Use gestures and diagrams and provide information in writing to reinforce what you are saying.

If you have difficulty understanding what a person is saying, tell them in a respectful way. The person maybe able to respond with a gesture to questions that require just a “yes “or “no” answer.

If requested by a Deaf person, book an Irish Sign Language interpreter in advance of an appointment. Take all reasonable steps to ensure that a Deaf person can access a qualified Irish Sign Language interpreter of their choice. The absence of a professional interpreter can result in misdiagnosis, clinical risk and compromise safety. Where there is an unplanned visit or an emergency, you may be able to communicate through a remote sign language interpreter via video link. This requires a wifi-enabled computer with a camera, microphone and speakers, as found on modern laptops.

Be sensitive to the stress it may cause if someone has difficulty in communicating clearly or in understanding information. Facilitate them in giving it extra time and in explaining as clearly as you can, using gestures and diagrams to supplement the spoken word.

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9.9 Information

For further information see Guideline Five: Accessible information.

Provide information on accessibility features of your premises and services. Include this information on your communication materials; for example, on a website, information leaflets, booklets etc.

Provide take-home information to supplement what you say to your patients or service users. People may not be able to absorb everything you say during a consultation or treatment session. Information should be written in plain English and typed in clear print. Use simple language to explain medical terms. Provide appropriate diagrams, for example, for physical exercises.

Provide information to your patients on other relevant community support services and entitlements; for example, if a patient has recently developed a disability, you may be able to refer them to the appropriate support group for that condition. The Citizens Information Board publishes information on entitlements for people with disabilities.

Provide service user/patient information forms, information about after-care, prescriptions, medical certificates and other information leaflets in a large print format when required.

Some people with an intellectual disability may require information in Easy to Read format, which consists of short simple text and illustrations. There are a number of resources you can draw on, such as picture banks and picture books that are used by some people with an intellectual disability in health settings. Use pictures and symbols to explain treatments or health conditions

Do not presume that a person can read or understand the written information you provide. Always verbally explain any written information about medication, treatment or after-care, for example. Check that the service user understands what you have said and written down. If this is not clear repeat the information and be patient.

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9.10 Continuity of care

It will help some people with disabilities to see the same GP or other relevant professional each time they visit. For example, a person with an acquired brain injury or a person with an intellectual disability may experience less distress if they are dealing with a member of staff that they know.

Ensure that every member of staff is trained so that they may recognise the accessibility and communication needs of patients and service users and, in turn, communicate with and assist them as needed.

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9.11 Home visits

Some patients may find it physically difficult to get to a GP surgery or primary care centre. Others, such as a person with an intellectual disability or dementia, may be less disorientated or anxious if they are seen at home by a GP or other member of the primary care team. Where possible, arrange home visits in these circumstances

If you are visiting a person with impaired vision in their own home, let them know if you move something and let them know if you replace the item so that she/he can find it when you leave.

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9.12 Family members and carers

Family members, carers and support persons play a key role, particularly for people with significant levels of disability. They are often an invaluable source of expertise about a person’s disability, health and well-being. They can help achieve better outcomes in communication, understanding and decision-making. With the consent of the person with a disability, involve their family, members, carers and support persons in care plans.

Primary communication must be with the patient and not with their family member or personal assistant.

Where the person so consents, give family members, carers and support persons information that is easy to follow about the treatment, diagnosis, medication and follow-up appointments, to enable them to provide appropriate care and support.

Public health nurses, social workers and other members of primary care teams can play a key role in supporting family carers and in giving them information on the help and the entitlements open to them. The Citizens Information Board website is also a useful source on information on entitlements and supports.

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9.13 Referral and sharing of information

It is essential that patients and service users experience integrated care in primary care, specialist care, rehabilitation and hospital care services which is centred on the individual and their needs. Where appropriate, teams can share their knowledge and experience so that person centred care becomes the norm.

The multidisciplinary team in primary care can meet different aspects of an individual’s needs; for example, the public health nurse, physiotherapist, occupational therapist, social worker or speech and language therapist.

The primary care team plays an important role in supporting an individual with a disability who is awaiting a rehabilitation service or has been discharged from rehabilitation back to the community.

The individual’s family, carers or disability support service also have a key role. The primary care team may need to liaise with others involved in the person’s care, including hospital specialists or the community mental health care team, where appropriate.

It is important to have good communication between different individuals and teams which are looking after different aspects of a person’s medical, care and support needs so that these are addressed in a co-ordinated way.

It is also important to ensure that particular accessibility requirements, for example, preferred forms of communication, are shared between different professionals and services involved in the person’s care, so that these do not need to be negotiated again every time.

Ask for the person’s consent for their accessibility requirements being noted in their file and passed on to other practitioners

Include the person and their family (with the person’s consent where appropriate) in any multidisciplinary case conference.

Primary care team services and specialist disability support services may be necessary after the onset of a disability; for example, if a person acquires a brain injury from an accident. Often there is a waiting list for rehabilitation, which means that there is a key role for community support and information for the person during this interim period.

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10. Guideline Ten
Accessible Hospital Services, including Out-Patient Departments

The following section should be read in conjunction with Part One:

  • Guideline Three: Accessible services - general advice
  • Guideline Four: Communication
  • Guideline Five: Accessible information
  • Guideline Six: Accessible buildings and facilities
  • Guideline Seven: Consent
  • Guideline Eight: Role of family members and support persons

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10.1 Ask, Listen, Learn, Plan, Do

People with disabilities are often experts in what they need. See Guideline One: Developing accessible health and social care services for more information on Ask, Listen, Learn, Plan and Do.

Ask

  • Ask all patients: Do you have any specific requirements that must be accommodated? Is there anything we can do to assist you? Remember many disabilities are not visible
  • With the consent of the person with a disability, family members, carers or support workers may also be able to guide on any specific needs.

Listen

  • Listen attentively to what their requirements are and how they can be addressed.

Learn

  • Use booking visits or pre-admission clinics to identify any accessibility needs before a person attends for elective or pre-planned treatment
  • If accessibility requirements have not been determined at pre-admission stage, make a plan when the person first visits the hospital

Plan

  • Plan the support required for:
    1. Admission
    2. Hospital stay
    3. Discharge

Do

  • Put the plan into action

The following sections will give you more information on planning the support for each of these stages.

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10.2 Who to talk to when developing the care plan?

Discuss any options with the individual. Involve, with the consent of the person with a disability, their family, members, carers and support persons in the drawing up of care plans.

  • Family members, carers and support persons can play a key role in supporting and caring for people with disabilities and are an invaluable source of expertise about a person’s disability, health and well-being
  • In so far as possible, facilitate a person with a disability, where they so wish, to receive care and support from family members, carers or personal assistants while in hospital. However, family carers and other support persons should never be used to replace general nursing or medical care staff
  • Family members or other carers may need to be given information about diagnosis, medication, treatment, exercises, care and any outpatients’ appointments, in order to provide effective support after discharge from hospital

Organise a multi-disciplinary case conference where this is required; for example, where the person has complex conditions or high support needs. Cross-disciplinary support may be invaluable in treating someone with dementia, with intellectual disability, with mental health difficulties, with spinal injuries or other complex needs.

  • Liaise with other medical teams involved in the person’s care and treatment as appropriate
  • Draw on the expertise of staff from across the hospital, such as physiotherapists, social workers and speech and language therapists, who will assist with planning services and information for people with disabilities prior to admission and on discharge
  • Liaise as required with disability service providers, the person’s key worker or clinical specialists in disability. This should also assist when co-ordinating care and planning between the hospital and the community
  • Liaise as required with older people’s specialists in the hospital and with specialist services, primary care teams, voluntary organisations and key workers in the community

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10.3 Identify existing care protocols

Identify if there are any care protocols associated with the person’s primary disability or pre-existing condition. For example:

  • People with spinal injuries may have particular requirements around posture, toileting, and avoidance of pressure sores
  • People may need help with their toileting and bathing requirements, eating and drinking, regular turning to prevent pressure sores or in providing accessible communication

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10.4 Prepare in advance

Book any equipment or arrange assistance or adaptations before the person is admitted to hospital. For example, a lifting hoist may be needed in a treatment room in order for someone to move safely from their wheelchair onto an examination.

Place an accessibility checklist in the person’s file so that all accessibility requirements can be noted. (See Appendix 1 for a sample checklist. An online checklist may suit some people). Use the list at follow-up appointments or when referred to other diagnostic or treatment services in the hospital, or to community based services. Check if any requirements have changed at each subsequent visit.

Enable access to an independent advocate; provide the person with contact details for independent advocacy services to help the person avail of their entitlements.

Arrange where possible for continuity of care so that someone with a disability can benefit from seeing same health practitioner each time they attend an outpatient appointment. Factor this into the scheduling of appointments. For example, someone with an acquired brain injury or a person with an intellectual disability is likely to experience less distress if the person they see if known to them.

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10.5 In the hospital

Admission - In reception

  • Where a low reception desk is available, make sure that the low space is kept clear and is not blocked with office equipment, to allow face-to-face contact with a manual or powered wheelchair user and people of short stature
  • People with mental health difficulties or an intellectual disability may prefer to sit and wait in a quiet area if available

Informing people of their turn to be seen

  • Be sensitive about how you call a person; do not shout or compromise the person’s privacy. If there is not a dual spoken and visual announcement of someone’s turn, people may require a receptionist to alert them when their appointment is called. For example:
    • People with impaired vision can be alerted by a gentle tap on their shoulder or arm
    • People who are Deaf or hard of hearing can be alerted visually by a hand movement, such as a discreet wave or by tapping the person gently on their shoulder or arm

Getting to the appointment / ward

  • People with walking difficulties or balance problems may need assistance in getting to an outpatient clinic or ward. For example:
    • Porters should be available to assist a person if requested, for example, to sit down or stand from a seated position, and/or provide a wheelchair and accompany a person with a mobility difficulty
    • If the outpatient clinic, consulting or treatment room is in a part of the hospital which the patient cannot access (for example, up stairs), arrange to see the person in an alternative location that is accessible to the patient. Put in place a plan so that this will be rectified in the future
  • A person with impaired vision may request a ‘sighted guide’. Again, porters, receptionists and other staff can all learn how to accompany and guide people with impaired vision appropriately when requested

In the ward

  • Accommodate the requirements of a person with a disability when they are admitted to a ward. For example:
    • allocate a bed close to an accessible toilet and washing facilities
    • ensure that there is a facility for people who are Deaf or hard of hearing to access subtitles, if there is a television in the room
  • Where possible, a person may prefer to be in a quiet part of the ward or in a single room; for example:
    • a person with mental health difficulties may prefer to be located in a quiet part of the ward or in a single room, if possible, away from loud noises and bright lights. A single room may be important for someone who needs to get a good night’s sleep to manage a particular condition (for example, bipolar disorder)
    • a person who is hard of hearing may find it easier to communicate more effectively in a quiet part of the ward or a single room. Where possible, position their bed so that they can see when someone comes into the room
    • a person with impaired vision may find it easier to communicate in a quiet part of the ward or in a single room
    • a person with an intellectual disability or cognitive impairment may be less anxious if they are in a familiar and quiet environment
    • a person with dementia or other cognitive impairment may benefit from being in a quiet part of the ward or in a single room. This may help to reduce confusion and anxiety. Avoid moving people with dementia from one room to another where possible, as that can give rise to distress

Meal times

  • When serving a meal, catering staff should tell a person with impaired vision that the meal has arrived and has been placed in front of him/her
  • Adapted cutlery and drinking aids should be made available to those who need them
  • Serve food on a tray that has a good edge – anything spilled will stay on the tray
  • Help the person identify where the food is on a dinner plate by using a clock system. For example, “the meat is at 12 o’clock, the peas are at 3 o’clock and the potatoes are at 6 o’clock”
  • For someone with low vision, providing good colour contrast between a drink and its container can avoid accidents. For example, water in a clear glass may not be easily seen; instead place the water in a brightly coloured cup. Another example is to pour tea into a white mug where it is easier to see than in a brown mug
  • Sometimes a personal assistant or support person is able to assist with feeding; for example, where the person has swallowing difficulties. This should only be carried out with the consent of the person with a disability, and should never replace general care provided by hospital staff
  • Make special provision for people with disabilities who do not have a carer or support person to assist them. It is very important to provide assistance with meals and hydration

Care from family or carer

  • Where possible, provide flexibility in visiting times so that people with disabilities can receive support from their family member, carer, support person or personal assistant, if requested. This is important for people with significant disabilities
  • Make special provision for people with disabilities who do not have a carer or support person to assist them. It is very important to provide assistance with meals and hydration, using the toilet and washing
  • Care from family or a carer should never replace general care provided by hospital staff

Disability-specific care needs

  • Be aware of specific disability-related health support needs. Being aware of the need for specific care can avoid the onset of more complicated health problems For example:
    • A person may require regular turning to avoid the risk of the build-up of pressure sores
    • A person may require the use of a hoist, wheelchair or other specialised equipment
    • A person with a spinal cord injury or paralysis may require timely and respectful bowel care procedures to be implemented at specified times.

Where people cannot articulate their needs

  • It is particularly important that hospital staff be aware that some people with disabilities, such as people with an intellectual disability or people with an acquired brain injury, may not be able to articulate their requirements clearly; for example, asking for water or using the toilet
  • This is also important because a person may not be able to articulate changes in their symptoms or pain levels. The following may be helpful:
    • a higher level of clinical observation and the building of a good relationship and communications
    • sensitivity and good communications to assist the person in communicating pain and discomfort; and
    • the use of pictures and symbols or asking a person to touch the part of their body that hurts

Familiar objects

  • Encourage people with intellectual disabilities and people with dementia to bring some familiar objects such as photographs of family members on their bedside table

Television

  • Ensure that the facility for subtitles is switched on as this will mean that the television is accessible for people who are Deaf or hard of hearing
  • Many people with sight loss enjoy television, so don’t be embarrassed to ask the person if they would like the television switched on

Hearing loop / Listening Devices

  • Where possible, provide a facility for a person who is a hearing aid user to have a portable induction loop so that they can communicate with staff or visitors during their stay in hospital. Listening devices that amplify sound can help improve communication with people who are hard of hearing

Explain medical procedures clearly and accessibly

  • If a person is undergoing an operation or any procedure, it is important that what is going to happen is clearly explained in advance
  • It is particularly important to let someone who is blind or has low vision know what is happening verbally, as they will not be able to see it. Explain clearly and step-by-step what is happening at each stage. For example:
    • If an anaesthetist is going to apply an oxygen mask, this should be explained in advance
    • If a person is having an MRI scan, mammogram or x-ray, explain all procedures clearly and let the person know when you move behind a screen or into another room
    • If diagnostic equipment is being used, such as an echocardiogram, describe clearly what is on the screen, as this may not be seen by a person with impaired vision or understood by people with cognitive impairments
    • If people with impaired vision are asked to wear a halter monitor or blood pressure monitor, point out where the monitor will be located before it is put on
  • Always ask people with disabilities, “Is there anything we can do to assist you?”

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10.6 Discharge from hospital -integrated discharge planning

“To ensure service users are discharged or transferred safely and on time requires full assessment of their individual healthcare needs, planning and co-operation of many health and social care professionals.”13

Make a plan for continuity of care and support after discharge in accordance with the “Integrated care guidance: A practical guide to discharge and transfer from hospital”.

See section 3.14 for an extract from the “Discharge and transfer from hospital - The nine steps quick reference guide” and some helpful guidance.

  • Step one: Begin planning for discharge before or on admission
  • Step two: Identify whether the service user has simple or complex needs
  • Step three: Develop a treatment plan within 24 hours of admission
  • Step four: Work together to provide comprehensive service user assessment and treatment
  • Step five: Set a predicted date of discharge / transfer within 24 – 48 hours of admission
  • Step six: Involve service users and carers so they make informed decisions and choices
  • Step seven: Review the treatment plan on a daily basis with the service user
  • Step eight: Use a discharge checklist 24 – 48 hours before discharge
  • Step nine: Make decisions to discharge / transfer service users each day

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11. Guideline Eleven
Accessible Emergency Departments

The following section should be read in conjunction with Part One:

  • Guideline Three: Accessible services - general advice
  • Guideline Four: Communication
  • Guideline Five: Accessible information
  • Guideline Six: Accessible buildings and facilities
  • Guideline Seven: Consent
  • Guideline Eight: Role of family members and support persons

Staff should also refer to The National Emergency Medicine Programme – A strategy to improve safety, quality, access and value in Emergency Medicine in Ireland which is referenced throughout the section below.

Emergency Sign Language Interpretative Service

Once Emergency Department staff identify that a person is Deaf and uses Irish Sign Language (ISL) as their primary language, they should follow the local policy in place to arrange an interpreter. The emergency contact number for the Sign Language Interpretative Services is 087 672 5179.

Emergency Multilingual Aids (EMA)

EMAs are available to assist staff and patients in an emergency where English is not their first language. These are available on: http://www.hse.ie/eng/services/Publications/SocialInclusion/EMA.html

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11.1 On arrival

Extract from the National Emergency Medicine Programme (EMP) Strategy: Section 16.8.2.10 Vulnerable adults:

Adults with a physical or intellectual disability, cognitive impairment or mental ill-health diagnoses may require additional social supports during and following their Emergency Department (ED) presentation.

The National Emergency Medicine Programme (EMP) – A strategy to improve safety, quality, access and value in Emergency Medicine (EM) in Ireland (referred to as theNational EMP Strategy in the following section) notes that some people have additional or particular care needs when they present to emergency services. The strategy makes specific reference to patients with complex psycho-social problems, people with an intellectual disability, people with a physical disability, and people with language or communication problems. All of these service users may have accessibility needs. It is, therefore, important to be sensitive to the needs of patients and service users, and to identify as early as possible in the patient / service user experience what needs a person may have so that they can be managed accordingly. For example:

The receptionist may during the check in process identify if the service user or their carer has any obvious accessibility needs and, where appropriate, inform clinical staff. Local procedures should be developed to support staff who identify accessibility needs; for example, how to arrange an interpretative service in an emergency.

While the National EMP Strategy identifies the most important component of Emergency Medicine work as the “prioritised evaluation and treatment of patients with time-critical healthcare needs”, it may take additional time to assess a person’s immediate communication or other support requirements where they have accessibility needs.

Assigned nurses or doctors may routinely identify any accessibility need when asking about the past history of note or at the end of a triage process, when asking “Is there anything else you need to tell us?”. However, in order to evaluate and treat some patients, it can be helpful for staff to tailor questions to specifically identify accessibility needs or, alternatively, how to meet them.

Top Tips

  • Remember some forms of disability are not visible
  • Provide assistance to people to meet their accessibility requirements where possible. However, do not assume that you know best. Just because people have the same disability, it does not mean their needs are the same. Always ask if there are specific requirements to accommodate a person’s disability. A person with a disability is normally an expert in what is required to ensure that their accessibility needs are met
  • The triage nurse should document any identified accessibility needs on the front of the Emergency Department card and highlight it in handover. This not only improves the experience for the patient or their family / carer, but also saves staff critical time
  • For some patients, it can be helpful to have the same staff member involved in their care throughout the Emergency Department journey; however, this is not always possible

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11.2 Communication

Extract from National EMP Strategy, Section 21.7 People with Language or Communication Problems

Excellent communication is essential to the successful interaction with all patients and their families attending Emergency Care Networks (ECN) units14. Clear information is required on access routes to the hospital; therefore, effective road and hospital signage detailing the type of ECN unit is essential.

Communication barriers that can impede successful interaction include:

  • Literacy difficulties
  • Not speaking the same language
  • Communication barriers in the environment, including poor signage and a noisy environment
  • The inability to access and/or use services or equipment
  • Physical disability restricting communication, such as difficulties with writing
  • A visual or hearing impairment; and
  • A lack of ability to concentrate and focus on communication

Patients may present to the ECN with one or a variety of the above barriers to effective communication. Resources to assist with removing and reducing language and communication barriers are listed in the References and Resources section of the National EMP Strategy. Speech and Language Therapists can also provide assistance with reducing communication barriers as outlined in Chapter 16 of the strategy. Where a patient doesn’t have adequate English skills, the HSE recommends the use of professional interpreting services for clinical examinations or obtaining consent to ensure patient confidentiality.

Effective communication is essential to take a good case history and identify symptoms. Difficulties in communication can increase the risk that health conditions or symptoms pass undetected.

Provide for accessible communication and information at every stage of the patient’s journey. Establish if there are any specific communication aids that the person wants to use and their preferred form of communication so that their accessibility needs are met. For example:

  • Some people with an intellectual disability have a communication passport; some people with speech impairments use a communications board. Communication aids will normally contain information about the person’s disability, communication needs, medication or health.15 The patient passport, where possible, should be used to inform the Acute Needs Assessment
  • If funding becomes available, it may be helpful to procure a portable induction loop for hearing aid users or a portable listening device for hard of hearing service users

Building trust is essential to good communication.

Always communicate with the person with a disability in the first instance. If this is not possible, involve the person’s carer or support person.

You may need to allow additional time to communicate with service users depending on their needs. Providing the time may be important in detecting a health problem that is not obvious, making a correct diagnosis and explaining this and follow up treatment. A person with an intellectual disability, for example, may need more time in order to understand the diagnosis and the treatment.

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

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11.3 Accessibility requirements

As attendance in an emergency department is not planned, people with disabilities will not have let the hospital know in advance of any support needs.

“The infrastructure of each facility in the ECN (Emergency Care Network) must meet the needs of patients with a physical disability, thus ensuring they are cared for in a safe environment. Emergency Department infrastructure should also accommodate patients’ family members, carers, Emergency Department staff and other hospital staff who have physical disability.”16 In addition to an accessible treatment space, equipment can also be helpful. Examples include a height adjustable trolley or examination couch, and hoists to assist a wheelchair user to safely move onto an adjustable trolley / examination couch from their wheelchair.

It is part of essential care to ensure that patients are hydrated, that basic comfort needs are met and that any additional interventions are undertaken to prevent the risk of build-up of pressure sores, particularly if they have to wait on a trolley for more than two hours.

A person with a disability may have specific support needs around basic activities, such as eating, drinking, turning to prevent pressure sores or going to the bathroom. For example, if a person is in the emergency department for long periods of time on a trolley, they may need to be turned regularly to prevent the risk of pressure sores, or they may need assistance with any feeding and hydration required.

This support is especially important if the person does not have a family member, personal assistant or care worker with them. However, even if they are available and may wish to assist in the process, family carers and other support persons should never be used to replace general nursing or medical care staff.

While many of the support needs around basic activities will be routinely met as part of the professional standards adhered to by staff providing essential care, staff may need to be made aware of specific needs during handover processes, and other disciplines of staff may need guidance on their role. In a busy emergency department, it is important to ensure that specific requirements of someone with a disability are not overlooked.

  • Ensure that relevant staff have received appropriate training to assist
  • Handover between staff in different disciplines should routinely include a briefing on specific accessibility needs
  • Where necessary, develop an agreed approach to ensure that specific care needs are managed at appropriate intervals as required

The emergency department staff may need to liaise with appropriate services to identify specific needs. This might include the person’s GP or specialist (for example, the psychiatric team or community mental health team) or their disability support service. See Section 16 of the National EMP Strategy for information on the roles of therapy professionals and medical social workers in emergency care including physiotherapists, occupational therapists, orthoptists, speech and language therapists, dieticians, podiatrists and medical social workers.

See Guideline 4: Communication for more information on communicating with patients and service users with specific disabilities.

If admitted to hospital, it is essential that a person’s accessibility requirements are passed on to all relevant staff, including receptionists, porters and catering staff. Inform the person with a disability of any information that is being passed onto other staff or service providers.

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11.4 Waiting to be seen

“Emergency Department clinicians and hospitals have a duty of care to patients who may need to be accommodated in a waiting room area.” See Section 19.9.2. Recommendations for Patient Care in Emergency Department waiting Rooms of the National EMP Strategy.

Use this time as an opportunity to find out if there are any specific requirements while the person is waiting.

The triage process will identify the priority in the treatment of patients, based on the severity of their condition which can lead to delays for other patients.

Some patients and service users may experience significant distress or anxiety in unfamiliar, crowded or noisy environments; for example, a person with a mental health difficulty, an acquired brain injury, an intellectual disability or a person with dementia. If the Emergency Department has the space and/or capacity, the following measures may be helpful for service users in this situation. However, it should be noted that these suggestions are not to provide a person with a disability a preferential service over any other patient or service user, but rather to ensure that compassion is shown in a situation where a person’s disability directly leads to significant distress or anxiety which could be alleviated. Please note, the following suggestions are dependent on local resources:

  • Ask a person if they would prefer to wait in a quiet room / elsewhere and call them when their turn is near
  • Inform a person if there is to be a long wait and how long it will be, if this is known. This may allow them an opportunity to go away and get a cup of tea or a meal. Send a text message or call them on their mobile phone if they are near the top of the queue

Make sure that systems are in place to ensure that people are informed appropriately when it is their turn to be seen if they have impaired vision or are Deaf, hard of hearing or deafblind.

  • Where possible, plan to have both spoken and visual announcements
  • If this is not possible, people with impaired vision can be alerted by a gentle tap on their shoulder or arm
  • People who are Deaf or hard of hearing can be alerted visually by a hand movement, such as a discreet wave, or by tapping the person gently on their shoulder or arm

If there is a television in the emergency department waiting room, make sure that it displays subtitles and can be accessed by people who are Deaf or hard of hearing.

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11.5 Family or carer support

A person with a disability may need support while waiting to be seen, as well as in communicating their medical history, making informed decisions and giving consent to care. In an accident or emergency setting, family members, carers or personal assistants can assist the person with a disability and be an invaluable source of expertise about a person’s disability, health and well-being.

Facilitate the person with a disability to be supported by a family member, carer, personal assistant or advocate, where they so wish. The triage nurse may be the person who makes this decision, which should be communicated to other staff

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11.6 Assigned staff

It may be helpful to assign a key member of staff to assist a person with a disability to ensure that her/his requirements are met. This can be very important for a person who has significant disabilities or someone who has no accompanying person to support them. However, it is recognised that it is not possible to facilitate this in every setting.

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11.7 Explain medical procedures clearly and accessibly

If a person is undergoing any procedure, it is important to explain what is going to happen clearly and in advance.

It is particularly important to let someone who is blind or has impaired vision know what is happening as they will not be able to see it. Tell them about any procedure you are going to do, such as taking blood or giving an injection, and where the needle site will be. If performing a physical examination, explain in advance where you plan to examine (i.e., touch).

Explain clearly and step-by-step what is happening at each stage.

Explain all diagnostic procedures clearly, such as an ultrasound, rectal examination, electrocardiogram, an x-ray or MRI scan. Let the person know when you move behind a screen or into another room.

If performing an intimate examination as part of standard protocol, ensure a chaperone is present.

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11.8 Integrated Discharge Planning from the Emergency Department

Health and social care professionals should refer to:

  • Guideline Three: Accessible services -general advice, Section 3.14, Integrated Discharge Planning
  • Guideline Ten: Accessible Hospital Services,Section 10.6, Discharge from hospital integrated discharge planning
  • 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
Recommendation
s for Patient Discharge and Departure

  • All patients should have an appropriate brief discharge summary sent to their GP
  • The Emergency Medicine Programme will develop a template for Emergency Department discharge summaries in collaboration with the Directorate of Clinical Strategy and Programmes Primary Care Programme
  • The time of Emergency Medical discharge and the time of Emergency Department departure should be recorded for all patients
  • Follow-up care arrangements for all patients should be recorded in the patient’s Emergency Department records/Emergency Department Information Systems
  • Standard National Emergency Care Systems datasets will include follow-up arrangements for ED patients
  • Patients should be provided with self-care information as part of the discharge process (for example, head injury advice)

Where appropriate to the Emergency Department, make a plan for continuing care and support after discharge.

Safe discharge may mean that staff will liaise with other disciplines, such as the Public Health Nurse, their GP, the specialist treating their primary disability or other condition or their disability support service. “Multidisciplinary assessment is particularly valuable in supporting the safe discharge of patients with complex care needs.”: Section 19.19.4, Patient Discharge, National EMP Strategy.

All GPs should be informed following a service user’s attendance at the Emergency Department as part of standard processes. Where this post exists, this may be the task of a GP liaison nurse.

Assess if any additional supports are needed when the person goes home, following their Emergency Department visit.

When a person is discharged from hospital, explain all follow-up procedures, medication, after-care or when further appointments are needed. Print this information off in clear print so the person has it to keep.

It is important that family members, carers or support persons also understand the medication regime. While it is important to respect the person’s privacy, it is also important for their safety that those assisting them know which medication should be taken. Carers also need to be told when and under what conditions the person needs to return to the hospital.

Signpost a person towards relevant disability organisations for support and information if appropriate.

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12. Guideline Twelve
Accessible maternity services

The following section should be read in conjunction with Part One:

  • Guideline Three: Accessible services - general advice
  • Guideline Four: Communication
  • Guideline Five: Accessible information
  • Guideline Six: Accessible buildings and facilities
  • Guideline Seven: Consent
  • Guideline Eight: Role of family members and support persons

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12.1 Introduction

The guidelines are written in the knowledge that services may not have financial resources to implement all measures outlined. However, many of the guidelines are cost neutral, and they also serve as a resource for health and social care professionals who may be planning services in the future.

These guidelines are for all health and social care staff and should be read in conjunction with the relevant Code of Professional Conduct and with the existing guidelines for staff, including the Clinical Guidelines of the Institute of Obstetricians and Gynaecologists at theRoyal College of Physicians in Ireland and Midwifery Practice Standards (2010) from An Bord Altranais agus Cnaimhseachais.

An Bord Altranais midwifery practice standards state that health professionals should enhance their knowledge of services and supports available to women with disabilities, in line with the Royal College of Nursing’s (2007) guidelines. The Royal College of Nursing guidelines, entitledPregnancy and Disability: RCN Guidance for Midwives and Nurses, can be accessed at http:// www.rcn.org.uk/.

More detail is available on accessible services inGuideline Three: Accessible services - general advice; Guideline Four: Communication; Guideline Five: Accessible information; Guideline Six: Accessible buildings and facilities and Guideline Seven: Consent.

Clinical staff need to be knowledgeable about particular needs and issues connected with disability and to have corresponding clinical skills. For example, relevant clinicians should know about epidural anaesthesia for someone with spina bifida or spinal cord injury.

It should be noted that this section is primarily about accessible maternity services from the woman’s perspective. However, patients and service users may wish to have a partner, family member, friend or an advocate accompany them, who may have an accessibility requirement. In this regard, services may need to give consideration to their needs also; for example, a blind parent attending the birth of their baby.

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12.2 Non-judgmental

In accordance with the Code of Professional Conduct, be non-judgmental and professional in caring for women who are pregnant.

  • Do not query her decision to get pregnant nor her capacity to care for and nurture her baby
  • Do not assume that she has or does not have any specific requirements – ask. People with disabilities may have a lot of expertise around specific needs they have and how they could be met

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12.3 Planning for specific requirements

Birth or Care plan

A birth or care plan should take account of any specific needs a service user may have, and this includes accessibility requirements associated with a woman’s disability. Ideally an assessment of these needs should be conducted at the first antenatal booking visit.

Participation in care is important. Actively involve the woman in the assessment and birth or care plan. Enable her make informed choices at every step – about antenatal care and classes, about the birth of her child, about baby feeding, about support with parenting skills etc.

Where appropriate, further information may need to be sought from the person’s GP, other health professionals or specialist services. Where care requirements are more complex (for example, a woman with multiple disabilities, intellectual disability or significant mental health difficulties), involving a multi-disciplinary team can address different aspects of care. It may be necessary to hold a case conference to help formulate a comprehensive birth or care plan.

Ensure that relevant staff are aware of any requirements in relation to care or treatment that are associated with the underlying impairment; for example, the need to maintain a particular posture for someone with a spinal injury.

Plan ahead. For example:

  • Book accessible aids and equipment, such as a height-adjustable examination couch or a hoist for a woman with a physical disability
  • Ensure the delivery suite is accessible

Some women with disabilities will benefit from seeing the same health practitioner each time they attend an antenatal clinic. Where possible, factor this into the scheduling of appointments.

Appoint a staff member to a key worker role in situations where it is required; for example:

  • Where a woman has significant disabilities or
  • A woman with disabilities who does not have the support of a partner available. This key worker should have received appropriate training

Share relevant information with the care team and other staff

It is essential that relevant information is shared with staff involved in the woman’s care at different stages of the care journey; for example, in antenatal care, during birth and during postnatal care. This can minimise the need for a woman with a disability to negotiate the same issues at different stages of her care or when she meets different health personnel.

  • Include relevant information; for example, communication preferences on her chart and an IT system for booking questionnaires, where available
  • Clinical staff, including medical, nursing and therapy staff, should be informed of specific elements of the birth or care plan
  • Information relevant to care and support on discharge should be passed on to relevant staff, such as the woman’s GP, public health nurse or social worker
  • Relevant staff, such as catering, housekeeping and reception staff in the hospital, should be informed of any individual requirements relevant to their roles; for example, any special requirements around managing meals

Accessible premises

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

Ensure that buildings are easy to access and get around:

  • Provide handrails and seating where people have to walk some distance between departments
  • Provide clear signage in plain English to enable people find their way

Provide open accessible toilets to serve waiting areas, the delivery suite and the wards. Maintain in good working order.

Provide accessible shower and bath facilities on the wards. See National Disability Authority’s Building for Everyonewww.universaldesign.ie/buildingforeveryone,Sanitary Services for the appropriate technical standards.

Ensure that the bed layout in the delivery suite and the maternity ward facilitates a woman who uses a manual or powered wheelchair or a woman who has impaired vision to move around easily.

Provide good lighting everywhere: in reception, the antenatal clinic, the delivery suite and on the postnatal ward. This benefits everyone, including those who are partially sighted.

Ensure that waiting rooms, corridors, consultation rooms and wards are free of obstacles that could impede mobility or be a hazard for someone who cannot see. For example:

  • Do not store equipment in a corridor where it could block circulation or present a hazard
  • Do not store cleaning materials in an accessible bathroom and
  • Ensure that leads and wires from equipment or vacuum cleaners are not left trailing on the floor where they are a hazard and may trip someone

Accessible equipment

Ensure that equipment is accessible or that an appropriate alternative is offered. For example:

  • Provide height-adjustable examination couches or beds, with a hoist available, so that a woman can transfer safely on and off
  • Provide weighing scales that are suitable for a wheelchair user
  • Provide height-adjustable baby cots incubators and baby bathing facilities so that women with physical disabilities can feed, lift, hold and bathe their babies; and
  • Ensure that appropriate equipment and aids can be used whether the woman is standing, seated or lying down

Appointments and waiting room

See Guideline Three: Accessible services – general advice for information on appointments and waiting rooms.

Communicate about appointments in the way that is accessible for the individual; for example, by e-mail or text message for someone who is Deaf or hard of hearing, or by phone or e-mail for someone who is blind or vision impaired. Ask the individual what their communication needs are.

Let people know approximately how long they have to wait and where they have to go when they are called.

Have a system which enables women who have difficulty seeing or women who have difficulty hearing to know when they are being called. Ticketing systems with visual electronic displays are accessible to someone who is Deaf. However, there needs to be an audio component for someone who cannot see. If this is not possible, someone who has a vision or hearing impairment could be informed that it is their turn by a gentle tap on the shoulder.

If you have a television in the waiting room for antenatal appointments or on the maternity ward, make sure that it has a facility for subtitles and is accessible to people who are hard of hearing or Deaf.

It can be helpful to schedule appointments with an interpreter so that waiting times and cost of interpretive services are minimised.

Information

Provide information about the accessibility of your premises and services; for example, in an information booklet or on your website. This could cover information about accessible parking, accessibility features of your building and any communication aids or other supports available.

Provide information on what to do and who to contact if complications emerge or in case of emergency.

Your information for mothers should cover issues around pregnancy and mental health, including post-natal depression.

  • Encourage women to disclose if they have mental health issues or are on medication so that they can get appropriate support both around their pregnancy and their mental health
  • Provide information on counselling supports available, support that can be received by telephone, and provide information for new mothers about post-natal depression support groups and counselling services

Ensure that information on the maternity services, childbirth and infant care can be provided in different formats on request and where practicable. You may be asked to provide information in large print, on audio, by e-mail, through your website or in Braille.

All information should be in plain English. A service may take steps to translate the information into other languages where necessary; however, this should also be written in a style which is easy to understand.

Ensure there is a text description of any pictures or diagrams, that can explain them to someone who cannot see: this is essential where a document on-line is being read using screen-reader technology.

Make use of Easy-to-Read health leaflets on specific procedures that are available. Easy to Read is the term for very simplified text with pictures, which is important for people with literacy problems or limited English.

Ante-natal classes can use visual teaching aids with subtitles to communicate with women who are hard of hearing or Deaf.

Video clips, audio clips and DVDs can enhance the accessibility of information to women with disabilities. Keep information in audio and video short as it can be difficult to retain a lot of information from such sources. Women who have difficulty retaining information can go over these again and again.

For more see Guideline Five: Accessible information.

Consent

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

To enable a woman to give informed consent to any procedure, appropriate information needs to be given and communicated in a way that meets the accessibility needs of the woman. Staff should explain in a clear and accessible way what will happen if a woman needs an intervention of any type. Some service users may need additional time and support, including, if necessary, repeating information to help them understand.

It must not be assumed that a service user lacks capacity to make a decision solely because of their age, disability, appearance, behaviour, mental condition (including intellectual disability, mental illness, dementia or scores on test of cognitive function), their beliefs, their apparent inability to communicate, or the fact that they make a decision that seems unwise to the health or social care professional. You should presume that all women have the capacity to consent to a particular procedure or intervention, unless there is an adequate trigger indicating otherwise.

All service users may experience temporary lack of capacity due to severe illness, loss of consciousness or other similar circumstances.

Always get consent to pass on any confidential information about accessibility requirements or to pass on information to other medical or support staff or the woman’s family.

Flexibility

Services may need to be flexible so that they can meet the needs of a service user with a disability.

When making appointment times, take into consideration that a woman with a disability:

  • May find early morning appointments difficult to attend due to medication, additional time needed to prepare etc; and
  • May need extra time to get to an antenatal or outpatient appointment

Be open to provide one-to-one support to enable a woman with a disability to participate in antenatal training and to support baby feeding and development of parenting skills.

Where possible, be flexible about offering home visits as an alternative to coming to the hospital or baby clinic where a woman’s disability would make that particularly challenging. This might include providing antenatal visits at home, teaching and supporting a woman with parenting skills at home, or having the baby weighed at home rather than in the baby clinic. This may not be feasible in some settings.

Allow flexibility in visiting times so that the woman’s partner or carer support person can assist and support her with her activities of daily living and with baby care.

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12.4 Antenatal services

Antenatal care

Factor in longer appointments where necessary. It may take longer to communicate with someone with a speech or hearing disability or someone with an intellectual disability. There should be sufficient time given to hear any concerns, to explain what is happening and to ensure the woman understands what is being said.

Where antenatal care is shared between the GP and the hospital, it is essential to ensure there is good communication about any aspect of the woman’s requirements that may be associated with her disability.

Explain the steps involved in any procedure or test in advance, in clear and simple language. These procedures can include blood tests, urine tests, blood pressure and weight checks or ultra sound examinations. For someone with a hearing difficulty or mental health impairment, using diagrams is a good way to explain. Explain in advance what is happening to someone who cannot see.

A woman with a mobility disability may need to sit down or lie down during an x-ray or other diagnostic examination. If this is not possible, discuss with the woman and take any guidance she may have on how to proceed into consideration when examining alterative options.

Provide a safe and supportive environment for women with mental health difficulties to disclose and discuss their concerns. Where needed, make a referral to the mental health team or to the mental health support midwife if there is one available.

Antenatal classes

Antenatal classes should be held in places that are physically accessible.

Where possible, ante-natal classes should be designed to be inclusive, where class content, information and presentation methods are accessible to everyone including mothers with disabilities.

Exercises and techniques should be adapted as appropriate where a woman has a physical disability.

  • A woman who cannot see will need diagrams or exercises explained orally
  • A woman who is hard of hearing or Deaf may need to sit close to the facilitator so that she can hear or lip read
  • Information to take away should be available in a range of accessible formats to suit the needs of individuals

Antenatal tutors should be able to tell women with physical disabilities about adaptive techniques or aids. It may also be helpful for them to liaise with staff in the delivery suite where appropriate, to ensure that they also have this information.

It is not always possible to cater for a woman with a disability in a mainstream ante-natal class, and one-to-one sessions may be required in particular cases.

Women with intellectual disabilities may also benefit from one-to-one antenatal sessions where material can be explained in a simple way at an appropriate pace. For example, if a woman with an intellectual disability is undergoing a planned caesarean, the procedure should be carefully explained in simple language.

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12.5 Giving birth

It is important at this stage to spend extra time with a woman with a disability to listen and respond to any concerns she may have.

Ensure that the midwife and clinical team are familiar with the specific requirements of a woman in relation to accessible care and / or any special communication issues they may have.

Ensure that the team have devised ways to communicate with the service user appropriately. For example:

  • A woman with a hearing impairment or an intellectual disability may find diagrams and gestures a useful aid to communication
  • A woman who is Deaf or hard of hearing can agree some signs or gestures which can act as alternatives if she is unable to lip read during labour
  • A woman who is visually impaired or who has an intellectual disability may need verbal explanations to understand what is happening
  • A woman with an intellectual disability may need a midwife or midwifery assistant to stay with her and give reassurance to reduce anxiety or fear. Keep information short and simple, not too much to take in
  • A woman with a physical disability may need to have assistance to move safely and change her position during labour, and may require an additional member of staff to assist

Explain clearly and step-by-step what is happening at each stage during an examination, and then what will happen depending on the findings; for example, if the woman’s cervix is dilated, if her waters have broken, if she is being referred for an emergency caesarean section or if she needs a forceps delivery.

Explain information about choices in pain control clearly and then what is happening when pain control is instituted. Explain that using gas and air may make someone feel disorientated.

During labour, ask ‘What can we do for you?” and “How can I make the pain easier for you?”.

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12.6 Care in the ward

If it is possible, it may be helpful for a woman with a disability to have a private room. This does not mean that a person with disabilities receives preferential treatment above other service users, but rather that their specific needs are taken into consideration as part of the provision of their care. For example:

  • Providing quiet can be important for a woman with mental health difficulties or a woman with hearing difficulties
  • Someone with a vision impairment may find it easier to orient themselves in a single room than on a busy ward

For a woman with hearing difficulties, if possible, the bed should face the door so that the woman can see when a catering assistant or nurse enters the room. If this is not possible, the staff member should make their presence known to the woman.

Where a woman with a disability is sharing a ward, try to ensure her bed is placed close to the washing and toilet facilities.

Help orientate women to the layout and facilities. Show them the location of light switches, toilets and showers, other facilities on the ward for the baby and how they can summon help. While this should be done for all patients and service users, it is particularly important for service users who have a visual impairment or an intellectual disability.

Provide height-adjustable cots for women who require this to enable them care for their baby as independently as possible.

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12.7 Post-natal care and after discharge

Communicate information to assist women with disabilities in their recovery from birth and in developing the practical skills of parenting and self-care. Communicate in a way that is accessible to the service user. This may take additional time depending on the needs of the woman. See Guideline Four: Communication for more information.

Provide information in a suitable format to take away. For example, this could be in large print, by e-mail, on audio or in pictorial Easy to Read format, as required in the particular case. See Guideline Five: Accessible information for more information.

Give adequate instructions on postnatal exercises and recovery after birth to women with disabilities. A physiotherapist may be able to assist women with physical disabilities about appropriate pelvic floor or other exercises that are recommended for recovery.

Provide support, assistance and guidance on the practical aspects of baby care. For example, the physiotherapist can assist the woman with techniques for lifting and holding her baby, provide advice on useful aids etc.

Communicate sensitively and in ways the woman can receive and understand, on any areas of difficulty or distress, such as if it is a crisis pregnancy, if the baby is ill or has a disability or on the death of the baby. Ensure there is counselling available that is capable of communicating with the woman and her partner in ways they can receive and understand.

Many women who are Deaf see deafness not as a disability but as an intrinsic part of their identity. Respect this perspective when informing her about the results of any hearing tests on her baby.

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12.8 Discharge and follow-up

It is important to plan for a woman’s accessibility requirements and her medical and support needs on discharge. Preparation for discharge may need to include a case conference between the maternity staff in the hospital and public health nurse, occupational therapist, social worker and GPs to ensure the needs of mother and child are supported when she returns home. With the woman’s consent, ensure that the details of a woman’s accessibility requirements are included in a plan for postnatal care and follow-up appointments.

Explain clearly when and where follow-up appointments will take place, and when she will see the public health nurse and attend the baby clinic to get the baby weighed. Provide this information on appointments in an accessible format to take away, such as large print, by e-mail, in audio or text format, as required.

Additional supports may be required depending on the circumstances of this case. Ensure that the woman is fully involved and informed about plans. For example:

  • It may be necessary to organise additional parenting support at home, such as a home help or a personal assistant
  • Specific support may need to be organised from a public health nurse in breastfeeding at home
  • Specific support may be needed for postnatal depression

Public health nurses can have a very important role to play in the provision of advice, information and support during the postnatal period. It is important that follow-up visits are put into their schedule so that the new mothers receive this support.

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12.9 Post-natal depression

Ensure there is a plan for the prevention, early detection and management of perinatal mental health problems and postnatal depression. Identify women at risk, facilitate appropriate support and access a range of supports for them.

Explain clearly and in non-judgmental ways how to address postnatal depression.

Provide accessible written information about postnatal depression and available health and support services for women experiencing postnatal depression.

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12.10 Good practice guidelines for women with specific disabilities

A woman with physical disabilities

Discuss with a woman with a physical disability additional support that can be provided by a physiotherapist in carrying out exercises and breathing as her pregnancy develops and in preparing for childbirth. A physiotherapist may also assist the woman in developing techniques for lifting and carrying her baby.

Plan ahead for an occupational therapist to visit a woman at home prior to the birth to see if there is any equipment or adjustments to the woman’s home that need to be made in advance of bringing a baby home. This could include accessible baby baths or changing areas.

Women with physical disabilities may experience difficulties in their mobility as a result of weight gain during pregnancy. A pregnant woman who is a wheelchair user may need a larger wheelchair, or a woman with a walking disability may need to avail of a mobility aid.

A height-adjustable baby cot or table to change a baby’s nappy can help a new mother to be independent.

Put plans in place to provide support at home where appropriate and possible.

  • A new mother may need home help / an assistant to assist her in the care of her baby, such as in nappy changing, lifting her baby from the cot or bathing the baby
  • Home visits may also be required if it is difficult for a woman with a physical disability to attend a baby clinic

A woman with mental health difficulties

Staff involved in maternity care should provide a safe and supportive environment where a mother can disclose and discuss any mental health issues and be referred to sources of support and care in relation to any mental health issues.

If available, offer a woman with mental health difficulties access to a specialist mental health service or mental health support midwife in the hospital.

Liaison between staff, such as maternity staff, physiotherapists, occupational therapists etc., and a community mental health team or mental health nurse should take place where appropriate, with the woman’s consent.

Midwives and doctors involved in maternity care should become familiar with a woman’s medication and mental health history where appropriate. Discuss with a pregnant woman the use or withdrawal of medications during her pregnancy and birth, particularly if medication that she is taking could be harmful to the foetus or a baby who is breastfed.

If a woman is transferred from a psychiatric hospital or ward, she will need to be supported by a mental health nurse and any medication managed appropriately.

Women with mental health difficulties often experience anxiety attending an appointment.

  • Take time to listen to the concerns or anxieties expressed by women with mental health difficulties
  • Take time to explain what will happen during an examination and at different stages of the birth process
  • Give reassurance and support where this is needed
  • To alleviate significant anxiety, if appropriate and where possible, try and ensure that the woman can wait in a quiet place and that she does not have to wait too long for the appointment

If the woman has given birth before, ask her if she had experienced anxiety or difficulty and find out what helped her and what did not help. Ask her what would help her during her current pregnancy and forthcoming birth.

It is important to plan with the woman the support that can be provided by the woman’s GP, the public health nurse, and the community mental health team after she is discharged from hospital.

Provide information on advocacy services, support groups and services for post-natal depression.

A woman with a vision impairment

When you talk to a woman with a vision impairment, give your name and explain your role. Let her know when someone else enters or leaves the room.

Allow a guide dog to accompany a woman to the hospital for antenatal appointments and classes, and discuss with her what the options are regarding bringing a guide dog with her when she is an inpatient and during the birth.

Explain all examinations and procedures in advance, step by step, to someone who cannot see what you are doing.

Provide written information in an accessible format which the service user can access; for example, large print, e-mail or Braille.

Explain the layout of the relevant parts of the hospital, such as the reception, waiting room and toilet facilities. In the birthing suite or in the ward, explain where the different facilities are, including the location of the toilet and shower and the call bell for assistance.

Offer to guide a woman with impaired vision to where she is going; for example, to a seat in the waiting room.

Provide a private space where she can give oral answers to fill in any form, without being overheard.

Ensure a woman with a vision impairment is let know orally when it is her turn to be called. Offer her assistance to go to the examination or treatment room.

If a woman with impaired vision is having a foetal ultrasound or examination, explain clearly and step-by-step what is happening on the screen. Facilitate a woman to hear her baby’s heart beat through vibration.

It is important to explain clearly any complications where repeated scans take place. Where possible, arrange for the ultrasound to be printed in large print format and arrange for it to be emailed to the woman if requested.

Explain procedures clearly and step by step during the birth.

Provide clear guidance on how to care for her baby taking her visual impairment into consideration. For example, give guidance on how to express milk or to make up formula feeds.

A woman who is Deaf or hard of hearing

A hearing loop enhances hearing for someone who uses a hearing aid. A portable loop system can enhance communication at different locations; for example, in the waiting room, the birthing suite and the ward.

  • Let service users know if you have one available
  • Check the loop system regularly to see that it is working

Some people who are Deaf or hard of hearing lip-read.

  • Position yourself face-to-face in front of the woman when speaking and with good light on your face
  • Do not speak when walking away or from behind a theatre mask
  • Speak clearly and make eye contact
  • Remember that she may not fully catch or understand what you are saying, so use diagrams, gestures and provide written information as well. For example, if there is a test being conducted on the mother or baby, a thumbs-up can signal that all is well

If a Deaf woman has requested an Irish Sign Language interpreter, put a plan in place for this to be provided at subsequent visits and when she comes into hospital to give birth. Plans may also need to be put in place in advance of an unplanned or emergency admission.

Where partners are attending antenatal classes or at the birth, make arrangements for access to Irish Sign Language Interpretation where the partner is Deaf.

Unless the woman requests it or in an emergency when there is no alternative, avoid relying on the woman’s partner to act as the interpreter. If he is needed by her to support her through labour pain or childbirth, it is difficult to also act as interpreter. In addition to this, Irish Sign Language Interpreters are qualified to interpret all of the information. A partner, family member or friend may not do so for a number of reasons; for example, in an effort to protect a service user from worry, etc.

During labour, it may be difficult for a woman to lip read. If this is the case, an additional member of staff may be needed to help with communication. Prior to labour, agree with the woman some visual signs or gestures that staff can use to help communicate.

Provide women who are hard of hearing or Deaf with baby alarms that vibrate when the baby cries. It is best if she is located in a single room on the ward as the alarm may pick up the cries of other babies.

A woman with an intellectual or cognitive disability

A woman with an intellectual or cognitive disability will need information explained to her in very simple language and simple terms that she can follow. Use of diagrams can be helpful. Remember the level of understanding may vary for each service user.

A woman who has other communication difficulties, other medical difficulties or another concurrent disability (for example, mobility, visual impairment, or mental health difficulties, etc.) will need additional support during pregnancy, childbirth and afterwards.

A woman with an intellectual or cognitive disability may require additional support from a physiotherapist to support her breathing during pregnancy or birth.

A woman with an intellectual or cognitive disability may experience difficulties in communicating pain during labour. It is important to anticipate this and to ensure she has assistance in communicating and managing pain; for example, being accompanied by a family member or carer during labour may provide additional reassurance for her.

It is important to explain simply and clearly in advance about any procedures to be undertaken, such as vaginal examinations.

The choices and possible complications of different ways of giving birth (natural birth or caesarean section) or use of epidural pain relief should be explained simply and clearly to enable informed consent to be obtained. See Section Fifteen: Consent for more information.

Information may need to be repeated several times, as a woman with an intellectual disability may not understand the first time she is given information. Check that what has been said is understood.

Information may not be well retained from one visit to the next, so ensure it is repeated.

Maternity services should liaise with the woman’s support network, including her family and service provider, where appropriate, to ensure that her needs are understood and met.

A multi-disciplinary case conference may need to be organised when a woman with an intellectual disability becomes pregnant to plan appropriate care and support for her during pregnancy, during the birth and on discharge.

Good coordination is required to provide appropriate care and support after discharge including support in caring for the baby.

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Additional Useful Resources

Back to Guidelines Main Menu

Specialist disability organisations

There are a number of disability services, service providers, advocacy services and carer support organisations available to support service users. The Citizens Information Board, Disability Managers in the HSE and other umbrella bodies will be able to guide you in the right direction.

Specialist disability organisations can have a wealth of practical information on matters like communication, accessibility, and day-to-day management and living with a particular condition.

Many organisations working with people with specific conditions can be found via one of the relevant umbrella bodies.

Specialist disability organisations
Further information Reference
General guidance The National Disability Authority's accessibility toolkit www. accessibility.ie provides general information on how to make services, buildings, information, and websites more accessible to people with disabilities. This website is updated regularly. Guidance on accessible buildings and places
Guidance on accessible buildings and places The Department of the Environment, Heritage and Local Government: Building Regulations 2010. Technical Guidance Document M Access and Use
Guidance on accessible buildings and places

www.environ.ie/en/Publications/DevelopmentandHousing/ BuildingStandards/FileDownLoad,24773,en.pdf

The National Disability Authority's Building for Everyone:www. universaldesign.ie/buildingforeveryone.

The Irish Wheelchair Association have developed Best Practice Access Guidelines -Designing Accessible Environments, following extensive consultation with their members and external organisations: www.iwa.ie/services/housing/iwahousing-advocacy/designing-accessible-environments

Guidance on safe evacuation The National Disability Authority Guidance on Safe Evacuation for All: http://nda.ie/Good-practice/Guidelines/Evacuation/Safe-Evacuation-for-All/Safe-Evacuation-for-All/Safe_Evacuation_for_All.pdf
Guidelines on accessible information and accessible formats

Citizens Information Board, Access to Information for All: http://www.citizensinformationboard.ie/publications/advocacy/accessibility_index.html

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

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

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

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

For information on how to write, prepare and design documents in plain English, see: www.simplyput.ie/

Make it Easy: a guide to preparing easy to read information
has been prepared by the Accessible Information Working Group who work with adults with intellectual disabilities in Ireland. It is available at: www.walk.ie

The National Adult Literacy Association has information on making health information easier to follow: www.citizensinformationboard.ie/publications/social/ downloads/AccessToInformationForAll.pdf

Accessible information using symbols and pictures

Easy Info has resources to help make information accessible information for people with intellectual disabilities, including guidance on how to use symbols and pictures and making documents Easy-to-Read: www.easyinfoforus.org.uk/ Organisations that provide symbols include:

Accessible information for blind people Contact the National Council for the Blind of Ireland's media centre for further guidance on how to provide alternatives, including Braille and good quality audio, for people with impaired vision: www.ncbi.ie.
Accessible information for Deaf or Hard of Hearing people The Irish Deaf Society has facilities for producing signed videos and DVDs: www.irishdeafsociety.ie.
Accessible information where English is not a first language and translation is required www.lenus.ie/hse/bitstream/10147/207010/1/Lostintranslation. pdf
Hospital care for people with dementia http://www.rcn.org.uk/development/practice/dementia/ commitment_to_the_care_of_people_with_dementia_in_ general_hospitals/commitment_to_dementia

Appendices

Appendix 1

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Accessibility checklist

The following is a checklist which staff can use to help them identify if there are any specific requirements relating to a person's disability

Are there specific requirements relating to the person’s disability?

  1. Does the person need:
  2. To make appointments by text message or e-mail?
  3. Help to know when it is their turn to be called?
  4. Support with communication or specific communication aids?
  5. Assistance with mobility?
  6. Consultations to take place on the ground floor?
  7. Specific equipment such as a lifting hoist, a height-adjustable or examination couch or accessible weighing scales?
  8. Adapted diagnostic equipment, such as an MRI or mammogram, adapted to accommodate their impairment?
  9. Specific support or care needs related to a pre-existing condition or primary disability?
  10. Specialist nursing staff, a key worker or social worker to assist with a disability?
  11. Arrangements in place for a family member, carer, support person, personal assistant or independent advocate?
  12. Specific assistance required to give informed consent to care?
  13. Accessibility requirements in relation to follow-up appointments, referrals to other services or services in the community?
  14. Does the person have any other accessibility requirements?
  • Does the person need an interpreter? If so, what language?

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Appendix 2


Core principles of a quality services

The National Healthcare Charter, You and Your Health Service, is a Statement of Commitment by the HSE describing what service users can expect when using health services in Ireland, and what they can do to help Irish health services to deliver more effective and safe services. It is based on eight principles which underpin high quality, people-centred care. These principles have been identified through a review of national and international patient charters and through wide consultation with the Irish public.
The National Healthcare Charter aims to inform and empower individuals, families and communities to actively look after their own health and to influence the quality of healthcare in Ireland.

You and Your Health Service - what does it do?
  • It outlines supporting arrangements for a partnership of care between everyone involved in healthcare: patients/service users, families, carers and healthcare providers.
  • It supports a healthcare culture that delivers health and social care services in a predictable, preventative, personal and participatory way.
  • It recognises that there are different roles and responsibilities for both service users and healthcare providers.
  • It promotes the importance of service users as individuals with diverse needs and not just a medical condition to be treated.
  • It applies to all public health and social care services, including community care services and acute hospital services.

The following table sets out the core principles of providing a quality service as set out in the National Healthcare Charter, You and Your Health Service

Core principles of providing a quality service as set out in the National Healthcare Charter, You and Your Health Service
8 Principles What patients and service users can expect
Access Our services are organised to ensure equity of access to public health and social care services.
Dignity and Respect We treat people with dignity, respect and compassion. We respect diversity of culture, beliefs and values in line with clinical decision-making.
Safe and Effective Services We provide services with competence, skill and care in a safe environment, delivered by trusted professionals.
Communication and Information We listen carefully and communicate openly and honestly, and provide clear, comprehensive and understandable health information and advice.
Participation We involve people and their families and carers in shared decision making about their healthcare. We take account of people's preferences and values.
Privacy We will do our best to ensure that you have adequate personal space and privacy when you use our health services. We maintain strict confidentiality of personal information.
Improving Health Our services promote health, prevent disease, and support and empower those with chronic conditions to self-manage their condition.
Accountability We welcome your complaints and feedback about care and services. We will investigate your complaints and work to address your concerns.

Extract from National Healthcare Charter - You and Your Health Service.

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Appendix 3

Disability - the numbers

The Census and the National Disability Survey give an indication of how many people experience different kinds of impairment. This can be useful for service planning.

There are different degrees of disability from total and severe to moderate and mild, and the number of people with disabilities is very sensitive to where the line is drawn, what exact question is asked and how it is asked.

Based on the National Disability Survey 2006, between one in five and one in ten of the population had a long-term disability. In Census 2011, 13% of the population stated they had a long-term disability. In addition, there are people who may be experiencing short-term impairment, because of a broken limb, for example, and older people who have some difficulties in everyday activities, but do not describe themselves as having a disability.

So the data presented in this section is indicative and not precise.

Mobility is the most frequently encountered disability. Of the 160,000 people who had difficulty in walking any distance, 83,000 used walking aids and 31,000 were wheelchair users.

People with a lot of difficulty in seeing (with glasses) greatly exceeded the numbers who were completely blind. So there is likely to be a widespread demand for large print but fewer Braille users.

The figures also suggest that health service staff are likely to encounter people who are hard of hearing more frequently than those without any hearing

Census 2011 showed there were about 2,600 people for whom Irish Sign Language was the language of the home.

People with disabilities by type of impairment and severity: National Disability Survey 2006 This is a table which is based on those people interviewed in the National Disability Survey 2006 who had disclosed a disability both in Census 2006 and in the National Disability Survey. It includes the type of impairment and severity.

Total % of population
Seeing 50,600 1.19
-moderate difficulty 27,600 0.65
-a lot of difficulty 20,700 0.49
-cannot see 2,300 0.05
Hearing 57,600 1.36
-moderate difficulty 35,200 0.83
-a lot of difficulty 20,600 0.49
-cannot hear 1,800 0.04
Speech 35,300 0.83
-moderate difficulty 16,800 0.40
-a lot of difficulty 12,200 0.29
-cannot speak 6,400 0.15
Mobility and dexterity 184,000 4.34
-moderate difficulty 57,000 1.34
-a lot of difficulty 62,200 1.47
-cannot do 64,900 1.53
Moving around home 101,200 2.39
-moderate difficulty 50,200 1.18
-a lot of difficulty 38,400 0.91
-cannot do 12,700 0.30
Going outside of home 128,900 3.04
-moderate difficulty 53,700 1.27
-a lot of difficulty 49,900 1.18
-cannot do 25,300 0.60
Walking for about 15 minutes 160,000 3.77
-moderate difficulty 47,200 1.11
-a lot of difficulty 52,900 1.25
-cannot do 60,000 1.42
Using hands and fingers 79,000 1.86
-moderate difficulty 33,900 0.80
-a lot of difficulty 30,900 0.73
-cannot do 14,300 0.34
Remembering & concentrating 113,000 2.67
-moderate difficulty 54,900 1.29
-a lot of difficulty 43,800 1.03
-cannot do 14,300 0.34
Remembering important things 77,600 1.83
-moderate difficulty 39,100 0.92
-a lot of difficulty 27,600 0.65
-cannot do 10,900 0.26
Forgetting where I put things 85,800 2.02
-moderate difficulty 44,600 1.05
-a lot of difficulty 30,400 0.72
-cannot do 10,800 0.25
Concentrating for 10 minutes 77,900 1.84
-moderate difficulty 35,000 0.83
-a lot of difficulty 29,800 0.70
-cannot do 13,100 0.31
Intellectual functions 27,700 0.65
-a little difficulty 4,000 0.09
-moderate difficulty 9,100 0.21
-a lot of difficulty 10,300 0.24
-cannot do 4,300 0.10
Intellectual & learning 71,600 1.69
-a little difficulty 12,000 0.28
-moderate difficulty 25,900 0.61
-a lot of difficulty 24,800 0.58
-cannot do 8,900 0.21
Interpersonal skills 22,300 0.53
-a little difficulty 4,600 0.11
-moderate difficulty 7,200 0.17
-a lot of difficulty 7,200 0.17
-cannot do 3,400 0.08
Learning everyday skills 55,000 1.30
-a little difficulty 10,200 0.24
-moderate difficulty 19,500 0.46
-a lot of difficulty 18,700 0.44
-cannot do 6,700 0.16
Diagnosed with intellectual disability 50,400 1.19
-a little difficulty 14,000 0.33
-moderate difficulty 24,200 0.57
-a lot of difficulty 9,000 0.21
-cannot do 3,200 0.08
Emotional, psychological & mental health 110,600 2.61
-a little difficulty 25,300 0.60
-moderate difficulty 46,300 1.09
-a lot of difficulty 35,100 0.83
-cannot do 8,900 0.21
Pain 152,800 3.60
-moderate difficulty 74,900 1.77
-a lot of difficulty 73,100 1.72
-cannot do 4,700 0.11
Breathing 71,500 1.69
-moderate difficulty 45,000 1.06
-a lot of difficulty 25,200 0.59
-cannot do 1,300 0.03
Total persons with a disability 393,785 9.29

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Appendix 4

Membership of the HSE Universal Access Steering Committee

The HSE Universal Access Steering Committee was established in 2011 to advise, make recommendations and support the development of a strategic approach to universal access in health and social care services. It is a partnership of key internal and external stakeholders and experts.

Membership of the HSE Universal Access Steering Committee
Greg Price Assistant National Director, QID, HSE
Cate Hartigan Assistant National Director, HSE (until July 2013)
Paul Defreine Chief Architectural Adviser, HSE Estates
Diane Nurse National Lead for Social Inclusion, HSE
Michael Shemeld National Disability Unit, HSE
William Reddy Acute Hospitals Programme, HSE (until June 2012)
Tony Leahy Mental Health Specialist, HSE
Enda Saul Communications, HSE
Rosalie Smith Lynch Area Manager, Consumer Affairs, HSE
Chris Rudland Assistant National Director, QAV
Helen Lahert Citizens Information Board
Elaine Howley Not for Profit Business Association
John Hannigan National Federation of Voluntary Bodies
Deirdre Carroll Inclusion Ireland (until June 2012)
Jim Winters Inclusion Ireland
Jacqueline Grogan Disability Federation of Ireland
Shane Hogan National Disability Authority (until June 2013)
Donie O’Shea National Disability Authority
Dr. Shari McDaid Mental Health Reform
Marie Prendergast Primary Care, HSE
Michele Guerin Equality Officer, HSE
Marian Murray Equality Officer, HSE
Sinead Burns Area Manager, Consumer Affairs, HSE
Deborah Keyes Area Manager, Consumer Affairs, HSE
Gerry Mulligan Primary Care Reimbursement Services, HSE
Helen Valentine Primary Care Reimbursement Services, HSE
Phil Garland Assistant National Director, Children and Families, HSE (until September 2012)
Caoimhe Gleeson National Specialist in Accessibility, QID
Angela Kennedy National Complaints Governance and Learning Team, QAV

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Publication Details

ISBN: 978-1-906218-80-5

Quality and Patient Safety Division
Health Service Executive
Oak House
Millennium Park
Naas
County Kildare

Tel: 045 880400
Fax: 1890 200 894
Email: yoursay@hse.ie
Website: www.hse.ie

National Disability Authority
25 Clyde Road
Dublin 4

Tel: 01 608 0400
Fax: 01 660 9935
Email: nda@nda.ie
Website: www.nda.ie

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14 Emergency Care Networks (ECN's) will include:

  • 24/7 Emergency Departments (ED's);
  • Local Injury Units (LIU's) where patients with non-life threatening injuries can receive care;
  • The potential role of Local Emergency Units (LEU's) providing daytime only emergency services may be considered on a limited number of sites. (back to footer 14)

15 See The National Emergency Medicine Programme - A strategy to improve safety, quality, access and value in Emergency Medicine in Ireland Section 21.5.1.1, Patient Passport and Section 21.5.1.2, Acute needs assessment. (back to footer 15)

16 See The National Emergency Medicine Programme - A strategy to improve safety, quality, access and value in Emergency Medicine in Ireland -Section 21.6 People with Physical Disability (back to footer 16)

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