Patient safety - more equal for some than others


By Ruth Northway, Professor of Learning Disability Nursing 

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17th September is the World Patient Safety Day and (as with similar days focused on other causes) its aim is to raise awareness of key issues that have a global impact. Patient safety is certainly an issue that affects us all since no matter our geographical location, gender, race, or age we will all, at some time, be a patient requiring health care. However, there are some groups of people for whom the risks of being ‘unsafe’ when receiving health care are greater and people with learning disabilities are one such group.

Several studies have highlighted the poor healthcare often received by people with learning disabilities and the impact this has both on quality of life, well-being, and life-expectancy, but it is beyond the scope of this blog to detail them all. Nonetheless, it is important to note that the Confidential Inquiry into Premature Deaths of People with Learning Disabilities found that people with learning disabilities in their sample were significantly more likely die from causes that were amenable to change though the provision of quality healthcare than their non-learning disabled peers. They were thus more likely to experience premature and avoidable deaths. More recently a scoping review highlighted a range of inequalities and inequities in patient safety experienced by people with learning disabilities across a number of areas including adverse events, post-operative outcomes and quality of care. However, they also identified factors that can protect against or mitigate the risk of such events namely the support of family and carers, and the extent to which health professionals understand the needs of people with learning disabilities.

At the University of South Wales we have, over the past couple of years, had the privilege of undertaking research and developing two key initiatives in partnership with Improvement Cymru which aim to increase these protective factors and hence to enhance patient safety. First is the All Wales Health Profile which aims to enhance communication and information sharing for people with learning disabilities when attending healthcare facilities. Second is the Learning Disability Educational Framework for Healthcare Staff in Wales which identifies the values, knowledge and skills that all healthcare staff need to recognise, understand and meet the health needs of people with learning disabilities in a timely, appropriate and effective manner. This framework is being used to inform the provision of mandatory learning disability awareness training in Wales.

The World Health Organisation (WHO), who coordinate World Patient Safety Day,  define patient safety as a healthcare discipline that aims to 'prevent and reduce risks, errors and harm that occur to patients during provision of healthcare'. Hopefully implementation of these two developments, alongside others, will help to ensure that people with learning disabilities receive safer healthcare and that inequalities and inequities are reduced. However, WHO add that the key to achieving safer healthcare is a focus on continuous learning and improvement.

Unfortunately, reports of people with learning disabilities receiving poor and unsafe health care continue to occur in many countries.  It is essential, therefore, that wherever we are in the world we continue to work in partnership with people with learning disabilities and their families to seek improvements in the health care they receive, to ensure that learning happens, and that lasting and effective change is actioned when things do go wrong.

The vision outlined in the WHO Global Patient Safety Action Plan 2021 - 2030 is for 'A world in which no one is harmed in healthcare and every patient receives safe and respectful care, every time, everywhere'. We need to ensure that people with learning disabilities are included in this vision and that current disparities are both recognised and addressed. Perhaps on World Patient Safety Day we can all take a few minutes to think about how we can help to make this vision a reality for people with learning disabilities.

About the author: Ruth Northway is a professor of Learning Disability Nursing and has led UDIDD since its inception in 2002. Her interests include the health and well-being of people with learning disabilities, safeguarding, the use of inclusive research approaches, ethics and professional issues in learning disability nursing. 

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