Provision of paid carers in acute hospitals to people with disabilities: letter

Letter from Cabinet Secretary, Jeane Freeman, on the provision of paid carers in acute hospitals to people with disabilities on 17 November 2020.

17 November 2020

Dear Colleagues,

Social Care in Hospital

I am writing on the issue of social care being provided in hospital. We recognise that those who require social care support for day to day living will continue to need that support by people who understand their needs when they are in hospital. This support should continue whether they are in the community or in hospital.

In 2017, the Scottish Learning Disabilities Observatory published a systematic review on premature death and causes of death in people with intellectual disabilities. This study found that people with intellectual disabilities die an average of 20 years earlier often from avoidable causes. In England, the confidential inquiry into premature deaths of people with learning disabilities found that men and women with learning disabilities died sooner than those without learning disabilities and that avoidable deaths from causes related to poor quality healthcare were higher than for those with no learning disabilities. Contributory factors included a lack of reasonable adjustments (particularly at clinic appointments and investigations).

Research into the safety of patients with learning disabilities in NHS hospitals also cited delays and omissions in treatment and basic care. The main barriers to better and safer hospital care for people with learning disabilities were found to be: the invisibility of such patients within hospitals; poor staff understanding of their specific vulnerabilities; a lack of consistent and effective carer involvement and misunderstanding by staff of the carer role, plus a lack of clear lines of responsibility and accountability for the care of each patient with learning disabilities.

It is the Scottish Government’s expectation, with the integration of health and social care, that both access and funding will not be a barrier to someone receiving social care support from their paid or unpaid carers in hospital.

Delivering safe, effective person-centred care is a strategic priority for NHS Scotland and the Scottish Government. We expect those providing care to work in partnership with people who use health and social care services, their families and carers, to deliver care that meets their needs.

Supporting person-centred visiting is a critical part of this approach and revised hospital visiting guidance aligned to the strategic framework is now in place across the country. At all times and in all local authorities, essential visitors continue to be welcomed – and in many places also one or two designated visitors. However, you will want to remember that carers are not to be counted as “visitors” whether they are paid carers or unpaid carers. Those who are providing care to a supported person should be supported to continue providing care if that person is admitted to hospital. This includes paid and unpaid carers as they are both essential to safe effective care.

The level of person centred social care provided to an individual should remain consistent regardless of whether they are in the community or in hospital. If someone with complex needs requires support in the community and they are admitted to hospital, they should not have a lesser level of support and are entitled to be supported by people who understand their needs.

This is about the continuation of social care provision in the community being received in hospital, not the introduction of new social care for patients. It is appreciated that there may be complexities in agreeing where responsibility rests but this should not delay the admittance of any person to hospital.

Social care support will be required in situations where someone has a high level of support needs and known care workers will be able to provide this. The social care staff and the hospital staff should work collaboratively to provide the level of support required to ensure the safety of the patient, each with distinct roles.

Additionally there is a duty to involve unpaid carers when the person they care for is being discharged from hospital. This is a duty under the Carers Act. Effective carer involvement supports caring relationships both during and after the hospital stay.

It is a legal requirement to make reasonable adjustments for people with disabilities. These adjustments should be made in partnership with the person and those most important to them to support their care. 

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