Learn Learning Disabilities & Autism Opinion

Breaking down barriers with reasonable adjustments

Sue Bridges RNLD, Dip (HE), BSc (Hons), MA
Independent Consultant Nurse

An estimated 2% of the population have a learning disability in the UK. Health inequalities start early in life for people with learning disabilities, often due to the barriers that people experience when trying to access care.  People with learning disabilities should be able to receive treatment, care and support that are safe and personalised, and have the same access to services and outcomes as their non-disabled peers (NHSI, 2018). Valuing People (Department of Health, 2001; 2009) and the Autism Act (2009) state that people with a learning disability or autism, should be able to live an ordinary life and access mainstream services wherever possible. This is substantiated by a legal requirement for statutory services to make ‘reasonable adjustments’ for people with disabilities. This includes people with a learning disability (Equality Act, 2010; Autism Act, 2009; Health and Social Care Act, 2012; NHS England Accessible Information Standards, 2015).

Breaking down barriers is not only best practice but a legal requirement. To ensure we break down barriers and enable fair access to services, reasonable adjustments can make a difference to people’s experiences. This means making adaptations to the approach or provision of services so that they are easier for people with learning disabilities to use. Changing our approach is not difficult nor expensive and simple changes can make a big difference.

Take time to understand the individual. Engage with family and those who know them well.  Involve people in their own care as understanding what it is like for the individual can help to break down barriers and lead to better understanding of individual needs.

Reasonable adjustments can mean alterations to the environment by providing lifts, wide doors, quieter areas, reduced lighting, ramps, and tactile signage, but importantly can also mean changes to policies, procedures, systems and how staff communicate and behave. Get the culture right, so that barriers no longer exist.

To truly break down barriers, it is important to educate all carers to the needs of the individual. Understanding learning disabilities can be achieved through greater knowledge and skills to ensure staff have a positive solution-focused attitude. Next year, the Oliver McGowan Mandatory Training from Skills for Care will become mandatory for all health and social care staff. This framework sets out the essential skills and knowledge necessary for all staff involved in caring for people with a learning disability. Link: The Oliver McGowan Mandatory Training in Learning Disability and Autism. | Health Education England (hee.nhs.uk)

Establish the best way to communicate with the individual and ensure all involved in their care are aware. Allow time for the person to process information, ensuring it is in a format that meets the persons needs, such as plain English, larger print, or in easy read. Make reasonable adjustment boxes containing sensory equipment and communication aids available to use.

Verify what the person needs and how can you meet those needs. Behind every behaviour, consider a physical or mental health reason. Recognition of ill health is often difficult and professional curiosity of what the issue is may result in less restrictive interventions. For example, someone banging their head may be frustration due to not being able to communicate that they are in pain, rather than just challenging behaviour. Think outside the box, act creatively and eliminate barriers.

Ultimately, to break down barriers is to ensure the person with a learning disability receives an equitable service. Reasonable adjustments can safeguard from inequalities and lead to a better quality of life and improve the outcomes for all.

Autism Act (2009) HMSO: London.
Department of Health (2001) Valuing People: A New Strategy for Learning Disability for the 21st Century. Cm 5086. London: Department of Health.
Department of Health (2009) Valuing People Now. London: Department of Health.
Equality Act (2010) HSMO: London
Health and Social Care Act (2012) HSMO: London
NHS England (2015) Accessible Information Standards, Available at: https://www.england.nhs.uk/ourwork/accessibleinfo/ (Accessed 28th October 2021).
Skills for Health (2016) Learning Disabilities Core Skills Education and Training Framework. Available at: https://www.hee.nhs.uk/our-work/learning-disability/oliver-mcgowan-mandatory-training-learning-disability-autism (Accessed: 19th October 2021).




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