Revalidation of Doctors - Health Committee Contents


Written evidence from Mencap (REV 08)

Mencap is the UK's leading learning disability charity, working with people with a learning disability, their families and carers. We want a world where people with a learning disability are valued equally, listened to and included. We want everyone to have the opportunity to achieve the things they want from life.

MENCAP'S RESPONSE

Mencap believes that revalidation needs substantial overhaul if it is to truly protect all patients, including those with a learning disability. This work needs to also be considered in the context of improving the fitness to practice work of the registering bodies.

At present, people with a learning disability experience significantly higher levels of illness than the general population, including diabetes, asthma and heart conditions. People with a learning disability are 58 times more likely to die before their 50th birthday than the general population.

Doctors, working in any healthcare setting, have a critical role to play in ensuring that patients with a learning disability are able to not only live longer, but also live healthier. Revalidation is crucial in ensuring that healthcare delivered to all patients, including those with a learning disability, delivers consistently high outcomes. Current GMC proposals round revalidation are too heavily weighted in favour of the convenience of doctors, rather than ensuring better outcomes for patients.

Mencap are pleased that the Health Select Committee has chosen to look at how the revalidation of doctors works. Mencap believes that revalidation needs substantial overhaul if it is to truly protect all patients, including those with a learning disability.

Healthcare for All (commissioned by the Department of Health in response to Mencap's Death by Indifference report) highlighted revalidation as a key method for driving standards of care and avoiding premature death. While the Department's recent 6 Lives Progress Report (2010) showed that there have been improvements to services, families across the country still continue to tell Mencap about the poor experience they have received from many doctors, including:

  • Doctors making little effort to communicate with a patient with a profound and multiple learning disability.
  • Carers saying that input is routinely ignored by doctors.
  • Evidence of doctors making prejudicial quality of life assumptions, particularly around Do Not Resuscitate orders.
  • Frequent diagnostic overshadowing by doctors, who see the disability and fail to act early to tackle the underlying, and often worsening, health condition.

Mencap believes that improving health outcomes for patients with a learning disability will require both an attitudinal shift as well as a strong and inclusive revalidation process requiring doctors to make reasonable adjustments. Mencap believes that doctors should be asked to provide evidence as to how they have made reasonable adjustments for people with a learning disability (as well as their carers) in order to be revalidated. Such evidence could look at how doctors have adjusted their practice in ways such as:

  • Intervening earlier when coming into contact with a patient with a learning disability, particularly when the patient is non-verbal.
  • Doctors' level of understanding by the doctor of mental capacity legislation.
  • As well as some of the more "low level reasonable adjustments" including: information provision, longer appointment lengths, linking with community teams (or secondary medicine) - and how these have led to better health outcomes.

Mencap believes all doctors should be able to consistently offer good care for all patients. Current GMC proposals appear to be far too weighted in favour of not inconveniencing doctors. They make almost no reference to patient safety - a clear omission in Mencap's view.

The proposed GMC timescale for revalidation of five years also feels too far tilted towards the interests of doctors and institutions rather than ensuring the confidence of patients with a learning disability.

Mencap welcomed the GMC proposals for engaging the public in the revalidation of doctors. Their consultation proposed that patient views would be garnered through patient survey, conducted by the hospital or GP surgery. This poses three difficulties:

  • Having a learning disability necessarily means having a difficulty in communication - extra effort needs to be made to record the views and experiences of patients with a learning disability.
  • If a person's experience with a GP has been poor, the willingness of the patient or to engage with an survey not in accessible formats (such as easy read pictures and symbols) is likely to be low.
  • Those that experience the worst outcomes may be least well represented in patient feedback.

Mencap believes revalidation should make explicit reference to the fact that for many people with a learning disability, written communication is not possible and other options, including support, should be offered as a routine.

CONCLUSION

The rights of patients with a learning disability are protected by law.

It is vital that revalidation ensures that doctors provide practical evidence as to how they have made reasonable adjustments for patients with a learning disability, if we are to continue to drive up health standards.

November 2010


 
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