Why communication is fundamental to good care

Unless care providers and their staff teams think about the communication needs of the people they support, the quality and effectiveness of the support will suffer. In addition, there are both legislative and good practice obligations placed on care providers in respect of communication needs. In this article, I will explore some of these and how care providers can ensure that they are embedded into systems, processes, and practices.

Accessible Information Standard

Let’s start with the Accessible Information Standard (AIS). This was introduced on 1st August 2016 and all organisations that provide NHS care and/or publicly funded adult social care are legally required to follow the standard. The AIS sets out a specific, consistent approach to identifying, recording, flagging, sharing, and meeting the information and communication support needs of patients, service users, carers, and parents with a disability, impairment, or sensory loss. However, the AIS does not cover those whose needs are in other languages, nor does it cover websites.

There are five steps in the AIS, these are:

• Identify- care providers must find out if people have disability-related communication needs. The AIS refers to the Equality Act 2010, which describes disability as follows, “A person has a disability if — (a)the person has a physical or mental impairment, and (b) the impairment has a substantial and long-term adverse effect on the person’s ability to carry out normal day-to-day activities.” In this respect the majority of those who use social care services could be regarded as having a disability and as such care providers must find out if they have related communication needs. This should be done as part of assessment and care planning and must be kept under constant review.
• Record – Linking to assessment and care planning, any disability-related communication needs must be recorded in the person's care plan. To be effective this recording must be detailed and specific. For example, if the care plan says that the person has hearing loss, this is not specific as it covers a wide spectrum from slight hearing loss to complete deafness.
• ?Flag – It is not sufficient just to record the communication needs, these need to be flagged up so that all staff in the service can quickly and easily be aware of the needs so that they can work to meet them.?It is not acceptable for social care staff to say that they were not aware of a person’s communication needs.
• Share- It is an essential part of partnership working for care providers to work with other agencies, where this work relates to meeting a person’s needs there needs to be a system to share information on people’s information and communication needs with other health and social care services. This means that other services can also respond to the person's information and communication needs.
• Meet – The first 4 steps are all well and good but if the communication needs are not met in practice, then the whole process has failed. To do this care providers must make sure that people receive information that they can access and understand. Care providers must also arrange communication support if people need it and provide their staff team with training in both meeting communication needs and the specific communication needs of those that support

Equality Act 2010 and reasonable adjustments

The Act places a legal duty on all service providers to take steps or make “reasonable adjustments” in order to avoid putting a disabled person at a substantial disadvantage when compared to a person who is not disabled. The Act is explicit in including the provision of information in “an accessible format” as a ‘reasonable step’ to be taken. This means that care providers must ensure that they can clearly evidence that they have done all that they can to enable all those they support to access information in their preferred format.

Assessing communication needs

One of the fundamental principles of the Accessible Information Standard is that people should be asked and supported to self-define their information and/or communication needs. It is also fundamental that it is these needs and not their disability which should be recorded. There is a clear rationale for this, in that the aim of the standard is to ensure that an individual receives information in a format that they can understand and any support which they need to communicate rather than being “labeled” by their disability. For example, recording that a person is ‘deaf’, does not explain whether they are able to read written English if they use British Sign Language (BSL) or are a lipreader and/or hearing aid user. Assumptions about communication support or alternative formats required, or any recording of needs, must not be made without consultation with the person and/or their representative (as appropriate to their mental capacity).

Meeting communication needs

Care providers must provide at least one communication method which is accessible to and useable by the person. The method(s) must enable the person to communicate with the service and the staff team and staff must use this method to communicate with the individual. In addition, where needed, appropriate, professional communication support must be arranged or provided to enable people to effectively access/receive care and support and to communicate with those providing the support. This will enable them to actively participate in decisions about their health, care, or treatment. Care providers and their staff must take appropriate action to enable people to communicate. This may include staff modifying their behavior and/or supporting the use of aids or tools.

Communication is key to inclusion

If care providers do not ensure that they and their staff team identify and consistently meet the communication needs of the people, they support then those people will be excluded from participating in their care and support. This will result in a breach of The Equality Act 2010 and the relevant social care legislation in that part of the UK. It will also mean that the person will not be able to define what matters to them and their preferences about how their needs will be met, these are fundamental components of well-being. Everybody must have a voice; care providers must do all that they can to ensure that that voice is that of the person receiving the care and support. Only if this is not possible or the person consents should care, providers, involve the person’s representative.?When this happens, the representative must act in the person’s best interests and must always seek to involve the person. If there is no representative whom it is practicable to involve then the care provider must ensure that a referral to an advocacy provider is made.?