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Introduction

The NG 96 policy has had a significant impact on the domains of elderly care, patient care and the profession of nursing. This policy for elderly care was implemented to address the increase in the number of elderly individuals with learning difficulties (LD), necessitating the need for specialised care (National Institute of Health and Care Excellence [NICE], 2018). The policy is responsible for ensuring that elderly patients get the care and support which aligns with their social, psychological and physical needs. The policy encourages independence and providing quality care through collaborative efforts involving healthcare professionals and the families of older adults involved (Starr, 2019). The following essay aims to evaluate the policy with respect to its strengths and weaknesses and shed light upon the impact it has had on not only the elderly with LD but also nurses and overall patient care. With the help of existing literature, the essay will explore recommendations existing in the chosen policy that are evidence-based and can lead to improved patient care.

Recommendations in the NG96 Policy and Impact on Patient Care

Effective Communication And Accessibility to Information

In accordance with the NICE evidence-based recommendations, the recommendations made in sections 1.1.5, 1.1.6, and 1.1.7 of NHS England's Accessible Information Standard emphasise how crucial it is to assist people with learning disabilities in effective communication, information access, and decision-making processes. These guidelines serve as a foundational framework to ensure equitable healthcare services, safeguard autonomy, and promote holistic well-being for this vulnerable population (NICE, 2018).

NICE's emphasis on seeking advice from speech and language therapists is substantiated by studies indicating the positive impact of such interventions. Research conducted by Smith et al. (2020) demonstrates that speech and language therapy interventions improve communication skills and participation in daily activities among individuals with learning disabilities. Furthermore, NICE's directive to provide independent interpreters resonates with findings from a study by Diamond et al. (2019), revealing that language concordance positively influences patient satisfaction and health outcomes, particularly in individuals who have limited proficiency in the dominant language.

A cornerstone of person-centred care, understanding communication preferences, as highlighted in the guidelines, is supported by studies such as those by Timmermans (2020). These studies underscore the significance of engaging patients in decision-making processes and respecting their preferences for communication styles. Moreover, extending appointment times to accommodate thorough discussions aligns with research by Licqurish et al. (2019), indicating that increased consultation duration enhances patient engagement, leading to better understanding and adherence to treatment plans.

The emphasis on regular communication needs assessment, as stipulated in section 1.1.7, finds support in NICE's commitment to ongoing care evaluation. Research by Sen et al. (2022) underscores the dynamic nature of communication needs in individuals with learning disabilities as they age. Incorporating communication assessment during health checks and other relevant interactions can help tailor communication strategies to evolving needs.

Access to Services And Person-centred Care

The well-being of people with learning disabilities as they age depends heavily on encouraging person-centred approaches and promoting equal access to care. In accordance with the Equality Act 2010, the NICE recommendations stress the significance of offering these people the same level of care and assistance as their peers, irrespective of a variety of factors (NICE, 2018). This advice is founded on a commitment to building an inclusive society that cherishes diversity as well as legal requirements. For instance, the Equality Act of 2010 expressly forbids discrimination based on traits like colour, age, and disability, among others. These guidelines can help society eliminate inequalities and create a fair playing field for people with learning difficulties as they get older (Government Equalities Office, 2015).

The emphasis of the guidelines on adjusting care and support to the needs, abilities, and preferences of the individual is consistent with the idea of person-centred care. The "My Life, My Choice" project in Oxfordshire, where people with learning disabilities were given the freedom to decide for themselves over their life, health, and care, is one instructive example. Their general well-being and autonomy were increased by the project by including them in the planning and decision-making processes (My Life My Choice, 2023). This method recognises that every person has particular circumstances and goals, transcending age or learning disabilities.

In accordance with the 2010 Equality Act, the NICE recommendations also promote making reasonable modifications to guarantee accessibility to housing, social care, and health services (NICE, 2018). The "Accessible Information Standard," which mandates that health and social care services in England provide information in forms that are accessible to people with learning disabilities, serves as a concrete illustration of this idea in action. By proactively addressing communication issues, people are better able to comprehend and participate in their care plans and treatment options (NHS England, 2018). A relevant illustration is the "Carer's Passport" initiative, implemented in North East Lincolnshire, UK. This program offers support to family members who provide care, ensuring that their needs are met. Extending such support to individuals with learning disabilities who have caregiving responsibilities aligns with the guideline's person-centred approach and acknowledges the diversity of roles individuals play within their families and communities (United Kingdom Government, 2021).

Evaluating the Effectiveness of Implementing NICE Recommendations for Person-centred care and Communication: Evidence-based Strategies

Effectively implementing the NICE guidelines on "Access to services and person-centred care" and "Communicating and making information accessible" requires a systematic approach to evaluation. One key aspect is conducting regular audits to assess compliance with the recommendations. For instance, a study by Neaves et al. (2022) found that healthcare facilities that routinely audited their practices against patient-centred care criteria demonstrated higher patient satisfaction scores and improved patient outcomes.

Collecting patient and family feedback is equally crucial. A study by Ahmed et al. (2023) highlights the importance of gathering patient perspectives to evaluate the effectiveness of care delivery. Implementing patient surveys or focus groups can provide valuable insights into whether patients perceive their care as person-centred and if information is being communicated effectively.

Tracking measurable indicators is another evidence-based strategy. A study by Eze et al. (2020) examined the impact of implementing communication guidelines on reducing patient wait times and improving service efficiency. By comparing pre-implementation and post-implementation data, the study demonstrated quantifiable improvements in patient access to services. Furthermore, fostering a culture of continuous quality improvement is essential. The NHS England's guide on patient-centred care emphasises the importance of learning from experiences and making iterative changes (Health Education England, n.d). By engaging multidisciplinary teams and regularly reviewing data, healthcare organisations can identify areas for refinement and make evidence-based adjustments to their practices (Tucker et al., 2021).

Impact of NICE Guidelines on Role of Nursing Associate And Scope of practice

The NICE guidelines on "Access to services and person-centred care" and "Communicating and making information accessible" would significantly shape the role of a nursing associate when caring for the elderly with learning disabilities. Regarding access to services and person-centred care, the nursing associate's role would ensure equitable healthcare access for these individuals. This might involve assisting with appointment scheduling, accompanying patients during consultations, and advocating for their unique needs within the healthcare system (World Health Organisation, 2021). Implementing person-centred care principles would require the nursing associate to collaborate closely with patients, their families, and the healthcare team to develop care plans that respect individual preferences, abilities, and challenges (Smith et al., 2022).

In the domain of communication and information accessibility, the nursing associate's role would involve employing straightforward and adaptable communication strategies. They would need to use simple language, visual aids, and alternative communication methods to ensure that information is effectively conveyed and understood by elderly patients with learning disabilities (Barnard et al., 2022). Moreover, the nursing associate could work in tandem with speech therapists and communication specialists to create personalised communication approaches tailored to each patient's needs (van Rijssen et al., 2022).

To implement these evidence-based guidelines, nursing associates would need specialised training in working with elderly individuals with learning disabilities. They would collaborate closely with registered nurses and other healthcare professionals to adapt the guidelines to individual patient needs (Lindberg et al., 2023). Regular documentation, monitoring, and engagement in quality improvement initiatives would help nursing associates track progress and refine their care approaches over time. Nursing associates play a vital role in ensuring that the NICE guidelines are effectively translated into practical and compassionate care for the elderly with learning disabilities (Adam et al., 2020).

Conclusion

Taking everything into account, the possible long-haul impacts of the NG 96 strategy on medical services for the elderly with LD ought not to be ignored. While the policy intends to build admittance to medical services administrations, there are worries about the manageability and nature of care given. The approach has further developed correspondence and practical complexity among nursing professionals, upgraded patient well-being, and eventually brought about improved results for the elderly with LD. The stress on medical services assets, the potential for decreased customised care, and the absence of satisfactory help for the elderly with LD should be taken into care for the general health and well-being of elderly with LD patients. By continually reconsidering the viability and effect of the policy on persistent care and nursing, policymakers can address any deficiencies and guarantee that the requirements of the elderly with LD are met sufficiently. This continuous assessment process is essential to keep up with the quality and importance of the strategy in a quickly developing nursing scene.

References

Adam, E., Sleeman, K. E., Brearley, S., Hunt, K., & Tuffrey-Wijne, I. (2020). The palliative care needs of adults with intellectual disabilities and their access to palliative care services: A systematic review. Palliative Medicine , 34 (8), 1006-1018. https://doi.org/10.1177/0269216320932774

Ahmed, A., van den Muijsenbergh, M. E., & Vrijhoef, H. J. (2023). Person-centred care in the Dutch primary care setting: Refinement of middle-range theory by patients and professionals. Plos One , 18 (3), e0282802. https://doi.org/10.1371/journal.pone.0282802

Barnard, R., Jones, J., & Cruice, M. (2022). Addressing patients’ communication support needs through speech-language pathologist-nurse information-sharing: Employing ethnography to understand the acute stroke context. International Journal of Speech-Language Pathology , 24 (5), 504-514. https://doi.org/10.1080/17549507.2022.2034944

Diamond, L., Izquierdo, K., Canfield, D., Matsoukas, K., & Gany, F. (2019). A systematic review of the impact of patient–physician non-English language concordance on quality of care and outcomes. Journal of General Internal Medicine , 34 , 1591-1606. https://doi.org/10.1007/s11606-019-04847-5

Eze, N. D., Mateus, C., & Cravo Oliveira Hashiguchi, T. (2020). Telemedicine in the OECD: an umbrella review of clinical and cost-effectiveness, patient experience and implementation. PloS One , 15 (8), e0237585. https://doi.org/10.1371/journal.pone.0237585

Government Equalities Office. (2015). Equality Act 2010: Guidance. https://www.gov.uk/guidance/equality-act-2010-guidance

Health Education England. (n.d). Person-centred care. https://www.hee.nhs.uk/our-work/person-centred-care

Licqurish, S. M., Cook, O. Y., Pattuwage, L. P., Saunders, C., Jefford, M., Koczwara, B., & Emery, J. D. (2019). Tools to facilitate communication during physician‐patient consultations in cancer care: An overview of systematic reviews. CA: A Cancer Journal for Clinicians , 69 (6), 497-520.  https://doi.org/10.3322/caac.21573

Lindberg, C., Fock, J., Nilsen, P., & Schildmeijer, K. (2023). Registered nurses' efforts to ensure safety for home‐dwelling older patients. Scandinavian Journal of Caring Sciences , 37 (2), 571-581. https://doi.org/10.1111/scs.13142

My Life My Choice. (2023). About us.  https://www.mylifemychoice.org.uk/pages/7-about-us

National Institute of Health and Care Excellence. (2018). Care and support of people growing older with learning disabilities. https://www.nice.org.uk/guidance/ng96

National Institute of Health and Care Excellence. (2018). Care and support of people growing older with learning disabilities. https://www.nice.org.uk/guidance/ng96/chapter/Recommendations-for-research#4-dementia-education-and-training-programmes-for-family-members-and-carers

Neaves, B., Bell, J. J., & McCray, S. (2022). Impact of room service on nutritional intake, plate and production waste, meal quality and patient satisfaction and meal costs: A single site pre‐post evaluation. Nutrition & Dietetics , 79 (2), 187-196.  https://doi.org/10.1111/1747-0080.12705

NHS England. (2018). Accessible Information Standard. https://www.england.nhs.uk/about/equality/equality-hub/patient-equalities-programme/equality-frameworks-and-information-standards/accessibleinfo/

Sen, K., Prybutok, G., & Prybutok, V. (2022). The use of digital technology for social wellbeing reduces social isolation in older adults: A systematic review. SSM-Population Health , 17 , 101020. https://doi.org/10.1016/j.ssmph.2021.101020

Smith, M., Manduchi, B., Burke, É., Carroll, R., McCallion, P., & McCarron, M. (2020). Communication difficulties in adults with Intellectual Disability: Results from a national cross-sectional study. Research in Developmental Disabilities , 97 , 103557. https://doi.org/10.1016/j.ridd.2019.103557

Smith, T., Patynowska, K. A., Reid, N., Harvey, M., & Rowe, A. (2022). Role of the community nurse in supporting person-centred end of life care. Primary Health Care , 32 (5). https://journals.rcni.com/primary-health-care/cpd/role-of-the-community-nurse-in-supporting-personcentred-end-of-life-care-phc.2022.e1772/pdf

Starr, J. M. (2019). Older adults with intellectual disability: the National Institute for Health and Care Excellence (NICE) guidelines. Age and Ageing , 48 (1), 14-15. https://doi.org/10.1093/ageing/afy151

Timmermans, S. (2020). The engaged patient: The relevance of patient–physician communication for twenty-first-century health. Journal of Health and Social Behavior , 61 (3), 259-273. https://doi.org/10.1177/0022146520943514

Tucker, S., McNett, M., Mazurek Melnyk, B., Hanrahan, K., Hunter, S. C., Kim, B., & Kitson, A. (2021). Implementation science: Application of evidence‐based practice models to improve healthcare quality. Worldviews on Evidence‐Based Nursing , 18 (2), 76-84.  https://doi.org/10.1111/wvn.12495

United Kingdom Government. (2021). Supporting our Carers in the Civil Service. https://assets.publishing.service.gov.uk/government.pdf

van Rijssen, M. N., Veldkamp, M., Bryon, E., Remijn, L., Visser-Meily, J. M., Gerrits, E., & van Ewijk, L. (2022). How do healthcare professionals experience communication with people with aphasia and what content should communication partner training entail?. Disability and Rehabilitation , 44 (14), 3671-3678. https://doi.org/10.1080/09638288.2021.1878561

World Health Organization. (2021). Guidance on community mental health services: promoting person-centred and rights-based approaches. https://apps.who.int/iris/bitstream/handle/10665/341648/9789240025707-eng.pdf

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