Can’t find the words by Helen Bogle

In October last year I was given the chance to partake in the multiagency self evaluation file reading. This is where professionals from different multiagency sectors (e.g. health, social care, police) who have experience of working with those under Adult Support and Protection legislation, review how the multiagency acted when a vulnerable person was identified as potentially requiring some more support following referral. It was a great opportunity to step away from the concerns in real time, reflect on how our teams worked individually and together, and reflect on how we could improve outcomes for people who are often at their most vulnerable.  We reviewed 50 referrals at this time and gained a lot of valuable insight into good practice, and areas for improvement.

One file I read really struck me as an important one to explore and learn from. An adult who was struggling a lot with his mental health, advised during an inpatient assessment that he had always struggled with his reading and writing, and left school early with no qualifications because of this. He had recently ended his relationship with his partner, and had been supporting him with general tasks like dealing with letters at home. Previously he had been offered support via a mental health support app,vbut said that he struggled accessing it due to communication barriers with reading and understanding how to access the app from written instructions.  This information was not passed on to the multiagency teams that he was referred to and he was sent all communication about support and appointments by letter. He did not opt in or engage and sadly was discharged from the service; and he was also informed about this via letter. Had the information of his reading and writing details been communicated between staff dealing with his care he may have been enabled to access the help and support that he needed.  

It is important to consider all communication needs and think of how you often receive information yourself. If you think of an appointment letter you received, if this other person received it would they be able to understand the information given to them and act on this as they wished? Would they feel involved and empowered through this to make an informed decision about the care they are receiving?

It reminded me of when I was beginning in my nursing career, and there was a patient who was very quiet, he did not read or do crossword puzzles like many did to pass the time.  He did not have visitors and just sat quietly all day, every day, between the ward rounds and procedures. He would be given his menu daily to complete but would hand it back empty saying he was not hungry, or that he couldn’t face food that day. It was only when talking to him about how good the hospital macaroni and cheese was that he said he liked the sound of that. I told him I’d go back and mark this on his menu, I asked if there was anything else he wanted added in as it had been a couple of days since he had something, from memory he could have ice-cream and jelly for pudding, he asked for this happily and ate everything on his tray. The next day he was without breakfast as his previous form was empty for breakfast, I said we had some cereal spare if he wanted some and again he happily had this all. As you’ve probably already guessed, this gentleman also had reading difficulties that he did not want to share, I never asked him about them but just sat and read his menu to him as he happily said his choices, and when I was coming to the end of my shift I added to the handover sheet that he may require support filling in forms. This simple handover of information about communication meant he could now fill in his menu, and get his nutrition when in hospital. He could now be read his medical documents, and give informed consent of forms for procedures. When he was being discharged, it was handed over to Social Work that he was for communication through visits or phone, and district nurses were also aware and would read directions or instructions to support him take his medication.

What is literacy?

Literacy is the ability to read, write, speak and listen in a way that lets us communicate effectively and make sense of the world.

The most recent statistics for adult literacy levels in Scotland (2009) show that In Scotland 1 in 4 (26.7%) of adults experience challenges due to their lack of literacy skills, this is the highest in the UK, within this, 1 in 28 (3.6%) face serious challenges in their literacy practices. (National Literacy Trust). https://literacytrust.org.uk/parents-and-families/adult-literacy/#:~:text=poor%20literacy%20skills.-,Scotland,their%20lack%20of%20literacy%20skills.

Such literacy difficulties can lead to ongoing challenges with navigating everyday life; accessing employment, finances, housing, support, and many more important things we can take for granted when we do not face this same struggle.

Whilst it seems a little bit of information to share, it is so important and can make the world of difference in someone’s care and journey.

Please think:

Are there any communication barriers for this patient?

Would they understand this better if I read it out loud to them or showed pictures?

If they do have a communication barrier, how will this impact them in the care they receive from other agencies and what can I do to help?

How can I effectively hand this over to other teams involved in their care?

If submitting an AP1 form, consider ticking communication barrier and providing more information.

Helen Bogle, Public Protection Advisor, Dumfries and Galloway NHS

Contact Us

The Public Protection Team can offer supervision, advice and support to anyone who wishes to discuss concerns about any person at risk of harm.

Phone: 01387 244300 

Email: dg.asp@nhs.scot or dg.childprotectionteam@nhs.scot

For information on Dumfries and Galloway Public Protection Week 2024 events please see https://www.dgppp.org.uk/article/24123/Dumfries-and-Galloway-Public-Protection-Week-2024-Programme