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Introduction
The risk of harm in UK hospitals is approximately one in ten admissions with around half being preventable (Vincent et al., 2001). The Care Quality Commission (CQC, 2011) identified safety concerns in half of all hospitals; with risk management one of the areas they were most likely to fail on (Nursing times.net, 2011). People with intellectual disabilities are almost twice as likely to come into hospital as the rest of the population (26 percent compared to 14 percent) (National Patient Safety Agency (NPSA), 2004) and are more likely to stay longer. Several high profile cases where patients with intellectual disabilities have died in hospital identified poor risk assessment and management as the root cause of their deaths (Six Lives, Parliamentary and Health Service Ombudsman, 2009; Clover and Clews, 2010). In 2009 the Ombudsman's report stated that people with intellectual disabilities have a significantly higher risk of adverse events happening to them in hospital (Six Lives, Parliamentary and Health Service Ombudsman, 2009).
Patient safety in hospitals is a national concern for all Trusts and for the patients that use them. The NPSA was founded to offer guidance and alert health care providers to specific clinical risks. The Department of Health (DH), (2011) identified 25 “never events” for 2011/2012. The Institute for Innovation and Improvement (2011) developed a “Leading Improvement in Patient Safety programme for acute care” (LIPS) (www.institute.nhs.uk).
In 2008 the intellectual disability charity HFT (2008) produced a guidance document Working Together: Easy Steps to Improving How People with Learning Disabilities are Supported When in Hospital. Contained in this document was a risk dependency and support assessment developed by Crispin Hebron which was recommended by National learning disability networks as best practice in risk assessment for people with intellectual disabilities (Access to Acute (Secondary) Care Network (A2A, 2011) and National Network for learning disability nurses and UK health and learning disability network 2011).
People with intellectual disabilities are known to die earlier than the rest of the population and are more likely to die of certain diseases (Glover and Ayub, 2010; Turner and Robinson, 2011). They are also more likely to have multiple co morbidities. These facts are compounded by complex issues of communication, mental capacity and compliance.
Adverse...