Staff survey

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Parts of this chapter have been reproduced with permission from Kenten et al.87 © 2019 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

The aim of this chapter is to present the results from an anonymised online survey of 2261 hospital staff working across 24 NHS hospitals across England (phase 1) and 429 community staff associated with a subset of seven of these hospitals (phase 2) (Table 4). Our target sample size for the hospital survey was 1800, which we exceeded, but our method of approaching eligible staff for survey completion (via local collaborators in the hospitals and community) precluded being able to determine response rates.

The results are used to help answer four of our five RQs (RQ1, RQ2, RQ3 and RQ5) related to inequality between children with and children without LD and their families. We also provide evidence of whether or not our related phase 1 hypotheses, developed a priori, are supported. The survey questions used for each domain are shown in Appendix 5.

Inequality between children with and children without learning disability, from the perspective of clinical staff

Comparing staff’s views about the hospital care and treatment of children with and children without LD and their families indicates the areas of practice in which staff perceive inequality (Table 5). The results showed significant differences in staff’s views in relation to children with LD (1) having access to high-quality hospital care that meets their particular needs (RQ1); (2) having access to hospital appointments, investigations and treatments (RQ2); (3) being involved as active partners in their treatment, care and services (RQ3); and (4) being safe (RQ4), indicating perceived inequality for children with LD in response to each of our RQs. The only exception was staff perceptions about staff relying on parents too much, which showed no difference between the two groups. However, community staff did perceive there to be a difference, feeling that parents of children with LD were relied on too much by staff, compared with parents of children without LD.

The z-scores and p-values are shown for the results of Wilcoxon tests for paired data, comparing staff’s responses about caring for children with and children without LD. The areas of practice that showed the greatest difference in hospital staff views were staff knowledge, skills and training to meet the needs of children with LD. This included their confidence in communicating effectively, managing pain and safely managing ‘challenging behaviour’; having access to necessary resources and an environment that is safe and appropriately designed to meet their needs; and being able to deliver safe care (see Table 5).

Hypotheses

The following phase 1 hypotheses were developed to address our RQs:

1. Staff will perceive that they are less able to meet the needs of children with LD, in terms of their confidence, capability and capacity, than the needs of children without LD.
2. Staff will perceive that children with LD and their parents have less involvement in decisions and planning services than children without LD and their parents.
3. Staff will perceive that children with LD are less safe in hospital than children without LD.
4. Staff will perceive that children with LD are valued less and treated with less dignity and respect than children without LD.

With the exception of one aspect, each of our hypotheses was supported by the data (see Appendix 4, Table 15, and Table 5):

1. Hospital staff reported less capacity and lower levels of capability and confidence in meeting the needs of children with LD compared with those without LD, and this was true for respondents from both children’s and non-children’s hospitals. This was also true for community staff with respect to confidence (see Appendix 4, Table 15).
2. Hospital staff perceived that children with LD were significantly less involved than children without LD in decisions about their care (see Table 5) and in planning services, and this was the case for respondents from both children’s and non-children’s hospitals and for community staff. Hospital staff from children’s and non-children’s hospitals also thought that parents of children with LD were significantly less involved than parents of children without LD in planning services, but this was not the case for community staff. However, although staff from children’s hospitals thought that parents of children with LD were significantly less involved than parents of children without LD in making decisions about care, those in non-children’s hospitals did not report any differences and neither did community staff.
3. Staff perceived that children with LD were less safe in hospital than children without LD. This finding was true for respondents from both children’s and non-children’s hospitals, but not for community staff, who did not report any difference in their perceptions of the safety of children with and children without LD (see Appendix 4, Table 15).
4. Staff perceived that children with LD were valued less and treated with less dignity and respect than children without LD, and this was true for respondents from both children’s and non-children’s hospitals.