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RADiANT End of Year One Report 2020

9/30/2020

We are pleased to share the One Year Progress Report which provides a full update of our RADiANT activity in our first year. In our first year, we have achieved a number of our initial aims, alongside a number of additional aims, such as establishing clinical research projects, improving public education and staff development. We were also the first research collaborative to produce clinical guidance on COVID-19 for intellectual disability settings. We would particularly like to thank all of our members who have guaranteed the success of our projects. We looking forward to Year 2!

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COVID-19 and People with Intellectual Disability: Guidance on Advances Planning for Treatment Escalation, Ceiling of Care, Palliative Care and End of Life.

4/15/2020

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In the the last two weeks, RADIANT produced two guidance documents People with intellectual disability and mental health/ behavioural problems: guidance on COVID-19 for in-patient psychiatric settings and People with intellectual disability and mental health/ behavioural problems: guidance on COVID-19 for community settings .

Today we launch our next guidance document titled COVID-19 and People with Intellectual Disability: Guidance on Advances Planning for Treatment Escalation, Ceiling of Care, Palliative Care and End of Life. Historically, there have been many instances of intellectual disability being recorded as a rationale for a Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) order. When the NICE rapid guidelines on access to critical care suggested the use of the Clinical Frailty Score (CFS), an instrument that would have systematically disadvantaged people with an intellectual disability, there was widespread concern. Following high profile public campaigning from many stakeholders, NICE amended the guidelines to make clear that the CFS should not be applied to this group.

However, many remain worried that in busy general hospitals during the COVID-19 crisis, these caveats may not apply and people with intellectual disabilities will be denied equitable healthcare due to incorrect assumptions about their functional level. As has been made clear pithily before, intellectual disability is not a potentially fatal condition and hence the default position should be that people with that condition should get access to the same level of physical healthcare as anyone else in the general population with reasonable adjustments as required by law.

In a few cases where there are additional acquired conditions, there may sometimes be a need for considering carefully treatment escalation, advance care plans, palliative care, end of life and DNACPR discussions. When these happen, it should be within a clear ethical framework. This document provides further guidance to aid that process. As our previous two guidance documents, this too is the result of a consultation process that included professionals from a range of disciplines including those from a range of medical and surgical specialties and experts by experience.

Please do contact RADIANT with your comments and suggestions.

Keep well all of you.

Professor Regi T Alexander
Convenor, RADIANT
@regalexa

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COVID-19 and Intellectual Disability Guidance

4/2/2020

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There are approximately 1.2 million people with an intellectual disability (ID) in the UK. They have comorbid mental health problems at a rate of about 40%, which is substantially higher than the general population. About 21% of them are in contact with specialist health services and about 0.16% (1955) are in in-patient psychiatric settings. For every one person in the general population who dies from an avoidable cause, 3 people with intellectual disability die from a condition amenable to good quality care. It is a startling statistic that highlights the vulnerability of this group, a vulnerability that is even more worrying in the light of the COVID 19 pandemic. RADIANT has already collated on its website, a set of useful guidance documents from a variety of sources. Further, we publish today, the first of a series of rapid guidance documents on physical and mental healthcare for this group. It is the result of a consultation process that included professionals from a range of disciplines and experts by experience.
1.People with intellectual disability and mental health/ behavioural problems: guidance on COVID-19 for in-patient psychiatric settings

2.People with intellectual disability and mental health/ behavioural problems: guidance on COVID-19 for community settings

Please do contact RADIANT with your comments and suggestions.

Keep well all of you.

Professor Regi T Alexander
Convenor, RADIANT
@regalexa

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RADiANT End of Year One Report 2020

COVID-19 and People with Intellectual Disability: Guidance on Advances Planning for Treatment Escalation, Ceiling of Care, Palliative Care and End of Life.

COVID-19 and Intellectual Disability Guidance

Regi Alexander

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