Below you will find details of Ask, Listen, Do. 

Ask:

• Always communicate with the person first, even if you're not sure they are able to understand you.
• Ask what someone's preferred methods of communication are.
• Ask if there is a communication passport, hospital passport, care plan or other document that the person, or their support, has that you could see. This could help you understand the person's needs and how best to support them.
• Begin with open questions. If people struggle, then provide more support and move on to yes and no questions, if needed.
• You may need to repeat or rephrase things.
• Ask:
• "what would you like to happen?"
• "how would you like to be supported?"
• "what is the best way I can help you?"
• Ask if there is anyone else it would be helpful to talk to.
• Always consider the person's capacity to make decisions about sharing information with others. Only share information, or talk to other people, with the person's consent or (if they lack capacity) where it is in their best interests.
• If someone is struggling, do not ask, "what is wrong with you?" but instead, "what has happened to you?"

Listen:

• Listen to all the ways that somebody might communicate their thoughts, feelings and preferences.
• This includes body language, tone, behaviour and any other method they use to communicate.
• Don't jump in when someone is taking time to think. Allow time and listen carefully to the person's views and choices.
• People need more processing time. Be patient and persevere.
• Listen to the person's own language and understanding; use their words where it is helpful.
• In listening, check that the person has understood what you have said; get them to summarise in their own words.
• Check that the person is not simply repeating what you have said, or just agreeing with you. If you notice any response patterns, try asking questions in a different way to see if you get the same answers.
• Avoid making judgements or assumptions, which can be barriers to good listening.
• Consider involving an advocate if the person needs support in order for their voice to be heard.

Do:

• Empower people. Support to them to have choice and control in their own life. Make sure that you keep the person at the centre.
• Encourage people to ask questions and to tell you if they don't understand something. Never talk about the person as if they weren't there.
• Treat the person in an age-appropriate way, respecting their roles and experiences.
• Be respectful and take time to find out about the person's preferences and cultural needs.
• Don't assume that because the person has a learning disability they don't understand. Instead, make sure that things are explained in more simple language. This means avoiding jargon and long, complex sentences.
• Break things down into chunks or smaller steps.
• Make use of existing reports and care plans, which help you to understand someone's areas of strength and needs and how best to adapt your approach.
• Think holistically about the person and their life. Consider their broader needs, such as good supportive relationships, meaningful occupation, the right environment and meeting their mental and physical health needs, and the impact these may have.
• Promote independence and skills development in a way that is meaningful and accessible for the person.

• Introduce easy read format letters so they are accessible from the beginning.
• Consider arranging appointments when it is quieter.
• Extend appointment times to give more time during appointments.
• Explain what will happen at an appointment, giving patients the opportunity to ask questions beforehand.
• Provide clear explanations with no jargon or acronyms and use easy words, so people can make their own informed decisions.
• For people attending outpatient appointments, provide introductory visits and information packs including pictures ahead of appointments.
• If you can't make the necessary adjustments, consider a home visit or an alternative venue.

• Offer awareness training, for example the Oliver McGowan Mandatory training, to help your employees understand how to support people with learning disabilities and/or autism.
• Ask your employees to be more patient and take extra time to explain and help people with learning disabilities and/or autism.
• Promote the support that is available on your website and in communications with patients.
• Be willing to make appropriate adjustments if they are asked for to help people to feel more comfortable and to reduce the risk of sensory overload.
• Consider who else (if anybody) needs to be involved to support your interactions in order to make sure that the voice of the individual is heard?
• Consider if someone responds better to a particular gender of worker and how you could facilitate their appointments being with that person so the individual feels empowered to speak up in their appointments.

• Remember to introduce yourself and explain who you are.
• Remember to talk to the person the appointment is for and ask them about who they have brought with them, if there are carers present.
• Be clear and direct in the language that you use; talk in the "here and now"; avoid jargon, abbreviations and "figures of speech".
• Spoken language can be challenging for some people so consider other methods of communication.
• Ask companions such as family and paid staff how to best adapt communication and, if in a hospital setting, ask for a learning disability liaison nurse.
• Be aware of your tone and approach; there is a careful balance to be found between matching someone's communication needs and appearing to talk down to someone.
• Use silences and allow greater gaps in conversation to allow more time for information processing.
• Look at the person as you talk to you them so that you can look for signs that they are understanding you, but do not insist that they look at you.
• Consider the wording of any questions you ask; asking "Can you…" may result in a verbal response of "yes" or "no", as opposed to the person actually carrying out the desired action.
• Provide regular summaries throughout your interaction and check whether it would be helpful to share some of the key points in writing or other formats such as pictures.
• Listen carefully and patiently, and persevere, even if you don't understand the first or second time.

• Ensure floorplans and maps are readily available.
• Provide virtual tours of your facilities for people to watch online before their visit.
• Use easy read signage or include pictures on signs.
• Provide clear directions and instructions.

• Create quiet waiting rooms or separate spaces to wait before appointments and offer these to people rather than wait to be asked.
• Lower or soften the lighting in waiting rooms.
• Use a Starlight Distraction Box filled with toy items and resources to support people who are worried about a medical procedure.
• Ensure members of staff regularly update people who are waiting so they know what is happening.

Click to download the bespoke small changes ICS email signature to show your support for the 'small changes' campaign. 

If you work for the ICB, you can download the bespoke small changes ICB email signature here, to show your support for the 'small changes' campaign. 

Download the small changes infographic here and find out about the types of small changes you can make. 

The Staffordshire and Stoke–on-Trent NHS Health Passport is for anyone with a learning disability, learning difficulty or autism.

It is an important document which tells NHS staff about a person’s needs such as,  medication,  personal details and how they like to communicate.

A Health Passport should be taken to every healthcare appointment and can help a person get the best care. Download your Health Passport here.

To read more about the Health Passport, please see our dedicated webpage.

Download the small changes pledge card and pledge to make a small change. Once you have filled in the pledge, please email them to ssotics.comms@staffsstoke.icb.nhs.uk. We will collect all the pledge cards and check in with you in six months time to see how you are getting on. If you aren't sure what pledge to make, have a look at the suggestions above, or email us and we can help you. 

Download the small changes poster here. You can print this poster and put this up in your workplace to inspire others to make changes too.

You can download the social media asset here to share on your own communication channels. 

Click to download the bespoke small changes ICS teams background to show your support for the campaign. 

If you work for the ICB, click to download the bespoke small changes ICB teams background here. 

What the video from Staffordshire County Council exploring why we should embrace autism and neurodiversity in the workplace.

This video from Staffordshire County Council, gives people the opportunity to experience autism and the sensory load that can often be experienced, through the use of a virtual reality headset. It was part of the Celebrating Differences campaign that the council ran in 2023. 

Information videos

The Misfits Theatre Company demonstrates how a simple reasonable adjustment can make a big difference to a person's experience of quality and access to care:

• NHS England. Reasonable adjustments make the biggest difference to people's health and wellbeing: View video

Kareem and his mum Fazilla talk about their experience of reasonable adjustments and the difference it makes to them when reasonable adjustments are offered:

• NHS England. Use of reasonable adjustments to reduce health inequalities for people with a learning disability: View video

How sharing information can help staff in health services know the right way to work with people with a learning disability and autistic people: 

• NHS England. What digital flagging means for patients: View video

Discussing consent, capacity and best interests decisions and how we can discuss these in plain language:

• Community Learning Disability Nursing. Bitesize Learning Disability Awareness for health Professionals No 9 Capacity and Best Interests:  View video

Resources

• Health and Social Care Act 2008. London: HMSO, 2008. View legislation
• North East and Cumbria Learning Disability Network. Reasonable Adjustment Campaign. View website
• An example appointment letter. Download letter

Useful elearning

• Accessible Information Standard View session
• Assessing capacity View session

I am a Medicines Optimisation Pharmacist, however, alongside this, I am an Invisible Disability Representative, within the staff Disability and Neurodiverse Group Network. This group supports colleagues who want to come forward to talk about their conditions and offers them emotional support with the difficulties they may face. The group allows members to be supportive of each other, whilst focusing on the ICB’s equality and diversity initiatives. One of the ICB initiatives I promote, is to encourage people to disclose their conditions, so other’s will be inspired others to come forward and have conversations with line mangers and their teams. 

In my role as Invisible Disability Representative, I have supported a member of staff to begin their diagnosis process. I am keen to expand this role and will be attending the Staffordshire Joint Autism Implementation Group, which looks at the autism strategy within the local area.

As a Health Improvement practitioner, I am passionate about reducing the clear disparities in access to cancer information and services for individuals who have a Learning Disability. Working in partnership with a broad range of stakeholders, I have been successful in delivering specialist tailored initiatives to address the health care inequalities for this cohort.

I have recently been part of a team who have developed an easy-read video, explaining what to expect before, during and after a breast cancer screening appointment. We hope this video encourages more people to attend their breast cancer screening appointments.

As a Learning Disability Champion, I ensure patients with a Learning Disability have access to a Tulip card. The Tulip card is unique to Newcastle Primary Care Network (PCN) and is specifically for those with a Learning Disability. People can present the Tulip card at health care appointments to make staff aware that they may need a little extra support when accessing services. This means people don’t have to explain their needs to staff in front of others in a busy waiting area.

Over the past year, I have planned two Health and Wellbeing Roadshows for local people to attend who may have, or know someone who has, a Learning Disability or autism. The roadshow includes a variety of local support groups, professionals and volunteers coming together to showcase the support and services available to them. Following the success of our first two events, we have a third planned at Newcastle College on Saturday 6 July 12 noon till 5pm. Of course, there will be an element of fun for families with an ice cream van, glitter/face painting stall and Bee Active with giant inflatables all attending on the day.

I am very fortunate to work in a team that is passionate about supporting our patients, particularly those who are more vulnerable and need extra support. Each year we ensure that our patients who have a learning disability are invited to come and have their annual health check and vaccinations. We have introduced easy-read body diaries to support with breast and testicular self-examination, which our nursing team are using to share with families and carers during the health check appointment.

We have carried out some targeted work with one patient in particular who had a high cholesterol. With the support of our health care assistant giving advice and providing the Heart UK healthy eating guide, the patient has lowered their cholesterol, lost weight and the chef at the home changed the menu in support. A real success story! 

Our team of care co-ordinators also support the learning disability homes by facilitating appointments and making daily contacts to ensure all is well and make early interventions where needed.