Your health

Within Greater Glasgow & Clyde there are approx. 5700 adults with learning disabilities. A learning disability is a significant, lifelong, condition that starts before adulthood. It affects a person’s development and means they need help to:

• Understand information
• Learn skills
• Cope independently

Learning difficulties, such as dyslexia, ADHD, dyspraxia and speech & language difficulties are not defined as a learning disability due to the specific nature of their developmental delay.

People with learning disabilities represent a diverse group. Historically, people with learning disabilities lived in hospitals. Then, in 2000, policies were introduced which advocated that people with learning disabilities should be supported to live in their local communities and have equal access to employment opportunities & health services. Despite this shift towards independent community living, people with learning disabilities are one of the most disadvantaged groups within Scotland.

90% of people with a learning disability have described an experience of bullying or harassment, with 32% experiencing this daily.

65% of people with a learning disability would like a job. In 2010/2011, 6.6% of people with a learning disability were in paid employment, the majority of whom worked less than 16 hours a week. This is significantly less than in the working age population (77.3 %) and the disabled population (47.4 %), NHSGGC is one of the partners involved in running an award winning learning disability employability programme called Project Search.

People with learning disabilities die younger than the general population – on average 13 (for females) or 20 (for males) years younger, with many of these deaths being from preventable causes.

People with a learning disability will also possess other protected characteristics and their experience of inequality will be made worse as a result.

Protected characteristics – characteristics that are protected by law, such as Disability – are listed on our home page and include sex, age and race.

Gender-based Violence & Women with Learning Disabilities

Research tells us that disabled women and girls are more susceptible to gender-based violence than non-disabled women and girls. Women with a learning disability are at greater risk of sexual abuse and are more likely to experience violence from perpetrators that are not partners, most notably other service users and men with learning disabilities.

Dependency on care, attitudes of staff and carers, poverty and isolation can make women more vulnerable or make it more difficult for them to disclose abuse. Poor availability of services such as day care centres also make it difficult for women to find help and support. As a result, the abuse often goes undetected and unreported.

To tackle gender based violence and support women with learning disabilities, services need to remove barriers to disclosure and provide better access to information and health and support services. Within NHSGGC, a programme of work is underway to raise awareness about the experience of gender-based violence amongst people with learning disabilities and to build staff confidence and competence in knowing how to identify and respond to this.

Learning Disability & Human Rights

When the behaviour of people with learning disabilities challenges carers and services, complex and competing human rights issues may emerge.

A Human Rights impact assessment was carried out in Netherton Learning Disabilities Unit. This initiative looked at human rights in relation to everyday practices in the Unit.

This work, which included workshops and interviews with staff and patients, highlighted a number of issues around the patients’ rights. For example, some residential units allowed free access to kitchen areas whereas others were much more restrictive. By using human rights guidelines along the PANEL principles set put below, they were able to explore the differences between practices in a patient-centred way.

• Participation – People should be involved in decisions that affect their rights.
• Accountability – There should be monitoring of how people’s rights are being affected, as well as remedies when things go wrong.
• Non-Discrimination – Nobody should be treated unfairly because of their age, gender, ethnicity, disability, religion or belief, sexual orientation or gender identity. People who face the biggest barriers to realising their rights should be prioritised when it comes to taking action.
• Empowerment – Everyone should understand their rights, and be fully supported to take part in developing policy and practices which affect their lives.
• Legality – Approaches should be grounded in the legal rights that are set out in domestic and/or international law.

People with learning disabilities experience some of the poorest health outcomes of any group in Scotland and much of their health needs are unrecognised and unmet. In addition to the same everyday health needs as the general population, people with learning disabilities have a different pattern of health needs

People with learning disabilities –

• have differing causes of death (respiratory illness, cardiovascular disease and gut cancers, as opposed to lung cancer, heart disease and strokes in the general Scottish population)
• have more physical health problems
• are more likely to have mental health problems – 40-50% of the learning disability population compared to 1-10% of general population
• on average, have 5 long term health conditions, compared with 1 or 2 in the general population
• are more likely to have a sensory impairment (approximately 60% will have a visual impairment and 40% will have a hearing impairment)
• are more likely to be underweight or obese than the general population.

Poor health can result from social isolation and deprivation. A large majority of people with learning disabilities have endured a lifetime of exclusion resulting from lack of choice and opportunity. People with learning disabilities experience a number of barriers when trying to access appropriate healthcare within the NHS. These include:

Communication – Many people with a learning disability may take longer to express what they want to say and may simply require patience and understanding on behalf of the listener to allow them to do this. Some people with learning disabilities have limited verbal communication skills and difficulties with understanding and processing information which can impact on their ability to understand health information. Health services are reliant on written information for advice, appointments, signs and information and this creates a significant barrier if it is not provided in an easily understood way. NHSGGC’s Clear to All accessible information policy aims to ensure that we provide effective communication for everyone and that information is provided in the format and language required.

Physical access – NHS establishments are required by law to be accessible to those with a disability. However, accessibility and signage is not always clear and navigating health centres and hospitals can be difficult for wheelchairs users or those with poor mobility who also are unable to read.

Attitudes – NHS staff all strive towards person centred care. However, many have not had experience of working with people with learning disabilities or had learning disability awareness training. This can often lead to negative assumptions about a person’s ability, even when it is well intentioned eg, a health care professional may talk to a carer to obtain health information instead of asking the person directly.

Diagnosis overshadowing – This occurs when a behaviour change is attributed to a person’s learning disability when it is in fact due to physical ill health or pain. Unfortunately this is common for people with a learning disability and can lead to delayed treatment and in some cases death.

NHSGGC is working to ensure that the organisation is addressing health inequality experienced by people with learning disabilities.

NHSGGC continues its engagement activity with patients and 3rd sector organisations. This includes our co-production work with The Life I Want partnership forum. This work is a valuable way of sharing information between our own organisation, learning disability support services and patients themselves and is one of the main ways in which we receive up to date feedback from patients regarding their experiences of accessing and using our health services.

We are also planning a new programme of staff training designed to provide a better awareness of how we can provide the best support for patients with a learning disability and improve their experiences of using our services. Patients with a learning disability will be involved in developing and delivering this training.

The Keys to Life (2019) is the Scottish Government strategy to promote inclusion and equality in all areas of life for people with learning disability. NHSGGC is committed to delivering these recommendations which promote a vision and shift towards independent living, employment opportunities, equal access to health services, education that meets the needs of every child and a Scotland with zero tolerance for inequalities.

The Learning Disability Liaison Team supports and enables NHSGGC services to adapt their approaches to meet the needs of people with learning disabilities. The Team supports the system to anticipate and respond to the general medical needs of people with learning disabilities. It also works with local learning disability teams and other agencies to ensure a co-ordinated approach in addressing health inequalities for people with learning disabilities.

For information contact: PCLTAdmin.Generic@ggc.scot.nhs.uk

A Strategy for the Future is NHSGGC’s service redesign for all community based learning disability specialist services. The redesign will enable NHSGGC services to deliver responsive and appropriate healthcare and provide specialist support when required. It aims to give people with learning disabilities more equality and control as well as improving health, wellbeing and safety.

The Scottish Learning Disabilities Observatory has been funded by the Scottish Government to help build understanding of the causes of poor health and health inequalities experienced by people with learning disabilities. The aim of the Observatory is to produce high quality evidence to support learning disability policy and practice and to work in partnership with the NHS, local authorities and Scottish government to improve the information gathered on people with learning disabilities.

Project Search is a targeted programme of employment training and support for young people who have a learning disability (18-24). Participants learn job skills which are transferable and marketable when looking for full time paid work. Students are supported to find work with their job coach either on site with the host business or with another employer. NHSGGC is planning for the 3rd year of this programme following 2 successful years resulting in graduates securing employment within NHSGGC.

As part of A Fairer NHSGGC 2020-24 we have a specific outcome looking at improving service delivery and experience of healthcare appointments for patients with a learning disability. This includes a programme of engagement with patients and third sector organisations to ensure service users are involved in this work.

Edwards’s Story

The video below is from a website featuring people with learning disabilities and their carers, written in collaboration with the Rix Centre. It presents the thoughts and feelings of these individuals in their own words, so that doctors and other health professionals can see what people want and how they wish to be involved in their own healthcare.

NHS Greater Glasgow and Clyde gathers stories and experiences of patient with a learning disability through our ongoing engagement activity. Some of these individual patient experiences will be used to inform our staff training programme.

Publications

• Coming Home – A Report on Out-of-Area Placements and Delayed Discharge for People with Learning Disabilities and Complex Needs
• Death by Indifference
• Health Needs Assessment for People with Learning Disability in Greater Glasgow and Clyde
• Keys to Life
• Learning Disability & Autism
• Project Search
• Specialist Adult Learning Disability Services in NHSGGC – A Strategy for the Future
• The Challenges of Estimating Scotland’s Learning Disabled Population
• The Keys To Life – Scotland’s National Learning Disability Strategy
• Towards Transformation 
• SCLD – Learning Disability Statistics for Scotland
• Learning Disabilities – Learning for NHS Staff

Video Resources

More information coming soon…

Websites

• CIPOLD – Confidential Inquiry into Premature Deaths of People With Learning Disabilities
• Easy Health
• ENABLE
• Epilepsy Scotland
• Keys to Life
• Learning Disability Change Programme
• Mencap
• PAMIS
• People First
• Scottish Consortium for Learning Disability
• Scottish Learning Disability Observatory
• Shaw Trust

What is Gender Reassignment?

In most cases we grow up feeling a sense of comfort or acceptance with our gender but this is not true for all people. Around 1 in 11,500 people will find that as they grow up, they feel less comfortable with the gender prescribed to them at birth, and will instead, find greater comfort and connection to another gender. They may then express the need to live in this different and more appropriate gender. In Scotland, those of us experiencing this are referred to as ‘transgender’ or ‘trans’ people. ‘Trans’  is an umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, their birth.

In the Equality Act it is known as gender reassignment*. All trans people share the common characteristic of gender reassignment.

To be protected from gender reassignment discrimination, you do not need to have undergone any specific treatment or surgery to change from your birth sex to your preferred gender. This is because changing your physiological or other gender attributes is a personal process rather than a medical one.You can be at any stage in the transition process – from proposing to reassign your gender, to undergoing a process to reassign your gender, or having completed it.

The Equality Act 2010 says that you must not be discriminated against because you have the protected characteristic of gender reassignment, where your gender identity is different from the gender assigned to you when you were born. For example, a person who was born female decides to spend the rest of his life as a man.

In the Equality Act this is known as gender reassignment. All trans people share the common characteristic of gender reassignment.

To be protected from gender reassignment discrimination, you do not need to have undergone any specific treatment or surgery to change characteristics associated with your sex recorded at birth. This is because changing your physiological or other gender attributes is a personal process rather than a medical one. You can be at any stage in the transition process – from proposing to reassign your gender, to undergoing a process to reassign your gender, or having completed it.

The Equality Act says that you must not be discriminated against because:

• of your gender reassignment as a trans person. You may prefer the description transgender person or trans male or female. A wide range of people are included in the terms ‘trans’ or ‘transgender’ but you are not protected as transgender unless you propose to change your gender or have done so. For example, a group of men on a stag do who put on fancy dress as women are turned away from a restaurant. They are not trans so not protected from discrimination
• someone thinks you are trans, for example because you occasionally cross-dress or are gender variant (this is known as discrimination by perception)
• you are connected to a trans person, or someone wrongly thought to be trans (this is known as discrimination by association)

Intersex people (the term used to describe a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t fit the typical definitions of female or male) are not explicitly protected from discrimination by the Equality Act, but you must not be discriminated against because of your gender or perceived gender. For example, if a woman with an intersex condition is refused entry to a women-only swimming pool because the attendants think her to be a man, this could be sex discrimination.

Following is a short film by the Equality & Human Rights Commission titled ‘What is gender reassignment discrimination?’.

Trans people are entitled to the same level of quality care as everyone else and should expect to receive it based on their gender identity, gender expression or physical body. However, it is important to appreciate the lived experience of many trans people to ensure the care health services provide is appropriate and sensitive.

Findings from the recent INCLUSION Project research showed significant issues for trans people include:

• Mental health problems including suicide, self harm, anxiety and depression
• Lack of primary care facilities as many GPs have no or little knowledge of trans people’s needs
• Lack of access to essential medical treatment for gender identity issues, i.e. electrolysis for trans women
• Lack of awareness and understanding of care providers so that trans people are in appropriately treated in single gender out patient and in patient services.
• Inconsistent funding and access to transitioning services throughout Scotland
• Lack of social work service to support children, young people, adults and families with gender identity issues.
• Social exclusion, violence and abuse and the resulting negative impact on health and well-being

Trans people are entitled to the same level of quality care as everyone else and should expect to receive it based on their gender identity, gender expression or physical body. However, it is important to appreciate the lived experience of many trans people to ensure the care health services provide is appropriate and sensitive.

Findings from the recent INCLUSION Project research showed significant issues for trans people include:

• Mental health problems including suicide, self harm, anxiety and depression
• Lack of primary care facilities as many GPs have no or little knowledge of trans people’s needs
• Lack of access to essential medical treatment for gender identity issues, i.e. electrolysis for trans women
• Lack of awareness and understanding of care providers so that trans people are in appropriately treated in single gender out patient and in patient services.
• Inconsistent funding and access to transitioning services throughout Scotland
• Lack of social work service to support children, young people, adults and families with gender identity issues.
• Social exclusion, violence and abuse and the resulting negative impact on health and well-being

NHS Greater Glasgow and Clyde were the first NHS Board in Scotland to publish a Gender Reassignment Policy (currently under review in light of the Supreme Court ruling of April 16th 2025) which sets out our commitment to ensure equality of access to services that are both appropriate and sensitive.

We have the busiest trans services in Scotland at the Sandyford Initiative and provide a number of specialist services that are recognised as being amongst the best in the UK. However, there are still barriers experienced by trans people using mainstream NHS services.

It is essential that frontline NHS staff do all they can to remove the stigma of transitioning and play their part in delivering services of the highest standard to trans people. To this end, guidance has been issued to support staff in responding to queries from trans service users.

Fran’s Story

Fran transitioned from male to female 10 years ago. She has spent her life experiencing bullying and harassment because of her gender identity and has been the victim of several hate crime incidents.

Fran was experiencing pain in her right thigh and attended an outpatient appointment.  When Fran entered the waiting area she gave her name and confirmed her appointment time.  The receptionist explained there wasn’t an appointment for a Fran Walker but there was one for a Mr Frank Walker.  Fran explained that she should now be referred to as Fran as she had requested all records be updated to reflect her gender reassignment.  The receptionist explained she was unable to do that until the medical records were updated.  Fran was asked to take a seat in the waiting area.  Fran was in discomfort but before taking a seat explained again it was Fran or Ms Walker, not Frank or Mr Walker.

While Fran was waiting for her appointment she heard a member of staff calling for a Mr Frank Walker.  Fran sat where she was, angry, frustrated and embarrassed that she was still being referred to in the wrong gender.  Eventually after a repeat call she stood and walked into the treatment room.  She was still very upset and asked why, despite explaining she wished to be called by her new name, staff insisted on calling her by her previous name.  The member of staff explained the name on her record was Frank Walker, not Fran, and until they heard otherwise, she would continue to be addressed as Frank or Mr Walker.

Fran tried to remain calm and explained that if she was referred to as Frank again she would make a formal complaint.  The member of staff reiterated the position so Fran explained that staff were in breach of legislation protecting trans people. They were deliberately disclosing her previous birth gender and so could be held liable and receive a significant financial penalty under UK law. Fran stated that if it happened again she would take formal action.

Legislation protects trans people in a number of ways, one of which is to ensure previous birth gender is only disclosed to another party when necessary with appropriate controls in place and then only with the expressed permission of the trans person.

Supreme Court Ruling Update – Thursday 17th April 2025

We are currently reviewing our policies in light of the Supreme Court’s ruling on 16 April 2025 that ‘sex’ in the Equality Act 2010 refers to biological sex.

Publications

• NHSGGC Transitioning in the Workplace – Guidance for Managers Nov 24 (under review)
• Changing Your CHI (under review)
• Gender Reassignment Policy Review 2021 (under review)
• Sharing Trans Information (under review)

Websites

• Gender Identity Research & Education Society (GIRES)
• LGBT Youth Scotland
• Press for Change
• Sandyford Initiative
• Scottish Trans Alliance

A person has a disability that is covered by the Equality Act 2010 if they have a physical or mental impairment that has a substantial and long-term effect on their ability to carry out normal day-to-day activities.

For example:

• Sensory impairments such as being blind or deaf
• Mobility difficulties and other physical disabilities
• Learning disabilities and people who are autistic (go to our Learning Disabilities page)
• Mental health problems
• Facial disfigurements
• Neurodiversity or autism
• Speech impairments
• Memory problems, such as dementia.
• Long-term conditions, such as epilepsy, dyslexia and cancer.

It is important to note that the definition can cover illnesses and conditions which some people may not immediately think of as a disability, such as asthma, depression, heart disease or diabetes. Also, not all disabilities are immediately apparent and may be described as “hidden disabilities” These could include long term conditions such as epilepsy, Autism, some sensory impairments and mental health conditions.

The social model of disability

This model recognises that an individual is disabled not by their impairment or medical condition, but by a society which fails to meet their needs.

For example, if an individual is unable to read information provided at an open day because they have a visual impairment, the social model sees the organisation as the problem because they have not provided suitable material that can be read by someone who is visually impaired, such as Braille or large print documents.

The lived experience Model of disability

The Lived Experience Model of disability recognises that each individual experience may be different but that there will be commonalities too and it is these commonalities which should inform policy and services etc. Many people see this type of model as a development of the social model.

It is the social and, increasingly, the lived experience models of disability that the Equality & Human Rights Team place at the core of its work in relation to disability

The Equality Act is designed to ensure that large public organisations like NHSGGC promote disability equality and challenge discrimination on the grounds of disability.

Discrimination occurs when a person or organisation treats a disabled person less favourably than they would treat others. This discrimination can affect issues such as education, employment, income and health.

For example:

• Disabled people of working age face considerable disadvantage compared to people without an impairment. On average their incomes are about 20 per cent lower than the incomes of non-disabled individuals and their employment rates are half the size
• International evidence shows that people with learning difficulties or long term mental health problems on average die 5-10 years younger than other people, often from preventable illnesses
• 15% of deaf or hard of hearing people say they avoid going to their GP because of communication problems

Following is a short film by the Equality & Human Rights Commission titled ‘What is Disability discrimination?’.

A recent survey of people with disabilities found the following:

• 63% of respondents reported that they were not in work, and 91% of those were not seeking employment – well above national averages.
• Over 30% of respondents stated that they found it difficult or very difficult to manage on their current income.
• In the UK Black people are more likely to be detained under the Mental Health Act
• Women are more likely to become disabled throughout the course of their lives
• More than one third of LGBTQ+ identify as having a disability

Identifying as a disabled person does not mean that a person does not also identify in some other way in relation to, for example, their religion, sexuality or social class. Such intersecting identities need to be considered when promoting disability equality and when ensuring equal access to services across NHSGGC.

In the 2011 census, 22% of NHSGGC’s population declared a disability.

People with disabilities can suffer poorer health for a wide variety of reasons. For example, it may be due to the fact that:

• people can’t get access to services or communicate with service providers
• how we plan our services does not take account of the needs of disabled people e.g. having an adult changing table, quiet space for autistic people
• the health of disabled people is given less priority than that of other patients
• an illness may be wrongly thought to be part of a person’s mental or physical disability
• people with long term disabilities are particularly likely to live in poverty
• some conditions are linked to a higher rate of a particular health problems

NHSGGC promotes the social model of disability, which means that it is up to the organisation and the people in it to ensure that disabled people have the same opportunities to enjoy good health as non-disabled people.

NHSGGC’s The Equality & Human Rights Team works directly with disabled people (patients and staff) and disabled people’s organisations to gain insight and understanding of their lived experience. This insight is then used to inform the work of the team

It is the responsibility of service providers and employers not to discriminate against a person on the grounds of their disability, regardless of how the person may describe themselves. This is important because many people may not regard themselves as ‘disabled’, but they will still have rights under the Equality Act. The law applies to all disabled people who use NHS services. This includes visitors and members of the public, as well as patients and staff

Specific examples of work include:

Sensitising Patient Pathways for Autistic People

Starting with day surgery, the Equality and Human Rights Team are exploring how our patient pathways can be made sensitive to non-neurotypical people and autistic people. Working with staff and the charitable sector we will publish as a learning tool for staff.

Deaf People & Health Services

A range of work currently being undertaken by NHSGGC to promote British Sign Language (BSL) as a language and culture and improve the experience of our Deaf BSL patients. This includes a BSL Online Interpreting Service, a plan to better meet the mental health needs of Deaf and hard of hearing people, staff training in BSL and a BSL Health Champions Group. We are also consulting with our patients regarding NHSGGC’s response to the BSL Act.

Facilities & Estates

The Facilities and Estate Department have a programme of actions to ensure our estate is accessible for disabled people. We work with our disabled patients through the Disability Access Group and our Staff Disability Forum to drive actions for change. For example, a guide for people using mobility scooters to access NHSGGC sites has been produced.

Interpreting Service

Interpreting services address a number of risks for both service users and staff. For example, patients whose first language is British Sign Language or who utilise Deaf Blind communicators must always have interpreters at their out patent appointments and at key times during in-patient stays such as admission, discharge, doctors rounds, significant nurse interventions and to communicate with family members if needed.

Ensuring that everyone has an equal opportunity to engage in the health care process benefits all concerned. In addition, equalities legislation stipulates that the organisation must be pro-active in ensuring that this is the case.

NHSGGC’s in-house interpreting service provides interpreters to our patients on request. BSL user can now also access on line interpreters through our communication support iPads. The iPads also contain a number of support apps including the AVA app which subtitles what staff saying in real time, to help those who have a hearing loss.

Clear to All Accessible Information Policy

Effective information and communication are vital for the provision of high-quality services and care. Many of those who access services have difficulty understanding the information provided. An accessible information policy has been produced to ensure that all information can be made available in the appropriate format to meet the needs of disabled people who may need this e.g. Braille, words and pictures, British Sign Language or audio version.

Details are available on the ‘Clear to All’ Accessible Information Policy web page.

Margaret’s Story

Margaret is Deaf. Her first language is British Sign Language.

Margaret fell at home. She couldn’t move and thought she had broken her leg. She couldn’t call for an ambulance as she couldn’t use a hearing phone so she asked her mother to take her to her local Accident & Emergency.

When Margaret got to A&E she told the person checking her in that she was Deaf. She explained her mother was also Deaf. She said that she would not be able to hear her name being called.

Margaret waited for over an hour and was getting anxious about her appointment, so approached the desk again. She was told she hadn’t been called. She waited again. Eventually after 5 hours and having approached the desk on more than one occasion she was told that she missed her appointment.

Margaret was distressed and frustrated that her needs as a deaf person were not taken into account. She may have had a long wait in A&E if other emergencies had come in but she felt she had waited so long because she was deaf.

NHSGGC’s Communication Support and Language Plan aims to ensure that the communication needs of individual patients are assessed, in order for the right kind of support to be provided.

Publications

• Assistance Dog Policy
• Being Disabled in Britain
• BSL National Plan (2017-2023)
• Disability Perceptions Gap
• Health Needs Assessment – Deafblind and Deaf Communities
• Staff Guidelines for people who are Deaf, have hearing loss or are Deafblind
• NHSGGC Staff Guidelines – Working with people with visual impairment
• Principles of Inclusive Communication

Video

Websites

• Access Panel Network
• Alliance  
• Disability Equality Scotland
• Disability Information Scotland
• Citizens Advice Scotland 
• Glasgow Disability Alliance [GDA] 
• Inclusion Scotland
• Inclusive Communication
• Disability Safety 
• Accessible Travel 

We do not require explicit consent to share the information contained within the Future Care Plan. Therefore the Future Care Plan Summary no longer records if someone has given consent to have a Future Care Plan.

A Future Care Plan is a document brings many pieces of information together into a shareable format. Therefore by engaging in a Future Care Plan conversation, the individual (or legal guardian) is agreeing to share this information.

Article 6(1)(e) of the UKGDPR in conjunction with the Intra NHS Scotland Sharing Accord allow the information contained within this document to be shared with Primary Care and other NHS Boards including NHS 24 and Scottish Ambulance, without the need for explicit consent. We are sharing this information for routine patient care as part of our Board’s duty to provide healthcare to our patients. It is best practice for staff to make sure the individual and/or their legal proxy is aware this information will be shared when conducting ACP conversations. If the patient would like further information about how the Board uses their data it can be found in our Privacy Notice here – https://www.nhsggc.org.uk/patients-and-visitors/faqs/data-protection-privacy/#

Although we no longer record consent on the Future Care Plan Summary, the summary does include a question about whether or not an individual (or their legal guardian) wishes to have an Future Care Plan.

By asking this question we hope to enable staff to evidence when a conversation takes place, but the offer of a Future Care Plan is declined. We will monitor this data.

If a Future Care Plan is refused, staff have the opportunity to record the reason for this. We would ask all staff to complete this in order to provide context to their colleagues who may wish to revisit the conversation at a later date.

We would encourage all staff to consider carrying out a Rockwood Frailty Assessment and select the appropriate score in the Future Care Plan Summary.

If a frailty assessment is not applicable please select “0 – Not Applicable”.

Frailty Score Guidance (you can also download an app – Clinical Frailty Scale (CFS) – to help with the assessment – download for apple or android).

Overview of person including family circumstances, accommodation information, health goals, what matters to them, emergency planning information etc. If person is a carer, or has informal carers please state too.

If person lacks capacity ensure this is recorded alongside who has been present during any discussions.

If a person declines a Future Care Plan, staff are encouraged to ask permission to record this decision on the Future Care Plan Summary so that other services are aware that a Future Care Plan has been offered. It is also best practice to indicate whether the person may be willing to revisit these conversations at a later date. Please record this in the appropriate question.

Overview of health issues and diagnoses. Baseline functional and clinical status to help clinician identify deterioration – e.g. baseline O2%, 6-CIT score, level of mobility, current or planned treatments.

It is good practice to indicate if there are any treatments or interventions that the person would not wish. If they have an Advanced Directive this can be indicated.

Depending on the person’s own circumstance and health journey, this may include preference about:

• long term care (e.g. nursing or residential care)

• place of treatment. This could include short or long term treatment.

• place of death

This section may also include the current level of care being provided by informal carers and/or any discussions which have occurred regarding on going and future care they may be able to provide.

It is best practice to give as much information as possible regarding views about hospital admission and explore with people what might happen in different scenarios. For example people may be willing to be admitted for a short period for symptom management, however would be unwilling to be admitted if it was likely they would be in hospital for long periods.

For people who are frail, in residential/nursing homes or approaching the end of their lives, it may be useful to discuss the 3 following scenarios:

1. If you had a sudden illness (such as a stroke or a heart condition), how do you think you would like
   to be cared for?
2. If you had a serious infection that was not improving with treatments we can give in the community like antibiotic tablets or syrup, how do you think you would like to be cared for?
3. If you were not eating or drinking because you were now very unwell, how do you think you would like to be cared for?

What to expect from Control IT Plus.

Understanding and managing Type 2 Diabetes.

Healthy eating and the impact of diet on your health.

The benefits of physical activity.

Your guide to foot care and its importance.

Setting goals to self-manage your condition.

Services and resources to help you self-manage your condition.

To self-refer to one of our group Control It Plus sessions, or if you have any questions please get in touch.

Email: ggc.type2diabeteshub@ggc.scot.nhs.uk

Phone: 0141 531 8901 (Opening Hours: Monday – Friday, 08:30-16:30)

Don’t forget you can access our Control It Plus programme booklet.

In addition, My Diabetes My Way have a rang of eLearning courses which can support your self-management and we would encourage to complete these.

Pregnancy related aches, pains and concerns

POGP: Fit for Pregnancy

POGP: Pregnancy related pelvic girdle pain and other common conditions

Coccydynia Leaflet

DeQuervains Tenosynovitis Leaflet

Ante Natal Exercise (Pilates) booklet

Pelvic Floor concerns

Pelvic Floor Muscle Exercise and Urinary Incontinence Leaflet

Overactive Bladder Leaflet

Pelvic Organ Prolapse Leaflet

Emptying your Bowels Leaflet

Obstetrics Anal Sphincter Injuries (OASIS) 3rd / 4th degree tears Leaflet

Labour, Birth and Post-Natal period

POGP: Fit for birth

POGP: Fit for the Future

Obstetrics Anal Sphincter Injuries (OASIS) 3rd / 4th degree tears Leaflet

POGP: Post Natal Pilates

POGP: Exercise and Advice after the loss of your baby

Arabic

تمارين تقوية البيرينيوم والبطن للنساء

(Pelvic Floor and Abdominal Exercises for women)

 معلومات حول إصابات العضلة العاصرة الشرجية التوليدية (OASIS)

(Information about Obstetric Anal Sphincter Injuries (OASIS))

ممارسة ما بعد الولادة والمشورة

(Post-Natal Exercise and Advice)

العناية بجسمك أثناء الحمل

(Care of your body during Pregnancy)

الوظائف أثناء العمل كتيب

(Positions during labour booklet)

نصيحة مبكرة بعد العملية القيصرية

(Early advice after a Caesarean Section)

Farsi

Pelvic Floor and Abdominal Exercises for women

Information about Obstetric Anal Sphincter Injuries (OASIS)

Post-Natal Exercise and Advice

Care of your body during Pregnancy

Early advice after a Caesarean Section

French

Exercises de renforcement du périnée et des abdominaux pour les femmes

(Pelvic Floor and Abdominal Exercises for women)

Informations sur les lésions obstétricales du sphincter anal (LOSA)

(Information about Obstetric Anal Sphincter Injuries (OASIS))

Premiers conseils après une césarienne

(Early advice after a Caesarean Section)

Exercices et conseils postnatals

(Post-Natal Exercise and Advice)

Prendre soin de son corps pendant la grossesse

(Care of your body during Pregnancy)

Positions et respirations pour l’accouchement

(Positions during labour booklet)

Hindi

महिलाओं के लिए परिणीति और पेट को मजबूत बनाने के व्यायाम

(Pelvic Floor and Abdominal Exercises for women)

प्रसूति गुदा स्फिंकर चोटों के बारे में जानकारी (ओएसिस)

(Information about Obstetric Anal Sphincter Injuries (OASIS))

सीज़ेरियन सेक्शन के बाद जल्द सलाह

(Early advice after a caesarean section)

प्रसव के बाद व्यायाम और सलाह

(Post-Natal Exercise and Advice)

गर्भावस्था के दौरान आपके शरीर की देखभाल

(Care of your body during Pregnancy)

Kurdish Sorani

ڕاهێنانی بەهێزکردنی پێرنیۆم و دووگیانی بۆ ژنان

(Pelvic Floor and Abdominal Exercises for women)

ڕاهێنان و ئامۆژگاری دوای ناتال

(Post-Natal Exercise and Advice)

ئامۆژگاری زوو دوای بەشی قەیسەری

(Early advice after a Caesarean Section)

Mandarin/Simplified Chinese

女性腹腔和腹部强化练习

(Pelvic Floor and Abdominal Exercises for women)

的信息 有关产科肛门括约肌损伤（OASIS）

(Information about Obstetric Anal Sphincter Injuries (OASIS))

剖腹产后的早期建议

(Early advice after a Caesarean Section)

产后锻炼和建议

(Post-Natal Exercise and Advice)

怀孕期间照顾您的身体

(Care of your body during Pregnancy)

分娩期间的姿势小册子

(Positions during labour booklet)

Polish

Krocze i ćwiczenia wzmacniające brzucha dla kobiet

(Pelvic Floor and Abdominal Exercises for women)

 Informacje na temat Urazu poporodowego zwieraczy odbytu

(Information about Obstetric Anal Sphincter Injuries (OASIS))

Wczesne porady po cesarskim cięciu

(Early advice after a Caesarean Section)

Ćwiczenia i porady dla kobiet po porodzie

(Post-Natal Exercise and Advice)

Dbaj o swoje ciało w czasie ciąży

(Care of your body during Pregnancy)

Stanowiska podczas pracy broszury

(Positions during labour booklet)

Punjabi

ਪ੍ਰਸੂਤੀ ਗੁਦਾ ਸਫਿਨਟਰ ਸੱਟਾਂ ਬਾਰੇ ਜਾਣਕਾਰੀ (ਓਏਏਸਿਸ)

(Information about Obstetric Anal Sphincter Injuries (OASIS))

ਸੀਜ਼ੇਰੀਅਨ ਸੈਕਸ਼ਨ ਦੇ ਬਾਅਦ ਜਲਦੀ ਸਲਾਹ

(Early advice after a caesarean section)

ਜਨਮ ਤੋਂ ਬਾਅਦ ਕਸਰਤ ਅਤੇ ਸਲਾਹ

(Post-Natal Exercise and Advice)

ਗਰਭਅਵਸਥਾ ਦੌਰਾਨ ਤੁਹਾਡੇ ਸਰੀਰ ਦੀ ਸੰਭਾਲ

(Care of your body during Pregnancy)

Romanian

Sfaturi timpurii pentru Operatia de cezariană

(Early advice after a Caesarean Section)

Informații despre Traumatisme obstetricale ale sfincterului anal (OASIS)

(Information about Obstetric Anal Sphincter Injuries (OASIS))

Sfaturi și exerciții postnatale

(Post-Natal Exercise and Advice)

Îngrijirea corpului în timpul sarcinii

(Care of your body during Pregnancy)

Spanish

Recomendaciones tras una cesarea

(Early Advice after a Caesarean Section)

Información y recomendaciones sobre ejercision posparto

(Post-Natal Exercise And Advice)

Ukranian

Післяпологові вправи та поради

(Post-Natal Exercise And Advice)

ранні поради після кесаревого розтину

(Early advice after a caesarean section)

Urdu

خواتین کے لئے پیڑو فرش اور پیٹ کی مشقیں

(Pelvic floor and abdominal exercises for women)

زچگی کے گدا سفنکٹر چوٹوں کے بارے میں معلومات (او آئی ایس ای ایس)

(Information about Obstetric Anal Sphincter Injuries (OASIS))

پیدائش کے بعد ورزش اور مشورے

(Post-Natal Exercise and Advice)

حمل کے دوران اپنے جسم کی دیکھ بھال

(Care of your body during Pregnancy)

پیڑو کے اعضاء کے پرولیپس کے بارے میں فزیوتھراپی کی معلومات

(Physiotherapy information about Pelvic Organ Prolapse)

لیبر بکلیٹ کے دوران عہدے

(Positions during labour booklet)

سیزیرین سیکشن کے بعد ابتدائی مشورہ

(Early Advice after a Caesarean Section)

Circulation Changes in Pregnancy – Managing Aches & Pains Video (2 min)

Pelvic Floor, Deep Abdominal & Pelvic Tilting Video (4 min)

Positions for Labour & Breathing Video (4 min)

Relaxation for Labour Video (4 min)

Post Natal Exercise Video (3 min)

Diastasis Rectus Abdominus Muscles (DRAM) Video  (3 min)

Relaxation Video (4 min)