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Reasonable Adjustment Flag case study

Reasonable adjustments for Jamie

This is an example of a flag that can be created in the system using a theoretical case study built around stakeholder feedback and using the learning from the flag pilots.

This example does not outline all the adjustments Jamie will need. Instead, it focusses on the most relevant for recording on the flag, representing what will help a care episode go well and deliver optimum care for Jamie.

Meet Jamie

Eighteen-year-old Jamie is autistic and has a moderate learning disability. He lives with his mum whilst attending a local college and stays with his dad at weekends and during the holidays. Jamie is supported by paid staff for a few hours a week to go out and about in the community – there are a lot of different people in his life.

Jamie feels safe around familiar faces and places. He can become anxious and agitated with people he doesn’t know, who do not understand his routines and needs, especially when in unfamiliar or busy, noisy surroundings.

Jamie requires a very specific diet. Whilst he has a wheat intolerance, he will seek out bread-based, particularly sweet, foods at any opportunity and cannot tolerate strong smelling or spicy foods. He will also only drink a particular fruit squash and nothing else - no other fluids, particularly any hot drinks which make him agitated and cross. He has been known to throw hot drinks when particularly agitated.

Jamie’s mum co-ordinates all his care needs and deals with all communication relating to his health and care. At Jamie’s annual health check with his GP, Jamie was offered to have additional information added to his Summary Care Record (SCR). As he could not consent, a best interest decision was made in consultation with his mum and additional information was automatically added from his GP record to his SCR. Jamie regularly sees a speech and language therapist and a dietician from the local learning disability team. These clinicians told Jamie and his mum about the Reasonable Adjustment Flag, and again a best interest decision was made to create a flag for Jamie. This would help to ensure his particular requirements are known and met when he needs support from different services (reasonable adjustments). 

A flag was created which identifies key information - Jamie’s autism and learning disability, along with six specific adjustments.

The flag on the Spine contains key essential information with typically up to a “helping handful” of adjustments. Further detailed information is recorded in his local detailed care record and GP record (with corresponding information automatically added from his GP record to his SCR with additional information) and can be signposted from the flag. Jamie also has a hospital passport which contains useful information in relation to eating, drinking and other aspects of care and support including risk. A copy of the care passport is carried by Jamie's carers wherever he goes. In the future, a copy of a care passport could be available via the National Record Locator (NRL), alongside other information such as crisis plans.

Jamie's reasonable adjustment flag

Key information recorded on the flag is summarised below:

  • Profile: 18-year-old man (Jamie) living at home with mum
  • Consent: Best Interest Decision in consultation with mum
  • Flag created by: Speech and Language Therapist from Community Learning Disability Team
  • Impairments: Learning Disability (moderate), Autism

Screenshot of Jamie's reasonable adjustments that have been recorded in the flag

The table below provides details of Jamie's reasonable adjustments that have been recorded in the flag.  

Category Clinical code Supporting text
Specific contact method Requires contact via carer All contact to be made via Jamie’s mum – contact details on demographics
Additional communication support Has My Healthcare Passport Jamie's carer can provide a copy of the latest passport – containing essential information on diet and risk. Further information is also in available in Jamie’s SCR with Additional Information. 
Additional support Unsafe to be left alone Jamie needs dedicated and known support available at all times when accessing services
Additional support Care to be delivered in consultation with patient's carers  
Adjustments to environment Requires low noise environment Jamie becomes very anxious and agitated in busy and noisy environments
Individual requirements Has anxiety related to clinical settings  
Bespoke reasonable adjustment Requires reasonable adjustments for health and care access (Equality Act 2010) Jamie is phobic to any hot drinks and will become very agitated when hot drinks are offered or nearby

Scenarios in which the flag is used

Hospital admission

Jamie needed a hospital admission for a hernia repair. The hospital knew Jamie was autistic and might be agitated, so he was given a side room and the nurses were asked to maintain high levels of observation during the admission. One of Jamie’s visits to the bathroom coincided with teas and coffees being offered to patients on the main ward. The nurse at the nursing station had read Jamie’s flag and was aware of the risks with hot drinks so, she helped him back to his room in a way that avoided contact with any hot drinks being served.

Jamie’s eating and drinking guidelines were held in his notes, which were not always available to staff helping Jamie with his food. The Reasonable Adjustment Flag and a copy of his care passport helped to bring staff’ attention to the intolerances Jamie has and the need for careful monitoring of his access and exposure to certain foods.


Jamie does not like any contact with dentists and only attends in person when there is an identified need, with his mum monitoring his dental hygiene in between times. Mum became concerned that Jamie was not his usual self and seemed to be in pain – she thought he may have an abscess. An appointment was made with the specialist dental team who familiarised themselves with Jamie’s needs from the Reasonable Adjustment Flag and other sign-posted documentation, even though they had not met him before.

Minor injuries unit

Jamie falls at college and bangs his head. A temporary member of staff, who is unfamiliar with Jamie, takes him to the minor injuries unit nearby. Jamie is very distressed. On arrival, while the triage nurse checks Jamie’s details, other patients are disturbed by Jamie’s shouting and are wary of what he might do. The nurse asks a nursing assistant to see if she can help Jamie and his carer to calm him while she looks at his record, which includes the Reasonable Adjustment Flag.

The nursing assistant takes Jamie and his carer to some seats near a vending machine where other patients and staff are dispensing hot drinks – Jamie’s agitation is increasing. The triage nurse reads Jamie’s Reasonable Adjustment Flag and quickly informs the nursing assistant of triggers for heightened anxiety and suggests supporting Jamie in a side room whilst Jamie’s assessment is prioritised, and his mum is contacted.

Last edited: 11 June 2020 4:02 pm