Do you see me?

In healthcare, harm does not only happen when treatment is delayed or a diagnosis is missed. It can also happen when a person is not truly seen. For people with a learning disability, safety can depend on whether healthcare staff recognise who they are, understand how they communicate and make the adjustments needed for their care. The question is simple, but profound: do we see the person in front of us and do we understand what they need to be safe?

That is the challenge highlighted in our investigations into caring for adults with a learning disability in acute hospitals and into medicine omissions in learning disability secure units. The findings point to the safety impact of whether the health and care system recognises the person, responds to their needs and adapts care accordingly. When this does not happen care can be fragmented, standardised, ineffective and unsafe. The patient may be present, treated and recorded, but still not truly seen.

Seeing the person, not just the patient

One clear lesson is the importance of identifying, recording and sharing information about a person’s learning disability and the reasonable adjustments they may need and how these may change.

This includes:

• how they communicate
• how distress may show itself
• what support helps
• what needs to change for care to be safe.

Without this information, staff are often left to make assumptions, especially in busy settings. Tools such as health and care passports can help, but only if they are accurate, easy to access and used in practice.

When communication is missed, safety is missed

Our reports also show how closely communication and safety are linked. If a patient cannot understand what is happening, explain what they need, or take part in decisions, the risk of harm grows. What may look like non-engagement or refusal can in fact reflect fear, confusion, sensory overload, previous experiences, or care that has not been adapted to the individual.

This is especially important when staff record that a patient has ‘refused’ care or medication. The investigations suggest that this language can sometimes hide a more complex picture. What is written down as refusal may not be an informed choice at all. It may be a sign that the system did not make the adjustments needed to help the person understand or engage with their care. If we do not stop to ask what the behaviour is telling us, we may miss an opportunity to prevent harm.

Healthcare staff need systems that help them do the right thing

Our investigations highlight systems that do not always make it easy for healthcare staff to provide safe, personalised care for people with a learning disability. Many staff need practical guidance, time, access to specialist advice and systems that make reasonable adjustments visible and usable. Without that support, they are left trying to bridge the gaps as best they can.

Specialist learning disability staff and services can make a real difference by helping colleagues understand a person’s needs and adapt care around them. But specialist support on its own is not enough. Safer care depends on mainstream services being designed for inclusion, so that reasonable adjustments are part of everyday practice rather than something that relies on individual effort.

Families and carers often hold the missing information

Families, carers and others who know the person well often hold vital safety information. They may understand how the person communicates, what signals distress, which routines are reassuring and what helps or hinders care. When that knowledge is not listened to, or not built into care planning, important opportunities to support safe care can be lost.

Seeing the person also means valuing the people around them who help us understand who they are and what they need. That is not only about kindness or dignity, important though both are. It is also about safety. A system that makes it easy to hear and act on the knowledge of families and carers is more likely to respond to the patient as an individual, rather than through a standard process.

Do you see me?

‘Do you see me?’ is more than a human question. It is a patient safety challenge to the whole healthcare system. It asks whether services can recognise the whole person, understand what matters to them and adapt care so it can be delivered safely.

If we are serious about safer care, awareness alone is not enough. Services must make reasonable adjustments visible, expected and practical. They must equip healthcare staff with the time, confidence and specialist support they need, listen to families and carers, and design care around the person rather than the convenience of the system. Because when healthcare truly sees people with a learning disability, it does more than improve experience. It reduces risk, prevents harm and makes safer care possible.