Makaton Governance in Learning Disability Services

Makaton governance in learning disability services means having clear oversight of how signs, symbols and speech are used, reviewed and evidenced. Makaton should not depend on one enthusiastic staff member or sit only within training certificates. It should be embedded into daily support, communication profiles, supervision, handovers and quality assurance.

Strong providers include Makaton governance within wider communication and accessibility in learning disability support and connect it with learning disability service pathways and support models. This matters because communication consistency affects choice, health access, safeguarding, PBS, routines, transitions and social inclusion.

Concept explained clearly

Makaton governance is the system that ensures signs and symbols are used correctly, consistently and meaningfully. It covers who identifies the person’s signs, how staff are trained, how adapted signs are recorded, how changes are reviewed and how outcomes are monitored.

The purpose is not to over-formalise communication. The purpose is to make sure the person is understood across staff, settings and situations.

Why it matters in real services

Without governance, Makaton can become inconsistent. One worker may use signs daily, another may forget them, and agency staff may not know which signs are essential. A person’s adapted sign for stop, pain or help may be missed if it is not recorded clearly.

Providers should be able to evidence that Makaton is part of live support practice, not a disconnected training activity.

What good looks like

Good governance identifies the person’s core signs, records how they use them, trains staff, observes practice and reviews outcomes. It also checks whether Makaton remains the right method or needs to be combined with other communication approaches.

Strong services demonstrate a clear line of sight from governance to communication consistency, staff response and improved outcomes.

Operational Example 1: Creating a person-specific Makaton register

Context: A supported living provider found that several people used Makaton, but staff knowledge varied. Some signs were known only by long-standing workers, and newer staff relied on verbal prompts.

Support approach: The provider introduced a person-specific Makaton register within each communication profile.

Five practical steps:

1. The team listed the signs each person understood and used in daily support.
2. Staff recorded any adapted signs and what response they required.
3. Managers checked that signs were linked to routines, risks and outcomes.
4. New staff were briefed through shadowing and supervision.
5. The register was reviewed during support plan updates and quality checks.

Day-to-day delivery detail: One person used a small hand movement to mean finished. This was added to the profile with guidance that staff should stop the activity, confirm finished and avoid repeating the task verbally.

How effectiveness was evidenced: Staff responded more consistently, and records showed fewer repeated prompts. The provider evidenced that the register improved recognition of the person’s communication.

Deepening governance through total communication

Makaton governance should connect with total communication beyond spoken language. Many people use Makaton alongside objects, photos, gestures, facial expression, vocal sounds, sensory cues and routines.

This means governance should not isolate signs from the wider communication plan. The record should explain how Makaton fits with the person’s whole communication style.

Operational Example 2: Governing Makaton across agency and bank staff

Context: A residential service used regular bank staff. One person became distressed when unfamiliar workers missed their signs for help and wait during evening routines.

Support approach: The provider created a short essential communication briefing for staff who did not know the person well.

Five practical steps:

1. The manager identified signs that were essential for safety, dignity and distress prevention.
2. A one-page briefing was created for bank and agency workers.
3. Shift leaders demonstrated the signs before support began.
4. Handovers recorded whether signs were used and understood during the shift.
5. Managers reviewed distress patterns linked to unfamiliar staff.

Day-to-day delivery detail: Bank staff were shown the person’s signs for wait, finished and help before personal care. When the person used wait, staff paused rather than continuing the routine.

How effectiveness was evidenced: Evening distress reduced during bank-staff shifts. Handover records showed clearer use of essential signs and better staff response.

Systems, workforce and consistency

Makaton governance should be built into induction, supervision, communication audits, PBS reviews, health action planning and safeguarding reviews. Staff should know where sign information is stored and how updates are agreed.

Supervision should check whether staff use signs in practice, not only whether they have received training. Leaders should observe routines, sample records and test whether staff understand the person’s adapted communication.

Operational Example 3: Reviewing Makaton after a health incident

Context: A person experienced delayed recognition of pain because staff did not connect their repeated mouth-related sign with dental discomfort. The service needed to strengthen communication governance after the incident.

Support approach: The provider reviewed health-related Makaton signs using principles aligned with accessible information standards in learning disability services.

Five practical steps:

1. The manager reviewed records before the health concern was identified.
2. The team clarified the person’s signs for pain, mouth, stop and help.
3. Health-related signs were added to the hospital passport and health action plan.
4. Staff received focused supervision on recognising repeated health communication.
5. Future health concerns were audited for earlier escalation evidence.

Day-to-day delivery detail: Staff were instructed to record repeated pain-related signs as health communication, not simply behaviour change. The person’s mouth sign was added to appointment preparation records and GP contact guidance.

How effectiveness was evidenced: Later health concerns were escalated more quickly. Records showed stronger links between Makaton communication, staff interpretation and health action.

Governance and evidence

The audit trail may include communication profiles, Makaton sign registers, training records, competency checks, supervision notes, handover records, health passports, PBS plans, safeguarding records and outcome reviews.

Data may show reduced distress, clearer choice-making, earlier health escalation, improved appointment completion, fewer missed communication cues or better staff consistency. Qualitative evidence should explain how governance changed practice and improved understanding.

Commissioner and CQC expectations

Commissioners expect providers to evidence personalised communication, workforce competence, inclusion and outcome-focused support. Makaton governance helps show that signs and symbols are maintained, shared and used consistently.

CQC expects effective communication, skilled staff, person-centred care, safe support and good governance. Inspectors may look at whether communication methods are known by staff and whether leaders check that they work in practice.

Common pitfalls

• Relying on training certificates instead of observing practice.
• Failing to record adapted signs that the person actually uses.
• Leaving bank or agency staff without essential communication guidance.
• Not linking Makaton to health, safeguarding or PBS records.
• Allowing signs to vary across staff without review.
• Auditing whether Makaton exists rather than whether it improves outcomes.

Conclusion

Makaton governance keeps communication consistent, visible and accountable. Strong providers demonstrate that signs and symbols are recorded, taught, reviewed and linked to outcomes. When governance is clear, Makaton becomes part of reliable person-centred support rather than an isolated skill held by individual staff.

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