Leeds Institute of Health Sciences FACULTY OF MEDICINE Health Facilitation and Learning Disability Ghazala Mir, Victoria Allgar, Joyce Evans, David Cottrell, Phil Heywood and Joyce Marshall

Background to the research Extensive evidence of health inequalities and poor access to services Valuing People health targets - every person with a learning disability should be offered: - A named health facilitator by June Registration with a GP by June A Health Action Plan by June 2005

What is health facilitation? Support for people with learning disabilities, their relatives and support workers Help to find their way around the NHS and access good healthcare Work to develop services (level 1/strategic) Work with individuals (level 2/person-centred) Department of Health 2002: ‘Action for Health’ Good Practice Guidance for Partnership Boards

Level 1/Strategic Health Facilitation: The Intended Process Lead HF Post in each PCT Training and Invest- ment Supports development of Level 2 hf Mainstream Service Develop- ment Feedback to Partnership Board informs service planning Health needs identified and met

Level 2/Operational Health Facilitation: The Intended Process Identify people with learning disabilities GPs offer health facilitation Health action plans produced Health needs identified and met

Identifying people and offering HAPs Identification on GP registers – -Lack of interest/incentives -Tools to identify not available – template developed by research team -Confusion about definition of learning disability -Concerns about ‘labelling’ Explanation/trust increased take up of HAPs Carers could refuse plans on behalf of person with learning disability

Health Action Plans Health checklists and other models did not always address: -Need for ‘Circles of support’, linking up different actors -Determinants of health -Priorities of person or family carer GPs almost completely absent from the process Reaching only a minority of people HAPS Valued by people who had them/raised awareness Took time to produce; specialist skills and third party involvement important for people with challenging behaviour Little or no monitoring or review of Plans

Inclusion People with complex needs: HAPs not being used to address concerns of people with mental health problems Could be conflict of interest where health facilitator was family carer/supporter People from minority ethnic communities: Low contact with specialist services Specialist learning disabilities staff needed training in cultural competence

Links to Level 1/Strategic Health Facilitation Valuing People targets perceived as ‘aspirational’ not ‘hard targets’ Not tied in to other more closely monitored policies to improve engagement of mainstream services Limited capacity within PCTs – need for Strategic Health Facilitator posts Decision-making by the Partnership Board did not include all stakeholders Need for more information, training, collaboration, work with GPs, work with excluded groups Need for more incentives to balance disincentives that currently exist

Recommendations Developed with local stakeholders for: PCT/acute sector Partnership Board Learning Disability Services Strategic Health Authority Department of Health/Office for Disability Issues

Recommendations: PCT/Acute Sector Appoint Strategic Health Facilitator Promote legal duties under DDA and RR(A)A 2006 Inclusive approach to NSF and other priority targets Invest in training for professionals/health facilitators Named hospital Learning Disability leads to work with the Strategic HF Aggregate evidence of need from Health Action Plans to inform the development of local services

Recommendations: Learning Disability Services Review skills and knowledge within teams Provide training to health facilitators and staff carrying out other forms of assessments Ensure that training covers inclusion A named individual for each area of the city and collaboration to identify/offer health facilitation Promote tools and best practice from national activity HAPs focus on priorities of people with learning disabilities and their family carers and support provided to implement Plans Collaborate with a range of other actors to create ‘circles of support’

Produce joined-up policies Monitor and report progress on Valuing People health targets Joint work to promote Valuing People health targets using the Disability Discrimination Act 2006 Review current mechanisms to monitor policy implementation of health policies for inclusion Work with professional bodies to extend learning disability components of professional education courses Department of Health/Office for Disability Issues