Introduction Medicines Event Learning Disability Programme 8 April 2016

Thankyou for attending today Anne Webster David Gill NHS England Learning Disability Programme Anne and david both introduce ourselves

What we’re going to talk about The context of this work Why is this work important? Core Messages of STOMPLD project YOUR role in this Anne

About the Learning Disability Transforming Care Programme 6 partner organisations committed to change 3 big aims: Reduce numbers of people in inpatient settings Reduce how long people stay in inpatient settings Better quality of care and support for people (in both hospital and community settings) AND reducing health inequalities Anne- mention other workstreams about areas such as Annual health checks, care and treatment reviews, reducing number of beds

So what’s it all about?

This is why we’re here ‘My son has had many indignities foisted upon him. He was deprived of his liberty, abused, removed from his home and medicated all without his consent. In his position would you stand for it?’ By Ann, whose son was at Winterbourne View Hospital It was 3 years before he went home David

A human rights issue If you are drugged up, you can’t communicate with people properly The world passes you by It can make your behaviour more challenging in the long run It doesn’t help you learn or change It doesn’t help you get out of hospital, the opposite in fact It hurts to think people live like that In the run up to Care and Treatment Reviews which are now carried out by local teams around the country, our Improving Lives team at NHS England carried out well over 100 in depth reviews of people’s care. Of the people we reviewed who were still in hospital (whose situations were particularly complex), at least 3 out of 5 people were receiving regular anti-psychotic medication. The team found that too many patients were over-medicated, which affected their ability to communicate and take part in meaningful activities. We even had one person who was given PRN on the day of her review and could no longer take part, even though she wanted to. Also, as in her case, when medication was combined with frequent or lengthy periods of physical restraint and seclusion, the observed risks to health were even higher. The team concluded that this contributed to a poor quality of life for a significant number of people. Some patients had been unable to progress and in a few cases it was a big factor in people being stuck in hospital for years. It was therefore a priority for reviews to offer practical advice aimed at reducing reliance on medication, helping patients and their care teams find other ways to manage this issue. David/ anne maybe chip in too

What is it hiding? There’s usually a reason: Not listened to or understood? Abuse or trauma? Unable to deal with feelings? Too much physical restraint? Too little contact with others? Poor relationships with staff or patients? Pain or illness? Is medication the answer? Anne “In the past my son was prescribed 3 different drugs to manage his behavioural difficulties. The behavioural problems were often a result of environmental issues such as bullying, excessive use of restraint, the use of punitive/aversive approaches or rapid staff turnover which resulted in a failure to deliver the person centred care plan. Pain from physical problems such as an undiagnosed, untreated, bleeding stomach ulcer, an untreated urinary tract infection and other commonly occurring illnesses would often result in Challenging Behaviour. Once the health issues were addressed and proper person centred care was in place the medication was not needed. Regrettably the issues around sustaining the right model of care and support proved impossible to resolve and the decision to use Sertraline and Carbamazepine in an effort to compensate for environmental issues which could not be solved was reluctantly accepted by us”

Medicines Project Core Message It is estimated that on an average day in England, between 30,000 and 35,000 adults with a learning disability are being prescribed an antipsychotic, an antidepressant or both without an appropriate clinical reason. Unnecessary use of these drugs, puts people at risk of significant weight gain, organ failure and premature death. Is one of these 35,000 people your patient? Stop this happening and take action today. Check and review your patients immediately to ensure another day of potential harm doesn’t go by. David

Nurses……………… Take action if you don’t: Understand why the person is on the drug Understand the drug and the side affects Believe that the drugs are helping the person to lead a healthy, and good life. Anne

For more information Visit the NHS England website www.england.nhs.uk/learningdisabilities David