Learning Disability Annual Health checks. Dr Jenni Lawrence Lynne Taylor And friends!

What is a learning disability? Internationally know as “Intellectual disability”. Affects 1-3 % of the population. 77% are probably unknown to any health or social care service.

Diagnosis of Learning Disability. 1.Impaired cognitive functioning 2.Limitations of learning, adaptive behaviour and skills 3.Early onset (before adulthood) with lasting effect on development Have a significantly reduced ability to •understand new or complex information •learn new skills

•Can generally learn to read, write and do basic maths Mild 85% •Can generally learn to read, write and do basic maths •Many adults will be able to work, and live independently Moderate 10% •May be able to learn basic reading and writing •Most can learn to develop some degree of independence. •Adults will need some support. Severe 5% •Probably unable to read or write •May learn self-help skills and routines •Some verbal skills, but may need augmented communication aids •Need supervision and support in all daily activities and living environment Profound 1% Need intensive support Eagle eyed among you will notice this is 101%! Figures are approximate!! People with mild learning disabilities may struggle to… •Understand written instructions •Keep appointments •Grasp the purpose of procedures •Stick to treatment regimes •Understand consent procedures

Annual health check Opportunity to give information to people. Yearly review at GP surgery for those with LD on the GP’s LD register. Offered to all over the age of 14. Gain consent during this visit to share information with other health care professionals including the screening services. Opportunity to give information to people.

L.E.S All practices taking part. Get QOF LD register verified. Do the annual health check. To leave with summary of check. Get paid approx £140.00 per check.

Uptake of Annual Health Checks.   CCG No. of Patients on LD register who have had an annual health check (14/15) Total No. of Patients on the LD Register (14/15) Proportion % Total No. of Patients on LD register for whom Annual Health Check data was returned Difference in Proportion of Patients who have had an Annual Health Check based on the two different denominators NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 300 639 47% 604 50% -3% NHS HARROGATE AND RURAL DISTRICT CCG 530 1031 51% 0% NHS SCARBOROUGH AND RYEDALE CCG 177 597 30% NHS VALE OF YORK CCG 569 1115 974 58% -7%

Belgrave not responded as time of putting this talk together Belgrave not responded as time of putting this talk together. Castle Health 28%.

The only way is up! Proportion of practices doing at least one annual health check has gone up form 73.6% in 2014 to 93.3% in 2017. More people are annual health checks from 20.1% of those eligible on the LD registers in 2014 to 45.4% in 2017. More people are getting a Health Action Plan - 14.3% in 2014 vs 38.7% in 2017 And percentage of HAP not recorded gone down from 85% to 55.6%. This is based on the most recent data although due to be updated any day now.

Awareness.

So why are health checks important?

Confidential Inquiry into the deaths of people with Learning Disabilities. All known deaths of people with learning disabilities From 5 PCT areas ( in SW England) From 1st June 2010 –31stMay 2012. 233 adults with learning disabilities 14 children with learning disabilities 58 comparator cases.

CIPOLD – 2013. Median age at death for males was 65 years. Men with learning disabilities died on average 13 years earlier than men in the general population. Median age at death for women was 63 years. Women with learning disabilities died on average 20 years earlier than women in the general population. 42% of these are thought to be preventable and avoidable. Attributed to delays in diagnosis, treatment and failure to provide adequate care. Over 1000 people with LD die prematurely each year through failure to provide adequate care. People with LD die 16 years younger than the general population. Genetic and biological reasons for some of these.

Associated health problems of people with LD (2 Associated health problems of people with LD (2.5x as many co-morbidities as other patients) Psychiatric and behavioural problems more common Anxiety and depression 5X Schizophrenia 3X 30% epilepsy 30% visual problems 30% hearing problems Vulnerable to abuse by carers and others

Associated health problems Many Down’s pts develop dementia in middle age c30% Down’s patients become hypothyroid Continence problems very common Mobility problems very common Obesity common Most unable to take responsibility for own health or read instructions

Barriers. Diagnostic overshadowing (symptoms wrongly assumed to be related to LD condition) Communication Prejudice Lack of awareness or knowledge Systems Physical environment

This is not an annual health check… Hello. Do you drink alcohol? Do you smoke? What do you weigh? What is your height? BP check. Goodbye.

So what does a good health check look like?

Easy read invite ideas.

Based on Cardiff template – covers a wide range of health issues. Should take a lot longer than the normal 10 mins appointment – eg 45 mins. Might be with GP or nurse or both. Should leave with a summary/ Health Action Plan.

Ideally should cover…. Social information ( housing, employment, carer, social services, LD team etc) Bladder and bowel assessment Mobility Vision and hearing Dental Smoking and Alcohol Screening Usual obs ( height, weight, waist, BP, risk calculators) Depression and mood Sexual health Blood tests incl thyroid function esp if Down’s. Consent to share information ( SCR, screening services) Symptoms incl “ red flag” symptoms. National template coming out…. Nil infor from systm 1 at all….

Health Summary.

Health Action Plan.

Self Assessment Tool. 1.How well is the GP practice doing at performing the AHC? 2.How well are we doing at identifying patients with learning disabilities? 3.How well are we doing at arranging for people to attend for a health check? 4.How well are we doing at putting reasonable adjustments in place to maximise the effectiveness of AHCs? 5.How well are we doing at arranging for and supporting the uptake of follow-up actions? 6.How well are we doing at improving our practices? https://www.ndti.org.uk/resources/useful-tools/quality-checking-health-checks-for-people-with-learning-disabilities

An audit tool.

http://www.rcgp.org.uk/clinical-and-research/toolkits/health-check-toolkit

Fabulous video! https://www.ndti.org.uk/resources/publications/better-health-for-people-with-learning-disabilities

Other Useful resources. http://www.easyhealth.org.uk/ https://www.macmillan.org.uk/information-and-support/resources-and-publications/other-formats/easy-read.html https://www.mencap.org.uk/

LD Community Team Eastfield Clinic Westway Scarborough, YO1 3EG Tel: 01723 580940