Improving the Health and Wellbeing of People with Learning Disabilities: An Evidence-Based Commissioning Guide for Clinical Commissioning Groups Dr Matt Hoghton; RCGP Clinical Champion Learning Disabilities Sue Turner; Improving Health and Lives Learning Disabilities Public Health Observatory Dr Ian Hall; Faculty of Psychiatry of Intellectual Disability, Royal College of Psychiatrists

Why is the guide important? People with learning disabilities experience poorer health than the general population, differences which are to an extent avoidable (health inequalities). Some health inequalities relate to barriers in accessing health care and health screening. Winterbourne View latest in a series of scandals regarding support for people who challenge services, and those with complex needs.

Aim of guide To bring information about people with learning disabilities and links to good practice guidance together in one document.

Aim of guide To assist CCGs to: Commission high quality, cost effective general and specialist health services; Jointly commission services for people who challenge services and those with complex needs; Work with Health and Wellbeing Boards Local Authorities and others to address the social factors which affect the health of people with learning disabilities.

How was the guidance written? Royal College of General Practitioners (RCGP) Improving Health and Lives (IHaL) – Learning Disabilities Public Health Observatory Joint Commissioning Panel for Mental Health (JCP)/Royal College of Psychiatrists Three CCG pathfinders Wide consultation via SHA leads, RCGP Intellectual Disability Professional Network, Janet Cobb network and the Professional Senate

Structure of guidance Primary care (general good practice) Acute care Specialist learning disability services Wider health and wellbeing and public health issues Cross cutting commissioning considerations Mental health services (JCP writing) Appendices - Commissioning cycle and Clinical lead Job Description.

Principles Keep it short! Links to further information Health Self-Assessment Framework (SAF) indicators National outcomes frameworks Winterbourne View recommendations Good practice examples

Key Messages Know about children and adults with learning disabilities and families locally. Find out what they need and want. Ensure the information is in the Joint Strategic Needs Assessment and use it to inform strategy. Use what is out there (SAF, Partnership Boards, local expertise and good practice guidance). Turn good practice into common practice.

Key messages Commissioners remain accountable for the services they commission. Work in partnership with The NHS Commissioning Board, Health and Wellbeing Boards, Local Authorities, public health and providers. Commission to reduce health inequalities – and ensure commissioned services are underpinned by Valuing People principles (Rights, Independence, Control and Inclusion). Better health for people with learning disabilities is everyone’s responsibility.

Primary care – good practice CCGs should have a learning disability lead (job description appendix II) Health checks promoted (target 90%) Up to date registers Flagging system Reasonable adjustments Data collection to inform service planning Support for family carers Support access to other primary care services Specialist learning disability services can help.

Acute hospital services The Monitor Compliance Framework Patients with learning disabilities identified Reasonable adjustments in place Support for family carers Training for staff Representation of people and families Regular audit of above Learning disability liaison functions or equivalent

Acute hospital services Death by indifference: 74 deaths and counting Robust care pathways and use of a Patient Passport Use of a pain identification tool and training Full compliance with Mental Capacity Act Board level ownership

Specialist learning disability services Community learning disability teams Various models but all teams should: Enable access to other services Provide direct assessment and support Some areas also have intensive response teams. Health facilitators/acute liaison nurses Enable access – increasing evidence of effectiveness Assessment and treatment services Should only be used as part of an agreed care pathway with clear outcomes and discharge plan Forensic services and the criminal justice system Prevention, identification and support

Specialist learning disability services SAF indicators The Monitor compliance framework (for Foundation Trusts) People with learning disabilities in the criminal justice system have access to the full range of healthcare provision All NHS funded (full and joint) care packages regularly monitored and reviewed People with learning disabilities, families and carers involved in planning and decision making

Specialist learning disability services Local safeguarding adult boards assured of all providers safeguarding practices People with learning disabilities and families involved in staff recruitment, training and monitoring Providers gather patient experience leading to improved practice Core service spec. for learning disability services being developed by NHS Commissioning Board, ADASS and other key partners - due March 2013 Quality of health principles to be embedded in NHS contracting

Where to find the guide For Guide Easy read guide Presentation Easy read presentation

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