Health Challenge John Greensill

Current arrangements A fully integrated Health and Social Care Service funded 50:50 by NHS Walsall and Walsall Council Budget around £32million Slightly less spend than local towns –Walsall £60 per head –Average £63 per head

Current organisation The Council is the lead partner Part of Social Care & Inclusion Part of the Disability Service Governance –Partnership Executive Group 2 x Walsall NHS Directors 2 x Senior Council Managers Reports to –NHS Walsall Board –NHS Walsall Community Health Board –Learning Disability Partnership Board

Services Provided - Health Supports around 900 people with a Severe Learning Disability Severe means generally an IQ < 55 with limited social functioning but a wide spectrum Medical Team: 2 x Consultants + 2 x Staff Grade Range of LD Nurses including specialists Therapists inc OT, SALT, Physio, Psychology Assessment & Treatment presently 9 beds Range of Health Facilitators, Health Action Planners

Health risks in LD Cancer – Gastrointestinal Cancer 48-58% of cancer deaths vs. 25% of general population Breast Screening – 17% when in family care and 52% in formal care compared with 78% Cervical Screening – 3% when in family care and 17% in formal care compared with 85% Coronary Heart Disease – 50% of people with Down’s syndrome affected Respiratory Disease – 46-52% vs % of the general population Epilepsy – prevalence rate of 22% compared with the general population of 0.4-1%.

The BIG Health Issues Demography –client group increasing by average 5.5% per annum (range 3.2% to 7.4%) Dependency –increasing due to improved survivability and increasing age range with early onset Dementia a real issue Health needs –most people with LD have poorer health than the rest of the general population and are likely to die at a younger age - 58 times more likely (Hollins et al 1998) Specialist health needs –in particular Autism, Epilepsy, Dementia Inequality –Equal Treatment Closing the gap 2006, Death by Indifference 2007, A life like no other 2007, Healthcare for All 2008

The Walsall Clinical Challenge Baseline LD Services in the town compare well with other towns There is a funded Strategic Plan to achieve most national drivers But -‘Healthcare for All’ found “convincing evidence that people with learning disabilities have higher levels of unmet need and received less effective treatment, despite the fact that the Disability Discrimination Act and Mental Capacity Act set out a clear legal framework for delivery of equal treatment” Reports to the NHS Walsall Board, Community Health Board and Partnership Executive Group have identified service issues in Walsall which mirror the experiences described in Healthcare for All

The Health priorities Valuing People NOW 2009 – Delivery Plan Improve access to, and quality of, NHS services for people with LD National Group to oversee/performance manage Delivery Plan with particular focus on Healthcare for All Scoping study on premature deaths Develop a Public Health Observatory for LD – commission 2009/10 Promote annual health checks 2009/10

The Health priorities Valuing People NOW 2009 – Delivery Plan Identify best practice 2009/10 Implement Health Self Assessment Performance Framework 2009/10 Guidance on Health Action Planning and Facilitation 2009 Guidance on the Disability Equality Duty 2009 Improve training and education of NHS staff in relation to LD Improve coverage by LD Nurses in the Criminal Justice System

What should Walsall do? Maintain existing service developments and strategies Seek Clinician support – both Primary and Secondary – to address the challenges in ‘Healthcare for All’ The challenges are ones of clinical leadership – the hearts and minds of the NHS Healthcare for All said “there is no simple or single solution. The requirement is to make the health system across the country work as effectively for this group of the population as it does for any other. Much more effective leadership at all levels of the health service is needed”

What is Walsall doing? Engage Clinicians – Doctors, Nurses and Therapists - in a leadership debate Holding an evening event on 23 rd March ‘Inspiration for Health’ to launch ‘Healthcare for All’ ‘Valuing People NOW’ Developing engagement from the Walsall LD Service with clinicians in Primary & Secondary care Writing a Walsall Action Plan to implement ‘Healthcare for All’ recommendations