Debra Moore Health action planning and health facilitation Problems, progress and priorities

 “The NHS is there when we need it most. It provides round the clock, compassionate care and comfort”  Lord Ara Darzi  “Witnesses described some appalling examples of discrimination, abuse and neglect across the range of health services”  Sir Johnathon Michaels

 You are here!  Main agencies and organisations have this in their ‘sights’ and are here  Lots of mainstream examples of good practice e.g. Sheffield  Acknowledge competing demands and financial climate  Recognise inevitable ‘higher priorities’ and ‘play our hand’ accordingly Yes!

 We met with a range of people at several events and canvassed view  We heard about the issues emerging from research in this area  We looked at good practice and ‘what helped and what hindered’  We looked at VP targets in this area and issues relating to Learning Disability Partnership Boards  Considered changes in the policy landscape and new mechanisms to support change e.g. JSNA

 VP Targets for health action planning and health facilitation not hit in many areas  Many areas lack an up to date ‘Action for Health Framework’ and lack local evidence, data or outcome measures  Health has not enough ‘air time’ at many Learning Disability Partnership Boards  Some LDPB’s don’t have a health subgroup or its poorly attended or not right people there  Some LDPB’s failed to make the relationships with commissioners and providers of mainstream and specialist health services  Ultimately – undermines not just achievement of VP targets but ability to address DRC, Mencap, Michaels, Healthcare Commission audit etc etc etc So has it been a missed opportunity?

What helped locally?  Taking an honest but constructive approach  Leadership - a critical factor  ‘Ownership’ by the mainstream  Emphasising the wider benefits to all groups  Involving people and families who have appropriate skills and knowledge in training  Performance management – SHA’S, PCT’s and Healthcare Commission  Incentivising the system – LES & DES  Seeing HF and HAP as part of a wider health agenda – ‘tools’ or means to an end rather than the end game Lots of good practice examples – so it can be done!

Good 1:1 health facilitators  Know and trusted by the person  Puts the person at the centre of plan  Works closely with those who know and love them  Know a lot about the persons health needs and wishes and rights  Know how to access opticians, dentists, GP etc  Good communicator  Knows how to format a plan that is useful to the individual Good strategic health facilitators  Good leaders  Know about the health needs of people with learning disabilities  Understand how health services are commissioned and delivered  Can monitor and audit intiatives to reduce inequalities  Can work across a locality and different agencies and services  Understand mainstream and specialist health policy

 Don’t have just one approach/format – need to be useful to the person  Need to have some ‘documentation’ that looks similar that health professionals recognise e.g. ‘grab sheets’ etc  Provide training and resources for people and families as well as health and social care professionals  Make good use of universal services  Need to make sure health action planning it is a part of person centred planning (and CPA where appropriate)  “Style and format less important that explaining the plan clearly and ensuring actions take place”

Primary Care Trusts some key messages from the field  ‘Commission to improve outcomes’ - data and evidence and LD population needs and wishes should be seen within commissioning strategies and priorities  Provide leadership within the PCT, at the Learning Disability Partnership Board and beyond  Harness the expertise of specialist health provision and maximise contribution e.g. CTLD’s  Lead the delivery of the local Action for Health Framework and related strategies e.g. ‘Green Light’

key messages- continued  Invest in posts that assist the PCT to deliver the changes required e.g. Strategic Health Facilitation and deliver provider support e.g. Acute Liaison Nurses  Employ coherent data systems to monitor GP registration, the uptake of health checks and health action plans  Make sure that local health policies and practices are assessed (Equality Impact Assessments).  Undertake reasonable adjustments - including mental health and offender health services  Utilise Primary Care Service Framework and associated tools

Learning Disability Partnership Boards need to vaccinate against the ‘Dibleys’  Have the right people at the Board and the health subgroup – expertise and authority – earn their place!  Make sure they have a firm grip of the health agenda – be business like!  Have good evidence of what works and what’s not working nationally and locally  Have clear outcomes and develop locally relevant metrics that include social care and universal supports e.g. uptake in sport  Harness the skills of people and families (especially those with more ‘complex needs’)  Be decisive and get on with it - do what you can, where you can and do it now!

Action for Health Frameworks

Primary care Acute hospitals Specialist LD health services ‘Gearing up the different parts to work together’

‘Better health’ sits within a ‘broader context’ We need to make sure everyone understands the implications for people’s lives and the achievement of their hopes and dreams This IS a matter of ‘LIFE AND DEATH’