1. A Health Needs Assessment for Adults with a Learning Disability in Nottingham and Nottinghamshire Presented at the Help and Advice for Learning Disability Commissioners Event Birmingham 30 th November 2010 Anne Pridgeon Health Improvement Principal NHS Nottinghamshire County and NHS Bassetlaw Iain Little Public Health Development Manager NHS Nottingham City

2. Health Needs Assessment Systematically assess the health needs of adults with learning disabilities Review the evidence base for health need and effectiveness of services Review local information on prevalence, health needs and healthcare service use Identify gaps and inequities Make recommendations

3. Prevalence of learning disabilities Precise local prevalence and incidence figures not available Used national estimates and future projections along with recorded primary care prevalence Much practice- and cluster-level variation in the recorded prevalence Estimates based on general projections - need to know local population characteristics

4. Recorded prevalence by practice

5. Demographic profiling Adults known to Adult Social Care Services –3,244 matched to NHS number –higher rates in NHS Nottinghamshire County and NHS Bassetlaw than in NHS Nottingham City –majority aged 18-59 –ratio of 1.41 males:1 female adult with a learning disability –rates by ward varied from 0 to 14.5 adults with learning disabilities per 1,000 population Adults known to specialist LD services –2,236 adults –majority aged 20-59 –ratio of 1.35 males: 1 female –ethnicity profile similar to general population

6. Population distribution of adults with learning disabilities known to Adult Social Care services

7. Pattern of health need and use Lifestyle issues Lower rates of smoking No data on obesity, physical activity or alcohol Screening Lower proportion of eligible women attend breast and cervical screening appointments than the general population Lower proportion participate in bowel screening programme

8. Cervical screening

9. Pattern of health need and use Secondary care Compared to the general population –admission rates to secondary healthcare are approximately 1.2 – 1.4 times higher –higher rates of both elective and emergency admissions (lower rate of maternity admissions) –longer median length of stay –attendance rates at out-patient clinics are between 1.4 and 2.2 times higher –attendance rates at A&E approximately twice as high

10. Shorter life expectancy Age profile of adults with LD known to Social Care services and general population Age of death of adults with LD recorded on death certificate and all deaths

11. Other sections of HNA Current service provision review Corporate views –Performance and self assessment framework –Stakeholder views –PALS enquires and complaints Comparative assessment –Compared with other PCT’s in East Midlands and Yorkshire and Humber using Performance and Self Assessment Framework

12. Gaps and Recommendations Gaps and recommendations cover whole of the health system and reviewed by: –Learning Disability Partnership Boards –Joint Commissioning Groups –Better Health Group (Health sub group of LDPB’s) Better Health Group in process of developing action plan and will review implementation of recommendations

13. How findings are being taken forward Work to improve the cervical screening rates Findings have been included in updated JSNA’s Review to determine whether provision of specialist services match need Health Equity Audit of access to services by people with learning disabilities, using extracted primary care data Recommendations included in local strategies and action plans

14. Contact details Iain.Little@nottinghamcity.nhs.uk 0115 883 9238 Anne.Pridgeon@nottspct.nhs.uk 01623 673513