1. Working with People with Learning Disabilities Directed Enhanced Service (DES) - Learning Disabilities 2008/09

2. What is a learning disability? The Department of Health defines learning disability as: A significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence with an IQ below 70) with; A reduced ability to cope independently (impaired social functioning) and; Which started before adulthood, with a lasting effect on development

3. Prevalence Nationally it is estimated 2-3% of the population have a learning disability Estimates suggest: - 210,000 people with severe & profound learning disabilities - 1.2 million people with mild/moderate learning disabilities Per GP practice of 2000 patients – average of 40 people with learning disabilities

4. Identification & Coding Information for GP Practices to Identify their Patients with Learning Disabilities Issues with Coding: Eu81.% Identification Coding Downs syndrome Learning difficulty + Learning disability

5. Health Issues More likely to: Die early Die from breathing problems Have heart problems Be overweight, and eat badly Have certain cancers Have epilepsy Have Autism Be mentally ill

6. Health Issues More likely to: Have dementia Be given psychotropic drugs Have a physical disability Be deaf or blind Have communication problems Have thyroid dysfunction Have dental problems. Use medical hospital services Be discharged quickly

7. Health Issues Less likely to: Have a health check Be screened for cancer Use surgical hospital services Have sight tested Have hearing tested Receive pain relief Get Health Promotion advice Be included in consultations/ patient forums

8. Special Health Needs of People with Learning Disabilities 2.5x more likely to have a physical condition that warrants medical intervention Lack of early intervention/detection Great difficulty & barriers in accessing all aspects of healthcare Health outcomes fall short Diagnostic overshadowing

9. The Health Check Guidance on the Annual Health Check Template & Website Resource Dr Tom Howseman

10. Overcoming Barriers People with learning disabilities have higher health needs but poorer health outcomes than the general population. What do you think the barriers are for people with learning disabilities accessing health care?

11. Practice Guide: 1. Preparation for Health Checks Identify a clinical lead for Learning Disabilities within your practice Identify which patients are priorities for health checks from the list provided by the PCT Agree on health check tool to be used Contact your local Strategic Health Facilitator & named link member of the local Community Learning Disability Team GP, Practice Nurse & Practice Manager/Senior Receptionist to attend multi-professional education session

12. 2. Carrying Out Health Checks Ensure adequate appointment time has been allocated Obtain patient consent. Consider best interests if appropriate Carry out health check. Capture details & outcomes of check Invite patient for a health check. Check invitation was received Draw up an agreed Health Action Plan or add to current HAP Agree any follow up appointment or annual review date

13. 3. Following Health Checks Continue liaison with family and Community Learning Disability Team staff as appropriate Review practice procedure for health checks Attend any new or refresher training as appropriate Follow up any specific actions (referrals to other services, management of co-morbidities etc.) Ensure patient review and recall system is in place

14. DDA/Disability Equality Duty Disability Discrimination Act – 2005 To promote equality of opportunity for disabled people Disability Equality Duty – Requires all public authorities to promote disability equality by: Eliminating unlawful discrimination Making ‘reasonable’ adjustments for disabled people Promoting positive attitudes and encouraging participation

15. Consent The Mental Capacity Act (2005)‏  5 Key Principles: 1.Every adult has the right to make their own decisions & must be assumed capable of doing so until proved otherwise 1.Everyone should be given all the support they need to make their own decisions before conclusions are made that they cannot

16. Consent 1.People should be able to make unwise or eccentric decisions - it is capacity to make decisions, not decisions themselves, that is the issue 1.Any decisions or anything done for or on behalf of a person who lacks capacity must be made or done in their best interests 1.Anything done for or on behalf of people without capacity should restrict their rights & freedoms as little as possible

17. Functions of Health Action Plans Health Action Plan Belongs to the person Person centred Accessible Identifies health needs Lists actions needed Identifies support needed Provides links to a range of other services Provides links to GP, primary care & other health services Coordinates services Influences services Educates & informs Integral part of PCP & other plans Most important are in shaded boxes

18. What should be in a HAP? Identified health needs or issues What actions are needed to maintain health What actions are needed to improve health Who will help ensure these actions take place (especially if this is someone other than the health facilitator)‏ Timescales for various actions and when there will be a follow up or a review.

19. Speech & Language Therapist G.P, practice nurse with support from family & team member Psychology/ Community nurse To assess & set up a communication system To complete health check to exclude any underlying physical health problems e.g. ear infection To assess & manage challenging behaviour Amy has communication difficulties Recent onset of challenging behaviour Action by:Health ActionHealth issue/need Health Action Plan

20. Strategic level Specialist level Individual level - Service development work - Informing planning & commissioning A health professional who provides advice, support or treatment usually on a short term basis in partnership with patient & their Health Facilitator. Can support or contribute to the Health Action Plan Focus on individual work and health outcomes. A support worker, advocate, friend, or family carer could fulfil the role at this level. The person should choose who they want as their Health Facilitator Varying levels of support to the individual Joint working required between different levels of health facilitation

21. Working together At different times of their lives people with learning disabilities require different levels of support from different services: Role of the Community Learning Disability Team Role of carers Social care support