1. Meeting the Health Needs of people with Learning Disabilities

2. Plan Discuss the health needs of people with learning disabilities. Barriers they face in accessing healthcare Role of Acute Liaison Nurses

3. Health Inequalities Start early in life and continue into Adult hood Thought to be, in part, due to barriers they face in accessing health services Shorter life expectancy Life expectancy for people with Down’s syndrome increasing Mild learning disability > Moderate to severe Learning disability, mortality rate is 3 times higher than that of the general population.

4. 4 Health and People with Learning Disabilities Cardiac Disease Respiratory Disease Helicobacter Pylori Cancers Epilepsy Mental Illness

5. 5 Health and People with Learning Disabilities Sensory Impairments Dementia Dysphagia Diabetes Gastro-oesophageal reflux disease Constipation

6. Health and People with Learning Disabilities Physical Disability Osteoporosis Women’s health Oral health

7. 7 Barriers to accessing healthcare Communication Difficulties Inflexible services Lack of education/preparation that assists individuals to negotiate GP practices Lack of education for Primary Care/Acute Hospital staff GPs are unfamiliar with services for people with learning disabilities GP systems / appt slots

8. 8 Barriers to PLD Accessing Services Limited development of information leaflets/documentation about people with learning disabilities and associated health needs Assumptions made about ability to consent and / or comply with treatments, lack of knowledge about MCA Social Exclusion of people with learning disabilities Low expectations of health both of the individual and their carer Waiting times

9. Current documents and guidance Valuing People, DOH (2001) Valuing People Now: a new three-year strategy for people with learning disabilities, DOH (2009) Healthcare for all (2008) Death by Indifference, Mencap (2007) Mental Capacity Act (2005) Six lives report Equal access

10. Recommendations Flexible non-discriminatory services and reasonable adjustments:- Accessible information Easy to access environment i.e. physical environment and signage Menu’s Appointment times and letters Feedback Inclusion in service developments

11. Acute Liaison Nurse Service 5 Acute hospitals within Surrey. Royal Surrey Hospital- Kathryn Fisher St Peters and Frimley Park- Nicola James Epsom General and East Surrey Hospitals – Lynne Ramnanansingh We also provide support to Surrey patients going into Ashford and St Heliers.

12. Role of Acute Liaison Nurse Attempt to ensure that people with learning disabilities have access to all the information they need in relation to proposed treatment Make sure the hospital staff have the information they require in order to provide effective care and treatment for someone with a learning disability. Co-ordinate between the person with learning disabilities/ family carers / paid care staff/ and the hospital to ensure that their needs are met. Plan hospital admissions and provide training to acute staff regarding the client’s needs. Advising on capacity, consent, Mental capacity act procedures.

13. Initial Aims To promote the role. Implement training sessions for acute staff. To build relationships with social services, community teams and acute staff. To review policies and pathways in the acute setting to reflect the needs of people with learning disabilities. To review accessible information.

14. 1 Year on Focus particularly on problem areas identified Build links with primary care Provide training to palliative care staff / hospice staff Set up service user groups SALT pathway Pre-op assessment

15. Ongoing Work Plan Identify link nurses in each clinical area. Provide 1 days full training for link nurses covering Learning Disability awareness, health needs of people with learning disabilities, communication, behaviour support, safeguarding. CQUIN Commence Learning disability steering group. Extend induction training (ESH)

16. Ongoing Work Plan Flagging Ward based training sessions (EGH) Focus on Accident and Emergency and acute admissions wards. Review feedback questionnaires. Continue to work on accessible information with the communication people. Developing work based competencies for acute nursing staff.

17. Good Experiences The hospital passport has been embraced by many care providers and acute areas. Support from senior hospital staff. Palliative care at ESH Pre-op assessment at Epsom Training sessions are always well received Ward links.

18. Challenges Referrals Accident and Emergency Depts. Challenging outdated practice. Education slots Working over two areas i.e. Epsom and St. Heliers, Surrey and Sussex Feedback

19. Summary Progress is evident Feedback is needed from service users, paid care staff and family carers about their experience to allow further development of target areas As the role progresses need to review man power

20. Lynne Ramnanansingh Learning Disability Acute Liaison Nurse Epsom Hospital Telephone : 07717850309 Pager Number:07699723474 lynne.ramnanansingh@nhs.net lynne.ramnanansingh@nhs.net