1. Our Passion, Your Care. Making Reasonable Adjustments in Primary Health Care June 2015 Sally Ryan BSc (Hons) Nurse Spec- Learning Disability

2. Our Passion, Your Care. Health Inequality People with a learning disability have poorer health than their non-disabled peers. Yet they are less likely to access primary healthcare. 26% of people with a learning disability are admitted to hospital compared to 14% of their non-disabled peers.

3. Our Passion, Your Care. Health Inequality National Inquiries 2006 Closing the Gap (Disability Rights Commission) 2007 Death By Indifference (Mencap) 2008 Healthcare for All (Michael) 2009 Six Lives Parliamentary and Health Service Ombudsmen) 2010 Health Inequalities and People with Learning Disabilities in the UK (Public Health Learning Disabilities Observatory)

4. Our Passion, Your Care. Diagnostic overshadowing Some health professionals may not investigate issues early enough as they rationalise new symptoms as part of the learning disability rather than explain new symptoms particularly with mental health issues.

5. Our Passion, Your Care. What is a learning Disability? Valuing People (2001) defines learning disability as: Significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence) with Reduced ability to cope independently (impaired social functioning) That started before adulthood, with a lasting effect on development.

6. Our Passion, Your Care. Numbers Currently QOF registers identify 4.33 people with learning disabilities per 1,000 population, whereas the estimated prevalence of people with learning disabilities in the population is 2%-3%

7. Our Passion, Your Care. GP Registers The Enhanced service designed to encourage practices to identify all patients over 14 with LD. This is completed using QOF indicators and local authority data.

8. Our Passion, Your Care. Reasonable Adjustments Reasonable adjustments are those necessary changes to our normal routine practices which support accessibility to our service. Some adjustments are relatively easy to make where others may require more creativity and forward planning.

9. Our Passion, Your Care. The challenges for us! What do we do if we are faced with… Communication difficulties. Difficulty providing a sequential history. Provision of irrelevant information. Difficulty in understanding questions and responding to information quickly. Inability to deal with more than one question or task at a time. Repeating phrases in conversation. Lack of understanding or vagueness. Difficulty in following straightforward instructions. Poor planning and sequencing abilities. Difficulty in understanding abstract concepts such as time, distance or directions. Confusion about times of appointments.

10. Our Passion, Your Care. Communication Information should be given in a way that is meaningful for the individual. There are user accessible/easy read resources available- but where to find them? Keep information simple. Speak slowly, not too much information at a time Be clear, don’t use jargon Listen to the person with a learning disability and their ‘expert carers’ Share information

11. Our Passion, Your Care. Main Health Issues Gastro-intestinal Respiratory Dysphagia Diabetes Coronary Heart Disease Urinary Sepsis Epilepsy Thyroid function Osteoporosis Mental health Issues Dementia Sensory issues Dental care Postural care

12. Our Passion, Your Care. Annual Health Checks It is clear from the results of a systematic review (DOH 2010) of the impact of health checks that they typically lead to: (1) the detection of unmet, unrecognised and potentially treatable health conditions (including serious and life threatening conditions such as cancer, heart disease and dementia) (2) targeted actions to address health needs.

13. Our Passion, Your Care. Overcoming Barriers Accessing the practice, having the necessary equipment available Understanding information given Non- compliance Not being given copies of letters Using language which is not understood Assumptions

14. Our Passion, Your Care. Mental Capacity and Consent The two-stage test of capacity:  is there an impairment of, or disturbance in, the functioning of the person’s mind or brain?  if so, is the impairment or disturbance sufficient to cause the person to be unable to make that particular decision at the relevant time?

15. Our Passion, Your Care. Functional assessment Does the person have the ability to: understand the information? retain information related to the decision? use or assess the information while considering the decision? communicate the decision by any means?

16. Our Passion, Your Care. Pathway Identify Gather information about reasonable adjustments Easy read invitation with information about why Pre-health check questionnaire Bloods forms and urine pots (think about desensitisation) Complete health check- remember Mental Capacity Act (MCA)! Develop Health Action Plan- identify roles and responsibilities- make sure everyone knows the plan Referrals on to include reasonable adjustments required and MCA issues