1. Pictures used have been taken from Change Picture Bank, www.changepeople.co.ukwww.changepeople.co.uk, The Leicester Symbols Project and www.through-the-maze.org.uk Updated February 2007 Some information has been adapted from Cambridge Learning Disability Partnership & Wokingham PCT

2. What is a Health Action Plan? A Health Action Plan is a plan about your health. It says what things you are doing to keep fit and well. It says what else you want to do to be more healthy. It says what help you may need to keep healthy. Your Health Action Plan belongs to you and should be easy for you to understand. Your plan could be on a tape, video, a poster for your wall or a booklet like this one. Why have a Health Action Plan? Good health means being well in your body and in your mind. If you are healthy you will be able to do more things in life. If you are healthy you will be able to enjoy more things in life. We all have the right to be as healthy as we can be. A Health Action Plan will help you to be healthy. Health Action Plans

3. Health Facilitators. A health facilitator is someone who will help you to think about your health. You can choose someone to be your Health Facilitator. You should choose someone you know and trust, like a family member, friend or a support worker. Your health facilitator will listen to you. They will help you to make your own choices. They will help you with your health action plan. Who should have a Health Action Plan? Everyone with a learning disability should be asked if they want a Health Action Plan. You do not have to have one if you do not want one. It is a good idea to have a Health Action Plan If you need a lot of help to be healthy, If you have a lot of health needs, If things are changing in your life If you are getting older.

4. Starting a Health Action Plan. You can start your Health Action Plan at any time. This booklet has ideas to help you make sure you have a good health action plan. To start your plan you should think about all the things that are important to you, like getting a job or meeting people. The things that are important to you will help you to feel happy and well. If these things stopped it may affect your health. It is important for these things to continue. There are questions to help you to think about your health. There are spaces for you to write or draw what you have thought about. You can add pictures or photographs if you want to. You do not have to use this booklet as your Health Action Plan, it can be used as just a guide. Your Health Action Plan can be part of your Person Centred Plan or any other plan you may have. It is a good idea to have your plan checked by your doctor or nurse. It is a good idea to show your plan to the people who help you during the day so they can help you to be healthy. You can choose who sees your plan, you do not have to show it to anyone you do not want to.

5. This Plan Belongs to Resource developed by Leicestershire Partnership Trust. The pictures used in this plan are from the Change Picture Bank, the Leicester Symbols Project and www.through-the-maze.org.uk.

6. Next date to be reviewed: Review carried out Yes / No Next date to be reviewed: Review carried out Yes / No Next date to be reviewed: Review carried out Yes / No Next date to be reviewed: Review carried out Yes / No Next date to be reviewed: Review carried out Yes / No Next date to be reviewed: Review carried out Yes / No Date booklet started:

7. These people have a copy of my Health Action Plan These people can see my Health Action Plan I would like these people to be involved in helping me with my Health Action Plan My Health Facilitator is……………………………………………………… I understand what a ‘Health Action Plan’ is and have decided that I would like one. Signed…………………………………………………………………………. Health Action Plan

8. ……...……..……..is not able to understand what a Health Action Plan is. Health Action Plan These people have copies of …..……………………..Health Action Plan. These people will see …………………………...Health Action Plan. These people will be involved in ………………………Health Action Plan. ………………………..Health Facilitator is ………………………………….. These people decided it would be in ………………………. best interest to have a Health Action Plan. These are the important people in ………………………..life.

9. The things that are important to me The things that I enjoy doing

10. Family, friends and people who support me. If I became very poorly the people I would want you to contact are: My next of Kin is: My next of Kin’s telephone number is:

11. Name……………………………………………. What the person does…………………………. Address……………………………………….………… …………………………………………… Telephone No…………………………………. Last time they saw me………………………… Next appointment……………………………… Nurse Name……………………………………………. What the person does…………………………. Address……………………………………….………… …………………………………………… Telephone No…………………………………. Last time they saw me………………………… Next appointment……………………………… Doctor These are the people who support me with my health Name……………………………………………. What the person does…………………………. Address……………………………………….………… …………………………………………… Telephone No…………………………………. Last time they saw me………………………… Next appointment………………………………

12. Name……………………………………………. What the person does…………………………. Address……………………………………….………… …………………………………………… Telephone No…………………………………. Last time they saw me………………………… Next appointment……………………………… Name……………………………………………. What the person does…………………………. Address……………………………………….………… …………………………………………… Telephone No…………………………………. Last time they saw me………………………… Next appointment……………………………… Name……………………………………………. What the person does…………………………. Address……………………………………….………… …………………………………………… Telephone No…………………………………. Last time they saw me………………………… Next appointment………………………………

13. The support I need Going to the Dentist Going to the Opticians Going to the Doctors

14. Do you have any problems seeing or hearing? Do you wear glasses or a hearing aid? When were your eyes and ears last tested? What things do you do to make sure your eyes and ears are healthy? What help do you need to look after your eyes and ears? Have you had an eye test in the last 2 years? To help you to think about your hearing & vision use the Seeing & Hearing Checklist. Keeping my eyes and ears healthy How do you have let others know what you feel or think? Do you use speech or some other form of communicating? For people with communication difficulties, use the Communication Passport Worksheet available from the Learning Disability Speech & Language Therapy Department. Good Communication Things to think about:Area of Health

15. You can help me to communicate by doing these things How I communicate The things I already do to look after my eyes are The things I already do to look after my ears are

16. Area of healthThings to think about Weight Do you know how tall you are? Do you know what you weigh? Have you lost or gained weight recently? Do you weigh the right amount for your height and age? What things do you do to make sure you stay the right weight? Smoking Do you smoke? How many do you smoke? Do you know why you smoke? Do you want to stop smoking? Alcohol Do you drink alcohol? How much do you drink? Do you want to cut down on how much you drink? Is there anything that makes you feel ill when you swallow it, touch it or if it comes near you (an allergy). Have you had any problems with your health in the past that people may need to know about? Has anyone in your family had any health problems that you could also suffer from such as diabetes, heart problems and arthritis? Have you had a Well man/ woman check up at your doctors if you have not visited your doctors in the last year?

17. Alcohol Smoking Weight

18. What medicines do you take (tablets/ syrups)? What are you taking your medication for and how long you have been taking it? Has your doctor told you about the side effects of the medication that you take? Are you allergic to any medication? Do you have problems taking medicines? What help do you need to take your medicine? Would you like to be able to take your medicine independently? What do you have to do to look after your medication? Have you had a medication review in the last year for any routinely prescribed medication? Medicines Things to think about:Area of Health Do you have any special health needs that you already know about like epilepsy, asthma, diabetes or high blood pressure? What things do you do to look after your special health needs so that you are healthy? What help do you need to look after your special health needs? Do you want to know more about your special health needs? Have you had a recent check up at your doctors for your special health need? Special Health Needs

19. The things I am already doing to look after my special health needs are:

20. I am allergic to this medication Medication This is the medication I take Other information How I like to take my medication, Reason for taking medication Dose & TimeForm – tablet or syrup Name of medication

21. Do you have difficulty moving parts of your body? Do you need things to help you move around like a walking stick, frame or a wheel chair? What help do you need to move around? Do you have help from a physiotherapist? Moving Around Do you have any problems with your feet or toenails such as fungal infections? What things do you do to look after your feet and toenails? Are you able to cut your own toenails? What help do you need to look after your feet or toe nails? Do you get any pain in your feet? What things do you do to reduce the pain in your feet? Residential home staff can only file toenails following training from a chiropodist. Contact your community hospital chiropody department to arrange training. Keeping my feet healthy Things to think about:Area of Health

22. You can help me to move around by doing these things: These are the things that help me to move around Moving Around Feet and Toenails The things I already do to keep my feet and toenails healthy are

23. Area of Health&Things to think about Keeping my teeth healthy How do you look after your teeth and gums? What problems do you have with your teeth and gums? What help do you need to look after your teeth and gums? Have you changed your toothbrush in the last 3 months? Have you had your teeth checked by a dentist in the last 6-12 months? Skin Do you have any problems with your skin such as rashes or itchy skin? Do you suffer from pressure sores? Do you have any moles? Do you know what your moles look like? How do you look after your skin and keep it healthy? What do you do to protect your skin when it is sunny? Using the Toilet Do you have problems going to the toilet? Do you suffer from any pain or any other problems when going to the toilet? What help do you need to go to the toilet?

24. The things I already do to look after my teeth and gums are: Looking after my Teeth and gums The things I already do to look after my skin are: Looking after my skin You can help me with going to the toilet by doing these things: Using the Toilet

25. Area of healthThings to think about Feelings and mood Are there things that often make you feel sad, scared, worried or angry? Has anything changed the way you feel i.e. someone dying or moving house? What things do you do to stay happy and well? What support do you need to stay happy and well? Are you on Care Programme Approach? Your health action plan can be part of your CPA. Sleep Do you sleep well at night? What helps you to sleep well at night? Do you sleep during the day? Death & dying Would you like to talk to someone about death and dying? Pain How do the people that support you know if you are in pain or not? How do you tell people when you are in pain? How do you tell people if you feel unwell?

26. How people know when I’m well and happy How people know when I’m unwell or sad To support me to stay happy and well these are the things you can do Sleep Death and Dying PainHow people know when I’m in pain

27. Do you check your testicles (balls) for lumps or changes? Do you want to know more about checking your own testicles (balls)? How do you keep yourself clean and tidy? Do you have any close relationships? Do you understand about safe sex? Health issues for men Do you know how to check your breasts for lumps or changes? Have you had your breasts screened in the last 3 years (If you are between 50-70 years old)? Do you want to know more about checking your breasts? Do you want to know more about breast screening? Have you had a smear test in the last 3 years (If you are aged between 25-64 years old)? Do you want to know more about having a smear test? Do you have regular periods? Do you need any help when you are on your period? How do you keep yourself clean and tidy? Do you have any close relationships? Do you understand about safe sex? Health issues for women Things to think about:Area of Health

28. Health Issues for Men Health Issues for Women

29. What sort of exercise do you like to do? How much exercise do you do each day? Do you do 30 minutes of exercise or physical activity each day? Do you want to do more exercise? For improved health, activity should be increased gradually to 30 minutes of moderate intensity for 5-7 days of the week. The 30 minutes can be broken down into 10 –15 minute sessions per day. Exercise and physical activity Things to think about:Area of Health There are lots of different types of exercise and activity, think about what you can easily build into your day such as using the stairs not the lift or walking some of the way to work. House Work Cycling Stair climbing

30. Exercise planner I am going to try and do ……… minutes of exercise or activity each day The activities I would like to try The activities I like doingThe activities I do not like doing

31. The activities I do each day ampm Monday Tuesday Wednesday Thursday Friday

32. Other fruit or vegetables I’d like to try What sort of food do you eat? Are you eating well – a healthy balanced diet? Do you eat 5 pieces of fruit and vegetables a day? Do you grill or steam your food instead of frying? What help do you need during mealtimes? How much fluid do you drink each day, such as water or sugar free juice or squash? What are you going to do to make sure you eat healthy food and drink the right amounts Do you have problems with eating or swallowing? If you have problems with eating & drinking, you can contact the Learning Disability Service, who will assess your needs. Healthy Eating and drinking The fruit and vegetables I don’t like:The fruit and vegetables I like: There is an easy read leaflet all about 5 a day which has pictures of different fruit and vegetables. It tells you about what a portion is. You can get a copy of the leaflet from the DOH www.5aday.nhs.uk

33. Sunday Saturday Friday Thursday Wednesday Tuesday Monday 54321 5 a day check list Try and eat at least 5 portions of fruit and vegetables a day. You can use this diary to help you eat more fruit and vegetables. Every time you eat a portion of fruit or vegetables write what you have had in the box.

34. Drinks check list Try and drink 8 to 10 cups, glasses or mugs of fluid a day. Try and drink more water or have drinks that have no added sugar. Remember to drink more during hot weather. Monday Tuesday Wednesday Thursday Friday Saturday Sunday

35. Who will helpWhat needs to be doneBy when Health Problem Date Name of health facilitator Health Action Plan

36. Appointments If you are going to an appointment on your own you could use this sheet to help you remember what the health professional tells you to do. What needs to be doneOK or not OKDate and Time

37. Ring NHS Direct: You can ring this number if you are worried about your health. They will ask you questions. They might suggest you go to see the Doctor or tell you what you could do if you are feeling poorly. The number to dial is 0845 4647 Ring the ‘Lead Health Facilitator’, Laura Summers. She will be able to provide you with support and advice and will help you with any worries you have about Health Action Plans. The number to dial is: 0116 225 5299 or 07917271278 Ring the Adult Learning Disability Services. The teams are made up of Community Nurses, Psychiatrists, Psychology, Physio’s, Speech and Language Therapy and Occupational Therapists (OT’s), & Social Workers. There are 6 Locality Teams in Leicestershire and there is a team in Leicester city. Hinckley and Bosworth, 01455 636964 Leicester City, 0116 2255200Oadby, Wigston & Blaby, 0116 2787111 Market Harborough, 01858 465331Melton and Rutland, 01664 561074 North West Leicester, 01530 834422Charnwood, 01509 568866 Contact Details

38. Valuing People said that a Health Action Plan should be based on a comprehensive health check undertaken within Primary Care. It is possible that from 2007 your local doctor’s surgery may start offering yearly health checks for their patients with a learning disability. Prior to this you could contact your doctor’s surgery and ask for a general health check or a well women/man check. This section should be filled in with support from your the Health Facilitator before your appointment. It should be given to the person doing the health check to help them during your appointment. You should keep a copy of this information for yourself. There is space for the person undertaking the health check to make summary notes if they want to and suggestions about what actions they may want you to take. There is a blank Health Action Plan at the end, which the person undertaking the health check should be asked to fill out if there are any health needs identified during the appointment. This information should then be added to the accessible Health Action Plan by the health facilitator. If you have already started a Health Action Plan you may want to show it to the person doing the health check to make sure you are doing the right sort of things. Section 2 Information for my health check (To be taken to the GP practice for Health Checks) 1

39. Learning Disability Template (PCAG Eu81-z) Date:______________________________________________________________ What is the cause of learning disability (if known)___________________________ My main carer is:____________________________________________________ Relationship:________________________________________________________ If my carer is unpaid, are they on the carers register?________________________ How do you communicate?______________________________________________________ Health Screen Template How much do you weigh?___________________How tall are you?_____________ Have you had a hepatitis B injection? ______________ Date: Have you had a flu injection?_____________________ Date: Have you ever had a TB injection?_________________ Date: Are you aware of any family history of bowel cancer?_________ Do you enjoy your meals?_____________________________________________ On average how many cups of fluid do you drink in a day____________________ Is this more or less or the same as 6 months ago?__________________________ Do you smoke?______________________________________________________ If yes, how many each day ____________________________________________ Does anyone in your house smoke?_____________________________________ Do you drink alcohol?________________________________________________ If yes, how many units each week_______________________________________ Are you often short of breath?__________________________________________ Do you do any exercise?______________________________________________ Name:_______________________________Completed by:____________________ 2

40. Medication Review Template Do you take tablets/medicines?_________________________________________ _____________________________________________________________________________ _______________________________________________________ __________________________________________________________________ Who monitors your medication?_________________________________________ When was your medication last reviewed? 6months1yearlonger Do you think you suffer from any side-effects?_____________________________ Do you have any problems taking your medication?_________________________ Possible actions to be taken:–(To be completed by nurse in GP practice) Consider adding a Flag for communication methods BMI Check BP Consider Framingham CHD 10 year risk template Arrange cholesterol check Check feet Provide health education –Easy read 5 a day Referral to dietician, Learning Disability professionals, smoking cessation clinic, chiropody, GP referral exercise scheme. Contraception template This section asks you to consider sexual health. The subject is difficult for some people to talk about. It is important that sexual health is not ignored. Please think about the needs of the individual when answering these questions. Are you sexually active?______________________________________________ If so: Do you understand about pregnancy?___________________________________ Do you use condoms?_______________________________________________ Do you use any form of contraception?__________________________________ Possible actions to be taken:–(To be completed by nurse in GP practice) Referral to GP for full medication review. 3

41. Women -Neoplasm / Cervical screen Templates Have you ever had a smear test?_______________________________________ Have you ever had a mammogram? (breast screening)_____________________ Do you check your own breasts for changes?_____________________________ Do you have any concerns about your periods?___________________________ Men – Do you check your testicles for changes? Disability Health Assessment Template (PCAG) Do you have any trouble with your teeth?________________________________ Do you go to the dentist twice a year?___________________________________ If not why? ________________________________________________________ When did you last go to the dentist?_____________________________________ Do you have any trouble with your sight?_________________________________ When did you last visit an optician? _____________________________________ Do you have glasses?_______________________________________________ Possible actions to be taken:–(To be completed by nurse/doctor) Health Education – NHS Easy read Cervical/ breast screening leaflets. Referral to Community Learning Disability Teams –education/ preparation 4

42. Do you sometimes have trouble with your ears?______________________________ Have you ever had your hearing tested?____________________________________ Do you have a hearing aid?______________________________________________ Do you have problems with mobility?_______________________________________ Do you have any problems with eating or drinking?___________________________ Possible actions to be taken:–(To be completed by nurse/doctor) Check ears Referral to Community Dental Service – if has anxiety/fear of dentist Referral to LRI specialist hearing clinic Referral to eye clinic Referral to physiotherapy Referral to Community Learning Disability Team for eating and drinking assessment. Templates for Asthma/diabetes/thyroid function/mental health/lithium monitoring/ Epilepsy (as required) Do you feel well?_________________________________________________ Do you suffer from: Lots of headaches_________________________________________________ Lots of chest infections_____________________________________________ Lots of urine infections_____________________________________________ 5

43. Itching anywhere on the body________________________________________ Any allergies_____________________________________________________ Asthma_________________________________________________________ When did you last have an asthma review?____________________________ Diabetes________________________________________________________ When did you last have an diabetes review?____________________________ Thyroid problems________________________________________________ When did you last have an thyroid review?______________________________ Mental Health Problems___________________________________________ When did you last have an mental health review?________________________ Continence Any problems with bladder or bowel control_____________________________ Epilepsy________________________________________________________ How often do you have seizures______________________________________ Who monitors your epilepsy?________________________________________ When did you last have an epilepsy review?____________________________ Possible actions to be taken:–(To be completed by nurse/doctor) Urinalysis Referral to specialist dermatology/asthma/diabetes/continence professionals Referral to Community Learning Disability Team for any uncontrolled epilepsy Contact CPA coordinator re mental health review. 6

44. Health Action Plan Name: To be completed by nurse or doctor in GP practice Completed with: Date:Health Issue:Health Action needed:Review datePerson responsible 7 This information should be added to the main HAP by the Health Facilitator so that the person can understand it.