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Valuing People (2001). Valuing People said that
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1. Valuing HealthImproving the Health of People with Learning DisabilitiesWest Midlands Event 30.4.2007
Rachel Heywood – CSIP/ Valuing People
Rick Robson & Ricky Owens - Shropshire
Jo Corbett - Staffordshire
Sherryl Gaskell- Coventry
Jackie Howells - Dudley
2. Valuing People (2001) Valuing People said that
“ all people with learning disabilities should get the same health services that are available to everyone else with expert care when they need it”
To enable people with learning disabilities to access a health service designed around their individual needs, with fast and convenient care delivered to a consistently high standard, with additional support where necessary”
3. Valuing People’s Health RIGHTS – to register with a doctor; to have access to community health services
CHOICE – of the right care and support
INDEPENDENCE – services will work with people to support them to be independent
INCLUSION – people must be included in the way their local health and social services are delivered
4. Health Inequalities People with learning disabilities have greater health needs than most of the population – but often get the worse health services (Research Evidence on health needs of people with learning disabilities 2003)
Health Services do not do enough to target their services/ or adapt them for people’s needs (DRC Enquiry 2006)
People with learning disabilities are dying from preventable conditions (Mencap “Treat Me Right/ Death by Indifference” 2007)
5. Some of the key health needs of people Inequalities in cancer rates, preventable cancers and reduced access to screening
Higher deaths from respiratory disease
Increasing rates of CHD
High rates of epilepsy
High rates of sensory impairments
Higher rates of dementia and young-onset dementia
Higher levels of osteoporosis
Less likely to eat healthy diet – more likely to be underweight or overweight
Lower levels of physical activity
Higher rates of severe mental health problems
(ref: Key Highlights of Research Evidence on the Health of people with Learning Disabilities 2003)
6. Key Health Targets for Valuing People People with learning disabilities to be registered with a GP, and identified via GP read-codes
People will have access to Health Facilitators
All people will have a Health Action Plan
Mainstream services (Primary Care and Hospitals) must make sure they are accessible for people
Work to be developed to ensure that health inequalities are targeted
Specialist services to meet specific and complex needs
7. From Valuing People to Our Health, Our Care, Our Say All-means-All
Our Health, Our Care, Our Say
for every person
For every person with a learning disability
Adds to Valuing People
8. What are the Key Things it Says? Choice and Control
Better information
Individual Budgets
Easier access to services
Community Based services
Local Services for Local People
Joined up Care
Health, Social Services and Community Services need to work better together
They need to make communication better and accessible
9. Equal Health People have the RIGHT to have the same access to good health
Health Action Plans, to develop into “Personal Health & Social Care Plans”
Good access to healthy opportunities i.e. Healthy Living Centres, Leisure Opportunities, Healthy Eating
10. Equal Health – Care from your Doctor Dr’s to make sure that INFORMATION is accessible and easy to understand
Dr’s will “buy” services for people – need to make sure they are the right services for people
11. What’s happening in the West Midlands Health Facilitation Nurses in PCT’s
Health Facilitation Network – share good practice, showcase at national events
Learning Disability Nurses Network
Access 2 Acutes Network
National scoping of best-practice
Learning Disability Partnership Boards – Health Groups
Health Commissioners Networks
12. Thanks for the invite
Privilege to be here and hope that you find it useful
Ricky to introduce self
RR
Flurry of e-mails between CH & RRThanks for the invite
Privilege to be here and hope that you find it useful
Ricky to introduce self
RR
Flurry of e-mails between CH & RR
13. Outline Examine the issues faced by
People with learning disabilities/ mental health need.
Carers including Family carers
and Staff
Identify some practical solutions
14. Problems
15. Problems
16. Small fish in a big pond
Circles of support
Who makes which decisions?
Who co-ordinates?
How does the ‘patient / client’ / person at the centre feel about all these people and their current situation
ROBSON Small fish in a big pond
Circles of support
Who makes which decisions?
Who co-ordinates?
How does the ‘patient / client’ / person at the centre feel about all these people and their current situation
ROBSON
17. Access to Secondary Healthcare - Learning Disabilty
18. Communication Face to face
Use person’s name
Speak slowly
Consider using audio recordings
Check and check again
Consent
Consult with carers Examples Dr Who learnt Maketon
Accessible format
Objects of reference
Speak to the personExamples Dr Who learnt Maketon
Accessible format
Objects of reference
Speak to the person
20.
We said that most important was
To tell NHS Direct what our needs were
and
To have good communication
We said that most important was
To tell NHS Direct what our needs were
and
To have good communication
21.
Communication Establish liaison group – PRH issue
Pre op. assessment
Commitment Can DO culture
Helping hands – ‘volunteers’ / care staff
Co-ordination role for C. / N SaLT Board master symbols
Code of practice need to be one care pathways SIG
Champion cultivate a spare special interest group
Difficult time for all parties
Little or no information
Often a poor comprehension of complex needs
Diagnostic overshadowing
Consent issues
Carers’ issues- informal -> relatives
formal
Confusion
Communication Establish liaison group – PRH issue
Pre op. assessment
Commitment Can DO culture
Helping hands – ‘volunteers’ / care staff
Co-ordination role for C. / N SaLT Board master symbols
Code of practice need to be one care pathways SIG
Champion cultivate a spare special interest group
Difficult time for all parties
Little or no information
Often a poor comprehension of complex needs
Diagnostic overshadowing
Consent issues
Carers’ issues- informal -> relatives
formal
Confusion
22. Improving Access
Now there is a big push by Health Services to get PwID better access to health.
Working with NHS Direct is only a little bit of the work being done.
Now there is a big push by Health Services to get PwID better access to health.
Working with NHS Direct is only a little bit of the work being done.
23. Thank youFor further information
Ricky Owen
Rick Robson
Telephone 01743 261 182
Email : rick.robson@shropshirepct.nhs.uk
www.valuingpeople.gov.uk
26. PURPOSE OF NETWORK
29.
Health Facilitation
South Staffordshire PCT
Introduce selvesIntroduce selves
30. Key issues of the training
Explore the meaning of learning disabilities and consider its effect
Explore primary healthcare for people with learning disabilities [PWLD]
Explore some possible barriers to healthcare
Have an awareness of recent government directives
Have an understanding of Health Action Planning [HAP]
Explore consent issues/Mental Capacity Act 2005
The training includes sharing information on these using group activitiesThe training includes sharing information on these using group activities
31.
32. Primary care
Quality outcomes framework – practices to produce a register of people with learning disabilities.
Data collected to cross reference other clinical registers and screening programmes.
Templates for use in Health Screening.
Reasons for training are to support requirements of qof and looking at options to support improving health of PWLD One of the ways of approaching this was to collect baseline info. Reasons for training are to support requirements of qof and looking at options to support improving health of PWLD One of the ways of approaching this was to collect baseline info.
33. Data collection sheet
Practice………………………………………………
People on Learning Disability Register (918e)
Adults (Over 18)………………………………………
Under 18……………………………………………...
Total on register……………………………………
No on other Clinical registers
Diabetes……………………………………………….
Epilepsy……………………………………………….
Asthma…………………………………………………
Hypertension………………………………………….
Obesity/BMI 30-50……………………………………
COPD………………………………………………….
CHD……………………………………………………
MH/depression/anxiety………………………………
34. Data collection sheet continued…
Screening
Number Eligible for Cervical screening……………
Number taken………………………………………..
Number declined……………………………………..
Number Eligible for Breast Screening……………..
Number Taken……………………………………….
Number Declined…………………………………….
Other
No with Downs syndrome…………………………..
No with Downs over 40……………………………..
HAP offered (9HB1)……………………………..
HAP completed (9HB4)……………………………...
HAP reviewed (9HB2)……………………………...
HAP Declined (9HB0)……………………………..
35. Epilepsy as expected, Diab similar rates to general pop although research suggests it could be as high as 9%. BMI not true reflection expect that to be much higher. COPD Respiratory disease is biggest cause of death. ?? The low figure reflects undetected cases. MH needs not recorded due LD.
Break info down by locality and practice.Epilepsy as expected, Diab similar rates to general pop although research suggests it could be as high as 9%. BMI not true reflection expect that to be much higher. COPD Respiratory disease is biggest cause of death. ?? The low figure reflects undetected cases. MH needs not recorded due LD.
Break info down by locality and practice.
36.
37. Uptake is quite good across staffs, however individual practices or groups are highlighted.Uptake is quite good across staffs, however individual practices or groups are highlighted.
38. NHs cancer screening suggests 1 in 4 or only 25% of women with LD will have the test. General uptake is 80%NHs cancer screening suggests 1 in 4 or only 25% of women with LD will have the test. General uptake is 80%
40. Coventry & Warwickshire Partnership Trust Sherryl Gaskell, Health Facilitator, Lead Nurse.
CLDT, Henley Green Road, Coventry, CV2 1AG.
Telephone 02476 785950
sherryl.gaskell@coventry.gov.uk
41. Health Facilitation A Learning Disability Nurse Led Model
Acute Liaison
Education
Group work
Health checks
42. Acute Liaison University Hospital Coventry & Warwickshire
Learning Disability Steering Group
Modern Matrons
Collaborative Protocols
Funding arrangements
Neurology links
Essence of Care
Link Nurses
43. Education Direct care providers
NVQ & LDAF accreditation
Well person group
Healthy Lifestyles – service users & staff teams training
Road-shows
44. Health Facilitation Process Why this method?
6 Localities within Coventry
Information packs sent to GP’s
Practice meeting
Read Code searches & cross reference
GP report
Database
45. Health ChecksFindings
49. Skin – Ulcerated and infected
50. Foot Health referral?
51. Foot Health
52. Outcomes Identified significant unmet need
Increase referrals
Raised awareness of client group
Increased knowledge base
Increased confidence
Collaborative working
53. The Future Hand role over the Practice Nurses
Joint checks with Practice Nurses
Audit health check outcomes
Develop training packages
Develop group work
Develop protocols to include PAM’s
54. Jackie HowellsDudley
“Increasing the uptake of breast screening for women with learning disabilities”
55. Screening programmes for women with Learning Disabilities Jacqui Howells
Dudley PCT.
56. Breast Screening Dudley breast screening service has created an improved service tailored to meet the needs of women with Learning Disabilities.
Prior to this service, there was no protocol to identify which women had LD, uptake was often poor and below the national average (41%).
57. Key objectives of the service To increase uptake of breast screening by women with learning disabilities.
To improve the health and well being of this excluded group.
To promote good health.
To provide information in an accessible, understandable way.
58. Service development Using the Special Needs Register, eligible women were identified by age, GP practice, address and date of birth.
Screening invitation letters were adapted to have symbols and simple language.
Each woman was assessed and offered support to meet their needs.
The use of “disabled” appointments meant women were given more time in department.
59. Results and Benefits Before the service uptake was 67% and 2006 it was 73%.
Three screen detected cancers have been identified and treated and two women still survive.
Women and their carers have been educated in breast awareness.
Women have re-attended for further screening appointments.
Women who have previously DNA’d have now attended.
60. Screening uptakes for LD women
61. Cervical Screening Due to a lack of information available in an understandable format, many women with learning disabilities do not attend the NHS cervical screening programme
As a result, uptake in this client group is exceptionally low with incidents of women being ceased from the programme for in appropriate reasons
62. Findings in Dudley. 314 women with LD were eligible, of those women only 125 were called.
104 were ceased from the programme for no reason
17 disclaimers signed
16 at GP request
6 as they have Downs Syndrome
17 have moved out of borough
7 have no cervix
22 no current trace of these women