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HealthInequalitiesandPeoplewithLearningDisabilitiesintheUK:2011ImplicationsandactionsforcommissionersandprovidersofsocialcareEvidenceintopracticereportno.4SueTurnerNovember2011
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HealthInequalitiesandPeoplewithLearningDisabilitiesintheUKImplicationsandactionsforcommissionersandprovidersofsocialcareEvidenceintopracticereportno.4
ContentsPage
Introduction……………………………………………………………………………………………………………………… 4
HealthInequalities…………………………………………………………………………………………………………… 5
1 Thesocialdeterminantsofpoorerhealth…………………………………………………………………. 6Suggestedactionsforsocialcare
2 Increasedriskofhealthproblemsassociatedwithspecificgeneticandbiologicalcausesoflearningdisabilities…………………………………………………………………… 7
Suggestedactionsforsocialcare
3 Communicationandunderstandingofhealthissues…………………………………………………….. 8Suggestedactionsforsocialcare
4 Personalhealthrisksandbehaviours……………………………………………………………………….. 10Suggestedactionsforsocialcare
5.Accesstoandthequalityofhealthcareandotherservices………………………………………… 11
Suggestedactionsforsocialcare
Summaryofsuggestedkeyactions…………………………………………………………………………………………… 13
Conclusions…………………………………………………………………………………………………………………………………14
References…………………………………………………………………………………………………………………………………15
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Abouttheauthor
SueTurnerinitiallytrainedasanurseforpeoplewithlearningdisabilitiesinBristol.Shehasworkedwithintraining,asaNurseAdvisorinGloucestershire,andhasmanagedavarietyofservicesforpeoplewithlearningdisabilitiesinGloucestershireandBristolincludingcommunitylearningdisabilityteams.Suewas
theValuingPeopleLeadfortheSouthWestRegionforfourandahalfyears,initiallyjobsharingtherolewithCarolRobinson.Duringthistime,SuedevelopedthehealthnetworkintheSouthWestandintroducedthehealthself‐assessmenttotheregion.ShelaterworkedcloselywiththeStrategicHealthAuthorityonits
implementation.SueisnowleadingontheImprovingHealthandLivesprojectfortheNationalDevelopmentTeamforInclusion.
Acknowledgements
WewouldliketothankalltheparticipantsatourImprovingHealthandLives–implicationsforsocialcareeventsfortheirhelpfulcommentsonthedraftofthisdocument.
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IntroductionImprovingHealthandLives(IHaL)istheLearningDisabilitiesPublicHealthObservatory‐www.ihal.org.uk–
athreeyearprojectfundedbytheDepartmentofHealthinresponsetoSirJonathanMichael’s2008inquiryintoaccesstohealthcareforpeoplewithlearningdisabilities1.Thenationalobservatoryaimstoprovidebetter,easiertounderstandinformationonthehealthandwellbeingofpeoplewithlearningdisabilities
andtohelpcommissionersandothersmakeuseofexistinginformationwhilstworkingtowardsimprovingthequalityandrelevanceofdatainthefuture.
MostIHaLpublicationsareaimedathealthcommissionersandproviders.However,anumberofthehealthinequalitiesthatpeoplewithlearningdisabilitiesfacealsohaveimplicationsforsocialcarecommissioners
andproviders,andsocialcareprovidershavearesponsibilitytosupportpeopletoaccesshealthservices.
BasedontheHealthInequalitiesandPeoplewithLearningDisabilitiesintheUK:2011report2thisevidenceintopracticereportsetsoutthedeterminantsofhealthinequalities,andaskswhattheymeanforsocialcareincludingsocialcarecommissioners,caremanagers/socialworkers,providersandsupportworkers.
Whyshouldsocialcarecommissionersandprovidersbotherabouthealthinequalities?
• Somehealthinequalitiesarerelatedtowidersocialcareissueslikepoverty,unemploymentand
poorhousing.
• Theimpactofhealthinequalitiesisserious,affectingbothqualityoflifeandlifeexpectancy.
• Socialcareprovidershavealegalduty(undertheHealthandSocialCareAct2008(Regulated
Activities)Regulations2010)tosupportpeopletoaccesshealthcareservices.Anunderstanding
ofhealthinequalitiesandtheirdeterminantscanenablesupportstafftobemoreeffectiveinthis
role.
• Poorhealthcancostmoney.Forexample,peoplewithlearningdisabilitieswhoareinpain
associatedwithuntreatedmedicaldisordersmaydevelopchallengingbehaviour.Peoplewith
poormobilityduetolifestyleissuessuchasobesitycanrequirecostlyequipment.Addressing
healthinequalitiescanmakeasignificantcontributiontothepreventionagendainsocialcare.
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Healthinequalities
Peoplewithlearningdisabilitieshavepoorerhealththantheirnon‐disabledpeers.Thesedifferencesaretoanextentavoidable,andassuchrepresenthealthinequalities.Theimpactoftheseinequalitiesisserious.
Theresearchindicatesthatpeoplewithmoderatetoseverelearningdisabilitiesarethreetimesaslikelytodieearlythanthegeneralpopulation.
Therearefivekeydeterminantsofhealthinequalities2:
1. Greaterriskofexposuretosocialdeterminantsofpoorerhealthsuchaspoverty,poorhousing,
unemploymentandsocialdisconnectedness.
2. Increasedriskofhealthproblemsassociatedwithspecificgenetic,biologicalandenvironmental
causesoflearningdisabilities.
3. Communicationdifficultiesandreducedhealthliteracy.
4. Personalhealthrisksandbehaviourssuchaspoordietandlackofexercise.
5. Deficienciesrelatingtoaccesstohealthcareprovision.
Wesuggesttheactionsdescribedbelowcanhelpsocialcarecommissionersandproviders,inpartnership
withhealthcommissionersandcommunitylearningdisabilityteams/specialisthealthstaffimprovehealth
outcomesforpeoplewithlearningdisabilities.
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1. Thesocialdeterminantsofpoorerhealth
Theimportanceofpoverty,poorhousing,unemploymentandsocialisolationasfactorsleadingtopoorer
healtharewellknown.Peoplewithlearningdisabilitiesaremorelikelytoexperiencesomeorallofthese
factors.
Bullyingatschoolanddiscriminationinadulthoodarefrequentlyexperiencedbypeoplewithlearning
disabilities.Theyarealsorelatedtopoorerhealth.Peoplewithlearningdisabilitiesfromminorityethnic
communitiesmayexperiencepovertyandracism,andthusfacegreaterhealthinequalitiesthanpeople
withlearningdisabilitiesfrommajorityethniccommunities.
Suggestedactionsforsocialcare
o SocialcarecommissionerscanworkwithClinical
CommissioningGroups(CCGs)andPublicHealthtopool
knowledgeandunderstandingofthesocialdeterminants
ofhealth.Informationontheseissuesshouldbe
includedintheJointStrategicNeedsAssessment(JSNA)
toinformHealthandWellbeingBoards.Agoodexample
ofaJSNAcanbefoundat:
www.cambridgeshirejsna.org.uk/
o Planstoincreaseemploymentandtenancies/home
ownership(settledaccommodation)forpeoplewith
learningdisabilitiesshouldbepartoflocalstrategies.
Socialcarecommissionersandcaremanagersplaya
crucialroleinchangingthecultureoflocalservicesso
thatemploymentandsettledaccommodationareseen
aspriorities.
o Socialcarecommissionersandcaremanagerscan
supportthecreativeuseofpersonalbudgetstoenable
accesstothecommunityandsupportpeopleintowork.
TheJobsFirstinitiativeistestingtheuseofpersonal
budgets,alongwithotherfundingstreamstofund
employmentrelatedsupport.Theinterimreportis
availableat:
www.kcl.ac.uk/sspp/kpi/scwru/res/roles/jobs.aspx
o Socialcarecommissionerscanworkwithlocal
authoritiestoenableaccesstocommunityfacilitiesas
thiscancombatsocialexclusionandisolation,andresult
inhealthbenefits.Somelocalauthoritieshaveemployed
stafftosupportaccesstocommunityfacilities.
o Socialcarecommissionerscanworkwiththepolicetodeveloplocalstrategiestoaddresshate
crime.Goodpracticeguidancecanbeaccessedat:
http://www.inclusionnorth.org/documents/HateCrimeGoodPracticeGuide.pdf
Forexample:InDevon,caremanagerswhobringsupportplanstopanelareaskediftheyhaveconsidered
employmentfortheindividualbeforefundingisagreed.Providersarealsoaskedhowmanypeopleofworkingage
theysupporthaveemploymentof16+hoursaweek.Askingthesequestionshashelpedstafftothinkabout
employmentasthefirstoptionforindividuals.
Forexample:TheInclusiveFitness
Initiative(IFI)supportsthefitness
industrytobecomemoreinclusiveforall
disabledpeople.Itaddressesfourkey
areas:accessiblefacilities,inclusive
fitnessequipment,stafftrainingand
inclusivemarketingstrategies.South
GloucestershireemployedanIFIco‐
ordinatortoencouragetheengagement
ofpeoplewithlearningdisabilitiesin
physicalactivity,andincreasetheuptake
oftheIFIMark,aqualitymark
accreditationscheme.Mostleisureand
fitnessfacilitiesinSouthGloucestershire
arenowaccredited.Forfurther
informationonIFIpleasegoto:
www.inclusivefitness.org/
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2. Increasedriskofhealthproblemsassociatedwithspecificgeneticandbiologicalcausesoflearningdisabilities
Thereareanumberofsyndromesassociatedwithlearningdisabilitieswhicharealsoassociatedwith
specifichealthrisks.Forexample,peoplewithDown’ssyndromearemorelikelytoexperienceearlyonsetdementia,andpeoplewithautisticspectrumdisordersaremorelikelytohavementalhealthproblems.
Recentresearchhashighlightedpossibleinteractionsbetweensomegeneticcausesforlearningdisabilityandtheenvironment.Forexample,peoplewithAngelmansyndromemaydisplayaggressiveorself‐
injuriousbehaviourifitiseffectiveinmaintainingtheattentionofcarers,astheyoftenfindsocialcontactverypleasing.
Suggestedactionsforsocialcare
o Socialandhealthcarecommissionersneedtoworkwith
publichealthandCCGstounderstandthelocalpopulation
ofpeoplewithlearningdisabilitiesintermsofageprofile,
ethnicgroupandothersignificantpopulationissuessuch
asnumberofpeoplewithDown’ssyndrome,sothatthey
canplanstrategicallytomeetfutureneed.
o Providersandsupportstaffneedtounderstandthe
implicationsofspecificsyndromesandplanperson
centredcareaccordingly.Trainingshouldbeprovidedfor
supportstaffasappropriate.Communitylearning
disabilityteamscanalsoprovideadviceandsupport.
o Providersandsupportstaffshouldencourageandsupportpeoplewithlearningdisabilitiestohave
healthchecks(seenextsection).Thereareanumberofsyndromespecifichealthchecksthatcan
becarriedout.Forfurtherinformationsee aStepbyStepguidetoannualhealthchecksforGPs5:www.rcgp.org.uk/pdf/CIRC_A%20Step%20by%20Step%20Guide%20for%20Practices%20(October%
2010).pdf
Forexample:TheTeesintegrated
commissioninggrouprecognisedthat
theyhadanageinglearningdisability
populationatriskofdementia.They
jointlyfundedadevelopmentpostto
supporttheimplementationofthe
NationalDementiaStrategy3.
Understandinglocaldemographyand
providingapopulationforecasttoplan
futureserviceswasamajorpartofthe
project4.Forfurtherinformationsee:
www.phine.org.uk/securefiles/110720_1
133//South%20Tees%20LD%20Dementi
a%20Report%202010.pdf
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3.Communicationandunderstandingofhealthissues
Peoplewithlearningdisabilitiesmayhavepoorawarenessoftheirbodiesandhealthissuesgenerally.Theymaynotexpresspainordiscomfortinawaythatothersrecognise.Limitedcommunicationskillsmayreducetheirabilitytoletothersknowthatsomethingiswrong.Asaresult,thosewhoknowtheindividual
wellplayanimportantroleintheidentificationofhealthneedsformanypeople,particularlythosewithmoreseverelearningdisabilities.
Suggestedactionsforsocialcare
o Supportstaffareoftenthefirsttonoticechangeswhichmayindicateahealthproblemiftheindividuallivesinsupportedlivingorresidential
care.However,researchindicatesthatsupportstaffmayfeeltheyarelackinginskills,knowledgeandtrainingtoidentifyhealthneeds2.Socialcare
providersneedtoensurethatsupportstaffreceivetrainingsothattheycanrecognisehealthneeds.Socialandhealthcarecommissionerscan
jointlycommissioncommunitylearningdisabilityteamstosupportproviders,enablingsupportworkerstorecognisepotentialproblems,andtakeaction.Thewayinwhichindividualsexpress
painordiscomfortshouldbedocumented,andsupportstafftrainedtousethisinformationandreactappropriately.
o Socialcareprovidersshouldsupportpeoplewithlearningdisabilitiestounderstandmoreabouttheirbodiesandgeneralhealthissues.Communitylearningdisabilityteamscansupportproviderswiththeseissues.Therearealsosomegoodaccessibleresourcesavailableat:
www.easyhealth.org.ukandwww.apictureofhealth.southwest.nhs.uk
o AnnualhealthchecksarecurrentlypartofaDirectedEnhancedServicewhichrequiresPCTstooffer
GPstheopportunitytocarryouthealthchecksonpeoplewithlearningdisabilitiesknowntosocialcareforafixedpayment.Thereisclearevidencethathealthchecksleadtothedetectionofunmethealthneeds,andresultintargetedactionstoaddressneedsidentified6.However,althoughthe
numberofhealthchecksisimproving,in2010/11justunder50%ofthoseeligiblereceivedahealthcheck7.GPpracticesshouldinvitepeoplewithlearningdisabilitieswhoareeligibletoattendforahealthcheckappointment.Itisgoodpracticetoincludeapre‐healthcheckquestionnairewiththe
invitation8,9.Foranexampleofaquestionnaire,pleasesee:www.oxleas.nhs.uk/site‐media/cms‐downloads/Microsoft_Word_‐_Oxleas_HAP_prehealth_check_for_DES.pdfProviders/supportstaffcanhelpthepersonhaveasuccessfulhealthcheckby:
Helpingthepersonwithlearningdisabilitiesunderstandtheimportanceofahealth
check. Supportingthemtofilloutthepre‐healthcheckquestionnaire. Arrangingforsomeonewhoknowsthepersonwelltogowiththemtothehealth
check. Workingwithcommunitylearningdisabilityteams/specialisthealthstaffandthe
GPpracticetoputinplaceanyreasonableadjustmentsnecessary(suchaslonger
appointmenttimes)forthepersontohaveasuccessfulhealthcheck.
Forexample:TheAnticipatoryCare
Calendar(ACC)wasdevelopedin2006bytheMerseysideandCheshireCancerNetwork.Itworksonatrafficlight
systemandisdesignedtoalertsocialcarestafftohealthchangesandprovidecleardirectionsaboutaccessingprimary
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Furtherinformationabouthealthchecksisavailableat:www.ihal.org.uk
o HealthActionPlanscanbeahelpfulwayofsupportingthepersonwithlearningdisabilitiesto
understandabouttheirhealth.Theyshouldbeupdatedafterahealthcheck.Providers/supportstaffshouldensurethatthepersonknowsaboutandattendsanyfollow‐upappointmentsandreferrals.Specialisthealthstaff/communitylearningdisabilityteamscansupportproviderswiththe
introductionandmaintenanceofHealthActionPlans.
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4. Personalhealthrisksandbehaviours
Peoplewithlearningdisabilitiestakelessexercisethanthegeneralpopulation,andtheirdietisoftenunbalancedwithaninsufficientintakeoffruitandvegetables.Peoplewithlearningdisabilitiescanalsofindithardtounderstandtheconsequencesoflifestyleontheirhealth,andaremuchmorelikelytobe
overweightthanthegeneralpopulation.
Peoplewithlearningdisabilitiesarealsomuchmorelikelytobeunderweightthanthegeneralpopulation.
Youngpeoplewithmildlearningdisabilitieshavehigherratesofsmokingthantheirpeers.
Peoplewithlearningdisabilitiesmaynothavethesameaccesstoinformationaboutsexandsexualityasotheryoungpeople,andmayfaceparticularbarriersinaccessingsexualhealthservices.
Suggestedactionsforsocialcare
o Socialcareproviders/supportworkersneedtounderstandwhatconstitutesahealthylifestylesotheycanenablepeoplewithlearningdisabilitiestomake
informedchoices.Healthandsocialcarecommissionersneedtoensurethathealthpromotionandadviceisavailabletosocialcareproviders.
o Providers/supportworkersneedtoensurethatpeople
withlearningdisabilitieshaveaccessibleinformationand
supporttounderstandlifestylechoiceswithregardtodietandexercise.Accessibleinformationisavailableasreferencedabove.
o Providers/supportworkersneedtobeabletorecognise
ifapersonwithlearningdisabilitiesisunderweight,and
seekmedicaladvice.
o Providers/supportworkersshouldsupportpeoplewith
learningdisabilitiestoaccessgeneralhealthpromotioninitiativesregardingtobacco,alcohol,substancemisuseandsexualhealthinthesamewayasthegeneral
population.Socialcarecommissionersshouldalerthealthcommissionerstoanyproblemswithaccesssothattheycanbeaddressed.
Forexample:HaltonhasaCommunityBridgeBuildingTeamwhichsupportspeopletousecommunityfacilities.P
wasrecentlyreferredtotheteamasonthedayhehadnoactivitieshewasboredandinthepasthadspenttheday
drinking.Plikesphysicalactivitiesbuthadbeenunabletoorganiseanythingforhimself.Afterdiscussingoptions
withPhedecidedhewouldliketousealocalleisurecentretogethimselffit.P
wassupportedtogetaHaltonLeisureCardandabuspass,andbeganusingtheleisurecentrealmostimmediately.P
nowusestheleisurecentreindependently,andithasbeennotedhowmuchhappierheis.Psayshefeels
fitter,haslostweightandiskeentocontinuewithhisnewhealthierlifestyle.TheteamkeepintouchwithPto
monitorhowthingsaregoingbuttodatePhasnotneededanyextrasupportandseemstobetakingfulladvantageof
hisnewfoundindependence.
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5. Accesstoandthequalityofhealthcareandotherservices
Peoplewithlearningdisabilitiescanfindithardtoaccesshealthservicesforanumberofreasons,includingthefailureofhealthservicestomakereasonableadjustmentstoenableaccess,disablistattitudesamonghealthcarestaffand‘diagnosticovershadowing’(whensymptomsofillhealtharemistakenforbehavioural
problemsorasbeingpartoftheperson’slearningdisability).
Peoplewithlearningdisabilitieshavealoweruptakeofhealthpromotionandscreeningopportunitiesthanthegeneralpopulation.Thismeansthatearlystagecancersmaynotbepickedup,anddental,hearingandsightconditionsremainuntreated.Useofprimarycareservicesisalsolowerthanmightbeexpectedfor
peoplewithlearningdisabilities,whooftenhavechronichealthconditions.
Peoplewithlearningdisabilitieswhohavecancerarelesslikelytobetoldoftheirdiagnosisorprognosis.Theyarelesslikelytobeinvolvedindecisionsabouttheircare,givenpainrelieforhaveaccesstopalliative
care.
Peoplewithlearningdisabilitiesmaynotgetthesameaccesstoprimaryandsecondarymentalhealthservicesasthegeneralpopulation.
Averyhighproportionofpeoplewithlearningdisabilitiesarereceivingpsychotropicmedication,mostoftenanti‐psychoticdrugs,tocontrolchallengingbehaviourdespitelackofevidencefortheireffectiveness
andevidenceofconsiderableharmfulsideeffects.
ThereisworryingevidenceoffailuretocomplywiththeMentalCapacityActincludingexamplesofDoNotResuscitateordersbeingplacedonpatients’recordswithoutdiscussionwiththeindividualorfamily,andfamilycarersbeingaskedtosignconsentformsforadults10.Thereisalsoevidencethatsocialcarestaff
lackunderstandingoftheMentalCapacityAct2
Transitionbetweenservicesremainsproblematicforsomepeoplewithlearningdisabilities.Thisincludestransitionbetweenchildren’sandadultservices,andothertransitionssuchastransitionbetweenhospitalandhomeorcommunity.
Suggestedactionsforsocialcare
Manyoftheseissuesareabouthealthservices.Howeveritisimportantthatsocialcareproviders/supportstaffunderstandthedifficultiespeoplewithlearningdisabilitiesface,andtheirrightstoreasonableadjustments,sotheycanactasadvocateswherenecessary.Providers/supportstaffalsohavearolein
enablingpeoplewithlearningdisabilitiestoaccesshealthserviceseffectively.
o Providers/supportstaffcanmakeamajorcontributiontotheeffectivenessofthecarepeoplereceivefromhealthservices.Theycanprovideimportantinformationaboutthewayapersoncommunicates,riskissuesandtheirmedicalhistory.Ifthepersonneedstobeadmittedtohospital,
thereisahelpfulguide11thatsetsoutwhathospitals,familycarersandpaidsupportstaffcandotohelpmaketheperson’sstayasuccess.Theguidecanbedownloadedfrom:www.hft.org.uk/Resources/Home%20Farm%20Trust/Family%20Carer%20Support/Documents/Wo
rkingTogether.pdf
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o PatientPassportsareagoodwayofprovidingvitalinformationabouttheindividualtohospital
staff.Providerscanworkwithcommunitylearningdisabilityteams/specialisthealthstafftoensurethatpeoplewithlearningdisabilitieshavePatientPassports,andthattheseareusedshouldthepersonneedtogotohospital.TherearenumerousexamplesofPatientPassports.Someare
availableontheIHaLreasonableadjustmentsdatabase.See:www.improvinghealthandlives.org.uk/adjustments/
o Providerscansupportpeoplewithlearningdisabilitiestounderstandtheimportanceofhealthscreeningandpromotion.Asreferencedabove,thereisaccessibleinformationavailabletosupport
peoplethroughdifficultprocedures.InadditiontheSeeabilitywebsitewww.lookupinfo.org/containsusefulinformationforpeoplewhoneedasighttestandwhoexperiencesightproblems,andtheHearingandLearningDisabilitieswebsitewww.hald.org.ukhasusefulinformationon
audiologyandhearingloss.
o Socialandhealthcarecommissionersandprovidersneedtoensurethatstaffhavetrainingand
supporttounderstandandcomplywiththeMentalCapacityAct(2005).HelpfulguidanceontheMentalCapacityAct12,13canbefoundat:www.hft.org.uk/family_carer_support/MCA_resource_guideand
www.rcgp.org.uk/PDF/CIRC_Mental%20Capacity%20Act%20Toolkit.pdf
o Poortransitionbetweenservicescanleadtopoor
outcomes,aswellascausingconfusionandanxietyforpeoplewithlearningdisabilitiesandfamilycarers.Socialandhealthcarecommissionersneedtoensurethereare
robusttransitionprotocolsinplace.Goodpracticeguidanceontransitiontoadulthood14canbedownloadedat:www.gettingalife.org.uk/downloads/2011‐Pathways‐
to‐getting‐a‐life.pdf.Thereisalsogoodpracticeguidanceonyoungpeoplewithcomplexneeds15whichcanbedownloadedat:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_083592.Withregardtodischargefromhospital,socialandhealthcare
commissionersshouldplanfordischargeimmediatelyafteradmission,orbeforehandiftheadmissionisplanned.Anydischargeplanningshouldbebasedonthe
patient’spersoncentredplanandrelevantfactorsinthehomeenvironmentincludinganyriskfactors.
o Providersshouldplan,withtheindividualifpossible,forendoflifecare.Communitylearningdisabilityteamscansupportprovidersandadvancedcareplanningtoolsare
available16.Forfurtherinformationpleasesee:www.endoflifecareforadults.nhs.uk/publications/ppcform
o Socialandhealthcarecommissionersshouldjointlycommissionservicestoworktogetherto
addresslocalpopulationneedandworktowardsoutcomes.
Forexample:LivingWell,‘isadedicatedpersonfocussedservicethatsupportspeoplewithalearningdisabilitywho
havelifethreateningillnessorhaveaneedforterminalhealthsupporttohaveapersonalisedcarepackagetosupport
theirdiscreetsupportneeds.Asupportbooklethasbeendevelopedthatcapturesthe‘wholeperson‘providing
informationonhowtosupporttheindividualtocontinueparticipatinginlife
tothefull.ThepartnershipincludesHullCityCouncil,TheCancerNetwork,thelocalhospice,localprimarycareservices
includingcontinuinghealthcareandthelocalCTLDservices.Theworkhasreachednationalrecognitionthrough
thepartnershipworkundertakenwithHelenSanderson’spersoncentredplanningassociation’.Forfurther
informationpleasecontact:[email protected]
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Summaryofsuggestedkeyactions
Commissioners
• Developajointunderstandingofthelocalpopulation,andthehealthinequalitiespeoplewithlearningdisabilitiesface.Developjointcommissioningplanstoreduceandwherepossibleeliminateavoidablehealthinequalities.
• Ensurethatlocalstrategiesprioritiseemploymentandsettledaccommodation,andplantouse
personalbudgetscreativelytosupportemploymentandaccesstothecommunity.
• Workwiththepolicetoaddresshatecrime.
• Ensurethatprovidersknowhowtosupportpeoplewithlearningdisabilitiestounderstandtheimportanceofhealthscreeningandpromotion,andworkwithhealthcommissionerstoensurethatpeoplewithlearningdisabilitiescanaccessgeneralhealthpromotioninitiatives.
• MonitorunderstandingandcompliancewiththeMentalCapacityAct.
• Ensuregoodtransitionprotocolsareinplace.Providers
• Providetrainingandadviceforsupportstaffsothattheycanunderstandtheimplicationsof
specificsyndromesandplanpersoncentredcareaccordingly.
• Ensurethatsupportstaffhavetheknowledgeandskillstorecognisechangesinanindividual’s
behaviourwhichmayindicatetheyareindiscomfortorunwell,andprovidethemwith
informationwhichwillenablethemtosupportpeoplewithlearningdisabilitiestoaccesshealthservices,includinghealthchecks,appropriately.
• Ensurethatsupportstaffunderstandwhatconstitutesahealthylifestyle,sothattheycansupportpeoplewithlearningdisabilitiestomakeinformedchoices.
• Workwithspecialisthealthstafftoensurethatsupportstaffhaveaccesstoandcanuseappropriateaccessibleinformationtosupportpeoplewithlearningdisabilitiestounderstandtheirhealthissues,includingtheuseofHealthActionPlansandHealthPassports.
• EnsurethatallstaffunderstandandcomplywiththeMentalCapacityAct.
• Planwithindividualsforendoflifecare.
•
•
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Conclusions
Peoplewithlearningdisabilitiesexperienceunacceptablehealthinequalitiesthatputthematriskof
diseaseandprematuredeath.Manyofthedeterminantsofpoorhealthcanbemitigatedbyappropriate
preventativemeasuressuchasbetterscreening,targetedinformation,adviceandsupportandreasonable
adjustmentstoensurepeoplegetgoodqualityhealthcare.Inthisdocument,aswellassettingoutwhy
healthinequalitiesmustbetackled,wehavesuggestedhowtheycanbeaddressedandhavereferenceda
numberofusefulcommissioningtoolsandcaseexamplestosupportbetterpracticeintreatingpeoplewith
learningdisabilities.Healthcommissionershaveakeyroleinensuringprogressinthisareaandinsecuring
abetterexperienceforpeoplewithlearningdisabilities,butsocialcarecommissionersandstaffalsohavea
roletoplay.
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