Strategic Health Authority Learning Disability Obesity Charter

1. Strategic Health AuthorityLearning Disability Obesity Charter Sally Cornfield Public Health 2012

2. AN OVERVIEW • Launched Regionally in January 2012 The initial stages of the work programme included: • Gaining an understanding of the agendas, policies and challenges effecting people with Learning Disabilities (LD) • Developing an understanding of the relationship between obesity and LD • Understanding the challenges of maintaining a healthy weight for people with LD • Developing knowledge of the programmes of work and effective practice happening already to tackle obesity within this specific group. • At it’s heart is the “Valuing People Now” vision (2009) “All people have the right to leave their lives like any others, with the same opportunities and responsibilities, with the right support to make this possible and be treated with the same dignity and respect”

3. Charter Aims • Promote and support prioritisation of the needs of people with LD to inform effective commissioning and delivery of specialist and community services to aid weight management • Strengthen commissioning processes and advise on the standards expected of providers when delivering services • Aid the local prioritisation of services that maximise opportunities for people with learning disabilities, their carers and families to be supported to maintain a healthy weight • The Charter provides a framework for developing effective practice, meeting service user’s expectations and a common set of values to aid commissioning.

4. Definitions • Learning Disability • Includes the presence of: • a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence) • a reduced ability to cope independently (impaired social functioning) • which started before adulthood, with lasting effect on development

5. Some Facts • About one person in three with a LD is obese compared to one in five of the general population • Less than 10% of adults with LD in supported accommodation eat a balanced diet, with an insufficient intake of fruit and vegetables • Carers generally have a poor knowledge about public health recommendations on dietary intake • People with more severe LD and people living in more restrictive environments are at increased risk of inactivity • The rate of Type 2 Diabetes in people with LD

6. The Charter • Implementation of the Charter will: • Improve practice relating to the commissioning and delivery of weight management and related services for people with learning disabilities, their carers and families • Standardise the services offered to people with learning disabilities, their carers and families regarding weight management • Advise on the standards that are expected when commissioning and delivering services to people with learning disabilities to support them in maintaining a healthy weight • Action Plan -Five Priority Areas: • Local Policy Development • Research • Training • Alignment of Joint Priorities • Profile

7. Charter Documentation

8. Key Recommendations - Local Training & Resources • To consider reviewing elements of social care resources ensuring that they are updated and standardised to provide quality support to these professionals. • To develop a list of (local) resources available to support professionals working with people with LD to enable cross fertilisation of training and support opportunities through professionals being able to access resources that are currently not easily found within their own professional domain. • To recognise the training and support requirements of staff involved in data collection and ensure that these are met to improve the robustness of data.

9. Key Recommendations – cont. Consultation • To explore the support needs of people with LD and how they would like to be provided with information or support in making healthier lifestyle decisions. Ensure that this is embedded into the West Midlands approaches to making reasonable adjustments to services. Networking • To consider developing a LD health network, that can provide peer support, expertise, shadowing/ mentoring opportunities and advice between professionals as and when it is needed. This may include a ‘skills swap shop’ approach to generic training and induction programmes.

10. Key Recommendations – cont. Data – Primary Care • To improve local data to provide demographic information that includes disability and distinguishes between physical disability, LD and limiting chronic health conditions. • To maximise the opportunities that the LD Health Checks provide for data collection and analysis to aid service planning. • GP practices to implement systems to monitor the number of people with LD who are overweight/obese and those referred/ involved in practice and community based weight management/ physical activity/healthy eating services. Data – CCG / Local Authority / Public Health • To identify opportunities to facilitate discussions on data collection with Local LD Partnerships as part of the on-going commitment to the “Valuing People Now” assessments

11. Key Recommendations – cont. Data – Public Health / Local Authority • To develop systems to determine the number and type of organisations providing physical activity, healthy eating and weight management services for people with LD to enable gap analysis to be undertaken. • Commissioners should include data collection for LD and Obesity within service specifications and commissioning contracts Commissioning • Consider rolling out the NHS West Midlands CQIN relating to the coding and flagging of LD within provider trusts to incorporate weight management related data linked to LD status

12. Key Recommendations - National • To consider developing a suite of resources for professionals to help them apply their current topic expertise and experience i.e. visual handouts suitable for people with LD, tips and pointers on how to help people with LD, evidence summary of what works, lesson plan, presentation pack, recipes and interactive activities. • To consider developing the resources suggested above in collaboration with the information sources that professionals most frequently use, including: Change4Life, British Heart Foundation, NHS Choices and Mencap, as this is likely to increase awareness and use of existing and new resource. • To consider developing training or resources that provide professionals with generic information on LD, working with adults and children with learning disabilities, and how to adapt main stream services tomaximise the engagement of adults and children with LD.

13. Key Recommendations – National • To work together to establish a corecriteria for the local delivery of training relating to LD, healthy eating, physical activity and weight maintenance. • To investigate the potential for LD read coding to be linked to chronic conditions through QOF so that data extraction queries can include cross referencing of patients with a LD who are overweight/obese at consortia and practice level to aid service planning and development. Regional Support • To support the roll out of the Equality Metrics Framework in the West Midlands localities with physical activity and obesity included within the healthy living indicators. • To adopt data collection as a key strand within the peer review process for “Valuing People Now” in the West Midlands

14. Wider Policy Context • Valuing People Now and the Valuing People Now Summary report on progress (2010) • The NHS White Paper, Equity and excellence: Liberating the NHS (2010) Healthy Lives, • Healthy People: Our strategy for public health in England (2010) • Social Care White Paper 'A vision for adult social care: Capable communities and active citizens’ • Public Health White Paper; Healthy Lives, Healthy People (2010) and the healthy Lives Healthy People update and way forward document published in July 2011. • No Health Without Mental Health Strategy (2011) • The Quality, Innovation, Productivity and Prevention (QIPP) agenda • Forthcoming Green Paper on Special Educational Needs and Disability • Healthy Lives, Healthy People: A call to action on obesity in England • The 2011 update for the UK Physical Activity Guidelines

15. Dudley LD Obesity Services • Services launched in 2006 (Weight Watchers) • 2012 – 8 services • LD clients accessing these services • ?? Success • ?? what, if any reasonable adjustments are required • ?? appropriate rate of weight loss • ?? outcome measures other than weight • Slimmers Kitchen - NICE

16. Public Health & Health Access Service Timeline of Partnership

17. Organisation/Partnerships (O/P) sign up to embed the charter and its principles into practice at a leadership level (O/P) inform partners, contractors that they are signed up to the Charter and will be embedding the principles within commissioning/ delivery mechanisms (O/P) inform staff that they are signed up to the Charter and will be embedding the principles within commissioning / delivery mechanisms. Provide staff with the Charter annexe, which documents what they can expect (O/P) action plan how they will embed the appropriate actions within their work Commissioners within (O/P) to embed the use of the “Commissioners Checklist” into commissioning systems to support effective contracting Deliverers of services should use the commissioning statements to develop their services to meet commissioners and service user’s needs. This could be as part of developing service tenders or service improvement plans Commissioners to use commissioning statements for specific services within commissioning specifications and contracting (O/P) should monitor the implementation of the Charter actions / checklists/ commissioning statements / service improvement statements and identify the outcomes for service users