Healthcare for people with learning disability in primary care in england
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Healthcare for People with Learning Disability in Primary Care in England. Jill Rasmussen Moat House Clinic; GPwSI LD Surrey Primary Care Trust; Chair RCGP LD Group. Overview. Where are we coming from? Where are we going? How are we getting there? Other Initiatives / Resources.

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Healthcare for people with learning disability in primary care in england

Healthcare for People with Learning Disability in Primary Care in England

Jill Rasmussen

Moat House Clinic; GPwSI LD Surrey Primary Care Trust;

Chair RCGP LD Group


Overview
Overview Care in England

  • Where are we coming from?

  • Where are we going?

  • How are we getting there?

  • Other Initiatives / Resources


Where are we coming from
Where are We Coming From ? Care in England

  • In 2001 Valuing People proposed annual health checks

  • The initiative was then promised in the Department of Health 2004 strategy document

  • Mencap have been campaigning for annual health checks for people with a learning disability in ‘Death by indifference' and ‘Treat me right!‘

  • Sept 2008 the Government agreed to provide annual health checks to people with learning disabilities in England

    • The proclamation emerged as part of ministers' response to a damning government-commissioned independent inquiry into healthcare for people with learning disabilities published in July, carried out by Jonathan Michael


Annual health checks wales
Annual health Checks - Wales Care in England

  • Have been provided to some extent since 2003

  • In April 2006 primary care based, annual health checks for adults with LD on local authority registers, were introduced as a directed enhanced service (DES)

  • April 2007 Welsh Assembly Government funded a proposal to monitor and evaluate the initiative over a 3 yr period

    • Submitted by the National Public Health Service (NPHS) and Welsh Centre for Learning Disabilities (WCLD)

  • First Progress Report Jan 2008


Annual health checks wales proportion of people on ld register invited
Annual Health Checks Wales: Care in EnglandProportion of People on LD Register Invited

Ref: Ref: First report of the joint NPHS/WCLD project group, January 2008


Annual health checks wales proportion of invites resulting in health checks
Annual health Checks Wales: Care in EnglandProportion of Invites Resulting in Health Checks

Ref: Ref: First report of the joint NPHS/WCLD project group, January 2008


Annual health checks wales first report key findings
Annual health Checks – Wales Care in EnglandFirst Report – Key Findings

  • Estimated 10,000 people aged  18 on LD registers in Wales in 2006/7

  • Of those who received an invitation, around 1/3 (32%) actually received a health check.

    • 6450 were invited; 2910 health checks undertaken

  • Wide variation between LHBs in the

    • Rates of invitations issued

    • Health Check ‘take-up’ rate

  • Likelihood of receiving a health check was related strongly to where people lived

Ref: First report of the joint NPHS/WCLD project group, January 2008


Michael report
Michael Report Care in England

  • People with LD find it much harder than others to access assessment and treatment for general health problems that have nothing directly to do with their disability.

  • There is insufficient attention given to making reasonable adjustments to support the delivery of equal treatment, as required by the Disability Discrimination Act.

  • Health service staff, particularly those working in general healthcare, have very limited knowledge about LD

  • Partnership working and communication is poor in relation to services for adults with LD

    • between different agencies providing care, between services for different age groups, and across NHS primary, secondary and tertiary boundaries

Ref: Ref: Sir Jonathan Michael Jul 2008


Michael report1
Michael Report Care in England

  • People with LD are not visible or identifiable to health services, hence the quality of care is impossible to assess.

  • Data and information on this sub-set of the population and their journeys through the general healthcare system are largely lacking

  • The health needs of people with LD do not appear to represent a priority for the NHS.

  • Training and education about LD provided to under- and postgraduate clinical staff, in primary care and in hospital services across the NHS is very limited.

Ref: Ref: Sir Jonathan Michael Jul 2008


Michael report2
Michael Report Care in England

  • Comprehensive legislative and advisory framework to prevent discrimination.

    • A primary care service framework for managing the health of people with LD from Primary Care Contracting

    • Reform of the General Medical Services (GMS) contract so that GPs can earn points through the Quality and Outcome Framework by establishing a register of their patients over eighteen years old with a learning disability

    • A range of guidance including on health checks, health facilitation, health action planning, the role of community learning disabilities teams (CLDTs), and how to develop Disability Equality Schemes.

Ref: Sir Jonathan Michael Jul 2008


Where are we going? Care in England


What will the health check be
What will the health check be? Care in England

  • People with a learning disability who are on the local authority register will be invited to come to their GP surgery for a health check.

  • The check will include:

    • Physical health

    • Medication

    • Mental health

    • Transition reviews (where appropriate)

    • Epilepsy (where appropriate)

  • To be able to give the health check doctors, nurses and receptionists have to have training in LD.

    • Must include people with LD, their families and carers.

Ref: http://www.mencap.org.uk



Annual health check findings
Annual Health Check – Findings Care in England

  • 3 to 4 referrals per patient

  • Primary / community care

    • Practice nurse, chiropody, dentistry

  • CTPLD

    • Dysphagia screening, Video-fluoroscopy

    • Dietician, speech and Language, continence advisor

    • Health Education

      • Cervical smear, sexual health

  • Secondary Care

    • Gastroenterology, cardiology, haematology, neurology

    • Bone Mass Density Scan

      • Long-term antipsychotics, AEDs

    • Dementia screening

      • Downs


Annual health check issues
Annual Health Check – Issues Care in England

  • Ear / eye drops

    • Check technique

    • Check ALL staff taught

  • Dietary Needs

    • Check All staff know about specific:

      • Needs – pureed, chopped

      • Specific utensils

      • Likes / dislikes

      • Understand pt choice vs obsessions / compulsions

  • Compliance with meds

    • Blister packs

      • Rationale for more expensive Melt formulations

    • Issues with ear / eye drops


Annual health check issues1
Annual Health Check – Issues Care in England

  • Establish review times:

    • Chiropody - 3 monthly

    • Dentist - 6 to 12 monthly

    • Audiology - as relevant

    • Optician - as relevant, minimum bi-annual

  • Monitoring

    • Blood tests

      • Sedation / Best Interest

      • May need District Nurse

    • Annual unless otherwise for QoF

    • AEDs / Mood stabilisers FBC, LFTS before anaesthetic

    • Epilepsy NOT seizure free

      • AED levels trough annual


Annual health check issues2
Annual Health Check – Issues Care in England

  • Time

    • More able pts with LD take TWICE as long

  • Flexibility

    • Where pts are seen

    • Hospital protocols

  • Health Action Plans MUST be a “living document”

  • Funding

    • Clinical

    • Social

  • Direct Enhanced Scheme is voluntary

    • Does not currently apply to ALL service users

    • Buddy scheme

  • Commissioning implications


Educational resources surrey specific
Educational Resources – Surrey Specific Care in England

  • Acute Hospital Pack

  • HAP Information pack

  • Feeling Poorly Pack

  • Screening

    • Cervical*, Breast*, Testicular*

    • Cardiovascular, diabetes, osteoporosis

    • Dysphagia

  • Dementia booklets**

  • Continence booklet

  • Pain

  • Disorder Specific Guides


Annual health checks summary points
Annual Health Checks Summary Points Care in England

  • People with LD have twice as many health problems as the general population

    • Beware Diagnostic Overshadowing

  • Communication:

    • Speak to the pt

    • Use pictures, gestures, and body language

  • Medical history

    • Obtain from pt as far as possible

    • Accompanying family member / carer / advocate

  • Excess morbidity:

    • Related to disabilities

    • Syndrome related

    • Secondary e.g. obesity, reflux disease

  • Accessible health promotion materials are scarce

  • Recall and audit



Ld des training
LD DES Training Care in England

  • To fulfill the requirements of the DES

  • To provide Practices with an introduction to:

    • Why the emphasis on health care for people with LD

    • The Health Action Plan process overall

    • LD Services and Resources in Surrey

  • To provide training in how to:

    • Compile an accurate LD register

    • Conduct “Individualised Health Checks”

  • To educate staff in primary care about:

    • Challenges faced by and healthcare needs of people with LD

    • Adaptations necessary for success of annual checks


Ld des training surrey
LD DES Training - Surrey Care in England

  • Two three hour sessions

    • First attended by Admin, Doctor and nurse

    • Second – doctor and nurse

  • Faculty

    • GPSi LD

    • CTPLD manager

    • Nurse Consultant LD

    • Psychologist

      • Downs register, Pain project

    • LD psychiatrist

    • PCT

    • Pt / Carer


Ld des training surrey1
LD DES Training - Surrey Care in England

  • Addresses

    • LD DES

      • Background, requirements

    • LD QoF and DES registers

    • Rationale for Annual Health Checks, Health Action Plans

    • Preparation for Annual health Check

      • GP, nurse, pt, family / carer, admin staff

      • Roles and Responsibilities

      • Support materials – educational, charts

    • Annual Health Check Pilot Findings

      • Time, referrals

    • Best Interest

    • Diagnostic Overshadowing

    • Case Studies


Bristol bowel chart
Bristol Bowel Chart Care in England


Elearning for health elfh
eLearning for Health (elfh) Care in England

  • A Department of Health Programme in partnership with the NHS and Professional Bodies providing high quality content free of charge for the training of the NHS workforce across the UK

  • In the process of delivering over 30 e-learning projects in partnership with medical Royal Colleges

  • Recommended as a key resource for teaching and learning critical appraisal skills in an independent review of critical appraisal resources to be published in Education for Primary Care

  • Access is granted via the e-LfH website and the respective Colleges

Ref: http://www.e-lfh.org.uk/


Elearning for health elfh1
eLearning for Health (elfh) Care in England

  • The e-GP website

    • Access to the e-GP online e-learning resource for NHS GPs & doctors undertaking specialty training for UK general practice

    • Jointly developed by the Royal College of General Practitioners (RCGP) and e-Learning for Healthcare (e-LfH).

    • It differs from other e-learning resources in that it is explicitly written by GPs for GPs

  • Provides a programme of e-learning modules covering the RCGP curriculum.

    • Each module made up of reflective and interactive e-learning sessions

      • Enhance GP training and support preparation for appraisal and revalidation

  • Launched at the Royal College of General Practitioners (RCGP) on July 2009



Elearning for health elfh learning disabilities module 14
eLearning for Health (elfh) Care in EnglandLearning Disabilities - Module 14



British inst of learning disabilities bild
British Inst of Learning Disabilities (BILD) Care in England

  • Provides a range of training that includes:

    • Communication

    • Intensive Interaction

    • Person centred approaches to better lives

    • Meeting the needs of people with PMLD

    • Literacy activities for people with PMLD

    • Understanding the Mental Capacity Act and its implications

    • Non-instructed advocacy

    • The emotional impact of self injurious behaviour

    • Understanding challenging behaviour

Ref: http://www.bildservices.org.uk


Mencap training resources
Mencap – Training Resources Care in England

  • Learning Disability Awareness Workshops. 

    • For external organisations to:

      • Aid understanding of learning disabilities

      • Develop organisation to offer an improved service for their customers whoo have LD.

    • Easy Read Services

      • How to make information more accessible

  • Profound and Multiple Learning Disabilities (PMLD)

    • Accredited courses in B’ham. Manchester, Northampton

Ref: http://www.mencap.org.uk


Impact in europe background
ImPaCT in Europe – Background Care in England

  • 10% of Europeans have disabilities (all types)

    • 37 million in the EU; 80 million in Greater Europe

  • Demographic change,  ageing population, is leading to:

    •  financial pressure on health and social care systems

    • people live longer, more likely to develop minor disabilities

  • Improved health care for people with LD

    •  longevity

    •  number people whose family unable to cont caring

  • Clear need for Person Centred Technology (PCT) to provide:

    • Enhanced services at a lower unit cost per person.

    • New types of social / health care service provision:

      • Telehealth, call centres, Assistive Technology for the promotion of health / safety at home / work

Ref: http://www.impact-in-europe


Impact in europe project outline
ImPaCT in Europe – Project Outline Care in England

  • Objective:

    • To raise awareness of benefits of Person Centred Technology (PCT) for disabled people and their carers

      • Technology specifically designed around individual

        • Improving QoL; open up potential employment opportunities

      • Demonstrate how assistive technology and ICT can support independence

  • Launched by partnership of European organisations coordinated by EASPD

    • European Association of Service providers for Persons with Disabilities.

  • Funded under the Lifelong Learning Programme of DG Education and Culture Europe

    • Runs from January 2009 to December 2011

Ref: http://www.impact-in-europe


Impact in europe project outline1
ImPaCT in Europe – Project Outline Care in England

  • Targets people with cognitive, intellectual and physical disabilities and their carers

  • Will develop an ethical code that is based upon a person centred approach.

  • Will carry out a training needs analysis and mapping exercise across countries within the EU, researching how and where PCT, including ICT, is used and to what extent

  • Information to be shared across diverse audience:

    • users, carers, policy makers, purchasers, providers and manufacturers

  • Dissemination through seminars and conferences in the partner countries.

Ref: http://www.impact-in-europe



Impact in europe contacts
ImPaCT in Europe - Contacts Care in England

  • EASPD

    • Miriana Giraldi, Project Coordinator

    • [email protected]

    • +32 2 282 46 11

    • http://www.easpd.eu

  • UK:

    • Nottingham Community Housing Association and HFT

    • http://www.hft.org.uk


Thank you Care in England


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