1 / 37

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. Where are we coming from? Where are we going? How are we getting there? Other Initiatives / Resources.

quinto
Download Presentation

Healthcare for People with Learning Disability in Primary Care in England

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. 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

  2. Overview • Where are we coming from? • Where are we going? • How are we getting there? • Other Initiatives / Resources

  3. Where are We Coming From ? • 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

  4. Annual health Checks - Wales • 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

  5. Annual Health Checks Wales: Proportion of People on LD Register Invited Ref: Ref: First report of the joint NPHS/WCLD project group, January 2008

  6. Annual health Checks Wales:Proportion of Invites Resulting in Health Checks Ref: Ref: First report of the joint NPHS/WCLD project group, January 2008

  7. Annual health Checks – WalesFirst 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

  8. Michael Report • 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

  9. Michael Report • 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

  10. Michael Report • 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

  11. Where are we going?

  12. What will the health check be? • 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

  13. LD Quality Indicators Vision

  14. Annual Health Check – Findings • 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

  15. Annual Health Check – Issues • 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

  16. Annual Health Check – Issues • 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

  17. Annual Health Check – Issues • 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

  18. Educational Resources – Surrey Specific • 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

  19. Annual Health Checks Summary Points • 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

  20. How are we getting there ?

  21. LD DES Training • 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

  22. LD DES Training - Surrey • 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

  23. LD DES Training - Surrey • 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

  24. Bristol Bowel Chart

  25. eLearning for Health (elfh) • 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/

  26. eLearning for Health (elfh) • 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

  27. eLearning for Health (elfh)

  28. eLearning for Health (elfh) Learning Disabilities - Module 14

  29. Other Initiatives & Resources ?

  30. British Inst of Learning Disabilities (BILD) • 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

  31. Mencap – Training Resources • 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

  32. ImPaCT in Europe – Background • 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

  33. ImPaCT in Europe – Project Outline • 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

  34. ImPaCT in Europe – Project Outline • 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

  35. ImPaCT in Europe - Partners

  36. ImPaCT in Europe - Contacts • EASPD • Miriana Giraldi, Project Coordinator • Miriana.Giraldi@easpd.eu • +32 2 282 46 11 • http://www.easpd.eu • UK: • Nottingham Community Housing Association and HFT • http://www.hft.org.uk

  37. Thank you

More Related