Transcript Achieving Health Gain for People with Learning Disabilities

Achieving Health Gain for
People with Learning
Disabilities in General Practice
Facilitated by Annie Webster, Ipswich and East CCG/West
Suffolk CCG (RNLD DipHe BSc hons MSc)
and John Stevens Parent Carer
Annie and John are Joint Leads in Pathway for Health
Safety and Wellbeing Suffolk Learning Disability Strategy
Health gain for PWLD
Parameters of health gain are concerned with
Health protection
Health promotion
Health intervention
The Equality Act 2010
Under English Equalities Law, public sector
organisations are required to tailor the way they
provide care so that people with disabilities are not
disadvantaged.
Law governing the regulation of healthcare makes
explicit the requirement for healthcare providers to
make reasonable adjustment at the point of access to
services that is anticipatory.
Mental Capacity Act 2005
Assumes that the person has capacity
Is clear that when assessing capacity the burden of
proof must be that there must be a burden of proof to
determine whether the person does not have capacity.
This must be assessed on each event.
Practitioners must evidence processes used when
determining capacity and making best interest decisions
Factors that influence health gain and
positive health outcomes for PWLD
Higher predisposition ill health
Syndrome related pathology
Level of learning disability
Co-morbidity
Polypharmacy
Lifestyle/levels of support
Long term management of chronic health care conditions
Parameters of Learning disabilities
Difficulties with Cognition
Difficulties in Communication
Difficulties in social functioning
Difficulties in responding to and operating in
established norms and patterns of social
convention.
Difficulties in adapting to unfamiliar
environments
Cognition
• Defined as The mental action or process of
acquiring knowledge and understanding
• Assessment of cognition is required to ascertain
an individuals capacity and need for assistance in
decision making in all aspects of their treatment
and care.
Impact of reduced cognitive
ability
“A reduced ability to understand
new or complex information”
Knowledge by association is a
complicated process
Complex concepts and ideas
are hard for PWLD to
Understand
To enable a person with learning disabilities to develop health
literacy, concepts must be explored and explained in a
measured way to enable people to process information
A staged approach enables you to assess the persons
understanding
Greater understanding will support the person with learning
disabilities to make decisions about their health.
Cognition
Think how this
happens in your
surgery. How
might it be
different?
Communication
We communicate in ways that are meaningful to us.
We make adjustments in how we do this in every
consultation with patients we meet every day.
We do this implicitly and often in a responsive way.
In general terms communication is not planned
 So How does it work?
Expressive
Communication
Expressive language/communication is the use of
words to form sentences in order to communicate
with other people. Difficulties in using expressive
language to communicate can range from difficulties
putting words in the right order,
being unable to form words in a meaningful
way that others can understand,
having no expressive vocabulary at all
Expressive communication
When a person is unable to make use of
expressive language, the result in frustration at
not being able to explain themselves, difficulty
interacting with other people, and difficulty
expressing their needs.
How does problems with expressive
communication influence health gain?
• Difficulties in articulation symptoms of
illness/pain/discomfort leading to poorer health
outcomes and unmanaged need
• May result in frustration leading he person to express
themselves in other ways e.g. using behaviours that can
be seen as challenging .
• Affects the individuals ability to demonstrate capacity in
decision making.
• The person may disengage with health services and
resulting on poor short and long term health outcomes.
Receptive communication
Involves the understanding of expressive
language. The use of receptive language is not
dependent on being able to use expressive
language.
Some people with learning disabilities may not
be able to form words and sentences
themselves, but are able to understand
expressive language when it is used by others
Receptive communication
Abilities can range from being able to
understand what others say, to only being able
to comprehend key words and phrases.
Everyone is different; some people may be able
to use both receptive and expressive language to
different degrees, whilst others may be able to
use one or neither.
How does problems with receptive
communication influence health gain?
• Understanding self care instructions
• Changes in medication
• Options for treatment
Communication
Think
communication and
how this happens in
your surgery. How
might it be
different?
Getting the best from a
consultation
Promoting
 good access to services and reducing barriers (e.g.
telephone triage)
Managing
the environment making reasonable adjustment,
time and location of consultation.
Awareness
 of Reasonable adjustments that will enable the
person with learning disabilities to engage in the
consultation
Getting the best from a
consultation
Investing your time to save time
double appointments gives the opportunity for the
person with learning disabilities to ensure that
health need is identified and that there is sufficient
with communicate and discuss any treatment
Consistency
as far as possible it is helpful for people with
learning disabilities to see the same doctor and
members of the practice team, this promotes
familiarisation, confidence and shared decision
making which is ethically sound and within
governance frameworks.
Framework for facilitating health Gain
• Health Checks and Health Action Planning
In 2006 the Disability Rights Commission
recommended the introduction of annual health
checks for people with learning disabilities to
address the significant health inequalities the
contribute to greater morbidity and earlier
mortality.
Health Check and Health Action
Planning
 In April 2014, a new enhanced service (ES) was
introduced, which built on the previous directed
enhanced service, to extend eligibility to young
people with learning disabilities aged 14 and over,
and to require participating practices to produce a
health action plan linked to each person's health
check
 The Directed Enhanced Service was based on
evidence about the effectiveness and value of health
checks in mitigating the health inequalities faced by
people with learning disabilities.
Why complete Annual Health Checks
and Health Action Plans
People with learning disabilities may be
experiencing new health problems or changes to
existing conditions.
Primary care services can be to be reactive, and this
can lead to misdiagnosis or undetected health
problems.
People with learning disabilities may be unaware of
the medical implications of symptoms they
experience and have difficulty communicating their
symptoms and be less likely to report them to family,
carers.
Why complete Annual Health Checks
and Health Action Planning
Carers may not always attribute the
manifestations of clinical symptoms to physical
or mental illness.
Health checks provide a way to detect, treat and
prevent new and/or unmet health conditions in
this population.
Annual Health Checks and Health Action
Plans
Specific targeted learning disabilities
health checks are designed to pick up a
wider range of unmet health needs
Generally these are all the things that
people who do not have a learning
disability would normally go to their
doctor for unprompted
Benefits of
Annual Health Checks
There is clear evidence to suggest that the provision of
health checks for people with learning disabilities in
primary care is effective in identifying previously
unrecognised health needs, including those associated
with life-threatening illnesses.
The benefits of a health check model are that it fosters
familiarity and understanding between people with
learning disability and their local health services helping
them learn how to access and use these services
effectively and develop health gains
Longer term benefits
Protection and prevention can be carried out at an early
stage to Improved health outcomes and reduce the need
for complex intervention
PWLD can be given time to demonstrate or regain capacity.
More efficient use of practice time
Accurate diagnosis
Less polypharmacy and unnecessary prescribing.
Changes in culture that embed positive clinical practice so that
PWLD experience a good quality service.
Sources of Evidence
• Closing the Gap- a report from the Disability Rights Commission (DRC 2006)
• The Equality Act HM Parliament (2010)
• H
„ ealthcare for All. The findings of the Independent Inquiry into the health
inequalities of people with learning disabilities (Michael 2008)
• Mental Capacity Act HM Parliament (2005)
• Six lives: the provision of public services to people with learning
disabilities(Parliamentary and Health Services Ombudsman 2009)„Health
Inequalities & People with Learning Disabilities in the UK: 2010.
• Taggart,. L and Cousins W. (2014) Health Promotion for People with Intellectual
Disabilities and Developmental Disabilities. Berkshire: Open University Press
• The Public Health Learning Disabilities Observatory. (Emerson 2010)
Over to you
questions thoughts and
observations