Transcript Training for Primary Care Staff.

Learning Disability
Awareness Session
Training for Primary Care Staff.
DES 2008 / 2009
NHS North Yorkshire and York
Community and Mental Health
Services
Aims
To include :








Definition of Learning Disability
Prevalence
Learning Disability health issues and barriers
The use of health checks in relation to meeting
the needs of people with learning disabilities
Consent
Disability Discrimination Act / Duty
Health action plans and health facilitation
Explore ways in which to increase the
effectiveness of the health check appointment.
NHS North Yorkshire and York
Community and Mental Health
Services
What is a Learning Disability?
Learning disability includes the
presence of:



A significantly reduced ability to understand new
or complex information, to learn new skills
(impaired intelligence) with:
A reduced ability to cope independently
(impaired social functioning)
Which started before adulthood, with a lasting
effect on development
(Valuing People 2001)
NHS North Yorkshire and York
Community and Mental Health
Services
Learning Disability does not include




learning difficulty
a change in ability after the age of 18
years
Aspergers / Autism where IQ is above 70
A definitive IQ cut off point (social
functioning and communication should be
considered)
Valuing People 2001
NHS North Yorkshire and York
Community and Mental Health
Services
World Health Organisation
(WHO 1992)ICD.10




Mild
Moderate
Severe
Profound
IQ
50-69
35 – 49
20 – 34
<20
MA
(9-12)
(6-9)
(3-6)
(<3)
NHS North Yorkshire and York
Community and Mental Health
Services
Code
F70
F71
F72
F73
Levels of Learning Disability


Mild Learning Disability – IQ between 50 –
70, independent with social care, coupled
with the ability to maintain social networks
and employment.
Moderate LD – IQ between 35 – 50 some
degree of day to day support required,
often living with family and accessing
services in the community
NHS North Yorkshire and York
Community and Mental Health
Services
Levels of Learning Disability

Severe/Profound LD below 35 –
individualised communication using non
verbal techniques, this may be coupled
with physical impairments and mobility
issues. This group will rely upon a circle of
support to identify any health issues.
NHS North Yorkshire and York
Community and Mental Health
Services
Prevalence of Learning Disability




National prevalence estimated at 2-3%
Severe and profound 210,000
65,000 children
120,000 adults of working age
25,000 Older people
Mild to Moderate 25 per 1000 population
(1.2 Million)
Per GP practice of 2000 patients – average of 40 people
with a learning disability.
NHS North Yorkshire and York
Community and Mental Health
Services
Health Issues – more likely to :







Die early
Die from breathing problems
Have heart problems
Have certain cancers
Have epilepsy
Have autism
Be mentally ill
NHS North Yorkshire and York
Community and Mental Health
Services
Health Issues – more likely to :






Have dementia
Be given psychotropic drug
Have a physical disability
Have sensory impairments
Have communication problems
Have dental problems
NHS North Yorkshire and York
Community and Mental Health
Services
Syndromes
Down’s syndrome –
 Hypothyroidism
 Visual & hearing impairment
 Reoccurring respiratory tract infections
 Sleep apnoea
 Obesity
 Dementia
 Congenital heart disease
NHS North Yorkshire and York
Community and Mental Health
Services
Health Issues – less likely to :






Have a health check
Be screened for cancer
Have a sight test
Have a hearing test
Receive pain relief
Get health promotion advice
NHS North Yorkshire and York
Community and Mental Health
Services
Barriers to accessing Primary
Care
Trying to limit and remove Barriers to
healthcare would be considered a
responsibility under the
Disability Discrimination Act
The following information was
gathered from services users and
carers following a Health Check-up day
NHS North Yorkshire and York
Community and Mental Health
Services
Barriers





Having difficulty when ringing the service
with automated multi-choice systems
Difficulty with touch screen systems
Not been spoken to directly
People not been fully aware of the
medication they take or why they take it
Doctors and nurses using words which
they cannot understand
NHS North Yorkshire and York
Community and Mental Health
Services
Barriers





Receiving letters that they cannot understand
Appropriate examinations not always being
carried out
Lack of facilities within the practice i.e. hoists
Not enough time being allowed for appointments
No changing facilities for people’s personal care
needs
NHS North Yorkshire and York
Community and Mental Health
Services
Why is Learning Disability an issue?





Valuing People (DOH 2001)
Treat me right (Mencap 2004)
Closing the Gap
Disability Rights Commission
(2006)
Death by indifference
Mencap (2007)
Health Care for all
Independent inquiry (2008)
NHS North Yorkshire and York
Community and Mental Health
Services
Findings








More ill health than other people
Higher rates of premature death
Diagnostic overshadowing
Low uptake of health screening
Difficulty accessing health services
Low rates of pain relief
Poor communication of public health messages
Carers not involved appropriately regarding
capacity issues
NHS North Yorkshire and York
Community and Mental Health
Services
Mental Capacity Act
Code of Practice 2005
NHS North Yorkshire and York
Community and Mental Health
Services
What is Mental Capacity?
Mental Capacity is the ability to make a
decision. This includes the ability to make
a decision that affects daily life – such as
when to get up, what to wear, or whether
to go to the doctor when feeling unwell as
well as more serious or significant
decisions
NHS North Yorkshire and York
Community and Mental Health
Services
What is Mental Capacity?

It also refers to a person’s ability to make
a decision which may have legal
implications – for them or others.
Examples include agreeing to medical
treatment, buying goods or making a will
NHS North Yorkshire and York
Community and Mental Health
Services
What does the act do?



It provides the legal framework for acting and
making decisions on behalf of individuals who
lack capacity to make a particular decision for
themselves
Everyone working with or caring for an adult
who may lack capacity must comply with this
act.
The same rules apply for decisions that are lifechanging as well as everyday matters
NHS North Yorkshire and York
Community and Mental Health
Services
Mental Capacity Act
5 Key Principles


1 A person must be assumed to have
capacity unless it is established they
lack capacity
2 A person is not to be treated as unable
to make a decision unless all practical
steps to help him do so have been
taken
NHS North Yorkshire and York
Community and Mental Health
Services
Mental Capacity Act
5 Key Principles


3 A person is not to be treated as unable
to make a decision merely because he
makes an unwise decision
4 An act done, or decision made, under
the Act for or on behalf of a person
who lacks capacity must be done, or
made, in his or her ‘best interest’
NHS North Yorkshire and York
Community and Mental Health
Services
Mental Capacity Act
5 Key Principles

5 Before the Act or decision is
completed, regard must be given as to
whether the purpose for which it is
needed can be as effectively done in a
way that is less restrictive
NHS North Yorkshire and York
Community and Mental Health
Services
The Act involves several new roles,
all of which will support the Act



Attorneys appointed under lasting Power
of Attorney
New Court of Protection and Court
appointed deputies
(IMCA) Independent Mental Capacity
Advocate: this is someone who is there to
help people who are unable to make
decisions for themselves
NHS North Yorkshire and York
Community and Mental Health
Services
Disability Discrimination Act


The Disability Discrimination Act 2005 is there to
put into law the reasonable rights of a disabled
person
Reasonable is a vague term, but we would
recognise that rather than saying something is
not possible because someone is disabled, or
exempt them from QOF on the basis of things
being impossible to carry out, we should look at
what we can change to make things fairer
NHS North Yorkshire and York
Community and Mental Health
Services
Disability Discrimination Act



A reasonable adjustment is a change you need
to make to your business in order to meet the
duties of the Disability Discrimination Act.
The DDA gives disabled people important rights
of access to everyday services which includes
services provided by local councils, doctors,
shops theatres etc.
Access to services is not just about installing
ramps and widening doorways for wheelchair
users. It is about making services easier to use
for disabled people.
NHS North Yorkshire and York
Community and Mental Health
Services
Disability Discrimination Act

The direct.gov.website breaks things down
into five key areas






Access to goods, premises and services
Rights in employment
Rights in Health
Education
Mental Health
Transport
NHS North Yorkshire and York
Community and Mental Health
Services
Disability Equality Duty



Since December 2006, there has been a legal duty on all
public sector organisations to promote equality of
opportunity for disabled people.
People who work in the public sector have to consider
the impact of their work on disabled people, and take
action to tackle disability inequality.
The Disability Equality Duty is meant to ensure that all
public bodies - such as central or local government,
schools, health trusts or emergency services – pay ’due
regard‘ to the promotion of equality for disabled people
in every area of their work.
NHS North Yorkshire and York
Community and Mental Health
Services
What does the Learning Disability
team do?



Provide health interventions and specialist
therapies to support independence
Provide advice and support about
accessing generic health services
Share expertise including training, advice
and practical support to people with
learning disabilities, families, carers,
health colleagues and other agencies.
NHS North Yorkshire and York
Community and Mental Health
Services
What does the Learning Disability
team do?



Support people with learning disabilities to stay
healthy and safe, e.g. health promotion advice
Support the communication needs of people
with learning disabilities and help other health
professionals and services to communicate
effectively.
Develop new ways of working with others to
deliver better services for people with learning
disabilities.
NHS North Yorkshire and York
Community and Mental Health
Services
Who can support you?


Health Facilitation
Learning Disability Team (Health)
Who is in the team?
•Administration
•Physiotherapist
•Occupational therapist
•Community Nurses
•Healthcare Assistant
•Speech and language
Therapist
•Consultant Psychiatrist
•Psychologist
•Health Facilitator
•Health Facilitation Nurse
•Dietitian
NHS North Yorkshire and York
Community and Mental Health
Services
Joint working required
between different levels
of Health facilitation
Strategic
Level
Varying levels
Of support to the
individual
-Service
development work
- Informing planning
& commissioning
Specialist level
A health professional who provides
advice, support or treatment usually on a short
term basis in partnership with patient &
their Health Facilitator. can support or
Contribute to the Health Action Plan
Individual level
Focus on individual work and health outcomes. A support
worker, advocate, friend, or family carer could fulfil the role
at this level. The person should choose who they want as
their Health Facilitator.
Removing the Barriers

Health Action Plans

Health Checks

Reasonably adjusted services
NHS North Yorkshire and York
Community and Mental Health
Services
What is a Health Action Plan?



It is owned by the person but usually
created together with other people
It is a document to enable people with
learning disabilities to record information
about their health
It identifies who will support them to
maintain and improve their health
NHS North Yorkshire and York
Community and Mental Health
Services
Health Action Plan



A summary of the person’s Health Action
Plan should be held by the GP
It should be updated as the person’s
health needs change and reviewed at least
annually
It helps the person and their carers to
understand more about their health
NHS North Yorkshire and York
Community and Mental Health
Services
Functions of Health Action Plans
Belongs to the
person
Influences
services
Coordinates
services
Educates and
informs
Accessible
Health Action Plan
Person centred
Provides
links to GP,
Primary care
& other
agencies
Identify support
needs
NHS North Yorkshire and York
Community and Mental Health
Services
Identifies
health needs
List actions
needed
Treatment Plan
Action
By Whom
By When
NHS North Yorkshire and York
Community and Mental Health
Services
Outcome
Why yearly health checks are
important.








ensure health needs are identified and met
check and review patients Health Action Plans/Treatment
plans
offer health promotion advice
to build relationships
assist in meeting NSF targets
prevent illness and assist in early diagnosis
identify previously unrecognised health problems within
the learning disability population
medication reviews could lead to reduced prescribing
NHS North Yorkshire and York
Community and Mental Health
Services
Making Health Checks Happen




Accessible invitation
Follow-up the invitation
Contact those who have not responded
You may find it helps to ring and remind
people the day before
NHS North Yorkshire and York
Community and Mental Health
Services
Reasonable Adjustments
some ideas…….





Extra time for appointments to help
communication
Easy read / accessible information and letters
Giving the patient a print out of health
information for health action plan
Giving patient a written record of the
appointment
Seeing the person where they feel safe e.g. the
car park
NHS North Yorkshire and York
Community and Mental Health
Services
But remember…..





People want you to speak to them
It is OK to ask the best way to communicate
People want information about treatments and
medications
Carers can have very valuable information
People with learning disabilities have the same
illness worries and concerns as the rest of your
caseload!
NHS North Yorkshire and York
Community and Mental Health
Services
READ CODES
Learning Disability Assessment:
9HB3
9HB5
69DB from 2009/10
(see revised DES spec Sept 2009)
NHS North Yorkshire and York
Community and Mental Health
Services
PRACTICE GUIDE: PREPARATION
FOR HEALTH CHECKS
SEE HANDOUT
NHS North Yorkshire and York
Community and Mental Health
Services
Useful contacts and thanks



With thanks to GP Tom Website
WWW.gptom.com
http://www.bild.org.uk/05faqs.htm#FAQs
www.rcgp.org.uk
“A step by step guide for GP practices:
Annual Health Checks for People with a
Learning Disability”
NHS North Yorkshire and York
Community and Mental Health
Services
QUESTIONS
NHS North Yorkshire and York
Community and Mental Health
Services