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
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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. - PowerPoint PPT Presentation
Transcript of Healthcare for People with Learning Disability in Primary Care in England
Healthcare for People with Learning Disability in Primary Care in England
Jill RasmussenMoat House Clinic; GPwSI LD Surrey Primary Care Trust;
Chair RCGP LD Group
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Overview
Where are we coming from?
Where are we going?
How are we getting there?
Other Initiatives / Resources
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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
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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
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Annual Health Checks Wales: Proportion of People on LD Register Invited
Ref: Ref: First report of the joint NPHS/WCLD project group, January 2008
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Annual health Checks Wales:Proportion of Invites Resulting in Health Checks
Ref: Ref: First report of the joint NPHS/WCLD project group, January 2008
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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
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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
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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
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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
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Where are we going?
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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
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LD Quality Indicators Vision
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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
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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
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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
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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
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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
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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
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How are we getting there ?
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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
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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
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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
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Bristol Bowel Chart
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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/
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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
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eLearning for Health (elfh)
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eLearning for Health (elfh) Learning Disabilities - Module 14
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Other Initiatives & Resources ?
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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
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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
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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
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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
o 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
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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
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ImPaCT in Europe - Partners
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ImPaCT in Europe - Contacts
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
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Thank you
