Learning Disabilities and Obesity Framework for...

October 2011 1

West Midlands Strategic Health AuthorityWest Midlands Strategic Health AuthorityWest Midlands Strategic Health AuthorityWest Midlands Strategic Health Authority

Learning Disabilities and Obesity

West Midlands Framework for Action

Introduction

The Department of Health West Midlands and its partners made the decision in 2009/10 to develop a focus on the needs of people with learning difficulties regarding

maintaining a healthy weight, participating in physical activity and making healthy food choices.

The initial stages of this focus included:

• Gaining an understanding of the agendas, policies and challenges effecting people with learning disabilities

• Developing an understanding of the relationship between obesity and learning disabilities

• Understanding the challenges of maintaining a healthy weight for people with learning disabilities

• Developing knowledge of the programmes of work happening already to tackle obesity within this specific group in the community.

These areas of work were developed in partnership with Department of Health West Midlands, public health and social care teams, West Midlands Public Health

Observatory, NHS West Midlands and PAN-WM culminating in a workshop focussing on learning and Disabilities that was held in early January 2010.

The event was attended by a range of specialists from the obesity, learning disabilities, physical activity, sport, transport, dance, healthy eating and health sectors and

focussed on answering the following questions.

1. What are the strategic hooks and levers that will support us in taking forward work regarding obesity and learning disabilities?

2. Please identify any programmes of work that you are aware of that are happening in the West Midlands to target people with Learning Disabilities regarding

maintaining a healthy weight, healthy eating and physical activity. Please indicate those that you consider to be good practice

3. What are the Challenges faced by people with learning disabilities in maintaining a healthy weight, eat healthily and participate in physical activity?

2

4. What Challenges do we face in a) effectively targeting and developing programmes to reach this target group and b) ensuring that mainstream services are

accessible for people with learning disabilities?

5. What more do we need to do at a regional level to support people with learning disabilities to maintain a healthy weight, eat healthily and become more

active?

6. Following your discussions what actions would you like to see taken forward following this meeting?

The feedback from the workshop has been used to develop this framework for action for the Department of Health West Midlands, NHS West Midlands, PAN-WM and

their partners across the West Midlands.

2.0 The context for the development of the framework for action

2.1 Current knowledge regarding Learning Disability and Obesity

• Learning disability is one of the most common forms of disability in the UK. (Source: Mencap).

• About 985,000 people in England have a learning disability (about 2% of the population). 796,000 of them are aged 20 or over.

• The number of adults with learning disabilities is predicted to increase by 11% between 2001 and 2021. This would raise the number of people in England aged 15

and above with learning disabilities to over one million in 2021. (Source: Estimating Future Need/Demand for Supports for Adults with Learning Disabilities in

England, Institute for Health Research, Lancaster University 2004).

• There are 55,000-75,000 children with a moderate or severe learning disability in England. (Source: www.learningdisabilities.org.uk statistics – accessed online

2009)

• In 2008/09 there were 14185 working age West Midlands learning disabled clients known to CASSRs who are in settled accommodation at the time of their latest

assessment or review. (Source: NASCIS National Adult Social Care Intelligence Service)

• Figures in relation to the numbers of people with a learning disability who are also obese are scarce.

• Data is available for the prevalence and rates of obesity; similarly it is possible to obtain some limited data in relation to numbers of people with a learning disability

- There does not seem to be an overlap to identify people in both groupings.

3

• Obesity appears to be more common among people with learning disabilities. Source (Obesity in people with intellectual disabilities; the impact of nurse-led health

screenings and health promotion activities; Marshall D et al. Journal of advances Nursing - 2003)

• About one person in three with a learning disability is obese compared to one in five of the general population. (Source: Equal Treatment: Closing the Gap Interim

Report, Disability Rights Commission 2005)

Sport and Recreational Activities

• In 2007/08, disabled people were significantly less likely to participate in active sports or in moderate intensity level sports during the past 4 weeks than non

disabled people. 30.1% of disabled people participated in active sports compared to 59.6% of non disabled people.

• Figures from 2007/08 show that in activities such as the historic environment, museums and galleries, a significantly smaller proportion of disabled people

participated than non disabled people.

• There is some evidence to suggest that levels of physical activity are lower in people with limiting disabilities

(Source: Taking Part Survey. ‘Taking Part: The National Survey of Culture, Leisure and Sport’ - DCMS)

Diet and Nutrition

• Historically many people with a learning disability lived in long stay hospitals and many nutritional problems have been found in these people.

• Some people with a learning disability may only eat a limited range of foods. An example of this is when someone will only eat certain textures, such as those that

don’t need to be chewed.

• Prader-Willis is a syndrome where people with a learning disability have an insatiable appetite and eat excessively even when they are full. This can lead to chronic

obesity (Source: Mencap – Diet and people with a learning disability)

2.2 The Strategic context for the development of the framework.

The West Midlands Learning Disabilities and Obesity Framework for Action will support the delivery of a number of strategies at a National and West Midlands level. This

list is not exhaustive but identifies the key health, social care and public health related policies contributing to this agenda. It is recommended that this framework be read

in the context of wider policies that contribute to the Obesity, health and social care agendas for example, economic, environmental, planning, sport and transport

strategies at all levels of governance.

4

National:

• Valuing People Now and the Valuing People Now Summary report on progress (2010)

• The NHS White Paper, Equity and excellence: Liberating the NHS (2010)Healthy Lives, Healthy People: Our strategy for public health in England (2010)

• Social Care White Paper 'A vision for adult social care: Capable communities and active citizens'

• Public Health White Paper; Healthy Lives, Healthy People (2010)

• No Health Without Mental Health Strategy (2011)

• The Quality, Innovation, Productivity and Prevention (QIPP) programme

• Forthcoming Green Paper on Special Educational Needs and Disability

• Healthy Lives, Healthy People: A call to action on obesity in England

• The 2011 update for the UK Physical Activity Guidelines

The Coalition Government have stated their commitment to fulfil the priorities laid out by the previous Government in the Valuing People Now strategy, reiterating a

pledge for equity, excellence and personalised services for all people with learning disabilities. The vision stated in Valuing People Now is reinforced in the valuing

People Now Summary Report as;

“All people have the right to lead their lives like any others, with the same opportunities and responsibilities, with the right

support to make this possible and be treated with the same dignity and respect”

The summary document details the progress made by the Learning Disability Partnership Boards at a local and regional level, recognising the improvements made across

health, housing and employment priorities, this includes 59,000 people having received an annual health check in 2009/10. Concerns raised in the report include:

• Obeying the law around capacity, consent and best interests decision making

• Lack of understanding of people who work in the health service about the needs of people with learning disabilities, how to communicate effectively and how to

make “reasonable adjustments” were all key issues.

• Complaints and advocacy

• Half of those eligible for annual health checks are not undertaking them.

The areas of work identified for improved delivery in the progress report are clearly aligned to the agendas featured in the NHS White Paper, Equity and excellence:

Liberating the NHS providing;

• Greater control to people over their health and care

• Greater accountability for patient outcomes for both the NHS and Social care

5

• Health and care professionals being encouraged and supported to work more effectively across boundaries to achieve improved outcomes.

The Department of Health business plan for 2011 – 2015 states a priority to create a public health service which rebalances our approach to health, drawing together

national leadership with local delivery, and fostering a new sense of community and social responsibility. This includes the delivery of a social care white paper and the

Public health White Paper that was published in December 2010.

The Public Health White Paper plans see an increased priority for Public Health within Government plans with dedicated resource allocated through ring fenced public

health budgets for the Local Authorities, this could be in excess of £4 billion per annum (although this has not yet been confirmed). The document takes a life course

approach to public health and recognises that further documents (including strategies) are needed to focus on specific areas such as mental health, obesity, physical activity

etc. The Obesity and Physical Activity papers are due to be published in spring 2011. The document also makes links to the Local Transport White Paper and the Natural

Environment White Papers that are due out imminently.

The new Public Health Service will focus on key outcomes developed into a framework that will include 5 domains:

• Health protection

• Tackling wider determinants

• Health improvement – promoting the adoption of health lifestyles

• Preventing ill health

• Healthy life expectancy

The Healthy Lives, Healthy People: A call to action on obesity in England sets out the Government’s new national ambitions for a downward trend in excess weight in both

children and adults by 2020 and details the wide ranging partnerships across the public, private and voluntary sector that will be needed to make the ambition a reality.

This framework links directly into this call for action and the updated physical activity guidelines that were launched in 2011.

All of the Public health and the aforementioned obesity outcomes are directly linked to the actions within this framework and localities signing up to deliver the actions

outlined in this framework will be showing their commitment to the delivery of these outcomes for people with Learning Disabilities and their carers.

The Social Care White Paper “A vision for adult social care: Capable communities and active citizens”(published in November 2010) is set around the pillars of Freedom,

Fairness and Responsibility and 7 key principles of Prevention, Personalisation, Partnerships, Plurality of the markets, Protection, Productivity and People. The delivery of

the vision, pillars and principles focus upon;

• Extend the provision of personal budgets

6

• Professionals working more closely with people who use services

• Carers provided with support

• Developing local schemes and networks of support run by communities

• Breaking down barriers between health and social care funding to incentivise preventative action

• Enabling people to have the freedom to choose the services that are right for them.

The “No Health Without Mental Health” Strategy published by the Department of Health in February 2011 sets the Government’s approach to working in partnership to

deliver better mental health outcomes for all, taking a life course approach. It focuses on 6 objectives;

• More people will have good mental health

• More people with mental health problems will recover

• More people with mental health problems will have good physical health

• More people will have a positive experience of care and support

• Fewer people will suffer avoidable harm

• Fewer people will experience stigma and discrimination

The strategy is linked to wider Government and society agendas including employment, education, benefits system reforms, criminality and reducing health risk behaviours.

The strategy documents that 25 – 40% of people with Learning Disabilities have mental health problems and recognises the need to make mental health accessible to all

disabled people and to consider early interventions to prevent later problems for children and young people with special educational needs and disability in the special

educational needs and disability green paper from the Department for Education. The strategy includes actions to:

• Provide support to carers

• Improve the inclusivity of mainstream mental health services for people with learning disabilities who have mental health problems.

7

• Develop the skills of staff and the provision of adjustments to meet the individual needs of people with learning disabilities and autism in mental health, health and

public health services.

The Quality, Innovation, Productivity and Prevention (QIPP) programme works at a national, regional and local level to support NHS organisations to improve the quality of

care they deliver while making efficiency savings that can be reinvested in the service to deliver year on year quality improvements. There are 12 national work-streams

linked to the programme, five of which focus on how care is commissioned, long-term conditions, right care, safe care, urgent care and end of life care. A further five look at

procurement, how organisations are staffed and run, improving productivity and efficiency. The final two elements focus on primary care commissioning and contracting

and the role of digital technology in delivering quality and productivity improvement.

The long term conditions work-stream is perhaps the most relevant to the LD and Obesity agenda and includes support to

• Ensure commissioners understand the needs of their population and managing those at risk to prevent disease progression

• Empower patients to maximise self-management including ensuring patients have a care plan and appropriate information and knowledge about how to manage

their condition.

• Provide joined up and personal services particularly in community and primary care and working closely and effectively with social care.

• Deliver strong professional and clinical leadership and workforce development

The commissioning, procurement and staffing work-streams also have relevance to this framework with regards to how services are procured and commissioned and the

staff development required to enable services to have reasonable adjustments made to support people with learning disabilities to maintain a healthy weight.

Measuring outcomes

The Public Health, NHS and Adult Social Care Outcomes framework have been developed to measure progress towards meeting the objectives in the aforementioned

strategies. The indicators that relate to learning disabilities and obesity and this framework for action are identified in the table overleaf.

8

Indicator/Improvement area Public Health Outcomes Framework NHS Outcomes Framework

2011/2012

Adult Social Care Outcomes

Framework

Domain

2

Domain

3

Domain

4

Domain

5

Domain

1

Domain

2

Domain

4

Domain

1

Domain

3

Domain

4

Proportion of People with

mental illness and or disability

in settled accommodation

(Source TBC)

x

Access & utilisation of green

space (Engagement with

Natural Environment Survey)

x

Cycling Participation (Active

People)

x

Social connectedness (DCLG

Citizenship Survey)

x

Prevalence of healthy weight

in 4 – 5 & 10 – 11 year olds

(NCMP)

x

Prevalence of healthy weight

in adults (Health Survey for

England)

x

% of adults meeting

recommended guidelines on

physical activity (5 x 30) per

week (Active People)

x

Self-reported wellbeing (TBC) x

Prevalence of recorded

Diabetes (GP Practice System)

x

Mortality rate of people with

mental illness (TBC)*

(Reducing premature death in

people with serious mental

illness)

x x

Under 75 mortality rate CV x

9


2011/2012


Framework

Domain

2

Domain

3

Domain

4

Domain

5

Domain

1

Domain

2

Domain

4

Domain

1

Domain

3

Domain

4

disease

Ensuring people supported to

manage their condition;

Proportion of people feeling

supported to manage their

condition

x x

Enhancing Quality of Life for

carers; Health related quality

of life for carers

x x

Patient experience of Primary

Care

x

Patient experience of Hospital

Care

x

Overarching measure; Social

care related quality of life

(Adult Social Care Survey)

x

The proportion of people

using Adult Social Care

Services who have control

over their daily life

x

Promoting personalised

services; proportion of people

using social care who receive

self-directed support (Social

Care data collection)

x

Overall satisfaction with local

adult social care services

(Adult Social Care Survey)

x

Proportion of people using

social care and carers who

x

10


2011/2012


Framework

Domain

2

Domain

3

Domain

4

Domain

5

Domain

1

Domain

2

Domain

4

Domain

1

Domain

3

Domain

4

express difficulty in finding

information and advice about

local services (Adult Social

Care Survey & Carers Survey)

Treating carers as equal

partners; The proportion of

carers who report they have

been included or consulted in

discussions about the person

they care for.

x

Ensuring a safe environment

for people with LD;

Proportion of adults with LD

in settled accommodation

(Adult Social Care combined

activity return)

x

West Midlands Context

The delivery of this Framework for Action would support the meeting of the;

• West Midlands Health and Well Being Strategy

• NHS West Midlands Investing4Health Programme

• Regional valuing People Now Strategic Programme

• Commissioning for Quality and Innovation (CQUIN) Improving Care and Health Outcomes for people with Learning Disabilities in Acute Hospital Settings through

implementing the coding and flagging systems indicator, training for staff on improving care pathways for people with LD indicator and improving the quality of

patient care through reasonable adjustments to care systems indicator.

11

The context for the local delivery of this framework would be determined by local partners working to tackle obesity and deliver the valuing people now agendas and

services for people with learning disabilities.

3.0 The Framework for action

The Action Plan is formulated under 5 headings, 4 of which were determined at the January 2010 workshop with a fifth strand of strategic development included to ensure

that the framework is effectively linked to the West Midlands Learning Disability Partnership, the headings are:

Local Policy Development

Research

Training

Alignment of Joint Priorities

Profile

Area of work Action Links to existing

work

Lead

Organisation

Partner

Organisations

Timescales Progress

LOCAL POLICY DEVELOPMENT

Deliver further

progress against the

Valuing People Now

agenda, taking forward

the areas for

improvement

identified in the

summary report

• Deliver plans to give greater control

to people over their health and care

• Deliver plans for greater

accountability for patient outcomes

for both the NHS and Social care

linked to the NHS White Paper

• Deliver the actions in this

framework to support and

encourage Health and care

professionals to work more

12


work

Lead

Organisation

Partner

Organisations

Timescales Progress

effectively across boundaries to

achieve improved outcomes.

• Increase the percentage of eligible

people attending the annual health

check.

• Ensure the Learning Disability and

Obesity agenda is effectively linked

to regional and local QIPP and

CQUIN agendas.

Improve Cross

boundary working to

deliver better

outcomes for people

with Learning

Disabilities and their

carers.

• Create effective links between Local

Learning Disability Partnerships and

emerging Health and Well Being

Boards.

• Achieve 100% sign up of Health and

Well Being Boards to the delivery of

this framework

• Work with one or more of the

Trailblazer Clinical Commissioning

Groups to profile and trial how LD

and Obesity can best feature in their

commissioning plans and share best

practice across the region.

• Encourage Health and Well Being

13


work

Lead

Organisation

Partner

Organisations

Timescales Progress

Boards and NHS Commissioning

Boards to utilise NHS and Public

health incentives to maximise

delivery of obesity related services

to people with Learning Disabilities

and their carers

• Encourage local partnerships to

embed obesity prevention and

management in social care agendas

and prioritise people with Learning

Disabilities within plans to tackle

Obesity.

• Support work to develop the

plurality of the social care and

health market – particularly

informing and supporting physical

activity/healthy eating/weight

management organisations in the

private and voluntary sector (linked

to social care white paper) to

maximise opportunities from the

personalisation and prevention

agendas to create better outcomes.

Influence National

agendas

• Brief the national DH Obesity,

physical activity, healthy eating and

14


work

Lead

Organisation

Partner

Organisations

Timescales Progress

social care teams regarding the WM

approach to Learning Disabilities

and Obesity and report progress

made.

• Influence the inclusion of people

with learning disabilities at risk of

obesity or identified as having

obesity within the Government’s

Responsibility deal networks,

particularly the food, physical

activity and behaviour change

networks.

• Ensure that best practice identified

during the delivery of the

framework is circulated to national

partners.

Manage change and

ensure that this

Framework for Action

remains Fit for purpose

• Regularly review the framework for

action against the emerging

national, West Midlands and local

landscape and priorities and ensure

that amendments are made to

enable it to remain fit for purpose.

RESEARCH

Develop a better

understanding of what

• Investigate the potential for an

obesity/physical activity/healthy

15


work

Lead

Organisation

Partner

Organisations

Timescales Progress

is happening to

prevent/tackle obesity

for people with

learning disabilities

eating question to be included

within the Locality VPN Self

Assessment Tool.

• Investigate the potential to develop

a West Midlands approach to the

Locality VPN Self Assessment data

that incorporates obesity

• Investigate how issue of target

groups for projects can be included

within future physical activity and

healthy eating auditing of PCTs.

• Investigate examples of physical

activity, healthy eating and obesity

programmes targeting people with

learning disabilities on the

Pacesetters website

• Collate and share examples of best

practice through obesity, PAN-WM,

food and learning disabilities

networks.

• Investigate levels of facilitated

physical activities and healthy eating

sessions within accommodation and

day centres for people with learning

disabilities.

• Investigate current and potential

future role of Health Trainers in

working with specific groups in the

16


work

Lead

Organisation

Partner

Organisations

Timescales Progress

community to support behaviour

change – including those with

learning disabilities and their carers.

Develop a better

understanding of

healthy eating and

physical activity needs

of people with learning

disabilities and their

carers.

• Commission a review/survey into

healthy eating and physical activity

levels for people with learning

disabilities

• Create links to the Public Health

Observatory leading on learning

disabilities

• Work with localities to determine

the best methods to access people

with learning disabilities and their

carers to provide messages.

TRAINING

Training needs

identification

• Identify who needs to receive

training regarding obesity, healthy

eating, and physical activity to

support people with learning

disabilities to achieve a healthy

weight. Possibilities include people

with learning disabilities, carers,

support workers, caterers, and

health professionals.

17


work

Lead

Organisation

Partner

Organisations

Timescales Progress

• Identify the training and support

needs of carers regarding

supporting people with learning

disabilities to become more active

and eat healthily.

Training development

and delivery

• Prioritise the identified training

needs, develop and deliver training

to meet the identified needs

ALIGNMENT OF JOINT PRIORITIES

Create links to related

programmes and

agendas

• Create and maximise the 2012

Olympic and Paralypmic legacy

opportunities to raise the profile of

learning disabilities.

• Ensure that the West Midlands

2012 plans and programmes

incorporate messages regarding

people with learning disabilities

being equals in creating and

benefiting from a legacy

Dispel the myths

surrounding learning

disabilities, physical

activity, healthy eating

and maintaining a

healthy weight

• Work with partners to develop an

understanding of the myths

surrounding people with learning

disabilities and develop a campaign

and related programme to dispel

these myths.

Influence the physical • Develop a bank of inspirational case

18


work

Lead

Organisation

Partner

Organisations

Timescales Progress

activity and eating

choices of people with


and their carers

studies and individual stories to

advocate and raise the profile of

healthy eating and physical activity

success stories for people with


PROFILE

Raise the profile of the

needs of people with


regarding physical

activity, healthy eating

and maintaining a

healthy weight

• Identify methods of raising the

profile of the needs of people with

learning disabilities regarding

obesity, healthy eating and physical

activity and the need to do more

work in this area.

• Identify newsletters and

partnerships that will enable the

profile of the needs of people with

learning disabilities with regards to

maintaining a healthy weight to be

raised.

• Develop briefing papers, articles,

presentations to support the profile

raising requirement of this

framework for action.

• Develop a briefing paper for

commissioner’s on the needs of

people with learning disabilities to

19


work

Lead

Organisation

Partner

Organisations

Timescales Progress

support them in

achieving/maintaining a healthy

weight to influence future

programme development.

Influence other

Partnerships in the

West Midlands to

embed a focus on


and obesity agendas.

• Identify national, West Midlands

and local partnerships to link to and

influence them as appropriate to

embed a focus on learning

disabilities and obesity agendas.

• Ensure that areas of work

determined from this group are fed

into the Regional VPN Programme

Board and Locality Partnerships.

• Ensure the work of the Learning

Disabilities and Obesity group is

available on the West Midlands

Obesity, food and physical activity

websites.

Influence investments

into supporting

children and young

people with learning

disabilities into

physical activity and

healthy eating

• Influence Local Authorities

regarding activity and healthy

eating/cooking sessions being

resourced as part of the Short

Breaks provision for the Aiming

Higher programme.

Support developments • Work with the Change4Life national

20


work

Lead

Organisation

Partner

Organisations

Timescales Progress

to the Change4Life

campaign to target this

group in the

community

team regarding the development of

the brand to effectively target

people with learning disabilities and

their carers

• Identify what Change4Life resources

require adaptation to support use

by people with learning disabilities

and their carers?

Copies of this document and others relating to the West Midlands Learning Disability and Obesity programme can be downloaded from

http://www.obesitywm.org.uk/panlinks.aspx?id=OBESITY_LEARNING_DISABILITIES

Learning Disabilities and Obesity Framework for...

Documents

Transcript of Learning Disabilities and Obesity Framework for...