NHS North Yorkshire and York Community and Mental Health Services Learning Disability Awareness...

NHS North Yorkshire and York CoNHS North Yorkshire and York Community and Mental Health Servimmunity and Mental Health Servicesces

Learning DisabilityLearning Disability Awareness Session Awareness Session

Training for Primary Care Staff.Training for Primary Care Staff.

DES 2008 / 2009DES 2008 / 2009


AimsAimsTo To includeinclude : :

Definition of Learning Disability Definition of Learning Disability PrevalencePrevalence Learning Disability health issues and barriersLearning Disability health issues and barriers The use of health checks in relation to meeting The use of health checks in relation to meeting

the needs of people with learning disabilitiesthe needs of people with learning disabilities ConsentConsent Disability Discrimination Act / DutyDisability Discrimination Act / Duty Health action plans and health facilitationHealth action plans and health facilitation Explore ways in which to increase the Explore ways in which to increase the

effectiveness of the health check appointment.effectiveness of the health check appointment.


What is a Learning Disability?What is a Learning Disability?Learning disability includes the Learning disability includes the

presence of:presence of: A significantly reduced ability to A significantly reduced ability to

understand new or complex information, understand new or complex information, to learn new skills (impaired intelligence) to learn new skills (impaired intelligence) with:with:

A reduced ability to cope independently A reduced ability to cope independently (impaired social functioning)(impaired social functioning)

Which started before adulthood, with a Which started before adulthood, with a lasting effect on developmentlasting effect on development

(Valuing People 2001)(Valuing People 2001)


LearningLearning DisabilityDisability doesdoes notnot includeinclude

learning difficultylearning difficulty a change in ability after the age of 18 a change in ability after the age of 18

yearsyears Aspergers / Autism where IQ is above Aspergers / Autism where IQ is above

7070 A definitive IQ cut off point (social A definitive IQ cut off point (social

functioning and communication should functioning and communication should be considered)be considered)

Valuing People 2001Valuing People 2001


World Health Organisation World Health Organisation (WHO 1992)ICD.10(WHO 1992)ICD.10

IQIQ MAMA CodeCode MildMild 50-6950-69 (9-12)(9-12) F70F70 ModerateModerate 35 – 4935 – 49 (6-9)(6-9)

F71F71 SevereSevere 20 – 3420 – 34 (3-6)(3-6)

F72F72 ProfoundProfound<20<20 (<3)(<3) F73F73


Levels of Learning DisabilityLevels of Learning Disability

Mild Learning Disability – IQ between Mild Learning Disability – IQ between 50 – 70, independent with social care, 50 – 70, independent with social care, coupled with the ability to maintain coupled with the ability to maintain social networks and employment. social networks and employment.

Moderate LD – IQ between 35 – 50 Moderate LD – IQ between 35 – 50 some degree of day to day support some degree of day to day support required, often living with family and required, often living with family and accessing services in the communityaccessing services in the community


Levels of Learning DisabilityLevels of Learning Disability

Severe/Profound LD below 35 – Severe/Profound LD below 35 – individualised communication using individualised communication using non verbal techniques, this may be non verbal techniques, this may be coupled with physical impairments coupled with physical impairments and mobility issues. This group will and mobility issues. This group will rely upon a circle of support to rely upon a circle of support to identify any health issues.identify any health issues.


Prevalence of Learning Prevalence of Learning DisabilityDisability

National prevalence estimated at 2-3%National prevalence estimated at 2-3%

Severe and profound 210,000Severe and profound 210,00065,000 children65,000 children120,000 adults of working age120,000 adults of working age25,000 Older people25,000 Older people

Mild to Moderate 25 per 1000 populationMild to Moderate 25 per 1000 population (1.2 Million)(1.2 Million)

Per GP practice of 2000 patients – average of 40 Per GP practice of 2000 patients – average of 40 people with a learning disability.people with a learning disability.


Health Issues – more likely Health Issues – more likely to :to :

Die earlyDie early Die from breathing problemsDie from breathing problems Have heart problemsHave heart problems Have certain cancersHave certain cancers Have epilepsyHave epilepsy Have autismHave autism Be mentally illBe mentally ill


Health Issues – more likely Health Issues – more likely to :to :

Have dementiaHave dementia Be given psychotropic drugBe given psychotropic drug Have a physical disabilityHave a physical disability Have sensory impairmentsHave sensory impairments Have communication problems Have communication problems Have dental problemsHave dental problems


SyndromesSyndromes

Down’s syndrome –Down’s syndrome – HypothyroidismHypothyroidism Visual & hearing impairmentVisual & hearing impairment Reoccurring respiratory tract infectionsReoccurring respiratory tract infections Sleep apnoeaSleep apnoea ObesityObesity DementiaDementia Congenital heart diseaseCongenital heart disease


Health Issues – less likely Health Issues – less likely to :to :

Have a health checkHave a health check Be screened for cancerBe screened for cancer Have a sight testHave a sight test Have a hearing testHave a hearing test Receive pain relief Receive pain relief Get health promotion adviceGet health promotion advice


Barriers to accessing Barriers to accessing Primary CarePrimary Care

Trying to limit and remove Barriers Trying to limit and remove Barriers to healthcare would be considered to healthcare would be considered

a responsibility under the a responsibility under the Disability Discrimination ActDisability Discrimination Act

The following information was The following information was gathered from services users and gathered from services users and

carers following a Health Check-up carers following a Health Check-up day day


BarriersBarriers

Having difficulty when ringing the Having difficulty when ringing the service with automated multi-choice service with automated multi-choice systemssystems

Difficulty with touch screen systemsDifficulty with touch screen systems Not been spoken to directlyNot been spoken to directly People not been fully aware of the People not been fully aware of the

medication they take or why they take itmedication they take or why they take it Doctors and nurses using words which Doctors and nurses using words which

they cannot understandthey cannot understand


BarriersBarriers

Receiving letters that they cannot understandReceiving letters that they cannot understand Appropriate examinations not always being Appropriate examinations not always being

carried outcarried out Lack of facilities within the practice i.e. hoistsLack of facilities within the practice i.e. hoists Not enough time being allowed for Not enough time being allowed for

appointmentsappointments No changing facilities for people’s personal No changing facilities for people’s personal

care needscare needs


Why is Learning Disability an Why is Learning Disability an issue?issue? Valuing People (DOH 2001)Valuing People (DOH 2001)

Treat me right (Mencap 2004)Treat me right (Mencap 2004) Closing the Gap Closing the Gap

Disability Rights Commission Disability Rights Commission (2006)(2006) Death by indifference Death by indifference

Mencap (2007)Mencap (2007) Health Care for allHealth Care for all

Independent inquiry (2008)Independent inquiry (2008)

http://images.google.co.uk/imgres?imgurl=http://www.iahpld.org.uk/cover.jpg&imgrefurl=http://www.iahpld.org.uk/&usg=__FedM5Qa3mFDvt50moVsbRScChUg=&h=1166&w=819&sz=37&hl=en&start=9&tbnid=nbK26jtfs4CihM:&tbnh=150&tbnw=105&prev=/images%3Fq%3Ddeath%2Bby%2Bindifference%26gbv%3D2%26hl%3Den%26safe%3Dvss

http://images.google.co.uk/imgres?imgurl=http://www.scld.org.uk/data/image/mencap.JPG&imgrefurl=http://www.scld.org.uk/campaigns-events/health-working-group/group-reports.xhtml&usg=__8q_jUDfSRx2f4wn8JlVFhDvVq4c=&h=842&w=595&sz=59&hl=en&start=10&tbnid=7jH16Qfr8_buxM:&tbnh=145&tbnw=102&prev=/images%3Fq%3Ddeath%2Bby%2Bindifference%26gbv%3D2%26hl%3Den%26safe%3Dvss


FindingsFindings

More ill health than other peopleMore ill health than other people Higher rates of premature deathHigher rates of premature death Diagnostic overshadowing Diagnostic overshadowing Low uptake of health screeningLow uptake of health screening Difficulty accessing health servicesDifficulty accessing health services Low rates of pain reliefLow rates of pain relief Poor communication of public health Poor communication of public health

messagesmessages Carers not involved appropriately Carers not involved appropriately

regarding capacity issuesregarding capacity issues


Mental Capacity ActMental Capacity Act

Code of Practice 2005Code of Practice 2005


What is Mental Capacity?What is Mental Capacity?

Mental Capacity is the ability to make Mental Capacity is the ability to make a decision. This includes the ability a decision. This includes the ability to make a decision that affects daily to make a decision that affects daily life – such as when to get up, what to life – such as when to get up, what to wear, or whether to go to the doctor wear, or whether to go to the doctor when feeling unwell as well as more when feeling unwell as well as more serious or significant decisionsserious or significant decisions


What is Mental Capacity?What is Mental Capacity?

It also refers to a person’s ability to It also refers to a person’s ability to make a decision which may have make a decision which may have legal implications – for them or legal implications – for them or others. Examples include agreeing others. Examples include agreeing to medical treatment, buying goods to medical treatment, buying goods or making a willor making a will


What does the act do?What does the act do?

It provides the legal framework for acting It provides the legal framework for acting and making decisions on behalf of and making decisions on behalf of individuals who lack capacity to make a individuals who lack capacity to make a particular decision for themselvesparticular decision for themselves

Everyone working with or caring for an Everyone working with or caring for an adult who may lack capacity must comply adult who may lack capacity must comply with this act.with this act.

The same rules apply for decisions that are The same rules apply for decisions that are life-changing as well as everyday matterslife-changing as well as everyday matters


Mental Capacity Act Mental Capacity Act 5 Key Principles5 Key Principles

11 A person must be assumed to A person must be assumed to have have capacity unless it is capacity unless it is established they established they lack capacitylack capacity

22 A person is not to be treated as A person is not to be treated as unable unable to make a decision unless to make a decision unless all practical all practical steps to help him do so steps to help him do so have been have been takentaken


Mental Capacity ActMental Capacity Act5 Key Principles5 Key Principles

33 A person is not to be treated as A person is not to be treated as unable unable to make a decision merely to make a decision merely because he because he makes an unwise decisionmakes an unwise decision

44 An act done, or decision made, An act done, or decision made, under under the Act for or on behalf of a the Act for or on behalf of a person person who lacks capacity must be who lacks capacity must be done, or done, or made, in his or her ‘made, in his or her ‘best best interestinterest’’


Mental Capacity ActMental Capacity Act5 Key Principles5 Key Principles

55 Before the Act or decision is Before the Act or decision is completed, regard must be given as completed, regard must be given as to to whether the purpose for which it whether the purpose for which it is is needed can be as effectively needed can be as effectively done in a done in a way that is less way that is less restrictiverestrictive


The Act involves several new The Act involves several new roles, all of which will support roles, all of which will support

the Actthe Act Attorneys appointed under lasting Attorneys appointed under lasting

Power of AttorneyPower of Attorney New Court of Protection and Court New Court of Protection and Court

appointed deputiesappointed deputies (IMCA) Independent Mental Capacity (IMCA) Independent Mental Capacity

Advocate: this is someone who is Advocate: this is someone who is there to help people who are unable there to help people who are unable to make decisions for themselvesto make decisions for themselves


Disability Discrimination ActDisability Discrimination Act

The Disability Discrimination Act 2005 is The Disability Discrimination Act 2005 is there to put into law the reasonable rights of there to put into law the reasonable rights of a disabled persona disabled person

Reasonable is a vague term, but we would Reasonable is a vague term, but we would recognise that rather than saying something recognise that rather than saying something is not possible because someone is disabled, is not possible because someone is disabled, or exempt them from QOF on the basis of or exempt them from QOF on the basis of things being impossible to carry out, we things being impossible to carry out, we should look at what we can change to make should look at what we can change to make things fairerthings fairer



A reasonable adjustment is a change you A reasonable adjustment is a change you need to make to your business in order to need to make to your business in order to meet the duties of the Disability meet the duties of the Disability Discrimination Act.Discrimination Act.

The DDA gives disabled people important The DDA gives disabled people important rights of access to everyday services which rights of access to everyday services which includes services provided by local councils, includes services provided by local councils, doctors, shops theatres etc.doctors, shops theatres etc.

Access to services is not just about Access to services is not just about installing ramps and widening doorways for installing ramps and widening doorways for wheelchair users. It is about making wheelchair users. It is about making services easier to use for disabled people.services easier to use for disabled people.



The The direct.gov.websitedirect.gov.website breaks things breaks things down into five key areasdown into five key areas Access to goods, premises and servicesAccess to goods, premises and services Rights in employmentRights in employment Rights in HealthRights in Health EducationEducation Mental HealthMental Health TransportTransport


Disability Equality DutyDisability Equality Duty

Since December 2006, there has been a legal duty on Since December 2006, there has been a legal duty on all public sector organisations to promote equality of all public sector organisations to promote equality of opportunity for disabled people.opportunity for disabled people.

People who work in the public sector have to consider People who work in the public sector have to consider the impact of their work on disabled people, and take the impact of their work on disabled people, and take action to tackle disability inequality. action to tackle disability inequality.

The Disability Equality Duty is meant to ensure that The Disability Equality Duty is meant to ensure that all public bodies - such as central or local all public bodies - such as central or local government, schools, health trusts or emergency government, schools, health trusts or emergency services – pay ’due regard‘ to the promotion of services – pay ’due regard‘ to the promotion of equality for disabled people in every area of their equality for disabled people in every area of their work. work.


What does the Learning What does the Learning Disability team do?Disability team do?

Provide health interventions and Provide health interventions and specialist therapies to support specialist therapies to support independenceindependence

Provide advice and support about Provide advice and support about accessing generic health servicesaccessing generic health services

Share expertise including training, advice Share expertise including training, advice and practical support to people with and practical support to people with learning disabilities, families, carers, learning disabilities, families, carers, health colleagues and other agencies.health colleagues and other agencies.


What does the Learning What does the Learning Disability team do?Disability team do?

Support people with learning disabilities to Support people with learning disabilities to stay healthy and safe, e.g. health promotion stay healthy and safe, e.g. health promotion adviceadvice

Support the communication needs of people Support the communication needs of people with learning disabilities and help other health with learning disabilities and help other health professionals and services to communicate professionals and services to communicate effectively.effectively.

Develop new ways of working with others to Develop new ways of working with others to deliver better services for people with deliver better services for people with learning disabilities.learning disabilities.


Who can support you?Who can support you? Health FacilitationHealth Facilitation Learning Disability Team (Health)Learning Disability Team (Health)

Who is in the team?•Administration •Physiotherapist•Occupational therapist•Community Nurses•Healthcare Assistant•Speech and languageTherapist

•Consultant Psychiatrist•Psychologist•Health Facilitator•Health Facilitation Nurse•Dietitian

Strategic Level

-Service development work - Informing planning& commissioning

Specialist levelA 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 levelIndividual levelFocus on individual work and health outcomes. A support Focus on individual work and health outcomes. A support worker, advocate, friend, or family carer could fulfil the roleworker, advocate, friend, or family carer could fulfil the roleat this level. The person should choose who they want as at this level. The person should choose who they want as

their Health Facilitator. their Health Facilitator.

Joint working required between different levels of Health facilitation

Varying levelsOf support to the individual


Removing the Barriers Removing the Barriers

Health Action PlansHealth Action Plans

Health ChecksHealth Checks

Reasonably adjusted servicesReasonably adjusted services


What is a Health Action What is a Health Action Plan?Plan?

It is owned by the person but usually It is owned by the person but usually created together with other peoplecreated together with other people

It is a document to enable people It is a document to enable people with learning disabilities to record with learning disabilities to record information about their healthinformation about their health

It identifies who will support them to It identifies who will support them to maintain and improve their healthmaintain and improve their health


Health Action PlanHealth Action Plan

A summary of the person’s Health A summary of the person’s Health Action Plan should be held by the GPAction Plan should be held by the GP

It should be updated as the person’s It should be updated as the person’s health needs change and reviewed at health needs change and reviewed at least annually least annually

It helps the person and their carers It helps the person and their carers to understand more about their to understand more about their healthhealth


Functions of Health Action Functions of Health Action PlansPlans

Health Action PlanHealth Action Plan

Person centredPerson centred

Belongs to the person

Accessible

Identifies health needs

List actions needed

Identify support needs

Provides links to GP, Primary care & other agencies

Educates and informs

Coordinates services

Influences services


ActionAction By WhomBy Whom By WhenBy When OutcomeOutcome

Treatment Plan


Why yearly health checks are Why yearly health checks are important.important.

ensure health needs are identified and met ensure health needs are identified and met check and review patients Health Action check and review patients Health Action

Plans/Treatment plans Plans/Treatment plans offer health promotion adviceoffer health promotion advice to build relationshipsto build relationships assist in meeting NSF targetsassist in meeting NSF targets prevent illness and assist in early diagnosisprevent illness and assist in early diagnosis identify previously unrecognised health problems identify previously unrecognised health problems

within the learning disability populationwithin the learning disability population medication reviews could lead to reduced medication reviews could lead to reduced

prescribing prescribing


Making Health Checks Making Health Checks HappenHappen

Accessible invitation Accessible invitation Follow-up the invitation Follow-up the invitation Contact those who have not Contact those who have not

respondedresponded You may find it helps to ring and You may find it helps to ring and

remind people the day beforeremind people the day before


Reasonable AdjustmentsReasonable Adjustmentssome ideas…….some ideas…….

Extra time for appointments to help Extra time for appointments to help communicationcommunication

Easy read / accessible information and Easy read / accessible information and lettersletters

Giving the patient a print out of health Giving the patient a print out of health information for health action planinformation for health action plan

Giving patient a written record of the Giving patient a written record of the appointmentappointment

Seeing the person where they feel safe Seeing the person where they feel safe e.g. the car parke.g. the car park


But remember…..But remember…..

People want you to speak to themPeople want you to speak to them It is It is OKOK to ask the best way to to ask the best way to

communicatecommunicate People want information about treatments People want information about treatments

and medications and medications Carers can have very valuable informationCarers can have very valuable information People with learning disabilities have the People with learning disabilities have the

same illness worries and concerns as the same illness worries and concerns as the rest of your caseload!rest of your caseload!


READ CODESREAD CODES

Learning Disability Assessment:Learning Disability Assessment:

9HB39HB3

9HB59HB5

69DB from 2009/1069DB from 2009/10

(see revised DES spec Sept 2009)(see revised DES spec Sept 2009)


PRACTICE GUIDE: PRACTICE GUIDE: PREPARATION FOR HEALTH PREPARATION FOR HEALTH

CHECKSCHECKS

SEE HANDOUTSEE HANDOUT


NHS North Yorkshire and York NHS North Yorkshire and York Community and Mental Health Community and Mental Health

ServicesServices

Useful contacts and thanks Useful contacts and thanks

With thanks to GP Tom Website With thanks to GP Tom Website WWW.gptom.comWWW.gptom.com

http://www.bild.org.uk/05faqs.htm#Fhttp://www.bild.org.uk/05faqs.htm#FAQsAQs

www.rcgp.org.ukwww.rcgp.org.uk

““A step by step guide for GP A step by step guide for GP practices: Annual Health Checks for practices: Annual Health Checks for People with a Learning Disability”People with a Learning Disability”

http://www.gptom.com/

http://www.bild.org.uk/05faqs.htm#FAQs

http://www.bild.org.uk/05faqs.htm#FAQs

http://www.rcgp.org.uk/


QUESTIONSQUESTIONS

NHS North Yorkshire and York Community and Mental Health Services Learning Disability Awareness...

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