Bristol Community Learning Difficulties Service

Directed Enhanced Service Training

Introductions

We are……………

And you are? We would like to know:-

• Your name

• Your role within the practice and

• Your experience of working with people with a learning difficulty or disability

Training Session Content• Rationale for the DES• Definitions and identifying a Learning Difficulty• Eligibility• Common Health Problems• Communication• Consent• Disability Rights Act• Preparation for Health Check• Discussion

Rationale for the DES• People with a Learning Disability have

poorer health than the rest of the population and are more likely to die at a younger age.

• “Healthcare for All” (the Jonathan Michael Report 2008) made 10 key recommendations. The D.E.S. addresses all of these. (and specifically recommendation 8)

Learning Difficulty or Disability?

People with a learning difficulty living in Bristol have said they prefer the term “Difficulty”.

However, many professionals and government organisations e.g. Department of Health, World Health Organisation etc. use the term “Learning Disability”.

In this presentation the two terms mean exactly the same.

What is a Learning Disability?A significantly reduced ability to understand new or

complex information, to learning new skills (impaired intellectual functioning)

With a reduced ability to cope independently (impairment of adaptive/social functioning)

Which started before adulthood,

With a lasting effect on development.

(Valuing People, 2001, DOH - pg 14 – 1.5)

How to identify if a person may have a Learning Difficulty

1. Explore their Communication skills and Understanding.

2. Ask about their Daily Living Skills and what they do during the day.

3. Discuss their History (esp. Schooling)4. Question what, if any, Services they use.5. Identify what type of accommodation they

live in (e.g. supported living) 6. Relevant Medical Conditions

See our website http://www.bristollearningdifficulties.nhs.uk

CLDT Eligibility Criteria

To establish definitively whether a person has a Learning Disability (and thus eligible for LD specialist services) the CLDT use all or some of the following tools:-

• ISACA (Initial Screening Assessment Checklist for Adults)• Psychology Assessments• Occupational Therapy assessments• Speech & Language assessments

Common Health Problems

• Respiratory Disease• Coronary Heart

Disease• Sensory Impairments• Cancer• Epilepsy• Helicobacter pylori• Dysphagia

• Weight (under or over)

• Mobility• Skin Disorders• Dental Problems• Infections• Mental Health

Conditions also associated with LD

• Cerebral Palsy• Downs Syndrome• Prader-Willi

Syndrome• Fragile X• Tubular Sclerosis• Phenylketonuria

(PKU)

• GORD (Gastro-oesophageal reflux disease)

• Autism• Epilepsy

Dementia

The incidence of dementia is much higher in people with Downs Syndrome than within the general population.

Down’s Syndrome incidence rises with increasing age and rates vary:

2% - 30 - 39 years

55% - 60 - 69 years

Average onset 54th year

(Prasher 1995)

What are Community Learning Difficulty Teams – the CLDT?

The CLDT is a group of professional staff from Bristol Primary Care Trust’s provider function “Bristol Community Health” (BCH) who provide assessment, support, advice and therapeutic interventions to people who have learning difficulties.

We are co-located with Bristol’s City Council’s, Health and Social Care, Learning Difficulty Teams.

Composition of the CLDT

• Community Nurses• Psychologists• Speech & Language

Therapists• Occupational

Therapists• Physiotherapists• Arts Therapists• Dieticians

• Administration & Team support

• Bristol Intensive Response Team (BIRT)

• Social Workers• Psychiatrists • Forensic Team

CLDT linked services:-

• Health Trainers

• Health Facilitator

• Co Trainer

• Hospital Liaison Nurses

• Transition Services

• Courts & Prison LD Nurses

Contact Details for the CLDT

• Bristol North Team (Brentry) 9085000• Bristol Central Team (Stapleton) 9585666• Bristol South Team (Withywood) 9878383• Bristol Intensive Response Team via the

above teams• Open referral system and a referral form is

on our Website:-http://www.bristollearningdifficulties.nhs.uk

Associated LD Services

• Mental Health : Lansdowne Assessment and Treatment unit (Part of AWP)

• Placement Crisis: Concorde Lodge (Bristol City Council)

• Residential & Domiciliary Care providers e.g. Brandon, Aspects & Milestones, Freeways, Mencap etc.

What are CM7s ?

They are a comprehensive HEALTH NEEDS ASSESSMENT which when combined with an Assessment of Need will be used to inform the package of care commissioned.

They can affect where someone lives, what support they have and their package of care.

Communication• All people with a learning disability have

communication problems. It is probably the most significant barrier to services that they have.

• Many service users are highly adept at concealing their communication and understanding problems

• Please don’t assume that if a person is agreeing with you they know what you are talking about!

Top Tips for Communication(1) • Speak directly to the person with learning difficulties

• Take your time – extra time may be needed

• Get advice from the carers regarding how to communicate with a person

• Arrange to have a quiet environment with not too many distractions

• Get the persons attention e.g. use their name / make eye contact

• Use everyday words e.g. heart rather than cardiac

Top Tips for Communication (2)• Use short sentences covering one topic.

• Try to avoid questions/statements that the person can simply agree with (as sometimes people will give the answer they think you want.)

• Use clear direct questions e.g. Does this hurt?

• Use pictures or objects and gestures to back up what you are saying

• Some procedures can be demonstrated on the carer first e.g. taking blood pressure, using a stethoscope

• Clarify whether the person has understood by asking them feed back what you have said so as to test their understanding.

• Some people may not remember information about their medication/treatment. Simple written information that they can look at or share with carers may help this.

Communication Exercise

• Using the resources supplied ……

Consent :The FACTS (1)• No-one can give consent on behalf of another adult

• It must be assumed that a person can give consent i.e. that they can make their own decisions unless proven otherwise

• It is the responsibility of the treatment provider to make a decision about the person’s capacity to consent to treatment

• It is a criminal offence to treat a person who has capacity and has not consented

Consent :The FACTS (2)• Everything possible must be done to help someone make their own

decision

• If it is decided that someone is unable to make a particular decision, it does not stop that person making other decisions

• Decisions can legally be made for someone thought to lack capacity by: -- Those involved in the care and treatment of the person (within

the framework of a best interests multi disciplinary meeting)- a court- a deputy appointed by the court- someone chosen by the person to make decisions for them

(lasting Power of Attorney)

5 Key Principles of Consent• Adults are assumed to have the capacity unless

proved otherwise • A person must be given all available support

before it is concluded that they cannot make decisions for themselves

• Individuals retain the right to make unwise decisions

• Anything done for someone without capacity must be in their best interests

• Anything done for someone without capacity should restrict their rights and basic freedoms as little as possible.

Disability Discrimination Act 1995

• It is a legal requirement not to treat people with a disability less favourably

• It is a legal requirement to make “reasonable adjustments”

• To ensure equality may mean treating some people differently

• “Reasonable adjustments” are often about practices and procedures rather than physical access

Preparation for a Health Check• Accessible appointment Letter• Health Check Questionnaire (HCQ) sent out• Pre appointment phone call? Remind to bring

HCQ• Carers support required?• Allocate one hour per patient.• Plan how and by whom check will be done• At the end of the health check the last page of

the HCQ needs to be complete and agreed with the Service user.

• Advise CLDT of DNA’s on second failure.

Health Action Plans• This was an initiative started in 2001.• Some service users may already have a H.A.P

which they may bring to their Health Check Appointment

• When the health check is completed the last page of the HCQ needs to be completed, agreed with the Service user and actioned.

• This document can then work as their revised Health Action Plan

What next for the CLDT?• To maintain close links with yourselves• To explore appointing CLDT primary care

liaison workers (similar to the hospital liaison nurses)

• To help you keep your register up to date• To continue to develop services together

that are accessible, effective and improve the health of people with a learning disability

The End

Any Questions?