HealthInequalitiesandPeoplewithLearningDisabilitiesintheUK:2011ImplicationsandactionsforcommissionersandprovidersofsocialcareEvidenceintopracticereportno.4SueTurnerNovember2011

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HealthInequalitiesandPeoplewithLearningDisabilitiesintheUKImplicationsandactionsforcommissionersandprovidersofsocialcareEvidenceintopracticereportno.4

ContentsPage

Introduction……………………………………………………………………………………………………………………… 4

HealthInequalities…………………………………………………………………………………………………………… 5

1 Thesocialdeterminantsofpoorerhealth…………………………………………………………………. 6Suggestedactionsforsocialcare

2 Increasedriskofhealthproblemsassociatedwithspecificgeneticandbiologicalcausesoflearningdisabilities…………………………………………………………………… 7

Suggestedactionsforsocialcare

3 Communicationandunderstandingofhealthissues…………………………………………………….. 8Suggestedactionsforsocialcare

4 Personalhealthrisksandbehaviours……………………………………………………………………….. 10Suggestedactionsforsocialcare

5.Accesstoandthequalityofhealthcareandotherservices………………………………………… 11

Suggestedactionsforsocialcare

Summaryofsuggestedkeyactions…………………………………………………………………………………………… 13

Conclusions…………………………………………………………………………………………………………………………………14

References…………………………………………………………………………………………………………………………………15

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Abouttheauthor

SueTurnerinitiallytrainedasanurseforpeoplewithlearningdisabilitiesinBristol.Shehasworkedwithintraining,asaNurseAdvisorinGloucestershire,andhasmanagedavarietyofservicesforpeoplewithlearningdisabilitiesinGloucestershireandBristolincludingcommunitylearningdisabilityteams.Suewas

theValuingPeopleLeadfortheSouthWestRegionforfourandahalfyears,initiallyjobsharingtherolewithCarolRobinson.Duringthistime,SuedevelopedthehealthnetworkintheSouthWestandintroducedthehealthself‐assessmenttotheregion.ShelaterworkedcloselywiththeStrategicHealthAuthorityonits

implementation.SueisnowleadingontheImprovingHealthandLivesprojectfortheNationalDevelopmentTeamforInclusion.

Acknowledgements

WewouldliketothankalltheparticipantsatourImprovingHealthandLives–implicationsforsocialcareeventsfortheirhelpfulcommentsonthedraftofthisdocument.

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IntroductionImprovingHealthandLives(IHaL)istheLearningDisabilitiesPublicHealthObservatory‐www.ihal.org.uk–

athreeyearprojectfundedbytheDepartmentofHealthinresponsetoSirJonathanMichael’s2008inquiryintoaccesstohealthcareforpeoplewithlearningdisabilities1.Thenationalobservatoryaimstoprovidebetter,easiertounderstandinformationonthehealthandwellbeingofpeoplewithlearningdisabilities

andtohelpcommissionersandothersmakeuseofexistinginformationwhilstworkingtowardsimprovingthequalityandrelevanceofdatainthefuture.

MostIHaLpublicationsareaimedathealthcommissionersandproviders.However,anumberofthehealthinequalitiesthatpeoplewithlearningdisabilitiesfacealsohaveimplicationsforsocialcarecommissioners

andproviders,andsocialcareprovidershavearesponsibilitytosupportpeopletoaccesshealthservices.

BasedontheHealthInequalitiesandPeoplewithLearningDisabilitiesintheUK:2011report2thisevidenceintopracticereportsetsoutthedeterminantsofhealthinequalities,andaskswhattheymeanforsocialcareincludingsocialcarecommissioners,caremanagers/socialworkers,providersandsupportworkers.

Whyshouldsocialcarecommissionersandprovidersbotherabouthealthinequalities?

• Somehealthinequalitiesarerelatedtowidersocialcareissueslikepoverty,unemploymentand

poorhousing.

• Theimpactofhealthinequalitiesisserious,affectingbothqualityoflifeandlifeexpectancy.

• Socialcareprovidershavealegalduty(undertheHealthandSocialCareAct2008(Regulated

Activities)Regulations2010)tosupportpeopletoaccesshealthcareservices.Anunderstanding

ofhealthinequalitiesandtheirdeterminantscanenablesupportstafftobemoreeffectiveinthis

role.

• Poorhealthcancostmoney.Forexample,peoplewithlearningdisabilitieswhoareinpain

associatedwithuntreatedmedicaldisordersmaydevelopchallengingbehaviour.Peoplewith

poormobilityduetolifestyleissuessuchasobesitycanrequirecostlyequipment.Addressing

healthinequalitiescanmakeasignificantcontributiontothepreventionagendainsocialcare.

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Healthinequalities

Peoplewithlearningdisabilitieshavepoorerhealththantheirnon‐disabledpeers.Thesedifferencesaretoanextentavoidable,andassuchrepresenthealthinequalities.Theimpactoftheseinequalitiesisserious.

Theresearchindicatesthatpeoplewithmoderatetoseverelearningdisabilitiesarethreetimesaslikelytodieearlythanthegeneralpopulation.

Therearefivekeydeterminantsofhealthinequalities2:

1. Greaterriskofexposuretosocialdeterminantsofpoorerhealthsuchaspoverty,poorhousing,

unemploymentandsocialdisconnectedness.

2. Increasedriskofhealthproblemsassociatedwithspecificgenetic,biologicalandenvironmental

causesoflearningdisabilities.

3. Communicationdifficultiesandreducedhealthliteracy.

4. Personalhealthrisksandbehaviourssuchaspoordietandlackofexercise.

5. Deficienciesrelatingtoaccesstohealthcareprovision.

Wesuggesttheactionsdescribedbelowcanhelpsocialcarecommissionersandproviders,inpartnership

withhealthcommissionersandcommunitylearningdisabilityteams/specialisthealthstaffimprovehealth

outcomesforpeoplewithlearningdisabilities.

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1. Thesocialdeterminantsofpoorerhealth

Theimportanceofpoverty,poorhousing,unemploymentandsocialisolationasfactorsleadingtopoorer

healtharewellknown.Peoplewithlearningdisabilitiesaremorelikelytoexperiencesomeorallofthese

factors.

Bullyingatschoolanddiscriminationinadulthoodarefrequentlyexperiencedbypeoplewithlearning

disabilities.Theyarealsorelatedtopoorerhealth.Peoplewithlearningdisabilitiesfromminorityethnic

communitiesmayexperiencepovertyandracism,andthusfacegreaterhealthinequalitiesthanpeople

withlearningdisabilitiesfrommajorityethniccommunities.

Suggestedactionsforsocialcare

o SocialcarecommissionerscanworkwithClinical

CommissioningGroups(CCGs)andPublicHealthtopool

knowledgeandunderstandingofthesocialdeterminants

ofhealth.Informationontheseissuesshouldbe

includedintheJointStrategicNeedsAssessment(JSNA)

toinformHealthandWellbeingBoards.Agoodexample

ofaJSNAcanbefoundat:

www.cambridgeshirejsna.org.uk/

o Planstoincreaseemploymentandtenancies/home

ownership(settledaccommodation)forpeoplewith

learningdisabilitiesshouldbepartoflocalstrategies.

Socialcarecommissionersandcaremanagersplaya

crucialroleinchangingthecultureoflocalservicesso

thatemploymentandsettledaccommodationareseen

aspriorities.

o Socialcarecommissionersandcaremanagerscan

supportthecreativeuseofpersonalbudgetstoenable

accesstothecommunityandsupportpeopleintowork.

TheJobsFirstinitiativeistestingtheuseofpersonal

budgets,alongwithotherfundingstreamstofund

employmentrelatedsupport.Theinterimreportis

availableat:

www.kcl.ac.uk/sspp/kpi/scwru/res/roles/jobs.aspx

o Socialcarecommissionerscanworkwithlocal

authoritiestoenableaccesstocommunityfacilitiesas

thiscancombatsocialexclusionandisolation,andresult

inhealthbenefits.Somelocalauthoritieshaveemployed

stafftosupportaccesstocommunityfacilities.

o Socialcarecommissionerscanworkwiththepolicetodeveloplocalstrategiestoaddresshate

crime.Goodpracticeguidancecanbeaccessedat:

http://www.inclusionnorth.org/documents/HateCrimeGoodPracticeGuide.pdf

Forexample:InDevon,caremanagerswhobringsupportplanstopanelareaskediftheyhaveconsidered

employmentfortheindividualbeforefundingisagreed.Providersarealsoaskedhowmanypeopleofworkingage

theysupporthaveemploymentof16+hoursaweek.Askingthesequestionshashelpedstafftothinkabout

employmentasthefirstoptionforindividuals.

Forexample:TheInclusiveFitness

Initiative(IFI)supportsthefitness

industrytobecomemoreinclusiveforall

disabledpeople.Itaddressesfourkey

areas:accessiblefacilities,inclusive

fitnessequipment,stafftrainingand

inclusivemarketingstrategies.South

GloucestershireemployedanIFIco‐

ordinatortoencouragetheengagement

ofpeoplewithlearningdisabilitiesin

physicalactivity,andincreasetheuptake

oftheIFIMark,aqualitymark

accreditationscheme.Mostleisureand

fitnessfacilitiesinSouthGloucestershire

arenowaccredited.Forfurther

informationonIFIpleasegoto:

www.inclusivefitness.org/

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2. Increasedriskofhealthproblemsassociatedwithspecificgeneticandbiologicalcausesoflearningdisabilities

Thereareanumberofsyndromesassociatedwithlearningdisabilitieswhicharealsoassociatedwith

specifichealthrisks.Forexample,peoplewithDown’ssyndromearemorelikelytoexperienceearlyonsetdementia,andpeoplewithautisticspectrumdisordersaremorelikelytohavementalhealthproblems.

Recentresearchhashighlightedpossibleinteractionsbetweensomegeneticcausesforlearningdisabilityandtheenvironment.Forexample,peoplewithAngelmansyndromemaydisplayaggressiveorself‐

injuriousbehaviourifitiseffectiveinmaintainingtheattentionofcarers,astheyoftenfindsocialcontactverypleasing.

Suggestedactionsforsocialcare

o Socialandhealthcarecommissionersneedtoworkwith

publichealthandCCGstounderstandthelocalpopulation

ofpeoplewithlearningdisabilitiesintermsofageprofile,

ethnicgroupandothersignificantpopulationissuessuch

asnumberofpeoplewithDown’ssyndrome,sothatthey

canplanstrategicallytomeetfutureneed.

o Providersandsupportstaffneedtounderstandthe

implicationsofspecificsyndromesandplanperson

centredcareaccordingly.Trainingshouldbeprovidedfor

supportstaffasappropriate.Communitylearning

disabilityteamscanalsoprovideadviceandsupport.

o Providersandsupportstaffshouldencourageandsupportpeoplewithlearningdisabilitiestohave

healthchecks(seenextsection).Thereareanumberofsyndromespecifichealthchecksthatcan

becarriedout.Forfurtherinformationsee aStepbyStepguidetoannualhealthchecksforGPs5:www.rcgp.org.uk/pdf/CIRC_A%20Step%20by%20Step%20Guide%20for%20Practices%20(October%

2010).pdf

Forexample:TheTeesintegrated

commissioninggrouprecognisedthat

theyhadanageinglearningdisability

populationatriskofdementia.They

jointlyfundedadevelopmentpostto

supporttheimplementationofthe

NationalDementiaStrategy3.

Understandinglocaldemographyand

providingapopulationforecasttoplan

futureserviceswasamajorpartofthe

project4.Forfurtherinformationsee:

www.phine.org.uk/securefiles/110720_1

133//South%20Tees%20LD%20Dementi

a%20Report%202010.pdf

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3.Communicationandunderstandingofhealthissues

Peoplewithlearningdisabilitiesmayhavepoorawarenessoftheirbodiesandhealthissuesgenerally.Theymaynotexpresspainordiscomfortinawaythatothersrecognise.Limitedcommunicationskillsmayreducetheirabilitytoletothersknowthatsomethingiswrong.Asaresult,thosewhoknowtheindividual

wellplayanimportantroleintheidentificationofhealthneedsformanypeople,particularlythosewithmoreseverelearningdisabilities.

Suggestedactionsforsocialcare

o Supportstaffareoftenthefirsttonoticechangeswhichmayindicateahealthproblemiftheindividuallivesinsupportedlivingorresidential

care.However,researchindicatesthatsupportstaffmayfeeltheyarelackinginskills,knowledgeandtrainingtoidentifyhealthneeds2.Socialcare

providersneedtoensurethatsupportstaffreceivetrainingsothattheycanrecognisehealthneeds.Socialandhealthcarecommissionerscan

jointlycommissioncommunitylearningdisabilityteamstosupportproviders,enablingsupportworkerstorecognisepotentialproblems,andtakeaction.Thewayinwhichindividualsexpress

painordiscomfortshouldbedocumented,andsupportstafftrainedtousethisinformationandreactappropriately.

o Socialcareprovidersshouldsupportpeoplewithlearningdisabilitiestounderstandmoreabouttheirbodiesandgeneralhealthissues.Communitylearningdisabilityteamscansupportproviderswiththeseissues.Therearealsosomegoodaccessibleresourcesavailableat:

www.easyhealth.org.ukandwww.apictureofhealth.southwest.nhs.uk

o AnnualhealthchecksarecurrentlypartofaDirectedEnhancedServicewhichrequiresPCTstooffer

GPstheopportunitytocarryouthealthchecksonpeoplewithlearningdisabilitiesknowntosocialcareforafixedpayment.Thereisclearevidencethathealthchecksleadtothedetectionofunmethealthneeds,andresultintargetedactionstoaddressneedsidentified6.However,althoughthe

numberofhealthchecksisimproving,in2010/11justunder50%ofthoseeligiblereceivedahealthcheck7.GPpracticesshouldinvitepeoplewithlearningdisabilitieswhoareeligibletoattendforahealthcheckappointment.Itisgoodpracticetoincludeapre‐healthcheckquestionnairewiththe

invitation8,9.Foranexampleofaquestionnaire,pleasesee:www.oxleas.nhs.uk/site‐media/cms‐downloads/Microsoft_Word_‐_Oxleas_HAP_prehealth_check_for_DES.pdfProviders/supportstaffcanhelpthepersonhaveasuccessfulhealthcheckby:

Helpingthepersonwithlearningdisabilitiesunderstandtheimportanceofahealth

check. Supportingthemtofilloutthepre‐healthcheckquestionnaire. Arrangingforsomeonewhoknowsthepersonwelltogowiththemtothehealth

check. Workingwithcommunitylearningdisabilityteams/specialisthealthstaffandthe

GPpracticetoputinplaceanyreasonableadjustmentsnecessary(suchaslonger

appointmenttimes)forthepersontohaveasuccessfulhealthcheck.

Forexample:TheAnticipatoryCare

Calendar(ACC)wasdevelopedin2006bytheMerseysideandCheshireCancerNetwork.Itworksonatrafficlight

systemandisdesignedtoalertsocialcarestafftohealthchangesandprovidecleardirectionsaboutaccessingprimary

care.ForfurtherinformationpleasecontactTracie.Keats@mccn.nhs.uk

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Furtherinformationabouthealthchecksisavailableat:www.ihal.org.uk

o HealthActionPlanscanbeahelpfulwayofsupportingthepersonwithlearningdisabilitiesto

understandabouttheirhealth.Theyshouldbeupdatedafterahealthcheck.Providers/supportstaffshouldensurethatthepersonknowsaboutandattendsanyfollow‐upappointmentsandreferrals.Specialisthealthstaff/communitylearningdisabilityteamscansupportproviderswiththe

introductionandmaintenanceofHealthActionPlans.

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4. Personalhealthrisksandbehaviours

Peoplewithlearningdisabilitiestakelessexercisethanthegeneralpopulation,andtheirdietisoftenunbalancedwithaninsufficientintakeoffruitandvegetables.Peoplewithlearningdisabilitiescanalsofindithardtounderstandtheconsequencesoflifestyleontheirhealth,andaremuchmorelikelytobe

overweightthanthegeneralpopulation.

Peoplewithlearningdisabilitiesarealsomuchmorelikelytobeunderweightthanthegeneralpopulation.

Youngpeoplewithmildlearningdisabilitieshavehigherratesofsmokingthantheirpeers.

Peoplewithlearningdisabilitiesmaynothavethesameaccesstoinformationaboutsexandsexualityasotheryoungpeople,andmayfaceparticularbarriersinaccessingsexualhealthservices.

Suggestedactionsforsocialcare

o Socialcareproviders/supportworkersneedtounderstandwhatconstitutesahealthylifestylesotheycanenablepeoplewithlearningdisabilitiestomake

informedchoices.Healthandsocialcarecommissionersneedtoensurethathealthpromotionandadviceisavailabletosocialcareproviders.

o Providers/supportworkersneedtoensurethatpeople

withlearningdisabilitieshaveaccessibleinformationand

supporttounderstandlifestylechoiceswithregardtodietandexercise.Accessibleinformationisavailableasreferencedabove.

o Providers/supportworkersneedtobeabletorecognise

ifapersonwithlearningdisabilitiesisunderweight,and

seekmedicaladvice.

o Providers/supportworkersshouldsupportpeoplewith

learningdisabilitiestoaccessgeneralhealthpromotioninitiativesregardingtobacco,alcohol,substancemisuseandsexualhealthinthesamewayasthegeneral

population.Socialcarecommissionersshouldalerthealthcommissionerstoanyproblemswithaccesssothattheycanbeaddressed.

Forexample:HaltonhasaCommunityBridgeBuildingTeamwhichsupportspeopletousecommunityfacilities.P

wasrecentlyreferredtotheteamasonthedayhehadnoactivitieshewasboredandinthepasthadspenttheday

drinking.Plikesphysicalactivitiesbuthadbeenunabletoorganiseanythingforhimself.Afterdiscussingoptions

withPhedecidedhewouldliketousealocalleisurecentretogethimselffit.P

wassupportedtogetaHaltonLeisureCardandabuspass,andbeganusingtheleisurecentrealmostimmediately.P

nowusestheleisurecentreindependently,andithasbeennotedhowmuchhappierheis.Psayshefeels

fitter,haslostweightandiskeentocontinuewithhisnewhealthierlifestyle.TheteamkeepintouchwithPto

monitorhowthingsaregoingbuttodatePhasnotneededanyextrasupportandseemstobetakingfulladvantageof

hisnewfoundindependence.

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5. Accesstoandthequalityofhealthcareandotherservices

Peoplewithlearningdisabilitiescanfindithardtoaccesshealthservicesforanumberofreasons,includingthefailureofhealthservicestomakereasonableadjustmentstoenableaccess,disablistattitudesamonghealthcarestaffand‘diagnosticovershadowing’(whensymptomsofillhealtharemistakenforbehavioural

problemsorasbeingpartoftheperson’slearningdisability).

Peoplewithlearningdisabilitieshavealoweruptakeofhealthpromotionandscreeningopportunitiesthanthegeneralpopulation.Thismeansthatearlystagecancersmaynotbepickedup,anddental,hearingandsightconditionsremainuntreated.Useofprimarycareservicesisalsolowerthanmightbeexpectedfor

peoplewithlearningdisabilities,whooftenhavechronichealthconditions.

Peoplewithlearningdisabilitieswhohavecancerarelesslikelytobetoldoftheirdiagnosisorprognosis.Theyarelesslikelytobeinvolvedindecisionsabouttheircare,givenpainrelieforhaveaccesstopalliative

care.

Peoplewithlearningdisabilitiesmaynotgetthesameaccesstoprimaryandsecondarymentalhealthservicesasthegeneralpopulation.

Averyhighproportionofpeoplewithlearningdisabilitiesarereceivingpsychotropicmedication,mostoftenanti‐psychoticdrugs,tocontrolchallengingbehaviourdespitelackofevidencefortheireffectiveness

andevidenceofconsiderableharmfulsideeffects.

ThereisworryingevidenceoffailuretocomplywiththeMentalCapacityActincludingexamplesofDoNotResuscitateordersbeingplacedonpatients’recordswithoutdiscussionwiththeindividualorfamily,andfamilycarersbeingaskedtosignconsentformsforadults10.Thereisalsoevidencethatsocialcarestaff

lackunderstandingoftheMentalCapacityAct2

Transitionbetweenservicesremainsproblematicforsomepeoplewithlearningdisabilities.Thisincludestransitionbetweenchildren’sandadultservices,andothertransitionssuchastransitionbetweenhospitalandhomeorcommunity.

Suggestedactionsforsocialcare

Manyoftheseissuesareabouthealthservices.Howeveritisimportantthatsocialcareproviders/supportstaffunderstandthedifficultiespeoplewithlearningdisabilitiesface,andtheirrightstoreasonableadjustments,sotheycanactasadvocateswherenecessary.Providers/supportstaffalsohavearolein

enablingpeoplewithlearningdisabilitiestoaccesshealthserviceseffectively.

o Providers/supportstaffcanmakeamajorcontributiontotheeffectivenessofthecarepeoplereceivefromhealthservices.Theycanprovideimportantinformationaboutthewayapersoncommunicates,riskissuesandtheirmedicalhistory.Ifthepersonneedstobeadmittedtohospital,

thereisahelpfulguide11thatsetsoutwhathospitals,familycarersandpaidsupportstaffcandotohelpmaketheperson’sstayasuccess.Theguidecanbedownloadedfrom:www.hft.org.uk/Resources/Home%20Farm%20Trust/Family%20Carer%20Support/Documents/Wo

rkingTogether.pdf

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o PatientPassportsareagoodwayofprovidingvitalinformationabouttheindividualtohospital

staff.Providerscanworkwithcommunitylearningdisabilityteams/specialisthealthstafftoensurethatpeoplewithlearningdisabilitieshavePatientPassports,andthattheseareusedshouldthepersonneedtogotohospital.TherearenumerousexamplesofPatientPassports.Someare

availableontheIHaLreasonableadjustmentsdatabase.See:www.improvinghealthandlives.org.uk/adjustments/

o Providerscansupportpeoplewithlearningdisabilitiestounderstandtheimportanceofhealthscreeningandpromotion.Asreferencedabove,thereisaccessibleinformationavailabletosupport

peoplethroughdifficultprocedures.InadditiontheSeeabilitywebsitewww.lookupinfo.org/containsusefulinformationforpeoplewhoneedasighttestandwhoexperiencesightproblems,andtheHearingandLearningDisabilitieswebsitewww.hald.org.ukhasusefulinformationon

audiologyandhearingloss.

o Socialandhealthcarecommissionersandprovidersneedtoensurethatstaffhavetrainingand

supporttounderstandandcomplywiththeMentalCapacityAct(2005).HelpfulguidanceontheMentalCapacityAct12,13canbefoundat:www.hft.org.uk/family_carer_support/MCA_resource_guideand

www.rcgp.org.uk/PDF/CIRC_Mental%20Capacity%20Act%20Toolkit.pdf

o Poortransitionbetweenservicescanleadtopoor

outcomes,aswellascausingconfusionandanxietyforpeoplewithlearningdisabilitiesandfamilycarers.Socialandhealthcarecommissionersneedtoensurethereare

robusttransitionprotocolsinplace.Goodpracticeguidanceontransitiontoadulthood14canbedownloadedat:www.gettingalife.org.uk/downloads/2011‐Pathways‐

to‐getting‐a‐life.pdf.Thereisalsogoodpracticeguidanceonyoungpeoplewithcomplexneeds15whichcanbedownloadedat:

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_083592.Withregardtodischargefromhospital,socialandhealthcare

commissionersshouldplanfordischargeimmediatelyafteradmission,orbeforehandiftheadmissionisplanned.Anydischargeplanningshouldbebasedonthe

patient’spersoncentredplanandrelevantfactorsinthehomeenvironmentincludinganyriskfactors.

o Providersshouldplan,withtheindividualifpossible,forendoflifecare.Communitylearningdisabilityteamscansupportprovidersandadvancedcareplanningtoolsare

available16.Forfurtherinformationpleasesee:www.endoflifecareforadults.nhs.uk/publications/ppcform

o Socialandhealthcarecommissionersshouldjointlycommissionservicestoworktogetherto

addresslocalpopulationneedandworktowardsoutcomes.

Forexample:LivingWell,‘isadedicatedpersonfocussedservicethatsupportspeoplewithalearningdisabilitywho

havelifethreateningillnessorhaveaneedforterminalhealthsupporttohaveapersonalisedcarepackagetosupport

theirdiscreetsupportneeds.Asupportbooklethasbeendevelopedthatcapturesthe‘wholeperson‘providing

informationonhowtosupporttheindividualtocontinueparticipatinginlife

tothefull.ThepartnershipincludesHullCityCouncil,TheCancerNetwork,thelocalhospice,localprimarycareservices

includingcontinuinghealthcareandthelocalCTLDservices.Theworkhasreachednationalrecognitionthrough

thepartnershipworkundertakenwithHelenSanderson’spersoncentredplanningassociation’.Forfurther

informationpleasecontact:Tracy.meyerhoff@hullcc.gov.uk

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Summaryofsuggestedkeyactions

Commissioners

• Developajointunderstandingofthelocalpopulation,andthehealthinequalitiespeoplewithlearningdisabilitiesface.Developjointcommissioningplanstoreduceandwherepossibleeliminateavoidablehealthinequalities.

• Ensurethatlocalstrategiesprioritiseemploymentandsettledaccommodation,andplantouse

personalbudgetscreativelytosupportemploymentandaccesstothecommunity.

• Workwiththepolicetoaddresshatecrime.

• Ensurethatprovidersknowhowtosupportpeoplewithlearningdisabilitiestounderstandtheimportanceofhealthscreeningandpromotion,andworkwithhealthcommissionerstoensurethatpeoplewithlearningdisabilitiescanaccessgeneralhealthpromotioninitiatives.

• MonitorunderstandingandcompliancewiththeMentalCapacityAct.

• Ensuregoodtransitionprotocolsareinplace.Providers

• Providetrainingandadviceforsupportstaffsothattheycanunderstandtheimplicationsof

specificsyndromesandplanpersoncentredcareaccordingly.

• Ensurethatsupportstaffhavetheknowledgeandskillstorecognisechangesinanindividual’s

behaviourwhichmayindicatetheyareindiscomfortorunwell,andprovidethemwith

informationwhichwillenablethemtosupportpeoplewithlearningdisabilitiestoaccesshealthservices,includinghealthchecks,appropriately.

• Ensurethatsupportstaffunderstandwhatconstitutesahealthylifestyle,sothattheycansupportpeoplewithlearningdisabilitiestomakeinformedchoices.

• Workwithspecialisthealthstafftoensurethatsupportstaffhaveaccesstoandcanuseappropriateaccessibleinformationtosupportpeoplewithlearningdisabilitiestounderstandtheirhealthissues,includingtheuseofHealthActionPlansandHealthPassports.

• EnsurethatallstaffunderstandandcomplywiththeMentalCapacityAct.

• Planwithindividualsforendoflifecare.

•

•

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Conclusions

Peoplewithlearningdisabilitiesexperienceunacceptablehealthinequalitiesthatputthematriskof

diseaseandprematuredeath.Manyofthedeterminantsofpoorhealthcanbemitigatedbyappropriate

preventativemeasuressuchasbetterscreening,targetedinformation,adviceandsupportandreasonable

adjustmentstoensurepeoplegetgoodqualityhealthcare.Inthisdocument,aswellassettingoutwhy

healthinequalitiesmustbetackled,wehavesuggestedhowtheycanbeaddressedandhavereferenceda

numberofusefulcommissioningtoolsandcaseexamplestosupportbetterpracticeintreatingpeoplewith

learningdisabilities.Healthcommissionershaveakeyroleinensuringprogressinthisareaandinsecuring

abetterexperienceforpeoplewithlearningdisabilities,butsocialcarecommissionersandstaffalsohavea

roletoplay.

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