Working Well - Health

Introduction

A learning disability affects the way a person learns new skills in any area of life.  It affects the way they understand information and how they communicate.  Learning disability is defined by the Department of Health as:

• the presence of a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence, often defined as an IQ level of 70 or less), with;
• a reduced ability to cope independently (impaired social functioning);
• which started before adulthood, with a lasting effect on development.

People with a learning disability can have difficulty understanding new or complex information, learning new skills and coping independently.  A learning disability can be mild, moderate or severe. Learning disabilities are a spectrum - people with a mild learning disability can talk easily and look after themselves, but take a bit longer than usual to learn new skills whilst others may not be able to communicate at all and may have more than one disability.

Adults with learning disabilities are one of the most vulnerable groups in society, experiencing health inequalities, social exclusion and stigmatisation.  In general, adults with learning disabilities have greater and more complex health needs than the general population, and often these needs are not identified or treated.  Life expectancy of this group is shorter than the general population.  Adults with learning disabilities often experience barriers to accessing healthcare services, and poor levels of care.  They are more likely to die from a preventable cause than the general population.  Health needs amongst adults with a learning disability are different to the general population.

There are about 1.5 million people in the UK with learning disabilities.

Learning Disability

The prevalence of learning disability within the adult population of Hartlepool, as captured in the Quality Outcome Framework (QOF), is 0.7% in 2017/18. This is the largest rate in the north east and the 2nd largest in England, however, there is only 0.5% between the highest rate and the lowest rate in England, and there are 13 local authorities in England and seven in the north east on 0.7%.

The proportion of eligible adults with a learning disability receiving a GP health check has increased from 43.4% in 2014/15 to 58.3% 2017/18. The 2014/15 level of 43.4% was worse than the England average of 49.4%. However three years of continuous improvement have seen the Hartlepool rate climb to a position of statistical superiority to both the England and north east averages of 51.7% and 51.0% respectively.

The proportion of supported working aged adults with a learning disability who are living in settled accommodation in Hartlepool has been statistically superior to the England average for all four of the reporting periods since 2014/15.

Hartlepool’s rate of 90.8% in 2017/18 was the first time that there hadn’t been a year on year increase, but this is still statistically superior to both the England and north east averages. Hartlepool’s 2017/18 rate is the 3rd best in the north east and the 16th best in England.

For the proportion of supported working aged adults with a learning disability who are employed Hartlepool has the best rate in England in 2017/18.

Hartlepool’s rate of 20.0% in 2017/18 is nearly twice the same of the next largest rate in the north east, and is more than three times the size of the England average. Hartlepool’s rate has seen increases of 13.3% from 2015/16 to 2016/17, and 23.5% from 2016/17 to 2017/18. At the same time the England average has remained relatively stable at around 6%.

 

Current Services

Adult Learning Disabilities Community Team

The service provides a comprehensive assessment of health needs, personalised care planning and interventions for people whose needs are associated with or additional to a learning disability.

Each person is assisted by the service to access personalised and integrated healthcare support.

Creative and flexible treatments or interventions which meet the individual needs of the person will be designed by members of the multi-disciplinary team, who will focus provision within the person's everyday living/care environment and work flexibly to deliver cohesive and appropriate services.

The service is available to adults:

• 18 years and over
• With a diagnosed learning disability (typically an IQ <70)

A range of individualised, evidence based, safe therapies and interventions will be provided including:

• Family therapy and social and skills training to support carers
• Psychological therapies including counselling or cognitive behavioural therapy
• Psychiatric interventions including medication therapy
• Challenging behaviour intervention programmes
• Specialist therapeutic interventions from physiotherapy, occupational therapy, speech and language therapy or dietetics
• Communication skills training for the service user and/or those supporting them
• Dysphasia treatment
• Seating and postural care, mobility, appliances assessment and provision group therapy sessions around specific areas of need, e.g. dementia, healthy living, men's/women's groups.

 

Future intentions

• More people will gain and maintain employment (paid and voluntary) through work placements, education and training.
• More people with have their support needs met by accessing social and leisure groups.
• People will not feel socially isolated.
• People will be supported to live in their own home, either by themselves or with people they have chosen to live with.
• People will have access to innovative community based crisis support.
• People will be able to choose from a range of ways to have a break from their family carers.
• People will access a range of support to set up, develop, implement and update their support plans.
• People will have access to a range of specialised advocacy.
• People will be able to employ their own Personal Assistants who have the specialist knowledge and skills needed to offer support.
• Providers will work together to create support pathways that support people over their life span.
• People will have access to a range of support that is able to meet their cultural and/or spiritual needs.
• Admission to hospital settings will be a last resort and will be guided by good clinical evidence, a supportive treatment plan and linked to best practice.
• Providers will be given opportunities to develop their plans for local investment and will be encouraged to develop services to meet local need.

 

Community activities –providing recreational, social and leisure opportunities in the local community.

Short Breaks – some people and their carers may wish to take breaks away, stay in a hotel, stay with another family or have assistants to stay in their home rather than use traditional residential models. Carers also need to feel confident that services can respond in the event of an emergency

Personal support – some people may wish to have personal support to support them to gain more independence, rather than receiving traditional care on a day to day basis.

Employment, education, voluntary work and training –providing support and opportunities for people to engage in employment, education, volunteering and training.

Advocacy, support planning and brokerage – some people with personal budgets may need support to make decisions and choices regarding their package of care. You may wish to offer services to help people set up and maintain their support plan or provide different types of advocacy support.

Managing a budget –services to support people and their carers to manage their personal budget.

Back office services – people who choose to have a personal budget may wish to employ a personal assistant to help them manage their support package and finances. This means they may need support recruiting, employing and training people as personal assistants, or help with job descriptions, payroll and CRB checks.

Condition Management support – people with autism and those people with dementia or long term conditions (dual diagnosis) want information to be able to support them to understand how best to maintain and manage their health. Providers may wish to look at how this could be managed as part of a holistic support process.

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