working with people with learning disabilities directed enhanced service (des) learning disabilities...
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Working with People with Learning Disabilities
Directed Enhanced Service (DES) Learning Disabilities 2013/14
Appendix 5
Presented by
Helen Grant Community Nurse Professional Lead
Anne Hutchinson, Health Facilitation Coordinator
A significantly reduced ability to understand new or complex information, to learn new skill (impaired intelligence with an IQ below 70) with:-
A reduced ability to cope independently (impaired social functioning)
Which started before adulthood, with a lasting effect on development
What is a Learning Disability?
MILD (IQ 50-69 )
MODERATE (IQ 35 -49 )
SEVERE (IQ 20-34 )
PROFOUND (IQ <20 )
Classification of Learning Disability
Nationally it is estimated 2-3% of the population have a learning disability. Estimates suggest:
210,000 people with severe & profoundlearning disabilities
1.2 million people with mild/moderate learning disabilities
Per GP practice of 2000 patients – average of 40 people with learning disabilities
Prevalence
Legislation which should make health services
non discriminatory and safe
Disability Discrimination Act Disability Equality Duty Safeguarding Adults Human Rights Act Mental Capacity Act Deprivation of Liberty
The DES..why now?
Evidence of Poor health and discrimination
Disability Rights Commission “Equal Treatment: Closing the Gap” found people with learning disability died ten years younger than other people of preventable health conditions
Mencap report “Death by Indifference” reports the experience of the treatment and deaths of 6 people with learning disability in hospital
Castlebeck -The regime of abuse at the Winterbourne View unit, in Hambrook, near Bristol, was exposed by the BBC Panorama programme.
Confidential Inquiry into Premature Deaths of People with Learning Disabilities (CIPOLD) March 2013
What does the Des hope to achieve
To provide an annual health check on people with moderate to severe learning disability who are 18 years or older this year
Identify unmet health needs and health inequalities
To improve the contact between primary care and people with a learning disability.
To put individuals and their families more in control of their health
The Cardiff Health Check This is a seven section
document
Uses Yes/No tick box format
Asks a series of questions in relation to the health of the individual
Health Promotion
Chronic Illness and Systems
Enquiry
Epilepsy
Behaviour
Physical Examination
Syndrome Specific
Medication
An updated version of this is available on the RCGP and signpostsheffield website.
Cardiff Health Check for People with a Learning Disability Date Name Marital status Ethnic origin Principal carer Age Sex
Address ______________________________________________________________________________________ Weight (kg/stone)………………..……… Height (meters /feet) …………………… Blood Pressure ………………………… Urine Analysis …………………………. Smoke (per day) …………………………. Alcohol (units per week) ………………. Body Mass Index Cholesterol/ (weight in kg / height in m2) ………………… Serum lipids ……………………….… _____________________________________________________________________ Immunization - People with learning disability should have the same regimes as others and the same
contra indications apply. (please circle)
Tetanus in last ten years? Yes No
If no has tetanus been given? Yes No
Has influenza vaccine been given? Yes No
Is Hepatitis B status known? Yes No
Result? ………………………………………………………………………...…… ________________________________________________________________________ Cervical screen – people with a learning disability have same indications for cervical cytology as others.
Is a smear indicated? Yes No If yes when was last smear? ..…/……/…… When is next due? ……/……/…… What was the result? ………………………………………………………………… ________________________________________________________________________ Mammography – this should be arranged as per local practice.
Improving Health and LivesLearning Disabilities Observatory
Is made up of the following organisations:-
Nepho North East Public health Observatory NDTi National Development Team for Inclusion CeDR Centre for Disability Research Provide information and statistics on effects of the health
checks by region. Other health information relating to people with a learning disability is also available on the website
www.nepho.org.uk
Health Checks for People with Learning DisabilitiesAn Audit Tool (including indicators of success)
Flipchart activity
Discussion – which health issues are people with a learning disability most likely to experience.
Die early Die from breathing
problems Have heart problems Be overweight, and
eat badly Have certain cancers Have epilepsy Have Autism Be mentally ill
Health Issues More Likely To:
Be given psychotropic drugs
Have a physical disability Be deaf or blind Have dementia Have communication
problems Have thyroid dysfunction Have dental problems. Use medical hospital
services Be discharged quickly
Health IssuesMore Likely To:
Have a health check Be screened for cancer Use surgical hospital
services Have sight tested Have hearing tested Receive pain relief Get Health Promotion
advice Be included in
consultations/ patient forums
Health IssuesLess Likely To:
Health Action PlansSimply a plan which
identifies WITH the person
The health need The action to be
taken Who will help the
person do it The date when the
plan will be reviewed Any further actions to
be taken
Capacity and Consent
How do you assess capacity?
Get into small groups
Discuss how you do this
Identify any issues
Feedback and discussion
Mental Capacity Act 2005“Provides a statutory framework to empower and protect vulnerable people who may not be able to make their own decisions. It makes clear who takes decisions in which situations and how they should go about this. It enables people to plan ahead for a time when they may lose capacity.”Implemented 1 April 2007For more information go to the GP Commissioning intranet.http://www.sheffieldccg.nhs.uk
5 Key Principles
1. Presumption of capacity, unless proved otherwise.
2. Right to be supported to make decision, before concluded they can not make own decision.
3. Right to make “eccentric or unwise” decisions.4. Best interests – any act done for a person
without capacity must be “in their best interests”.
5. Least restrictive intervention.
Defining mental capacityAbility to make decisions or take actions affecting daily life
The burden of proof is on any person who asserts that the other person lacks capacity.
They will have to show, on the balance of probabilities, that the individual lacks capacity to make the decision in question.
The two stage test1. Impairment of, or disturbance in functioning of, person’s mind or brain? If so,2. is the impairment sufficient that they lack capacity to make the decision.
Assessing lack of capacity (part 2 of two stage test) Testing whether someone is unable to make a
specific decision (4 questions of functional test).1. Understand the information relevant to the
decision (understand the consequences of options)
2. Retain that information3. Weigh up that information as part of a decision-
making process, OR4. Communicate the decision
A ‘No’ on any = lack of capacity.
Best interests
Everything done for person who lacks capacity must be in their “best interests”
Section 4 sets out a checklist of steps and factors to be considered (see next slide)
Consideration must be given to whether there are other options that may be less restrictive of the person’s rights.
The decision maker must reasonably believe that any action intended to restrain a person who lacks capacity is necessary to prevent harm to the person and a proportionate response to the likelihood of seriousness of harm.
Best Interest Checklist Equal consideration and non-
discrimination Considering all relevant circumstances. Regaining capacity Permitting and encouraging participation Special considerations for life-sustaining
treatment. The person’s wishes & feelings, beliefs &
values. The views of other people.
What is restraint ?
The Oxford Dictionary defines “restraint” as “to check or hold in; to keep in check or
under control; keep down”
•Physical restraint•Mechanical restraint•Chemical restraint•Restricting individuals’ choices•Withholding information•And more………
Easy English Guide
How do you support people with a learning disability to complain
Are your leaflets accessible?
Have you identified someone who can help?
Is your feedback communicated in a way that that the person can understand ?
Working Together Community Learning Disability Teams(CLDT)
Intensive Support Service (ISS) Respite Care Services
The Sheffield Case Register
Further information
www.signpostsheffield.org.uk Deprivation of Liberty Safeguards hotline – 0114 205 3783 (Mon-Fri
9.30-4.00) Mental Capacity Act Code of Practice –
http://www.dca.gov.uk/legal-policy/mental-capacity/mca-cp.pdf Deprivation of Liberty Safeguards Code of Practice -
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085476
Alternatives to Restraint – Dr Zara Clarke – 0114 271 6939 or Anita Winter 0114 271 6741
http://www.gmc-uk.org/learningdisabilities
http://www.bris.ac.uk/cipold/fullfinalreport.pdf