Transcript A Health Needs Assessment for Adults with a Learning

A Health Needs Assessment for Adults
with a Learning Disability in Nottingham
and Nottinghamshire
Presented at the Help and Advice for Learning Disability
Commissioners Event
Birmingham 30th November 2010
Anne Pridgeon
Health Improvement Principal
NHS Nottinghamshire County
and NHS Bassetlaw
Iain Little
Public Health Development Manager
NHS Nottingham City
Health Needs Assessment
• Systematically assess the health needs of adults with learning
disabilities
• Review the evidence base for health need and effectiveness of
services
• Review local information on prevalence, health needs and
healthcare service use
• Identify gaps and inequities
• Make recommendations
Prevalence of learning disabilities
• Precise local prevalence and incidence figures not available
• Used national estimates and future projections along with recorded
primary care prevalence
• Much practice- and cluster-level variation in the recorded prevalence
• Estimates based on general projections - need to know local
population characteristics
2.0%
1.5%
1.5%
Age-specific (18+) recorded prevalence (%)
2.0%
1.0%
0.5%
NHS Nottinghamshire County
1.0%
NHS Bassetlaw
0.5%
0.0%
0.0%
NHS Bassetlaw practices
NHS Nottinghamshire County practices
2.0%
Age-specific (18+) recorded prevalence (%)
Age-specific (18+) recorded prevalence (%)
Recorded prevalence by practice
1.5%
1.0%
0.5%
NHS Nottingham City
0.0%
NHS Nottingham City practices
Demographic profiling
• Adults known to Adult Social Care Services
– 3,244 matched to NHS number
– higher rates in NHS Nottinghamshire County and NHS
Bassetlaw than in NHS Nottingham City
– majority aged 18-59
– ratio of 1.41 males:1 female adult with a learning disability
– rates by ward varied from 0 to 14.5 adults with learning
disabilities per 1,000 population
• Adults known to specialist LD services
–
–
–
–
2,236 adults
majority aged 20-59
ratio of 1.35 males: 1 female
ethnicity profile similar to general population
Population distribution of
adults with learning
disabilities known to Adult
Social Care services
Pattern of health need and use
Lifestyle issues
• Lower rates of smoking
• No data on obesity, physical activity or alcohol
Screening
• Lower proportion of eligible women attend breast and cervical
screening appointments than the general population
• Lower proportion participate in bowel screening programme
Cervical screening
60
Learning Disability population suspended
General population suspended
Proportion of total female population aged 24-65 (%)
50
Learning Disability population ceased
General population ceased
40
30
20
10
0
NHS Nottinghamshire County
NHS Bassetlaw
NHS Nottingham City
Pattern of health need and use
Secondary care
• Compared to the general population
– admission rates to secondary healthcare are approximately 1.2 –
1.4 times higher
– higher rates of both elective and emergency admissions (lower
rate of maternity admissions)
– longer median length of stay
– attendance rates at out-patient clinics are between 1.4 and 2.2
times higher
– attendance rates at A&E approximately twice as high
Shorter life expectancy
50
Adults with a diagnosis of learning disability recorded
All adult deaths
Age of death of adults with
LD recorded on death
certificate and all deaths
30
20
10
0
18-19
20-29
30-39
40-49
50-59
60-69
70-79
80-89
90-99
100+
Age band
30%
Adults with a learning disability
General adult population
Age profile of adults with
LD known to Social Care
services and general
population
Proportion of population (%)
Proportion of deaths (%)
40
20%
10%
0%
18-19
20-29
30-39
40-49
50-59
Age band
60-69
70-79
80+
Other sections of HNA
• Current service provision review
• Corporate views
– Performance and self assessment framework
– Stakeholder views
– PALS enquires and complaints
• Comparative assessment
– Compared with other PCT’s in East Midlands and Yorkshire and
Humber using Performance and Self Assessment Framework
Gaps and Recommendations
• Gaps and recommendations cover whole of the health system and
reviewed by:
– Learning Disability Partnership Boards
– Joint Commissioning Groups
– Better Health Group (Health sub group of LDPB’s)
• Better Health Group in process of developing action plan and will
review implementation of recommendations
How findings are being taken forward
• Work to improve the cervical screening rates
• Findings have been included in updated JSNA’s
• Review to determine whether provision of specialist services match
need
• Health Equity Audit of access to services by people with learning
disabilities, using extracted primary care data
• Recommendations included in local strategies and action plans
Contact details
• [email protected]
• 0115 883 9238
• [email protected]
• 01623 673513