Transcript Document

…What’s the story with
Learning Disabilities…
…so far…
Pól Toner
Head of Mental Health and Learning Disabilities
East of England NHS
Chair National Learning Disabilities
Leadership Group
1st to be Frank
So what's the big issue?
• People with learning disabilities
frequently have greater health needs
than the general population, with a
higher than average proportion having
complex and multiple health needs.
Explain!
• People with learning disabilities,
particularly Down’s Syndrome, have an
increased risks, although overall life
expectancy in this population has
increased over time.
Explain!
• Given the frequent co-existence of long
term conditions such as coronary heart
disease, services are frequently not
equipped to meet the needs of this
group.
Explain!
• Dementia and other mental health problems,
– 21% of people aged 65 years and older being
diagnosed with dementia compared with
– 5.7% in the general population.
• Mental illness rates are approximately 3 times
higher than in the general population,
• and people in this group are more likely to be
prescribed psychotropic medication than
someone without a learning disability.
Health care for all
• AT LAST you may say!!
Health care for all and what it means
• People with learning disabilities should be
able to access the same range of services
available to anybody else in the population.
Indeed, given the propensity for this group to
experience greater complexity in their health
status, there is strong evidence that services
should be targeted at this group, through the
introduction of health facilitators and annual
screening in primary care.
…but why do we need to be told
to do this??
• Nationally, we know that there are
inconsistencies in health provision for
people with learning disabilities and that
there is evidence that people with
learning disabilities have trouble
accessing the help they need.
Mainstream services are frequently not
equipped to meet the needs of this
group
For example
• Population screening programmes for
people with learning disabilities have
also been highlighted as an area of
concern, particularly in cervical
screening where only 19% of the female
population with a leaning disability
receive screening compared with 77%
of women in the general population!!
Key interventions to meet the health needs of
people with learning disabilities include:
• explicit and targeted efforts to increase uptake of
cervical and breast screening among women with a
learning disability;
• ensuring equitable access to mental health services;
• targeted health checks in primary care;
• ensuring that all secondary care services are
routinely accessible to people with learning
disabilities on the basis of need;
• provision of health information in a range of learning
disability orientated media.
So if we continue to do the same
as we have always done ?
• Well, we will then get the same as we
have always got so.
• So, its…
We need to do this strategically
and in partnership locally
• Otherwise we will end up…
In the East of England
• Made our pledges via the next stage
review (Darzi Review)
• Consulted on the pledges
• Moving towards implementation
Our pledges…
• Ensure people with a Learning Disability
receive appropriate health care
(Healthcare for All)
– Re-establish/ re-vitalise partnership boards
– Introduce LD self assessment
– Ensure completion of commissioning/
funding transfer
Our pledges…
• No one living in the NHS by 2010
(campus closure)
• Implement Valuing People Now (now)
• Commissioning :
– All contracts for health care include LD and
disability requirements.
Our pledges…
• All training contracts to promote greater
awareness of LD and disability
• 2008/9 use of new DES in 50% of GP
practices
• Commissioning specific training for
primary care staff to aid identification
and support for people with a LD
Our pledges…
• Reduce unwarranted disparity in access
to screening programmes for people
with Learning Disability
• And then…
• Mainstream this agenda…
Where are the National Variations?
• Joint
Commissioning
• Involvement
• Strategy
Development
• Commissioning
Capacity
• Needs Assessment
& Use of Data
The scale of the commissioning
challenge
• World Class Commissioning
– Market Stimulation
– Contracting/ Procurement
Capacity
– Robust Needs Assessment
• Choice
• Personalisation Agenda
– Understanding the needs of
your consumers including
those yet to use services
• Commissioning for
Outcomes
– Recovery/ Wellbeing
• Joint Commissioning
‘Silo-ed Thinking’
We are All a bit ‘Guilty’ of this and..
• unless addressed we will
not fully..
•
•
..maximise the Benefits for the
Consumer
..flex Commissioning ‘Muscle’.
So we must..
•
•
•
..Sell Collective Priorities =
Collective Gain
..Promote cross agency and in
own organisation, and
ensure Best Value
Which Silos?
• Health
– Acute
– ‘Working Age’
– CAMH
– MHSOP
– LD
• Local Authority
• DWP
• Housing
• Supporting People
• Police
• Probation
• Home Office…
…To name but a few.
Now is the time to…
Market management
• For too long services for people
with a learning Disability have
been served by what’s available in
the local trust
• Is that really what we want??
If its not ? then what can you
do a bout it
• Provider stimulation (without
destabilisation)
• Bring new providers in around the table
• Develop what models of care you want
• Work with commissioners to turn that
into specifications and put you plan to
the market
• Its not easy but…
Acknowledge that we have never
had a bigger platform to shout from
• We need to get on with it and own the
solution, not hang onto the problem
• And above all…
Work in Tandem