…What’s the story with Learning Disabilities…

Pól TonerHead of Mental Health and Learning Disabilities

East of England NHS Chair National Learning Disabilities

Leadership Group

…so far…

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