1. About me Making my plan happen Making my plan happen Health assessment Health assessment Find out more? How is my plan going? How is my plan going? Actions for Health Actions for Health What is really important? What is really important? NHS services Links to other plans Links to other plans About my health Getting started i i i i ii i i i ii c a i > > a a a a a a i c cc c c Integrated Care Pathway for Health Action Plans a a c > i> Dedicated NHS services Social care services Voluntary / independent sector Voluntary / independent sector Civic services i i > > >> i a c > KEY Information Access and Communication Consent and information sharing Referral pathway

2. About me - information i Back to pathway Health Action Plans are a person centred approach to addressing health and healthy living. They start with the person, who they are, their particular circumstances and lifestyle, and what really matters to them. Check  Has this person been identified as having a learning disability on the GP practice register?  Does he or she have sensory impairments; and/or profound and multiple impairments; and/or complex and continuing health needs needs?  Are other special or enhanced needs identifiable?  What are this person’s particular circumstances? ( for example, who do they live with; what do they do during the day; how do they enjoy themselves; what kind of support do they need for every day living; who are the people who keep them healthy)  Is this person from a black or minority ethnic background?  Are they moving from child to adult services?  Are they moving from adult to older age services?  Are there other important life events for this person, such as bereavement; marriage or pregnancy?  What are their person priorities now?

3. About me – access and communication a Back to pathway Some people may have difficulties with communication, or communicate in unconventional ways. Or they may be anxious in talking about themselves. It can be helpful to ask a person’s supporters if they have any special ways in which they communicate.  What is the person’s preferred language? Do we need a language or a sign language interpreter?  Does this person have any special ways of communication? Can their carer or health facilitator tell you?  How does this person tell you ‘yes’ and ‘no’ and if they are feeling unwell or in pain?  Are the person’s ways of communication set out in a communication passport? Check

4. About my health- information i People with learning disabilities have poorer health than the rest of the population. Many people have undiagnosed and untreated health problems. This affects their life chances. Major reviews of people with learning disabilities confirm increased risk of early death compared with the general population. Proactive approaches to identifying the health needs of people with learning disabilities are helpful. Valuing People identifies the following health issues as particularly relevant to people with learning disabilities: oral health and dental care; fitness and mobility; continence; vision; hearing; nutrition; emotional needs; medication taken and side effects; and records of any screening tests.The National Patient Safety Agency has also highlighted health and safety issues for people with learning disabilities: the use of control and restraint; the vulnerability of people in general hospitals; people who have swallowing difficulties; lack of accessible information; and illness or disease being misdiagnosed.  Has this person and their family access to health information in a format they can use, such as easy to read literature; symbols, pictures or photographs, audio tape, or DVD?  Does this person’s primary health care team have a resource pack on people with learning disabilities and health?  Does this person’s primary health care team know how to get in touch with the local community learning disability team for additional support if needed? Back to pathway Check

5. About my health- access and communication a Back to pathway Check Although people with learning disabilities have the same rights as everyone else to access health services, many do not get the services they need. Equality for people with disabilities is not simply about treating people the same, but rather making reasonable adjustments so that people can achieve equal opportunities and equal outcomes.  Will our building(s) and ways of doing things help or prevent this person from using our service?

6. Getting started- information 1 i Back to pathway Anyone with a learning disability can have a health action plan. Health Action Plans usually begin with transition planning around the age of 14. Valuing People says services should offer and review plans for people with learning disabilities when: leaving school; leaving home to move into residential services; moving from one provider to another; moving to an out of area placement; changes to health status, for example, following from out-patient care or in-patient treatment; on retirement; when planning transition for those living with older family carers.Other times for starting Health Action Plans could be when NHS Life Checks are due. People with learning disabilities and their families may start a Health Action Plan themselves.They may be prompted by life events such as becoming ill, becoming pregnant, the start of a new year, and thinking about health in the context of other plans for the future. People usually start by gathering information about their health. This can be done in different ways to suit individual needs and approaches. Some people like to make sure all the information about their health is in one place, for example through a: Personal Health Profile, or electronic version of their NHS personal health guide linked to their HealthSpace on the internet. Some people choose a personal health facilitator to help them with their Health Action Plans. Similarly, Health Action Plans can be started with the person by support staff in housing and day programmes; dedicated health professionals involved with the person; and the person’s primary health care team.

7. Getting started- information 2 i Back to pathway  Is it important for this person to start a health action plan now, and when is the best time to make an appointment to see a primary health care practitioner?  Should the primary care team call this person in for a health check as they have not been to the practice for 3 years?  Has this person already started gathering information about their health; and have they already set up an appointment with a primary health care practitioner?  Has this person a named health facilitator to help with their health action plan? Check Good practice  It makes sense: a) for general practices to make sure that everyone with a learning disability registered with them is offered a Health Action Plan, by whatever route; and b) for everyone to have their health checked by a primary health care practitioner before taking their Health Action Plan forward. Strategic health facilitators can help general practices with organising and monitoring this.

8. Getting started-access and communication 1 a Back to pathway Some people with learning disabilities have a health facilitator to help with their Health Action Plan. Lots of people can be the health facilitator: another person with a learning disability, a family carer, a staff supporter, or a health professional. Sometimes it is helpful if a health professional who just works with people with learning disabilities is the health facilitator for individuals with complex health needs. Some people from black or minority ethnic communities may also find it helpful to have a ‘link worker’ accompany them. There may be a number of physical and organisational barriers to overcome for people with learning disabilities to have a health check appointment with their GP or primary health care practitioner. Some people with learning disabilities say that negative and unhelpful attitudes of health care workers affect their willingness to use health services. A small number of people have disabilities that prevent them from travelling or using the centre without a lot of difficulty, or have very poor health, or find health care surroundings too anxiety provoking or distressing. In these situations, it makes sense for people to have their health assessed at home.

9. Getting started-access and communication 2 a Back to pathway Health Facilitator  Has this person chosen a health facilitator (or link worker) who should be invited to their appointment? Appointments  Is it important for this person to be seen at home or can they come to the practice?  Has a letter been sent out in a format that they can understand? Is it worth sending out a reminder, or making a phone call for people supported by staff teams where communications may get ‘lost’?  Has this person been offered the chance to prepare before appointments, for example, through easy to understand information, visiting waiting rooms and familiarisation with equipment and procedures?  Would it be best to make an appointment at the beginning or end of the day, and to make more time for the appointment?  (For a small number of people), is it helpful to wait in a side room?  Are failed appointments followed up to find out what has happened? Check

10. Getting started-access and communication 3 a Back to pathway Travel  How will this person get to their appointment? Can they walk or use public transport? Is there someone who can drive them to the health centre or GP practice? Buildings  Will this person cope with the design and layout of this building? Do they have physical and sensory impairments to take into account? Social access  Are there arrangements for this person to check in and be called for their appointment without embarrassing them?  What is the best way to welcome this person, explain who you are and make them feel comfortable before starting a session? Check

11. Getting started-consent and information sharing 1 c Back to pathway Health practitioners usually need a person’s consent before they can examine or treat them. As long as the person is over 18, and can understand what is involved in treatment, they are the only person who can give consent. The key test is ‘Can this person understand and weigh up the information provided?’. Many people with learning disabilities can decide for themselves, given time and the right kind of support to go through the options. Also people also may be able to consent to some things and not others. They can change their minds at any time. There is a common law duty for health practitioners to provide treatment to adults who are unable to consent or refuse treatment, if that treatment is necessary and in their ‘best interests’. This can cover all sorts of situations ranging from eye tests to more exceptional surgery. Such treatment must preserve the life, health, or well being of the person. In reaching a decision about ‘best interests’, health practitioners should listen to the person themselves, and people who know and care about them.  Have you assessed this person’s capacity to consent to a Health Action Plan? Have you taken advice from other professionals, such as community learning disability teams, and speech and language therapists, and people who know them well? Have you recorded your assessment and conclusions? Check

12. Getting started-consent and information sharing 2 c Back to pathway  Has anyone explained what to the person what a Health Action Plan is and how it might benefit them in ways they can understand?  Has this person agreed to a Health Action Plan- who will be involved, where will this take place, how will it be communicated and to whom?  Have they agreed to a Health Facilitator (or a link worker) and to have their Health Facilitator attend their appointments with them?  If a person does not want a Health Action Plan, have the reasons for this been explored with them? Have any practical solutions been offered to overcome the worries they may have?  If a health practitioner goes ahead with a Health Action Plan for a person on the basis of ‘best interests’, have they recorded the reasons for their decision, and the involvement of those closest to the person? Have they also recorded any disagreements between practitioners and those closest to the person?  If the person does not want a Health Action Plan, think about how to make sure they stay healthy and monitor their health care.  Offer the person the opportunity to rethink their decision at a future date.  Make sure you have a consent policy that has been drawn up with the involvement of people with learning disabilities and their families Good practice Check

13. Health assessment – information 1 i Back to pathway It is important that GPs and primary health care practitioners assess the health of their patients with a learning disability for the purposes of: a) identifying their health needs and prompting timely and appropriate access to health services; b) case finding to identify especially vulnerable patients who are at risk of admission to hospital or institutional care and who would benefit from structured anticipatory care; and c) establishing baseline and follow up health measures to ensure that national and local health targets are met. Primary health care practitioners are likely to draw upon existing health information and use a standardised or locally developed health screening check to assess the health of their patients with a learning disability. They will reference this with The Quality Outcomes Framework (QOF) for General Practice. This highlights the identification of people with learning disabilities on GP practice registers, and important health issues for the wider population, such as epilepsy, coronary heart disease, clinical obesity and mental health issues. People with learning disabilities also typically show many of these conditions.

14. Health assessment – information 2 i Back to pathway  What is already known about this person’s health from their patient care records and any patient held information?  Has a Health Action Plan been started? Has it been initiated or checked by a primary health care professional, and is it based on a comprehensive health check? This will help ensure that the plan does not include actions that are unsuitable for the individual and that no health opportunities have been missed.  Does the assessment consider: health issues that are relevant to this person, given their particular circumstances and concerns? health issues usually relevant to people with learning disabilities? issues relating to the wider determinants of health?, such as poverty; poor housing; unemployment, isolation and abuse that may affect this person’s health. This is especially important where a Health Action Plan is the main or only plan in process  Does the assessment cover health issues identified as important by The Quality Outcomes Framework? Check

15. Health assessment -access and communication 1 a It is important to listen carefully to the views and experiences of people with learning disabilities and their families, and to use different ways to communicate and provide information that people can understand. The local community learning disabilities team can help with this. Some good suggestions are:  Offer the first or last appointment to someone who has a learning disability  Offer double consultation time  Speak to the person with learning disabilities first, and only then check out with the carer if something is not clear. Be sensitive to the client’s feelings and encouraging  Try asking open questions or changing the question round to check out if you still get the same response  Explain the process of the consultation before you start  Use language that the person understands at a simple level, or use a communication aid, for example, life-size models, pictures or symbols  Sometimes it may be useful to get information from supporters as well  Always check out that the person has understood by asking them to explain to you in their own words  When you are talking about time, use events that the person will understand (for example, take this medicine with breakfast and supper, rather than twice daily)  Do not assume that the person will understand the connection between the illness and something they have done or something that has happened to them Back to pathway Good practice

16. Health assessment -access and communication 2 a  How does this person communicate? Will a language or sign language interpreter be needed? Can a health facilitator help explain the person’s special ways of communicating?  Is information about the health assessment available to this person in different formats, such as easy to read English, other languages, illustrated material or taped books?  Is there support from a health facilitator if this person becomes anxious or distressed in an assessment situation? Check Back to pathway

17. Health assessment -consent and information sharing c Back to pathway Seeking consent is an ongoing process. It is helpful to explain the reasons for the health assessment and what it will involve at the beginning of the session, and confirm that the person is willing to go ahead.  Have you explained the reasons for a health assessment to the person in ways they can understand?  Have you asked the person if they understand what you are going to do? (it is often helpful to ask them to repeat what you have said back to you)  Has the person agreed to continue? Check

18. Find out more? –information 1 i Some people have a Health Action Plan based on specific, already identified health issues. Other people require a comprehensive, structured assessment by a primary health care practitioner when: There has been no previous or recent focus on the person’s health The person does not or cannot communicate symptoms conventionally and/or does not have someone close to them who can recognise and report health changes. A health problem is suspected and it is not possible or appropriate for those initiating a health action plan to decide if action is needed (for example, weight loss, unexplained behavioural changes) A more detailed assessment may cover; for example: medical history taking, structured physical examination of body systems, and investigations; differential diagnosis of impairments; differential diagnosis of the condition underlying a person’s learning disability; and mental health screening. If further investigations and assessments are necessary for the individual, the primary care practitioner may refer them directly to other services, as part of their ‘health prescription’.  Are medical issues are properly addressed, including those related to the specific syndrome associated with the person’s learning disability and its’ consequences for health?  Have you made assumptions about the nature of this person’s disability that could lead to diagnostic overshadowing or misdiagnosis? Check Back to pathway

19. Find out more? –information 2 i Back to pathway  Have you identified indications of pain and addressed these?  Have you reviewed the person’s medication with them and their supporters to ensure accuracy, safety and appropriate frequency? With complex, multiple prescriptions and psychotropic medication, have you sought advice from the local medicine management team and relevant health professionals? (for example, with skills in the management of epilepsy or mental health issues)  Have you assessed the person’s vulnerability to dysphagia (swallowing difficulties) and identified whether a care plan is needed?  If the person has additional disabilities, have they been offered the full range of assessments covering all impairments and needs for assistive technologies, care and support?  Have you identified risks to the person’s mental health and well being and referred them for appropriate help?  Signs of emotional distress and behavioural disturbance are recognised as a possible response to: a) physical illness or a symptom, including pain; b) abuse, bereavement or other life changes; c) underlying mental health problems or illness, most often depression, or early onset dementia  Symptoms such as halitosis, blepharitis, pressure sores, bruising are examined further as a possible indication of: a) deterioration in the person’s functioning;b) poor care, neglect, or abuse; or c) the carer is not coping, and may need additional support Check Good practice

20. Find out more?-access and communication a Back to pathway Some people with learning disabilities require a lot of support and preparation prior to more extensive assessments, examinations and investigations. Visual aids can be helpful.  Will it be helpful for this person to look at easy to understand information about medical procedures and what to expect beforehand? Or for the person to do a pre- assessment visit to the GP practice with their health facilitator and go through what is likely to happen?  Before you do anything, have you: Shown them what you are going to do? Told them why you are going to do it, and why you are using the instrument that you are going to use on them? Told them if you think it might hurt? Asked the person if they understand what you are going to do? Check

21. Find out more?-consent and information sharing 1 c Back to pathway People who have agreed to a health care assessment can change their minds and withdraw their consent at any point. Similarly, they can change their minds and consent to further assessments that they have earlier refused. Where a person objects and appears to withdraw consent during examination (for example, smear test), stop the procedure if possible and establish what their concerns are. Sometimes an apparent objection may reflect pain or distress rather than withdrawal of consent, and appropriate reassurance may enable you to continue with the procedure.  Have you explained the reasons for the assessments, examinations and investigations to the person in ways they can understand?  Have you asked the person if they understand what you are going to do? (it is often helpful to ask them to repeat what you have said back to you)  If assessment procedures are distressing for the person, despite reassurances, have you considered whether they are really necessary, and whether there are acceptable alternatives? Check

22. Find out more?-consent and information sharing 2 c Back to pathway  Have you decided on ’best interests’ for this person? If so: Does this reflect their overall best interest for the person, not just medical best interest, and have other people who know and care about this person been consulted on this decision? If the decision is very complex, or there are strong disagreements, or the outcome likely to be significant for the individual (for example, sterilisation as a form of contraception), have you sought independent legal advice?  Have you recorded the reasons for a ‘best interests’ decision, and the involvement of those closest to the person? Have you also recorded any disagreements between practitioners and those closest to the person? Check

23. Find out more?- other health pathways > Back to pathway As part of a more detailed health assessment, GPs and primary health care practitioners may pursue predetermined health screens for care pathways relating to the local population, or to specific syndromes that the person may have.  Have you pursued the following health screens for: National Service Frameworks, such as for diabetes and mental health Community based health improvement programmes, such as smoking cessation and ‘Reach for Health’ Specific conditions associated with a learning disability, if a pathway is available

24. What is really important -information Back to pathway i Health assessments should identify what really matters for the person. For example:  Health issues that are particularly relevant to this individual, including: a) mental health, behaviour and psychological issues, and b) areas where this person is likely to be vulnerable to poor health, for example, because they: are currently ill; have epilepsy; have a particular syndrome with health consequences; have issues related to self abuse; have issues relating to their sexuality or sexual health; have profound and multiple impairments; have issues related to postural care; are from a minority ethnic group; are a younger person in transition; are an older person; have a sensory impairment; have issues relating to physical or sexual abuse Health issues that are particularly relevant to this individual, including: a) mental health, behaviour and psychological issues, and b) areas where this person is likely to be vulnerable to poor health, for example, because they: are currently ill; have epilepsy; have a particular syndrome with health consequences; have issues related to self abuse; have issues relating to their sexuality or sexual health; have profound and multiple impairments; have issues related to postural care; are from a minority ethnic group; are a younger person in transition; are an older person; have a sensory impairment; have issues relating to physical or sexual abuse  Health issues, which if resolved would open up new opportunities and experiences for this person, for example, improved hearing; control of epilepsy Health issues, which if resolved would open up new opportunities and experiences for this person, for example, improved hearing; control of epilepsy  Health issues that are the focus of national or local health initiatives and apply to this person, such as NSF’s for mental health, diabetes and long term conditions Health issues that are the focus of national or local health initiatives and apply to this person, such as NSF’s for mental health, diabetes and long term conditions  Will the actions for health identified for this person make a difference to their health in ways that are important to them? Will the actions for health identified for this person make a difference to their health in ways that are important to them?  Will the actions for health support or open up new lifestyle opportunities and experiences for this person in ways indicated by their person centred plan, if they have one? Will the actions for health support or open up new lifestyle opportunities and experiences for this person in ways indicated by their person centred plan, if they have one? Check

25. What is really important- access and communication a Back to pathway  Take time to explore the person’s ideas and concerns for each problem, its’ impact on their life, and what sort of help they expect. Encourage them to express their feelings and thoughts  Use concise, easy to understand language and avoid jargon  Regularly clarify and summarise what the person has said to check your own understanding and allow the person to correct this if necessary and provide further information  Ask the person to repeat back what you have said in their own words, to check their understanding, and allow you to clarify further if necessary  It may be helpful to ask the person’s carer or health facilitator to contribute to the discussion  Visual aids may be helpful Good practice

26. What is really important- consent and information sharing c Back to pathway  Has the person had the opportunity to identify what health issues are important to them?  Have you checked out: What really worries them about their health? How their health affects their ability to do things, go places and meet people? Whether they know about health issues that are seen as important for everyone everywhere?  Have you decided on ‘best interests’ for this person? If so: Does this reflect their overall best interest for the person, not just medical best interest and have other people who know and care about this person been consulted on this decision? If the decision is very complex, or there are strong disagreements, or the outcome likely to be significant for the individual (for example, sterilisation as a form of contraception), have you sought independent legal advice?  Have you recorded the reasons for a ‘best interests’ decision, and the involvement of those closest to the person? Have you also recorded any disagreements between practitioners and those closest to the person? Check

27. Actions for Health (‘Health Prescription’) - information i Back to pathway The person’s health assessment may highlight a number of health issues. For each of these, the primary health care practitioner identifies with the person what they need to do to:  keep healthy;  improve their health;  better manage an existing long term condition;  take an active part in self care. These are the Actions for Health or ‘Health Prescription’. They form the basis for Health Action Plan.  Have you identified and recorded actions for health that are relevant to this person?, for example, in relation to:  Health care, including further screening, investigation, examination and assessment; health care treatment, interventions and support, including medication; and looking after the person’s health  Healthy living options, such as walking to the shops; walking upstairs rather than taking the lift; going swimming; eating ‘ 5 a day’ fruit and vegetables; and giving up smoking  Information sharing, education and skills development for active self care Check

28. Actions for health- access and communication Back to pathway a  Have you summarised the session and clarified the actions for health with the person and their carer or health facilitator in words that are easy to understand, or with the use of visual aids? Does the person need help from their carer, health facilitator, or a language or sign language interpreter to understand the information about their health?  Is the person and their supporter or facilitator clear about the next steps or follow up interventions?  Have you explained possible unexpected outcomes, what to do if the plan is not working, and how to seek help?  Have you given the person and their carer easy to understand information about their medication? People with learning disabilities can have multiple medications. They (and sometimes their carers) may have difficulty in coping with changes to medication, and forget or not understand the importance of taking the correct medication in the right way Check

29. Actions for health- consent and information 1 c Back to pathway People need enough information before they consent to or refuse their proposed actions for health. In particular, they need information about: the benefits and risks of the actions for health proposed; what the actions will involve; what the implications of not pursuing the actions are; what alternatives may be available;  what the practical effects on their lives of taking the actions forward or not will be It is important that this information is provided in a form that the person can understand. This may involve using pictures, or explaining what is involved in simple terms and short sentences, and being willing to repeat or reword explanations. A communication board, indicating yes and no answers, may be helpful. It may be helpful to share information about a person’s health, when, for instance, the health care practitioner wishes to refer them onto another service, or there are aspects of a person’s health that impacts on other parts of their life, or services need to co- ordinate who does hat and when, to avoid duplication, or not doing things, and to help people get on with their lives. Under The Freedom of Information Act everyone is entitled to have copies of information about themselves.

30. Actions for health- consent and information 2 c Back to pathway  Has the person been given relevant information about the health actions proposed and in a suitable format?  Has the person understood and agreed with the actions for their health? Have they had the chance to think about potential benefits and weigh this up against any worries they might have? Are there any changes to be made?  Have you discussed with the person who else may need to know about their health? Have they agreed to information being shared with other people? Is there information they do not wish to share? Has this been recorded?  Does the person want copies of the results of health assessments, health prescriptions, and letters about them? Should copies be sent through the post, or picked up by the person at a later date? Has this been recorded? Check

31. Actions for health- referral pathway > Back to pathway The primary health care practitioner may ‘prescribe’ further screening, investigations, examination or assessments, and make a direct referral to other health services. Increasingly, they may use Choose and Book to offer people choice about their health care. They may also refer people to community based Clinical Assessment Services (CASs) or a referral management centre, for mental health services and for presenting conditions such as musculo-skeletal conditions. The primary health care practitioner may also refer the person to other services, such as social care services and dedicated learning disability services, if they are not already involved with them.  Have you referred this person for further screening, or assessments, or health care interventions and support that may helpful to them now?  Should this person be referred to other services?  The primary healthcare practitioner refers the person to sports and leisure services as part of their ‘exercise prescription’ Good practice Check

32. Making my plan happen -information i Back to pathway The Health Action Plan will identify:  The right person, service, or resource to help with each of the person’s actions for health.  Who will help take the actions forward (for example, someone to accompany person at keep fit classes or walking; learning to speak up more effectively about health; working with a provider to make their service more responsive).  Dates for a review or follow up on each of the actions. If there is difficulty in finding specific resources and supports for any individual, health facilitators can help to identify or create them.  Has a Health Action Plan been completed for this person that clearly identifies their actions for health and which services or resources will help? Has this been recorded on the GP’s patient data system?  How does the Plan include this person in mainstream health services and agendas?  What is being done to: help this person take care of their health? support family carers to look after their relative’s health? support social care staff to focus on health issues and health routines? help health services provide a good response to the health needs of this person? Check

33. Making my plan happen -access and communication a Back to pathway Everyone should be offered a copy of their Health Action Plan. Many people choose to keep a summary of their plan, in a format that makes sense to them. Support staff, family and/or a health professional can help to produce this. The summary could be included in their personal health profile, or their HealthSpace  Is there a summary of the Health Action Plan available to the person that is geared to their communication preferences as far as possible; for example, by using easy language, pictures or symbols, and being available in tape format or their own language?  Is there a named health facilitator who can provide motivational and practical support for this person to take their health action plan forward? Check

34. Making my plan happen -consent and information sharing c Back to pathway Health services should help people with learning disabilities become active partners in their care. This includes talking though confidentiality issues. Health action planning involves collecting and recording a lot of information about a person. Some of it may be very intimate. Sometimes the person is comfortable for most information to be shared with other people. Sometimes they accept that one or two people may need to know something, but they may want to keep it private from others. If the person is unable to express their wishes on confidentiality, then information should only be shared with people who need to know it to do their job properly  Have you completed Health Action Planning and decision-making with the the person ?  Have you agreed confidentiality issues, such as who sees the Health Action Plan and where it is kept, with the person? It may be helpful for each plan to state how many copies there are and who holds them  Have you offered this person a copy of their Health Action Plan? Many people find it helpful to receive a summary of their plan, in a format that makes sense to them  Is a record of the plan held at the GP surgery? This need not be an accessible version. This could be used to record any health issues that the person does not want to be recorded in their patient held record Check

35. Making my plan happen- referral to other services > Back to pathway The Health Action Plan may refer the individual to a range of other services and resources. The Plan expects that these services will deliver the responses required, and provide feedback on the health actions identified for the individual when the plan is reviewed. A personal health facilitator may help the individual find their way around health services and co-ordinate different health inputs. Other primary health care professionals, such as community matrons, can also take on this role.  Does the Health Action Plan make full use of universal and mainstream services, and so help promote independence and inclusion for this person?  Is there a named person to co-ordinate different health inputs for this person within their Health Action Plan?

36. Making my plan happen – Referral to other services- access and communication a Back to pathway All services should understand that laws on rights apply equally to people with learning disabilities. Health facilitators may need to help develop the skills and confidence of other services to include people with learning disabilities.  Are they culturally competent, and can they meet all the cultural needs of this person, particularly if they are from a black or minority ethnic community?  Are services provided equitably to all who need them, and will they include this person, regardless of their age, gender, disability and circumstances?  Do services actively challenge discrimination on the grounds of age, gender, ethnicity, religion, disability and sexuality?  Are local service buildings accessible by this person?  Are there good local transport systems with disabled access to enable this person get out and about more easily?  Is there a health facilitator who can enable services to include and support this person? Check

37. Civic services- information i Back to pathway T he Health Action Plan may contain a number of actions related to changing a person’s living arrangements and lifestyle, that improve their chances for better health.The person may be referred to services that are available to everybody locally, such as: housing; education; employment; benefits; sports and leisure facilities. The Health Action Plan may also draw on local community initiatives such as walking and cycling groups; ‘healthy hearts project’; and home delivery of fresh fruit and vegetables by a local food co- operative.  Is this person is encouraged to use local services, programmes and initiatives that are available to everyone else to improve their health and well being?. Check

38. Civic services- referral pathway > Back to pathway Local Governments provide ‘one stop shops’ through which local people can access or find out about a whole array of services and initiatives. Some public health initiatives may be organised through the primary care trust.  Has this person (or their facilitator) got details of local council ‘one stop shops’ for local services, programmes and initiatives; and relevant primary care trust initiatives? Check

39. NHS services -information i > With the right sort of help and support, people with learning disabilities can use the whole range of primary, community healthcare, hospital services and highly specialised health services that are available to their local population.  Is this person is supported to make full use of primary and community healthcare services?  If relevant, has this person got access to highly specialised treatment and care, on the basis as for other members of the population, for example, for complex forms of epilepsy, or specialised cancer services?  If the person is admitted to an acute hospital, is there a system in place to ensure that patients with learning disabilities are identified and they are given the right support?  Is there effective communication between primary and secondary care, social care and learning disabilities services prior to admission and on admission to hospital, so that the person receives the care and support they need?  Is there advice and guidance for hospital staff on gaining consent for treatment from people with learning disabilities?  If the person has a serious mental health problem, do they benefit from the NSF for mental health, and do they have swift access to local services?  Are the person’s vulnerability to the risks highlighted by the National Safety Agency for people with learning disabilities identified and acted upon? Check Back to pathway

40. NHS services -referral pathway > Back to pathway GPs and primary care teams have a key role in providing health care for people with learning disabilities and acting as the ‘gateway’ to other NHS services. Through Choose and Book, GPs can offer people choice about where and when they get elective health care. In the first instance, this will apply to hospital care, before Choose and Book is rolled out to other areas. A person may also be referred to community based Clinical Assessment Services (CASs) or a referral management centre, for example for mental health services. Primary Care Trusts have a responsibility to provide targeted packages of support designed to ensure that all patients can benefit from choice.  Has this person had the chance to choose where and when they receive health care interventions and support, so that they get a more personalised service?  Has their GP or primary health care practitioner discussed the clinical aspects of their choice with them?  Has this person had the chance to discuss the non clinical aspects of their choice (waiting times; location and convenience of the service; and patient experience) with a relevant person? Have they been given the right information and in accessible format to support their choice?  Is additional help available to help this person make choices; for example, from their health facilitator; Patient Advice and Liaison Service (PALS); Patient Care Advisor; local advocacy group; or voluntary sector organizations? Check

41. Dedicated NHS services for people with learning disabilities – information 1 i Back to pathway Many people with learning disabilities are supported by a local community learning disability team. The role of the health members of the team includes health facilitation. They can, for example, help with: health action planning for people with complex and continuing health care needs; communication with other health care professionals; assessing capacity to consent; and developing health literacy skills with people with learning disabilities, family carers and staff. Dedicated health services for a small number of people with learning disabilities may also include access to in-patient assessment and treatment facilities; and, very occasionally, use of out of area facilities.  Does this person and their carer have contact details for the local community learning disability team and information about the services they offer?  Is this person already known to the community learning disability team?  Does this person have access to health and social care resources within the team, so that services are planned and focused on the whole person and there is continuity of provision?  Through the team, does this person have access to high quality skills and expertise for people with complex needs; for example: for the care and support of people whose behaviour severely challenges services, and people with mental health conditions, offending behaviour, and conditions associated with older age, epilepsy, sensory impairments and physical disabilities? Check

42. Dedicated NHS services for people with learning disabilities – information 2 i Back to pathway  If the person has very intensive and high support needs, will the team work with them and their family and other agencies to help ensure that they remain in their usual and preferred surroundings, and are not sent to an out of area placement?  Very occasionally, a person’s needs can not be met locally, despite all efforts to do so, and they are placed in specialised services elsewhere, for example, for people who offend or are at risk of doing so, or for people whose behaviour severely challenges services. If so, is this seen only as an interim solution, with work continuing to bring the person back home with the right kind of housing and support? Check

43. Dedicated NHS services for people with learning disabilities- referral pathway > Back to pathway Check The community learning disability team should provide a single point of access to a range of professional help for people with learning disabilities, and be clear about eligibility criteria for accessing services.  Does this person benefit from help and support by the local community team? Are they eligible?

44. Social care services -information i Back to pathway Social care services for people with learning disabilities may cover: care management; personal assistance; help with benefits; housing; education; employment; daytime activities; leisure; short term breaks; community equipment (including environmental adaptations and supporting communication and sensory related aids, and mobility). Social care services have an important role in promoting healthy lifestyle choices for people with learning disabilities, and helping them to take care of their health and monitor health concerns. Increasingly, people with learning disabilities may be offered Direct Payments, or Individual Budgets to give people more control over their social care and more say in the type of support they receive. Support arrangements may combine informal supports (such as family and friends), universal services (such as housing, employment, and leisure), and voluntary, independent, and public sector services (providing, for example, personal assistance for the person).  Does this person have personalised, ‘wrap around’ supports that promote independence, inclusion, choice and rights?  Do social care arrangements for the person improve their chances for health?  Do health care interventions and support fit in with other aspects of a person’s life and their support arrangements? Check

45. Social care services -referral pathway > Back to pathway  Do you know the criteria to ensure fair and consistent access to social care services that are applied locally?  Is there a care manager to co-ordinate care for this person if they have intensive or complex support needs?  There are joint care management arrangements, combining a health and social input towards the design, co-ordination and review of the person’s support arrangements Check Good practice

46. Voluntary/ independent sector -information i Back to pathway An increasing range of services are provided by the voluntary and independent sector. These can provide flexibility and choice for people with learning disabilities, and may include: Peer group support for people with learning disabilities and family carers, including for people sharing the same condition (such as The Down’s Association) Advocacy and campaigning groups Advice, information, education and training Assistive technologies for example, with communication and mobility) Help with specific issues; for example, with postural care, movement and independent mobility Volunteer help Personal assistance, housing, employment, daytime programmes, and leisure Peer support and sharing, information and advice, and campaigning activities on single topic issues, that may be unrelated to disabilities, such as women’s or men’s groups; conservation societies; Al-anon, and so on.  Does this person have information about the range of resources and activities available through the voluntary and independent sector? Check

47. Voluntary/ independent sector – referral pathway > Back to pathway Services are typically accessed in a variety of ways: self referral, direct referral, or through the person’s care manager.  Is this person supported to access the range of resources and activities available through the voluntary and independent sector? Check

48. Links with other plans and records i Health Action Plans may be an entry point into other forms of planning, such as Person Centred Planning, Single Assessment Framework planning and a Care Programme Approach plan. They are also an important part of Transition Planning when a young person moves from child to adult services. Similarly, other plans may prompt the development of a Health Action Plan. Key questions are how the plans fit together, who co- ordinates the plans and what information is shared between people and agencies.  Is a person centred approach adopted across all the plans developed for this person?  Does the person’s Health Action Plan support their person centred plan, for example, by addressing health issues that are having an adverse impact on the person’s plans for work, or other life changes?  When other forms of planning take place for the person, do those involved check that a Health Action Plan has been initiated? Does the Health Action Plan cover health issues that are not covered by other forms of planning?  Does a young person’s Transition Plan include a Health Action Plan, and identify the linkages between child and adult services?  Do other forms of planning for this person address the wider health issues arising from the Health Action Plan? Where the Health Action Plan is the main or only plan, does it identify how to take forward broader issues that may affect the person’s health? Back to pathway Check

49. Links with other plans and records - consent and information sharing c Back to pathway The individual may wish to keep their Health Action Plan separate from other plans, or they may wish them to be fully integrated, for example as part of their Person Centred Plan or Care Programme Approach plan.  Has the person understood and agreed what information will be shared with whom and under what circumstances?  Conflicts over confidentiality are worked through. Sometimes the person does not want their family to know something. Sometimes paid staff exclude the family from discussions about health because they think that everything like that should be kept confidential. However, families often hold vital information about a person’s health. They may also be best at understanding the person’s way of communicating. So, it is important to talk through with the family about how they will be involved. Good practice Check

50. How is my plan going? -information i Back to pathway Reviewing Health Action Plans entails:  checking that actions have been taken forward and that any necessary help was given to achieve them.  evaluating the effectiveness of the plan.  assessing the need for any new actions for health. It is important to get feedback from the person themselves, their carer and health facilitator, and from the other agencies identified in the plan. Other plans, such as the individual’s person centred plan, can also provide feedback. Not all the actions for health will have the same timescales attached to them. It may be helpful to run a repeat annual health check for the person to clarify progress within their Health Action Plan.  Are the actions for health reviewed by the date agreed with everyone?  Has a primary health care practitioner checked whether there has been any improvement in the health status of the individual, and what new actions for health or follow up interventions are required?  If things are not happening as planned, have the person and their supporters (including their health facilitator) identified different ways of helping the person achieve their prescription for health? Check

51. Feedback loop - information i Back to pathway A successful health action plan will improve the health status of the individual. It will also open up new opportunities for community living. A follow up health check with the person and their health facilitator will identify new actions for health and help needed to take these forward. In this way, Health Action Plans for individuals are dynamic and ongoing. Health action planning applied to local populations offers a powerful tool for reducing health inequalities for people with learning disabilities.  Have clinical improvement data been used to track changes in the health status for this person?  Have these data been aggregated within public health information systems?  Have unmet health needs for this person also been identified and aggregated within public health information systems? Check