1. Learning Disability Annual Health checks.
Dr Jenni Lawrence
Lynne Taylor
And friends!

2. What is a learning disability?
Internationally know as “Intellectual disability”.
Affects 1-3 % of the population.
77% are probably unknown to any health or social care service.

3. Diagnosis of Learning Disability.
1.Impaired cognitive functioning
2.Limitations of learning, adaptive behaviour and skills
3.Early onset (before adulthood) with lasting effect on development
Have a significantly reduced ability to
•understand new or complex information
•learn new skills

4. •Can generally learn to read, write and do basic maths
Mild
85%
•Can generally learn to read, write and do basic maths
•Many adults will be able to work, and live independently
Moderate
10%
•May be able to learn basic reading and writing
•Most can learn to develop some degree of independence.
•Adults will need some support.
Severe 5%
•Probably unable to read or write
•May learn self-help skills and routines
•Some verbal skills, but may need augmented communication aids
•Need supervision and support in all daily activities and living environment
Profound 1%
Need intensive support
Eagle eyed among you will notice this is 101%! Figures are approximate!!
People with mild learning disabilities may struggle to…
•Understand written instructions
•Keep appointments
•Grasp the purpose of procedures
•Stick to treatment regimes
•Understand consent procedures

5. Annual health check Opportunity to give information to people.
Yearly review at GP surgery for those with LD on the GP’s LD register.
Offered to all over the age of 14.
Gain consent during this visit to share information with other health care professionals including the screening services.
Opportunity to give information to people.

6. L.E.S All practices taking part. Get QOF LD register verified.
Do the annual health check.
To leave with summary of check.
Get paid approx £ per check.

7. Uptake of Annual Health Checks.
CCG
No. of Patients on LD register who have had an annual health check (14/15)
Total No. of Patients on the LD Register (14/15)
Proportion %
Total No. of Patients on LD register for whom Annual Health Check data was returned
Difference in Proportion of Patients who have had an Annual Health Check based on the two different denominators
NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG
300
639
47%
604
50%
-3%
NHS HARROGATE AND RURAL DISTRICT CCG
530
1031
51% 0%
NHS SCARBOROUGH AND RYEDALE CCG
177
597
30%
NHS VALE OF YORK CCG
569
1115
974
58%
-7%

8. Belgrave not responded as time of putting this talk together
Belgrave not responded as time of putting this talk together. Castle Health 28%.

9. The only way is up!
Proportion of practices doing at least one annual health check has gone up form 73.6% in 2014 to 93.3% in 2017.
More people are annual health checks from 20.1% of those eligible on the LD registers in 2014 to 45.4% in 2017.
More people are getting a Health Action Plan % in 2014 vs 38.7% in 2017
And percentage of HAP not recorded gone down from 85% to 55.6%.
This is based on the most recent data although due to be updated any day now.

10. Awareness.

11. So why are health checks important?

12. Confidential Inquiry into the deaths of people with Learning Disabilities.
All known deaths of people with learning disabilities
From 5 PCT areas ( in SW England)
From 1st June 2010 –31stMay 2012.
233 adults with learning disabilities
14 children with learning disabilities
58 comparator cases.

13. CIPOLD – 2013. Median age at death for males was 65 years.
Men with learning disabilities died on average 13 years earlier than men in the general population.
Median age at death for women was 63 years.
Women with learning disabilities died on average 20 years earlier than women in the general population.
42% of these are thought to be preventable and avoidable.
Attributed to delays in diagnosis, treatment and failure to provide adequate care.
Over 1000 people with LD die prematurely each year through failure to provide adequate care.
People with LD die 16 years younger than the general population.
Genetic and biological reasons for some of these.

14. Associated health problems of people with LD (2
Associated health problems of people with LD (2.5x as many co-morbidities as other patients)
Psychiatric and behavioural problems more common
Anxiety and depression 5X
Schizophrenia 3X
30% epilepsy
30% visual problems
30% hearing problems
Vulnerable to abuse by carers and others

15. Associated health problems
Many Down’s pts develop dementia in middle age
c30% Down’s patients become hypothyroid
Continence problems very common
Mobility problems very common
Obesity common
Most unable to take responsibility for own health or read instructions

16. Barriers.
Diagnostic overshadowing (symptoms wrongly assumed to be related to LD condition)
Communication
Prejudice
Lack of awareness or knowledge
Systems
Physical environment

17. This is not an annual health check…
Hello.
Do you drink alcohol?
Do you smoke?
What do you weigh?
What is your height?
BP check.
Goodbye.

18. So what does a good health check look like?

19. Easy read invite ideas.

20. Based on Cardiff template – covers a wide range of health issues.
Should take a lot longer than the normal 10 mins appointment – eg 45 mins.
Might be with GP or nurse or both.
Should leave with a summary/ Health Action Plan.

21. Ideally should cover….
Social information ( housing, employment, carer, social services, LD team etc)
Bladder and bowel assessment
Mobility
Vision and hearing
Dental
Smoking and Alcohol
Screening
Usual obs ( height, weight, waist, BP, risk calculators)
Depression and mood
Sexual health
Blood tests incl thyroid function esp if Down’s.
Consent to share information ( SCR, screening services)
Symptoms incl “ red flag” symptoms.
National template coming out…. Nil infor from systm 1 at all….

22. Health Summary.

23. Health Action Plan.

24. Self Assessment Tool.
1.How well is the GP practice doing at performing the AHC?
2.How well are we doing at identifying patients with learning disabilities?
3.How well are we doing at arranging for people to attend for a health check?
4.How well are we doing at putting reasonable adjustments in place to maximise the effectiveness of AHCs?
5.How well are we doing at arranging for and supporting the uptake of follow-up actions?
6.How well are we doing at improving our practices?

25. An audit tool.

27. Fabulous video!

28. Other Useful resources.

29. LD Community Team Eastfield Clinic Westway Scarborough, YO1 3EG
Tel: