1. Identifying Young People with Learning Disabilities and Meeting their Health Needs In Greenwich… Mark Bradley Health Facilitation Coordinator

2. Overview The changing NHS and the Importance of Information (Data) Are we talking about the same thing? (‘Learning Difficulty’, SEN or Health labels??). Some issues to think about… The Picture in Greenwich (what we know and what we don’t)….? Sharing ideas for the future and some tools for the job.

3. NHS Commissioning Board Providers Key national priority to set up new health and social care architecture: Who ensures people with learning disability are included? Funding Accountability Other Parliament Patients and PublicLocal HealthWatch contract Accountability for results Health & Wellbeing Boards (HWBs ) Public Health England Clinical Commissioning Groups (CCGs) contract Monitor (economic regulator) contract Local Authorities (incl. Public Health) Commissioning Support Services NHS Trust Development Authority NHS CB Patch Teams NHS Trusts Version 0.5 Joint licensing between Monitor and CQC CQC National Sector ‘Footprint’ / Local Health Education England DH NHS CB London Sector NHS TDA London Sector FTs LETBs Work together to ensure commissioner support for aspirant FTs Clinical Senates PHE London Sector

4. Approaching Adulthood.. GPs will be commissioning NHS services for everyone. It might be useful to think about young people with learning disabilities coming into the GP radar? GP RADAR LD?

5. The Importance of Information! Having good information about local people is crucial. In your area, can you answer: How many young people with a particular ‘label’ are there? What are their specific needs (e.g. their pattern of ill-health)? Are current services enough to meet demand? Are current or planned services designed to meet identified needs?

6. The Problem with Labels?! Who are we talking about?? Labels mean different things to different people. They can be negative and associated with social stigma They can be necessary to access services They can help identify need but do not meet it In health – use is specific & narrow, for a ‘diagnostic purpose’. In social care and education, they are usually wide ranging leading to access to resources. Adults with ‘Learning Disability’ and ‘Learning Difficulty’ have different diagnostic criteria (health) but are often used interchangeably. SEN

7. A VERY different label!

8. What is a Learning Disability? The Department of Health defines a Learning Disability as including the Presence of: A significantly reduced ability to understand new or complex information, or learn new skills (impaired intelligence – IQ 70 or below), with; A reduced ability to cope independently (impaired social functioning); Which started before adulthood, with a lasting effect on development.

9. World Health Organisation (WHO, 1992) ICD-10 Mild – IQ between 50 and 70 Moderate - IQ between 35 and 50 Severe and Profound Learning Disability - IQ = below 35

10. Differences in Adult and Child Service Design. The SEN Code of Practice refers to the duty to ‘identify, assess and make provision for children’s special educational needs.’ A ‘SEN’ is a focus on what support is needed to be educated in line with the National Curriculum. Unlike a formal diagnosis of ‘learning disability’ – moderate difficulties referred to in a Statement, can simply refer to how difficult it might be to access education. This could be a physical impairment etc. (Nov. 2001)

11. FACS criteria Fair Access to Care Service criteria, like SEN criteria, is linked to a resource. How much support do you need to live independently? Are you in Critical, Substantial, Moderate or Low need of support? In Adult Services, Educational, Health and Social Care Assessments mean VERY different things…

12. The Self Assessment - Health Need evidence that says: (B3) Plans are in place to ensure locally available provision of the future mainstream and specialist health services needed to support young people approaching adulthood - and their families

13. SAF Level to achieve: Evidence of person centred and individualised care and Person centred care and support plans include outcome for health. Families and are involved in long term planning There is a local profile of children and young people including their health needs that informs commissioning. Starting to formulise local plans for 14-25 planning Action

14. Greenwich Borough – watch the birdy!

15. A bit about Greenwich… ‘The population is richly diverse. Our black and ethnic minority population in 2009 was estimated to be between 85,000 and 100,000, approximately 40% of the total population.’ – (Children and Young People’s plan, 2011- 14) There are 1,307 children in Greenwich State Schools that are recorded as having a Statement of Special Educational Need (SEN). 309 children were identified as having a ‘learning disability’ in their statement. Estimate of 124 from BME communities.

16. Of the 309 Young People with ‘learning difficulties’: The Greenwich JSNA (Joint Strategic Needs Assessment) reported: 30 people with ‘profound and multiple learning difficulties’, all attend special schools 63 have a ‘severe difficulty’ 45 have a ‘moderate difficulty’ 12 have a ‘specific difficulty’ 159 have a ‘general difficulty’

17. Greenwich Profile - IHAL Higher than average no of children with ‘autistic spectrum’ known to schools. Less than average no. of children with ‘learning difficulties’ known to schools. For ‘Autistic Spectrum’ or ‘Learning Difficulties’ - ‘A formal medical diagnosis is not required, as such these numbers may not reflect those seen in data from medical sources’.

18. Greenwich – Rise in Young People

19. What we can do… Focus on the young people we know about. Offer a thorough health check to everyone we know post 16. Provide easy read info about the health check. Provide a Health Action Plan. Include GP practice in process and inform their ‘Learning Disability’ Registers from Transition. Improve awareness and systems to identify and record those we have not yet found!

20. Tools for the Job Health Check Invitation Pre-health check questionnaire New Health Check Screening Template will be available for Primary Care Systems (Including Prisons). New Health Check Template includes referral form and Health Action Planning Tool. Personal Health Profiles & Health Action Plans Primary Care School Nursing and GP Training specific for Transition.

21. QOF Clinical Domains: Primary Care see this as our mutual interest. For transition, it might be worth thinking about young people being appropriately seen on primary care systems?

22. Other Work.. Training in ISIS YOI re: identifying young people with learning disabilities and associated health issues. Approaching NICE and DH re: QOF LD register age.

23. Transition Pathway (1)

24. Transition Pathway (2)

25. For more information… Visit www.oxleas.nhs.ukwww.oxleas.nhs.uk Go to the ‘GP/Referrers’ section and click on Learning Disability Services. Phone – 0208 269 3349 Thank you!