Adult Disability Provider Forum11th December 2019

Agenda

• HCC Commissioning Update• LeDeR (mortality review) Learning for Services • Health Liaison Update • Annual Health Check Survey • Classes for Service Users

www.hertfordshire.gov.ukwww.hertfordshire.gov.uk

HCC update

Nadine RaenkeCommunity Commissioning - Adult Disabilities

www.hertfordshire.gov.uk

Supported Living framework• 79 referrals made so far:

41 Supported Living; 38 Community Support• Response rates:

Supported Living 90%, Community Support 61%• Referrals: worth responding with offer, even if not exact requirements• Transforming Care: community of practice (‘champions’) • Housing: let’s have conversations prior to decisions• Next steps: -summarise and share gaps information

-publish referrals in clusters-improve long term planning-will extend response times

www.hertfordshire.gov.uk

ADS Accommodation Strategy 2019-2021• Main need: single occupancy housing in small clusters or ‘pepper-potted’ to enable

shared care integrated in community• All to meet M4(2) and some to meet M4(3) building regulations• Enabled for assistive technology• Key challenge: housing for people with more complex needs• Link with Regional TC lead, NHS capital money available• Need to link with STP processes

Three work streams:

Working with Districts

• Shared vision• Prospectus• Standard protocols

for referrals

HCC’s Assets

• Use of land• Redevelopment of

current buildings• Capital Investment

Working with PVI sector

• Networking support• Capital grant• ‘Homesin’ software• Shared ownership

www.hertfordshire.gov.uk

Shortbreak Services (Respite)

• Consultation closed in November. As result of feedback now re-opened with a additional option to be considered https://www.hertfordshire.gov.uk/about-the-council/consultations/adult-

social-services/additional-short-breaks-respite-consultation.aspx#• Consultation to end in January 2020, through political process for

decision in February 2020• Development of new specification for new contract• ADS residential providers interested in offering shortbreaks?

https://surveys.hertfordshire.gov.uk/s/shortbreakssurvey/

www.hertfordshire.gov.uk

Community Opportunities (Day Services) • Contracts for preventative sector extended to June 2020• Contracts for spots extended to September 2020• Between April and now a number of financial and pre- procurement workshops

took place• Final PPME took place 9.12.; confirmed details; well attended• Grant and Framework process will open in January• Grant to be implemented by 01.07.2020• Framework to be implemented by 01.10.2020• PLEASE APPLY (for new & existing placements)• In-house services are undergoing separate process but are expected to adhere to

same specifications

www.hertfordshire.gov.uk

Orange Travel Wallet

• To help maintain people’s independence• Can be used by anyone who travels on a bus and has:

a learning disabilitya physical disabilityhearing or sight loss

• Travel wallets are free• Good to include in travel training• www.hertfordshire.gov.uk/orangetravelwallet

www.hertfordshire.gov.ukwww.hertfordshire.gov.uk

thank you

www.hertfordshire.gov.uk

LeDeR

Learning Disability Review of Mortality

Kathryn Dempsey - LeDeR Local Area ContactKathryn.dempsey@hertfordshire.gov.uk

&Hansa Nariapara - Commissioning Officer

Hansa.nariapara@hertfordshire.gov.uk

BackgroundIt is well documented that people with a learning disability die, on averagemore than 20 years sooner than people in the general population, with someof those deaths identified as preventable had the person received betterquality health or social care.

LeDeR Programme

The Learning Disabilities Mortality Review (LeDeR) is a national NHS England programme which requires that anydeath of a person over the age of 4 years with a learning disability is reviewed. It was established to: identify learning from deaths andtake forward the learning into service improvement initiatives to improve the standard and quality of care for people with learning disabilities.

National LeDeR Report

Women dying 27 years & men 23 years sooner than general population

Reasons for death: pneumonia; aspiration pneumonia, sepsis (48%) Other causes: Dementia, Cancer and epilepsy

Hertfordshire data (to 31 October 2019)

.

Number of deaths reported in total (since April 17) 146*

% of total

Number of deaths reported in 2017/18 (to March 18) 45

Number of deaths reported in 2018/19 (to March 19) 58

Number of deaths reported in 2019/20 (to end Oct 19) 43

Total number of reviews completed

45** 30%

In line with this year’s national report, thetop 3 causes of death are pneumonia,aspiration pneumonia and sepsis. Theseaccount for 49% of the total deathsreported since April 17.

‘Other’ causes of death reported include anoverdose & choking on food. For one casethe cause of death was stated as ‘DownsSyndrome’.

32, 22%

18, 12%

24, 16%11, 7%

15, 10%

7, 5%

6, 4%

11, 8%

11, 8%

11, 8%

Reasons for deathPneumonia Aspiration Pneumonia

Sepsis Cardiovascular

Neoplasms Digestive Systems

Dementia and behavioural Neurological

Others Not known (Review not completed)

• The Median age of the cases reported in total since April 2017 is 63 yrs (58yrs nationally). This is considerably lower than the median age of the general population which is approximately 81 years.

• The age range of reported cases is 9 years to 98 years of age

8

6870

30

4 yrs -17yrs 18 yrs - 64 yrs 65+ Under 50

Age range of reported deaths

What have we found in Hertfordshire?

•78% of the people who have died since January 2019 lived in a Provider setting

• Poor understanding/ application of Mental Capacity Act

•DNACPR processes not always followed

•No advance care planning taking place

•End of life plans put in place too late

•Limited examples of joined up working

Case ExampleIdentified Issue Learning Recommendation to address issue

XX wanted to die at home but there was insufficient time between her admission to hospital and her death for a meeting to take place to consider this. The SJR notes that consideration was given to returning her home and this was ruled out as she was insufficiently stable to travel.

Whilst not formally placed on an end of life pathway, XX's death was not unexpected and some time elapsed between the hospital consulting her family about non resuscitation and her actual death. This period of time proved insufficient to hold a meeting about her end of life care.

Providers should put end of life plans in place for all people using their services and these should include arrangements including fast track arrangements for fulfilling their wish to die at home where this is the case. These arrangements should avoid transporting people from their homes to hospital when death is imminent if they have expressed the wish to die at home.

Addressing Outcomes of Reviews

Improving Health Outcomes Group – the ‘doers’

Same representation – as on Steering group but operational staff and several additional specialist practitioners i.e. End of Life; sepsis; specialist dentistry and colleagues from Public Health

Have developed a shared action plan across steering group and IHOG

What evidence change has been effective?

Diagnostic Overshadowing

• Website – easy read information available

• Videos developed – for example, Sepsis and hand washing

• Top to Toe Folder

• Thinking about a campaign on what a good day looks like to share with health professionals and a development of an app being discussed.

Annual Health Check and Flu Jabs

• Carers preparation checklist

• Website has a dedicated page for carers

• Health Action Plan following annual health check

Advance Care Planning and End of Life Care

• ‘My plan’ easy read version being piloted

• Dedicated training for providers – to date

(12 homes in total 80 staff trained in East and North Herts, 30 in West Herts)

Communication

• Purple Folders – support to keep them updated for professionals

• Understand the law – accessible standards/reasonable adjustments

• East of England contract - one of the standards- expectation of providers is ‘health’

Next Steps

• Work with HCPA - training

Learning Disability awareness will be mandatory in 2021

• Daily Caring – for example, good diets to avoid diabetes, constipation, obesity

• Areas to work on – application of Mental Capacity Act, Best interest, Dols.

• Always ask questions

Useful links & information HCC Website:www.hertfordshire.gov.uk/LDmyhealth

NHSE information:www.gov.uk/government/collections/reasonable-adjustments-for-people-with-a-learning-disability

LeDeR:www.bristol.ac.uk/sps/leder/

Annual Health Checks-

Everyone should get a health check action plan – this is joint responsibility – so support staff need to make sure they have done the ground work for the annual health check and considered all the areas of health in the carer Prep tool – they need to raise with the GP any areas of concern.

Staff need to also enable people to become health resilient and health savvy

Use all the tools on the web pages to support

Professionals can find information on our service and tools available at www.hertfordshire.gov.uk/ldprofessionals

This year GP’s are targeted on Advanced Health Checks to make sure:1.All people eligible for breast, bowel and cervical screening – if they have not attended in the past –that staff work with them to understand the importance of this and take every step possible to enable this to happen… engage with LD nurse if they have done everything possible and not succeeded. LD nurse will Not take over but will help THEM to take all steps to get the person through this

2.Regular breast and testicle checks – everyone can check to some degree – guide is on the web pages. If people who support need to have a plan in place –this is at the very least, a monthly reminder to the person to check themselves and record that they have come back saying they have.

If they don't the GP should add this to the action plan for staff to start. The monitoring officers are also aware of this and will be checking all care agencies have this in place.

Professionals can find information on our service and tools available at www.hertfordshire.gov.uk/ldprofessionals

STOMP – if someone has been on long term psychotropic or anxiotic meds and aren't under a psychiatrist they should contact LD nursing service to request and assessment of need and risk. GP should add this to health check action plan. they should contact LD nursing service to request and assessment of need and risk. GP should add this to health check action plan.

FLU - Please can you ensure that anyone with an LD who may go to pharmacists or GP independently for their flu vaccine has a copy of this letter to take. It just ensures they don’t meet a

health professional who questions their entitlement to free vaccine and don’t know how to overcome this barrier.

Measles – in the region there has been an outbreak of 8 people with LD getting measles – this raises the question – have some people with LD missed all their childhood Immunisations? Can staff check all the people they support to have the GP check their imms records and make sure they are protected against all the diseases children are immunised against [measles mumps rubella polio whooping cough tetanus etc]

If you were given the option to have classes for your service users what opportunities would you like for them?