Health from a social care perspective

Implications for social care

13th and 19th October 2011

We will be looking at:

• What are the inequalities?

• What impact do they have?

• What have we done?

• What lessons can be learned?

• What can we do in the future?

What are the inequalities?• Greater risk of poverty, poor housing,

unemployment and social exclusion• Increased risk due to genetic, biological and

environmental causes of learning disability• Communication and understanding

problems• Personal health risks such as poor diet, lack

of exercise• Poor access to healthcare

Additional difficulties?• 1.77 million jobs estimated in adult social care (2010)• 1.56 million people working in adult social care (2010)• Estimated rise in jobs of between 24% and 82% between

2010 and 2025• 2.1 to 3.1 million jobs by 2025

Ref: Skills for Care: ‘The size and structure of adult social care sector and workforce in England, 2011, researched and complied by William Fenton August 2011.

• Vacancy level in social care 25% national average 12% (2009)• Turnover rate for care workers was 22.8% which equates to about 1 in 4 workers leaving in a year

Ref: Skills for Care: the state of the adult social care workforce in England, 2010,for the report of Skills for Care’s research and analysis units.

What is the impact on the people who we are supporting?

• A Support staff member telephoning to book an annual health check for a person with limited communication, mobility problems and learning disabilities had to argue for a double appointment!

Annual Health Checks• Recommended in 2006 by Disability Rights

Commission• Department of Health recommended in 2008• In 2009 the health checks could be part of

‘Direct Enhanced Service’• This was extended from 2008-2010 to 2010-

2012• Only 48-49% of those eligible received them

in 2010/11

A person with learning disabilities and high support needs in hospital:

• Left alone in side room• Support staff told must only visit at stated visiting times• Refusal to use specialist pads provided by support staff• No regular toileting • No care taken in positioning, etc.• No support with drinking and feeding

• The individual with complex needs and communication problems in hospital for an endoscopy.

• When hospital staff commenced the procedure without anesthetic, the support staff asked for the procedure to be stopped as the individual was becoming distressed.

• The hospital staff insisted on continuing leaving

individual with damaged and sore throat and chipped tooth!

• In local GP practice

• Person with mild learning disability, requests repeat prescription and shows empty packet of pills.

• Receptionist’s response is:

“Complete this paper with your details and your prescription details and doses and put it in the red box outside,” whilst thrusting a pen and paper at the confused lady.

What can we do?

ARC have had some real successes with health related projects:

• Happy Heart

• Our Good Health

• Take the Health Challenge

Happy Heart

• A project to promote heart health to people with learning disabilities through running short courses.

• Took place 2008, in Wales.

• Funded by Heart Research UK

Comments from participants on the courses

It’s great.

I enjoy it.

Happy Heart

After the project finished:• A 5-7 week course was designed to meet

the needs of individuals with a learning disability.

It covered: • What the heart does• What it needs to be healthy, focusing on

healthy eating and the importance of exercise.

Your heart needs to be

happy

Happy Heart

The 12 month project was extended:• More than 120 people with learning

disability participated

• On the Island of Anglesey

• A 6 week programme aimed at increasing knowledge and understanding of healthy living and importance of food and exercise was implemented .

Our Good Health

• Looked at the problems that people with a learning disability encountered when accessing mainstream healthy lifestyle initiatives

• Working with individuals with a learning disability and service providers

• Funded by Pfizer Foundation, Lloyds TSB Foundation and Anglesey Health Alliance

Our Good Health

• They talked to individuals with a learning disability, carers and families.

• A report was produced.

• The report was aimed to help service providers support individuals to learn about healthy eating and choose a healthier diet.

Our Good Health

Barriers to good health that they found:• There is a lack of knowledge and understanding

• Dependence on knowledge and willingness of others

• Often disengaged from food

• Food labels are confusing and complex

Our Good Health

• Focus on reducing ‘fatty foods’ only

• Many people with a learning disability struggle with motivation

• Lack of training for support staff

• Low expectation of achievement

• Sedentary lifestyles

Our Good Health

Other challenges that were faced:

• Duty of care versus individual’s choice

• Individuals who wanted to change their lifestyle needed a lot of help and support

• Carers and support staff discrepancies

Our Good Health

• Food used as reward or having a treat

• Huge resistance to being on a diet

• Support staff had received no training on principles of nutrition healthy living

Our Good Health

The problems support staff had:

Staff using processed food instead of fresh

We need more time to prepare meals

They don’t like food like salad or vegetables Service

user’s sweet tooth

We usually get told off if we encourage them. It has to be their choice

They buy food for themselves like crisps and chocolate

Our Good Health

Their solutions:• ‘Eat well’ an easy to read introduction to healthy eating

was developed• ‘Our Good Health’ CD rom, with more detailed information• ‘Take the Health Challenge’ DVD• Networking in Wales and England• Cycling taster days• Healthy eating sessions for staff and those using the

services.• Happy Heart Groups

Take the health challenge

• Targeted accessible health promotion information for people with a learning disability

• 1 day training for support staff

• Eight 6 week ‘Happy Heart’ sessions to people with a learning disability and their supporters

• Piloting ‘21 day Health Challenge’

Our Good Health

Original aim • 50 people with a learning

disability• 20 then to do 21 day

challenge • 100 staff from 10 settings • 60 people in circles of

support increased understanding

Final numbers

• 74 people

• 21 people

• 122 staff

• 89 people from circles of support

Our Good Health

Outcomes:

• Out of 21 doing the Health Challenge 14 made clear lifestyle changes and reported benefits

• 7 non-completers

I really enjoyed it. It felt a bit long but I liked preparing food and picking out healthy food at the supermarket.

The best thing about it was eating tangerines. It was a bit long. I want to do more cycling when it’s warmer.

I am really pleased. I’m going to keep it up. It was a bit hard sometimes but I got good support.

Lessons to be learned from the 3 projects

• You can show individuals with a learning disability a healthy diet and explain the right types of exercise but…

• Support staff are not always aware of how to follow a healthy diet and lifestyle

• Exercise or activity for someone with a learning disability may not be as helpful as it could or should be.

• Often full meals are provided in day services, individuals have full meal when they get home.

• Duty of Care versus Individual Choice

• Small changes that stick are more valuable than large changes that end up abandoned

• People with a learning disability need to follow the same health guidelines as the rest of the population

Over to you ….

What can we do now and in the future?