Our Passion, Your Care.

Making Reasonable Adjustments in Primary Health

Care

June 2015

Sally Ryan BSc (Hons) Nurse Spec- Learning Disability

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Health Inequality

People with a learning disability have poorer health than their non-disabled peers.

Yet they are less likely to access primary healthcare.

26% of people with a learning disability are admitted to hospital compared to 14% of their non-disabled peers.

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Health Inequality National Inquiries

• 2006 Closing the Gap (Disability Rights Commission)

• 2007 Death By Indifference (Mencap)• 2008 Healthcare for All (Michael)• 2009 Six Lives Parliamentary and Health

Service Ombudsmen)• 2010 Health Inequalities and People with

Learning Disabilities in the UK (Public Health Learning Disabilities Observatory)

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Diagnostic overshadowing

Some health professionals may not investigate issues early enough as they rationalise new symptoms as part of the learning disability rather than explain new symptoms particularly with mental health issues.

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What is a learning Disability?

Valuing People (2001) defines learning disability as:

• Significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence) with

• Reduced ability to cope independently (impaired social functioning)

• That started before adulthood, with a lasting effect on development.

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Numbers

Currently QOF registers identify 4.33 people with learning disabilities per 1,000 population, whereas the

estimated prevalence of people with learning disabilities in the population is 2%-3%

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GP Registers

The Enhanced service designed to encourage practices to identify all patients over 14 with LD.

This is completed using QOF indicators and local authority data.

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Reasonable Adjustments

Reasonable adjustments are those

necessary changes to our normal routine

practices which support accessibility to our

service.

Some adjustments are relatively easy to

make where others may require more

creativity and forward planning.

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The challenges for us! What do we do if we are faced with…

• Communication difficulties.• Difficulty providing a sequential history. • Provision of irrelevant information.• Difficulty in understanding questions and responding to information

quickly.• Inability to deal with more than one question or task at a time.• Repeating phrases in conversation.• Lack of understanding or vagueness.• Difficulty in following straightforward instructions.• Poor planning and sequencing abilities.• Difficulty in understanding abstract concepts such as time, distance

or directions.• Confusion about times of appointments.

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Communication

• Information should be given in a way that is meaningful for the individual.

There are user accessible/easy read resources available- but where to find them?

• Keep information simple.• Speak slowly, not too much information at a time• Be clear, don’t use jargon• Listen to the person with a learning disability and their

‘expert carers’• Share information

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Main Health Issues

• Gastro-intestinal• Respiratory• Dysphagia• Diabetes• Coronary Heart Disease• Urinary Sepsis• Epilepsy• Thyroid function• Osteoporosis• Mental health Issues• Dementia• Sensory issues• Dental care• Postural care

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Annual Health Checks

It is clear from the results of a systematic review (DOH 2010) of the impact of health checks that they typically lead to:

(1) the detection of unmet, unrecognised and potentially treatable health conditions (including serious and life threatening conditions such as cancer, heart disease and dementia)

(2) targeted actions to address health needs.

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Overcoming Barriers

• Accessing the practice, having the necessary equipment available

• Understanding information given• Non- compliance• Not being given copies of letters• Using language which is not understood• Assumptions

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Mental Capacity and Consent

• The two-stage test of capacity: is there an impairment of, or disturbance in, the

functioning of the person’s mind or brain? if so, is the impairment or disturbance sufficient

to cause the person to be unable to make that particular decision at the relevant time?

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Functional assessment

Does the person have the ability to:

• understand the information?• retain information related to the decision?• use or assess the information while

considering the decision?• communicate the decision by any means?

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Pathway

• Identify• Gather information about reasonable adjustments• Easy read invitation with information about why• Pre-health check questionnaire• Bloods forms and urine pots (think about desensitisation)• Complete health check- remember Mental Capacity Act (MCA)!• Develop Health Action Plan- identify roles and responsibilities- make

sure everyone knows the plan• Referrals on to include reasonable adjustments required and MCA

issues