1. Health, wellbeing and people with learning disabilities – Professor Jane Cummings 2. What the numbers are telling us – Professor Chris Hatton 3. What the numbers are telling us – Professor Chris Hatton (accessible) 4. The Learning Disability Mortality Review – and what it is telling us – Dr Richard Jeffrey 5. The Learning Disability Mortality Review – and what it is telling us – Dr Richard Jeffrey (accessible) 6. Health inequalities – Dr Angela Donkin 7. Health Checks – Dr Kirsten Lamb

1. Better Health, Better Lives Conference
Tuesday 20 June 2017
Presentations – Contents
1. Health, wellbeing and people with learning disabilities – Professor Jane Cummings
2. What the numbers are telling us – Professor Chris Hatton
3. What the numbers are telling us – Professor Chris Hatton (accessible)
4. The Learning Disability Mortality Review – and what it is telling us – Dr Richard Jeffrey
5. The Learning Disability Mortality Review – and what it is telling us – Dr Richard Jeffrey (accessible)
6. Health inequalities – Dr Angela Donkin
7. Health Checks – Dr Kirsten Lamb

2. Health, wellbeing and people with
learning disabilities
Professor Jane Cummings

3. www.england.nhs.uk
‘Better Health Better Lives’
for people with a learning
disability:
everyone should have good
healthcare and a good life
Professor Jane Cummings,
Chief Nursing Officer for England
June 2017

4. www.england.nhs.uk
• People aren’t living long
enough or as well as they
could
• Not enough people are
known to their GP as having
a learning disability
• Not enough people are
getting routine screening,
missing out on diagnosis
and treatment
• People are given too much
medication
What we know
4

5. www.england.nhs.uk
• Delays in diagnosis
and treatment aren’t
inevitable!
• They can happen
because a person
finds it difficult to
communicate or make
decisions
• Providers can make
adjustments
What we know
5

6. www.england.nhs.uk
• STOMP
• Priority in the flu plan
• Learning disabilities in the
National Diabetes Audit
• ‘Lab in a bag’ project
• Children and young people
• End of life care
• Annual Health Checks
A priority to get right - what NHS England
is doing:
6

7. www.england.nhs.uk
Tell the doctor or nurse about your
learning disability – don’t miss out!
7

8. www.england.nhs.uk
• Prevention, support and
choice
• Housing options
• Employment
• Use of personal budgets
• What does better health
and better lives mean to
you?
• We are ambitious for people’s lives as
well as their care!
8

9. www.england.nhs.uk
Good news!
9
More funding….
to build more support in the
community
for better health and better lives!

10. www.england.nhs.uk
• Help people to understand NHS
111
• Show people what to expect
when they phone 111
• Give tips on what to do to have a
good call
• Get more people with a learning
disability and/or autism to use
NHS 111
Inclusive NHS 111

11. www.england.nhs.uk

12. www.england.nhs.uk
Website: https://www.england.nhs.uk/learningdisabilities/
E-mail: England.learning.disability@nhs.net
Our personal stories initiative:
#CareTransformed project to gather and share good
practice
www.england.nhs.uk/caretransformed
Keep in touch

13. www.england.nhs.uk

14. What the numbers are telling us
Professor Chris Hatton

15. The health of people with learning
disabilities:
What do the numbers tell us?
Professor Chris Hatton
Public Health England Learning Disabilities Observatory

16. What do the numbers tell us?
• About when people die?
• About how good people’s health is?
• About why people have worse health?

17. When do people with learning disabilities die?
• People with learning disabilities are
living longer than in the past
• BUT…
• People with learning disabilities die
15-20 years younger than other
people
• AND
• Many deaths of people with learning
disabilities are avoidable

18. Median age of death: men with learning disabilities in England

19. Median age of death: women with learning disabilities in England

20. Avoidable deaths
• Nearly half of deaths of people
with learning disabilities were
avoidable
• Common problems:
• Delays in diagnosis and
treatment
• A lack of reasonable
adjustments to healthcare

21. How good is people’s health?
• Not very good
• In many ways
• At every age

22. The health of 7-year old children
0
10
20
30
40
50
60
Parent rates
child health as
fair/poor
Child has 3+
health
problems
Child is very
overweight
Children with learning
disabilities
Other children

23. The health of people known to GPs
Much more likely for people with learning
disabilities:
• Epilepsy
• Severe mental health problems
• Dementia
• Underactive thyroid gland

24. The health of people known to GPs
More likely for people with learning disabilities:
• Heart failure
• Type 1 and 2 diabetes
• Kidney disease
• Stroke
• Asthma

25. The health of people known to GPs
Less likely for people with learning
disabilities:
• Diseases that make breathing difficult
• Cancer
• Diseases that stop the blood going
round your body

26. The health of the ‘hidden majority’
0
5
10
15
20
25
30
35
Poor health Poor mental health
Adults with learning
disabilities
Other adults

27. Exercise
0
10
20
30
40
50
60
Children - never does
sport/exercise
Adults - not walked 10
minutes or more in last 4
weeks
People with learning
disabilities
Other people

28. Being very overweight
• Being very overweight (obese)
twice as likely for young adults
with learning disabilities
• Increases with age
• Older people with learning
disabilities twice as likely to be
underweight

29. Why do people with learning
disabilities have poorer health?
• A learning disability is not in itself a health problem
• Bad things (all of which make people ill) are more likely
happen to people with learning disabilities
• Being poor as a child
• Bullied and abused
• Excluded and isolated
• Being poor and unemployed as an adult
• Poor health care

30. Bullying and violence
0
2
4
6
8
10
12
14
16
Children - bullied more
than 1 or 2 times at
school
Adults - threatened/actual
violence
People with learning
disabilities
Other people

31. Being in a paid job
0
10
20
30
40
50
60
70
80
All adults Adults with
learning
disabilities
Percentageofpopulationinwork
Working more than
16 hours per week
Working up to 16
hours per week

32. Cancer screening

33. Diabetes
• Compared to other people…
• People with learning disabilities with
Type 1 diabetes more likely to get
checks
• People with learning disabilities with
Type 2 diabetes less likely to get
checks
• People with learning disabilities are
treated well for their diabetes

34. What do the numbers tell us?
• Numbers can never tell us the whole story
• On average, the health of people with learning
disabilities is poorer than the health of other people
• But for some health conditions, people with learning
disabilities are doing well and are being treated well
• There are lots of things we can do to help people live
longer, healthier lives

35. Thank you!
LDT@phe.gov.uk
@ihal_talk
35 LDT@phe.gov.uk
The pictures in these slides are from Photosymbols: www.photosymbols.co.uk

36. Sources of information
People with Learning Disabilities in England 2015. Public Health England
www.gov.uk/government/publications/people-with-learning-disabilities-in-england-
2015
Confidential Inquiry into Premature Deaths of People with Learning Disabilities.
University of Bristol www.bristol.ac.uk/cipold/reports/
Health and Care of People with Learning Disabilities. NHS Digital and Public Health
England http://content.digital.nhs.uk/article/7543/Health-and-Care-of-People-with-
Learning-Disabilities
Joint Health and Social Care Self-Assessment Framework 2014. Public Health England
http://content.digital.nhs.uk/article/7543/Health-and-Care-of-People-with-Learning-
Disabilities
National Diabetes Audit 2015-16. Report 1: Care Processes and Treatment Targets.
Learning Disability Supplementary Information. NHS Digital
http://content.digital.nhs.uk/catalogue/PUB23241/nati-diab-rep1-audi-ld-suppl-2015-
16.pdf
Emerson E & Hatton C (2014). Health inequalities and people with intellectual
disabilities. Cambridge: Cambridge University Press.
36 LDT@phe.gov.uk

37. What the numbers are telling us
(accessible)
Professor Chris Hatton

38. The health of
people with learning disabilities:
What do the numbers tell us?
This presentation is based on the presentation by
Professor Chris Hatton
Public Health England Learning Disabilities Observatory

39. What do the numbers tell us?
About when people die
About why people have worse health
About how good people’s health is

40. What do the numbers tell us?
Numbers can never tell us the whole story
The health of people with learning disabilities
is worse than the health of other people
But for some health conditions,
people with learning disabilities
are doing well and will be treated well
There are lots of things we can do
to help people live longer, healthier lives

41. The Learning Disability Mortality
Review and what it is telling us
Dr Richard Jeffrey

42. Learning Disabilities Mortality Review
(LeDeR) Programme
LeDeR Programme Manager
Richard Jeffery
42

43. Content
• What is the LeDeR programme?
• What are the main parts of the Programme?
• What is LeDeR telling us, as of today?
43

44. Background
• Several reports and inquiries have said that people with
learning disabilities are not getting good health and social
care
• Some people are dying too soon
These reports include:
Mencap – Death by Indifference (2007)
The Confidential Inquiry into deaths of
people with learning disabilities (2013)
44

45. What do we know?
Some people with learning disabilities:
• Are more likely to die at a young age
than other people
• Some deaths should not happen when
they do
45

46. Age at death
Men and women with learning
disabilities die about 20 years
sooner than people without
learning disabilities
46

47. People with learning disabilities are:
47
Three times more likely to
die from a cause of death
that could be prevented
by good quality care …..
than people in the general
population.

48. LeDeR programme aims
• Improve health and social care
services
• Stop so many people dying early
48

49. What are the main parts of the Programme?
49

50. • Someone lets us know when a person
dies
• A local reviewer speaks to those who
knew the person best, including their
family
• And then they look at their notes
• Find out what happened…
Initial review
50

51. • If it is felt that further learning could
come from a full review, they organise
a multi-agency meeting
• A multi-agency meeting
looks more closely at why
someone died
51

52. • Deaths of people from black and
minority ethnic communities
• Deaths of young people aged 18-24
Things we will look at more closely:
52

53. • All the information from a review is
discussed in the local area to decide
whether changes need to be made to
improve services
• These are called action plans listing
actions & recommendations
Action planning and improvements
53

54. • We collect all of the information from
across England and look at it in more
detail
• We send reports to national LeDeR
steering groups to say what the
information tells us and what patterns
we can see
• We help make sure action plans are
carried out
Action planning and improvements
54

55. What is LeDeR telling us?
55

56. As of today…
• 15 of the 38 national LeDeR steering
groups are setup. Complete by
December 2017
• LeDeR has trained 750 staff
• LeDeR has been notified of over 500
deaths of people with a learning
disability. Those eligible for review is
over 470.
56

57. Of eligible deaths notified to LeDeR so far…
• 52% are male & 48% female
• Most of the deaths we have been told about
are people aged 55-64 years of age. A small
number (3%) were between ages 18-24
• Most individuals were single (80%) and lived
with someone else (79%)
• Most common place of death so far has
been the hospital (61%)
n=471
57

58. Cause of Death
Of those reviews currently coded into ICD10 , the first
recorded reason for cause of death was:
1. Pneumonia (18%)
2. Aspiration pneumonia (14%)
3. Sepsis (13%)
n=173
58

59. Associated health conditions
We know from the reviews, some of the common health
conditions of the deceased are:
1. Epilepsy(13%)
2. Dementia (7%)
3. Cerebral Palsy (6%)
4. Diabetes (4%)
5. Cancer (3%)
n=471
59

60. Actions & Recommendations so far…
• We have finished 19 reviews
so far
• These have given 27 actions
and recommendations
• Some completed reviews
generated no actions, because
there were no issues with the
care provided
60

61. Secondary Care recommendations
Examples
• Accident & Emergency learning disability training
• Better communication at patient discharge
• Better communications with regard Mental Health referrals
• Ensure reasonable adjustments are made in Accident &
Emergency
• Improve end of life care through better end of life training
• Reducing infections whilst in hospital
• Improving communication with regard medication changes
• Improving processes on the best action to take should the
person suffer cardiac arrest or die suddenly
61

62. Primary Care recommendations
Examples
• Audit annual health checks & raise awareness of
importance of the health check
• Better understanding in primary care with regard
completing Cause of Death certificates
• Ensuring patients with a learning disability or a
mental health condition are on the correct registers
• Improving communication between case
coordinators & case managers
• Improving communication with regard medication
changes
62

63. Other recommendations include
• Multi-disciplinary meetings must be fully inclusive of
all agencies
• Ensuring social care staff are aware of the importance
of recording & documenting contact with families
• Implement end of life training in residential &
supported living accommodation
• More timely Mental Capacity Assessments
• Improving learning disability awareness training with
District Nurses
• Ambulance Trust - Ensure reasonable adjustments
are made
63

64. Five key factors contributing to early deaths
(from CIPOLD 2013)
1. Not listening to people with learning disabilities
and their family and carers
2. Not knowing who has a learning disability and
making reasonable adjustments
3. Not finding out what is wrong and treating illness
quickly
4. Not coordinating a persons care and sharing
information
5. Not following the Mental Capacity Act 2005
64

65. What else is LeDeR telling us?
• The programme is already improving
services for people with a learning
disability
• Actions from completed reviews show
lots of different improvements in care, in
different organisations
• We will bring the learning together from
all the local reviews to help improve
services across the country
65

66. What else is LeDeR telling us?
• We have trained reviewers from all professions
across the country. But we need to work more with
GPs and social care
• We also know what works well and need to share
this across the country
• LeDeR steering groups need help to turn actions
from reviews into better services & commissioning.
We have workshops in June and July to do this
66

67. 67
Thank You

68. Contact details
Richard Jeffery, Programme Manager
Norah Fry Centre for Disability Studies,
University of Bristol, 8 Priory Road, Bristol BS8 1TN
LeDeR-team@bristol.ac.uk
Tel: 0117 3310686
http://www.bristol.ac.uk/sps/leder/
@leder_team
https://www.facebook.com/lederteam/
68

69. The Learning Disability Mortality
Review and what it is telling us
(accessible)
Dr Richard Jeffrey

70. Learning Disabilities Mortality Review
(LeDeR) Programme
This presentation is an
accessible version of a
presentation by
LeDeR Programme Manager
Richard Jeffery
70

71. 71
The LeDeR programme is about
finding out about the deaths of
people with a learning disability.
The LeDeR programme is about
anyone aged 4 or more who dies
that has a learning disability.

72. 72
Finding out if anything could have
been done better for the person
that died is important.
It will help health services make
improvements to the way they work
for people with a learning disability.

73. 73
Families, carers and staff who
support people can take part in
reviews if they want to.
This helps make sure the review
knows about who the person that
died was – not just about their
medical condition.

74. Health inequalities
Dr Angela Donkin

75. Improving the health of
people with a learning
disabilities-
improving the social
determinants of health
Dr Angela
Donkin,
Dr Wendy Rickard
UCL Institute of
Health Equity

76. Marmot
Review Policy
Objectives:
The Social
Determinant
s of Health
• Give every child the best start in life
• Help all people have control over their
lives.
• Create good jobs for all
• Help people have enough money to live
well
• Make places and communities more
accessible
• Stop people from getting ill

77. Nearly half of the increased risk of mental health difficulties
among children with learning disability may be attributable to
their increased rate of exposure to common ‘social
determinants’ of poorer mental health rather than to their
intellectual disability per se’
(Emerson & Hatton 2007, 2015)

78. British adults with
intellectual impairments
living in general households
are at significantly increased
risk of potential mental
health problems than their
non-disabled peers.
Adjusting for differences in
age, gender and socio-
economic position (e.g. if
poor, in a good job)
eliminated this increased
risk

79. People with learning disabilities often have worse health.
Health can be improved by improving daily life:
Enough money
Having work/a purpose
Better housing
More support and less bullying

80. A. Give
every child
the best
start in life
Children with learning disabilities:
• More likely to have poor bonding with
parent and harsh, inconsistent parenting.
• More likely to be poor
• Being poor associated with worse child
mental health and more risky health
behaviours, such as not exercising
enough, not eating healthily, and smoking
and drinking alcohol too much.
• British children second highest rate of
untreated tooth decay
• highest rate of never having had an eye
exam

81. What
works
• Three domains – action with children, action with parents
and action to improve the context in which children live. (An
Equal Start IHE 2012)
• Improve mothers mental health
• Reduce stress -
• improve income/reduce prices
• support social networks
• Better information and support for positive parenting.
• Building communication skills and ability to control
behaviour
• Specialised parenting programmes
PLUS…
Focus on basics – teeth brushing, diet, eye tests, exercise – all
still important.

82. Outcomes can improve
• Incredible Years programme with parents of 2-5 year olds with LD.
in negative parent behaviour (63% to 24% parents after 12 week sessions)
poor child behaviour (10% to 6% after programme).
• Triple P “Stepping Stones” parents and children aged 2-8 with LD.
significant positive impact on: parenting style, how parents feel about how well
they are doing and on relationship between parents and children

83. B. Enable all
children,
young people
and adults to
maximise their
capabilities
and have
control over
their lives: key
points
• Foundation level learning focusing on social and
emotional skills has been positive.
• Children and young people twice as likely to be on free
school meals
• Better outcomes for those with mild LD is possible
• E.g. Numbers achieving the expected level of
attainment in both English and Maths rose from
9% to 15%
• Bullying is a big issue.
• 83% of young people with learning disabilities
experience bullying.
• Bullying at school leads to poorer health in adults.
• Awful conditions in secure settings (a quarter of those
in secure settings have LD)
• High use of restraint
• High level of isolation

84. Regional differences provide an opportunity to learn from others……
Good level of Development (Age 5) and eligible for Free School Meals
Nearly seven out of ten children in Haringey, Lewisham, Bexley, Greenwich on free
school meals reach a good level of development by age 5
Just four in ten children in Stockton onTees, Blackburn and Darwen, and
Leicestershire reach a good level of development by age 5.
In London the gap in GCSE attainment between those on free school meals
and all children is half the size of the
gap in the South East..

85. What to
do?
• Maintain/build on strength of foundation level
learning
• Maintain improvements in subjects for those
with mild learning disabilities
• Reduce inequalities in outcomes by level of
poverty/types of jobs
• Eye exams and dentists – appropriate access
needed
• Effective anti-bullying interventions
• Reduce poverty
• Reduce restraint/isolation in secure
settings/move children closer to homes/more
early intervention to reduce numbers needing
to be in secure settings
• Improve clarity on best educational system –
best for results? Best for well-
being/happiness? What is the goal?

86. Work and
income
• Most of those with learning
disabilities want to work
• However only 6% do.
• Disincentives to look for non
existent work as would lose more
generous benefits.
• More likely to live in poverty

87. Good work may be different and this
could benefit employers – need a ‘sell’ to
push up demand
Capabilities will vary but
more than 6% can work.
More routine, repetitive
work may be appropriate
with little autonomy over
how tasks are completed.
A third of family carers of
adults with learning
disabilities are also not in
paid employment due to
their caring responsibilities
(PHE, 2014).
Need to recognise real
difficulties regarding
gaining work/income
generation for this group
and pay/ and support
appropriately.

88. A minimum income for
healthy living
JRF acceptable minimum income
standard 2016
In 2016, single people need to earn
at least £17,100 a year before tax
to achieve the MIS, and couples
with two children at least £18,900
each.
Incomes of working-age
households receiving out-of-work
benefits were far below MIS. Single
people could afford 39 per cent of
the budget and couples with two
children 61 per cent.

89. Outcomes can be better
In the state of Vermont, USA, a programme begun in 1983
had achieved a 48% employment rate in regular jobs for
people classified with ‘developmental disabilities’ by 2015
compared to a USA average of 19%
All paid at Vermont minimum wage or higher.
A 2015 survey showed 90 per cent of these workers enjoyed
their current job although just 52 per cent felt they were
able to work enough hours.

90. Discrimination
• Tackling discrimination is not explicitly in UK Marmot review
as key recommendation but picked up subsequently in
Euro/other country reports as important SD health.
• People with learning disabilities are more likely to suffer
discrimination, poor access to some health services and
worse employment prospects as a result of their disabilities,
all of which impact negatively on their health.

91. Improve data on effective interventions
A good (systematic) review of interventions to prevent violence against people with disabilities
concluded that the current evidence base offers little guidance to policy makers, program
commissioners, and persons with disabilities for selecting hate-crime prevention
interventions.
Consider developing new interventions and testing them
• Rounded whole package/household centred support
Given the importance of the few relationships those with learning disabilities have, it is
important that carers and family are supported in their role as care providers for those with
learning disabilities.
• Improve living conditions
Poor social determinants of health will exacerbate stress and so efforts to tackle
unemployment, low income and poor housing, alongside measures to reduce reliance on one
person should be considered.
• Widen and strengthen adherence to diversity legislation in non work/school
settings.
There is a clear need to design and test new interventions to minimise discrimination on
high streets and in public places, alongside tighter monitoring by the police and
publicity of cases that have successfully resulted in criminal charges appear to be
indicated.
What to do - discrimination

92. Isolation
and social
participati
on
• 50% of people with a learning disability
experience chronic loneliness, compared
to around 15-30% of people in the general
population
• As in the general population, loneliness
has been associated with health risks such
as depression and stress amongst people
with a learning disability, high blood
pressure and higher risk of death.

93. Ways forward
• Reduce bullying/more visability
• Teach people how to communicate with those with
learning disabilities/courses
• Recognise the chronic loneliness and centre care
around people not provision of services
• Signposting to groups/support by schools/GPs etc

94. The ‘Stay Up Late’ Campaign - active social lives for people with
learning disabilities.
On-line tweet campaign, with 16, 600 followers
Based on workshops about the freedoms that people with learning
disabilities want, conducted over a three year period, Stay Up Late have
drawn up a ‘Magna Carta’.
This sets out a range of freedoms –
- to choose support staff,
- to have happy support staff,
- to choose friends and have a social life,
- to choose where to live
- to have the right to have a relationship and a sex life.
Stay Up Late have helped set up a number of GigBuddies projects in the
UK, aiming to match people with learning disabilities who like going out
to mainstream gigs and events with volunteers who like the same types
of music

95. Next steps
• In scope
• Stakeholder group, editing and
finalising recommendations in context
of Marmot review
• Including setting out priority evidence
gaps
• Future possibilities
• Consider could be a work in progress,
possibility to have a hub/portal for
effective interventions
• Consider monitoring on annual basis
alongside Marmot indicators
• Clarify priorities for action and
funding streams

96. Thank you
a.donkin@ucl.ac.uk
http://www.instituteofhealthequity.org/

97. Health Checks
Dr Kirsten Lamb

98. The Learning Disability
Annual Health Check
Dr Kirsten Lamb
HVCCG Clinical Lead for Learning Disability

99. Why is it important?
2010 – IHAL review of the evidence shows that
health checks improve:
• the detection of unmet, unrecognised and
potentially treatable health needs (including
serious and life threatening conditions such as
cancer, heart disease and dementia)
• targeted actions to address these health needs
Recent study in The Lancet showed GP practices
in the ES had:
• increased rates of general and specific health
assessments
• increased identification of co-morbidities
• more health action plans and secondary care
referrals

100. What we know
• People with learning disabilities have poorer physical and
mental health than other people. This is not inevitable.
• The average age of death for people with a learning
disability is 65 for men and 63 for women. (Average age of
death of 78 for men and 83 for women in the general
population)
• 37% of people with a learning disability die from avoidable
causes, compared with 8.8% of the general population
• Only 49% of adults with a learning disability on the GP or
health register in England received an annual health check
in 2014-15
• Annual health checks can reduce health inequalities, but
not enough people with a learning disability get them

101. Evidence from ‘Being Disabled in
Britain’
• Increased hospital admission for
problems that should be
managed in community –
76/1000 for people with LD and
15/1000 for those without LD
• Low uptake of health promotion
and screening in people with LD
• Prolonged psychiatric hospital
stays for assessment and
treatment
• Over-use of psychotropic
medication as chemical restraint

102. Health problems for people with a
learning disability
• NHS Digital and Public Health England data (Gyles
Glover) – General Practice Extraction Service
• Covered 51% of all patients registered with a GP in
England = 127,350 people with a learning disability

103. Significant health problems for
people with a learning disability
• Obesity
• Epilepsy
• Severe mental illness
• Dementia
• Diabetes
• Gastrointestinal problems eg constipation, gastro-
oesophageal reflux disorder, dysphagia
• And many others

104. The Learning Disability Direct
Enhanced Service
Health checks
• Practices should invite all patients on the health check register for a
review of physical and mental health annually. As a minimum the health
check should include:
• A collaborative review with the patient and carer (where applicable) of
physical and mental health including: health promotion, chronic illness
and symptoms enquiry; physical examination; epilepsy, dysphagia,
behaviour and mental health and specific syndrome check
• Accuracy and appropriateness of prescribed medication checked
• A review of co-ordination arrangements with secondary care
• A review of transition arrangements (where appropriate).
• A review of communication needs
• A review of family and carer needs
• Support for the patient to manage their own health and make decisions
about the health and healthcare

105. What do we need to do?
• Ensure that everyone who has a learning disability of
any age, is on the GP learning disability register – see
Mencap ‘Don’t Miss Out campaign’
https://www.mencap.org.uk/advice-and-
support/health/dont-miss-out/dont-miss-out-annual-
health-checks
• Ensure that as many people aged 14 and over have a
health check each year.
• Ensure the health check is meaningful and of good
quality
• Ensure that everyone has a health-check action plan

106. Improving the quality of the GP
health check
The plan:
• Discuss the content of the health check at national level
with the General Practitioner Committee of the BMA
• Develop a National computer template for the health
check
• Develop guidance to go alongside the template – RCGP
step-by-step toolkit
• Develop guidance for carers about the importance and
specific aspects of the health check

107. The National Template
There is a summary and overview on NHS England
website -
https://www.england.nhs.uk/wp-
content/uploads/2017/05/nat-elec-health-check-ld-
clinical-template.pdf

108. The template
• Has a practice nurse
section
• Has a GP section
• Can automatically
produce an
easy read health-check
action plan

109. Example screen shot from the EMIS
version = 1st part of the GP section

110. The practice nurse section of the
template
• Support and patient
information
• Immunisation
• Allergies
• Reasonable adjustments
and communication needs
• Functional life skills
• Lifestyle and health
promotion
• Screening
• Vision, hearing, dental

111. Practice nurse measurements
• Weight
• Height
• Body Mass Index
• Blood pressure
• Ear examination for wax

112. The GP section
• Systems review
• Mental health review
• Specific syndrome issues
• Medication review
• Investigations
• Physical examination

113. Other issues
• Advance care planning
• Safeguarding

114. Summary Care Record with
Additional Information
• Specifically included on
template
• This means that the GP can
make information available
to others such as doctors in
hospital.
• https://digital.nhs.uk/media/
1175/Easy-read-SCR-
additional-information-
leaflet/pdf/scr_easy_read_pa
tient_leaflet_additional_infor
mation

115. The health-check action plan

116. The final message!
• We all have to work together
• People with a learning
disability and their carers
understand the benefit of the
health check
• People are proactive in asking
for a check
• GP practices are well organised
to make it work for people
• The health check action plan is
meaningful
• Community learning disability
teams support the process

117. Thank you for listening!
Resources:
• https://www.england.nhs.uk/learning-disabilities/
• RCGP Step by Step guide - http://www.rcgp.org.uk/clinical-and-
research/toolkits/health-check-toolkit.aspx
• National Learning Disability Health Check -
https://www.england.nhs.uk/gp/gpfv/investment/gp-contract/
• Summary Care Records -
http://webarchive.nationalarchives.gov.uk/20160921135209/http://s
ystems.digital.nhs.uk/scr/additional
• Mencap ‘Don’t miss out” - https://www.mencap.org.uk/advice-and-
support/health/dont-miss-out/dont-miss-out-guides