An NHS Trust in Yorkshire has been praised by NHS England for leading the way in work to clear the elective care waiting lists for people with a learning disability.
Calderdale and Huddersfield NHS Foundation Trust (CHFT) recently embedded a range of initiatives to ensure equitable access, experience and outcomes for people with a learning disability in their Trust.
This included developing and implementing a range of tools to identify people with learning disabilities and understand their experiences. They monitored the difference made with a flagging system within patient records, a learning disabilities data dashboard, and a data model offering comparisons against the general population.
In addition, dedicated sessions on all aspects of living with a learning disability were delivered to the board, and an enhanced task and finish group was established to advance learning disability priorities within the Trust with support from those with lived experience.
CHFT serves a population of around 440,000 people living across Halifax and Huddersfield; approximately 3,000 of which are patients with a learning disability which is known to a health provider. In 2021 there were 77 patients with a learning disability on the waiting list – all of whom have now received their planned care.
Brendan Brown, Chief Executive, CHFT said: “It is really important that the care we provide for all of our patients is designed to meet their needs and that we treat people as individuals. It is not acceptable that people with learning disabilities are dying earlier than the general population from treatable conditions.
“By taking a whole trust approach to address the needs of this under-served group we have been able to eliminate the backlog waiting list of people with a learning disability waiting for elective care. We have also improved ‘did not attend’ or ‘was not brought’ rates, reduced the length of stay in hospital, reduced the number of people who are readmitted, and reduced waiting times. Importantly, outcomes for this group of people have also improved. As a result, work satisfaction scores from colleagues have improved, and the trust has realised cost savings.
“We continue to work with communities across the area to improve access, experience and outcomes. For us, it’s not about getting the number on our waiting list down; it’s about making real and sustainable changes for the people we support.”
The Trust also did a deep dive into patient journeys from point of referral to treatment and reviewed the reasonable adjustments made by the trust, cancer data and missed appointments. The trust also looked at information on readmissions, length of stay and mortality for people with a learning disability.
This enabled them to identify areas for targeted action which included prioritising people with a learning disability who were waiting for surgery. Part of this involved partnership work with a private special needs dental service to restart theatre sessions and increase capacity to reduce the backlog on waiting lists.
The trust has also developed an inpatient standard operating procedure for adults with a learning disability and a pilot outpatient template for children and young people.
Learning disability champions are in place across the trust, and easy-read training is provided for trust project managers. Makaton sessions are also available to all staff to support communication with patients.
Resources have been developed to raise staff awareness around learning disabilities. These include a mandatory e-learning package for all staff, as well as a leaflet and video which are shared at staff induction. There is also bespoke learning disability training for cancer care navigators and clinical nurse specialists.
Going forward, the trust is looking to introduce learning disability care navigators and is undertaking further work to identify more of the local learning disability population, in particular children and young people.
Evidence shows that people with a learning disability have poorer health and experience greater and more persistent healthcare inequalities, including premature mortality. The 2021 review, Learning from Lives and Deaths – people with a learning disability and autistic people (LeDeR), reported disparities in avoidable medical causes of death between those with a learning disability and the general population. LeDeR reports have also highlighted that a third of deaths of people with a learning disability were from treatable medical causes.
