NHS England’s Building the Right Support (2015) outlined a clear national service model for people with learning disabilities that included annual health checks for everyone aged over 14 years. It was part of a broader ambition to ensure that people with learning disabilities ‘get the support they need to live healthy, safe and rewarding lives’.
“People are getting health care in their community and reducing stays in our six-bed Assessment and Treatment Unit.”
Two years on, the national figures show a positive shift in the numbers receiving checks but we’ve still got some way to go. It needs everyone to be on board – every service provider across every locality – to make it happen.
Bradford, like other Trusts, started to focus on health checks back in 2008, in line with national guidance. Our community-based health teams were supporting health and care providers to ensure checks were happening, to pick up any changes in people’s presentations earlier and provide support earlier, to avoid hospital admissions.
The latest statistics now show 64 per cent of people aged 14 years and over across Bradford and Airedale received a health check last year. This compares to a national average of around 44 per cent (source: Mencap).
A physical health check is the first thing we do when someone’s behaviour starts to deteriorate, to ensure there are no underlying health issues, and it helps us to identify other health conditions early. It also means that people are getting health care in their community and reducing stays in our six-bed Assessment and Treatment Unit.
When we started, we found that health checks were happening in GP practices but the numbers and quality varied. The positive take-up is a result of a joint effort across primary care and our health support team.
Three key factors have contributed to the higher than average take-up of health checks.
A multi-disciplinary team at our Waddiloves clinic runs specialist clinics for people who can’t access mainstream services, but also supports the mainstream services on specific areas such as blood tests. These all take place in the community and close to home.
We developed a health check template that takes practice staff through the key health areas that are particularly relevant to people with learning disabilities – NICE guidance – and best practice that acts as a prompt on what needs to be covered. NHS England has since developed an on-line template. We review our template annually so it reflects the latest evidence-based thinking. For example, ensuring that chest infections are on the checklist that has been identified as one of the high risk areas for people with learning disabilities in the national mortality review.
We also contact those GPs that are achieving less than 50 percent of health checks to offer training and support on an individual, practice, or practice cluster level to increase uptake. Training can cover a range of areas from the basics of going through the template, reasonable adjustments and signposting to other community services and support.
If someone hasn’t had a health check, we’re asking why and if we need to, working with the individual and the practice to do de-sensitisation work to make it happen. In practices, often it’s down to low awareness or skills, or inaccessibility of services for the individual. This could be something as simple as not using easy-read appointment letters, so people don’t turn up. The health provider thinks it’s a ‘did not attend’ and people fall between the gaps.
Alongside the health check, we’re also doing physical health reviews when people are newly prescribed anti-psychotic medication. This gives us a baseline for the individual’s on-going health checks and something that we can monitor over time.
Health checks aim to keep people well at home and identify issues early but for those with a learning disability and mental health challenges, our mental health intensive support team provides additional support. Out of hours, our 24/7 mental health crisis care service, First Response, enables people to self-refer. It provides specialist support, using a bespoke care pathway that we’ve developed.
The pathway ensures that mental health specialists are familiar with reasonable adjustments, such as visiting the individual in their home rather than doing a phone assessment. It has included de-sensitisation work so that individuals get to know the service and staff and are comfortable using the service if they need urgent support. Again, this is about supporting people in the community and avoiding unnecessary hospital admissions.
Transforming Care has focused everyone’s minds on how we can do things better. Yes there is still more work to do, but we all recognise that health checks are fundamental to ensure we spot health issues early and keep people well, at home.
Health checks have significantly improved the health and general wellbeing of one man in his early 20s, supporting his transition from hospital to community-based care. He has autism and learning disabilities and struggles with change, particularly when it’s unexpected and unplanned. Historically he has had long periods in hospital but has now been living in the community for two years, with support from a multi-disciplinary health and care team.
Ensuring the young man can access mainstream health services and receive his routine health checks have been part of the positive move to community-based living. The health check on discharge provided a baseline and an opportunity to review his antipsychotic medication; these meds have now been significantly reduced, making him more active and impacting positively on his weight. Similarly, we did de-sensitisation work to reduce anxiety levels around dental visits and he now attends these.
Whilst his care support worker ensures he attends his routine GP health checks, we’ve also done de-sensitisation work to support key areas such as getting bloods done. We’ve used ‘social stories’ so he knows what to expect. His quality of life and general health has been transformed. Regular access to the community, with his own flat and car, and on-going reductions in his medication that has improved his physical and mental health, and levels of positive social engagement.
