At Advance, we fully recognise the health inequalities that people with learning disabilities and mental health conditions are likely to face. You can read our first article about the topic and our recent actions amid the Coronavirus pandemic to overcome these obstacles here (link to article 1).
We are also planning for the future and making sure we have all the systems, information and approaches in place to ensure our customers can enjoy good health and wellbeing.
Future Learning, Physical Health & Collecting Data
Our Quality Improvement Manager is working with our Customer Engagement Manager as well as Area Managers to tackle the barriers that exist for people with mental health conditions and learning disabilities to minimise health inequalities and access health care services.
On average, the life expectancy of women with a learning disability is 18 years shorter than for women in the general population.
The life expectancy of men with a learning disability is 14 years shorter than for men in the general population (NHS Digital 2017).
At Advance we are sensitive to these figures and are working to enable all our customers to enjoy good health and be conscious of health risks, screening appointments, overmedication and the numerous other health challenges they are likely to face.
With valuable input from customers, we will be inviting everyone who accesses our services to complete a health survey. This will be an annual survey that will help us to identify the main areas to focus on in order to make the biggest difference for the people we support. This information will enable us to have a full body of data from which to work and will therefore allow us to spot patterns or trends in relation to health and to determine areas we can work on. The range of questions will include:
- Date of birth, gender, ethnic background, Advance service used
- How are you feeling right now
- What stops you taking care of yourself
- What are your top 3 health priorities
- Height, weight, waist measurement, family history, other conditions, medication
- Lifestyle factors (e.g. alcohol, smoking, levels of activity, diet, drug use)
- Upcoming health screenings
Attending health screenings is important for everyone. It is common however, for people receiving support to miss their health screenings. This can be for a variety of reasons including a lack of understanding, lack of reasonable adjustments, a lack of accessible information or support staff not acknowledging the importance of a screening.
An example: Breast Cancer Risk factors which can increase the risk of developing breast cancer include: being overweight, lack of exercise, eating a poor diet, smoking, drinking alcohol and not having children.
Women with learning disabilities who developed breast cancer were twice as likely to be obese than those who had not contracted the disease.
(A French study: Trétarre et al. 2017)
Our health survey, Easy Read guides and news stories will continue to highlight the importance of health screenings for both customers and staff members. We are hoping to see an uptake in screening attendances in the future, now that this issue has been identified and there is a more inclusive approach to medical appointments. We also widely share information and promote access to the flu jab and will be doing similar with the new Covid vaccination. The survey will also include key questions that so that we can benchmark Advance against other care providers.
NHS Annual Health Check
Annual health checks are for adults and young people with a learning disability. Someone does not have to be ill to have a health check. It is a preventative way of identifying any avoidable health issues. Unfortunately, not everyone with a learning disability does attend their annual health check – this is something we want to change at Advance.
From 2016 to 2017, about 53% of people with a learning disability who are on their GP's learning disability register had a health check. This means just under half of people who are on the register did not have a health check.
Monitoring health and wellbeing is an ongoing part of support work and forms a part of our online support planning system – iPlanit. Here staff can monitor and record who has attended their annual health check. We are encouraging support staff to pay attention to this and reinforce that annual health checks can go ahead regardless of local tier levels.
It is our goal at Advance to have 80% of all our customers with learning disabilities to attend their annual health check and we are gathering information to be able to monitor this and sharing information to make sure our staff conscious of this as well as customers. We have also created an accessible letter that customers can use to communicate their needs and any adjustments they need to their doctor.
Learning from Deaths and Preventing Avoidable Deaths
At Advance we know that poor quality healthcare can cause health inequalities and avoidable deaths amongst people with learning disabilities. When someone who uses our services passes away we always review their death and monitor any findings to see if anything could have been done differently.
The 2018 Learning Disabilities Mortality Review (LeDeR) found the median age at death was 60 for men and 59 for women, for those (aged 4 and over) who died April 2017 to December 2018. This is significantly less than the median age of death of 83 for men and 86 for women in the general population. This means the difference in median age of death between people with a learning disability (aged 4 and over) and the general population is 23 years for men and 27 years for women. (Taken from Mencap)
The Confidential Inquiry into premature deaths of people with a learning disability also found that 38% of people with a learning disability died from an avoidable cause, compared to 9% in a comparison population of people without a learning disability. (Heslop et al. 2013, p. 92)
LeDeR continues to research this topic and reviews the death of anyone with a learning disability. At Advance, we have paid close attention to their work and followed suit to remodel our death reviewing approach in order to gather more information and be able to identify any patterns or areas for improvement. This review incorporates a holistic approach and addresses medical history, lifestyle factors, quality of life and more. For example - attending annual health checks, health screenings and maintaining a healthy wellbeing with a fulfilling social life are all things to be considered.
What we are doing at Advance
- If cancer is not diagnosed in time it is often untreatable and shortens the length of someone’s life significantly. Along with sharing information on routine screenings to increase awareness amongst both support workers and customers, we are promoting awareness of the early signs of cancer too so that people are aware of symptoms to look out for.
Addiction and Underlying Health Conditions:
- It is well-known that addiction and substance abuse can lead to long term poor health. If our customers experience addiction we use a risk assessment to identify the known health hazards and to decide how to raise awareness with the customer and those supporting them.
- This same risk assessment applies for customers with underlying health conditions to help support staff and customers manage and monitor their physical health.
- We also provide standard resources for substances which are commonly used by those with an addiction.
- We know that those who receive less support can be more vulnerable. We are providing support staff who work in services where customers receive minimal support with clear guidance on supporting people who are making unwise
- Our new annual health survey will also be an effective way to promote awareness of lifestyle risk factors and discuss health and wellbeing.
Annual Health Checks:
- We are promoting annual health checks for everyone who accesses our services, so people with mental health conditions as well as people with learning disabilities.
- In areas where annual health checks aren’t offered to people with mental health problems we plan to write to NHS Clinical Commissioning Groups to acknowledge how important these checks are and to request a review of their approach.
Serious ill health incidents:
- We are promoting the use of oximeters and thermometers in identifying early signs of serious illness. This has been particularly helpful during the pandemic.
- We are sharing best practice stories from staff who have experienced supporting someone who has suddenly become seriously unwell (e.g. recognising a stroke, CPR, burst stomach ulcer) to promote awareness of potential health complications and what to do.
Mencap has a useful FAQ section on Health which you can view here.
Advance feels passionate about supporting vulnerable adults to live the life they choose. Our intention is to provide the right information, support and services so that our customers can enjoy the same quality of life as everyone else.