Improving Patient Experience Committee
Date: 29.11.13.
Agenda No:
Title of Document:
Learning Disabilities Annual Report 2013
Report Author:
David Feakes – Learning Disability Health Lead
Lead Director: Zoe Packman, Director of Nursing, Midwifery and Allied Health
Professionals
Summary:
This report covers the period from 1st April 2012 to 31st March 2013
Recommendations:
The Board is invited to:
 Agree the contents of the annual report
 Acknowledge the actions as highlighted
 Note the referral numbers
NHS Constitution considerations:
Copy available at http://www.dh.gov.uk/en/Healthcare/NHSConstitution/DH_093184
Who have you engaged with in the production of this document:
Patients
Public
Partners
Patient Assembly
Other please state
Trust Committees please state
Staff
Outcomes of engagement:
For staff to become fully engaged and integral to ensuring the actions are realised.
Has an equality impact assessment form been completed?
Not applicable for this document
Key Risks:
CQC Self Certification minimal risk of non compliance due to CRS go live and flagging
system.
1
Learning Disabilities Annual Report for Croydon Health Services
1.0 BACKGROUND







Croydon Health Service is committed to providing healthcare and support to people with
learning disabilities and continued management of the health element of the Joint
Community Learning Disability Team that provides services for adults with learning
disabilities, living in and registered with a Croydon General Practitioner in order to
maintain and develop independence, improve health and wellbeing and encourage full
citizenship.
The service comprises of the following disciplines:Community Learning Disability Nursing
Clinical Psychology
Speech & Language Therapy
Physiotherapy
Dietetics
Acute Liaison Nursing
Learning Disability Health Lead who manages the service
The Learning Disability Team provides the above specialist community based services to
people with a diagnosed learning disability as defined by the Department of Health, world
health organisation and Valuing People white paper 2001:
 ‘Significant reduced ability to understand new or complex information to learning new
skills;
 reduced ability to cope independently which starts before adulthood with lasting effects
on development’
This is usually accompanied by an IQ of below 70.
2.0 ACTIVITY DURING THE REPORTING PERIOD.
2.1 POLICY AND PRACTICE DEVELOPMENT/ INFLUENCE
 Over the reporting period the following Trust wide work has been supported by various
members of the team in order to develop policy and practice within the Trust and health
services.
 Croydon University Hospital Carers Policy and Yellow Badge Scheme
 Carer Sleeper Chairs
 Specialist LD providers specialising arrangements for learning disabilities inpatients
 Planning visits to specific departments for patients with learning disabilities to reduce
anxieties about equipment, room and procedure.
 Care Pathways for SLAM Mental Health Learning disabilities services
 Behavioural support care pathway
 Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD)
action plan.
2
2.2 CLINICAL AUDIT
The following audits have been undertaken in partnership with Croydon Safeguarding
Children Board and NHS South West London: Croydon Borough / Croydon Clinical
Commissioning Group
Month of audit
March 2013
March 2013
March 2013
2.3
Name of audit
Learning Disability Hospital 10 case re-audit
Challenging Behaviour Workgroup Audit
Learning Disability CQUIN Audit
MULTI-AGENCY WORKING
Croydon Health Services NHS Trust provides the learning disability service in partnership
with three organisations:
 Croydon Council Social Services Department
Providing Care Management, social work and social care package funding
 South London and Maudsley (SLAM) Mental Health Learning Disabilities (MHLD)
Providing specialist mental health services for people with learning disabilities with a dual
diagnosis.
 Croydon Commissioning Group (CCG)
Providing joint commissioning responsibility for learning disability services and service
delivery developments, needs analysis and local support provider procurement and
contracting.
2.4



2.5
TRAINING
As part of the 2012/13 Learning Disability CQUIN, staff awareness training was a focus
for the team and in particular the acute liaison nursing and learning disability health lead
function. The target staff group were identified as, ‘clinical and non clinical patient
facing’ which directly related to that of adult safeguarding, (n-=1214). The percentage of
staff trained during the period of 2012/13 was 75% (n=911).
Learning Disability awareness is now an integral part of the corporate induction for all
staff commencing employment at Croydon Health Services NHS Trust.
Learning Disability general and health awareness training is being developed for
Doctors in General Practice within primary care to further develop screening, enhanced
health checks more effective primary care prevention and early detection of health
related issues for patients with learning disabilities.
Referral demand was high during the period of 2012/13 with a specialism breakdown
as follows:-


52 referrals were made via the SLAM care pathway for specialist clinical psychology for
people with dual diagnosis of mental health and learning disabilities requiring
therapeutic interventions such as CBT, Dementia screening for cognitive baseline
function assessment, anxiety, depression, OCD and Post traumatic stress disorder.
67 referrals were received for people with challenging behaviour requiring a multi
disciplinary approach for behaviour formulation and the design, implementation of
behavioural support programmes with unpaid and paid carers. The majority (44%,
n=29) of these referrals were made as a result of physical aggression to others.
3




36% (n=24) of the 67 referrals received lived with family members and therefore were
classified as unpaid carers.
The average episode of care length for people with challenging behaviour was 43
weeks due to the complexities of behaviours, dynamics of living environments,
consistency of approach to behavioural support by family members/ or paid carers and
life events during the episode of care.
There were 319 referrals received to the other disciplines including specialist
community nurses for health facilitation and support for primary health care access,
speech and language therapy for dysphagia screening and communication support (can
reduce behavioural referrals), physiotherapy and dietetics for obesity, underweight
management and healthy eating choices/ training.
Total referrals during 2012/13 = 438
2.6
Vacancy Rates
During 2012/13, the team had two leavers, one part time clinical psychologist and one
full time community learning disability nurse. Both posts were reappointed to and the
team has remained at maximum staffing resources with safe staffing levels over the
period.
2.7
Service Quality Review – ‘Big Health Check’
During the period, NHS London required the learning disability service to undertake a
self assessment review of its service with patients, carers, partners and other providers
in order to rate the service against set criteria. This was then validated with NHS
London by submitting evidence and follow up meetings being held. During 2012/2013
the ‘Big Health Check’ resulted in the Croydon Health Services NHS Trust learning
disability team being rated as the highest in London within the Traffic Light rating
system. During 2013/14 the review will incorporate the local authority social services
function.
3.0
3.1
GOVERNANCE ARRANGEMENTS
The learning disability team is managed by and accountable to the integrated care
board. The learning disability health lead is an active accountable member of the
Nursing and Midwifery Board, Integrated Care Quality Board and Integrated Care
Performance Board.
3.2
The learning disability health lead is an active member of the learning disability
partnership board. This board is managed by Croydon Council and consists of carers,
patients, professionals from all sectors, partners and commissioners.
4.0
4.1
RISK REGISTER
There are currently no risks registered for this service on the corporate risk register.
5.0
5.1
NATIONAL GUIDANCE AFFECTING THE TRUST:
In March of 2013, the Confidential Inquiry into Premature Deaths of People with
Learning Disabilities (CIPOLD). This report highlighted key recommendations for all
NHS Trusts to develop to prevent further deaths that are considered premature or
avoidable. Croydon Health Services NHS Trust CIPOLD action plan was ratified by the
Executive Management Board in August 2013.
4
6.0
KEY DEVELOPMENTS SINCE THE LAST BOARD REPORT:
This report is the first annual report.
7.0
7.1
CQC ACTIONS AND PROGRESS
The learning disability team is required to report on the self certification of learning
disabilities which includes: flagging of people with learning disabilities being admitted to
hospital, accessible information as required and reasonable adjustments made to
patient care.
8.0
NEXT STEPS
Action
To implement the CIPOLD Action Plan
CQC self certification
Reasonable Adjustments (10 Case Audit)
Timescale
March 2014
March 2014
March 2014
Lead
David Feakes
David Feakes
Susan Dunn (Acute Liaison)
David Feakes
Learning Disability Health Lead
28th October 2013
5