The NHS 10 year plan and learning disabilities - it doesn't go far enough

April 8th, 2019 by Louisa Watkin in Care and Support blog

Lou Watkin blog

Louisa Watkin, Learning Disabilities strategic lead here at Home Group discusses the NHS 10 year plan. Connect with Louisa on Linkedin.

You only have to cast an eye over some of the major online news sources such as the BBC and Sky so see far too regular reports of people with learning disabilities or autism being placed in care long ways from home, often in some form of institutionalised setting. Add to this the recent learning disability mortality review that shows that those with learning disability die needlessly younger than average members of the community then it would have been scandalous if the 10 year plan for the NHS was silent.

None of us can disagree with the mantra running through the plan of what matters to someone’ not just ‘what’s the matter with someone’ but will the long-term plan really make a difference? On paper, the plan shows a real commitment people with learning disability and autism and that’s great to see.

From my point of view there are four key asks.

Firstly, the point in the plan that resonates most strongly is the commitment to support the discharge of the customers who have been living in ATUs and hospitals – unnecessarily. Solving this does not come easily. Community services need to be resourced to support this. It’s not all about the number of people. We need to focus on workforce learning and development as well as more structural and fundamental changes. The biggest challenge will be transferring accountability to community services and the third sector who are significantly experienced in working holistically in the community and they are investing in their clinical infrastructures.

At Home Group, we took this decision some time ago. Our new models of care programme provide integrated health, housing and social care services. We work in partnership with the NHS and local government commissioners to achieve the triple aim of improving population health, the quality of care and reducing costs.

Secondly, will the proposals in the long term plan to free up resource through digitalisation result in people with more complex needs receiving additional healthcare support to address the rebalance in some of the entrenched inequalities? Any savings in staff resources need to be reinvested into community care not simply used to reduce the pressures in the big acute providers.

Community based care and support services can do their bit too ensuring that people have hospital passports and health action plans in place. This is key to tackling the issue of lower mortality rates for those with learning disabilities or autism.

I read a shocking story recently of a NHS patient who died prematurely simply because they weren’t accessing regular medical check-ups as they had a fear of stairs and no one had identified this issue, despite various arms of the NHS and social care system being in regular contact with them.

Thirdly, it’s heartening to see the recognition that health services need to be more differentiated, essentially more person centred in their approach.

Similarly, it would be good to see health action plans for people with learning disabilities become a commissioning requirement for community based care and support services.  

National public health campaigns such as smoking cessation, obesity management and diabetes care need modifying to make them more person-centred to support people marginalised by their inability to fit the generalist programmes. The third sector is well versed in providing person centred, strengths based programmes which can really help to address this.

The commitment in the plan for everyone in receipt of community care and support services with a learning disability to have an annual health check is a step in the right direction. But really, is the target of 75% eligible high enough? This leaves thousands of people that will miss out – not good enough in our view!

The plan talks about making reasonable adjustments for those with learning difficulties. What does reasonable adjustments mean? Does this go far enough to help the most vulnerable with complex care and support needs access the services they need? isn’t it about modified services, personalised and person centred?

Finally, and often the focus of most media attention is the issue of social prescribing. At Home Group, we taken the issue of providing wider healthcare and support seriously. In our services in Gloucester for example, we have implemented a number of social prescribing initiatives and are already seeing positive results.

The table below shows the reduction in primary care costs because of the intervention of our social prescribing service – Green line is forecast costs blue is actual costs. We’ve got lots to learn from the is initiative as spread this approach wider across our services.

NMC blog

Finally, our aim must be to develop a fully integrated community based healthcare system, that’s multi-disciplinary, includes the voluntary sector and blends health and social care for customers with complex needs.

We’re ready to support the NHS to be more person centred, we have the time to really get to know people and deliver a holistic approach to clinical care. We provide psychologically informed, person centred, strengths based care encompassing wellbeing, skills and physical health. We’re ready to take up the challenge – come and join us. Only then will people with learning disabilities and autism get the care they really deserve.