Agenda item

Purpose of Meeting: Scrutiny of Services

The Committee will scrutinise the accessibility of health services for people with learning disabilities, an issue that was identified by the recent Public Value Review.

Declarations of Interest:

None.

Witnesses:

Andy Erskine, Director of Services for People with Learning Disabilities, Surrey & Borders Partnership NHS Foundation Trust

Fiona Edwards, Chief Executive, Surrey & Borders Partnership

Kathryn Fisher, Liaison Nurse, People with Learning Disabilities, SABP

Chris Esson, Assistant Senior Manager, PLD Commissioning, Surrey County Council

Diane Woods, Associate Director for Mental Health and LD , NHS Surrey

Key Points Raised During the Discussion:

1.    The issue of accessible health services for people with learning disabilities was referred to the Committee by the Adult Social Care Select Committee.

2.    Steering groups have been set up for each acute trust in the County. Learning disabilities was a joint working partnership initiative. The service had undertaken a peer review and identified development areas, which included populating registers of people with learning disabilities, ensuring all people with a learning disability gave consent for care and ensuring that acute trusts had implemented the required adjustments.

3.    Partners had been identifying residential/nursing homes with a high prevalence of hospital admissions from people with learning disabilities. The acute nurse liaison service had picked up issues with these homes, such as poor practice in enteral feeding. All agencies then worked proactively to address concerns. These issues might not have been looked at without the acute liaison nurse service. This work improved the quality of care for individuals and avoided future hospital admissions, thus saving resources.

4.    Care packages are designed around individual service user. When a service user enters a hospital setting they should have a easy-read Health Passport that helps them to manage their interaction with health for example likes and dislikes, eating and drinking issues, pain management, medication, sight and hearing etc. Every person with a learning disability that comes into an acute hospital is asked to fill one in if they don’t already have one. Adult Social Care looks at these passports as part of any care review or assessment.  There is the intention to roll out the Passports to the Children’s service and the Alzheimer’s Society want to publicise it nationally. In Surrey, partners have been working with Surrey County Council Procurement to assess the use of the Passports and are looking at the terms and conditions for contracts with providers of services to people with learning disabilities to make this part of the contractual requirement.

5.    Members were concerned about the overall workload of the three acute liaison nurses and whether the number of posts was adequate. The Committee were informed that Surrey was one of the first places in the country to have such a service and the focus has been on learning from the new service. The number of posts was linked to the funding allocated and the resources is greater than other parts of the country. Nonetheless, covering five busy acute hospitals with three posts can be a challenge. It could be argued that an increase in liaison nurses would have a benefit on reducing health and social care expenditure system-wide. The most significant gap was a need to further develop flagging systems to reflect back to primary care on the co-morbidities and other health needs that occur more frequently for people with a learning disability. This information is key to commissioning services for the future. The liaison nurses had been involved in reviewing pathways across the acute hospitals. 

6.    Members inquired about the level of financial resource that was available. The meeting was informed that, in future, the decision would be taken by CCGs. The issue is that it is about the whole health and social care budget: investment in the right places given the economic environment. There is strong economic evidence that for every pound spent on a service like the acute liaison nurses, there could be a £4 saving. The meeting was reassured that there was not an intention to disinvest in learning disability services.

7.    Members welcomed the liaison nurses and were keen to champion it to CCGs and the National Commissioning Board. Surrey has one of the largest population of people with learning disabilities in Europe and historically twice the national average.

8.    The Committee agreed that in the context of an aging population and changing demographics the most rapidly increasing disease would be mental health. The meeting was informed that people with serious mental health issues lived on average fifteen years less than the rest of the population. Surrey needs to integrate physical and mental health.

Recommendations:

1.    Witnesses be thanked for their attendance and the joint working to develop the People with a Learning Disability Liaison Nurse service and other services for people with learning disabilities be commended;

2.    The Committee recognises the vital importance of the Liaison Nurses and related services but is concerned about the level of funding in the new health system; and

3.    The Committee encourages health commissioners to give priority to increasing investment in services for people with a learning disability and mental health services.