The Atlas of Shared Learning

Case study

Reducing health inequalities – learning disability services in North Staffordshire

Leading change

A Lead Health Facilitation Nurse at the North Staffordshire Combined Healthcare NHS Trust led the work to establish a Learning Disability Health Facilitation and Acute Liaison Service at the Trust, on behalf of the Learning Disability Directorate. This new service has led to improved outcomes and enhanced experience for patients with learning disabilities as well as their families and carers. North Staffordshire Combined Healthcare NHS Trust is a provider of mental health, social care and learning disability services in the West Midlands.

Where to look

Evidence indicates that people with learning disabilities have poorer health than people without a learning disability and have differences in health status that are, to an extent, avoidable. The health inequalities faced by people with learning disabilities in the UK start early in life, and often result from barriers they face in accessing timely, appropriate and effective health care (Emerson and Baines 2010).

The delivery of the Primary Healthcare Facilitation Service within Stoke-on-Trent was transferred to the Combined Healthcare NHS Trust and was provided by the Community Learning Disability Health Team (CLDHT). Stoke-on-Trent Clinical Commissioning Group (CCG) requested that the CLDHT continue to provide the Primary Health Care Facilitation Service and the nurse leaders in the CLDHT used this opportunity to complete a review and scoping exercise to identify options for future service delivery which included Acute Liaison and support into prison services.

The nursing leadership team at the Trust identified unwarranted variation in compliance with best practice, for example, recommendations on annual health checks and person-centred care planning were not systematically adhered to. The nurse leaders identified an opportunity to update the clinical pathways and improve communication channels between frontline, clinical nurses and senior nurses within the organisation. The nursing leads recognised the possibility to reduce observed health inequalities in the local learning disability patient groups, to improve outcomes and experiences of those using the services.

What to change

Working closely with commissioners, the nurse leaders in the CLDHT undertook the review of the existing service delivery, focusing on service structure and governance, as well as alignment with local primary care and acute hospital services. They also ensured that service user, carer and care staff views and experience of the service were incorporated.

Learning disability nurses within the service used their ‘knowledge, skills and expertise to improve access across the health system and lead improvements in physical health care for people with complex mental health and/or learning disabilities’ (NHS England, 2015). The nursing leads documented and reported health outcomes for their service users and identified gaps and opportunities to develop the scope of the service. This would also further reduce health inequalities. In addition to reviewing the available data relating to the current service delivery, a series of workshops and focus groups with attendees including Practice Managers, Practice Nurses, Learning Disability Steering Group members and learning disability Partnership Board colleagues were held.

How to change

The nurse-led Health Facilitation and Acute Liaison Team within the CLDHT aims to improve the healthcare of people with a learning disability. The service provides opportunities for health care professionals to review and improve their knowledge to continually enhance the accessibility of the service for people with learning disabilities. Training is provided to support awareness raising of learning disabilities and the effective delivery of annual health checks for all practice staff. The training is co-delivered with patients with lived experiences which has been a powerful mechanism for delivery and has quickly stimulated changes in practice. The team also liaise with national screening services so that the needs of people with a learning disability are considered in line with national standards.

This new service has embraced open communication and the nurses have established a Trust-wide group to support good-practice sharing, collaborative working and to support the effective understanding of the needs of people with learning disabilities and the coordination of services available to them. This group has further reinforced efforts to standardise practice in relation to care planning, completion of ‘hospital passports’ as well as striving to enhance accessible information for the Trust. The CLDHT now supports nurses to review and evaluate recent nurse-led learning disability research, to support colleagues to be confident in reviewing research and to consider recent advances for application into practice.

The group has developed a continuing professional development (CPD) pathway, specifically for learning disability nurses, focussing on clinical leadership and management. These pathways include enhancing skills in developing and guiding interventions and service delivery as well as learning disability register validation, blood desensitisation, transition and maternity services.

Adding value

Better outcomes – The CLDHT now has a specific health facilitation team, with the remit to challenge the health inequalities faced by people with learning disabilities. Health facilitation nurses are established in GP practices to ensure annual health checks and health promotion are standard practice. Although data isn’t currently available, these are anecdotally continuing to improve. The visibility of this team has ensured clear clinical pathways for learning disability patients which has led to improved access to services as well as supported the reduction in barriers in care within local systems.

Better experience – Feedback from staff has been positive, with staff feeling increasingly empowered and supported to provide high quality care. Examples include:

Thank you for your support and coordination to ensure that a holistic approach was agreed to identify how patients can be supported in their own homes to prevent unnecessary admissions and increased person-centred care.

The acute liaison role in the hospital has been needed for so long, it’s like the missing link is now in place.

Patient feedback from a ‘Don’t miss out on your health check awareness session’ has included:

Thanks – Didn’t know I can have a health check every year, I have now booked an appointment with my GP.

I have asked if I am on the learning disability register to make sure that my Doctors know I may need some help.

Better use of resources – Establishing the CLDHT and its key coordination role has had a positive impact on the use of resources within the Trust which has been complemented by best-practice shared learning. Plans are in place to further quantify the impact of the service on resources within the Trust and the wider health economy.

Challenges and lessons learnt for implementation

Input from those with lived experience of learning disability into the development of the health facilitation service has been fundamental in achieving better outcomes.

Challenges included managing expectations of the service whilst evolving from the more traditional approach of the existing service.

Identifying an effective model of health facilitation is a process of learning as nationally there are several models demonstrating benefit.

Creating the time and opportunity for staff to develop some of the ideas and initiatives identified in the network group was challenging, but vital.

A nursing forum has been key to our success as it provided a platform for empowering nurses to feel confident in their practice and to share good practice more widely.

Find out more

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