People with an intellectual disability are more likely to have a shorter lifespan than the general population; life expectancy is thought to be 19.7 years shorter than the general population (Glover et al. 2017). The Learning Disabilities Mortality Review (LeDeR) programme was commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England and aimed to support local services to review the deaths of people with an intellectual disability, and identify common themes and learning points. Whilst the LeDeR programme is reviewing all deaths, there is sufficient information from completed LeDeR reviews and existing health inequalities research that highlighted causes of preventable deaths in this population. However, at present, there are no systematic and objective ways of proactively and reliably identifying those who are at risk.
Cheshire and Wirral Partnership NHS Foundation Trust, with the help from the local Transforming Care Partnership Board, developed a Dynamic Support Tool – physical health (DST-PH) to objectively identify those with intellectual disability who are at risk of premature mortality or preventable death. The project followed a systematic methodology to identify potential variables and the structure of the tool; this included systematic review of the literature, number of focused groups of multi-disciplinary professionals, and Delphi Groups to identify core variables, their weighted scores, and to define the structure of the tool. The tool uses RAG (red, amber and green) ratings to identify levels of risk of premature mortality or preventable death. It considers underlying physical health conditions as well as factors that would have an impact on the overall outcomes; it uses weighted scores for these variables to reflect the level of risks. The RAG rating reflects the relative level of risk of premature mortality, or preventable death for that individual.
The use of the DST-PH tool would bring about a real impact by objectively and proactively identifying individuals at risk of premature mortality and would allow teams and health care services to proactively provide targeted interventions to reduce those risks. It would also allow health services to develop their pathways and provide innovative solutions to effectively meet the needs of the population.
Dr Sujeet Jaydeokar, Consultant Psychiatrist and Clinical Director, Cheshire and Wirral Partnership NHS Foundation TrustEditorial Lead: Centre for Autism, Neurodevelopmental Disorders and Intellectual Disability (CANDDID)