Agenda item

The Chairman welcomed Lorraine Regan, Service Director for Bromley and Trustwide ALD – Oxleas NHS Foundation Trust (“Service Director”) to the meeting to provide an update on support for adults with learning disabilities in Bromley.

People with learning disabilities had poorer general health, and the latest Learning Disability Mortality Review (LeDeR) report stated that the average age of death was 27 years younger for women and 23 years younger for men. In response to a question, the Service Director said that this compromised lifespan was linked with levels of capability. A large proportion of this population had comorbid physical health – it could also be difficult to diagnose physical health condition for this cohort, particularly those who were non-verbal. It was agreed that a link to the report would be circulated to Board Members following the meeting.

In addition to the NHS Long Term Plan, the NHS Improvement (NHSI) standards sought to reduce inequalities for people with learning disabilities (rights, inclusion, workforce and specialist services). Around 2% of the population were estimated to have a learning disability. This would equate to approximately 7,061 of the Bromley population – the GP registered population with learning disabilities was 1,338, and 342 were receiving Oxleas Adult Learning Disability services. There was a focus on providing specialist support for people with a learning disability to ensure they could access the same services as everyone else, and this was a key part of the work for clinicians and reasonable adjustments were needed to be made. The challenge of managing some health needs could be complex and compounded by a learning disability. When that challenge went beyond the capacity of mainstream NHS services, specialist support was needed and provided by the Oxleas Community Learning Disability Teams (CLDT).

The Service Director highlighted that there was some good work was taking place to reduce inequalities. This included:

-  GPs and pharmacists in all Primary Care Networks (PCNs) had tailored support with Annual Health Checks and prescribing.

-  Black Books were offered to everyone receiving CLDT support (these were taken to appointments and contained all the information required to provide a “complete story”).

-  Hospital Passports (provided hospital staff with essential information to make adjustments for people in their care).

-  ‘Can you understand it?’ group (who ensured that easy read materials were understandable).

-  Working in partnership with Bromley Public Health – analysis of data from Annual Health Checks (supporting ongoing learning and service development).

A key focus for Oxleas was reducing hospital admissions. In line with ‘Building the right support’, Bromley CLDT were currently supporting 125 people in the community with learning disabilities, mental illness and/or challenging behaviour, preventing hospital admissions. The Intensive Community Support Team (ICST) were also working with those who had complex challenging behaviour and risk likely to result in an admission or placement breakdown. Nursing and therapeutic interventions were combined to support people’s physical and mental health in the Bromley community and the Bromley Learning Disability Epilepsy Service currently had over 80 people receiving bespoke support to manage the risks associated with their epilepsy.

The Service Director highlighted the importance of ensuring that young people had a smooth transition into adult services. The team had been working with the population for some time, but two transition nurses had recently been appointed in Bromley to provide additional support to those coming into the service.

Throughout the COVID pandemic, the increased risk to the service users that Oxleas worked with had been documented. This population included hard to reach groups, who also found digital technology much harder to access – face to face contact had therefore been maintained when it was safe to do so. Service user risk assessment had been completed, regular welfare calls were made, and support was provided in relation to vaccinations. The Service Director considered that overall, things were looking relatively positive, however it would be some time before the full impact of the pandemic was known.

In response to questions, the Service Director said that waiting times for their learning disabilities service were currently low. The target time was 18 weeks, and patients were generally being seen in 2-6 weeks. Urgent referrals were seen within 2 working days, and hospital admission referrals were receiving same day appointments. However it was noted that there were long waiting times for autism services. This was expected to reduce over the coming years with diagnosis being made in childhood, and they were working with children’s services colleagues in relation to early intervention and proactive support.

The Chairman thanked the Service Director for her presentation to the Board and asked that an update provided to a future meeting include a section on ‘Building the right support’.

RESOLVED that the update be noted.