The Care Quality Commission (CQC) has just published ‘The State of Care 2017/18‘, its annual assessment of health and social care in England. The report ‘looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve’.
You can find links to the report, plus a summary and an easy read version on the CQC’s introductory webpage.
Obviously, the report covers an awful lot of ground and topics. Almost every reference to learning disability is accompanied with an observation on ‘room for improvement’.
The most relevant sections relating to learning disability are on page 48 and page 111 of the report (See extracts below). Having read these, and seen some of the statistics cited, you may think that the report understates the deficiencies in health and social care for people with learning disabilities.
P.48 We asked representatives of our inspection teams for their thoughts on the challenges facing different groups of people, and on the areas that each different local system needs to address.
People with a learning disability:
There are some concerns about continued inequalities in health and social care provision for them. For example, the deaths reviewed by the Learning Disabilities Mortality Review show that the median age of death for people with a learning disability is 23 years younger for men and 29 years younger for women compared with the general population, and that these deaths are ofen for entirely avoidable reasons.
Correctly diagnosing a person’s health conditions plays an important part in this. People with a learning disability have on average four times more symptoms that are unexplained compared with others.
The extent to which people with a learning disability experience joined-up care varies, and this can be related to a lack of understanding about their needs and how to meet them, for example approaches to communicating with people with a learning disability and understanding of the Mental Capacity Act. Commissioning the right care is a challenge. CQC has moved away from registering services and models of care that have been proved to be ineffective for people with a learning disability, autism or challenging behaviour, but there remain a significant number of these services operating in the adult social care sector.
GPs play a crucial role in identifying those with a learning disability and their carers in order to provide proactive management and coordination of their care needs. Where people with a learning disability need to access secondary care, acute care has a responsibility to ensure that learning disabilities are recognised, reasonable adjustments are made and people with a learning disabilityare supported. Schemes such as the “This is me passport” can be effective in identifying patients with additional needs and in helping staff to understand their individual needs.
P. 111 Reducing variation in health and social care outcomes.
Health outcomes are affected by many factors including poverty. Reducing the ‘health and wellbeing gap’ is a main aim in the NHS Five Year Forward View.
Differences in some outcomes are widening. Life expectancy is measured looking at two-year periods. The life expectancy at birth of men in 2014 to 2016 was 9.3 years greater in the most affluent areas compared with the most deprived areas. This has widened slightly since 2010 to 2012 when the difference was 9.1 years. The gap between life expectancy at birth for women in the least and most deprived areas over this period has increased from 6.8 years to 7.3 years.
Poverty is not the only factor that affects outcomes. The deaths reviewed by the Learning Disabilities Promoting Equality Mortality Review show that the median age of death for people with a learning disability is 23 years younger for men and 29 years younger for women compared with the general population, and that these deaths are ofen for entirely avoidable reasons.
Correctly diagnosing a person’s health conditions plays an important part in this. People with a learning disability have on average four times more symptoms that are unexplained compared with others. A survey of 500 healthcare professionals by YouGov found that 66% would like more training focused on people with a learning disability, 64% thought that there was a lack of practical resources in their service, and 50% thought that a lack of knowledge might be contributing to avoidable deaths