Mental Welfare Commission Recommendation 3
General practitioners and primary health care services in the Borders should be made aware of and have easy access to information about the needs of people who have a learning disability. Services must be flexible and delivered in a way that recognises and accommodates any special requirements of persons with a learning disability. Appropriate liaison and support from the specialist learning disability services should be in place in line with Promoting Health Supporting Inclusion, NHSQIS Learning Disability Quality Indicators and NHS Health Scotland Learning Disability Needs Assessment Report.
Evidence of progress implementing recommendation 3
Evidence of progress from record scrutiny
Not applicable.
From scrutiny of documents
There was an NHS Borders draft "Health Improvement Strategy for People with Learning Disabilities". This did not have specific objectives, a timescale or costings.
From meetings and visits
There was an NHS Borders steering group responsible for implementing the recommendations in 'Promoting Health Supporting Inclusion'. There was a conference for nurses in April 2004 to communicate proposed changes. These included new initiatives in nurse education, health promotion, transitions from child to adult services, specialist service provision and specialist liaison posts in hospitals. Training materials were intended to provide GPs and primary care staff with educational sessions and self-paced training materials.
In the two GP practices we saw, there was evidence of variability in relation to learning disability awareness and links to the community learning disability team. One health centre we visited was an example of good practice. Staff were well-informed. There was a community learning disability nurse linked to the practice. Record keeping was excellent. There was good communication within the primary care team and with other professionals and other parts of primary care. By contrast, staff at another health centre were not aware of any community learning disability nurses linked to the practice. There was poor awareness of learning disability issues and a negative attitude to dealing with the learning disability services.
The failure, at GP practice level, to identify and pass on relevant information relating to vulnerable adults was a key finding of the Mental Welfare Commission's Report. As recently as May 2005 the Chief Medical Officer for Scotland wrote to all GPs emphasising the responsibilities of GPs dealing with people with learning disabilities.
GPs had been offered vulnerable adult protection training, but at the time of the inspection, no GPs had taken up this training. This was disappointing. A separate training event for GPs was planned for 26 October 2005, as part of the Time for Multi-Disciplinary Education ( TiME) programme. More than half the primary health care teams have had training, delivered on-site.
Learning disability services were accessed via GPs, service referral or self-referrals. Each practice had a "link" community nurse from the learning disability team. One of three nurses was the named link for each GP practice in the Borders. Although the three nurses had a list of their allocated practices, not all GP practices were able to name their link nurse, or give information on their roles and responsibilities.
Adults and young people with learning disabilities attended well woman/well man clinics. Attendance was not monitored specifically for people with learning disabilities. There were tentative plans for a public health nurse for minority and socially excluded groups.
A learning disability liaison nurse had been appointed. Her impact, in liaising with and informing primary care staff, was most noticeable at the Borders General Hospital. We found her impact was less evident elsewhere in community services and in specialist services.
No specific arrangements were in place to identify and support the communication needs of children and adults with learning disabilities admitted to hospital. For example, learning disability speech and language therapists and acute speech and language therapists were not routinely told when people with learning disabilities were admitted.
The training and development department records attendance of primary care staff at training events related to the needs of children and adults with learning disabilities. Staff interviewed liked the "investigation to case conference" training.
There was a plan to have a list of good practice "champions" for Promoting Health Supporting Inclusion across the Borders.
NHS Borders had modified their existing complaints procedure. There was an easy read leaflet, " I Want to Complain".
NHS Borders and Scottish Borders Council commissioned a range of advocacy services. Funding to support advocacy (2004-2007) was inadequate to meet all priority needs. The advocacy plan for 2004-2007 mentioned children with learning disabilities.
The chart below shows what people with learning disabilities said about advocacy.
Interviews with people with learning disabilities
The chart below shows what people with learning disabilities said about health issues.
People with learning disabilities said:
"My GP is very good".
"I would go to all the GPs, they are all nice".
Conclusion
NHS Borders had tried hard to make information about the special needs of people with learning disabilities available to GPs and primary care staff. The chair of the new Primary and Community Services Board had raised the profile of the needs of people with learning disabilities in primary care. The community learning disability services and the liaison nurse should make sure that all GP practices know about how the learning disability team operates and what it can offer. Uptake of vulnerable adult training by GPs needs to be carefully monitored. Primary care services need to be more aware of the role of the liaison nurse.