Learning Disability - Adults

The graph below shows that currently in Calderdale there are 3,861 people age 18 - 85+ predicted to have a learning disability. Of which 807 are predicted to have a moderate or severe learning disability. Hence, likely to be in receipt of services.

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Source: Projecting Adult Needs and Service Information (PANSI & POPPI)

There are currently 618 people in Calderdale, in receipt of a service, whose Primary Support Reason is LD.

People with a learning disability have worse physical and mental health than people without a learning disability.

On average, the life expectancy of women with a learning disability is 18 years shorter than for women in the general population. The life expectancy of men with a learning disability is 14 years shorter than for men in the general population (NHS Digital 2017).

Studies show that there are many reasons for the health inequalities faced by people with a learning disability - all of which have solutions:

• Higher risk of social factors like poverty that can affect health.
• Health professionals often have little or no training in learning disability, resulting in poor quality healthcare and reasonable adjustments not being made.
• Lower understanding of how to stay healthy, resulting in lifestyle-related issues, like being more over or under weight than the general population.
• Higher risk of health conditions like epilepsy, diabetes, heart problems and mental health problems. If diagnosed early and properly treated, the effects of these conditions can be much less severe.

(Source: Mencap)

The Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD) found an average age of death of 65 for men and 63 for women. This was from a sample of 247 people with a learning disability in the UK. This is significantly less than the average age of death of 78 for men and 83 for women in the general population (Heslop et al. 2013).

The current LeDeR Programme aims to make improvements in the quality of health and social care for people with learning disabilities. Also, to reduce premature deaths in this population.

There are two main Programme activities:

1. To support local reviews of deaths of people with learning disabilities throughout England.  
2. To undertake a number of other related projects to help us find out how many people with learning disabilities die each year in England. Also why Local boards have been established to ensure that learning from the reviews is addressed. This aims to improve healthcare and support for people with a learning disability.

The Calderdale All Age Disability Strategy clearly sets out an initial plan for how disabled people can live happy, independent and successful lives. Around 37,600 residents in Calderdale have some form of disability. They all deserve to be able to:

• access support;
• develop their skills;
• and to meet life's challenges and make the most of their chances.

Adults with a learning disability are having increased longevity. The local market has responded to these changing needs by increasing the range of accessible housing and specialist support as people's health needs grow.

Supported Living continues to grow as a preferred housing and support option for people with learning disabilities. Single tenancy apartment schemes are also being developed to extend the range of options available in Calderdale.

Currently, 93% of people with an LD across Calderdale live in settled accommodation. Meaning that they have their own tenancies or live within the family home. (Q1 2018/19)

There are a wide range of daytime opportunities for people with a learning disability in Calderdale. 209 people accessed independent sector daytime opportunities and 85 people accessed local authority daytime opportunities. However many young people with a learning disability express a desire to gain paid employment and support to do this is limited.

Calderdale has established a 5 day offer for young people with a learning disability to support their transition to adulthood. A dedicated council officer works with young people to connect them to a range of employment, volunteering, educational and social opportunities in Calderdale. This is often done in conjunction with a further education programme provided locally. The officer supports young people and their families with information and practical support to look at creating a personalised timetable. This support has been enhanced by developing additional adulthood education opportunities at Calderdale Adult Learning. The officer also discusses any accommodation needs that young people may have and connects families to the relevant officers.

Project Search was established in Calderdale in 2017. It is an internationally recognised scheme of supported internships and supports up to 12 young people per year on a dedicated programme of work based internships. Calderdale's Project Search is hosted by the local hospital. It gives young people a range of employment opportunities across the hospital site. Project Search has a high success rate in supporting young people to gain paid employment.

Detailed below are numerous sources of advice and information available for people in Calderdale living with a learning disability.

Calderdale Support Services - Support services offer you opportunities to be a part of your local community, to take part in small group activities and to meet with friends. Using support services also gives your carers a break. The Community Learning Disabilities Team will assess the amount of support service you can have through the Community Care Assessment.

• Day Services - can support you with social, leisure and work opportunities.
• Outreach - support can be provided to help you take part in activities available to everyone in Calderdale.
• Home Care - is a service giving personal care in your own home.
• Accommodation and Support - is available to you in many different ways. These include Supported Living and Supported Tenancies, Residential Care, Nursing Care and Long Term Placements.
• Short Breaks - there is a dedicated Respite Service that can provide you with short breaks. Short breaks can also be personalised with the use of a DP.
• Staying with a family - you could stay overnight or have daytime support with a family who are registered to offer care.
• Emergency Accommodation - the Respite Service can provide you with somewhere to live if you are in an emergency situation.
• Employment - there are a number of sheltered work opportunities and training schemes in Calderdale. Project search offers supported internship to people aged 18-25.
• Specialist services outside Calderdale - if you need to use a special service that is not available in Calderdale, it may be possible to arrange this.

Where to go for information and advice

• Gateway to Care team in Calderdale can help make choices and help with many concerns. They can link with other people and services, so people can get the best help and advice.
• Calderdale Citizens Advice Bureau: The Citizens Advice Bureau is there to give help, advice or information on many issues.
• Community Learning Disability Team is the best place to go in the first instance for help and advice. The Team is there to help with your needs and find out what services you can get.
• Disability Advice Resource Team - Lead the Way provides information and advice to people with a Learning Disability, their families and carers who live in Calderdale.

Accommodation

Good housing and support is the foundation that allows people with a learning disability to live successfully in the community. Calderdale has a good range of housing and support options available to people with learning disabilities. Calderdale's vision is to provide choice and opportunities for people to live as independently as possible in ordinary community settings. With the aim to continue to provide a wide range of supported living options available to people. Also to enable people who are currently living out of area to return to Calderdale if they wish to do so.

Current provision

There are 39 supported living properties in Calderdale. These range from small apartment blocks to specialist adapted bungalows designed around individual needs. These properties have been developed with Registered Social Landlords to ensure that the tenants have a high standard of accommodation. A further 2 properties are due to open by the end of 2018.

There has also been a sustained programme of improvements in older supported living properties to ensure that they are in good condition and can meet any specialist requirements. Adaptations have included level access wet rooms, accessible kitchens and developing additional communal space.

Support is delivered by a range of voluntary sector and independent providers either through a contract or an Individual Service Fund. Support varies from a few hours per day to 24 hour support depending upon the needs of the tenants. Some tenants are eligible for Continuing Health Care Funding. These houses are jointly monitored with health colleagues.

In Calderdale, we continue to work with those providers who are willing to develop. We need to ensure we have the right accommodation to meet the needs of people with a learning disability. We try avoid the need to place people in residential care.

People aged 18-64 predicted to have a moderate or severe learning disability and be living with a parent, by age, projected to 2035 numbers are expected to stay about the same.

Source: Projecting Adult Needs and Service Information (PANSI)

What is the Transforming Care Partnership Programme?

In October 2015, the Local Government Association (LGA), Directors of Adult Social Services (ADASS) and NHS England published the 'Building the right support' national plan and service model. Its purpose is to develop community services and close inpatient facilities for people with a learning disability and/or autism. (Those who display behaviours that challenge, which include with a mental health condition.) As part of the Transforming Care Partnership Programme (TCP), 48 TCPs were established across England. The aim of each one to develop and deliver local TCP plans over a three year period from April 2016 to March 2019. Calderdale is part of the Calderdale, Kirklees, Wakefield and Barnsley TCP (CKWB).

The CKWB Transforming Care Partnership Plan TCP Plan was completed in June 2016. The below summarises the key components that are needed to deliver CKWB TCP plan.

The Plan

1. Small, local, short term, NHS A&T Unit.
2. Community intensive support teams.
3. More local specialist care providers and properties.
4. Workforce development.
5. Safe Places (x2).
6. Well performing rehabilitation services.
7. Forensic community LD team.
8. Risk register (CTR/CETR).

Three priority work streams were established in June 2017, led by Board members:

1. Children and Young People.
2. Early Intervention and Prevention of Admission.
3. Market Development (including Workforce Development).

The TCP partnership has reduced the number of people in hospital. It is now looking at long term bespoke solutions to further support remaining patients and prevent further admissions.

Demand for accommodation continues to grow with a continued focus on providing tenancies and reducing the need for residential care. Young people aspire to leave home at an earlier age and achieve greater independence by having their own tenancies. There is a steady flow of people with a learning disability who require accommodation as their older carers can no longer support them. There is demand to provide more specialist housing and support for people who would otherwise require out of area placements or hospital care. Recent developments have supported young people to return from out of area college placements.

There is continuing work with Calderdale's central housing team to ensure that we take advantage of any new developments and maximise grant funding to develop accessible and affordable housing. There are currently 2 new apartment developments being considered in Sowerby Bridge and Central Halifax. Both of these schemes are with Registered Social Landlords and will be delivered with affordable rents.

Employment opportunities have been developed and enhanced over the last 2 years. In particular, we have established a local project search supported internships programme in Calderdale. However there is still a lack of opportunity and supported pathways for people with a learning disability who aspire to gaining plaid employment. This will be a key focus in adult commissioning and we will work to develop more opportunities in Calderdale.

Population projections of the number of people predicted to have learning disability in Calderdale in future years are shown in the table and graph below.

Source: Projecting Adult Needs and Service Information (PANSI & POPPI)

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Source: Projecting Adult Needs and Service Information (PANSI & POPPI)

This shows that the number of adults under the age of 65 predicted to have a learning disability is expected to fall very slightly. Whereas the National picture, the number is expected to rise significantly. The number of adults aged over 65 with a learning disability is predicted to rise over the period. This is in-line with the raise in the overall population of older adults.

Predicted growth

We expect complexity to increase, together with an ageing population. Although, it is difficult to assume this will see a growth in the need for adult services.

• In January 2018, data on all children and young people aged 0 to 25 years was collected from the active caseload lists. This was based on disability or actively accessing services (irrespective of level of support). These were collected via two databases (CIS and CASS) held by the Adults and Children's Services Directorate of the Council. These 2 databases have the complete active caseload lists for all Calderdale services supporting CYP in Calderdale. This exercise has identified 2,276 children and young people aged 0-25 accessing services for children and young people with disabilities within Calderdale. This would equate to 3.5% of the Calderdale population aged 0 to 25 years.
• Learning difficulties and ASD remain the most common disabilities.
• It is known that there are some Children and Young People in the 0-25 age range who are not in touch with Calderdale services but do have a disability. Work is underway to establish how we can capture this data. (Data source '2018 Census analysis paper' - Disabled Children's Census)
• Information relating to children and young people (0-25 in education) who have an Education, Health, Care Plan (EHCP) previously called statements. Those pupils are considered to have high needs. The number of children and young people with EHCPs is increasing year on year. The number of children and young people with EHCP as a percentage of the total school population has remained at 2.6% for the last few years (slightly below 2.8% for England).

Primary need - the main areas of increase are:

• Speech, language and communication difficulties (SLCD).
• Autistic Spectrum Disorders (ASD).
• Social, Emotional, Mental Health (SEMH)(previously BESD).

It is difficult to predict however. These trends may, or may not, manifest themselves in the need for adults services.

NHS England's programme, Transforming Care, is all about making health and care services better. This is so more people with a learning disability, autism or both can live in the community, with the right support and close to home.

VIP Card and health passports: Alerts health providers to the need for additional support linked to GP codes. These are used in Calderdale to ensure that following hospital admission people with a learning disability receive the correct additional support. These documents include key information including any specific communication needs, support needs, adaptation and environmental considerations to ensure that the persons health and wellbeing can be maximized.

Health promotion initiatives include:

• Calderdale & Huddersfield Foundation Trust employ a complex needs matron dedicated to supporting people with a LD.
• Annual health checks: 49.7% of patients with a learning disability received an annual health check in 2016/17, an increase from 43.2% in 2014/15 (NHS Digital 2017).
• Flu immunisation: There has been a small increase in the proportion of patients with a learning disability receiving flu immunisation in recent years. From 40.8% in 2014/15 to 41.9% in 2016/17 (NHS Digital 2017).
• Cancer screening: Breast cancer screening for people with a learning disability has decreased in recent years. The largest decrease seen in women aged 65 to 69, from 54.6% in 2014/15 to 51.7% in 2016/17. Cervical cancer screening is much lower for women with a learning disability (30%) than in the general population (70%) (Glover 2017). Meanwhile, colorectal cancer screening for eligible patients with a learning disability aged 60-69 has increased from 68.6% in 2014/15 to 79.5% in 2016/17 (NHS Digital 2017).
• Mental health: Depression diagnoses have increased recently. In 2016/17, 13.2% of patients with a learning disability had an active diagnosis of depression, compared to 12.2% in 2014/15 (NHS Digital 2017). The LD Heath Team provide dedicated support and commissioned by the CCG. This includes outreach support in community settings and within people's homes.
• GORD: (Gastric oesophageal reflux disease) diagnoses have increased amongst patients with a learning disability in recent years. From 6.8% in 2014/15 to 7.8% in 2016/17 (NHS Digital 2017).

• Calderdale All Age Disability Strategy 2017-18(PDF 762KB)
• Transforming Care Partnership Plan(PDF 217KB)
• Themed review of LD services (Care Quality Commission).
• Confidential Inquiry into premature deaths of people with a learning disability (Bristol University).