LeDeR is a service improvement programme for people with a learning disability and autistic people. The aim is to improve care, reduce inequalities and prevent premature deaths.
Analysis of Salford’s LeDeR reviews showed some areas of concern across Primary Care, including:
poor uptake of the Learning Disability Annual Health Check and variance in content and quality
low uptake of flu vaccinations
limited examples of joint working between GP practices and the Learning Disability Team.
Funding was secured from Salford CCG and the Regional LeDeR Team for a time-limited secondment to support primary care initiatives and develop closer working relationships between GP practices and Salford Learning Disability Service.
My application for the role was successful, so I had the green light to start taking action.
Data was key
We started off by collecting data from each GP practice Learning Disability Register (38 practices) and initially cross-matching it with data held by Adult Social Care.
Frequently, people with other conditions, such as those on the Autistic spectrum, were found to have been added to the register in error, whilst other people with learning disabilities were not always registered as such with their GP practice.
We cleansed our data and a ‘master’ database was established.
Improving flu vaccination uptake
Using the master Learning Disability Register and working with each GP practice, I tracked flu vaccination uptake for 2020/21.
Individuals who had not received their vaccine or those who had been flagged by their GP practice as needing a home visit or reasonable adjustment, were identified and offered a home visit by a Learning Disability Nurse.
Result: Uptake of the flu vaccine in 2020/21 exceeded the previous year’s uptake by almost 5 per cent (see the attached poster for more detail).
Covid-19 vaccinations – nobody left behind
Attention soon turned towards the Covid-19 vaccination and our Learning Disability Nurses undertook additional training to administer this.
We took several actions to reduce the risk of widening health inequalities in this area:
An accessible Covid-19 vaccination booklet and invite letter was sent to all people who had not received their vaccine with follow-up phone calls to non-responders.
A dedicated telephone booking line was set-up.
Each person was offered the option of a home visit by a Learning Disability Nurse, which meant they could receive the vaccine in an environment that was familiar and by a health professional who understood their needs.
Family carers were also offered the vaccine.
Repeat visits were made to those who struggled to engage the first time and planned around individual needs and circumstances, such as routines important to the person.
For those who could attend a vaccination hub, dedicated sessions were held, enabling longer appointment times, shorter waits, and a calmer environment. Sessions were also held at education colleges for people with a learning disability to make things more accessible.
For those people who were unable to engage in having a vaccination due to complex needs or behaviours, best interest meetings were arranged and were attended by GPs to help plan an individualised way forward.
“Mandy came to my house. It helped that I already knew her. She made me feel more confident and helped me feel calm, just by being herself. It was brilliant, it will keep me safe.” Sean Dempsey.
Working in flexible, imaginative and person-centred ways, Learning Disability Nurses used their specialist skills to support people with complex and, sometimes, very challenging needs to have the vaccine. Helping to ensure that nobody got left behind.
Result: Covid Vaccination uptake exceeded that of the general population in Salford and across Greater Manchester (see the attached poster for more detail).
Learning Disability Annual Health Check – reaching out and removing barriers
We introduced a new, standardised Learning Disability Annual Health Check template in summer 2020, which was developed by a range of professionals from general and specialist services.
an easy read invite letter
pre health questionnaire
the option to populate a Health Action Plan.
The importance of continuing to complete the health check was promoted during the Pandemic. A video to promote the importance of the health check was developed to support uptake.
Where a lower-than-expected uptake was seen, practices were contacted to discuss any barriers.
Result: Salford exceeded the expected standard of 67 % set by NHS England.
Providing a point of contact for GP practices
Due to increased pressures of the Pandemic, identification of a Learning Disability Champion and roll out of an associated Link Learning Disability Nurse was not possible.
I was however able to act as a point of contact for all GP staff who had any concerns regarding patients with a learning disability and offer advice and support. As you can see from the data below, queries really varied in nature, showing the value in having an identified specialist nurse to reach out to.
Result: The project was very warmly received and supported by practice staff. Relationships between the Learning Disability Team and Primary Care are certainly improved, and we are seeing so many more referrals into our team.
Keeping the momentum going
It is now standard practice for Learning Disability Nurses to offer Covid and flu vaccinations for those people who would struggle to access general services and plans are underway to introduce the Link Nurse Programme.
My role in supporting Primary Care has been made permanent and there are plans to roll-out learning disability awareness training and focus upon increasing the uptake of participation in cancer screening programmes.
Final reflections and top tips
Whilst some delays and changes to project objectives were experienced due to the Pandemic, many objectives were met and clear health gains for people with a learning disability have been demonstrated.
If this can be achieved at such a difficult period for health and social care services, it is very encouraging and exciting to think about what might be achieved going forwards by continuing to work together.
I’ll leave you with my top tips for delivering a successful patient safety improvement project:
Be guided by local research and learning to identify the areas for improvement. In Salford, it was learning acquired via LeDeR reviews that pinpointed areas of need.
It is important not to blame general services for the poor health outcomes of people with a learning disability. It is about education, working together and supporting each other to help make things better for the future.
It is important to recognise that dedicated services/ initiatives for people with a learning disability are sometimes required to ensure that care provided meets their individual needs.