Priorities

Our analysis for learning disabilities in adults in Lancashire and their health needs provides strong evidence that there continues to be a poor health experience and early mortality of people with learning disabilities and autism. Here are the key issues:

• Nearly half of people experiencing a learning disability live in the most deprived areas of Lancashire.
• People with learning disabilities are much less likely to be in paid employment.
• People with learning disabilities are over-represented in prison populations.
• The changes to benefit allocation will also affect people with learning disabilities disproportionately.
• Housing needs of people with learning disabilities are considerable and will increase.
• People with learning disabilities experience much poorer health outcomes across a range of conditions.
• Prevalence and need is increasing whilst available budgets have been decreasing and are likely to continue to decrease.
• This has major implications for how services are delivered and will require a different approach to commissioning and developing co-produced services.

Recommendations

• Appoint a public health champion (and Clinical Commissioning Group lead) for learning disability and autism - clear evidence of inequalities overall that cannot be ignored.
• Undertake a comprehensive needs assessment into the health and wellbeing of children and young people with learning disabilities and special educational needs.
• Develop a learning disability addressing inequalities strategy or delivery plan for Lancashire, drawing on all the information in this assessment to inform that process. This needs to be a joint initiative with a multi-agency working group, which should be separate to the 'Valuing People Now' Board. It is suggested that this should involve the Director of Public Health and Clinical Commissioning Groups via Health and Wellbeing Board.
• Develop and agree a set of principles or a charter for all organisations to work towards to address inequalities (related to strategy above).
• Utilise the population data from children and young people services to inform anticipated growth in adult population and inform commissioning and delivery – now and future.
• Develop health promotion and early intervention activity to prevent or mitigate future health problems.
• This could be supported by obtaining data from GPs from annual health checks – as yet there has been no outcome data available from the three years of checks. A good practice guide should be developed based on the outcome data research study on Central Lancashire, East Lancashire and Blackburn with Darwen.
• There was limited availability of data relating to learning disability and autism in Lancashire. It is recommended that action be taken to address data gaps by improving coding, recording and sharing of information.
• It is recommended that there should be contractual requirements to address the identified health needs. This could be via locally enhanced services and should be pursued via the appropriate channels such as the Health and Wellbeing Boards.
• A piece of work is required to identify action to help mitigate the pressures that will be caused by the increased demand on services as the population with a learning disability increases and life expectancy increases, the complexity of the presentation also increases, and the certainty of reducing resources.
• Expand knowledge and application of asset-based approaches – co-producing services and doing more with fewer resources. One example of this could be the joint commissioning of community equipment.
• Prevalence research relating to offending behaviour of people with a learning disability is highlighting that numbers within the Criminal Justice System is low, in comparison with those in the Bradley report , although the levels of support required are complex.