Adults with learning disabilities

‘Learning disability’ is the term that the Department of Health use within their policy and practice documents.

In Valuing People, the Department of Health describe a ‘learning disability’ as a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence) with:

  • a reduced ability to cope independently (impaired social functioning)
  • which started before adulthood with lasting effects on development.

Many people with learning disabilities also have physical and/or sensory impairments.

Currently services are provided for children and young people (CYP) with a Learning Disability by the Children with Disabilities Team which is part of the integrated Service for Children with Learning Difficulties and Disabilities.

This Service comprises social workers, occupational therapists, and outreach worker, special educational needs (SEN) case workers, SEN Careers Advisers and a respite care unit. The Service also works closely with the voluntary sector to provide a range of short breaks for CYP without the need for a referral to social care.

The Children with Disabilities Team provides support for CYP up to the age of 18 years who meet the eligibility threshold. Where CYP do not meet the eligibility threshold they will be provided with information, advice and guidance as appropriate and may have their needs met through Slough’s early help offer.

Currently services are provided for adults with a Learning Disability by the Community Team for People with a Learning Disability (CTPLD). This is a multi disciplinary team funded by Slough Borough Council and Berkshire Health Foundation Trust.

It consists of social workers and a range of health professionals including community learning disability nurses, a physiotherapist and occupational therapist. Being a multi-disciplinary team enables a holistic approach so that all aspects of a person’s needs can be considered.

The team provides social care support for adults over the age of 18 who are eligible for Adult Social care under the substantial and critical domains of the Fair Access to Care criteria. Where individuals do not meet the eligibility threshold, information and advice is offered, signposting them to organisations that may be able to provide appropriate support.

The health professionals within the team also provide support to meet the health needs for any person with a Learning Disability who is registered with a Slough GP.

The CTPLD team has links with partner agencies and voluntary organisations providing support for people with learning disabilities and their carers. By sharing expertise, knowledge, training and advice, they are able to provide effective support to people with learning disabilities, their families, carers and other agencies.

What do we know?

People with a learning disability have many of the same aspirations as other citizens of Slough. They want to be able to choose where they live, what support they receive and to be healthy. The CTPLD team aim to address these aspirations through individualised packages of care.

Some of the means employed include the use of direct payments to employ personal assistants, increasing the number of agencies who can provide support and supporting people with their health needs.

Children and Young People (CYP) with a learning disability should have access to good quality education, care and support for their health needs and in order to support community inclusion there is an emphasis on developing local provision in order to meet these needs.

This links to the aspirations mentioned above which can be addressed through a range of good educational provision in Slough, individualised packages of care which can include the option of a direct payment, access to support services such as speech and language therapy, occupational therapy and support for the school staff working with the CYP in schools in Slough.

Facts, figures, trends

In Slough the rates of adults with learning disability known to the local authority is lower than the national average at 3.1 per 1000 (compared with 4.3 per 1000 nationally).
(Source: Public Health England Fingertips) 

A learning disability population prediction study commissioned by the Department of Health estimated numbers of people with learning disabilities is predicted to rise.

The study found that numbers of people with learning disabilities are increasing as a result of the future size and composition of the English population.

If, as predicted in this study, the population will rise from 50.9 million in 2007 to 53.5 million in 2017 (+5%) and 56.0 million in 2027 (+10% from 2007), then the increase in population will result in equivalent changes in the population of people with learning disabilities.

The study highlighted three significant factors leading to a predicted increase in numbers of adults with learning disabilities in England over the next two decades:

  • The increase in proportion of younger English adults who belong to South Asian minority ethnic communities.
  • Increased survival rates among young people with severe and complex disabilities.
  • Reduced mortality among older adults with learning disabilities.

The first of these factors is particularly significant to Slough in view of the culturally diverse population including high numbers of people of South Asian origin.

National predictions made in Valuing People Now are that not only are numbers of people with learning disabilities increasing, so too are the numbers with more complex needs.

National and local strategies (current best practices)

Historically people with learning disabilities had hidden lives. They were placed in long stay institutions away from their communities or were cared for by their families. This has changed over time and continues to change, reflecting changes in the public perception of people with a learning disability.

Various government initiatives have promoted and supported changes in practice and public opinion. There has been a variety of legislation and guidance to support people with a learning disability living fulfilling independent lives in the community.

Some of the key legislation is:

The Government’s key priorities for Learning Disability are laid out in Valuing People Now (Department of Health 2009). They are:

  1. Employment
  2. Housing
  3. Health

The Slough Wellbeing Board has signed up to the Disability Charter which has commitments, by September 2014 to:

  1. have detailed and accurate information on the disabled children and young people living in our area, and provide public information on how we plan to meet their needs
  2. engage directly with disabled children and young people and their participation is embedded in the work of our Wellbeing Board
  3. engage directly with parent carers of disabled children and young people and their participation is embedded in the work of our Wellbeing Board
  4. set clear strategic outcomes for our partners to meet in relation to disabled children, young people and their families, monitor progress towards achieving them and hold each other to account
  5. promote early intervention and support for smooth transitions between children and adult services for disabled children and young people
  6. work with key partners to strengthen integration between health, social care and education services, and with services provided by wider partners
  7. provide cohesive governance and leadership across the disabled children and young people’s agenda by linking effectively with key partners.

The council has a clear strategic approach to developing local provision to enable the majority of children and young people with disabilities to have their needs met whilst remaining at home and attending school in the local area.

What is this telling us?

Education

Children and Young People (CYP) with learning disabilities and/or Special Educational Needs (SEN) are less likely to achieve accreditation at school or college and are likely to make slower progress than their peers.

Slough Borough Council now works in partnership with Cambridge Education who provide support to schools to help them to narrow the attainment gap between CYP with SEN and those without SEN.

Slough Borough Council worked with schools in Slough, including Academies, to open 8 new specialist resource bases between September 2012 and September 2013 in response to the growing numbers of CYP with learning disabilities and/or SEN. This has enabled a significant number of CYP to have access to good quality education in the local area and avoid CYP having to travel long distances to school.

The Service for Children with Learning Disabilities and Difficulties co-ordinates multi-agency statutory assessments for CYP with SEN including those with learning disabilities and ensures these are completed within the statutory timeframe and CYP are allocated appropriate provision as quickly as possible.

Employment

People with learning disabilities are significantly less likely to be in paid employment compared to the rest of the population including those with other disabilities. The opportunities open to individuals with learning disabilities after leaving school are narrower than for other school-leavers, and this is reflected in the low employment rate.

Slough Borough Council is addressing this by providing an employment service for people who are eligible for Adult Social Care. This service offers support in seeking and sustaining employment. CTPLD is facilitating employment opportunities by the provision of personal assistants to support individuals in their working environment.

Liaising with one of our local supermarkets has resulted in providing several employment opportunities for people with a learning disability.

Housing

Historically people with complex care needs and challenging behaviour have been placed in residential care outside of Slough. Under the Learning Disability Change Program the team is, with the housing department, actively seeking new accommodation in Slough.

Slough Borough Council is commissioning, within a framework, new support providers. This will increase choice for service users within Slough. People with a learning disability placed outside of the borough will then have the opportunity to return to Slough to live and hold a tenancy. This initiative aims to reduce the number of people having to move outside of Slough in the future.

CYP with complex care needs will usually be supported to live at home but with appropriate respite for their parents/carers and support where deemed necessary. Some CYP with complex care needs may also receive overnight respite care.

The occupational therapists in the Children with Disabilities Team can support families to meet their children’s needs by providing appropriate equipment or aids for use in the home and to make recommendations about adaptations to the home.

Health

People with a learning disability are more likely to have additional health needs and are less likely to access health resources. CTPLD are committed to increasing the number of people with a learning disability having an annual health check from their GP. A further aim is to increase the number of people who have a health action plan.

Children and young people with additional health needs tend to have their health needs monitored by a paediatrician who will refer on to other specialist services as necessary including to social care where there is a clear care need. Health provision such a speech and language therapy and occupational therapy is often provided within schools and school staff are trained to deliver programmes.

CTPLD is also supporting people with a learning disability to access primary and specialist health care. A priority is to ensure an increase in the uptake of screening programmes. Other work includes providing groups to promote healthy living.

In conjunction with Slough GPs, health members of the team are in the process of identifying and registering all Slough citizens with a learning disability especially those not previously known to services to ensure their needs are highlighted and addressed.

What are the key inequalities?

Compared to the rest of the population, people with learning disabilities are continuing to experience inequalities in housing, access to employment and training as well as the provision of health screening and appropriate treatment.

Lack of employment opportunities leads to reduced financial power that impact upon housing and health.

The Service for Children with Learning Disabilities and Difficulties and CTPLD are working to address these inequalities though support, services, developing local provision, partnership working with Cambridge Education and the voluntary sector and the Learning Disability Change program.

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