1. Health Action Planning Planning for Health

2. Session Outline • To clearly define the concept of health as a holistic bio-psychosocial concept • Consider some of the influences on the health & well-being of people with learning disabilities • To consider how Health Action Planning could improve health outcomes for people with learning disabilities

3. How do we define health? An absence of disease? Sense of well-being? Whatever it means to the individual?

4. Definition of health • “A state of complete physical, social and mental well-being and not merely the absence of disease or infirmity. • The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, without distinction of race, religion, political beliefs, or economic and social conditions.” (World Health Organisation, 1948)

5. Definition of health • “The main social target of governments and of WHO should be the attainment by all the people of the world by the year 2000 of a level of health that would permit them to lead a socially and economically productive life.” (World Health Organisation, 1977)

6. What do we know about the health of people with learning disabilities?

7. Health needs • Studies suggest a greater level of health need compared to the general population • Different priorities or common health concerns • Greater use of acute hospital services • Many health problems are undetected • Under-use of health screening measures • Increased life expectancy means that difficulties related to old age and dementia are more common

8. Health needs • Mental ill-health and challenging behaviour common • Communication difficulties • Difficulties with relationships • Harassment and intimidation experienced on a frequent basis • Loss experienced on a frequent basis • Lack of choice and control • Social exclusion

9. Health Action Planning

10. Health Action Planning • What is it? A Health Action Plan is a personal plan about what a person with learning disabilities can do to be healthy. It lists any help support the person needs to do those things A Person Centred Action Plan would usually be agreed and later reviewed

11. Health Action Planning • Core principles Health action planning should support the core principles that underpin Valuing People Rights independence choice inclusion

12. Health Action Planning • People should choose whether or not to have a Health Action Plan • Dealing with uncertainty or resistance • Given the intrinsic link between health & well being Health Action Plans now form part of a Person Centred Plan

13. Health Facilitation A health facilitator is someone who assists a person with a learning disability to work through the process of health action planning (Individual; micro level) It could be a carer or parent or key worker Ideally the person should choose who they want to be their health facilitator

14. Health Facilitation Health Facilitation has also come to mean work to overcome some of the barriers faced by people with learning disabilities (macro level) Examples include: Working with acute services to consider accessibility and support issues (RBH long term conditions working group)

15. Health Facilitation Working with mainstream services to assist them to recognise the specific needs of people with learning disabilities (joint work with the Sexual Health Promotion Team, PALS) Work to address the specific need s of people with learning disabilities & to promote their inclusion in mainstream activities (Everybody Active, health promotion activities)

16. Health Action Planning Health Action Planning should be viewed as a process rather than an outcome Working in such a way that ensures that the person has a clearer understanding of their health needs may be more important than a health screen with a GP

17. Health Action Planning • Making a start How you go about completing a HAP needs to be decided between the person, the health facilitator and the circle of support. Deciding upon the right format will largely be an individual decision and may depend upon the complexity of the persons health needs or communication ability

18. Health Action Planning • Making a start You may want to involve a Community Nurse (or other health practitioners) for individuals whose health needs are particularly complex or changing It would also be good practice to undertake a health action plan with individuals who are in transition; for example if moving from parental home into supported living

19. Health Action Planning • Making progress You may not know the answers to specific questions relating to the persons health; however it is important to note uncertainty. It may become apparent that the person requires routine health checks; this should be noted in the person centred action plan & decisions made about who should be responsible for supporting these and when these should be completed by

20. Health Action Planning • Making progress It is important that you consider any social, emotional or psychological influences which may impact upon the persons health. For example A persons housing situation, the availability of skilled support or conflict with family or others may have a significant impact upon the persons health

21. Health Action Planning • Who can you approach for help? If necessary please ask for support from the Community Learning Disability Team or Community Nurses Speech & Language Therapists Dietician Specialist Nurses (Stoma Nurses, Diabetes Nurses)

22. Health Action Planning • Who can you approach for help? You can ask for support from the Community Learning Disability Team: Community Nurses Speech & Language Therapists Dietician Specialist Nurses (Stoma Nurses, Diabetes Nurses) Darryl Chapman, Community Nurse (0118 955 3742)

23. Legislative Framework • Valuing People (specific targets including everyone to be registered with a GP & Health Action Planning) • Disability Equality Duty (DED) (Disability Discrimination Act 2005). • Our Health, Our Care, Our Say: a new direction for community services (NHS, 2005) gave a commitment to exploring ways of achieving health checks. • DRC Formal Investigation Report: Equal Treatment Closing the Gap (2006)

24. Resources • www.soundshealthy.nhs.uk (Reads aloud health information, may not be easy read) • www.valuingpeople.gov.uk • www.easyhealth.org.uk (An online resource of easy read health information; to be launched in April 2008) • Berkshire Health Promotion Unit www.bhps.org.uk

25. Resources • Patient and Liaison Service (PALS) Primary Care Trust & Royal Berkshire Hospital • Everybody Active Contact: Claire Pirie (CLDT) • Berkshire West Primary Care Trust Community Learning Disability Team Sexual Health Promotion Library (Bath Road)