Date:

Improving Health Outcomes for People with Learning

Disabilities

Learning for Change Newsletter May 2019Learning for Change Newsletter May 2019Learning for Change Newsletter May 2019

The LeDeR (Learning Disability Review of Mortality) programme is a national programme aimed at making improvements to the lives of people with learning disabilities. Reviews are being carried out with a view to improve the standard and quality of care for people with learning disabilities. People with learning disabilities, their families and carers have been central to developing and delivering the programme. Recommendations and good practice are identified within the review and used to ensure change is embedded, improving services for the future. In Hertfordshire we want to make sure people with a learning disability stay healthy and well. We are working on a range of activities as a result of the reviews which will help to improve people’s health and wellbeing.

LeDeR Reviewers - So far from the reviews we have learnt that there are areas where health and social care provision can change how they deliver their services. This includes improving how the Mental Capacity Act is applied, advance care planning and better communication across services, but more specifically with the person with a learning disability and their families/carers. In addition there are key themes and causes of death that we are seeing in Hertfordshire. Over 50% of people have died as a result of pneumonia, aspiration pneumonia or sepsis which are conditions that can be treated.

Making Change Happen: There is lots more work taking place across the county

The Hertfordshire County Council website now has a webpage dedicated to providing information about health conditions. The page is aimed at offering guidance to people with a learning disability (in an accessible format); families, carers and health and care professionals. The information on here can be used for group sessions for service users and for staff inductions to help those that support people to be aware of the role they play in bridging health inequality gaps: www.hertfordshire.gov.uk/LDmyhealth The second link is for health professionals. This has the tools they can use and also the pathways to improving their health care delivery for people with learning disabilities: www.hertfordshire.gov.uk/ldprofessionals

Advance Care Planning As part of a winter pilot HCC has been running a pilot with the Health Liaison team to identify people who are at risk of hospital admission. Staff are monitoring the impact of this and will feedback the outcomes in due course. Pneumonia – Flu campaign This year GP practices have been offering the nasal spray to their patients with a learning disability who are unable to tolerate the flu vaccine by injection. There has been a significant increase on improving both flu vaccine and annual health check uptake to avoid admissions into hospitals.

Date:

Improving Health Outcomes for People with Learning

Disabilities

Learning for Change Newsletter May 2019Learning for Change Newsletter May 2019Learning for Change Newsletter May 2019

Making Change Happen: There is lots more work taking place across the county:

The Sepsis Song The Sepsis Song developed by Kate Harding, creative practitioner and the Purple All Stars with the Sepsis nurses from the Lister. The song educates people to know the signs of sepsis and advises when to seek medical attention and say 'Just check me for Sepsis, that's all I ask'.

Purple Wrist Bands East and North Hertfordshire NHS Trust are trialling the use of purple wrist bands for people with learning disabilities in the admissions areas at the Lister to remind people to make reasonable adjustments both on the wards and when they leave the ward for tests.

NHSE 10 Year Plan

The LeDeR programme features in the new NHSE 10 Year Plan. There will be a range of national guidance around a number of conditions aimed at families, carers and professionals that will assist and support the person with a learning disability better. Wheelchair Accessible Scales One of the issues that Community Nurses are identifying with care providers is a lack of weights recorded for service users, particularly when they are wheelchair users. This may be because providers are not aware of the number of wheelchair accessible weighing scales that are available. Monthly weight records are recommended to ensure any weight gains or losses are identified and a Care Plan can be put in to address this.

Call for reviewers

The LeDeR programme is always looking for reviewers. You will need to have clinical experience or a qualification in health/social care. Please contact: Kathryn.dempsey@hertfordshire.gov.uk for more information. LeDeR Reports The annual LeDeR report will be available in a few weeks. The Hertfordshire report in response to the national report will be available by July 2019. EasyRead Newsletter An Easy Read version of this newsletter is being prepared and will be available soon.

For any queries around the LeDeR Mortality Review Programme please contact: Kathryn.dempsey@hertfordshire.gov.uk

To be added to the distribution list please contact: Elaine.scott@hertfordshire.gov.uk

Elaine ScottNote

Accessing Wheelchair Scales

It is recommended that ALL Service Users (SU) have their weight monitored regularly. Routine weighing will increase compliance with CQC Outcome 5 regarding Nutrition. How often depends on each individual’s needs; a dietitian or GP can advise if you’re unsure.

SU’s who cannot stand safely should be weighed using either hoist scales, sitting scales or wheelchair scales. If your unit does not have suitable scales then please consider either purchasing a set of scales or making arrangements to take the SU to a location that has suitable scales.

Hertfordshire Scales Locations

1. Hertfordshire Wheelchair Service

Millbrook Healthcare

Unit J (Swiftfield), City Park

Watchmead

Welwyn Garden City Hertfordshire

AL7 1LT

Tel: 0333 234 0303

hertswcs@millbrookhealthcare.co.uk

No appointment needed. Remember; you will need to know how much the empty wheelchair weighs - remove items from that have been hung on wheelchair (bags, backpacks, blankets, clothing etc.) and leave on all wheelchair attachments including headrest and footplates. Please note there will not be anybody there to help with transfers. Millbrook have confirmed with the dietitian they are happy for people to be weighed. If there are any problems please contact your dietitian.

2. Kingsley Green

House 6 Forest Lane

Kingsley Green

Harper Lane

Radlett

WD7 9HQ

Opening Times: Mon-Fri 9:00am-4:30pm

Tel: 01923 633565

No appointment needed. Phone in advance to check the building is open as it is occasionally used for other purposes. The scales are located in the sensory room; with the main entrance behind you, turn left and go to the end of the corridor, last room on the right hand side (see pictures). Instructions on how to use scales are attached to them.

Please note there will not be anybody there to help with transfers.

Purchasing scales (Information correct 14.9.15)

Type

Cost

Advantage

Disadvantage

Wheelchair scales

(Marsden M-610)

£675 + vat

Suitable to weigh:

· SU in their own wheelchair (including specialist chairs).

· Ambulant SU’s who struggle with stand on scales.

Need to be set up for use each time (Unless kept in an empty/treatment room).

Chair Scales

£500 – 600 + vat

Suitable to weigh:

· SU’s who can be hoisted onto the chair.

· Ambulant SU’s who struggle with stand on scales.

Not suitable for:

· SU’s who are unable to independently support their upper body.

· SU who cannot be transferred to the chair scales.

· Some bariatric SU’s.

Hoist Scales

£500 – 600 + vat

Suitable to weigh:

· SU’s who are hoisted.

Not suitable for:

· SU who cannot tolerate being hoisted.

Can be less accurate and difficult to use.

Cost comparison

Purchasing specialist scales has an upfront cost that some care settings may find expensive. Below is the cost of wheelchair scales compared to regularly transporting one SU to a Hertfordshire Scales Location:

Cost per visit

Cost per year

Cost of scales

Wheelchair taxi.

Additional staff time/costs as taken away from the unit.

£50 – 100 per trip

Staff costs

Every 3 months = £100 – 400*

Once a month = £600 – 1200*

£500 – 675

* Excluding staffing costs

Therefore, the cost of purchasing specialist scales is less than transporting one SU to a Hertfordshire Scales Location over 6 - 18 months. Sharing with another unit can reduce the cost more.

For more information please contact West Hertfordshire Dietitian 01442 283464 or East & North Hertfordshire Dietitian 01438 792 160.

File AttachmentHPFT Guidance Wheelchair scales - locations.docx

Guide to using wheelchair scales

It is recommended that ALL Service Users (SU) have their weight monitored regularly. How often depends on each individual’s needs – See page 2.

SU’s who cannot stand safely should be weighed using suitable scales. If your unit does not have suitable scales then please consider either purchasing a set of scales or making arrangements to take the SU to a location that has wheelchair scales – See ‘Accessing Wheelchair Scales’ leaflet.

Step 1- Setting up the scales

Set up the scales on a solid flat floor e.g. wood, lino or tiles.

Follow the manufactures guidance to set up scales.

Turn on and check that the weight displayed is 0 kilograms (Kg).

Step 2- Weighing the empty wheelchair

Remove items from that have been hung on wheelchair; bags, backpacks, blankets, clothing etc.

Leave on all wheelchair attachments including headrest and footplates.

Write a list of the attachments and brief description to identify the wheelchair.

· Check the scales are turned on and the display is showing 0kg.

Wheel the chair onto the scales; make sure all wheels are in the centre of the weighing plates. Apply the brakes, let go of the chair and check it is not touching anything.

· Electronic scales will usually ‘bleep’ when ready. Record the date and wheelchair weight.

Repeat the process 3 times to ensure accuracy.

Step 3- Weighing the person + wheelchair together

· Check the person being weighed is not wearing any heavy items of clothing (remove coat) and does not have anything heavy in their pockets (e.g. coins or phone). Check that extra items have not been added to the chair; no bags or blankets etc. and all wheelchair attachment are still in place (footplates, head rest).

It is recommended that people are weighed after receiving personal care so that continence pads are dry.

Explain to the procedure to the person and if possible gain their verbal consent to being weighed.

· Check the scales are turned on and the display is showing 0kg

Wheel the person onto the scales; make sure all wheels are in the centre of the weighing plates.

Apply the brakes, let go of the chair.

· Electronic scales will usually ‘bleep’ when ready. Record the date and person + wheelchair weight.

Repeat the process 3 times to ensure accuracy.

Step 4- Calculating actual weight

Subtract (take away) the weight of the empty wheelchair (step 2) from the combined weight of the person + wheelchair (step 3) to obtain the persons weight.

Person + Wheelchair step 3 – Empty Wheelchair step 2

= Actual Weight

Record this date and actual weight.

Step 5- Calculating percentage weight change

! Tip- you may find a calculator helpful.

You will need a historic weight from 3-6months ago and you will need the current weight.

Work out the difference by subtracting ‘-‘ the bigger number from the smaller number.

Divide ‘÷’ your answer by the historic weight.

Multiple ‘x’ by 100 to get a percentage (%).

If the previous weight is bigger than the current weigh you will have calculated percentage weight loss.

If the current weight is bigger than the previous weight you have calculated percentage weight gain.

More than 10% unintentional weight loss/ gain in 3 to 6months maybe a cause for concern. It is important to alert the person’s GP or other health care professional who may consider referral to a Dietitian.

Monitoring weight

It is recommended that ALL Service Users (SU) have their weight monitored regularly. Routine weighing will increase compliance with CQC Outcome 5 regarding Nutrition. How often depends on each individual’s needs; a dietitian or GP can advise if you are unsure.

Although there are no national guidelines for how often people in care should be weighed, the Specialist Dietitians (for Learning Disability & Forensics) recommend the following:

Routine:6 monthly. Routine for all SU’s.

Monthly:SU at risk of weight loss or weight gain, who are receiving prescription supplements, reduced appetite, pressure ulcers, other clinical concerns.

Other:As advised by Dietitian or other health care professional.

For more information please contact West Hertfordshire Dietitian 01442 283464 or East & North Hertfordshire Dietitian 01438 792 160.

Page 1 of 2

File AttachmentHPFT Wheelchair scales - user guide.docx

Patients with a learning disability can now decide if they wish to wear a purple wristband at the Lister Hospital. This will enable Health Professionals to know instantly that they have a learning disability and ensure Reasonable Adjustments are made for that person if required.

Wearing a Purple Wristband

TEACH and Reasonable Adjustments

You can make a difference. Follow these simple steps to make Reasonable Adjustments for people with Learning Disability.

Timing- allow more time for interventions to ensure you have the best chance of offering a positive experience. Environment – can a quieter area be used if a person cannot tolerate noise or finds social interaction difficult? Attitude- think about what health outcomes you expect if the person didn’t have a learning disability and make sure you take steps to overcome barriers to achieve the same. Communication- make sure you use the persons communication preferences [under the Accessible Information Standard] and check their Summary Care Record for any Reasonable Adjustment requirements Help- if you would like support to meet the health needs of a patient with learning disabilities please contact the Health Liaison Team.

File Attachment2019 Wrist Band and TEACH poster.pdf

Available Wheelchair accessible weighing scales across Hertfordshire

Type of Organisation

Organisation

Location

Availability

Number of scales

Private Residential Care Home

Life Opportunities Trust

6 Sewells

Welwyn garden city

Tel - 01707 321344

Yes - Strictly via appointment only

1

Private Residential Care Home

Crosby Close Care Home

1 & 2 Crosby Close, Hill End Lane, St Albans AL4 0AT

Tel - 01727 834139

Only for service users at Crosby Close

1

Private Residential Care Home

Macintyre Care

1 Station Road, Wheathampstead

Tel -01582 833957

Only for service users living in Macintyre care

1

Private care home

Meadow Acres

7 Crabtree Lane, Harpenden, Hertfordshire, AL5 5TA

Tel – 01582 768098

Only for use by service users living at Meadow Acres

1

Activity centre

Hertfordshire Partnership Foundation Trust

House 6 Forest Lane

Kingsley Green

Harper Lane

Radlett

WD7 9HQ

Tel - 01923 633565

Phone in advance to check the building is open as it is occasionally used for other purposes. The scales are located in the sensory room; with the main entrance behind you, turn left and go to the end of the corridor, last room on the right hand side.

Monday Friday

9am-4:30pm

1

Wheelchair Provider

Hertfordshire Wheelchair Service (Millbrook Healthcare)

Unit J, Swiftfields City ParkWatchmeadWelwyn Garden City, AL7 1LT

Tel - 0333 234 0303

No appointment needed.

1

HCC Day services

Stevenage Resource Centre

Chells Way, Stevenage

SG2 0LT

Tel – 01438 725820

Strictly via appointment only.

9am – 4pm Monday to Friday only

1

HCC Day services

Ware Rd Day Centre

Ware Rd

Ware

SG13 7HX

Hertford

Hoddesdon

Tel - 01920 461671

Strictly via appointment only.

9am – 4pm Monday to Friday only

1

Watford Leisure Centre, Woodside

Horseshoe Lane

Garston

Watford

WD25 7HH

Horseshoe Lane

Garston

Watford

WD25 7HH

A member of the fitness team on site to help out and assist.

Woodside opening hours are:-

Mon – Wed  6am 10.30pm

Thurs - Fri        6.30am – 10pm

Sat                          7am – 7pm

Sun                        8am – 7pm

1

Version 1, Audited Feb 2019. To be reviewed Feb 2020.

elaine scottFile AttachmentList of Wheelchair Accessible Scales available.docx