equal treatment: closing the gap · 2015. 11. 14. · edwina hart, am, mbe, minister for health and...

Equal Treatment: Closing the GapConference Report19 February 2008

EQUAL TREATMENT: CLOSING THE GAP CONFERENCE REPORT

Contents:

Foreword ...................................................... 1 Acknowledgements..................................... 3 Conference Programme.............................. 5 Conference Exhibitors and Photographs.. 7 Chair’s Welcome........................................ 10 Presentations of Keynote Speakers ........ 12 Abstracts and Award Winners.................. 39 Interactive Workshops .............................. 46

Reflections and Key Messages................. 49

Delegate Feedback..................................... 52

Foreword On Tuesday 19 February 2008, the NHS Centre for Equality and Human Rights (NHS CEHR) joined forces with the National Leadership & Innovation Agency for Healthcare (NLIAH) to celebrate the progress being made in NHS Wales in response to the former Disability Rights Commission’s (DRC) ‘Equal Treatment: Closing the Gap’ - a formal investigation into the health inequalities experienced by people with learning disabilities and people with mental health problems. The DRC launched this investigation in 2005 because they were concerned by evidence that showed that these groups are dying sooner and getting ill more often than the general population. The Conference, which was held in the All Nation’s Centre in Cardiff, was supported by the Welsh Assembly Government and chaired by Dr Neil Wooding, the Equality and Human Rights Commissioner for Wales. The Minister for Health and Social Services, Edwina Hart, AM, MBE, gave a keynote address. The Conference had three key themes: • achieving sustainable improvement and more effective transfer of

good practice • improving access to primary care, and • designing health promotion strategies that effectively address

different and individual needs. During the morning, 130 delegates from health and social care, local and central government and the voluntary sector, heard presentations from senior officers of the former DRC, the new Equality and Human Rights Commission, the National Public Health Service and Wales Centre for Health, Caerphilly Local Health Board and the Welsh Assembly Government. Recognising how important it is for people with learning disabilities and people with mental health problems to have a voice, two individuals told their stories and shared their personal experiences. A total of 24 abstracts were received under the three Conference themes and the Minister for Health and Social Services presented four

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organisations with awards for the best abstract in each category. Five interactive afternoon workshops explored the Conference themes and showcased innovative approaches to improving the delivery of healthcare and the patient experience. To close the day a plenary session reflected on some of the key messages. Conference feedback has been very positive with the majority of delegates being able to identify ideas and good practice to take back and share within their own organisations. Both the NHS CEHR and NLIAH are committed to supporting the delivery of the eleven Recommendations set out within the DRC ‘Report for Wales’. Strong leadership and commitment across the health service in Wales will help to ensure that the gap is closed and these health inequalities are eliminated. We look forward to continued progress across NHS Wales and to celebrating further achievements in the future.

Jan Williams Jo Davies Chief Executive, NLIAH Director, NHS CEHR Chair, NHS CEHR Forum


Acknowledgements The NHS CEHR and NLIAH would like to thank everybody who took part in the preparations for, and during, the Conference and for making the day such a success. In particular, thanks to the Conference Chair and keynote speakers for sharing their expertise and ensuring that the Conference was both informative and enjoyable. Chair: Dr Neil Wooding, Director, Public Service

Management Wales and Commissioner for Wales, Equality and Human Rights Commission (EHRC)

Presenting the Edwina Hart, AM, MBE, Minister for Health Abstract Awards: and Social Services, Welsh Assembly

Government Speakers: Will Bee, former Director, Disability Rights

Commission Edwina Hart, AM, MBE, Minister for Health and

Social Services, Welsh Assembly Government Kath Toms, Caerphilly People First Teresa Lewis, Mind Cymru Chrissie Hayes, Interim Chief Executive,

Caerphilly Local Health Board Dr Cerilan Rogers, National Director, National

Public Health Service for Wales and Interim Chief Executive, Wales Centre for Health

Phil Chick, Director of Mental Health, Welsh Assembly Government


Abstract Judges Many thanks to the panel of judges who gave freely of their time and expertise to judge the Conference abstracts: • Ruth Coombs, Influence and Change Manager, Mind Cymru • Wayne Crocker, Assistant Director, Mencap Cymru • Jim Crowe, Director, Learning Disability Wales • Ewan Hilton, Executive Director, Gofal Cymru • Neil Wooding, EHRC Commissioner for Wales • Alan Willson, Joint Director, 1,000 Lives Campaign, NHS Wales Venue and Communication Support Many thanks to the individuals and organisations below for their support: • Robert Sherwin and his staff at the All Nations Centre in Cardiff • Sheryll Holley and Hilary Maclean, our Palantypists for the day • Trosol for providing a Welsh translation service • Studio 49 Photography for taking photographs during the

Conference. Particular thanks must go to everyone who produced abstracts and

posters to display during the day.


Conference Programme

09.30 Registration and Refreshments 10.00 Chair’s Welcome Dr Neil Wooding, Commissioner for Wales, Equality and

Human Rights Commissioner 10.10 Delivering a Formal Investigation in Wales

Will Bee, Former Director, Disability Rights Commission, Wales

10.30 Minister’s Address

Edwina Hart, AM, MBE, Minister for Health and Social Services

10.45 Telling Our Stories

Kath Toms and Teresa Lewis 10.55 A Service Response

Chrissie Hayes, Interim Chief Executive, Caerphilly Local Health Board

11.10 BREAK 11.35 A Public Health Response

Dr Cerilan Rogers, Interim Chief Executive, Wales Centre for Health/National Director, National Public Health Service

11.55 The Role of the Commission: Making a Difference

Dr Neil Wooding, Commissioner for Wales, Equality and Human Rights Commission


12.15 Addressing the Gaps Group Discussion and Q&A Session

12.45 LUNCH 1.00 Take the Health Challenge – DVD Presentation 1.45 Workshops 3.00 BREAK 3.20 Plenary Session

Reflections and Key Messages Phil Chick, Mental Health Director, Welsh Assembly Government

3.45 Closing Remarks and Evaluation

Dr Neil Wooding, Commissioner for Wales, Equality and Human Rights Commission


Conference Exhibitors Many thanks to the following organisations who exhibited at the Conference: o Breast Cancer Care, Cymru o Gofal, Cymru o Hafal o Health Challenge Wales o Learning Disability Wales o Me and You o Mencap Cymru o Mind Cymru o Remploy o Royal College of General Practitioners, Wales o Welsh Assembly Government o NLIAH o NHS CEHR

Breast Cancer Care, Cymru


Me and Us

NLIAH


Learning Disability Wales

Royal College of General Practitioners, Wales


Chair’s Welcome Dr Neil Wooding Equality and Human Rights Commissioner for Wales Neil was appointed as the Equality and Human Rights Commissioner for

Wales in October 2007, having served as the Equal Opportunities Commissioner for Wales since 2002.

Equal Treatment : Closing the Gap Page 10 of 52 Conference Report

Neil is also the Director of Public Service Management Wales (PSMW), an organisation set up by the Welsh Assembly Government and public service organisations for the purpose of building leadership and managerial capacity. Neil has spent much of his career working with organisations across the UK to promote equality and human rights. Neil was the first Equality

Adviser to be appointed in Wales and is a highly respected authority on issues of equality and human rights. Introduction Delegates were welcomed to the Conference by Dr Neil Wooding, Equality and Human Rights Commissioner for Wales. The programme planned for the day included a number of keynote speakers, including an address by the Minister for Health and Social Services and two presentations that would help to promote the power of storytelling and personal experiences in thinking about disability. Storytelling is an effective way of connecting with other people’s experiences, conveying messages that sometimes need to be felt, as well as understood intellectually. The morning speakers would be followed by an afternoon of workshops and a plenary session. The communication support and other facilities, including Conference Packs produced in Easy Read, Welsh and Braille, were also highlighted. These were provided to ensure that all delegates were able to fully participate. Delegates were reminded of the purpose of the day which was the Formal Investigation, ‘Equal Treatment: Closing the Gap’ which had commenced in 2004 and was undertaken by the former Disability Rights Commission. Neil shared how he had the privilege of being involved

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during some of the early stages from a Welsh perspective. The investigation had demonstrated a lot of the creative intelligence and energy that existed in the Disability Rights Commission at the time and the wider community to deliver something that was very authentic in terms of the outcome needed across Wales. The investigation had evidenced high levels of mistreatment and disadvantage experienced by people with learning disabilities and people with mental health problems. It also demonstrated how those groups most vulnerable in society can actually experience the very poorest kind of healthcare we can offer. The decision to celebrate the achievements of the NHS in Wales in response to ‘Equal Treatment: Closing the Gap’ was a joint response made by the NHS Centre for Equality and Human Rights and the National Leadership and Innovation Agency for Healthcare. The aim of the Conference was to celebrate the tremendous amount of good work that is being done inside the health service, whilst acknowledging that we are all on a journey and there is no room for complacency. It was important that everyone continued to strive to bring about the changes that will allow everyone to receive free and effective access to healthcare, regardless of their differences.


Presentation of Key Note Speakers Will Bee Former Director, Disability Rights Commission, Wales

Will is the former Director of the Disability Rights Commission (DRC) Wales, from its opening in 2000 until its closure in September 2007. In the early years of his career, Will worked mainly in the voluntary sector, initially for disability organisations. In 1990, Will became Co-ordinator of Barton Hill Settlement, a multi-purpose community resource centre in East Bristol. Will now works as a freelance consultant specialising in disability and issues of organisational development.

Delivering a Formal Investigation in Wales In his introduction, Will Bee set out the reasons why the Disability Rights Commission decided to formally investigate the health inequalities affecting people with learning disabilities and/or mental health problems. When the DRC was launched in 2000, the expectation was that large scale disability discrimination would be exposed and brought to justice. The DRC’s helpline was inundated with calls; 50% higher than predicted. Cases did not materialise for many reasons. Callers often described treatment which was undoubtedly underpinned by discriminatory attitudes but they were either too complex to prove legally, or were outside the scope of the Disability Discrimination Act. When strong cases were assembled, many employers and service providers would settle out of Court, thereby avoiding bad publicity. Formal Investigation (FI) A FI allowed the DRC to look in detail at an area of service provision where discrimination was rife, but without the potential stigma of naming an organisation as an institutional discriminator against disabled people. The potential scope for a formal investigation on health was vast. The Commission chose to focus on provision for people with learning Equal Treatment : Closing the Gap Page 12 of 52 Conference Report

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disabilities and mental health problems as these groups had received little attention from the DRC and there was already some statistical evidence to show that these groups had poorer health outcomes compared with the rest of the population. The intention of the FI therefore was not simply to amass more evidence to prove the same point, but to look at measures which would bring an end to the problem. It was this emphasis on looking for changes in policies and procedures that presented particular opportunities in Wales. The relative openness of Government in Wales meant that the DRC was able to work closely with the Welsh Assembly Government to develop a set of proposals which would fit with the emerging policy agenda for NHS Wales and therefore had a stronger chance of being implemented. The investigation in Wales was also supported by the open door of the ministers who held the health portfolio throughout the process. Also important to the success of the FI was the establishment of a broadly based reference group bringing together all stakeholders, including the Director of NHS Wales and service users. Key Findings The FI found that people with schizophrenia or bi-polar disorder are more likely than the rest of the population to develop diabetes, coronary heart disease, high blood pressure and stroke. It also found that people with learning disabilities (particularly women) are more likely to be obese than the general population and have higher rates of respiratory disease. Also, people with learning disabilities did not receive many of the health screening programmes aimed at the general population. Recommendations The Investigation made eleven Recommendations aimed at all of those involved in the provision of primary health services for people with learning disabilities and/or mental health problems. They covered everything from the way the Assembly Government sets the policy framework for primary care, through to how GPs should provide their services in a way which is responsive to the needs of patients. The Investigation was clear that the health inequalities could only be resolved if there was strong leadership and an acknowledgement that they existed. Strategies needed to identify this issue as a priority and gather data which identifies that progress is (or is not) being made.


Messages must get through to staff dealing with patients that the problems identified in this report need to be taken seriously. Conclusion The FI approach had demonstrated that by identifying an issue of concern and conducting a truly independent investigation working with all stakeholders and maintaining political buy-in throughout the process, it is possible to produce a practical strategy to address the issue. That is the challenge of this Conference. Wales came out of the FI very well. In many ways, the health service in Wales was already ahead of England in acknowledging a problem and looking for solutions. There is a tool here that along with many others can finally begin to root out some of the health inequalities which blight health in many communities in Wales.


Edwina Hart, AM, MBE Minister for Health and Social Services Edwina Hart was elected to the first

Assembly in 1999 and became the Assembly's first Finance Secretary. In 2000, this was changed to include responsibility for local government and she became Minister for Finance and Local Government. After the 2003 Assembly election, she took on the newly created Social Justice portfolio and became the Assembly's first Social Justice and Regeneration Minister. After being elected to serve a third four year term in 2007, she became the Minister for Health and Social Services. Along with her new role she retained the responsibility of being the Cabinet’s armed forces liaison in Wales.

Minister’s Address In her introduction, the Minister said how delighted she was to be able to address the Conference because issues of equality have been a passion of hers for some time. The Minister emphasised the important role of Government Ministers in changing policy direction so that over time there are positive outcomes that improve people’s lives. The Minister described how the Welsh Assembly Government was involved in the Formal Investigation (FI) and was pleased to have heard the comments made by Will Bee about how positive the experience had been for the DRC in undertaking the FI in Wales. The Welsh Assembly Government had always enjoyed a very good relationship with the DRC. The Minister made reference to the eleven Recommendations set out within the FI Report for Wales and described them as being extremely practical and capable of changing people’s lives. The Minister shared the positive response received from general practitioners in Wales and said how delighted she was that annual health checks had been introduced in Wales.


It was acknowledged that there had been progress in Wales and a real commitment had been made to deliver the Recommendations as demonstrated by the revised guidance for Health, Social Care and Wellbeing Strategies and the inclusion of a national target in the manual operating framework. However, there remained many challenges for the Welsh Assembly Government and NHS Wales to address to fully implement all of the Recommendations. The Minister presented awards to the authors of the four winning abstracts and congratulated everyone who had submitted an abstract. The Minister said that the themes of the Conference are important in improving services for people with mental health problems and/or learning disabilities. The afternoon workshops presented a good opportunity for delegates to discuss the issues and ensure that Wales would continue to make sound progress with this important agenda. The measure of success would be the extent to which the work will positively impact on services and improves people’s experiences.


Teresa Lewis Teresa was a volunteer with Mind Cymru and was involved with the Equal Treatment: Closing the Gap Formal Investigation in Wales, taking an active part in focus groups set up for the Investigation. Teresa also spoke at the launch of the ‘Equal Treatment: Closing the Gap Report for Wales’ in October 2006. Teresa continues to undertake volunteering work and has more recently moved into volunteering with environmental projects and third world developments. Teresa was born and lives in Cardiff but has spent much of her life in England.

Telling My Story Teresa began her story by reminding us that people with mental health problems are all different and need to be treated as individuals. A ‘one size fits all’ approach often excludes some and makes others feel patronised. People differ from each other in many ways: in terms of levels of physical fitness, size, shape, age, body clocks, skills, education, family background, personal interests, diet and lifestyle. Therefore people cannot, and do not, wish to be treated the same. Teresa shared her experience of using primary healthcare services and highlighted some service improvements with more women general practitioners and training being provided in mental health issues. However, Teresa felt that there is still a postcode lottery with patients being taken more seriously in the more affluent areas. Teresa suggested that there are still many within the medical profession who believe that physical health problems have stress as the main cause. In respect of nutrition, much good work has been done by Jamie Oliver to improve school lunches and create training restaurants to employ marginalised youth. Teresa suggested that this kind of thinking could be extended to day centres and drop in centres for people with mental health problems. However, this would require attitudinal change amongst both staff and service users.


Teresa suggested that obesity amongst people with mental health problems is not just due to the side effects of medication, although some medication produces a craving for carbohydrates. There is also a lack of knowledge of nutrition, as well as the easy availability of convenience meals and junk food. People with mental health problems are not resistant to the idea of eating healthy food. The reality is that people eat junk food out of ingrained habits from childhood and the influence of advertising. Poor eating habits are passed down from generation to generation and it takes great courage for people to eat differently from their parents. Poverty may have been the reason why people did not eat much fresh food but attitudes really have not changed with rising incomes. There is still an attitude that there are more important things to spend money on than food. Teresa explained how unhealthy and excessive eating can lead to a whole host of health problems and anti-social behaviour such as depression, fatigue, irritability, foggy thinking and skin problems, but obesity is the most visible consequence. Teresa suggested that ‘Healthy Living Projects’ have done much to encourage healthy lifestyles amongst people in marginalised groups and it was a pity, therefore, that some of them have been closed down. It can also be difficult to gain access to exercise opportunities. Council leisure centres often have run down facilities with broken lockers and communal changing rooms and/or showers, making it difficult for women with a poor body image to use them. Outdoor exercise is most beneficial as this helps people to keep fit and to get out in the fresh air. Green gyms and Walking for Health programmes are two good examples. They can be a way into volunteering, doing conservation work or running an allotment or taking up rambling in the countryside. However, there was a need to keep up fitness levels when the weather is not so good in the winter. In this respect gyms, leisure centres, church halls and exercising at home are important. However, indoor exercise opportunities should be more available for people at all levels of fitness, on a low income or who cannot commit to a ten week course because of time, health or geographical problems. Exercising at home can be done at any time and under no pressure. However, sometimes, a few taster classes are needed to make sure the Equal Treatment : Closing the Gap Page 18 of 52 Conference Report

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posture and the moves are correct. A book or DVD can be helpful but feedback is needed. Drop in centre based exercise can be at a low level which can make people feel a bit patronised. However, they are useful for those with poor mobility or co-ordination and there is no need to be committed to attending every week. Finally, Teresa suggested that exercise on prescription should be available for anyone with weight problems whether they have mental health problems or not. To conclude, Teresa reminded us that 1 in 4 people may experience mental health problems. Whoever they are and whatever their needs, all people benefit from a healthy diet and active lifestyle. And, as the Formal Investigation has so clearly demonstrated, without equal access to these for everyone, more people will become ill.


Kath Toms Caerphilly People First

Kath Toms is a Peer Trainer with Caerphilly People First, a charity run by, and for, people with learning disabilities. In her work, Kath gives presentations to people about person-centred planning and shares her experiences with different groups. Kath is trained to teach people with learning disabilities about self-advocacy and teaches children in schools in the Caerphilly County Borough area. Kath has a learning disability and has been living independently in her own home in Blackwood for the last 18 months.

Telling My Story Kath began her story by explaining how she had joined Caerphilly People First as a volunteer three years ago and is now working in a paid capacity on an Independent Living Project. Kath described how her work involves giving presentations about person-centred planning and sharing her own experiences with different groups. This work is undertaken on behalf of All Wales People First, Learning Disability Wales and Reach Supported Housing. Kath enjoys her job and believes that having her own person-centred plan has helped her greatly to tell people what she needs. Kath explained that she is also trained to teach people about self-advocacy and currently teaches children in the Trinity Fields Resource Centre how to speak up for their rights. Kath reminded us that the FI, ‘Equal Treatment: Closing the Gap’ found that people with learning disabilities often experience poor physical health. Kath shared her understanding of how important it is to eat a balanced diet and take regular exercise to stay fit and healthy and how she is benefiting from the Greater Bargoed Activity Programme which provides a virtual Healthy Living Centre for people on low incomes, older people and people with mental health problems.


In developing the project, people living in the community were asked to identify activities that appealed to them and those identified were walking, cycling, Tai Chi, Yoga and gardening. A range of activities are now provided by the Bargoed Mentro Allan Partnership with partners including Caerphilly County Borough Council Leisure and Social Services Departments, Caerphilly Local Health Board, Groundwork Caerphilly and the Greater Bargoed Communities First Partnership Board. The activities include rambles around Bargoed Common, walks around the Country Park, bike rides and Green Gyms within the local allotments in and around Greater Bargoed. These activities are helping people with learning disabilities to stay healthy. Kath referred to the fruit and vegetable co-operatives in the Borough whereby people may order and buy a bag of fruit or vegetables for £2. The co-operatives are based in local community centres or schools in the area. Kath explained that some of her friends with learning disabilities help out with the co-operatives and their involvement with the project encourages them to eat healthy food as well. Kath reminded us that just like everyone else, people with learning disabilities need good, up-to-date information about how to stay healthy. However, for this information to be accessible to people with learning disabilities, it must be easy to understand. Kath stressed how important it is for everyone with a learning disability to have a health check and she hoped that by having annual health checks, people with learning disabilities will be able to stay healthy in the future.


Chrissie Hayes Interim Chief Executive, Caerphilly Local Health Board

Chrissie commenced her NHS career as a staff nurse before training as a midwife in Bristol. After a career break of 12 years, Chrissie returned to midwifery in Bristol and in 1993, moved to Wales to take up a post with Glan Hafren NHS Trust. After a succession of midwifery management posts including Head Midwife and Directorate Manager for Obstetrics, Lead Supervisor of Midwives and Welsh Midwife Member of the Nursing and Midwifery Transitional Council, Chrissie was appointed as Nurse Director for Caerphilly Local Health Board in 2003. Chrissie was appointed Interim Chief Executive of Caerphilly LHB in August 2007.

Making a Difference Chrissie Hayes was delighted to have been invited to give a commissioner’s perspective on the Disability Rights Commission’s (DRC) Formal Investigation (FI) and shared a range of initiatives that are not unique to Caerphilly Local Health Board, and are being undertaken in Local Health Boards across Wales. It was acknowledged that the progress made in Wales was attributable to the quality of the work of the former DRC and the NHS CEHR and to the leadership given to this work by the Welsh Assembly Government. A range of voluntary organisations also play an important role in providing support to the statutory sector and to individuals with learning disabilities and/or mental health problems. The progress demonstrated that Wales could set an example for the rest of the UK to follow. The FI sets out in simple terms the action that must be taken and brings to life the issues faced by people with learning disabilities and mental health problems in very human terms, serving as a reminder to everyone that behind the statistics, there are people who are experiencing poorer health outcomes than everyone else. Addressing these inequalities Equal Treatment : Closing the Gap Page 22 of 52 Conference Report

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should be at the heart of every healthcare professional’s role. To draw upon the experiences of people highlighted by the FI, Chrissie shared the story of Robert. Robert is not a real person but his story is real. Robert’s Story

Robert was an articulate 40 year old man with a learning disability who lived at home with his elderly parents. He was quite independent and had enjoyed reasonably good health, apart from being somewhat overweight and inactive due to ongoing problems with his feet. Apart from short respite periods twice a year which he enjoyed enormously, his parents asked for and received little advice and support from the statutory services. Robert was not registered with his local general practice as having moved 10 years ago, his parents never felt the need to register him (since he had been under the care of a hospital specialist previously although he was discharged some years ago). Sadly Robert suffered a stroke caused by undiagnosed high blood pressure. As a result of this stroke, of which there was a history in both his mother’s and father’s families, he had to live in a long term nursing care home. Because his speech had been affected, he found it difficult to communicate and he was labelled as having difficult behaviour. Robert sadly died two years later. We will return to Robert’s story later.

Responding to the FI Within Wales there is strong partnership working which ensures that planning and service delivery is user-led. Members of Caerphilly People First are partners in an LHB-led review of physical activity and nutrition projects. Within joint planning forums across the LHB and Local Authority, user representation is a key part of forum membership through a specific mental health joint planning group and a learning disabilities subgroup. Directly enhanced services in primary care were introduced in Wales in 2006 and provide general health reviews for patients on enhanced care programmes, and annual health checks for people with learning disabilities registered with the Local Authority. In Caerphilly, there is also a mental health outreach information bus with lifestyle coaches able to provide advice and guidance to those already experiencing mental health problems.


Expert patient programmes focus on issues raised directly by people with mental health problems. Lifestyle support programmes often run jointly with the Local Authority, range from sexual health and sexual safety for clients in residential and community settings to exercise, dietary advice and smoking cessation. There are also in reach services in residential care settings, including medication reviews, training and support for staff, and visits by optometrists, podiatrists and dentists. However, this is only the beginning and there remains much to do. There is a need to build on good practice and share knowledge and learning across organisational boundaries. Best practice must become standard practice and today’s Conference is just the beginning of a much longer programme of sharing good practice and is one in which the National Leadership and Innovation Agency for Healthcare (NLIAH) and the NHS CEHR have a key role to play. The considerable body of evidence to demonstrate the health inequalities faced by people with a learning disability or mental health problems need to be explicitly referenced in local partnership plans, such as the Health, Social Care and Wellbeing Strategies, and in priorities and resource setting processes. The evidence must drive change and ensure that there is urgency behind the change. Community profiles must be developed for people with learning disabilities and mental health problems including people living independently in their own homes and in residential settings. There is a need to know their gender, age, ethnicity, sexual orientation and religious/cultural beliefs and whether they have any other disability. There is the ‘Count Me In’ national census of mental health inpatients and the Patient Equality Monitoring project with its focus on secondary healthcare. Robust equality monitoring data is also needed in primary care to evaluate the extent to which a difference is being made and objectives are being achieved. Service users must be an integral part of plans to reduce inequalities. Patient and public involvement activities must directly seek the views of people with learning disabilities and mental health problems in relation to primary care, hospital, community and social care services. Organisations must be held accountable for action to address any concerns raised. Within Caerphilly, an annual report will cover progress made on a wide range of disability issues for every voluntary group in the Borough. A Hard to Reach Groups Strategy is also being developed


to ensure that those whose voice may otherwise not be heard is directly sought, and fed back into, wider commissioning and service development activities. Local Health Boards need to provide advice, guidance and hands on support to enable primary care to build upon the existing Mental Health, Learning Disability and Access enhanced services. The EquIP Cymru Project is a good example of how this can be taken forward in primary care. Within Caerphilly, much work has been done to support people with mental health problems in the workplace and to break down the stigma that can be associated with raising such issues. These include:

• an active re-enablement programme providing work placements;

there are two individuals with a learning disability on placement with Caerphilly LHB and another individual who is employed by the LHB

• a staff counselling service • organisational and individual stress audits • training for all executive directors and line managers on how to

identify staff who might be displaying symptoms of mental health problems, to ensure an early intervention before a crisis is reached

• an annual staff health needs assessment questionnaire, and • an employee assistance programme with counselling advice on

substance misuse and debt.

To conclude, Chrissie returned to the story of Robert and considered how his life might have been if the FI Recommendations are delivered.


Robert’s Story Robert is lucky to live in Wales because when his carer realised he was not registered with the GP he spoke to the local general practice and arranged for Robert to be on the list. Robert now has an annual health check with his GP and the practice nurse. Both have had training in how to communicate effectively with him. As a result of his last check up in which his blood pressure, BMI, and cholesterol were checked, he was identified as being at risk of a stroke particularly in light of his family history which was clearly outlined in his notes. Following this an exercise and dietary programme was agreed and statins were prescribed. It was agreed that Robert would be followed up on a 3 month basis by a practice nurse. To support this, accessible information leaflets and a short video were given to Robert and a summary of what was agreed was sent to Robert’s support worker who agreed to provide encouragement to Robert to make the necessary lifestyle changes. Robert’s feet had always been a problem because he was scared of having them touched. An in reach visit by a domiciliary chiropodist was arranged so that Robert could be treated in his own home. Robert could now go out and buy his first pair of trainers and take the regular exercise which his GP advised him to do. To support him in making the necessary changes, Robert was given a leaflet to explain what he could expect from his general practice and at the next annual review was asked to complete a questionnaire with his mum and dad asking him about the service he had received. He gave good feedback.

That is making a difference! Thank you.


MAKING A DIFFERENCE

Chrissie HayesInterim Chief Executive

The Human Face of Closing the Gap

Robert

Progress in Wales: How are we doing?Strong user involvement

Annual checks through Directly Enhanced Schemes in primary care

Wide range of outreach services and lifestyle support programmes

Expert patient programmes

Developing in reach services, for example medication reviews

Strong Commitment from Welsh Assembly Government and Statutory Partnerships

Priorities For Attention Cascading good practice and learning from each other

Strengthening the strategic priority of these services through our Health and Social Care Wellbeing Strategies

Using the available evidence to underpin our decision making andpriority setting

Borough wide and practice profiles

Improved health population and demographic data

Strengthened consultation and transparent accountability

Champions for change and advocates for service users

Hands on support, advice and training for primary care - ensuring annual assessments for all at risk

Setting an Example As a Good Employer

Re -enablement programmes

Funded counselling

Targeted recruitment

Stress Audits

Staff health needs assessments

Employment of staff with disabilities

Employee Assistance programmes

The Key Role of

Primary Care

Returning to Robert

MAKING A DIFFERENCE

WALES : SETTING AN EXAMPLE FOR THE UNITED KINGDOM


Dr Cerilan Rogers National Director, National Public Health Service/ Interim Chief Executive, Wales Centre for Health

Dr Cerilan Rogers is National Director of the National Public Health Service for Wales, which provides specialist public health services, including health protection; health improvement; health and social care quality and health intelligence. Dr Rogers was also appointed as Interim Chief Executive of the Wales Centre for Health in June 2007.

Understanding Health and its Determinants Dr Rogers introduced her presentation by talking about health and the factors that influence it. Health is a product of the interaction between the individual, society and the environment. It is very much an outcome. This is very important to understand because it means that it can be influenced. Disability in this context is one factor that is part of that interaction. Many factors are relevant to an individual’s health status and experience of health. There are genetic, biological and individual factors; individual lifestyle and behavioural issues; material factors and physical, social, cultural and environmental factors. It is a very rich interaction that produces individual’s an health outcomes. It is very important to understand this as it provides a way of dealing with inequalities in health. It is not just about healthcare. A whole range of factors impact on people’s health status. There are also barriers to healthcare - physical, sensory, behavioural and communication barriers. An individual with a disability may have difficulty communicating, but it is just as likely to be staff and other people who come into contact with them that have communication difficulties. The knowledge, skills and attitudes of staff are very important in terms of being able to design responsive services. There are diverse populations. It is not one size fits all. An individual’s needs may be very complex and varied and they may vary over time, but Equal Treatment : Closing the Gap Page 28 of 52 Conference Report

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we should not let the complexity of needs overwhelm us. Some of these needs are very simple to address if we have the will to do so. There is a need to consider syndrome specific conditions. People with Downs Syndrome have an increased likelihood of cardiovascular disease, thyroid disorders and leukaemia. These needs are known and therefore there is an opportunity for real health gain if we design services appropriately to meet these needs. The FI demonstrated increased levels of obesity for people with mental health problems, but one of the main factors in terms of ill health in people with serious mental illness is higher rates of smoking. The rate is double for people with a severe mental illness and that does have a significant impact because it is a major risk factor for coronary heart disease, diabetes, infections, and also, respiratory disease. Also, with regard to obesity, it is important to remember that some people with a learning disability have the opposite problem. Everybody's needs are different. The side effects of medication have been mentioned. There are statistics to show that people with severe mental illness have 3 to 4 times higher rates for consulting GPs in some studies. So, access to primary care does not seem to be the problem, however, taking the onward journey in terms of accessing appropriate care following on from primary care does seem to be a problem. There are intrinsic and extrinsic factors that cause health inequalities, a predisposition to risk factors and also the greater impact of society and the environment. A Public Health Response Public health is interested in improving the health of the population and in reducing inequalities. It is particularly interested in the population’s health overall and groups within that population. So health status, outcomes, health needs, the variations, the reasons for variation and, very importantly, interventions to improve health and reduce inequalities and the evidence base behind that are all relevant. There is a need to understand the issues, identify the problems, find and implement the solutions and monitor the outcomes. Improving information for decision makers is really important in this context. The information base is not robust. Equality impact assessment should be used much more systematically to provide the evidence about the consequences of decisions made in terms of policy, Equal Treatment : Closing the Gap Page 29 of 52 Conference Report

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strategy and service implementation. Outcomes should be evaluated to help build the evidence base. Annual Health Checks The evidence shows that primary care health checks can help reduce poor outcomes but well structured schemes are still needed. Health checks were introduced in Wales in 2006 and 50 per cent of the people who received these health checks had previously unidentified problems, so that is a really powerful message. There is a 3-year project to monitor the impact of health checks for people with learning disabilities which is being carried out jointly by the National Public Health Service and the Wales Centre for Learning Disabilities. 10,000 people aged 18 plus were on learning disability registers in Wales in 2006/2007. Of these, 6,450 were invited to have a health check. A total of 2, 910 checks were undertaken. There is a drop off at every stage but at least a start has been made. Promoting Best Practice There is a lot of good practice but it is often isolated and should be mainstreamed in commissioning. The National Public Health Service has produced guidance on best practice in promoting the physical healthcare of patients with a mental health problem in both primary care settings and community mental health teams for the Welsh Assembly Government. However, it is important that the guidance is used and this is something else we will need to monitor. There are many projects in health promotion and screening services. In this year’s work plan for ‘Stop Smoking Wales’, people with mental health problems are a target group. A project in North-West Wales Trust has developed materials to support women with learning disabilities to make informed choices about screening programmes. The important thing is that the project is growing and this should mean that the good practice will be spread and sustained. Because the screening programmes are available to all women, this is one way to bring this group closer to mainstream services. At least 20 projects of the nutrition network specify people with mental health problems as a target population and 22 projects mention learning disability. However, there is an issue about sustainability. All too often, by the time a project is established, the funding has come to an end. It is important to have systematic application of well evidenced health Equal Treatment : Closing the Gap Page 30 of 52 Conference Report

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promotion activities that are able to continue for a long period if the benefits are to be achieved. Being able to take a longer-term approach to this sort of work is exceptionally important. Health is a product of complex interactions and the more we understand that, the more likely we are to be able to do something about the issues we are facing. Significant steps have been made on this journey but there is still a very long way to go and today's Conference is another step on that journey. The important thing is to keep taking those steps. A measure of a civilised society is really how society deals with people who are most vulnerable and if we cannot actually promote and protect and enhance the lives of people who are most vulnerable, I am not sure what a society is for.


Equal Treatment: Closing the GapA Public Health Perspective

Dr Cerilan Rogers

Content

• Health and its determinants

• Health consequences of disability

• Public health response

What is Health?

“a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity.”

World Health Organisation (1948)

Health is a product of the interaction between the individual, society and the environment

Disability

“Disability is a physical or mental impairment which has a substantial and long-term adverse effect on the ability to carry out normal day-to-day activities.”

Disability Discrimination Act 1995as amended by the DDA 2005

A social model of healthA social model of health

Disability

“Disability is a physical or mental impairment which has a substantial and long-term adverse effect on the ability to carry out normal day-to-day activities.”

Disability Discrimination Act 1995as amended by the DDA 2005


• Difference in health status/outcomes– increased morbidity– increased mortality/ reduced life expectancy– increased negative impact of determinants of

health, e.g. poverty• Differences in health care

– unequal access to services – inequalities in the service provided

Consequences of Health Disability

Learning Disability

• Heterogeneous population• Increased sensory impairment (vision and

hearing)• Increase in epilepsy• Syndrome specific conditions• Increased levels of obesity, underweight,

hypersomnia, endocrine disease, skin conditions, psychiatric disorder, hypertension

Mental Health

• Increased levels of smoking and obesity

• Increase in coronary heart disease, diabetes, infections, respiratory disease

• Side effects of medication

Intrinsic:• Predisposition/risk factors• Greater impact of society and environment• Complex and variable needs

Extrinsic:• Multiagency response• Unequal access/provision• Socioeconomic factors

Reasons for Inequalities

What is Public Health?

"The science and art of preventing disease, prolonging life and promoting health through organised efforts of society.“

Sir Donald Acheson

What is it interested in?

• Population health• Health status/outcomes• Health needs• Variations in these (inequalities)• Reasons for variation• Interventions to improve health and

reduce inequalities


• Increasing knowledge of unidentified illness/disease eg Health Checks

• Improving information for decision makers

• Evaluating interventions

Building the evidence base

• Introduced in 2006• 3 year project to monitor impact (NPHS/WCLD)• 10,000 aged 18+ on learning disability registers

2006/07• 6,450 invited, 2,910 checks undertaken• Wide variation between LHBs – invitations and

take up rate• Qualitative study in 2008 on users’ views

Health Checks

Sharing and Informing Practice

• Promote consistent evidence based practice and commissioning

• Policy Implementation Guidance on Mental Health in Primary Care

• Policy Implementation Guidance on Community Mental Health Teams

Inclusive Health Promotion and Screening Services

• Stop Smoking Wales (mental health)

• Screening programmes (learning disability)

• Nutrition network (mental health and learning disability)

A social model of healthA social model of health


Dr Neil Wooding Equality and Human Rights Commissioner for Wales

Neil was appointed as the Equality and Human Rights Commissioner for Wales in October 2007, having served as the Equal Opportunities Commissioner for Wales since 2002. Neil is the Director of Public Service Management Wales (PSMW), an organisation set up by the Welsh Assembly Government and public service organisations for the purpose of building leadership and managerial capacity. Neil has spent much of his career working with organisations across the UK to promote equality and human rights. Neil was the first Equality Adviser to be appointed in Wales and is a highly respected authority on issues of equality and human rights.

The Role of the Commission - Making Differences Count On 1 October 2007, the single Equality and Human Rights Commission, a statutory body with its function and role enshrined in statute, replaced the separate and former Equal Opportunities Commission, Commission for Racial Equality and Disability Rights Commission. The new Commission operates across Wales, England and Scotland and acts as an independent advocate with a responsibility to provide impartial advice to Parliament on equality and human rights. The largest offices are located in Manchester and London, Scotland and Wales. In Wales a statutory Committee supports the Commission with members drawn from all branches of public life to advise on the work to be taken forward.


Vision and Aims The vision of the Commission is twofold: it is first and foremost to create a society built on fairness and respect. This is about recognising that the platform we need to create to generate well-being, health, success and social prosperity across communities is this basis of fairness and respect. The second part of the vision is for people to be confident in all aspects of their difference. This is about recognising our differences as strengths and not as weaknesses or as a model for vulnerability and that being different is just part of the diversity of the communities in which we live. We will be strong if we embrace our differences, we will be weaker if we exploit our differences. The Commission was established to promote equality; to reduce inequality and to eliminate discrimination; and to strengthen good relations between people and promote and protect human rights. The creation of a single Commission was to try and recognise that actually people do not fall into separate compartmentalised categories. Someone may have a disability, but in addition to having a disability there will be other factors, which will fundamentally impact on the way in which they receive treatment and are treated by society. These factors can relate to their gender, their age, their sexuality, their religion, their social circumstances, the class into which they were born or their education. The immense richness of the diversity of people and their circumstances means that it is deeply problematic for us to think about individuals falling within one category or one framework. Getting people to think in a much more integrated way is a goal of the Commission. We hold on to rules, rituals, regulations and protocols and often the things that make us feel safe and reassured. Therefore, moving forward into a world where we have to think much more about how we integrate, how we risk some of our personal significance to deliver a broader and more effective outcome is deeply problematic for all of us. It is a challenge but it is fundamentally the vision of the Commission and at large it is a vision we are trying to generate across the wider society.


Creating a new Understanding of Equality and Human Rights We all know the right to fair and equal treatment is a fundamental human right. The real issue for us is how we integrate this human rights message with the wider equalities agenda. Part of the Commission's role is to move away from the very popularised misunderstanding and mythologies about human rights that are often portrayed through the media and reclaim a sense of human rights and what it means. We have undertaken research throughout the autumn and the earlier part of this year into perceptions of human rights. When someone explains what human rights mean, people see it as something that fundamentally impacts upon them. This agenda is very much about trying to create a new narrative and a new dialogue around what we mean by equality and what we mean by human rights. We cannot compete for equality. We have to find ways in which we do it collaboratively. We must try to promote a sense of knowledge and understanding, to encourage people to think beyond traditional habitual ways of looking at these issues. People need to challenge themselves, to be open to human rights ideas and to see the future in a different way to how they have seen it in the past. Without doubt the three Commissions over the last 30 years have made an enormous impact upon our understanding of equality and human rights. However, implicit in that legacy is the fact that we have failed to address fundamental inequalities in our society. We are a society that tolerates inequalities. We are not intolerant of the disadvantage and the detriment some people are served as a consequence of being born into this society. We actually allow it to happen and we have to recognise that to move forward we have to dispel that. These inequalities in our society are not personally tolerable and, from a community perspective should not be either. We want to create leadership around new ideas of equality. We want people to share in those thoughts and ideas and challenge some of the contestable notions around equality. We see all kinds of difficulties and challenges inside the wider equalities arena. There are challenging issues around faith and sexuality. There are challenging issues around belief and ideology and our right to express ourselves within our communities. We see issues around disability impacting upon issues of gender. All issues of contestation. There is nothing binary about this agenda, it is not black or white or right or wrong. There is an enormous grey area in Equal Treatment : Closing the Gap Page 37 of 52 Conference Report

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the middle and we have to challenge the complexity that often surrounds equality, to find clarity not just for ourselves but for people who need our support and our help in the wider community and who are most vulnerable. Narrowing the Gap in Inequalities The Commission’s three-year strategic plan will focus upon the concept of narrowing the gap. Narrowing the gap in terms of issues around disability, independent living, the economy, in the pay between men and women, in terms of the representation of disadvantaged vulnerable groups within public life in Wales and in terms of reducing the disadvantage caused by the delivery of public services. We must find ways that narrow the gap between the expectations and the rights of individuals to receive first-class public services and the current level at which they are being delivered. Having worked in public service for over 20 years there is what feels to me like a contradiction in public services. There are pockets of enormous success and the abstracts demonstrate groups of people working in a very dedicated visionary way to make services more effective. But we also know inside those same public services there are pockets of major inequality. We can create inequality just by doing nothing. What we have to do is find ways in which we uplift public services across the board in a consistent way, creating an intolerance inside public services that says it is not good enough unless we can deliver the very best public services and measure our success in terms of those who are most vulnerable inside our society receiving the service that most meets their needs. We can make Equality Happen Having started my career over 20 years ago inside public services as an Equality Advisor, it was very clear to me at those very early stages that we can make equality happen. All it required was sufficient conviction and commitment from all of us to make a difference. Two decades later we are still trying to summon up the energy and conviction to make those changes but we can do so. In Wales we can do it probably a little bit more quickly and a bit more effectively than we can see across the rest of the UK but we can do it and together we are going to do it.


ABSTRACTS AND AWARD WINNERS Conference delegates were asked to submit abstracts under the following categories: • Spread and Sustainability • Improving Access to Primary Care • Health Promotion The 23 abstracts received are listed on the following pages and are also available to view on the NHS CEHR website at www.wales.nhs.uk/equality. A panel of judges were asked to select the best abstract in each category. Four abstracts were chosen to each receive an award of £500. The Minister for Health and Social Services, Edwina Hart, AM, MBE, presented the abstract winners with their awards. Details of the abstracts received and the award winners are set out below: Category: Improving Access to Primary Care The winning prize of £500 was presented to: Dr Mark Boulter, Royal College of General Practitioners (Wales)

Developing a Pan Disability Training Package for Primary Care The project has developed a pan disability training programme that delivers key messages to primary care staff. The programme was developed by a core group of disability organisations including the


http://www.wales.nhs.uk/equality

former DRC and is hosted by the Royal College of General Practitioners. Funding to deliver the training to general practices using the protected time organised by LHBs was secured from the Welsh Assembly Government. The training includes an introductory video, the DRC video, ‘Talk’ and workshops delivered by disabled people on mental health, learning disabilities, hearing and visual impairments, the Disability Discrimination Act and the Social Model of Disability. A self assessment toolkit has also been developed to assist general practices to develop disability equality action plans. The toolkit can be accessed at www.equip-cymru.org.uk Feedback from the training has been very positive and further evaluation is planned. The project aims to develop further tools to be used by front line staff to develop their understanding and break down institutional barriers. Category: Spread and Sustainability There were joint winners in this category. One prize of £500 was awarded to: Patrick Riley, Human Resources Manager, North Glamorgan NHS Trust

Promoting Health Through Employment


http://www.equip-cymru.org.uk/

The Trust provides a pre-employment to incapacity benefit claimants living in Merthyr Tydfil. The aim of the course is to build confidence and skills of ‘job ready’ claimants to a level where they are able to meet the requirements of jobs within the Trust. Participants are typically long term unemployed, unskilled, from all age groups and want to work. The course is provided through a partnership between the Trust, Job Centre Plus, Working Links, Remploy and the Gurnos Neighbourhood Learning Centre. At the end of the course all participants are interviewed for real jobs by representatives of the Trust. Those not successful at interview are provided with a ‘soft landing’; for example, 6 weeks’ work experience within the Trust to enhance their opportunity for employment. Whilst on the course participants continue to receive their benefits and crèche facilities and transport are provided. Since May 2005, 110 participants have attended the course and 60 have found employment with the Trust. Category: Spread and Sustainability One prize of £500 was awarded to: Dr Nicola Lewis and collected on her behalf by Jill Evans, Gwent Healthcare NHS Trust

The Development of a Service User Panel within a Learning Disability Service


The aim of the project was to establish a Service User Panel to ensure that people with a learning disability are able to make meaningful

19 February 2008

contributions to improving service delivery within the Trust. The Panel meets twice a year with up to 12 service users attending each meeting, with support if needed. The meetings are co-facilitated by an advocate and accessible agendas, minutes and presentations are provided to ensure that everyone is able to participate. The discussions are fed into various Trust committees and project groups. The Panel has generated a number of issues they wish to address including: • making information about health services accessible to people with

a learning disability using pictures, DVD’s and tapes. Others include,

• involving people with a learning disability in staff recruitment interviews and training, and

• developing a website to inform people with a learning disability and their families about health services and the Service Users Panel.

Category: Health Promotion

The winning prize of £500 was presented to:

Stuart Whittle, North West Wales NHS Trust

Promoting Health in Men with a Learning Disability It is well documented that men are poor at addressing their own health needs. Men with a learning disability are no different in this respect, but are further impeded by syndrome related illnesses and constraints placed by their intellectual disabilities. The aim of the project was to address this imbalance by targeting men with a learning disability who Equal Treatment : Closing the Gap Page 42 of 52 Conference Report

19 February 2008

can manage their own health needs with accessible information and advice. For those unable to manage their own health, nurse-led clinics have been introduced that offer a full health assessment. The men’s groups are bilingually facilitated and cover a wide range of subjects from primary care to testicular examination. The sessions normally include between 7 to 12 men and are held in colleges, village halls and a town centre pub. To date, 12 groups have been completed reaching a total of 103 men. The nurse-led men’s health clinics are offered on an annual basis and are facilitated bilingually by two nurses and are held on health premises. A total of 28 men were invited of which 25 attended. Following the assessments, there were 52 onward referrals and 25 ‘pieces’ of advice/education offered to carers. Feedback from group members has been very positive. The Directorate’s Clinical Governance Co-ordinator is developing a case for the clinics to be rolled out across the Trust.


Abstract Submissions

Organisation Contact Name Abstract Title 001 North East Wales NHS

Trust Mai Rees A Practical Guide

002 Pontypridd & Rhondda NHS Trust and University of Glamorgan

Dr Paul D Davies The Physical Health Problems of Adults Living In The Community With An Enduring Mental Health Problem

003 North Glamorgan NHS Trust

Patrick Riley Promoting Health Through Employment

004 North East Wales NHS Trust

Mairead Fripps–Jones and Deren Jones

Ty Celyn Medication/Healthy Living Clinic

005 North Glamorgan NHS Trust

Lynne Roberts Healthy Minds, Healthy Bodies

006 Conwy & Denbighshire NHS Trust

Sam Loughran Fair Ground In Health Choice

007 North East Wales Health Liaison Service

Kim Scandariato Breaking Down Barriers

008 Gwent Healthcare NHS Trust

Dr Nicola Lewis The Development Of A Service User Panel Within A Learning Disability Service

009 North East Wales NHS Trust

Alison Corfield Supporting Women With A Learning Disability With Cervical Smears And Breast Tests

010 NPHS Judith Tomlinson Monitoring The Public Health Impact Of Annual Health Checks For Adults With A Learning Disability

011 Bro Morgannwg NHS Trust

Angela Jones Breaking The Mould: A Multi-Disciplinary Team Approach To Dysphagia Management In Adults With Learning Disabilities

012 ARC Cymru Mandy Tilston-Viney

Promoting Health To People With Learning Disabilities



Organisation Contact Name Abstract Title 013 Bro Morgannwg NHS

Trust Paul Sussex Removing The Barriers

Between Mental And Physical Health

014 Arfon Learning Disabilities Team

Joanne Carribine Promoting Health In Women With A Learning Disability

015 North West Wales NHS Trust

Stuart Whittle Promoting Health In Men With A Learning Disability

016 Nephrology Cardiff and Vale NHS Trust

Jean Jenkins Empowering Patients With Learning Disabilities: Developing Of A Visual Tool To Aid Pre Dialysis Education

017 Disability Services Cardiff

Prof Kathy Lowe, Dr Edwin Jones, Prof David Allen

Training In Positive Behaviour Support Impact On Staff Attitudes & Knowledge


David Allen, Carys Evans, Andrew Hider & Helen Peckett

Offending Behaviour In Adults With Asperger Syndrome


Prof David Allen, Sarah Hawkins & Ms Vivian Cooper

Survey On Family Access To Training In Physical Interventions


Dr Edwin Jones, Prof Kathy Lowe

It's Not Just What You Do, It’s The Way That You Do It: Putting The Theory of Active Support Into Practice

021 RCGP Wales Dr Mark Boulter Developing A Pan-Disability Training Package For Primary Care Staff In Wales: Initial Findings

022 Innovate Trust Jonathon Lee Venture Out Cardiff 023 Wrexham LHB Angela Roberts,

Helen Lewis, Clare Wilkinson

Coronary Heart Disease And Gypsies and Travellers, An Out Reach Approach

19 February 2008

INTERACTIVE WORKSHOPS Five workshops explored the Conference themes of ‘Spread and Sustainability’, Improving Access to Primary Care’ and ‘Health Promotion’. A summary of each workshop is provided below. Workshop 1 : How do we hold the gains from ‘good practice’ and how do we spread the learning? Up to 90% of projects do not lead to lasting benefits after two years. The very term ‘project’ suggests it is temporary. Even when changed practice has proven benefits, it takes forever to spread. In healthcare, ‘forever’ has been calculated as 17 years! The workshop used the practical example of a successful project being undertaken in North West Wales NHS Trust to promote the health of men. The workshop discussed how good practice can be more effectively transferred and sustained, a topic which challenges private and public sector work across the world. The discussion explored the reasons why good practice does not spread; the design failures which mitigate against sustainability and considered some simple rules for ensuring that gains are held. Workshop 2 : Improving Access to Primary Care With reasonable changes it is possible for primary care to meet the needs of people with learning disabilities and people with mental health problems. This workshop considered some of the access barriers that have been identified and explored ways in which they can be overcome so that greater equity of care is achieved. The workshop also shared the development of a pan disability training package for primary care staff in Wales and a self assessment audit tool to help general practices develop disability equality action plans. Workshop 3 : Developing Inclusive Health Promotion Strategies that Address Different Needs


This workshop shared the work of a 12-month pilot project called ‘Our Good Health’ undertaken in Anglesey in 2006/2007. The project aims were to identify and remove the barriers to maintaining a healthy heart for people with learning disabilities. As well as producing accessible resources and adding to best practice in this field, the project developed and piloted ‘The Happy Heart Group’ with the Community Learning

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Disability Team, a 7 week training programme for people with learning disabilities and their families. Workshop 4 : Bridging the Gap with Positive Behavioural Support This workshop shared the e-learning programme developed by the Directorate of Learning Disabilities Services Special Projects Team in Bro Morgannwg NHS Trust in Positive Behavioural Support. People with learning disabilities and challenging behaviour are at increased risk of social exclusion, abuse, inappropriate treatment, deprivation and systematic neglect. A report recommended that alternatives to inappropriate use of anti psychotic medication to control behaviour were essential. Positive behaviour support is the most up-to-date, evidence based set of procedures for working effectively with this very vulnerable client group. Workshop participants considered how: • positive behaviour support provides an ethically based technology

to translate contemporary service values into action • blended e learning approaches can bridge the gap between the

current skill shortage in services and the needs of people who challenge.

Workshop 5 : Models of Good Practice This workshop shared the development of the North Wales Health Trusts Learning Disabilities Network. As well as describing the effective collaborative work that is taking place in North Wales, a number of specific projects were shared during the workshop. These included projects that have developed:

• photographic teaching packs, clinical pathways, checklists and professional packs to support women with a learning disability to make informed choices about cervical smear and breast tests. This project has been undertaken jointly by community learning disabilities team of North East Wales NHS Trust, Breast Test Wales and Cervical Screening Wales

• a ‘Well Women Group’ which provides information in a safe,

relaxing, fun and engaging environment to cover a broad range of female related health and well-being issues. The sessions aim to give participants a better understanding of their bodies to enable


them to make more informed choices about their care and overall health

• songs to help give people with learning disabilities a better

understanding of their bodies and how to look after their sexual health.

Reflections and Key Messages Workshop participants were asked to identify and agree three learning points from each workshop. These were shared with Conference delegates in the plenary session, chaired by Phil Chick.


Reflections and Key Messages Phil Chick Mental Health Director, Welsh Assembly Government

Phil shared his reflections of the day, giving a summary of the key messages from the morning’s presentations and afternoon workshops:

“Equal Treatment Closing the Gap”Tuesday 19th February 2008

Reflections and Key Messages

Phillip ChickMental Health Director

Welsh Assembly Government

Reflections

Objective 1:Creating a climate for wellbeing:

Mental Physical

Reflections

Objective 2:

Reflections

Tackling Inequalities

People with severe and enduring mental health problems and learning difficulties are more likely to..

Phil provides professional advice to the Chief Executive of NHS Wales and the Policy Division on mental health matters working at the interface between Government and mental health services. Phil is a qualified social worker with experience in providing and commissioning local authority and NHS mental health services.


Be socially excludedEndure stigma and discriminationLive in povertyBe unemployed/dependant upon welfare benefitsHave insecurity of tenureEnjoy worse healthExperience worse health outcomesHave reduced life expectancy

Challenging Questions

Do health inequalities merely serve to compound the array of inequalities and discriminatory practices experienced by these vulnerable groups?

OrAre they a consequence of these inequalities and a lack of full citizenship?

Delivering WellbeingHealth in Mind and BodyRecovery approach

Person centredWhole person

Service user perspectiveI am not a diagnosis, I am a person with needs, wishes, aspirations and a desire for full citizenship and hope

Organisational obstaclesLow expectations for people with SMI or a learning difficultyLow expectations of people with SMI or a learning difficulty

DRC Recommendations

1: Action and Leadership

2: Planning and Commissioning

3: Empowering users

4: Registering with a GP

5: Psychiatric and primary care

6: Those living in residential care or secure settings

7: Exclusion on multiple grounds8: ‘Reasonable adjustments’ to services9: Health Checks10:Support for healthy living &

managing side effects of medication11:Training

Solutions

Systemic changeWholesaleLastingHigh impact

Attitudinal changeEducationTrainingAwareness raisingService user centred/lead

Workshop 1 - Spread and Sustainability

Good practice examples across Wales but often without:

Workshop 2 - Improving Access to Primary Care

General Practices are ensuring that:primary care services take responsibility for the physical well being of all - with regular reviews, andImprove access to GP practices and primary care centres

sustainable funding streamsstrategies to share learning, orintegrate into mainstream services

Workshop 3 - Developing Inclusive Health Promotion Strategies

Workshop 4 - Positive Behaviour Support for People with Learning Disabilities

Development of evidence-based training and information resourcesIntegrating the requirements of staff and user groupsE-learning to allow maximum access

Design care delivery with the users of the services in mindPositively identify and remove all barriers Focus on the physical health needs of people with learning disabilities


Workshop 5 - North Wales Learning Disabilities

Empowering users to:

Closing the gap

Reaching the tipping point Creating a climate of wellbeingCreating sticky messagesThe law of the few

understand their rights signpost to services availableDevelop programmes that support self management and improved health and wellbeing


Delegate Feedback The feedback was very positive, with the majority of delegates selecting a high rating in all categories. Many delegates were able to identify ideas and good practice to take back and share within their own organisations and networks. Selection of Quotes “As a conference and event organiser I will take back some of the ideas from the Conference which made it more accessible” “I will revisit disability and gender action plans to see the issues raised today are properly reflected in our organisational priorities” “A service user perspective is a key element in evaluating services” “Excellent speakers, opportunities to network, time to think” “Workshop was excellent, participation of audience was good and debate was lively” “Having the time to stop and take stock of where we are in delivering on the Recommendations in the FI. Thank you for creating the opportunity for this” “A very well organised Conference with information that met different needs” We would like to thank all delegates for supporting the Conference

and contributing to the workshop discussions.


equal treatment: closing the gap · 2015. 11. 14. · edwina hart, am, mbe, minister for health and...

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