Health Promotion and Screening : Examples of Good Practice and Reasonable Adjustments

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1 Health Promotion and Screening : Examples of Good Practice and Reasonable Adjustments Improved access to mainstream services (reasonable adjustments): Date Service Location/Service April 2011 ongoing SU1 Goldhawk Road Surgery, High Street Dentist Dental Services on the high street which are not Specialist Services and which provide support for people with Learning Disabilities: Bush Doctors (GP) Service (SU) was referred to Community Learning Disability Nursing (CLDN) following a hospital admission. Supported to GP for annual health check and health action plan. It was discussed and agreed with the SU, GP and Community Nurse that SU can attend a high street dentist as he requested dentist local to where he lives. Supported by Community Nurse to register with high street dentist which was located beside SU s pharmacy where he attends regularly to collect his prescriptions. SU reported that he did not see a dentist as he did not have any teeth, although has dentures for approx. 15 years. He was unable to remember where he obtained the dentures from. Once he was supported by the CLDN to register with the dentist he told the nurse that it s good that the dentist is right beside my pharmacist, it s easy for me to remember where it is. I like the dentist and pharmacist, they help me. The dentist told me my gums were ok and he will help me get new dentures. That made me happy. The dentist said he will send me letters to remind me to go back for my dentures. I have my new dentures.

2 Improved access to mainstream services (reasonable adjustments): Date Service Location/Service April 2011 SU2 West London Mental Health Trust, Crisis Resolution Team Since August ongoing SU3 Chana Pharmacy (Harlesden) in conjunction with suppliers Nissan Pharmacy Good communication and joint working with Learning Disability Team (LD) to support SU during a period of acute mental ill health. Excellent person centred service. Weekly delivery of dosset medication which has helped SU s mother to manage her medication. Pharmacy have been very helpful and efficient whenever medication queries have arisen or changes to medication have occurred. Sept SU4 Chelsea and Westminster Hospital, Plastic Surgery Department Excellent support in terms of treatment and follow up. Good communication from Consultant to SU April ongoing Local housing provider for people with LD Boots Pharmacy Following number of safeguarding concerns in a residential provider the CLDN and the home manager made arrangements with the local BOOTS pharmacy to provide on site training for record keeping, dispensation and administration of medication. BOOTS pharmacy now provides on site training for new members of staff and if/when new medication is introduced, or if there are any further concerns. May 2012 SU5 Occupational Therapist (OT), Assistive Technology Service, Community Learning Disability Nurse (CLDN). Elderly lady living in her own flat. Her regular carer contacted the CLDN with concerns that the client was forgetting to take her medication or not taking the right medication at the correct time. Following joint visit between OT and CLDN, specialist electronic dosset box was ordered from Assistive Technology Service. The dosset box is programmed to signal the time when her medication is due and the alarm only stops when the client has taken the medication. Following this the CLDN nurse contacted the local pharmacy who dispenses the medication for the client and made arrangements for them to manage the dosset box. the system has been working effectively for over a year now, the pharmacist visits the client at home and refills her dosset box weekly. The client is continuing to manage her own medication and maintain her independence.

3 Improved access to mainstream services (reasonable adjustments): Date Service Location/Service Oct 2012 SU6 Palliative care team, GP, Dr. Jeffries, CLDN and local housing provider. SU diagnosed with primary and secondary cancer in Palliative stage, referred to the local Palliative care team and CLDN was allocated. Following contact with the allocated GP on request by the CLDN the GP referred to the local District Nurses team who visited the client on the same day. Following meeting between Palliative care nurse, CLDN and District Nurse, specialist equipment required was ordered (medical bed, pressure relief mattress and appropriate continence products). Due to the secondary cancer the SU requires specialist input from the District nurses to manage her continence needs, they agreed to be in contact daily. This enabled the client to remain in familiar environment and staff received appropriate specialist support that enabled them to support the client in end of life stage. Dec 2012 SU7 Chelsea and Westminster Hospital, Urologist Example of reasonable adjustment. SU was seen immediately at the designated appointment time and did not have to wait in the busy waiting area. The Urologist took time to explain the diagnosis and treatment plan to the SU, family and professionals supporting the SU. Also, responded immediately to request made by SU carer to investigate swollen finger (x-ray arranged immediately). May 2013 SU8 Hammersmith Surgery Excellent practice re Annual Health Checks. Minimum of 1 hour allocated and separate prior appointment for blood tests so that results are available prior to health check. Aug 2013 SU9 Hammersmith Surgery Reasonable adjustment. GP made arrangements for blood tests to be carried out at Charing Cross Hospital as this was expressed as a preference by SU.

4 Improved access to mainstream services (reasonable adjustments): Date Service Location/Service Aug 2013 to Oct 2013 SU10 Bush Doctors With CLDN support at Annual Health Check, need for Podiatry was identified and referral made to Milson Road which has led to significant improvement in SU s mobility. Sept 2013 Nov 2013 SU11 Community Respiratory Service (CRS) Reasonable adjustment. As SU would not have the cognitive capacity to complete further tests at home (Peak flow) a further referral was made to Charing Cross Hospital for full lung function test and chest x-ray before follow up with Community Respiratory Service. Comprehensive recommendations then forwarded to the GP and LD Service kept informed by CRS throughout. May 2014 Dec 2014 SU12 Mental Health Treatment and Recovery Team Excellent joint working with Learning Disability Service to provide seamless support to SU to prevent relapse and admission to hospital. This has led to a prolonged period of mental health stability. Previously disengagement from Services and non-compliance of medication led to rapid mental health deterioration and 3 x detentions under the Mental Health Act in a 12 month period. June 2014 SU13 Richford Gate Surgery/Options Day Centre Excellent joint working between Learning Disability Service, GP from Richford Gate Service and Options Day Centre to support SU with PMLD in terms of identifying and treating health needs ie suspected UTI and skin concern. Identified by Options, liaised with LDS and GP instantly agreed to reasonable adjustment of home visit and allocating a district nurse. Good follow up from the GP.

5 CVD/Obesity Date Service Aug 2013 SU14 - ongoing Location/Service Local Respite Unit Meals on Wheels Community Nurse SU has CVD and is morbidly obese. Partnership working with services is leading to improvements in his health: SU now has Care Package that includes 1:1 support at respite to encourage positive activity. Dietary/Health Promotion advice provided by Dietician and CLDN. Meals on Wheels (specific from advice from Dietician) service implemented.

6 Obesity Date April 2012 ongoing Service SU15, Transition Case Location/Service GP, Richford Gate, Community Learning Disability Nurse Central London Community Health Care Trust, Nutrition and Dietetic Service. Health improvement actions as a result of annual health check by GP: Referral to Nutrition and Dietetic Service by Healthy Living Clinic at Chelsea and Westminster Hospital at 18 yrs of age. Advice provided on diet and exercise, weekly weight check at clinic. Referral to local Gym, had Direct Payments agreed for support to attend daily. Also attends swimming at the Gym at weekends. Parent reported SU s physical and psychological well-being have greatly improved. This has continued and the individual is currently experiencing a significantly improved sense of physical and mental well being.

7 Diabetes Date June ongoing Service SU16 Location/Service Hammersmith Surgery/Practice Nurse/Barons Court Project SU has history of poor insulin compliance. Joint work with Practice Nurse and action plan for SU to attend surgery regularly and be observed administering insulin. SU s attendance at Surgery began to decrease. Joint working with LD Team, Hammersmith Surgery and Barons Court Project (with the consent/support of the SU) led to increased support to improve attendance. This included the Surgery telephoning Barons Court Project to remind the SU to attend if he missed an appointment. The SU is currently experiencing improved health and well-being. Epilepsy Date Service Location/Service Sept 2013 SU17 Chelsea and Westminster Hospital, Dental Dept Sands End GP Practice October ongoing SU18 Richford Gate Medical Practice LD Service May 2014 SU19 Richford Gate Medical Practice LD Service Medication to manage Epilepsy and anxieties to be reviewed, SU has severe LD and significant phobia of blood tests/needles. CLDN liaised with GP and Dental Consultant at Chelsea and Westminster hospital and blood tests carried out whilst SU undergoing dental treatment under General Anaesthetic to minimise anxiety to SU. SU has epilepsy and makes inappropriate calls to emergency services. Measures implemented by CLDN and SW (LDS) to improve appropriate monitoring and reduce inappropriate hospital admissions: Liaison with GP who offered fortnightly appointments with SU. Linkline support implemented Day centre/activities identified to improve quality of life for SU, reduce social isolation and enable monitoring of needs and support. Social Services increased care package at home. GP contacted the LD service to highlight concerns regarding the welfare of this client. GP, CLDN carried out unannounced home visit to meet with the client. At that point was established that the client has significant hoarding

8 October 2014 SU20 Brook Green Medical Centre LD Service problem and will require direct support from the social worker to clear her space and maintain her tenancy. Also chronic health problems were addressed and actions agreed. As a result the client is now comfortable to visit the GP practice and seek appropriate health advise with support from her support worker. LD Community Nurse contacted GP regarding SU. SU has several long term health conditions and refused to attend GP surgery. SU agreed to be seen by GP at home. Although the SU did not require an emergency home visits, GP visited him at home and fedback to LD Community Nurse.