Promoting Health, Supporting Inclusion The National Review of the contribution of all nurses and midwives to the care and support of people with learning disabilities v. u k SCOTTISH EXECUTIVE Working together for a healthy, caring Scotland
The Scottish Executive is working towards developing integrated policy that reduces inequalities in health and improves the lives of all people across Scotland. Central to this effort is a commitment to address the health needs of socially excluded and disadvantaged groups within society. People with learning disabilities are one such group. Children and adults with learning disabilities are people first, and have needs, dreams and aspirations like everyone else. They also have health needs like everyone else. To lead full and active lives as valued members of the community, they need to receive the services and support that will keep them healthy and enable them to participate fully in society. This means that where possible, people with learning disabilities should be able to use the same local services as everyone else, with some children and adults also benefiting from the provision of specialist social, health and education services. It is therefore necessary that actions required to improve health and reduce inequalities are supported by a strategic focus on planning, resourcing, knowledge and expertise. The National Nursing Review The National Nursing Review has been undertaken to reflect the important changes and developments that are impacting significantly upon the lives of people with learning disabilities and their families. The central aim of the National Nursing Review is to ensure that all nurses and midwives, wherever they practice, recognise the particular needs of people with learning disabilities and work towards promoting and improving their health. The review is set within the current context of the need to promote and enable social inclusion and address fundamental health inequalities and takes account of: > Policy > Health inequalities > Enabling social inclusion > Promoting health > Changing trends
The policy context The Scottish Executive has developed significant policies that focus on improving the lives of all people in Scotland. Some are aimed specifically at people with learning disabilities, while others focus on all the people of Scotland, including people with learning disabilities. The Same as You? The Scottish Executive published The Same As You? A review of services for people with learning disabilities in May 2000. The review is the first in-depth analysis of services and support for people with learning disabilities in Scotland for over two decades, and acts as a blueprint for services over the next 10 years. The Same as You?, defined people with learning disabilities as having: a significant, lifelong condition that started before adulthood, that affected their development and which means they need help to: understand information; learn skills; and cope independently. Caring for Scotland Caring for Scotland: The Strategy for Nursing and Midwifery in Scotland, published in March 2001, recommended that this National Nursing Review be undertaken. Caring for Scotland recognises that all nurses and midwives have an important contribution to make by working in partnership across health, social and education systems to improve health and wellbeing. The National Nursing Review focussed on 5 key questions: > what are the nursing and midwifery contributions across the life course of people with learning disabilities? > what are the areas of best practice across Scotland, where nurses and midwives make a difference? > what will the contribution of nurses and midwives need to be in the future? > what are the education needs of nurses and midwives? > what are the continuing practice development and research issues for nurses and midwives?
Health inequalities People with learning disabilities have health needs like the rest of the population, yet frequently have poorer health. Their additional health needs are evident across the life course throughout childhood, adulthood and into old age. Assumptions have been made that health services have been meeting the full range of health needs of people with learning disability across the life course. In reality, they have never been adequately addressed. Some health needs occur as a result of the learning disabilities, with additional complex needs requiring specific interventions and support from specialist staff, including nurses. For a small but significant number of people with very complex needs, highly specialised services will be required. After many years of neglect, their health needs are now considered a priority area. Changing trends Prevalence figures suggest that about 2 3 per cent of the general population 120,000 people in Scotland have some degree of learning disability. Around 15 per cent of these will have a severe learning disability about four per thousand of the population. Estimates suggest a cumulative annual increase of about 1 per cent in the prevalence of learning disabilities over the last 35 years. People with learning disabilities are living longer as they benefit from advances in health care, better access to health services and improved social care. Promoting health and social inclusion As the largest group of care providers in NHSScotland, nurses and midwives have a vital role in ensuring people with learning disabilities have their health needs met and gain access to services. All nurses and midwives not just those who have chosen to specialise in caring for people with learning disabilities need to work in partnership with people with learning disabilities and their family carers across health, social and education systems, in order to promote health and support inclusion.
Meeting needs with the Tiered Model People with learning disabilities need to access a variety of health services, ranging from everyday services such as primary care to those that are more specialised. Tier 0 Tier 1 Tier 2 Tier 3 Tier 4 All Tiers Community, public health and strategic approaches to care Community, public health and strategic approaches aim to promote the general health and wellbeing of all people to care with learning disabilities in all settings in the community. This includes public health and specialist nurses working with communities and local services to promote involvement, social inclusion and raise awareness. A strategic approach is required to identify health needs to inform evidence-based care. Primary care and directly accessed health services Health services must enable access for all people with learning disabilities to primary care services and directly accessed health services such as community pharmacy, dental and optician services. Health services accessed via primary care These are health services accessed via primary care and which support and enable primary care to meet general and additional health needs by providing appropriate assessment, treatment and specialist advice. Such services include outpatient, domiciliary and in-patient services delivered from general hospital services, and include palliative care. Specialist locality health services Specialist learning disability/mental health/child health services are usually provided on a locality basis. These services work to support primary care services and others by providing advice, assessment, interventions and treatments for complex specialist learning disability health needs. Specialists provide advice and practical support to people with learning disabilities, their families, and to local authority or voluntary sector providers such as schools, day services and short breaks services. Specialist area and regional health services These are specialist area and regional health services. They might be highly special assessment and treatment in-patient units, or area-wide specialist Additional Support Teams for people with complex challenging needs, or forensic services for people with learning disabilities. They may be in-patient as well as in-reach models of care. Working across all the Tiers Working across all the Tiers is the need to improve care by the education of all nurses and midwives, the monitoring of care and improve standards by undertaking research.
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