Social Care For People Research Articles

New models of health and social care for people in later life: mapping of innovation in services in two regions of the United Kingdom using a mixed method approach

BackgroundInnovation for reforming health and social care is high on the policy agenda in the United Kingdom in response to the growing needs of an ageing population. However, information about new innovations of care being implemented is sparse.MethodsWe mapped innovations for people in later life in two regions, North East England and South East Scotland. Data collection included discussions with stakeholders (n = 51), semi-structured interviews (n = 14) and website searches that focused on technology, evaluation and health inequalities. We analysed qualitative data using framework and thematic analyses. Quantitative data were analysed descriptively.ResultsOne hundred eleven innovations were identified across the two regions. Interviewees reported a wide range of technologies that had been rapidly introduced during the COVID-19 pandemic and many remained in use. Digital exclusion of certain groups of older people was an ongoing concern. Innovations fell into two groups; system-level ones that aimed to alleviate systems pressures such as preventing hospital (re)admissions, and patient-level ones which sought to enhance health and wellbeing directly. Interviewees were aware of the importance of health inequalities but lacked data to monitor the impact of innovations on these, and evaluation was challenging due to lack of time, training, and support. Quantitative findings revealed that two thirds of innovations (n = 74, 67%) primarily focused on the system level, whilst a third (n = 37, 33%) primarily focused on the patient-level. Overall, over half (n = 65, 59%) of innovations involved technologies although relatively few (n = 12, 11%) utilised advanced technologies. Very few (n = 16, 14%) focused on reducing health inequalities, and only a minority of innovations (n = 43, 39%) had undergone evaluation (most of which were conducted by the service providers themselves).ConclusionsWe found a wide range of innovative care services being developed for people in later life, yet alignment with key policy priorities, such as addressing health inequalities, was limited. There was a strong focus on technology, with little consideration for the potential to widen the health inequality gap. The absence of robust evaluation was also a concern as most innovations were implemented without support to monitor effectiveness and/or without plans for sustainability and spread.

Erratum to The Characteristics of High-Quality Health and Social Care for People on Probation: Professional and Lived Experience Perspectives

Erratum to The Characteristics of High-Quality Health and Social Care for People on Probation: Professional and Lived Experience Perspectives

Associations between social determinants of health and comorbidity and multimorbidity in people of black ethnicities with HIV.

Social determinants of health (SDH) are important determinants of long-term conditions and multimorbidity in the general population. The intersecting relationship between SDH and multimorbidity in people with HIV remains poorly studied. A cross-sectional study investigating the relationships between eight socio-economic parameters and prevalent comorbidities of clinical significance and multimorbidity in adults of African ancestry with HIV aged 18-65 years in South London, UK. Multivariable logistic regression analysis was used to evaluate associations between SDH and comorbidities and multimorbidity. Between September 2020 and January 2022, 398 participants (median age 52 years, 55% women) were enrolled; 85% reported at least one SDH and 72% had at least one comorbidity. There were no associations between SDH and diabetes mellitus or kidney disease, few associations between SDH (job and food insecurity) and cardiovascular or lung disease, and multiple associations between SDH (financial, food, housing and job insecurity, low educational level, social isolation, and discrimination) and poor mental health or chronic pain. Associations between SDH and multimorbidity mirrored those for constituent comorbidities. We demonstrate strong associations between SDH and poor mental health, chronic pain and multimorbidity in people of black ethnicities living with HIV in the UK. These findings highlight the likely impact of enduring socioeconomic hardship in these communities and underlines the importance of holistic health and social care for people with HIV to address these adverse psychosocial conditions.

The characteristics of high-quality health and social care for people on probation: Professional and lived experience perspectives.

We investigated the characteristics of high-quality health and social care for people on probation and how they might be measured. Online open-ended survey responses and focus group data were analysed using thematic analysis. Providing high-quality care involves an understanding of the population's needs; tailoring practice to accommodate and meet individuals' needs; inter-agency collaboration; and seeking and acting on lived experience input. High-quality care is evidence-based and accessible and produces positive outcomes for people on probation. Foundations for achieving these outcomes are supportive, trusting and consistent supervisory relationships (working alliances) with professional practice that is sufficiently resourced, compassionate and person-centred.

Порівняльна оцінка профілометричних показників нижньої частини обличчя у дорослих пацієнтів з вродженими незрощеннями верхньої губи і піднебіння до і після ортопедичного лікування

Topicality. Despite the search for diverse options for medical and social care for people with congenital cleft upper lip and palate after surgical interventions in adulthood, there are still problems related to the specifics of orthopedic treatment for such patients that need to be resolved. An important criterion for evaluating the effectiveness and success of treatment of patients with congenital cleft upper lip and palate is the improvement of their quality of life in the process of complex rehabilitation. One of the possible options for improving the quality of life of such patients and their social adaptation is orthopedic rehabilitation using numerous options for orthopedic designs of dentures, which reproduce both functional and, in part, aesthetic capabilities. The aim of the study. To conduct a comparative assessment of the presence of facial profile aesthetics before and after orthopedic rehabilitation of patients with congenital cleft upper lip and palate after surgical interventions. Materials and methods. A comparative assessment of the aesthetics of the face profile before and after orthopedic rehabilitation of 37 patients aged 17 to 42 years with congenital cleft upper lip and palate (CCULP) after surgical interventions was carried out. Researched: ratio in the area of the frontal height of the face (N-Sn-Gn), nasolabial angle (C-Sn-UL), conducted lip analysis according to Ricketts, as well as the angle between the line that passed through points (N-Pog’) and Ricketts’ line (aesthetic line) and profile concavity angle (G-An-Pog’) before and after orthopedic treatment as a percentage of these indexes. Conclusion. The analysis of the parameters of the profile of the lower part of the face, in particular the parameters of the lips according to Ricketts and the nasolabial angle, testify that as a result of orthopedic rehabilitation of patients with CCULP, regardless of the type of nonunion, both fixed and removable (combined) prosthetics, the profile of the lower part of the face improved significantly, which affected aesthetic parameters of the face. Key words: congenital cleft lip and palate, maxillofacial anomalies, defects and deformities of the maxillofacial system, orthopedic rehabilitation of adult patients, orthopedic structures, photostatic analysis of the face profile.

Epidemiological Specificity оf COVID-19 Comorbidity

Numerous observations have proven the influence of COVID-19 on the formation of comorbid pathology; however, the patterns of this relationship and the epidemiological consequences have not been sufficiently studied. Combination of two or more diseases of the cardiovascular system is a predictor of adverse outcomes in stroke patients with coronavirus infection, both in the acute period and after hospitalization. Ischemic stroke in patients with COVID-19 is associated with an increased risk of severe post-covid syndrome. The negative impact of the obligatory lockdown on disease outcomes has encouraged the authors to search for new organizational solutions as well as to elaborate appropriate technologies aimed at optimizing medical and social care for people who had no choice but to follow lockdown rules. Obligatory self-isolation, anxiety-depressive disorders, and frequent negative outcomes among these patients require the adoption of new organizational decisions and the development of effective technologies aimed at optimizing medical and social care. The authors conducted an analytical analysis of post-infectious complications in patients with ischemic stroke complicated by COVID-19. The authors conducted a combined retrospective study. Measures for improvement of medical care in stroke patients with concurrent COVID-19 were presented.

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HEALTH AND SOCIAL CARE FOR ADULTS WITH FUNCTIONAL DEPENDENCE IN CONDITIONS OF COVID 19 PANDEMIC

The importance of Public Healthcare as a science originates from the measures in an integrated manner, targeted at the health of the public through prevention and extending life in good health. Home health care for elderly people with chronic illnesses and functional dependence is one of the priorities of the social politics of Bulgaria, through the creation of regulations for the interaction when organising and planning the support that supplies their health and social needs. in the competencies of nurses is the provision of health and social care for people with chronic diseases and functional dependence. The covid 19 pandemic has presented challenges in implementing nursing interventions. Due to the declared global pandemic on 19.03.2020 of COVID-19, many countries including Bulgaria, introduced strict measures for maximal isolation and social distancing with the aim of reducing transmission to the minimum. This presented an array of challenges for the teams, carrying out the activities for patronage care in the homes of the care receivers. Objective: To review and analyze the impact of the COVID 19 pandemic on changes in the daily activities of health care providers in the municipalities of Burgas region. Methods: documentary - research and analysis of information; sociological-anonymous survey; statistically. Results: developed and implemented additional module “Patronage Care +” with expansion of the target group of users and services provided; provided personal protective equipment and disinfectants to the multidisciplinary team providing care; not all project managers have provided antigenic tests for the teams; communication between the team and the GPs of the users - difficult; periodic briefings for compliance with anti-epidemic measures; Of the 41 nurses, 19.51% were quarantined with complaints and positive PSR tests - without hospitalization, and of the home nurses 26.23%. Vaccinated nurses - certainly 2 / project managers are not familiar /; ineffective medical waste management. Conclusion: The provisioning of health and social services and care is absolutely necessary for the maintenance of the quality of life of people with chronic illnesses with functional dependencies and under the existing pandemic situation; The care receivers are willing to accept alternative approaches for realizing the activities, providing them with quality of life even with their chronic ailments and degree of disability; The managers and coordinators of project “Patron care” have the capabilities and the resources to maintain the quality of the offered integrated health and social service; The absence of medical nurses in the teams of some municipalities in the Burgas region negatively affects the carrying out of activities of the project. The high percentage of nurses placed under quarantine and home nurses supports the tendency for lack of emergency and periodic instruction, i.e. unsatisfactory activity of the occupational medicine services.

What has changed in the experiences of people with mental health problems during the COVID-19 pandemic: a coproduced, qualitative interview study

PurposeWe sought to understand how the experiences of people in the UK with pre-existing mental health conditions had developed during the course of the COVID-19 pandemic.MethodsIn September–October 2020, we interviewed adults with mental health conditions pre-dating the pandemic, whom we had previously interviewed 3 months earlier. Participants had been recruited through online advertising and voluntary sector community organisations. Semi-structured qualitative interviews were conducted by telephone or video-conference by researchers with lived experience of mental health difficulties, and, following principles of thematic analysis, were analysed to explore changes over time in people’s experience of the pandemic.ResultsWe interviewed 44 people, achieving diversity of demographic characteristics (73% female, 54% White British, aged 18–75) and a range of mental health conditions and service use among our sample. Three overarching themes were derived from interviews. The first theme “spectrum of adaptation” describes how participants reacted to reduced access to formal and informal support through personal coping responses or seeking new sources of help, with varying degrees of success. The second theme describes “accumulating pressures” from pandemic-related anxieties and sustained disruption to social contact and support, and to mental health treatment. The third theme “feeling overlooked” reflects participants’ feeling of people with mental health conditions being ignored during the pandemic by policy-makers at all levels, which was compounded for people from ethnic minority communities or with physical health problems.ConclusionIn line with previous research, our study highlights the need to support marginalised groups who are at risk of increased inequalities, and to maintain crucial mental and physical healthcare and social care for people with existing mental health conditions, notwithstanding challenges of the pandemic.

Systemic safety inequities for people with learning disabilities: a qualitative integrative analysis of the experiences of English health and social care for people with learning disabilities, their families and carers

BackgroundFailures in care for people with learning disabilities have been repeatedly highlighted and remain an international issue, exemplified by a disparity in premature death due to poor quality and unsafe care. This needs urgent attention. Therefore, the aim of the study was to understand the care experiences of people with learning disabilities, and explore the potential patient safety issues they, their carers and families raised.MethodsTwo data sources exploring the lived experience of care for people with learning disabilities were synthesised using an integrative approach, and explored using reflexive thematic analysis. This comprised two focus groups with a total of 13 people with learning disabilities and supportive staff, and 377 narratives posted publicly via the feedback platform Care Opinion.ResultsThe qualitative exploration highlighted three key themes. Firstly, health and social care systems operated with varying levels of rigidity. This contributed to an inability to effectively cater to; complex and individualised care needs, written and verbal communication needs and needs for adequate time and space. Secondly, there were various gaps and traps within systems for this population. This highlighted the importance of care continuity, interoperability and attending to the variation in support provision from professionals. Finally, essential ‘dependency work’ was reliant upon social capital and fulfilled by paid and unpaid caring roles to divergent extents, however, advocacy provided an additional supportive safety net.ConclusionsA series of safety inequities have been identified for people with learning disabilities, alongside potential protective buffers. These include; access to social support and advocacy, a malleable system able to accommodate for individualised care and communication needs, adequate staffing levels, sufficient learning disabilities expertise within and between care settings, and the interoperability of safety initiatives. In order to attend to the safety inequities for this population, these factors need to be considered at a policy and organisational level, spanning across health and social care systems. Findings have wide ranging implications for those with learning disabilities, their carers and families and health and social care providers, with the potential for international learning more widely.

Assessing the reliability and validity of the ICECAP-A instrument in Chinese type 2 diabetes patients

PurposeWe aimed to conduct psychometric tests for the Chinese version of ICECAP-A and compare the differences between ICECAP-A and EQ-5D-3L for patients with T2DM and explore the relationship between clinical conditions and ICECAP-A through diabetes-related clinical indicators.MethodsData were collected from a sample of 492 Chinese T2DM patients. The reliability and validity of the ICECAP-A were verified. Exploratory factor analysis (EFA), correlation analysis and regression analysis were conducted for both the ICECAP-A and EQ-5D-3L.ResultsOur results show that the Chinese version of ICECAP-A has good internal consistency with an overall Cronbach’s Alpha coefficient of 0.721. The mean scores of ICECAP-A and EQ-5D-3L are 0.85 vs. 0.94. A weak correlation (r = 0.116) was found between the ICECAP-A tariff and EQ-5D-3L utility. EFA showed that although the five dimensions of the ICECAP-A and EQ-5D-3L scales were loaded into two different factors respectively. However, the two scales captured different dimensions of quality of life and can complement each other. The ICECAP-A, EQ-5D-3L, and EQ-VAS scores showed differences across different socio-demographic characteristics and clinic conditions groups.ConclusionThe Chinese version of the ICECAP-A capability instrument can be for assessing outcomes in adults with T2DM. It may capture more dimensions of QoL than traditional Health-related QoL (HRQoL) instruments and may be useful for economic evaluations of health care and social care for people with T2DM or other chronic diseases.

Arts, Disability and Crip Theory: Temporal Re-Imagining in Social Care for People with Profound and Multiple Learning Disabilities

People with profound and multiple learning disabilities (PMLD) are some of the most marginalised in society and are perceived to lack agency. This paper contests such a narrative, presenting findings from an innovative project in Scotland, UK, exploring the impact of artists working collaboratively with people with PMLD and their formal carers. Art is conceived as a social practice, a process, an embodied aesthetic and sensory experience that takes place between individuals. Theoretically, the paper adopts an original approach, combining crip theory, the capability approach and social pedagogy to re-imagine and re-position people with PMLD. The year-long qualitative study used data from reflective diaries (n = 111) and semi-structured interviews (n = 9) with artists, carers and management of a day centre. An Interpretative Phenomenological Analysis of these shared experiences was used. The results reveal an unsettling of prevailing norms and creative ways of doing and experiencing social care that is relational.

A grounded theory study on work related stress in professionals who provide health & social care for people who exhibit behaviours that challenge.

Providing direct health and social care services for people who exhibit behaviours that challenge can be a highly stressful occupation. Existing literature has suggested that there is a need to develop further theoretical understanding of how work related stress can be reduced in professions that consist of providing care for people who exhibit behaviours that challenge. The aim for this study was to use a Classic Grounded Theory approach to develop a theoretical framework to illustrate a common issue that could influence work related stress levels experienced when managing behaviours that challenge in health and social care settings. A series of focus groups and 1:1 semi-structured interviews were conducted to explore the articulated experiences of 47 health/social care professionals who provide care for people who exhibit behaviours that challenge. This led to the development of Therapeutic Engagement Stress Theory (TEST), which illustrates that the perceived capacity to therapeutically engage with people who exhibit behaviours that challenge is an issue that can influence the levels of stress experienced by health/social care professionals. TEST provides a framework that could be applied to identify specific factors that inhibit staff to successfully deliver caring interventions for people who exhibit behaviours that challenge, and also inform bespoke support mechanisms to reduce stress in health/social care professionals.

‘We’re Giving Them Choice Which Is Controlled Choice’—Care Managers’ Views on Finding Social Care Support for People with Learning Disabilities

Abstract Choice and control are pivotal in UK Government policy for achieving personalisation of social care for people with learning disabilities; however, little is known about the role care management plays in supporting people with learning disabilities finding social care services. This article explores that the support care managers provide people with learning disabilities, how care managers source and use information to offer choice in relation to accommodation and support, with a focus on people receiving managed budgets. Qualitative interviews with eight care managers from two local authorities in the South East of England were analysed using thematic network analysis, producing three global themes. The first ‘shaping choice’ describes the role of the care management process and assessments have in determining opportunities for choice. The gathering and interpretation of quality information is explored in the second global theme, highlighting the role of visiting settings to understand their quality. ‘Choice in principle’ is the third global theme, whereby the factors shaping choice come to be seen as choice akin to that anyone else has. These findings have implications for future policy and practice in relation to care management for people with learning disabilities.

Integrated health and social care for people with dementia and their informal caregivers, research results

Background: The Deltaplan for Dementia is a nationwide public-private initiative that aims to tackle and manage the growing problem of dementia by utilising innovative strengths in science, product innovation and healthcare including healthcare policy. The EU Joint Programme – Neurodegenerative Disease Research JPND aims to increase investment between countries in research on the subject of neurodegenerative diseases. Nationally and Internationally, clients, health-care professionals and researchers work together in networks to establish integrated care. MEETINGDEM, aimed to adaptively implement and validate the, inclusive Dutch Meeting Centres Support Programme MCSP for community dwelling people with dementia and their family carers in three EU countries Italy, Poland, UK. MCSP provides people with dementia a social club, and carers information, practical, social and emotional support. It is concluded that MCSP is transferable across countries and has quality of life and mental health benefits for people with dementia and carers against reasonable additional costs. Decidem aimed to improve advance care planning ACP in general practice. A training for GPs is developed in initiating ACP with persons with dementia. A single blind cluster randomized controlled trail was conducted to study its effects. The ACP training leads to a significant increase in ACP conversation and medical and psychosocial topics. These findings also indicate that people with dementia PWD are able to engage in a shared decision making process. Thereby this study contributes to the evidence on capabilities of PWD. Moreover, the ACP conversation contributes to the empowerment of PWD. We advocate implementation of this ACP training. Three projects related to network-based covering formal care and informal care services, and integration of the variety of these services available in dementia care: i- DementiaNet - Evaluation of Sustainability and self-organisation of network-based primary care. DementiaNet is a network-based approach to improve primary care for community-dwelling dementia patients. Initial evaluation has showed merits of this approach, and important insights in factors of successful delivery of network-based care; ii- The “GOUDMantel-project” aims to use the valuable experiences and knowledge of former informal caregivers to better support current informal careers; ii- Dementia-Friendly Society - improving and sustaining positive health of people with dementia and their carers by creating dementia-friendly societies. D. Opportunities and challenges to enhance the social network of home dwelling people with dementia and their family carers. Aims and Objectives: This workshop gives insight in results and ongoing research, including and policy on more integrated care on people with dementia. Format timing, speakers, discussion, group work, etc: Three presentations will be given. One on the network-level and two on the project level. We will discuss the results with the target audience.

Dynamics of sustainable integration of health and social care: A 20-year case study

Background: Change initiatives face many challenges, and only a few lead to long-term sustainability. One area in which the challenge of achieving long-term sustainability is particularly noticeable is integrated health and social care. Service integration is crucial for a wide range of patients i.e. people with complex mental health and social care needs. However, previous research has focused on the initiation, resistance and implementation of change, while longitudinal studies remain sparse. The objective of this study was therefore to gain insight into the dynamics of sustainable changes in integrated health and social care through an analysis of local actions that were triggered by a national policy. Methods: A retrospective and qualitative case-study research design was used, and data from the model organisation’s steering-committee minutes covering 1995-2015 were gathered. Thematic analysis was used to handle the data and the results were mirrored to the key elements of the Dynamic Sustainability Framework DSF. At the outset, the analysis was explorative and inductive to map the steering committee’s actions. The results were intended to illustrate trends and changes in integration over time and to serve as a basis for the following analysis, which was the application of DSF on the findings. This two-step procedure resulted in a thorough data analysis that facilitated identification of the empirical themes from the narrative description. Results: Four empirical themes was identified, firstly, shared structure and ongoing refinement, secondly, continuous learning, thirdly, cooperation as a guiding principle for management and finally service user centeredness. Thus, the development of inter-sectorial cooperation was characterized by a participatory approach in which a shared structure was created to support cooperation and continuous quality improvement and learning based on the needs of the service user. A key management principle was cooperation, not only on all organisational levels, but also with service users, stakeholder associations and other partner organisations. It was shown that all these parts were interrelated and collectively contributed to the creation of a structure and a culture which supported the development of a dynamic, sustainable health and social care. Conclusion: This study provides valuable insights into the dynamics of organizational sustainability and understanding of key managerial actions in order to establish, develop and support integration of health and social care for people with complex mental health needs. We conclude that service user involvement and regular reviews of service users’ needs are essential in order to adapt to their current needs. Another major finding was the continuous adjustment of the content of intended change in relation to context. Therefore, we conclude that continuous refinement of the change content might be more important for sustainability than detailed designing of the change ahead of implementation. As this study primarily addresses the steering committee decisions and actions, future research could build on our findings by including perspectives on organisational champions and the meaning of organising networks for achieving sustainability. As the knowledge on champions and networks increases, we stress that organisations and services adjust accordingly.

Promoting functional independence in people with Alzheimer's disease: Outcomes of a home-based occupational therapy intervention in Spain.

Nonpharmacologic therapies such as occupational therapy (OT) are promising for people with Alzheimer's disease (AD). However, more research is needed to better understand the effectiveness of home-based OT programs. This pilot study aimed to assess the effects of a home-based, high-intensity and multicomponent OT intervention on the activities of daily living of people with AD in Spain. The secondary objective was to examine its impact on the cognitive functions. A multiple-baseline intrasubject design was used. Twenty-one community-dwelling older adults with mild AD (mean age 78.6years) and their primary caregivers participated in a 12-week home-based OT program. This intervention was replicated for 8 weeks after a 1.5-month intervention withdrawal period. The intervention followed a holistic, biopsychosocial and client-centred approach and consisted of the following components: meaningful activities/tasks, cognitive stimulation, activation of psychomotor and sensory skills, home modification, caregiver counselling and training in daily living skills. Functional independence was the primary outcome (Barthel Index). The cognitive functions were assessed by the Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G). Data were analysed using nonparametric tests. Main results showed that after completing the OT program, 6.5months after the moment of inclusion, the level of functional independence improved significantly and the effect size was large. Moreover, there was a significant moderate-to-substantial improvement in several cognitive functions after each of the two intervention periods: place orientation, time orientation and attention/concentration. In summary, the findings give a great deal of information as a basis for further research. This study provides evidence that an intensive home-based OT intervention has a positive influence on daily activities and some cognitive functions, suggesting that this program may be beneficial as a nonpharmacological supplementary tool in health and social care for people with AD living in the community.

Understanding the dynamics of sustainable change: A 20-year case study of integrated health and social care

BackgroundChange initiatives face many challenges, and only a few lead to long-term sustainability. One area in which the challenge of achieving long-term sustainability is particularly noticeable is integrated health and social care. Service integration is crucial for a wide range of patients including people with complex mental health and social care needs. However, previous research has focused on the initiation, resistance and implementation of change, while longitudinal studies remain sparse. The objective of this study was therefore to gain insight into the dynamics of sustainable changes in integrated health and social care through an analysis of local actions that were triggered by a national policy.MethodsA retrospective and qualitative case-study research design was used, and data from the model organisation’s steering-committee minutes covering 1995-2015 were gathered and analysed. The analysis generated a narrative case description, which was mirrored to the key elements of the Dynamic Sustainability Framework (DSF).ResultsThe development of inter-sectoral cooperation was characterized by a participatory approach in which a shared structure was created to support cooperation and on-going quality improvement and learning based on the needs of the service user. A key management principle was cooperation, not only on all organisational levels, but also with service users, stakeholder associations and other partner organisations. It was shown that all these parts were interrelated and collectively contributed to the creation of a structure and a culture which supported the development of a dynamic sustainable health and social care.ConclusionThis study provides valuable insights into the dynamics of organizational sustainability and understanding of key managerial actions taken to establish, develop and support integration of health and social care for people with complex mental health needs. The service user involvement and regular reviews of service users’ needs were essential in order to tailor services to the needs. Another major finding was the importance of continuously adapting the content of the change to suit its context. Hence, continuous refinement of the change content was found to be more important than designing the change at the pre-implementation stage.

The Learning Disabilities Mortality Review (LeDeR) programme

BackgroundSince the 1990s reports have consistently highlighted health inequalities faced by people with learning disabilities. Data from the Primary Care Research Database suggests an all-cause standardised mortality ratio for people with learning disabilities of 3.18, and that people with learning disabilities die approximately 20 years sooner than people without learning disabilities.AimThis presentation will provide an overview of the Learning Disabilities Mortality Review (LeDeR) programme. LeDeR aims to contribute to improvements in the quality of health and social care for people with learning disabilities in England through retrospective mortality reviews.MethodInitial reviews are undertaken of all deaths notified to the LeDeR programme of people with learning disabilities aged 4 years and over. Where indicated, a full multiagency review is conducted. Deaths of young people aged 18–24, and of people from Black and Minority Ethnic communities are subject to priority themed review; each of these receive a full multiagency review.ResultsThe LeDeR programme will be fully rolled out across England by the end of 2017. In this presentation we will share some of the learning from reviews that are particularly pertinent to GPs, and some of the service improvements that have resulted.ConclusionTo our knowledge, this is the first national programme of mortality reviews of people with learning disabilities in the world. Its focus is service improvement: it is about learning lessons and making changes to improve the lives of, and support for people with learning disabilities.

Equity in social care for people with intellectual disabilities? A cross-sectional study examining the distribution of social care funding across local authorities in England.

Many people with intellectual disabilities rely on social care provision, though little research has looked at how access to such provision is distributed nationally. Evidence from children's services suggests that there are large discrepancies between local authorities (LAs) in terms of the resources expended on interventions with children and families, which can be explained by variations linked to geographical location, namely the level of socioeconomic deprivation between LAs, constituting 'child welfare inequalities'. This study explored relationships between resources allocated to community services for people with intellectual disabilities in England and geographical factors, including deprivation, rurality and political leadership in the LAs where these individuals reside. Data were sourced from publicly available reports of spending of 151 English councils with adult social services responsibilities (CASSRs) for 2013-2014 and from CASSR index of multiple deprivation (IMD) scores and rurality for the same period. We found that more deprived LAs supported more people with intellectual disabilities, per 100,000 of population. We did not find effects for rurality or political party. However, it was not the case that more deprived LAs allocated more funds for expenditure on this group. These findings point to inequities in the distribution of social care resources for people with intellectual disabilities in England, as although more deprived LAs support more people with intellectual disabilities, they do not spend proportionally larger sums of money on this group. We discuss possible explanations for these findings and highlight the need for more research, particularly investigations about allocation of resources within LAs and more detailed explorations of how structural factors such as socioeconomic status of service users effects service access at the local level.