Debra Moore

1
Health action planning and health facilitation
Problems, progress and priorities

• Debra Moore
• debra_at_debramooreassociates.com
• www.debramooreassociates.com
• 07950 333884

2
Context

• The NHS is there when we need it most. It
  provides round the clock, compassionate care and
  comfort
• Lord Ara Darzi

• Witnesses described some appalling examples of
  discrimination, abuse and neglect across the
  range of health services
• Sir Johnathon Michaels

3
Am I bovvered?

• You are here!
• Main agencies and organisations have this in
  their sights and are here
• Lots of mainstream examples of good practice e.g.
  Sheffield
• Acknowledge competing demands and financial
  climate
• Recognise inevitable higher priorities and
  play our hand accordingly

Yes!
4
Health action planning health facilitation
Finding out..

• We met with a range of people at several events
  and canvassed view
• We heard about the issues emerging from research
  in this area
• We looked at good practice and what helped and
  what hindered
• We looked at VP targets in this area and issues
  relating to Learning Disability Partnership
  Boards
• Considered changes in the policy landscape and
  new mechanisms to support change e.g. JSNA

5
Health Action Planning and Health Facilitation
- what we heard

• VP Targets for health action planning and health
  facilitation not hit in many areas
• Many areas lack an up to date Action for Health
  Framework and lack local evidence, data or
  outcome measures
• Health has not enough air time at many Learning
  Disability Partnership Boards
• Some LDPBs dont have a health subgroup or its
  poorly attended or not right people there
• Some LDPBs failed to make the relationships with
  commissioners and providers of mainstream and
  specialist health services
• Ultimately undermines not just achievement of
  VP targets but ability to address DRC, Mencap,
  Michaels, Healthcare Commission audit etc etc etc

So has it been a missed opportunity?
6
Yeah, but no, but!

• What helped locally?
• Taking an honest but constructive approach
• Leadership - a critical factor
• Ownership by the mainstream
• Emphasising the wider benefits to all groups
• Involving people and families who have
  appropriate skills and knowledge in training
• Performance management SHAS, PCTs and
  Healthcare Commission
• Incentivising the system LES DES
• Seeing HF and HAP as part of a wider health
  agenda tools or means to an end rather than
  the end game

Lots of good practice examples so it can be
done!
7
What did people say?

• Good 11 health facilitators
• Know and trusted by the person
• Puts the person at the centre of plan
• Works closely with those who know and love them
• Know a lot about the persons health needs and
  wishes and rights
• Know how to access opticians, dentists, GP etc
• Good communicator
• Knows how to format a plan that is useful to the
  individual

• Good strategic health facilitators
• Good leaders
• Know about the health needs of people with
  learning disabilities
• Understand how health services are commissioned
  and delivered
• Can monitor and audit intiatives to reduce
  inequalities
• Can work across a locality and different agencies
  and services
• Understand mainstream and specialist health
  policy

8
What did people say Health Action Plans

• Dont have just one approach/format need to be
  useful to the person
• Need to have some documentation that looks
  similar that health professionals recognise e.g.
  grab sheets etc
• Provide training and resources for people and
  families as well as health and social care
  professionals
• Make good use of universal services
• Need to make sure health action planning it is a
  part of person centred planning (and CPA where
  appropriate)
• Style and format less important that explaining
  the plan clearly and ensuring actions take place

9
Primary Care Trusts some key messages from the
field

• Commission to improve outcomes - data and
  evidence and LD population needs and wishes
  should be seen within commissioning strategies
  and priorities
• Provide leadership within the PCT, at the
  Learning Disability Partnership Board and beyond
• Harness the expertise of specialist health
  provision and maximise contribution e.g. CTLDs
• Lead the delivery of the local Action for Health
  Framework and related strategies e.g. Green
  Light

10
key messages- continued

• Invest in posts that assist the PCT to deliver
  the changes required e.g. Strategic Health
  Facilitation and deliver provider support e.g.
  Acute Liaison Nurses
• Employ coherent data systems to monitor GP
  registration, the uptake of health checks and
  health action plans
• Make sure that local health policies and
  practices are assessed (Equality Impact
  Assessments).
• Undertake reasonable adjustments - including
  mental health and offender health services
• Utilise Primary Care Service Framework and
  associated tools

11
Learning Disability Partnership Boards need to
vaccinate against the Dibleys

• Have the right people at the Board and the health
  subgroup expertise and authority earn their
  place!
• Make sure they have a firm grip of the health
  agenda be business like!
• Have good evidence of what works and whats not
  working nationally and locally
• Have clear outcomes and develop locally relevant
  metrics that include social care and universal
  supports e.g. uptake in sport
• Harness the skills of people and families
  (especially those with more complex needs)
• Be decisive and get on with it - do what you can,
  where you can and do it now!

12
Action for Health Frameworks
13
Gearing up the different parts to work together
14

• Better health sits within a broader context
• We need to make sure everyone understands
• the implications for peoples lives and the
• achievement of their hopes and dreams
• This IS a matter of LIFE AND DEATH