Joint Strategic Needs Assessments (JSNAs): including information about people with learning disabilities

People with learning disabilities suffer inequities in health which start early in life and die sooner than the general population. They should be specifically included in JSNAs to identify current and future health and wellbeing needs in a way that will inform future service planning.

 

In 2017, around two-thirds (65%) of JSNAs included a section on adults with learning disabilities, up from under half of JSNAs (48%) in 2013. Far fewer JSNAs in 2017 (18%, up from 9% of JSNAs in 2013) included a section on children with learning disabilities or a section on older adults with learning disabilities (11% of JSNAs in 2013 and 2017).

 

We are currently writing guidance about sources of potentially useful information for JSNAs based on our latest analysis of JSNAs in 2017. In advance of this guidance, this is a quick update on where we’ve got to so far. Any suggestions for additional good sources of information for JSNAs concerning people with learning disabilities will be gratefully received via our usual email address, LDT@phe.gov.uk.

 

How many people in your area have learning disabilities?

Although there is no national register of people with learning disabilities, the regularly updated Public Health England Learning Disability Profiles include local information on the number of children and adults with learning disabilities according to education, adult social care and GP records.

In 2017, over two-thirds of JSNAs (68%) had some information on the number of adults with learning disabilities in their local area, and over two-fifths of JSNAs (42%) included information about the number of children with learning disabilities.

 

Health issues

NHS Digital publish data showing what GPs record about various aspects of the health and healthcare of people with and (where relevant) without learning disabilities, broken down by age and gender. Health issues covered include:

  • asthma
  • cancer
  • coronary heart disease
  • chronic kidney disease
  • constipation
  • chronic obstructive pulmonary disease
  • dementia
  • depression
  • diabetes
  • dysphagia
  • epilepsy
  • gastro oesophageal reflux disorder
  • heart failure
  • hypertension
  • hypothyroidism
  • severe mental illness
  • stroke or transient ischaemic attack

Data is available from 57% of GP practices and can be broken down by CCG locality using the interactive tool on the NHS digital website.

 

Annual health checks and cancer screening

Adults and young people with learning disabilities aged 14 or above should have an annual health check as part of a GP Enhanced Service scheme. In 2017, 16% of JSNAs provided information on annual health checks for people with learning disabilities. Information about the number of health checks completed in your area can be found in the regularly updated Public Health England Learning Disability Profiles.

Universal breast, bowel and cervical cancer screening are offered for populations in at risk groups. Relatively few JSNAs in 2017 (16%) included data on comparative screening rates on all three types of cancer screening for people with and without learning disabilities.

NHS Digital publish data showing what GPs record about various preventive health approaches for people with and without learning disabilities, including:

  • measurement of blood pressure
  • BMI
  • breast screening
  • cervical screening
  • colorectal cancer screening
  • flu jabs
  • in need of palliative care

 

Mortality

Two-fifths (40%) of JSNAs in 2017 included information on mortality and people with learning disabilities. The premature mortality of people with learning disabilities will be one of the priorities in the forthcoming NHS England 10-year plan, and is the focus of the Learning Disabilities Mortality Review Programme (LeDeR). This should, through local mortality review activity, provide important information for JSNAs.

 

Social determinants

Describing the social determinants of health inequalities is a vital component of a JSNA. In 2017, over half of JSNAs (58%) included some information about the social context of people with learning disabilities in their locality.

Information on the percentage of working age adults with learning disabilities getting long-term social care support who are in paid employment can be found in the Public Health England Learning Disability Profiles. Also available in these profiles are:

  • the proportion of adults with learning disabilities who are getting their long-term social care support in the form of a direct payment
  • the rate at which adults with learning disabilities are involved in Section 42 safeguarding enquiries
  • the percentage of adults with learning disabilities getting long-term social care support who are in settled accommodation, unsettled accommodation, severely unsatisfactory accommodation and whose accommodation is not known to their local authority

 

The visibility and accessibility of JSNAs

Our analyses of JSNAs to date have flagged up that the following would help them be more accessible to people with learning disabilities and families:

• all information about people with learning disabilities, if distributed throughout different parts of the JSNA, should also be pulled together into one easy to find document that is clearly dated
• the information on people with learning disabilities in the JSNA should be easy to find by members of the public
• accessible summaries of those aspects of the JSNA concerning people with learning disabilities should be included

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