Learning disability

Overview and key messages

There are several ways in which the term ‘learning disability’ can be defined, however for the purposes of this assessment, Learning Disability is defined as:

  • A significantly reduced ability to understand new or complex information and to learn new skills (impaired intelligence)
  • A reduced ability to cope independently (impaired social functioning); or
  • These are in evidence before adulthood and have a lasting effect on development.

The way in which the needs of people with a Learning Disability are met has changed over the last twenty years. People who would historically have been placed in institutional care are increasingly being supported to live in their communities. Health and social care services along with the third sector collaborate to maximise the independence and potential of those who use our services.

Although Autism is not a learning disability it has been included in this section as services for people on the spectrum are generally provided from within learning disability teams or community mental health teams and NICE guidance (2008, 2012) provides standards for provision of services.

 

 

Demographics and trends

  • In 2015 there were an estimated 1,483 people over the age of 18 with a moderate or severe learning disability in the West Wales region.
  • Carmarthenshire: 713
    Ceredigion: 305
    Pembrokeshire: 465




Demographics and trends

There is an expected significant rise in the numbers of people aged 65 and over with a learning disability.

Demographics and trends

Autism is a pervasive developmental disorder that is thought to affect 1 in 100 people in the population (Baird et al, 2006). The research shows that there is a high rate of co morbidity between Neuro-developmental disorders (ND) e.g. Autistic Spectrum Disorders (ASD)/Attention Deficit Hyperactivity Disorder (ADHD), and also of other mental health disorders. Research suggests that based on the population of Hywel Dda UHB:
  • 1% ASD, 2-4 % ADHD
  • 70% ADHD/ASD co-morbidity
  • 40% ASD anxiety disorder
  • 90% prisoners mental disorder including ND
  • 30% IP eating disorders have ASD
  • 40% specialist substance misuse ND
The current demand for the ASD diagnostic service is based on a pattern of referral which is likely to be an underestimation of the actual population’s need. Local data on referrals for ASD diagnostic services shows that for the period January 2013 – end of November 2015 there were 265 referrals. However, since April 2016, the service has received 99 referrals.

Current and future care and support needs

Across the region, numerous mechanisms are in place for engagement with users and carers to obtain their perspective on the care and support they would like to receive. Examples include:

  • Engagement events facilitated by Carmarthenshire People First in October 2015 to inform the development of Carmarthenshire County Council and Ceredigion County Council’s Equality Strategies, focusing specifically on the needs of people with a learning disability
  • Consultation in support of the development of Pembrokeshire County Council’s Strategy for People with Learning Disabilities in May 2016
  • Ongoing dialogue between service commissioners, providers and users and carers through local stakeholder groups in each county area.

Current care and support provision

A range of care and support services are in place across the region to support adults with a learning disability to live fulfilled lives within the community. Whilst specific care and support options vary across counties, current provision includes:
  • Universal services For example leisure centres, community centres, libraries, adult education opportunities although it is recognised that these services do not yet provide consistent equal access to people with LD
  • Preventative services Council grant funding supports the growth of alternative community services that are co-produced with members of communities enabling people to build upon their own individual strengths and resources. These include good neighbour schemes, luncheon clubs, community enterprises, community/ voluntary services
  • Specialist Health interventions Consultant psychiatry, psychology, community nursing, Speech and Language Therapy, Occupational Therapy and Physiotherapy provide specialist interventions to adults with a diagnosed learning disability both within in-patient and community setting
  • Specialist Health Autistic Spectrum Disorder Diagnostic and Pre/post Counselling Service The current service consists of allocated sessions from a locum consultant and a specialist practitioner
  • Day Opportunities Providing social contact and stimulation, reducing isolation and loneliness, maintaining and / or restoring independence, offering activities which provide mental and physical stimulation, providing care services, offering low-level support for people at risk
  • Pathways to employment A range of local initiatives including FRAME, Workways Plus, Stackpole Estate and ESTEAM in Pembrokeshire and Opportunities Team and ‘Steps’ in Carmarthenshire. In addition national programmes such as ‘Work choice’, run by the Department for Work and Pensions, support those with lower level LD
  • Respite provision Short breaks/respites is a key commitment in recognition that planned breaks are an essential part of supporting families
  • Commissioned Services Individually commissioned supported living arrangements which enable people with learning disabilities to live in their own tenancies with support at varying levels, and residential services which include both the provision of accommodation and care on site, with care being available 24 hours per day. These include a regional Shared Lives service, managed for the region by Carmarthenshire County Council and providing a route for people to return to their communities and is an example of an alternative to traditional residential services. Advocacy services are commissioned across the region; and
  • Direct Payments These provide another way for individuals to access a range of opportunities by being able to choose who provides the services they need
 

Assessment and care planning for people with a learning disability is managed through multi-disciplinary Community Teams for Learning Disability (CTLDs), in place across the region and staffed by health and social care professionals. The teams also work jointly with Disabled Children’s Teams and Transition Teams with occasional involvement from age 14 upwards and undertaking assessment when a young person in receipt of services reaches 17. Transition teams play a key role in supporting the transfer of care needs between one service and another, and typically between adult and children’s services. Data held by Data Cymru indicates that the reliance on residential care in each of the three counties is above the Welsh average. Pembrokeshire currently ranks third, Ceredigion sixth and Carmarthenshire eighth in Wales in relation to the proportion of people with a learning disability receiving care and support that are supported in this way.

Together we are committed to support people with individual needs live the life they choose. By providing a range of flexible care and support services we will ensure people with learning disabilities are as independent as possible and connected with their local communities.

From Model of Care and Support, Mid and West Wales Health and Social Care Collaborative (2015)

Gaps and Areas for Improvement

  • Improving the recognition, diagnosis and the treatment and management of people with neurodevelopmental disorders including ASD and ADHS
  • Empowering people with a learning disability to decide who provides their support and what form that support takes
  • Strengthening pathways back to local communities following education, and developing local education, volunteering and work opportunities in communities, making the necessary adjustments for people with a learning disability
  • Increasing access and availability of appropriate local housing and accommodation to enable people with a learning disability to live as independently as possible, in a place of their choice
  • Developing consistent, integrated commissioning and procurement processes that are based on co-production principles, which involve user-led community-based groups and fora in the design and delivery of services
  • ‘Right-sizing’ existing packages of care to ensure they meet current needs, facilitate personal development, increase independence and deliver cost-effective services that ensure best outcomes for service users
  • Developing a consistent, outcomes-based performance framework for service delivery across the region, utilising data to support future planning and commissioning