Camden’s work on avoiding preventable hospital admissions for people with learning disabilities was inspired by two avoidable deaths of people with learning disabilities.
These deaths were reviewed via Learning Disability Mortality Reviews (LeDeR) and, subsequently, Safeguarding Adult Reviews for Mr V and Adult W. Through these reviews, Camden Council and its’ health partners working together through the Safeguarding Board, identified that there was a high level of expectation on social care providers in supported living settings to manage physical health risks for people with learning disabilities and, where staff lacked confidence to manage these risks, the result was high levels of attendance at A&E, ambulance callouts and avoidable deterioration in physical health.
Camden Council hosts the integrated learning disability service, CLDS, which worked with its’ local hospitals to identify data on admissions for people with learning disabilities. The Royal Free Hospital provided five years of data on admissions, and were able to identify repeat admissions, especially from supported living settings, for people with learning disabilities. Looking at the data helped confirm suspicions and clarify the size of the issue which was much bigger than previously thought in terms of both number of admissions and length of stay. Taken together, these factors helped create the appetite internally and with partners to do something about it.
This information will enable health and social care partners to identify common causes of repeat admissions and identify individuals who may be at risk of avoidable or repeat admissions, and work proactively to prevent these. The other hospital covering Camden, University College London Hospital, now has a new data collection system and is also able to flag admissions of individuals with learning disabilities, so anticipates being able to yield similar data. CLDS is now planning to use the High Impact Change Model to complete a detailed review of this data.
Learning from the recommendations of the Safeguarding Adult Reviews, CLDS worked with NHSE colleagues who recommended piloting the North East London Foundation Trust’s Significant 7+ scheme, in which social care staff are trained to recognise and manage the major signs of health deterioration and risks in residents. Significant 7+ was originally designed for use in care homes to prevent avoidable A&E attendances and acute admissions for complex and frail people with dementia who were unable to reliably describe their symptoms.
Alongside adopting Significant 7+, Camden’s learning disability commissioners made a strategic decision to improve its relationships with social care providers, which had previously been poor. Improving relationships with providers was instrumental in gaining the trust of providers that was essential in encouraging them to pilot the Significant 7+ project with CLDS. Without the full and enthusiastic engagement of Camden’s supported living provider partners, the project would not have been possible.
The use of Significant 7+ with providers of supported living for people with learning disabilities has been very successful. So far, it has been attributed to saving at least one life through early identification of the signs of sepsis, and has resulted in an overall reduction in 999 calls from supported living as staff are more confident and better able to take early action on signs of deterioration to prevent ambulance call-outs.
During COVID these strong and trusting relationships have better enabled CLDS to support providers during the pandemic. The CLDS was able to support providers to access and use PPE appropriately, and there have been no COVID-19 deaths in supported living in the borough.
CLDS is building on this progress and now plans to take further steps to support its care providers and empower their staff to manage risks and reduce preventable admissions:
- Camden is exploring a tele-health monitoring approach to allow supported living providers to link into GP systems, piloting the WHZAN Blue Box all-in-one telehealth system which helps to flag early signs of decline before an illness worsens,.
- Camden is beginning to use HealtheIntent, a platform that will link health and care information from different sources to create a joined-up record of patient information collected by different providers over time. It is hoped that by increasing the ease of information sharing, it will become easier to spot trends, concerns, or gaps in care – such as repeat hospital admissions as well as improving uptake of LD Annual Health Checks.
Camden is also planning to work with the Rapid Response District Nursing team to make sure people with learning disabilities get referred to Rapid Response if needed, and working towards creating a Nurse Prescriber post to create a link between GPs, CLDS and Providers, playing a key advisory role to GPs who often don’t have significant experience of working with people with complex learning disabilities
Andrew Reece, Head of Camden Learning Disability Service