The aim of this Joint Strategic Needs Assessment (JSNA) is to provide information on people with a disability across the life course. Many people with learning disability will also have physical and sensory disabilities. There is less emphasis on older people and people with long-term conditions, as these are areas covered in previous and (potentially) future JSNAs. The effects of social and environmental factors are considered; of which housing is the subject of another JSNA. While the needs of carers have not been considered in this JSNA, this important group will be the subject of a future JSNA.
Children with a disability
Children and young people with disabilities are a diverse group who access a range of different services, provided by both health and social care. It is therefore important that services are well joined up. The National Service Framework for Children, Young People and Maternity Services, expects local authorities, Primary Care Trusts (now Clinical Commissioning Groups) and NHS Trusts, to ensure that there are ‘arrangements to encourage multi-agency strategic planning of services for disabled children… which allow for development and implementation of a locally-based, multi-agency database, containing core data on disabled children, based on shared and agreed definitions’. There is no agreed definition for children with a disability across services. It is therefore difficult to plan and improve services for children with disabilities. Although this issue is not unique to Cambridgeshire, sharing information across services is needed in order to enable understanding of whether children with complex needs are receiving optimum care, for example, whether they have a key worker.
Transition to adult services
There is a lack of flexibility in the transition age from children’s to adult services and a need for joint planning across agencies in line with the Children and Families Bill 2012-13. Although work on this is underway in Cambridgeshire, there is no current strategic county overview and policy between children and adult services that describes the multi-agency approach required to support young people in transitions.
Adults with a disability
Within adult social care (physical and sensory):
- Delayed discharges from hospital have been identified as a result of delays in care packages being set up at home (this affects both adults and older people). However, it is not currently possible (using current data systems) to identify whether these individuals required re-ablement or support from the physical disabilities service, it is necessary to be able to identify this in order to understand the reason for the delay.
- Supporting those with the most complex needs requires joint working across sensory, learning disabilities, older peoples and complex care teams.
Accommodation for a Transitions/Move on Unit is needed to help those with an acquired brain injury or other disability where they need more support in their tenancy and community that enables them to move towards more independence.
A recent mapping exercise identified key gaps in the provision of services to people with hearing loss.
There will be a need to ensure good and timely community provision for adults with learning disabilities in out-of-county, in-patient settings, reviewed as per the Winterbourne view concordat.
Key to improving the health and wellbeing of people with learning disabilities is the ability for services to share information. This facilitates, for example, the delivery of the evidence-based GP Health Check. In their report on unnecessary hospital admissions, the Improving Health and Lives: Learning Disabilities Observatory recommended the following:
“GPs and community learning disabilities teams should collaborate in developing a local register of people with learning disabilities, identifying their NHS numbers, age and gender. This should be done on the basis of requesting explicit consent from subjects and carers, and ‘best interests’ agreements, where the individuals concerned are not able to understand. At a local level, this would permit proper epidemiological monitoring of condition-specific admission patterns.