Heather Duff Project Manager Health Equalities Framework HEF

Heather Duff, Project Manager Health Equalities Framework (HEF) Learning Disability Managed Care Network South East Scotland Telephone: 01506 774753 Mobile: 07972247670 E-mail heather. duff@nhslothian. scot. nhs. uk

Data analysis HEF data has been aggregated on HEF’s completed by both CLDN & IP service nurses from the four NHS Boards. The population size of each of the boards is different Number of HEF’s completed varies: NHS Borders started in 2014. NHS Fife CLDN started Spring 2015 NHS Lothian CLDN’s started a rolling programme over 2015. NHS Forth Valley CLDN began use of the HEF in 2016. The three IP services began use of the HEF in 2016.

Data analysis The information captured is from May 14 – Dec 16. Demographic information gathered: gender, ethnicity, age, accommodation type Epidemiological data from pre determined info on the HEF. There are 5 determinants of health equality with a total of 29 indicator statements. The data collected averages the rating across all the indicator statements and provides an overall single average rating score presented as a percentage.

Number of HEF’s completed Amount of HEF’s completed: First HEF: 1, 208 Follow up HEF: 199 Final HEF: 185 Total: 1, 592 Baseline analysis is on the 1 st HEF’s: n=1208. Comparison data between 1 st and final HEF is based on a sub set: n= 147.

Total amount of HEF’s completed across board areas Borders: 449 (28. 2%). Fife: 311 (19. 5%), FV: 246 (15. 5%) and Lothian: 586 (36. 8%) 700 600 500 400 NHS Borders NHS Fife NHS Forth Valley 300 NHS Lothian 200 100 0 1 st HEF Follow up Final Total

Change in health inequalities Using average indicator scores reduction is noted from 1 st to final HEF for the sub set Coincidentally it could be inferred that similar is noted from the baseline data. 1 st HEF Final HEF Average score for the baseline full data report 30. 65 20. 28 Average score for the sub set 29. 53 19. 15

Gender count This is consistent with Scottish LD population Gender Amount of HEF’s % Females 556 46% Males 652 53%

Degree of learning disability count This is consistent with the UK LD population. 700 600 500 400 1 st HEF 300 200 100 0 Mild Moderate Severe Profound Not known

Ethnicity count 1 st HEF Asian British/other Black British White other Not known Other

Accommodation type count The three main types highlighted are “supported accommodation” “living with family carers” and “living in their own home”. 400 1 st HEF 350 300 250 200 150 1 st HEF 100 50 rte po Su p ed ar io n d ca r ac e co m pl ac od em at en t n iso Pr e m ho n he r Ow Sh Liv i ng w ith Ot rs ca fa m ily l in ta sp i Ho re el st m fo r ai et ld sp ita Ho al d ne es s el m Ho Ho e m ho re Ca Ca re ho m w e ith w ou ith tn nu ur sin rs in g g 0

Accommodation type by indicator scores Those with the highest average 1 st HEF score (greater amount of heath inequalities) from the baseline data fall into the categories of: homeless (42. 82) hostel (41. 38) prison (38. 36) care home with nursing (37. 17). However, from the analysis of the sub set (n=147)the highest average 1 st HEF score (greater amount of health inequalities) fall into the categories of: own home (31. 40) other (31. 03) hospital informal (30. 17) supported accommodation (29. 57).

Age count MCN > 46 = 566. 300 250 200 150 1 st HEF 100 50 0 0 - 15 16 - 25 26 - 35 36 - 45 46 - 55 56 - 65 66+

ry no ro Co e as ise r de so r t. D ar He gia sp ha Di Dy nc er tia n ai en Ca m c. P th t s en al He ni De e rin oc En d al ro Ch Or rm pa i ob le m se r en t ru ai Pr m g. I rin He a ry to ira sp ch el irm pa 800 Re he W ps y ile s m le ob Ep Pr le ce m tis t en en ob Pr l Im na l su a Vi tio tri Nu ep Sle nt in Co Au irm ur io tlh ea av eh pa l im ica ys Ph in g. B l. H ta en M ng le al Ch Health Inequalities by additional criteria pre-determined on the HEF tool Important to note patients can be scored on as many criteria as appropriate 1 st HEF 700 600 500 400 300 200 100 0

Health Inequalities by additional criteria pre-determined on the HEF tool Co-morbidities with a score of > 20% of the overall HEF’s are: Mental Health (57%) Challenging Behaviour (44%) Physical Impairment (26%)with an additional 10% wheelchair users Autism (26%) Continence (24%) Sleep (23%) Nutritional problems (21%)

Health inequalities by number of additional criteria from baseline data People with LD have multiple and highly complex long term health conditions reflecting the wider research on health inequalities. 450 400 350 300 250 1 st HEF 200 150 100 50 0 None One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve

Health improvement and reduction to the exposure to health inequalities There are five determinants of health inequality, the chart below provides data of the reduction noted from 1 st to final HEF across the five determinants from the sub set (n=147). Average for all determinants 1 st HEF score Final HEF score Reduction noted Social 33 24 9 Genetic & biological 33 17 16 Communication 33 23 10 Personal behaviour and lifestyle 26 18 8 Service quality 23 14 9 Weighted average 30 19 11

of dy Bo Ca Pl an s ice rv ed s ne Se of th re al He w vie ns Pl a n Aw ing Ad a ul re t. S ne up ss Ca po H ou re rt rs sin & Ab Pr ot g ilit e yt ct i o Re on Ca co Ri re g s rs Fa ky B nise ilu eh re av io to ur Re co gn ise M He edi ca al tio LD th S n cr Se ee rv ni ice ng Pr ov isi o Pr Fin n im an ar y/ ce Se s co Ba nd rri e ar y S rs er vic e Co s ns en Tr an t si Se xu tion Su al He bs ta nc alth e M isu se ck La n th et ns e Ne ps e He al Di t ice n ct ei gh sp o Re la Re n ta ho W e en t tio isa /C ity al gin on m cis er ge l. C ia pa c tio Re ca un i No m m Co Ca M ar So c Ex ga En average score out of 100 Areas across the 29 indicator statements within the baseline and sub set data with scores > 28% 60 50 40 30 20 10 0

Key messages from the analysis of the five determinants Determinant one Social, accommodation, activities, finance, social contact, marginalisation and safeguarding Determinant two Genetic and biological: mental and physical health, long term conditions, crisis/emergency planning and specialist LD provision Determinant three Communication five indicators Determinant four Personal lifestyle, exercise, weight, diet & hydration, substance misuse and sexual health Determinant five Service Quality and access Key message This determinant has the highest scores at 1 st HEF. Nurses feel less they are less able to influence access to accommodation, activities and social contact. Most overall reduction to the exposure of health inequalities is noted within this determinant. There is a smaller reduction noted in each of the five indicators: this requires to be explored further. Exercise, weight, diet & hydration have high scores; they are intrinsically linked and fundamental to good health. How doe we work in partnership with other to commission good care and inclusion of pwld within specialist and whole population health initiatives. Reduction in all areas notes however access to and quality of non health service scores highly on 1 st HEF in baseline and sub set data.

Planning and commissioning and public health There is a need to consider and identify how we continue to improve on how we provide health and social care services areas in a planned way strategic planning and public health colleagues to improve service delivery and better meet patient needs.