COMMUNITY CARE POLICY

People With Learning Disabilities Living In The Community

People With Learning Disabilities Living In The Community

Introduction

In the last decade, the provision of community and hospital medical services has undergone rapid changes in many developed countries. In the UK, a number of recent healthcare reforms were intended to reduce the role of costly (and typically hospital-based) specialist service providers and to increase the scope of community medical services. As traditional referral routes and treatment responsibilities are redesigned and redistributed, “patient journeys” have become a particular focus of interest. Ideally, historical arrangements would not only be replaced by less expensive systems, but also by organisational structures, which would lead to improvements in the selection of patients referred to specialist services. This would focus limited specialist care resources on those patients who could benefit most.

The Abuse

Optimal “patient journeys” probably matter most in conditions or situations where patients may not be able to seek out the most appropriate services for themselves, for instance in the area of healthcare provision for people with learning disabilities (LD).

In some ways, the disestablishment of specialised LD residential care facilities has led the way for changes in many other areas of healthcare provision. For instance, in one area in the UK, 54% of people with LD lived in specialist hospital accommodation in 1983, and only 6% in 1995.1 This means that the examination of an established model of community care for people with LD may offer important insights into the potential benefits and pitfalls of similar healthcare delivery models in other areas.

The arrangements put in place for people with LD in Sheffield, UK, in the 1970s placed particular emphasis on the integration of people with LD into general healthcare services. In this model, most medical care needs are addressed in a community setting, and the General Practitioner (GP) becomes the primary medical point of contact. Usual care is supplemented by multidisciplinary Community Learning Disability Teams covering certain geographical areas and consisting of physiotherapists, occupational therapists, psychologists, speech and language therapists, social workers and specialist nurses in LD. Although these teams have no direct referral rights to care specialist services they are intended to ensure that all of the patients' healthcare needs are met, using the GP to secure access to specialist advice if necessary. The Community Learning Disability Teams belong to the Joint Learning Disabilities Service (JLDS), which is part of the community mental health service. It retains a small medical LD service staffed with one psychiatrist with an interest in LD and a seven-bedded assessment and treatment unit (ATU) with a primarily psychiatric focus. It is the remit of the ATU to provide assessment and treatment of individuals with significant LD with challenging behaviour or comorbid psychiatric disorders. There is no access to EEG or video-telemetry. The JLDS also has access to five beds on a general psychiatric ward for people with mental disorders and less severe LD. Finally there are 15 designated beds for individuals with LD and complex health needs, which form the health component of ...