Developing a complex health pathway for adults with learning disabilities

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A case study describing action by Northern Devon Healthcare NHS Trust and Devon Partnership NHS Trust to set up a complex health pathway for adults with learning disabilities.

What was the aim?

Devon-wide learning disability service structures and teams introduced in 2015 encouraged access to mainstream services while also providing highly specialist assessment, intervention and consultation from specialist teams. Working together, clinicians from Devon Partnership Trust and Northern Devon Healthcare Trust realised that effective co-ordination of specialist services depended on developing pathways.

What was the solution?

The complex health pathway for people with a learning disability provides a multidisciplinary co-ordinated approach that crosses service and organisational boundaries, improving outcomes for people with complex and multiple disabilities. Developed in 2017, it has been implemented across primary care, secondary care and specialist learning disability services. Its main features include:

  • a qualified case co-ordinator
  • specially developed screening tools covering pain awareness, postural care and dysphagia
  • a screening programme to encourage early diagnosis and referral to appropriate professionals/services
  • core group multiprofessional case co-ordination meetings
  • sharing essential detailed information to support access or admission where a learning disability hospital passport is insufficient: the electronic notes system provides detailed information on essential postural care, mealtime advice and a manual handling plan
  • robust review and discharge processes.

What were the results?

Better co-ordinated services have improved outcomes. For example, a client with profound and multiple learning disability and a history of distress, pain and insomnia had had ongoing problems despite intervention from different professions at different times. Through the pathway’s multidisciplinary co-ordinated approach, they are now pain-free, no longer distressed and have a regular night-time sleeping pattern.

What were the learning points?

  • Professionals combined under a single team name do not automatically produce effective, co-ordinated multidisciplinary working.
  • A clear pathway with screening tools and timeframes can support effective and efficient multidisciplinary services that cross professional and organisational boundaries.
  • Multidisciplinary core group meetings improve service co-ordination and professionals’ involvement. 
  • Agreeing and documenting clear and appropriate goals and outcomes focuses direction, ensuring what is important to the patient is delivered and not forgotten.

Want to know more?

Sue Mason, Physiotherapist Principal, suemason2@nhs.net

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