Quality statement 4: Annual health check

Quality statement

People growing older with a learning disability have an annual health check, which is used to update their health action plan.

Rationale

People with a learning disability have poorer health and a lower life expectancy than the general population. They may not recognise that they are unwell or may be unable to communicate how they feel. They may also develop conditions or face challenges that are associated with the learning disability. The annual health checks for people with a learning disability differ from NHS health checks and include a more specific and detailed examination of a person's physical and mental health. Carrying out these checks ensures that health issues are identified early, support can be provided promptly, and the person's health action plan is up to date.

Quality measures

A specific age limit is not used to define older people with a learning disability in this quality standard (see the definitions section). For measurement purposes, commissioners may wish to define a specific age group or range of age groups based on their local population.

Structure

a) Evidence of local arrangements to ensure that GP practices have an up-to-date register of people growing older with a learning disability.

Data source: Quality and Outcomes Framework LD004.

b) Evidence of local arrangements to ensure that GP practices offer annual health checks for people growing older with a learning disability.

Data source: NHS England Learning Disabilities Health Check Scheme.

c) Evidence of local processes to ensure that health action plans for people growing older with a learning disability are updated after the annual health checks are carried out.

Data source: Local data collection, for example, review of GP records.

Process

a) Proportion of people growing older with a learning disability who had a health check within the past 12 months.

Numerator – the number in the denominator who had a health check within the past 12 months.

Denominator – the number of people growing older with a learning disability.

Data source: NHS England Learning Disabilities Health Check Scheme.

b) Proportion of people with a learning disability who had their health action plan updated after an annual health check.

Numerator – the number in the denominator who had their health action plan updated after the health check.

Denominator – the number of people with a learning disability who had a health check within the past 12 months.

Data source: Local data collection, for example, review of GP records.

What the quality statement means for different audiences

Service providers (such as GP practices or community learning disability teams) ensure that they have an up-to-date register of all people with a learning disability and invite them to an annual health check. They also ensure that the health checks are followed by prompt referral to specialist services, if needed, and that the health action plan is updated after each health check. Service providers have suitable arrangements in place to ensure that any communication about the appointments and the appointment itself meet the needs of the person growing older with a learning disability. They also have a process in place to share relevant information with the person's named lead practitioner and people in their support network if appropriate.

Healthcare professionals (such as GPs or learning disability nurses) carry out annual health checks in people growing older with a learning disability. They understand how to communicate with them and what arrangements need to be made before the appointment. They also understand the potential for diagnostic overshadowing and carry out the health check without assuming that any new issues are linked to the learning disability. Healthcare professionals should also investigate any concerns raised by people from the person's support network and refer to specialist services whenever needed. Healthcare professionals should record any actions identified by the annual health check in the person's health action plan and share the health action plan with the person.

Commissioners (such as clinical commissioning groups) ensure that they commission services that have an up-to-date register of all people with a learning disability and understand the needs of their local population. They also ensure that local GPs carry out annual health checks in people growing older with a learning disability and record any actions identified in the person's health action plan.

People growing older with a learning disability have a detailed health check every year that includes looking for health problems that are more common in people with a learning disability. The results of the checks are added to the person's health action plan, which helps them to understand how to stay healthy for longer. People growing older with a learning disability are involved in putting this plan together and they understand what it says.

People from the person's support network (family, friends, carers, advocates or others who provide emotional and practical help to the person) are involved in an annual health check for the person with a learning disability. They can talk to the doctor or nurse if they have any worries about the person they support and help the health professionals see the person and not just their disability. They can also find out how to support the person to stay healthy and look after themselves as they grow older.

Source guidance

Care and support of people growing older with learning disabilities (2018) NICE guideline NG96, recommendation 1.5.12

Definitions of terms used in this quality statement

People growing older with a learning disability

A specific age limit is not used in this quality standard to define people growing older because adults with a learning disability typically experience age-related difficulties at different ages, and at a younger age than the general population.

[NICE's guideline on care and support of people growing older with learning disabilities, terms used in this guideline]

Annual health check for people with a learning disability

An NHS initiative for adults and young people aged 14 and over with a learning disability to provide additional health support and help to identify health conditions that could otherwise go undetected.

The enhanced scheme for providing annual health checks for GPs specifies details of the checks required, including that they should be undertaken by an appropriately trained provider and based on a protocol that as a minimum covers:

  • A collaborative review of physical and mental health with referral through the usual practice routes if health problems are identified. This includes conditions such as epilepsy and dysphagia.

  • A specific syndrome check.

  • A check on the accuracy of prescribed medications.

  • A review of whether vaccinations and immunisations are up to date, for instance seasonal influenza, pneumonia or hepatitis B.

  • A review of coordination arrangements with secondary care.

  • A review of transition arrangements if appropriate.

  • A discussion of likely reasonable adjustments should secondary care be needed.

  • A review of communication needs, including how the person might communicate pain or distress.

  • A review of family carer needs.

  • Offering support to the person to manage their own health and make decisions about their health and healthcare, including through providing information in a format they can understand and any support they need to communicate.

[NICE's guideline on care and support of people growing older with learning disabilities, NHS England's Learning Disability Annual Health Check electronic clinical template and Public Health England's People with learning disabilities: health checks audit tool]

Health action plan

A personal plan for people with a learning disability about how to stay healthy. It should detail what help and support the person needs to look after their health. This might include support to manage physical or mental health conditions, or actions to improve their lifestyle, such as changes to diet and exercise.

[NICE's guideline on care and support of people growing older with learning disabilities, terms used in this guideline]