www.england.nhs.uk Building the Right Support for Learning Disabilities Turning improvement ideas into local action Kia Oval, Surrey County Cricket Club, London SE11 5SS 19 July 2016
Jan 21, 2018
www.england.nhs.uk
Building the Right
Support for
Learning Disabilities
Turning improvement ideas into
local action
Kia Oval, Surrey County
Cricket Club, London
SE11 5SS
19 July 2016
www.england.nhs.uk/learningdisabilities
Stopping over
medication of
people with
learning
disabilities
and autism
June 2016
www.england.nhs.uk/learningdisabilities
Thankyou for inviting us
David Branford
Carl Shaw
Ben Briggs
Learning Disability Programme
NHS England
www.england.nhs.uk/learningdisabilities
• Background to this work
• Why is this work important?
• The aims of STOMPLD
• YOUR role in this
What we’re going to talk about
www.england.nhs.uk/learningdisabilities
This work is part of Transforming Care
There are 6 partner organisations, and
48 local Transforming Care Partnerships.
We all work with people with learning
disabilities, families and services.
We want to:
1. Reduce the number of people in
learning disability and mental health
hospitals
2. Reduce how long people stay in these
hospitals
3. Improve the quality of care and
support for people in hospital and
community settings
www.england.nhs.uk/learningdisabilities
Medicines Programme Structure
Medicines Oversight Group
(Chaired by Hazel Watson)
Provides oversight, scrutiny and advice on the
work of the delivery group
Medicines Delivery Group
(Chaired by Anne Webster)
Responsible for delivering on the work set out in
the STOMPLD Project Plan, including
communications, TCP delivery of STOMP and
engagement with a wide range of stakeholders
Learning Disability
Programme Board
and Transforming Care
Assurance Board
Hazel Watson-
Quality Assurance and
Health Inequalities Work
stream Lead
www.england.nhs.uk/learningdisabilities
So what’s it all about?
www.england.nhs.uk/learningdisabilities
Psychotropic medication?
• Medication for psychosis –antipsychotics
• Medication for depression –antidepressants
• If people have psychosis or depression these medicines can be really helpful
When is it a problem?
• Too much
• Too many
• Too long
• Giving prescriptions without finding out what is wrong
• Using it to manage people’s behaviour
Problems of over-medication
www.england.nhs.uk/learningdisabilities
Ann and her son who was at
Winterbourne View Hospital
It was 3 years before he went home
This is why we’re here
www.england.nhs.uk/learningdisabilities
• If you are drugged up, you can’t
communicate with people properly
• The world passes you by
• It can make your behaviour more
challenging in the long run
• It doesn’t help you learn or change
• It doesn’t help you get out of
hospital, the opposite in fact
• People shouldn’t be living like that
A human rights issue
www.england.nhs.uk/learningdisabilities
Why?
There’s usually a reason:
• Not listened to or understood?
• Abuse or trauma?
• Unable to deal with feelings?
• Too much physical restraint?
• Too little contact with others?
• Poor relationships with staff or
patients?
• Pain or illness?
• Is medication always the answer?
www.england.nhs.uk/learningdisabilities
Figures from Public Health England
Think of 100 adults with learning
disabilities
• Doctors are prescribing
antipsychotics for 17of those
people
• Doctors are prescribing
antidepressants for 17 of those
people.
www.england.nhs.uk/learningdisabilities
• 7 people are being prescribed both
• Only 4 of those 100 adults with learning disabilities have psychosis
• Fewer than 7 people have depression
• 16 are taking one or other drug and don’t have either a psychosis or depression
Figures from Public Health England
www.england.nhs.uk/learningdisabilities
Medicines Project Core Message
Public Health England estimates that
every day 30,000 to 35,000 adults
with a learning disability are being
wrongly prescribed an antipsychotic,
antidepressant or both.
Unnecessary use of these drugs, puts
people at risk of significant weight
gain, organ failure and even
premature death.
www.england.nhs.uk/learningdisabilities
Time to change - STOMPLD
• This is about improving people’s lives
• This is about helping people live
longer and giving families more time
with their loved ones
• This is about stopping the use of
these drugs to manage people’s
behaviour
• Stop Over Medicating People with
Learning Disabilities - STOMPLD
www.england.nhs.uk/learningdisabilities
The STOMPLD PledgeThe STOMPLD pledge was signed at a
summit in London on 1 June by
• Royal Colleges of Nursing,
Psychiatrists and GPs
• Royal Pharmaceutical Society
• Challenging Behaviour Foundation
• British Psychological Society
• NHS England
• The Minister Alistair Burt
They have pledged to work together
and with people with a learning
disability and their families, to take real
and measurable steps to stop over
medication
www.england.nhs.uk/learningdisabilities
First steps – GP campaign
• As part of this, a new booklet for
GPs has been launched.
• It was written by NHS England and
the Royal College of GPs
• It encourages family doctors to
only consider psychotropic drugs
to manage behaviour when the
person is at severe risk of harming
themselves or others
• And only when all other options
have been explored
www.england.nhs.uk/learningdisabilities
STOMPLD is about more than….
• Better record keeping
• Better transfer of information about
medicines between GPs and specialists
(and everyone else involved)
• Ensuring people get a diagnosis
• Stopping prescription errors
• Although these are all important too
• It is about quality of life
www.england.nhs.uk/learningdisabilities
Over to you
What can you or your
organisation do to
stop the over medication
of people with learning
disabilities or autism?
www.england.nhs.uk/learningdisabilities
• Visit the NHS England website
• www.england.nhs.uk/learningdisabilities
For more information
www.england.nhs.uk/learningdisabilities
www.england.nhs.uk/learningdisabilities
Health and Social Care Information Centre
Learning Disabilities Census Report –
Further analysis England, 30 September
2013
• Survey responses were received from 104 provider organisations on behalf of 3,250 service users
• Over two thirds of service users (68.3% or 2,220) had been given anti-psychotic medication leading up to Census day. Of these, 93.0% (2,064) had been given them on a regular basis. .
www.england.nhs.uk/learningdisabilities
http://www.cqc.org.uk/sites/def
ault/files/20160209-
Survey_of_medication_for_det
ained_patients_with_a_learnin
g_disability.pdf
www.england.nhs.uk/learningdisabilities
Data from CPRD General Practice
prescribing study
www.england.nhs.uk/learningdisabilities
Data from CPRD General Practice
prescribing study
www.england.nhs.uk/learningdisabilities
www.england.nhs.uk/learningdisabilities
Make psychotropic medication the
last resortThe NICE guideline [NG11] Published date: May 2015 ‘Challenging
behaviour and learning disabilities: prevention and interventions for
people with learning disabilities whose behaviour challenges’
• Consider antipsychotic medication to manage behaviour that challenges only if:
• psychological or other interventions alone do not produce change within an agreed time or
• treatment for any coexisting mental or physical health problem has not led to a reduction in the behaviour or
• the risk to the person or others is very severe (for example, because of violence, aggression or self-injury).
• Only offer antipsychotic medication in combination with psychological or other interventions.
www.england.nhs.uk/learningdisabilities
International guide to prescribing
psychotropic medication for the
management of problem behaviours in
adults with intellectual disabilitiesDeb S et al ,World Psychiatry. 2009 Oct; 8(3): 181–186
• The medication should be prescribed at the lowest possible dose and for the minimum duration.
• Non-medication based management strategies and the withdrawal of medication should always be considered at regular intervals.
• If the improvement of the behaviours that challenge is unsatisfactory, an attempt should be made to revisit and re-evaluate the formulation and the management plan.