Learning Disabilities

• Prevalence: There is an increase in the estimated prevalence of children with autism since the 2016 health needs assessment. This predicted the 2019 figure would be 746 but this profile estimates 1,316. Underlying prevalence has not changed significantly so this is likely due to adjustments made by Office for National Statistics (ONS) to population projections.

• Projected Trends: The key trend to note is the increase in the number of older people with Learning Disability and Autism (LD/A), and how this might impact on local service provision particularly around earlier onset dementia and frailty. There will be a greater need to develop skills around LD/A in health and social care organisations who provide care for older people.

• Numbers known to services: There is a significant discrepancy between the estimated population with LD/A and the numbers recorded on GP registers. This means that a high volume of people may not be receiving reasonable adjustments or support in order to access primary and secondary care services.

• Support from Schools and Children's Services: Of particular note is the number of children presenting with Autism Spectrum Disorder (ASD) in both secondary and special schools. Analysis of the children and young people (aged under 18) who access inpatient mental health beds in Cheshire and Merseyside shows that the majority (c.90%) have an autism only diagnosis. Improving the skill mix to support children with autism in education should be considered, given the increased prevalence.

• Children in Need (CiN): LD/A represents a substantial proportion of CIN who have a disability.

• Support from Adult Social Care: Wirral supports less adults with LD per head of population than Cheshire & Merseyside, the North West and England.

• The proportion of adults living on their own or with their families is lower in Wirral than in Cheshire & Merseyside but higher than England. It is consistent with the principles of Transforming Care.

• The proportion in paid employment is lower than both Cheshire & Merseyside and England. Across Cheshire & Merseyside there are a number of initiatives to encourage young people into paid work, through Supported Internships primarily. There is a real need to increase the pace and consistency of this work across the footprint.

• Although the number of Safeguarding (Section 42) enquiries involving people with LD has fallen recently the Wirral rate has been statistically higher than England from 2015/16 to 2018/19.

• Mortality Rates: The death rate across England for people with LD is four-times higher than the general population. The average across Cheshire & Merseyside has been consistently higher than the England average. In Wirral it has consistently been lower, although the rate is statistically similar.

• Screening/ Annual Health Checks: It should be noted that Health Checks are not offered to children under 14, or to people with Autism-only at present. This remains an area of significant challenge for Cheshire and Merseyside. In Wirral uptake has fallen. At 54.6% it is now higher than Cheshire & Merseyside average but below England.

• Obesity: The rate of obesity for people with LD is considerably higher in all Cheshire and Merseyside CCGs compared to those without LD. Work to address this would significantly improve life expectancy and co-morbidity. Areas should consider targeted work around the STOMP/ STAMP initiatives and physical health and exercise.

• Flu vaccination rate is low. Wirral has performed consistently worse than Cheshire & Merseyside and England. At 39.5% uptake, it falls some way short of the minimum 55% target and a significant way off the World Health Organization 75% ambition (those under age 65 in a clinical ‘at risk’ group).

• Cancer: The low screening uptake for cervical and breast screening for people with Learning Disabilities is considerable. Previous co-produced work has been undertaken by the Transforming Care Partnership in relation to identifying Cancer Red Flags and Looking After Your Lungs. A targeted campaign to improve screening could be considered.

• Long-term conditions: Commissioners should consider carefully the higher prevalence for epilepsy, severe mental illness, dementia, non-type 1 diabetes and asthma. Prevalence of depression is also high, at a similar level to those without LD.

Wirral Learning Disability & Autistic Spectrum Disorder Profile (July 2020) (prepared by CHAMPS on behalf of Cheshire & Merseyside partners)

• Learning Disabilities Update (July 2016)

• Previous Wirral JSNA: Learning Disabilities Update (March 2016)

• Previous JSNA Learning Disabilities Chapter - up to August 2013

• Merseyside and North Cheshire Health Needs Assessment for Learning Disabilities and Autism (March 2016) 

• Merseyside and North Cheshire Learning Disabilities and Autism Health Needs Assessment - September 2013 - Liverpool Public Health Observatory No. 94 in series 

• Learning Disability Profiles now on PHE gateway website 

• Health inequalities and people with learning disabilities
  The following topics have been added to the collection of summaries about the health inequalities people with learning disabilities experience: Cardiovascular disease, Diabetes Type 1 and Type 2, Hypertension, Menstrual issues, Mental health problems, Overweight, obesity and underweight, Physical activity, Respiratory disease, Sensory impairments, Sexual health and Thyroid disorder

The Local Offer sets out what is available for your child in your area if they have special educational needs and or a disability.Visit the Local Offer Wirral website to find out more.  The Local Offer will:

• How do we make Wirral a better place to live for people with a learning disability and their families? July 2016 Wirral Mencap Consultation Report
  Wirral Mencap has gathered data from over 160 people with a learning disability and/ or family carers to establish the main concerns and aspirations of people living in Wirral. The data includes information gathered via surveys, focus groups, accessible consultation exercises and statistical information from existing service provision.

• Challenging behaviour and learning disabilities:NICE guidelines (NG11) (May 2015)
  This guideline covers interventions and support for children, young people and adults with a learning disability and behaviour that challenges. It highlights the importance of understanding the cause of behaviour that challenges, and performing thorough assessments so that steps can be taken to help people change their behaviour and improve their quality of life. The guideline also covers support and intervention for family members or carers.

• Inclusive integration: how whole person care can work for adults with disabilities (Institute for Public Policy Research) (December 2014)
  This report focuses on the needs of working-age disabled adults. It looks at how, as health and social care services are increasingly integrated, the needs of these individuals can be protected and more effectively met.