learning disabilities: turning improvement ideas into local action (ben briggs)

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

http://www.england.nhs.uk/learningdisabilities


Thankyou for inviting us

David Branford

Carl Shaw

Ben Briggs

Learning Disability Programme

NHS England



• Background to this work

• Why is this work important?

• The aims of STOMPLD

• YOUR role in this

What we’re going to talk about



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



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



So what’s it all about?



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



Ann and her son who was at

Winterbourne View Hospital

It was 3 years before he went home

This is why we’re here



• 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



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?



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.



• 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



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.



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



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



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



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



Over to you

What can you or your

organisation do to

stop the over medication

of people with learning

disabilities or autism?



• Visit the NHS England website

• www.england.nhs.uk/learningdisabilities

For more information




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. .



http://www.cqc.org.uk/sites/def

ault/files/20160209-

Survey_of_medication_for_det

ained_patients_with_a_learnin

g_disability.pdf



Data from CPRD General Practice

prescribing study



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.



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.


learning disabilities: turning improvement ideas into local action (ben briggs)

Healthcare