The PSC case-studies: entry

Understanding inequalities faced by people with learning difficulties

The PSC worked with Surrey Heartlands on a project to better understand the health inequalities experienced by people with learning difficulties and offered recommendations to reduce inequalities and improve lives moving forwards.

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The PSC’s project with Surrey Heartlands Health and Care Partnership analysed the impact of living circumstance and deprivation on the health inequalities experienced by people with learning difficulties in Surrey. This research informed recommended actions the system could take to mitigate these inequalities and improve life expectancy.

The PSC’s research included analysing GP Practice health data, living circumstance data, and publicly available datasets on deprivation, as well as lived experience engagements.

Understanding inequalities faced by people with learning difficulties

The Challenge

At the highest level, the challenge was that people with learning difficulties in Surrey were shown to be experiencing significant health inequalities when compared to the general population.

There is national momentum behind the goal to reduce health inequalities faced by vulnerable populations (for example, it is an explicit goal in the NHS Long Term Plan and the most recent NHS Mandate). Surrey Heartlands is particularly motivated to reduce the gap in life expectancy between people with learning difficulties and people without, which stands at 14.7 years for men and 20 years for women.

Furthermore, it was important to address the areas of living circumstance – for example, whether people with learning difficulties lived in a residential home, in supported living, or with their families – and deprivation. This was because the PSC’s previous work in Surrey had suggested that these could be a significant factors impacting the experience of people with learning difficulties.

Investigating these areas would create a better understanding of the experience of those with learning disabilities in Surrey and enable recommendations to be produced to tackle health inequalities and the life expectancy gap.


The Approach

Our approach to the data analysis was to develop hypotheses with the client and stakeholders for testing, as well as allowing inductive findings to emerge from the datasets in a more organic manner.

We analysed relationships between health inequalities, living circumstances and deprivation by mapping datasets to each other, and running correlation and regression analyses.

Our approach to the lived experience work in Surrey was to join existing forums, such as the Surrey Valuing People Groups, as well as running group interviews organised by Surrey Choices and Active Prospects. We also had phone interviews with carers and people with lived experience. We produced interview guides and Easy Read content with help and input from stakeholders, including a Surrey Heartlands social researcher.

Once we had collected key insights, we organised workshops with stakeholders from commissioning, Surrey and Borders Partnership NHS Foundation Trust, public health and primary care, to present findings and discuss recommendations of actions the system could take. We then synthesised findings and recommendations into a report.


The Impact

This piece of work largely focused on explorative research and thus success metrics centred on creating actionable recommendations to reduce the life expectancy gap. It was also about building confidence in leaders of learning difficulties teams to deliver high-priority transformational programmes and continuous service improvements, by actioning some key recommendations.

The outcomes so far have therefore centred on actioning further research into the inequalities highlighted.

Key findings included:

  • People with learning difficulties from the most deprived deciles suffer notably worse outcomes for smoking, diabetes and vaccination rates as compared to those from the least deprived.
  • For inequalities related to age of mortality, diabetes, BMI, and hypertension, the gap between those with learning difficulties and those without is greater for women than men.
  • People with learning difficulties who live in urban areas are significantly more likely to be overweight than those who live in rural areas.
  • People living in some form of residential care would be more likely to receive an Annual Health Check (AHC).

The deprivation levels of support staff for people with learning difficulties also affected the experience of people with learning difficulties themselves. For example, if support staff had high levels of deprivation, they were less likely to be able to drive people with learning difficulties to leisure activities in their local communities, or be able to support activities such as swimming.

These findings are leading to system-wide conversations. A discussion regarding AHCs for people with learning difficulties in Surrey Heartlands was convened in September 2022, to investigate how to better ensure those outside of residential homes received an AHC. This also reflects our success metric of building confidence of learning difficulties team leaders through discussions aimed at improving services and disseminating best practice. 


Client Feedback

"You're professional, slick, and organised. You do what you say you're going to do, and then do more without me having to ask... you're also really good at pre-empting what I'm going to ask!”

“On the lived experience side, people often find it quite hard to engage, but I have had lovely feedback about how warm, helpful, and inviting you have been, and what good conversations you've had.”

- Liz Williams, Joint Strategic Commissioning Convener (Learning Disability and Autism), Surrey Heartlands Health and Care Partnership

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