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The need for leadership: the impact of health action plans for people with learning disabilities living in England

Smith, Susan Elizabeth (2012) The need for leadership: the impact of health action plans for people with learning disabilities living in England. Doctoral thesis (PhD), Manchester Metropolitan University.


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This thesis reports on the impact of the introduction of health action plans in learning disability services in England between 2001 and 2007. The research compares the experience of a learning disability service in the North West of England to the national position. A mixed methodology was adopted. Firstly the experience of health facilitators nationally was examined using a self administered questionnaire to gather a mix of qualitative and quantitative data. Two local focus groups were then held with local health facilitators. A further focus group was held for people with learning disabilities who had a health action plan. The overall finding was that leadership was a crucial factor in determining the success of policy implementation. Health facilitators identified that they were not always prepared in the role of undertaking health action plans. Training was most likely to be offered to non nursing staff, but nurses themselves identified that they did require training as this was, in most cases a new and additional part of their role. Furthermore, contradictions in roles often hindered the health action plan process for nurses. Differences between areas of the country included experience of training; methods of introduction of health action plans; people responsible for the health action plan; and eligibility for a plan. The monitoring and audit of health action plans was also sporadic and there was considerable difference in relation to what constituted a plan. Several key themes emerged from the research. Health facilitators commented that health improvements had been identified through the use of health action plans, with more improvements being noted where health screening had informed the process. Other benefits of the health action plan included improved communication with the person with a learning disability, between professionals and carers and between carers and families. Local practice mirrored that identified nationally, with good examples provided of improved health for people with learning disabilities and cooperation with some primary care professionals. In conclusion, the thesis identifies that there has been good practice in the implementation of health action plans and some evidence to suggest that they have helped improve health. Some practice, however, has been less positive and it is argued in the thesis that better leadership, more informed guidance, training and support would have maximised the benefits of the policy.

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