Health Self Assessment Framework 2011/12 Learning Disabilities Health Self Assessment and Performance Framework An assurance system for Learning Disabilities

Health Self Assessment Framework 2011/12

Learning Disabilities Health Self Assessment and Performance Framework

An assurance system for Learning Disabilities and Autism

There are 3 tools to support local implementation: 1. Guidance pack: This explains the rational and the processes. It tells localities what needs to be done, by whom and the local timeframes for completing the self assessment framework. It also outlines any changes that have been made in the recent version of the benchmarking tool and any associated guidance notes and appendices.

2. The Self Assessment framework: this revised tool provides each local area with a nationally agreed benchmark to help assess their progress. The advantages of a national tool is that this is makes regions and localities comparable and allows the Public Health Observatory to analyse national data. The tool has been developed in partnership with all regions, commissioners and people with learning disabilities.

3.The feedback forms: Following previous exercises we have streamlined the feedback form which is now........

The process to complete the Self Assessment Framework is continues and should inform next years business planning

SAF 2010

The process in more detail

1. Nominated Lead: A lead should ideally be from the PCT, have a good knowledge of the mainstream health agenda, and have sufficient seniority to influence their provider and commissioner partners. Where this is delegated to the Learning Disability Lead in the Local Authority, such as a joint commissioner, then support needs to be provided from the PCT. The nominated lead is not expected to have all the answers but he or she has a crucial role in facilitating the responses.

2. Getting Ready Meetings: These are crucial so everybody has a clear understanding of their role. They are preparation for the Big Health Check Up Day. They will enable people with learning disabilities and family carers to have time together to think through some of the targets and objectives. They should be coordinated by the nominated lead. It would be useful to get a good written record of what people have said. People should bring that with them to the Big Health Check Up Day, and it should also be handed in so that it can be used in the feedback report to the SHA. The different targets often involve very different people, so it is useful to hold ‘target specific’ meetings. In London we will hold a number of central getting ready meeting to help localities. Flyers have been send out to self advocates and family carers.

3. Big Health Check Up Days: The aim of this day is to discuss and vote on the targets in the self assessment framework and identify actions to progress. This step is key in fulfilling the vision laid out in the White Paper ‘Local Democratic Legitimacy in Health’

Nominated Lead identified

Getting Ready Meetings

Big Health Check Up Day

The process in more detail 4. Collecting Evidence and Submission: the process followed should now enable the health lead

to fill out the self assessment framework with qualitative and quantitative information. The lead will benchmark their local progress against the national framework This is then submitted to the Strategic Health Authority (SHA). Any previously submitted evidence won’t need to be submitted again.

5. Validation: The Health Lead in the SHA will now critically appraise the scoring and evidence and provide feedback. A Validation Meeting will be held where a final agreement on the scoring will be made. In some instances additional evidence may be submitted to help reach agreement on the right scoring.

Collect Evidence

and submit

Validation meeting

Reporting and information flow Learning Disability Board co-ordinate the completion and sign off of

the LD SAF

The framework is submitted to the Strategic Health Authority

The final RAG rating is agreed post validation meeting

Local summary report completed

Regional Overview Report is

completed by SHA based on

all local reports

Overview Report

provided to Department of

health

Data and outcomes are

provided to the Public Health Observatory

Report submitted to Partnership

Board

Reporting to PCT Board

Reporting to Acute Trust

Board

Reporting to LD/ MH

specialist Trust Board

Report submitted to Safeguarding

Board

Report to Health and Well Being

Board

Briefing to GP consortium

Report to Local

Authority Cabinet

The Self Assessment tool as a benchmark:Target

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Target 2: Addressing Health Inequalities

Target 3: Keeping People Safe

Target 4:

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The benchmarking tool

The Self Assessment Tool has been adopted throughout the NHS in England, as the best way to review the capacity and capability or providers and commissioners. It has therefore become useful as a benchmarking tool, as well as an assurance tool.

It incorporates specific learning disability recommendations such as those outlined in:• Healthcare For All• 6 Lives and the provision of public services for people with learning disabilities• Valuing People Now• Bradley Report It is aligned with, and helps meet the requirements of, these wider legislative and policy frameworks :• Mental Capacity Act• Autism Bill• Disability Discrimination Act

The tool is framed around 4 health targets with 25 sub-objectives. There are three levels of achievement (R-A-G) and each level outlines what a locality needs to achieve and provide as evidence.

Evidence is required for each self assessment decision. It may be useful to categorise the evidence as: user experience; action plan and audit; or strategic policy and intention.

The framework is not static and reflects changes in the policy landscape. Explanatory notes and definitions will help you work through the targets. There is also a guide about key roles who could provide information and data for each of the targets.

Strategic

intention

Action Plan and

Audit

Experience

The self assessment framework provides assurance for the whole local health economy. Therefore

different people will be involved with providing evidence for the individual target.

The people who will help and should be involved will vary from locality to locality, but this will provide the nominated

lead with a broad idea of who to involve:

NHS campus Closure Project Managers

Joint Commissioners/ Commissioners with Learning disabilities in their portfolio

Person Centred Planning Officers

Care Managers

Finance Leads

The people involved need to ensure that supporting evidence is provided in a timely fashion so that this can inform the Big Health Check Up Day and the return to the Strategic Health Authority.

Target 1: People who are who were formerly in NHS provided long term care have settled accommodation that reflects their person centred plans and there is a system in place to ensure minimum of annual review

Target 1: People who are who were formerly in NHS provided long term care have settled accommodation that reflects their person centred plans and there is a system in place to ensure minimum of annual review

Sub target

Guidance Explanation

General T1.1 Top Target 1 has been re-worded in line with the wording of the National Indicator 145 : People in settled accommodation.

General T1.2 This definition superseded the previous definition. A campus is a service that is one and two and can include three:• NHS provided long-term care in conjunction with NHS ownership/management of housing (residents do not have an independent landlord and housing rights)•Commissioned by the NHS •People who have been in assessment and treatment services more than one year, who are not compulsorily detained or undergoing a recognised evidence based treatment programme

People living in such accommodation are technically and legally NHS patients. The following cases would not be enough on their own to exclude services from re-provision: the properties being small houses in a dispersed setting an NHS discharge process having been followed People who live in settings registered with CSCI are not campuses.

1.1 T1.3 Objective 1.1 about long stay hospital resettlement has now been removed from the framework. This year objective 1.2 campus became 1.1 and 1.3 became 1.2.

1.1 T1.4 For the purposes of this information collection, when someone has been in Assessment and Treatment for over 12 months, that person is automatically considered to fall within the revised campus definition – i.e. the definition starts to be applied to everyone at 12 months, and not at 12 months following completion of treatment in A&T

1.2 T1.5 This sub-objective covers all adults who are in hospital – both private and NHS, and both in and out of the local area. It includes everyone irrespective of the NHS funding ‘stream’ that pays for their care – e.g. NHS ‘Continuing Care’. It includes people who are under MH Act or Home Office Section and people who are in forensic and low or medium secure services. It excludes any individuals already being reported on under the campus target above.





GP practices and consortia

Wider Primary Care Team

Public Health

Strategic Health Facilitator

Acute Liaison Nurses

Acute and non acute commissioners

IM&T

Equality and Diversity Lead

Long Term Condition Lead

Community Learning Disability Team


Target 2: Health and social care commissioners are working closely with local Partnership Boards and statutory and other partners to address the health inequalities faced by people with learning disabilities.


Sub target


2.3 T2.1 Where appropriate, the standards in this document should be cross-referenced with regional Clinical Networks e.g. Cancer standards, and their linked performance review processes. This sub-objective is about cross referencing QOF registers in primary care to provide a picture of people with learning disabilities co-morbidity and access to health care.

2.3 T2.2 This is a new measure introduced this year to focus on ‘exclusions’ to cancer screening – e.g. where certain patients registered with GPs may be ‘ceased’ because they are not deemed to meet the criteria for such screening – and are therefore not invited for screening

2.5.2.6 T2.3 Sub-objectives 2.5 and 2.6 relate to the responsibilities of all commissioners - and to the agreements and contracts they establish with NHS providers of both LD specific and mainstream NHS services

2.5 T2.4 Following publication of the 6 Lives report into the provision of healthcare to people with alearning disability and the subsequent publication of Healthcare for All (2008) Monitor hasIncorporated, in the Compliance Framework 2010-11 a requirement that trusts are satisfiedthat the NHS foundation trust: fulfil the requirements relating to six key questions in CQC’s guidance ‘access to healthcare for people with a learning disability’ and self assessed themselves.


Sub target


2.7 T2.5 Examples here might include: electronic recording of health check; links to Easy Health; link between the Health Check and the Health Action Plan; flagging systems across primary and secondary care; explicit reference in overall local IM&T strategy to needs of people with a learning disability – both from clinical perspective and also in terms of making information accessible and clear to people.

2.9 T2.6 This sub-objective uses the Mencap definition of profound and multiple learning Disability: Children and adults with profound and multiple learning disabilities have more than one disability, the most significant of which is a profound learning disability. All people who have profound and multiple learning disabilities will have great difficulty communicating. Many people will have additional sensory or physical disabilities, complex health needs or mental health difficulties. The combination of these needs and/or the lack of the right support may also affect behaviour. Some other people, such as those with autism and Down’s syndrome may also have profound and multiple learning disabilities.

The self assessment framework provides assurance for the whole local health economy. Thereforedifferent people will be involved with providing evidence for the individual target. The people who will help and should be involved will vary from locality to locality, but this will provide the nominatedlead with a broad idea of who to involve:

Director Nursing

Safeguarding Lead

Partnership Boards

IMCA service and commissioner

Equality and Diversity Lead

MCA Implementer

Complaints and PALS teams


Target 3:People with learning disabilities who are in services that the NHS commissions or provides are safe

Target 3:People with learning disabilities who are in services that the NHS commissions or provides are safe

Sub target


General T3.1 References in some of the objectives have been refined. The Target includes references to the imminent national Safeguarding Self Evaluation and Assurance Framework

General T3.2 Evidence suggest that in period of change there is potential for an increase in incidents and safeguarding alerts. This target should be made a priority for local organisation to ensure robust safeguarding procedures are in place during this transition phase.

3.4 T3.3 For training relating to safeguarding adults, it is expected that training referred to should be available and provided to all staff in all organisations. Preventative safeguarding should include the use of communication passports, Health Action Plans or similar documentation .

3.4 T3.4 Evidence of assurance include the Safeguarding Adults Healthcare Self-assessment and Assurance Framework. This has been developed by SHAs in collaboration with clinicians and leads from across their regional networks. The framework draws on existing standards and inspection frameworks including The Care Quality Commission Essential Standards for Quality and Safety; ADASS standards for Adult Protection & and the proposed NHS Outcomes Framework. If not adopted equally robust assurance should be provided.





Mental Health Provider Mental Health Commissioner Children with Disability Team/ Children CommissionerTransition WorkersEngagement OfficersPublic HealthOlder People Commissioner Autism LeadChallenging Behaviour LeadWorkforce Lead/ Training Departments Offender Health/ Criminal Justice Team


Target 4: Progress is being made in developing local service for those needing more help to be healthy

Target 4: Progress is being made in developing local service for those needing more help to be healthy

Sub target


General T4.1 As Top Target 4 relates more specifically to the planning, commissioning and provision of services to people with more complex needs - the wording here has been altered this year to offer a more accurate description.

General T4.2 Following last year’s shift of Objective 4.1 to appear under Top Target 1 – this year’s numbering has been revised with the result that last year’s Objective 4.2 will now become 4.1; last year’s 4.3 now becomes 4.2, etc.

4.1 T4.3 Last year’s objective 4.2 has moved up to become 4.1 A new objective has been added this year (4.2) with a particular focus on people (aged 14+) receiving ‘health’ funded and/or provided short break or respite care. Numbering for objectives 4.3 to 4.11 is the same as before

4.1 T4.4 This is a new objective this year. It has been included to bring a vital, additional focus on young people (aged 14+) and adults who continue to receive short break care sometimes referred to as “health respite”. This may be provided by NHS or private sector hospitals; may be 100% health funded; may not form part of local joint health and social care short-break/respite strategic plans.

4.3 T4.5 This includes young people who currently receive support/care either in or out of district, and in both NHS and social/educational provision

4.6 T4.6 This applies to those over 65 years old

4.8 T4.7 Local Plans, strategies are based on the Royal Society of Psychiatry ‘s ‘Clinical and service guidelines for supporting people with learning disabilities who are at risk of receivingabusive or restrictive practices’’ , Challenging Behaviour Charter (Challenging Behaviour Foundation) or similar.

Glossary • Integrated Assessments – This means assessments of what a person needs, done by health and social services

employees as an official part of their job. The aim is that there is an up to date record of a person’s needs that everyone who is helping that person – and the person him/herself knows about and agrees with

• Person Centred Plans – This is a plan about a person and what that person wants to do with his/her life. It is flexible, and puts no limits to the person’s wants, needs and dreams in life. Making a plan brings together all of the people who are important to the person including family, friends, neighbours, support workers and other professionals – all to focus on that person

• A&T – Inpatient Assessment and Treatment services

• Campus provision – See the most up to date Department of Health Definition of this in the Appendices attached to the full Framework document

• PCT – Primary Care Trust. Primary Care Trusts buy and organise health services in local areas

• QOF – Quality and Outcomes Framework. This is a voluntary annual reward and incentive scheme for all GP surgeries in England. Its aim is to resource - and then reward - good practice

• HAP – Health Action Plan. This is a guide to a person’s health. It is made by the person with a learning disability and the people who know him/her best.

• It can be used to tell doctors and hospitals about the person’s health and the best ways to support them to get the right treatment and health care

Glossary• DES – Directed Enhanced Services are special services or activities provided by GP Practices that have been

negotiated nationally. A DES specifically for people with learning disabilities came into force from April 2008 and GP’s will be deciding at the moment if they are going to provide the special services contained in that DES

• LES – Local Enhanced Services relate to the optional commission of services based on local needs. These were

originally introduced GP’s a major opportunity to expand and develop Primary Care.

• Read Code – A code which allows clinicians to make best use of computer systems. Codes help to access information from patient records, in order to more easily audit and research information across a lot of people, and also help to cut down on repetitive tasks

• Annual Health Check – People with Learning Disabilities can have a special meeting with their Doctor or nurse to check all parts of their health. This can help people stay safe and healthy

• BMI – Body Mass index. This is a useful way of working out a healthy body weight, based on how tall a person is

• Dysphagia – medical term for the symptom of difficulty in swallowing

• PALS – Patient Advice and Liaison Service provide information, advice and support to help patients, families and their parents. The NHS plan in 2000 required the establishment of such a service in every NHS Trust

• LINks – Local Involvement Networks, expected to be up and running in every locality by 2008. LINks were introduced to help communities influence the care they receive.

Glossary• Clinical Network or Managed Clinical Network – is a network of a variety of health staff and organisations working together to make• sure that everyone can gain access to good quality clinical services in their area

• NSF – National Service Framework

• P&V Sector – Private and Voluntary Sector

• DED – Disability Equality Duty. This means that people who work in the public sector - like health or social services - have to consider the

impact of their work on disabled people, and to make sure people with disabilities are not placed at a disadvantage when using their services. This should mean that disabled people have good access to health services, education, housing, jobs, etc. It should also help promote positive attitudes towards disabled people in everyday life.

• Since 4 December 2006, public authorities including Trusts, PCTs and SHAs (Strategic Health Authorities) etc have had to publish a 'Disability Equality Scheme' saying how they make sure this happens.

• DH – Department of Health

• LA – Local Authority

• JSNA – Joint Strategic Needs Assessment is a process that will identify the current and future health and wellbeing needs of a local population. This assessment is used to decide the priorities and targets contained in Local Area Agreements (LAAs).

• ASC – Autism Spectrum Conditions. This is the term used for a range of conditions linked to Autism, including Asperger Syndrome, ADHD, etc.

• LIT – Local Implementation Team, this is the mental health equivalent of the Partnership Board. The LIT is accountable for making sure the

national service framework for Mental Health is implemented in a locality

• VP – Valuing People

Timelines• Briefing April• Returns to SHA by 23rd September 2011• Validation Meetings 7th-22nd November

2011@SHA/NWTDT• Regional Report February 2012• Best Practice March 2012

Best Practice

• All presentations can be found at:• http://wwwnorthwestjip.co.uk/resources/

downloads/nwjip-events

Documents

Health Self Assessment Framework 2011/12 Learning Disabilities Health Self Assessment and Performance Framework An assurance system for Learning Disabilities