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Joint Health and Social Care Self-Assessment Framework Change report
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Joint Health and Social Care Self-Assessment Framework Change report
Joint Health and Social Care Self-Assessment Framework Change report
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About Public Health England
Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Public Health England Wellington House 133-155 Waterloo Road London SE1 8UG Tel: 020 7654 8000 www.gov.uk/phe Twitter: @PHE_uk Facebook: www.facebook.com/PublicHealthEngland Prepared by: Sebastian Fox, Gyles Glover. For queries relating to this document, please contact: [this line can be deleted if not required] © Crown copyright 2016 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence, visit OGL or email [email protected]. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Any enquiries regarding this publication should be sent to [insert email address]. Published February 2016 PHE publications gateway number: 2015639
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Introduction
The Joint Health and Social Care Self Assessment Framework was introduced by learning disability services as one of the measures responding to the appalling events at Winterbourne View. In ‘Transforming Care’, the Government’s final report on their investigation of these events, published in December 2012, NHS England and the Association of Directors of Adult Social Services pledged to develop a method for a joint annual self-review of local services.1 Before this, the principle of annual self-assessment of services for people with learning disabilities had been developed independently by both local partnership boards (at the prompting of the Department of Health) and NHS organisations. Partnership boards, which in most cases took local authority footprints, reported on accommodation, employment, some aspects of healthcare and safeguarding and the extent of spending on care for people with learning disabilities.2 NHS organisations developed a Strategic Health Authority led exercise with a more health focus. The NHS approach had initially been developed in Yorkshire and Humber Strategic Health Authority area as a participatory planning exercise. It was rolled out nationally in 2010 following the publication of Valuing People Now.3 Latterly the process focussed on red/amber/green ratings against quality standards. Local assessments were checked and validated against collated evidence by Strategic Health Authority lead officers in a complex document review process. The Joint Self-Assessment was developed in the three months prior to April 2013. It has run twice, in 2013 and 2014. Full documentation of these exercises is published on the Learning Disabilities Observatory website.4–7 In 2015 to 2016 the format is being reviewed. The purpose of this report is to contribute to the evaluation of the self-assessment exercise as a mechanism for promoting and documenting progress in service design and provision. The report shows the pattern of changes seen between the 2013 and 2014 exercises. It focusses exclusively on the section of the Assessment which uses red/amber/green ratings against standard quality measures. This report will also help partnership boards and regional groups to identify positive local developments and highlight areas of service design and provision that require further attention.
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Methods and Presentations
Changes are presented in this report in graphical format, and are shown both nationally and for regional areas. In calculating the change score for each question we used only responses from partnership boards that had responded to the question in both years. Displays show the number of partnership boards included for each question (out of a possible maximum of 152) in axis label. Some completely new questions or formats were introduced for the 2014 exervices. For these there is obviously no analysis of change. Some other questions were altered for the 2014 exercise. This reflected concerns that they might have been ambiguously worded or insufficiently ambitious. Questions are marked on the charts as ‘Same’, ‘Similar’, ‘More Precise’ or ‘Different’ to indicate this. An appendix sets out the full set of red/amber/green questions for each of the two years so readers can judge for themselves whether our categorisation of each question is appropriate. It is notable that for questions that stayed the same, responses tended to improve. Where questions have been made more precise, responses have commonly become less good. Figures 1 to 7 show overall change scores. These were calculated for each question by assigning scores of 1 for red responses, 2 for amber and 3 for green. Total response scores for each question were calculated for the former Government Office regions and for England for each year. Change scores were calculated as the 2014 score minus the 2013 score divided by the total number of partnership boards in that area (regardless of whether they responded in both years). Thus more green or fewer red ratings shows as positive change, while fewer green or more red ratings shows as a negative change. Page 16 onwards shows response profiles for each of the 27 questions in both years. The first page of this section shows the position for England, subsequent pages show the position for the areas of the former government office regions. Findings are arranged in columns for each of the three sections of the framework. Findings for 2014 are shown in bold colours, those for 2013 in pale colours.
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Overall change scores
The charts on the following pages show the overall progress on each question. Positive numbers indicate improving ratings, negative numbers deteriorating ones. The charts have been grouped by section (Staying Healthy, Keeping Safe, Living Well) and by how similar the question was to the previous year (same, more precise, similar). Where questions were different or new they are not presented in a chart. These questions were: • A3 – Annual health checks and annual health check registers • A4 – Health Action Plans • A5.1 – Cervical cancer screening • A5.2 – Breast cancer screening • A5.3 – Bowel cancer screening • B6 – Compassion, dignity and respect • C5 – Employment • C6 – Transition to Adulthood • C7 – Involvement in service planning and decision making • C8 – Carer satisfaction rating • C9 – Overall score
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Staying Healthy
Figure 1: questions that remained the same in the Staying Healthy section
Joint Health and Social Care Self-Assessment Framework Change report
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Figure 2: questions that became more precise in the Staying Healthy section
Joint Health and Social Care Self-Assessment Framework Change report
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Keeping Safe
Figure 3: questions that remained the same in the Keeping Safe section
Joint Health and Social Care Self-Assessment Framework Change report
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Figure 4: questions that were similar in the Keeping Safe section
Joint Health and Social Care Self-Assessment Framework Change report
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Figure 5: questions that became more precise in the Keeping Safe section
Joint Health and Social Care Self-Assessment Framework Change report
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Living Well
Figure 6: questions that were similar in the Living Well section
Joint Health and Social Care Self-Assessment Framework Change report
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Figure 7: questions that became more precise in the Living Well section
Joint Health and Social Care Self-Assessment Framework Change report
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Partnership board change scores
The chart in this section shows the change scores for each partnership board for each section. These change scores were calculated by including only questions where:
• partnership boards were able to answer the question in both years • the question was either the same, more precise or similar in 2014 compared to 2013 If the response in the second year was an improvement on the response in the first year the partnership board was given a score of plus one for that question. If the response in the second year was worse than the first year, the partnership board was given a score of minus one for that question. The overall change score was calculated by adding up each of the individual scores.
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Figure 8: overall change scores for each partnership board by section
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Response Profiles
This section shows a fuller profile of how partnership boards answered each question in each area. For each question the proportion of red, amber and green responses are shown graphically.
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England
0% 100%
(More precise/same) 2013Offender Health and the…
(Same) 2013Dentistry, optometry,…
(Same) 2013Acute LD liaison function…
(Same) 2013Primary / Secondary care…
(Different) 2013Bowel cancer screening…
(Different) 2013Breast cancer screening…
(Different) 2013Cervical cancer…
(Different) 2013Health Action Plans 2014
(Different) 2013Annual health checks… (Not so similar) 2013
Long Term Health… (Similar) 2013
GP registers 2014
0% 100%
(Similar) 2013
Mental Capacity Act and…
(More precise) 2013
Complaints lead to…
(More precise) 2013
Commissioning strategy…
(Different) 2013
Compassion, dignity and…
(Similar) 2013
Involvement of Self-…
(Same) 2013
Adult Safeguarding 2014
(Same) 2013
Monitor Assurances 2014
(More precise) 2013
Learning disability…
(More precise/same) 2013
Individual health and…
0% 100%
(New) 2013
Overall score 2014
(Different) 2013
Carer satisfaction rating…
(Different) 2013
Involvement in service…
(Different) 2013
Transition to Adulthood 2014
(Different) 2013
Employment 2014
(More precise) 2013
Sport and leisure Sport…
(More precise) 2013
Arts and Culture 2014
(More precise) 2013
Local amenities and…
(Similar) 2013
Effective joint working 2014
Joint Health and Social Care Self-Assessment Framework Change report
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North East
0% 20% 40% 60% 80%100%
(More precise/same)…
Offender Health and…
(Same) 2013
Dentistry, optometry,…
(Same) 2013
Acute LD liaison…
(Same) 2013
Primary / Secondary…
(Different) 2013
Bowel cancer…
(Different) 2013
Breast cancer…
(Different) 2013
Cervical cancer…
(Different) 2013
Health Action Plans…
(Different) 2013
Annual health checks…
(Not so similar) 2013
Long Term Health…
(Similar) 2013
GP registers 2014
0% 20% 40% 60% 80%100%
(Similar) 2013
Mental Capacity Act…
(More precise) 2013
Complaints lead to…
(More precise) 2013
Commissioning…
(Different) 2013
Compassion, dignity…
(Similar) 2013
Involvement of Self-…
(Same) 2013
Adult Safeguarding…
(Same) 2013
Monitor Assurances…
(More precise) 2013
Learning disability…
(More precise/same)…
Individual health and…
0% 20% 40% 60% 80%100%
(New) 2013
Overall score 2014
(Different) 2013
Carer satisfaction…
(Different) 2013
Involvement in…
(Different) 2013
Transition to…
(Different) 2013
Employment 2014
(More precise) 2013
Sport and leisure…
(More precise) 2013
Arts and Culture 2014
(More precise) 2013
Local amenities and…
(Similar) 2013
Effective joint…
Joint Health and Social Care Self-Assessment Framework Change report
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North West
0% 20% 40% 60% 80%100%
(More precise/same)…
Offender Health and…
(Same) 2013
Dentistry, optometry,…
(Same) 2013
Acute LD liaison…
(Same) 2013
Primary / Secondary…
(Different) 2013
Bowel cancer…
(Different) 2013
Breast cancer…
(Different) 2013
Cervical cancer…
(Different) 2013
Health Action Plans…
(Different) 2013
Annual health checks…
(Not so similar) 2013
Long Term Health…
(Similar) 2013
GP registers 2014
0% 20% 40% 60% 80%100%
(Similar) 2013
Mental Capacity Act…
(More precise) 2013
Complaints lead to…
(More precise) 2013
Commissioning…
(Different) 2013
Compassion, dignity…
(Similar) 2013
Involvement of Self-…
(Same) 2013
Adult Safeguarding…
(Same) 2013
Monitor Assurances…
(More precise) 2013
Learning disability…
(More precise/same)…
Individual health and…
0% 20% 40% 60% 80%100%
(New) 2013
Overall score 2014
(Different) 2013
Carer satisfaction…
(Different) 2013
Involvement in…
(Different) 2013
Transition to…
(Different) 2013
Employment 2014
(More precise) 2013
Sport and leisure…
(More precise) 2013
Arts and Culture 2014
(More precise) 2013
Local amenities and…
(Similar) 2013
Effective joint…
Joint Health and Social Care Self-Assessment Framework Change report
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Yorkshire and Humber
0% 20% 40% 60% 80%100%
(More precise/same)…
Offender Health and…
(Same) 2013
Dentistry, optometry,…
(Same) 2013
Acute LD liaison…
(Same) 2013
Primary / Secondary…
(Different) 2013
Bowel cancer…
(Different) 2013
Breast cancer…
(Different) 2013
Cervical cancer…
(Different) 2013
Health Action Plans…
(Different) 2013
Annual health checks…
(Not so similar) 2013
Long Term Health…
(Similar) 2013
GP registers 2014
0% 20% 40% 60% 80%100%
(Similar) 2013
Mental Capacity Act…
(More precise) 2013
Complaints lead to…
(More precise) 2013
Commissioning…
(Different) 2013
Compassion, dignity…
(Similar) 2013
Involvement of Self-…
(Same) 2013
Adult Safeguarding…
(Same) 2013
Monitor Assurances…
(More precise) 2013
Learning disability…
(More precise/same)…
Individual health and…
0% 20% 40% 60% 80%100%
(New) 2013
Overall score 2014
(Different) 2013
Carer satisfaction…
(Different) 2013
Involvement in…
(Different) 2013
Transition to…
(Different) 2013
Employment 2014
(More precise) 2013
Sport and leisure…
(More precise) 2013
Arts and Culture 2014
(More precise) 2013
Local amenities and…
(Similar) 2013
Effective joint…
Joint Health and Social Care Self-Assessment Framework Change report
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East Midlands
0% 20% 40% 60% 80%100%
(More precise/same)…
Offender Health and…
(Same) 2013
Dentistry, optometry,…
(Same) 2013
Acute LD liaison…
(Same) 2013
Primary / Secondary…
(Different) 2013
Bowel cancer…
(Different) 2013
Breast cancer…
(Different) 2013
Cervical cancer…
(Different) 2013
Health Action Plans…
(Different) 2013
Annual health checks…
(Not so similar) 2013
Long Term Health…
(Similar) 2013
GP registers 2014
0% 20% 40% 60% 80%100%
(Similar) 2013
Mental Capacity Act…
(More precise) 2013
Complaints lead to…
(More precise) 2013
Commissioning…
(Different) 2013
Compassion, dignity…
(Similar) 2013
Involvement of Self-…
(Same) 2013
Adult Safeguarding…
(Same) 2013
Monitor Assurances…
(More precise) 2013
Learning disability…
(More precise/same)…
Individual health and…
0% 20% 40% 60% 80%100%
(New) 2013
Overall score 2014
(Different) 2013
Carer satisfaction…
(Different) 2013
Involvement in…
(Different) 2013
Transition to…
(Different) 2013
Employment 2014
(More precise) 2013
Sport and leisure…
(More precise) 2013
Arts and Culture 2014
(More precise) 2013
Local amenities and…
(Similar) 2013
Effective joint…
Joint Health and Social Care Self-Assessment Framework Change report
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West Midlands
0% 20% 40% 60% 80%100%
(More precise/same)…
Offender Health and…
(Same) 2013
Dentistry, optometry,…
(Same) 2013
Acute LD liaison…
(Same) 2013
Primary / Secondary…
(Different) 2013
Bowel cancer…
(Different) 2013
Breast cancer…
(Different) 2013
Cervical cancer…
(Different) 2013
Health Action Plans…
(Different) 2013
Annual health checks…
(Not so similar) 2013
Long Term Health…
(Similar) 2013
GP registers 2014
0% 20% 40% 60% 80%100%
(Similar) 2013
Mental Capacity Act…
(More precise) 2013
Complaints lead to…
(More precise) 2013
Commissioning…
(Different) 2013
Compassion, dignity…
(Similar) 2013
Involvement of Self-…
(Same) 2013
Adult Safeguarding…
(Same) 2013
Monitor Assurances…
(More precise) 2013
Learning disability…
(More precise/same)…
Individual health and…
0% 20% 40% 60% 80%100%
(New) 2013
Overall score 2014
(Different) 2013
Carer satisfaction…
(Different) 2013
Involvement in…
(Different) 2013
Transition to…
(Different) 2013
Employment 2014
(More precise) 2013
Sport and leisure…
(More precise) 2013
Arts and Culture 2014
(More precise) 2013
Local amenities and…
(Similar) 2013
Effective joint…
Joint Health and Social Care Self-Assessment Framework Change report
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East of England
0% 20% 40% 60% 80%100%
(More precise/same)…
Offender Health and…
(Same) 2013
Dentistry, optometry,…
(Same) 2013
Acute LD liaison…
(Same) 2013
Primary / Secondary…
(Different) 2013
Bowel cancer…
(Different) 2013
Breast cancer…
(Different) 2013
Cervical cancer…
(Different) 2013
Health Action Plans…
(Different) 2013
Annual health checks…
(Not so similar) 2013
Long Term Health…
(Similar) 2013
GP registers 2014
0% 20% 40% 60% 80%100%
(Similar) 2013
Mental Capacity Act…
(More precise) 2013
Complaints lead to…
(More precise) 2013
Commissioning…
(Different) 2013
Compassion, dignity…
(Similar) 2013
Involvement of Self-…
(Same) 2013
Adult Safeguarding…
(Same) 2013
Monitor Assurances…
(More precise) 2013
Learning disability…
(More precise/same)…
Individual health and…
0% 20% 40% 60% 80%100%
(New) 2013
Overall score 2014
(Different) 2013
Carer satisfaction…
(Different) 2013
Involvement in…
(Different) 2013
Transition to…
(Different) 2013
Employment 2014
(More precise) 2013
Sport and leisure…
(More precise) 2013
Arts and Culture 2014
(More precise) 2013
Local amenities and…
(Similar) 2013
Effective joint…
Joint Health and Social Care Self-Assessment Framework Change report
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London
0% 20% 40% 60% 80%100%
(More precise/same)…
Offender Health and…
(Same) 2013
Dentistry, optometry,…
(Same) 2013
Acute LD liaison…
(Same) 2013
Primary / Secondary…
(Different) 2013
Bowel cancer…
(Different) 2013
Breast cancer…
(Different) 2013
Cervical cancer…
(Different) 2013
Health Action Plans…
(Different) 2013
Annual health checks…
(Not so similar) 2013
Long Term Health…
(Similar) 2013
GP registers 2014
0% 20% 40% 60% 80%100%
(Similar) 2013
Mental Capacity Act…
(More precise) 2013
Complaints lead to…
(More precise) 2013
Commissioning…
(Different) 2013
Compassion, dignity…
(Similar) 2013
Involvement of Self-…
(Same) 2013
Adult Safeguarding…
(Same) 2013
Monitor Assurances…
(More precise) 2013
Learning disability…
(More precise/same)…
Individual health and…
0% 20% 40% 60% 80%100%
(New) 2013
Overall score 2014
(Different) 2013
Carer satisfaction…
(Different) 2013
Involvement in…
(Different) 2013
Transition to…
(Different) 2013
Employment 2014
(More precise) 2013
Sport and leisure…
(More precise) 2013
Arts and Culture 2014
(More precise) 2013
Local amenities and…
(Similar) 2013
Effective joint…
Joint Health and Social Care Self-Assessment Framework Change report
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South East
0% 20% 40% 60% 80%100%
(More precise/same)…
Offender Health and…
(Same) 2013
Dentistry, optometry,…
(Same) 2013
Acute LD liaison…
(Same) 2013
Primary / Secondary…
(Different) 2013
Bowel cancer…
(Different) 2013
Breast cancer…
(Different) 2013
Cervical cancer…
(Different) 2013
Health Action Plans…
(Different) 2013
Annual health checks…
(Not so similar) 2013
Long Term Health…
(Similar) 2013
GP registers 2014
0% 20% 40% 60% 80%100%
(Similar) 2013
Mental Capacity Act…
(More precise) 2013
Complaints lead to…
(More precise) 2013
Commissioning…
(Different) 2013
Compassion, dignity…
(Similar) 2013
Involvement of Self-…
(Same) 2013
Adult Safeguarding…
(Same) 2013
Monitor Assurances…
(More precise) 2013
Learning disability…
(More precise/same)…
Individual health and…
0% 20% 40% 60% 80%100%
(New) 2013
Overall score 2014
(Different) 2013
Carer satisfaction…
(Different) 2013
Involvement in…
(Different) 2013
Transition to…
(Different) 2013
Employment 2014
(More precise) 2013
Sport and leisure…
(More precise) 2013
Arts and Culture 2014
(More precise) 2013
Local amenities and…
(Similar) 2013
Effective joint…
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South West
0% 20% 40% 60% 80%100%
(More precise/same)…
Offender Health and…
(Same) 2013
Dentistry, optometry,…
(Same) 2013
Acute LD liaison…
(Same) 2013
Primary / Secondary…
(Different) 2013
Bowel cancer…
(Different) 2013
Breast cancer…
(Different) 2013
Cervical cancer…
(Different) 2013
Health Action Plans…
(Different) 2013
Annual health checks…
(Not so similar) 2013
Long Term Health…
(Similar) 2013
GP registers 2014
0% 20% 40% 60% 80%100%
(Similar) 2013
Mental Capacity Act…
(More precise) 2013
Complaints lead to…
(More precise) 2013
Commissioning…
(Different) 2013
Compassion, dignity…
(Similar) 2013
Involvement of Self-…
(Same) 2013
Adult Safeguarding…
(Same) 2013
Monitor Assurances…
(More precise) 2013
Learning disability…
(More precise/same)…
Individual health and…
0% 20% 40% 60% 80%100%
(New) 2013
Overall score 2014
(Different) 2013
Carer satisfaction…
(Different) 2013
Involvement in…
(Different) 2013
Transition to…
(Different) 2013
Employment 2014
(More precise) 2013
Sport and leisure…
(More precise) 2013
Arts and Culture 2014
(More precise) 2013
Local amenities and…
(Similar) 2013
Effective joint…
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References
1. Department of Health. Transforming Care: A National Response to Winterbourne View Hospital. (2012). at www.wp.dh.gov.uk/publications/files/2012/12/final-report.pdf
2. Christie, A., Baines, S., Glover, G. & Hatton, C. Learning Disability Partnership Board Progress Reports 2011/12. (2013). at www.ihal.org.uk/gsf.php5?f=16987
3. Department of Health. Valuing People Now: a new three-year strategy for people with learning disabilities. ‘Making it happen for everyone’. (2009). at www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_093375.pdf
4. Christie, A., Baines, S., Hatton, C., Glover, G. & Turner, S. Joint Health and Social Care Self-Assessment Framework 2013 Detailed report and thematic analyses. (2014). at www.ihal.org.uk/gsf.php5?f=312895
5. Glover, G. & Christie, A. Joint Health and Social Care Self-Assessment Framework 2013 Detailed report on Number Questions. (2014). at www.ihal.org.uk/gsf.php5?f=312890
6. Glover, G., Fox, S., Baines, S. & Hatton, C. Joint Learning Disabilities Health and Social Care Self-Assessment Framework 2014. at www.ihal.org.uk/publications/1246
7. Fox, S. & Glover, G. Joint Health and Social Care Self-Assessment Framework 2014 Detailed report on number questions. (2015). at www.ihal.org.uk/gsf.php5?f=313846
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Appendix A
Staying Healthy
RAG descriptors for A1. Learning Disabilities QOF register in primary care. (More precise)
2014 2013
LD registers reflect prevalence data AND data stratified in every required data set (eg age / complexity / Autism diagnosis / black and minority ethnicities etc).
Learning Disability and Down Syndrome Registers reflect prevalence data AND Data stratified in every required data set (eg age / complexity / Autism diagnosis / BME etc).
LD registers reflect prevalence data but are not stratified in every required data set (eg age / complexity).
Learning Disability and Down Syndrome Registers reflect prevalence data but are not stratified in every required data set (eg age / complexity).
The numbers of people on LD registers reflect the requirements outlined in QOF.
The numbers of people on Learning Disability (LD) and Downs Syndrome Registers reflect the requirements outlined in QOF.
RAG descriptors for A2: Finding and managing long term health conditions: obesity, diabetes, cardiovascular disease, epilepsy. (More precise)
2014 2013
We compare treatment and outcomes for all four conditions between people with learning disabilities and others in the area and at local GP level.
Comparative data in all of the health areas listed in the descriptor at each of the following levels; LOCAL AREA TEAM CLINICAL COMMISSIONING GROUP INDIVIDUAL GP PRACTICE.
We compare treatment and outcomes for some of the conditions between people with learning disabilities and the general population in the area.
Comparative data in some of the health areas listed in the descriptor at LOCAL AREA TEAM/CLINICAL COMMISSIONING GROUP level.
No comparative data available. Evidence that people with learning disability are accessing disease prevention, health screening and health promotion in each of the following health areas: Obesity, Diabetes, Cardio vascular disease Epilepsy but NO COMPARATIVE DATA of the population that do not have a learning disability.
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RAG descriptors for A3: Annual health checks and annual health check registers. (Different)
2014 2013
80% or more of people with learning disability on the GP DES Register had an annual health check.
Validated on a minimum of an annual basis and process in place for all people aged 18 or over to be put on register. 80% of people with learning disability GP DES Register had an annual health check.
Between 41% and 79% of people with learning disability GP DES Register had an annual health check.
Registers Validated within past 12 months 50% of people with learning disability GP DES Register had an annual health check.
Fewer than 40% of people with learning disability on the GP DES Register had an annual health check.
Registers not validated since set up. 25% of people with learning disability on the GP DES Register had an annual health check.
RAG descriptors for A4: Specific Health Improvement Targets (Health Action Plans) generation at the time of AHC in primary care. (Different)
2014 2013
70% or more than of AHCs generate specific health improvement targets (Health Action Plan).
GP Health Action Plan (HAP) contains specific health improvement targets identified during the AHC for 50% of patients (to be captured through AHC template.
50% - 69% of AHCs generate specific health improvement targets (Health Action Plan).
GP Annual health check data indicates that a Health Action plan has been completed, directly as a result of an AHC, in the current year for 70% of patients.
Fewer than 50% of AHCs generate specific health improvement targets (Health Action Plan).
No evidence that the Annual Health Check and Health Action Plans are integrated.
RAG descriptors for A5: National Screening Programmes (bowel, breast and cervical). (Different)
2014 2013
Screening takes place for the same proportion (+ or – 5%) of eligible people with learning disabilities as the general population.
Numbers of completed health screening for eligible people who have a learning disability in every screening group; AND Comparative data of screening rates in the non LD population for every screening group; AND Scrutinised exception reporting and evidence of reasonably adjusted services.
Screening takes place for half the proportion or more of eligible people with learning disabilities compared to the rate of screening for the general population.
Numbers of completed health screening for eligible people who have a learning disability; AND Some comparative data but not for every screening group requested.
Screening takes place for less than half the proportion of eligible people with learning disabilities compared to the rate of screening for the general population or data unavailable.
Unable to produce data for people with learning disabilities in each and every screening group a, b & c.
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RAG descriptors for A6: Primary care communication of learning disability status to other healthcare providers. (Same)
2014 2013
Secondary care and other healthcare providers can evidence that they have a system for identifying LD status on referrals based upon the LD identification in primary care and acting on any reasonable adjustments suggested. There is evidence that both an individual’s capacity and consent are inherent to the system employed.
Secondary care and other healthcare providers can evidence that they have a system for identifying LD status on referrals based upon the LD identification in primary care and acting on any reasonable adjustments suggested. There is evidence that both an individual’s capacity and consent are inherent to the system employed
There is evidence of a local area team/clinical commissioning group wide system for ensuring LD status and suggested reasonable adjustments if required, are included in referrals. There is evidence that both an individual’s capacity and consent are inherent to the system employed.
There is evidence of a LOCAL AREA TEAM/CLINICAL COMMISSIONING GROUP wide system for ensuring LD status and suggested reasonable adjustments if required, are included in referrals. There is evidence that both an individual’s capacity and consent are inherent to the system employed.
There is no local area team/clinical commissioning group wide system for ensuring LD status and suggested reasonable adjustments are included in the referrals.
There is no LOCAL AREA TEAM/CLINICAL COMMISSIONING GROUP wide system for ensuring LD status and suggested reasonable adjustments are included in the referrals.
RAG descriptors for A7: Learning disability liaison function or equivalent process in acute setting. (Same)
2014 2013
Designated learning disability function in place or equivalent process, aligned with known learning disability activity data in the provider sites and there is broader assurance through executive board leadership and formal reporting / monitoring routes.
Designated learning disability function in place or equivalent process, aligned with known learning disability activity data in the provider sites and there is broader assurance through executive board leadership and formal reporting / monitoring routes.
Designated learning disability liaison function or equivalent process in place and details of the provider sites covered has been submitted. Providers are not yet using known activity data to effectively employ LD liaison function against demand.
Designated learning disability liaison function or equivalent process in place and details of the provider sites covered has been submitted. Providers are not yet using known activity data to effectively employ LD liaison function against demand.
No designated learning disability liaison function or equivalent process in place in one or more acute provider trusts per site.
No designated learning disability liaison function or equivalent process in place in one or more acute provider trusts per site.
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RAG descriptors for A8: NHS commissioned primary care: dentistry; optometry; community pharmacy; podiatry. (Same)
2014 2013
All people with learning disability accessing/using service are known and patient experience is captured. All of these services are able to provide evidence of reasonable adjustments and plans for service improvement.
All people with learning disability accessing/using service are known and patient experience is captured All of these services are able to provide evidence of reasonable adjustments and plans for service improvement.
Some of these services are able to provide evidence of reasonable adjustments and plans for service improvements.
Some of these services are able to provide evidence of reasonable adjustments and plans for service improvements.
People with learning disability accessing/using these services are not flagged or identified. There are no examples of reasonable adjusted care.
People with learning disability accessing/using these services are not flagged or identified. There are no examples of reasonable adjusted care.
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RAG descriptors for A9: Offender Health and the CJS. (More precise)
2014 2013 Local Commissioners have and act on data
about the numbers and prevalence of people with a learning disability in the criminal justice system:
• local commissioners have a working relationship with regional, specialist prison health commissioners AND
• there is good information about the health needs of people with LD in local prisons and wider criminal justice system and a clear plan about how such needs are to be met AND
• prisoners and young offenders with LD have had an annual health check which generates a health action plan, or are scheduled to have one in the coming 6 months AND
• evidence of 100% of all care packages including personal budgets reviewed at least annually
Local commissioners have good data about the numbers and prevalence of people with a learning disability in the criminal justice system. Local commissioners have a working relationship with regional, specialist prison health commissioners AND there is good information about the health needs of people with LD in local prisons and wider criminal justice system and a clear plan about how such needs are to be met. Prisoners and young offenders with LD have had an annual health check, or are scheduled to have one in the coming 6 months (either as part of custodial sentence or following release plans, as part of GP health check cycle). Prisoners and young offenders with LD can have a Health Action Plan if they choose. Evidence of 100% of all care packages including personal budgets reviewed at least annually.
In the absence of the above (or elements of the above) An assessment process has been agreed to identify people with LD in all offender health services eg learning disability screening questionnaire. Offender health teams receive LD awareness training to know how best to support individuals to meet their health needs AND There is easy read accessible information provided by the criminal justice system.
An assessment process has been agreed to identify people with LD in all offender health services eg learning disability screening questionnaire. Offender health teams receive LD awareness training to know how best to support individuals to meet their health needs AND There is easy read accessible information provided by the criminal justice system.
There is no systematic collection of data about the numbers of people with LD in the criminal justice system. There is no systematic learning disability awareness training for staff within the criminal justice system. The local offender health team does not yet have informed representation of the views and needs of people with learning disability.
There is no systematic collection of data about the numbers of people with LD in the criminal justice system. There is no systematic learning disability awareness training for staff within the criminal justice system. The local offender health team does not yet have informed representation of the views and needs of people with learning disability.
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Keeping Safe
RAG descriptors for B1: Individual health and social care package reviews. (More precise)
2014 2013
Evidence of 100% of all care packages including personal budgets reviewed within the 12 months covered by this self-assessment.
Evidence of 100% of all care packages including personal budgets reviewed at least annually.
Evidence of at least 90% of all care packages including personal budgets reviewed within the 12 months covered by this self-assessment.
Evidence of at least 90% of all care packages including personal budgets reviewed at least annually.
Less than 90% of all care packages including personal budgets reviewed within the 12 months covered by this self-assessment.
Less than 90% of all care packages including personal budgets reviewed at least annually.
RAG descriptors for B2: Learning disability services contract compliance. (More precise)
2014 2013
Evidence of 100% of health and social care commissioned services for people with learning disability: 1. Have had full scheduled annual contract
reviews; 2. Demonstrate a diverse range of indicators
and outcomes supporting quality assurance and including unannounced visits.
Evidence that the number regularly reviewed is reported at executive board level in both health and social care.
Evidence of 100% of health and social care commissioned services for people with learning disability have: • had full scheduled annual contract
and service reviews • demonstrate a diverse range of
indicators and outcomes supporting quality assurance
Evidence that the number regularly reviewed is reported at executive board level in both health and social care.
Evidence of at least 90% of health and social care commissioned services for people with learning disability: 1. Have had full scheduled annual contract
reviews; 2. Demonstrate a diverse range of indicators
and outcomes supporting quality assurance. Evidence that the number regularly reviewed is reported at executive board level in both health and social care.
Evidence of at least 90% of health and social care commissioned services for people with learning disability have: • had full scheduled annual contract
and service reviews • demonstrate a diverse range of
indicators and outcomes supporting quality assurance
Evidence that the number regularly reviewed is reported at executive board level in both health and social care.
Less than 90% of health and social care commissioned services for people with learning disability: 1) Have had full scheduled annual contract reviews; 2) Demonstrate a diverse range of indicators and outcomes supporting quality assurance.
Less than 90% of health and social care commissioned services for people with learning disability have • had full scheduled annual contract and
service reviews • demonstrate a diverse range of indicators
and outcomes supporting quality assurance
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RAG descriptors for B3: Monitor Assurances. (Same)
2014 2013
Commissioners review Monitor returns and review actual evidence used by FTs in agreeing ratings. Evidence that commissioners are aware of and working with non-FTs in their progress towards Monitor compliance.
Commissioners review monitor returns and EDS review actual evidence used by Foundation Trusts in agreeing ratings. Evidence that commissioners are aware of and working with non-foundation trusts in their progress towards monitor level and EDS compliance.
Commissioners review Monitor returns of FT providers. Evidence that commissioners are aware of and working with non-FTs in their progress towards Monitor compliance.
Commissioners review monitor and EDS returns of foundation trust providers. Evidence that commissioners are aware of and working with non-foundation trusts in their progress towards monitor level and EDS compliance.
Commissioners do not assure themselves of the on-going compliance, via Monitor returns, for each FT – OR – for non-FT, commissioners are not aware of the Trust’s position in working towards Monitor standards and FT status.
Commissioners do not assure themselves of the on-going compliance, via monitor returns and EDS, for each foundation trust OR for non-foundation trusts, commissioners are not aware of the trusts position in working towards monitor and EDS standards and foundation trust status.
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RAG descriptors for B4: Adult Safeguarding. (Same)
2014 2013
Evidence of robust, transparent and sustainable governance arrangements in place. in all statutory organisations including Local Safeguarding Adults Board(s), Health and Well-Being Boards and Clinical Commissioning Executive Boards. The provider can demonstrate that delivery of Safeguarding Adults within the current Statutory Accountability and Assurance Framework includes people with learning disabilities. This assurance is gained using DH Safeguarding Adults Assurance (SAAF) framework or equivalent. Every learning disability provider service has assured their board and others that quality, safety and safeguarding for people with learning disabilities is a clinical and strategic priority within all services. Key lessons from national reviews are included. There is evidence of active provider forum work addressing the learning disability agenda.
Evidence of robust, transparent and sustainable governance arrangements in place in all statutory organisations including Local Safeguarding Adults Board(s), Health and Well-Being Boards and Clinical Commissioning Executive Boards The provider can demonstrate delivery of Safeguarding adults within the current Statutory Accountability and Assurance Framework includes people with learning disabilities. This assurance is gained using DH Safeguarding Adults Assurance (SAAF) framework or equivalent. Every learning disability provider service have assured their board and others that quality, safety and safeguarding for people with learning disabilities is a clinical and strategic priority within all services. Key lessons from national reviews are included. There is evidence of active provider forum work addressing the learning disability agenda.
Regular Board reporting and key points and lessons learned are included in action plans. Evidence that Learning Disability Partnership Board(s) and/or health sub group(s) are involved in reviewing progress. The provider can demonstrate that delivery of Safeguarding Adults within the current Statutory Accountability and Assurance Framework includes people with learning disabilities. This assurance is gained using DH Safeguarding Adults Assurance (SAAF) framework or equivalent. Every learning disability provider service has assured their board that quality, safety and safeguarding for people with learning disabilities is a clinical and strategic priority within all services.
Regular Board Reporting and key points and lessons learned are included in action plans Evidence that Learning Disability Partnership Board(s) and/or health sub group(s) involved in reviewing progress The provider can demonstrate delivery of Safeguarding adults within the current Statutory Accountability and Assurance Framework includes people with learning disabilities. This assurance is gained using DH Safeguarding Adults Assurance (SAAF) framework or equivalent. Every learning disability provider service have assured their board that quality, safety and safeguarding for people with learning disabilities is a clinical and strategic priority within all services.
No Board assurance and learning points not identified. Action plan(s) either not in place, or not yet discussed with partners.
No Board Assurance and Learning points not identified Action plan(s) either not in place, or not yet discussed with partners.
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RAG descriptors for B5: Self-Advocates and Carers in training and recruitment. (Similar)
2014 2013 In LD specific services there is evidence of all of
services involving people with learning disabilities and families in recruitment and training. Commissioners of universal services can provide evidence of contracting for LD awareness training (for example as part of Disability Equality Training).
LD specific services: evidence of 100% of services involving people with learning disability and families in recruitment/training and monitoring of staff including advocates. Strong evidence of commissioners specifically raising the need for LD awareness training and reasonable adjustment within universal services in line with consultation by people with a learning disability and family carers. Strong evidence of universal services embedding LD awareness training and making reasonable adjustments for people with a learning disability and family carers to access and use the services AND of universal service providers sharing good practice and experience.
In LD specific services there is evidence of some services involving people with learning disabilities and families in recruitment and training. Commissioners of universal services can provide evidence of contracting for LD awareness training (for example as part of Disability Equality Training).
LD specific services: evidence of 90% of services involving people with learning disability and families in recruitment/training and monitoring of staff. Some evidence of universal services embedding LD awareness training and making reasonable adjustments for people with a learning disability and family carers to access and use the services.
No evidence of involvement in recruitment and training and appropriate levels of disability equality training.
No evidence of commissioning and provider practice that demonstrates involvement of people with learning disability and families in the recruitment and training of staff.
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RAG descriptors for B6: Compassion, dignity and respect (answered by self advocates and family carers). (Different)
2014 2013
Family carers and people with a learning disability agree that all providers do.
Clear evidence of commissioning practice that drives providers to demonstrate compassionate care and value base recruitment and management of the workforce Evidence of this approach in relevant universal services.
Family carers and people with a learning disability agree that some providers do.
LD Specific Provision: Some evidence of commissioning practice that drives providers to demonstrate compassionate care and value base recruitment and management of the workforce No clear evidence of this approach in relevant universal services.
Family carers and people with a learning disability agree that few or no providers do.
No evidence of commissioning practice that drives providers to demonstrate compassionate care and value base recruitment and management of the workforce.
RAG descriptors for B7: Commissioning strategy Impact Assessments. (More precise)
2014 2013 Up to date commissioning strategies and Impact
Assessments are in place. Impact Assessments and strategies have been developed with and presented to people who use services and their families.
Evidence of Commissioning Strategies and associated Equality Impact Assessments being presented to people who use services and their families and clear plans in place for the development of Care, Support and Housing for people with learning disabilities based on evidence of current and future demand.
Up to date commissioning strategies and Impact Assessments are in place.
Up to date Commissioning Strategies and Equality Impact Assessments are in place.
Not all commissioning strategies and Impact Assessments are in place.
Not all strategies are up to date and there are not Equality Impact Assessments in place for every strategy.
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RAG descriptors for B8: Complaints lead to changes. (More precise)
2014 2013 90% or more of commissioned services can
demonstrate improvements, based on the use of feedback from people who use services (for example complaints, surveys, quality checking). There is evidence of effective use of a whistleblowing policy where appropriate.
Evidence that 90% of commissioned practice and contracts require evidence of improved practice, based on the use of patient experience data, and the review and analysis of complaints. There is evidence of effective use of a Whistle-blowing policy where appropriate.
50-89% of commissioned services can demonstrate improvements, based on the use of feedback from people who use services (for example complaints, surveys, quality checking). There is evidence of effective use of a whistleblowing policy where appropriate.
Evidence that 50% of commissioned practice and contracts require evidence of improved practice, based on the use of patient experience data, and the review and analysis of complaints. There is evidence of effective use of a Whistle-blowing policy where appropriate.
Less than 50% of commissioned services can demonstrate improvements, based on the use of feedback from people who use services (for example complaints, surveys, quality checking). There is evidence of effective use of a whistleblowing policy where appropriate
No evidence of commissioning practice that demonstrates changed practice as a result of complaints and whistleblowing.
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RAG descriptors for B9: Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). (Similar)
2014 2013 Commissioners can evidence that all relevant
providers have well understood policies in relation to the MCA and DoLS in place and routinely monitor their implementation.
All appropriate providers have well understood policies in place and routinely monitor implementation of these in relation to, the Mental Capacity Act (including restraint, consent and deprivation of liberty). The provider can evidence action taken to improve and embed practice where necessary.
Commissioners have limited evidence about the adoption and implementation of policies in relation to MCA and DoLS by relevant providers.
There is limited evidence that the implementation of MCA guidance relating to decision making, capacity, and restrictions is checked within contract monitoring and commissioning.
Commissioners cannot produce any evidence about the adoption and implementation of policies in relation to MCA and DoLS by relevant providers.
There is no evidence that organisations routinely check implementation of MCA guidance relating to decision making, capacity, and restrictions.
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Living well
RAG descriptors for C1: Effective joint working across health and social care. (Similar)
2014 2013 There are well functioning formal partnership
agreements and arrangements between health and social care organisations. There is clear evidence of single point of health and social care leadership, joint commissioning strategies and or pooled budgets, integrated health and social care teams.
There are well functioning formal partnership agreements and arrangements between health and social care organisations. There is clear evidence of pooled budgets or pooled budget arrangements, joint commissioning structures, intentions, monitoring and reporting arrangements.
There are some examples of functioning formal partnership agreements and arrangements between health and social care organisations. There is clear evidence of at least one of the following:
• single point of health and social care leadership
• joint commissioning strategy and/ or pooled budgets
• integrated health and social care teams
Commissioners can provide evidence of integrated governance structures. Monitoring is undertaken jointly and key partners are involved at partnership board level. Joint commissioning functions are in place.
Joint working has not met either of the above measures.
There is no evidence of integrated governance structures such as Section 75 or 37 agreements. There are no joint commissioning functions in place.
RAG descriptors for C2: Local amenities and transport. (More precise)
2014 2013 Extensive and equitably distributed examples of
people with learning disability having access to reasonably adjusted local transport services, changing places and safe places (or similar schemes) in public venues and evidence that such schemes are communicated effectively.
Extensive and equitably geographically distributed examples of people with learning disability having access to reasonably adjusted facilities and services that enable them to participate fully and build / maintain social networks eg support to use local transport services, Changing Places in shopping centres, Safe Places and evidence that such schemes are communicated effectively.
Local but not widespread examples of all of these types of schemes.
Local examples of people with learning disability having access to reasonably adjusted facilities and services that enable them to participate fully and build / maintain social networks eg support to use local transport services, Changing Places in shopping centres, Safe Places.
Reasonably adjusted levels of support in these schemes do not reach any of the standards above.
No examples of people with learning disability having access to reasonably adjusted facilities and services that enable them to participate fully and build / maintain social networks eg support to use local transport services, Changing Places in shopping centres, Safe Places.
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RAG descriptors for C3: Arts and Culture. (More precise)
2014 2013 Extensive and equitably distributed examples of
people with learning disabilities having access to reasonably adjusted facilities and services that enable them to use amenities such as cinema, music venues, theatre, festivals and that the accessibility of such events and venues are communicated effectively.
Numerous examples of people with learning disability having access to reasonably adjusted facilities and services that enable them to participate fully eg cinema, music venues, theatre, festivals and that the accessibility of such events and venues are communicated effectively.
Local but not widespread examples of people with learning disabilities having access to reasonably adjusted facilities in these amenities. The accessibility of such events and venues are communicated effectively.
Few examples of people with learning disability having access to reasonably adjusted facilities and services that enable them to participate fully eg cinema, music venues, theatre, festivals.
Reasonable adjustments of these amenities do not reach any of the standards above.
No examples of people with learning disability having access to reasonably adjusted facilities and services that enable them to participate fully eg cinema, music venues, theatre, festivals.
RAG descriptors for C4: Sport and leisure. (More precise)
2014 2013 Extensive and equitably geographically
distributed examples of people with learning disability having access to reasonably adjusted sports and leisure activities and venues for example use of local parks, leisure centres, swimming pools and walking groups. Designated participation facilitators with learning disability expertise are available. There is evidence that such facilities and services are communicated effectively.
Extensive and equitably geographically distributed examples of people with learning disability having access to reasonably adjusted facilities and services that enable them to participate fully eg local parks, leisure centres, swimming pools, walking groups, designated participation facilitators with learning disability expertise etc. and evidence that such facilities and services are communicated effectively.
Local, but not widespread examples of people with learning disability having access to reasonably adjusted sports and leisure activities and venues for example use of local parks, leisure centres, swimming pools and walking groups. Designated participation facilitators with learning disability expertise are available. There is evidence that such facilities and services are communicated effectively.
Local examples of people with learning disability having access to reasonably adjusted facilities and services that enable them to participate fully eg local parks, leisure centres, swimming pools, walking groups etc.
Reasonable adjustments of these amenities do not reach any of the standards above.
No examples of people with learning disability having access to reasonably adjusted facilities and services that enable them to participate fully eg local parks, leisure centres, swimming pools, walking groups etc.
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RAG descriptors for C5: Employment. (Different)
2014 2013 Clear published local strategy for supporting
people with learning disabilities into paid employment. Relevant data is available and collected and shows the strategy is achieving its aims.
Relevant data available and collected. The targets nationally and locally determined (see ASCOF) have been met for people with learning disability supported into employment in the past 12 months. Employment activity of people with learning disability is linked to commissioning intent for future services. Commissioning is clearly linked to proportionate local need.
Clear published strategy for supporting people with learning disabilities into paid employment but limited evidence of aims being met or outcomes achieved.
Relevant data available and collected. The targets nationally and locally determined (see ASCOF) have been met for people with learning disability supported into employment in the past 12 months AND employment activity of people with learning disability is linked to data.
Not meeting either of the above measures. No data and commissioning intentions in place.
RAG descriptors for C6: Preparing for Adulthood. (Different)
2014 2013 There is a monitored strategy, service pathways
and multi-agency involvement across education, health and social care. There is evidence of clear preparing for adulthood services or functions that have joint health and social care scrutiny and ownership across children and adult services.
Evidence of 85% of people with learning disability have a current and up to date Single Education, Health and Care Plan from DATE TO BE CONFIRMED. There is evidence of well-established and monitored strategy, service pathways and multi-agency involvement across Health and Social Care. There is evidence of very clear transition services or functions that have joint health and social care scrutiny and ownership.
There is some evidence of clear preparing for adulthood services or functions that have joint education, health and social care scrutiny and ownership across children and adult services.
Evidence of at least 50% of people with learning disability have a current and up to date Single Education, Health and Care Plan from DATE TO BE CONFIRMED. There is evidence of effective plans, strategy, service pathways and multi-agency involvement across Health and Social Care.
There is no evidence of clear preparing for adulthood services or functions that include joint education, health and social care scrutiny and ownership across children and adult services.
No evidence of a Single Education, Health and Care Plan for people with learning disability. Little or no evidence of transition planning or structures to support effective transitions in health and social care.
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RAG descriptors for C7: Involvement in service planning and decision making. (Different)
2014 2013 Clear evidence of co-production in universal
services and learning disability services. The commissioners use this to inform commissioning practice.
Clear evidence of co-production in universal services that the commissioners use this to inform commissioning practice.
Clear evidence of co-production in all learning disability services that the commissioner uses to inform commissioning practice. Inconsistent or no evidence of co-production in universal services.
Clear evidence of co-production in all learning disability services that the commissioner uses to inform commissioning practice. Inconsistent or no evidence of co-production in universal services.
There is no evidence that people with learning disability and families have been involved in co-production of service planning and decision making.
There is no evidence that people with learning disability and families have been involved in co-production of service planning and decision making.
RAG descriptors for C8: Carer satisfaction rating. (Different)
2014 2013 Most carers are satisfied that their needs were
being met. Commissioners are using needs assessment information relating to carers to shape services and provide a range of support. There is clear evidence of a carers strategy that has been co-produced with family carers and that this has been consulted upon. There is clear evidence that providers of LD services involve family carers in service development. There is clear evidence that such involvement has led to service improvement.
Most carers were neither satisfied nor dissatisfied that their needs were being met.
Commissioners have clear information on the numbers of registered carers in the locality including the number of carers offered and in receipt of a carers assessment. There is clear evidence of a carers strategy and that this has been consulted upon. There is clear evidence that providers of LD services involve family carers in service development.
Most carers thought that their needs were not being met.
Commissioners do not have clear information on the numbers of registered carers in the locality. There is little evidence of formal arrangements to allow carer voice to shape commissioning intentions and provider delivery.
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Overall score (New)
RAG descriptors for Overall rating for assessment.
Board is in the top third of summed RAG scores (where green=3, amber=2, and red=1)
Board is in the middle third of summed RAG scores (where green=3, amber=2, and red=1)
Board is in the bottom third of summed RAG scores (where green=3, amber=2, and red=1)
