Joan Veysey - LEARNING DISABILITY PERFORMANCE AND SELF ASSESSMENT

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					LEARNING DISABILITY PERFORMANCE AND                                         Information
SELF ASSESSMENT FRAMEWORK
                                       Information

Name of Author         Joan Veysey, Head of Non Acute Commissioning

Name of Director       Kevin Mullins, Director of Commissioning

Purpose of the Report
       The purpose is to inform the Board of the outcome of Hillingdon’s performance in
        meeting the health needs of people with learning disabilities, determined and
        validated by NHS London’s Self Assessment Exercise.
       The Learning Disability Performance and Self Assessment Framework was
        initiated in response to the Ombudsman report ‘Six Lives’ and PCT’s were
        required to undertake a Performance and Self Assessment Review, and report
        their progress to SHAs by 31 March 2010.
       The Assessment Framework was structured around the four Top Targets for the
        NHS identified by the “Valuing People Now” National Team, including 25 subsidiary
        indicators.
       Following local assessment and validation by NHS London, the overall rating for
        NHS Hillingdon is AMBER.
       Feedback on Hillingdon’s Learning Disability Performance and Self Assessment
        identifies areas of good practice, and nine key areas for improvement (see
        attached Appendix 1)
       Key areas for improvement will form the basis of a multiagency program of work for
        2010-2012. An improvement plan will be completed by the Learning Disability
        Partnership Board in July 2010 and subsequently monitored. Priorities agreed for
        2010/2011 will focus on areas that are cost neutral.
       The PCT is required to repeat the Self Assessment Framework annually for three
        years, with the 2009/2010 assessment forming a baseline from which to
        demonstrate improvement.
       NHS London has requested that progress is reported to the Board at 6 monthly
        intervals.

Contact Details
Joan Veysey, Head of Non Acute Commissioning. 01895 55839




                 NHS Hillingdon Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 27 July 2010                                                  Page 1 of 1
                                                                                            Appendix 1



Yi Mien Koh
Chief Executive
NHS Hillingdon
Kirk House
97-109 High Street
Yiewsley
West Drayton
Middlesex
UB7 7HJ                                                                                 Tel: 020 7932 3700
                                                                                        Fax: 020 7932 3800
c.c.   Nominated Lead:         Joan Veysey
       LD Officer:             Sue George-Puce
       Sector Chief Executive: Anne Rainsberry

                                                                                         25 May 2010


Dear Yi Mien,

Re: 2010 Learning Disability Health Self Assessment

I write to thank you and your partners across NHS Hillingdon for the submission which you sent
to us in March, as part of London’s first annual health self assessment exercise. London has
made significant progress over the past five months in implementing this framework. This has
enabled NHS London to report good progress on addressing the health inequalities of people
with learning disabilities, to the Health and Parliamentary Ombudsman and to the Department of
Health.

Please find enclosed the Regional Overview Report, together with the red-amber-green
summary table. I would be grateful if you would forward this letter and its enclosures to your
Chief Executive colleagues in your local acute and specialist Trusts. This letter is also available
in an accessible format. Next, we will draw together a ‘Good Practice and Innovation Report’
from all of the submissions, in order to share learning.

London Overview
• You will see from the attached report that most areas have made good progress over the
   past year in helping people move to a new home from NHS Campus Provision, although not
   all areas will be able to meet the revised December 2010 deadline. This will therefore
   remain a high priority for the NHS in London.
• Most localities in the region have made some progress in establishing links between the
   specialist learning disabilities and mainstream services. Yet many reported that there is still
   a need for greater engagement from acute trusts and primary care.
• Almost all localities reported the need to develop public health data of people with learning
   disabilities. Thus, data collection has been identified as a priority area for the coming year,
   as was the need to enable organisation to embed ‘reasonable adjustments’ into processes
   and work practices.
• Workforce Development and clinical leadership and in particular training on the Mental
   Capacity Act, Challenging Behaviour and Safeguarding Adults in mainstream health and
   specialist learning disability services, were also cited as areas for improvement.




                                    London Strategic Health Authority

                     Chair: Sir Richard Sykes       Chief Executive: Ruth Carnall CBE
NHS Hillingdon
The following are the key points from your submission, discussed with your representatives at
the Validation Meeting, and identified by them as your priority actions for the coming year.


The Positives:
   • The Big Health Check Up Day was a success with good representation from service
      users, carers and professionals from all relevant areas.
   • Service user and carer feedback is taken seriously and monitored and that changes in
      services have been made as a result.
   • There is good representation of service user and carer involvement at the partnership
      board.
   • Great work has gone on within the acute trust with a learning disabilities day held for all
      clinical staff. We can see that commissioners and providers are working well to address
      issues raised by the report “Health care for all” to ensure recommendations are acted
      on.
   • There is evidence of good ongoing work around transitions for young people with
      learning disabilities.
   • There is a thorough strategy that has been developed to support people with autism
   • We have been told about a “Community Positive Behaviour Team” that has been
      developed to support people in Hillingdon who have challenging needs.


Your Identified Priorities for 2010-2011:
Target 1 – Plans are in place to meet the needs of people who are no longer receiving
treatment which requires in-patient care in an acute/long-stay residential facility or hospital
    • One person from Hillingdon remains in a residential unit within a long stay hospital but
       plans are in place for this person to move to their own accommodation with their own
       tenancy.
    • It was reported that 10 people are in hospital for assessment and treatment. Five are
       within borough and five placed out of borough. None of these people have a delayed
       discharge.
    • It will remain important to review people in Assessment and Treatment beds and to have
       Person-Centred Discharge Plans. In this way you will be able to reduce the potential for
       delayed transfers of care; these could result in people’s care being re-classified as
       Campus Re-provision. You will also thus minimise the potential for resources remaining
       tied up in beds, rather than being used imaginatively to prevent admission.

Target 2 – PCTs are working closely with the local Partnership Board and statutory and other
partners, to address the health inequalities faced by people with learning disabilities.
    • To improve the information available in primary care about the particular health needs of
       people with learning disabilities and their family carers, through the optimal use of
       existing data collection processes.
    • To produce accessible information on available health services, as well as information
       which informs people of their rights and about mechanisms through which they can give
       feedback to organisations of their experiences using services.
    • To improve access to the Direct Enhanced Scheme for Annual Health Checks
    • To increase training for GPs, and awareness about Health Checks among people with
       learning disabilities and their carers.
    • To develop reasonable adjustments in screening and primary care services, in order to
       move beyond the Annual Health Checks.
    • To work with the local Learning Disability Partnership Board to identify partners who
       will ensure the improved access to the broader range of Primary Health Care
       Services such as dentistry, podiatry and pharmacy.


                                                                                                   2
Target 3 – People with learning disabilities who are in services that the NHS commissions or
provides, are safe.
   • To improve access to acute services, through work with colleagues across organisations
       and teams. Firstly, to review the progress of current initiatives to date, and then to
       identify actions which will move this target forward and ensure people remain safe in the
       NHS. NHS London is committed to working with partners across the region on this
       target.
   • In addition NHS Hillingdon will report progress against Six Lives and the Michaels
       Report to its board no less than six-monthly.
   • To pro-actively utilise the functions of PALS and PPI in order to seek feedback from
       service users and carers; this information to then be included in Annual Reports on
       Complaints and Compliments. This will enable the organisations involved to demonstrate
       a reasonable adjustment of their existing Complaints processes.

Target 4 – progress is being made in the health service reforms and development described in
‘Valuing People Now’
    • To work with the Learning Disability Partnership Board to develop strategies to
       improve the care of people with a range of conditions, including Challenging Needs,
       Mental Health, Older Adults and Autistic Spectrum Disorder, as well as to improve
       the experiences of young people in Transition to Adult Services.


NHS Hillingdon has evidenced real commitment to improving the health and well being of
people with learning disabilities in the locality and we are keen to see progress continues to be
made over the coming year.

If you and the organisation you commission from have not already reported on progress
specifically related to ‘Healthcare for All’ and the ‘Six Lives’ Reports, please could I ask you to
contact Stephan Brusch urgently, in order to meet the requirement of the Health and
Parliamentary Ombudsman.

Thank you very much for all the work you and your colleagues have done to make this such a
valuable exercise.

Yours sincerely,




Professor Trish Morris-Thompson
Chief Nurse
NHS London




                                                                                                      3
LEARNING DISABILITY PERFORMANCE AND                                                 Appendix 2
SELF ASSESSMENT FRAMEWORK
                                                               Contact Name         Joan Veysey
                                                               Contact Tel No       01895 55839




EXECUTIVE SUMMARY

Background to key issues
1.       The Mencap report ‘death by indifference’, published in 2007, raised serious
concerns regarding the care of six adults with learning disabilities. An independent enquiry
led by Sir Jonathan Michael was subsequently published in July 2008, ‘Health care for All’
which described significant deficiencies in the way that people with a learning disability
access health care in England. It found convincing evidence that people with learning
disabilities have higher levels of unmet health need and receive less effective health care
treatment than other patient groups.

2.      These six cases, all of whom died, became the subject of a complaint investigation by
the Local Government Ombudsman. In March 2009, the Ombudsman report ‘Six Lives’ set
out the findings from the independent examination of the six cases, and recommended that
all NHS and social care organisations in England should urgently review:
     The effectiveness of systems they have in place to enable them to understand and
        plan to meet the full range of needs of people with a learning disability.
     The capacity and capability of the services they provide and or commission for their
        local population to meet the additional and often complex needs of people with
        learning disabilities.
     Report accordingly to those responsible for the governance of those organisations
        within 12 months of the publication of the Ombudsman’s report.

3.     The Department of Health initiated this review process, and PCTs were required to
undertake a Learning Disability Performance and Self Assessment Review, and report their
progress to SHAs by 31st March 2010.

Learning Disability Performance and Self Assessment Framework
4.     The Performance and Self Assessment Framework was structured around the four
Top Targets for the NHS identified by the “Valuing People Now” National Team. These were:
    Resettlement and campus closure
    Addressing health inequalities
    Making sure people with a learning disability are safe
    Continuing to achieve Valuing People objectives
The framework required PCTs to rate themselves against these four top targets including 25
subsidiary indicators.

Big Health Check Up Day and Validation
5.     To complete the framework, a comprehensive process with active involvement was
prescribed by NHS London, so that people with learning disabilities and their family or carers
could meaningfully engage in the process and have their voices heard. NHS Hillingdon held

                  NHS Hillingdon Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 27 July 2010                                                        Page 1 of 3
a ‘Big Health Check Up’ event on 25th February 2010, attended by service users and a wider
range of stakeholders, to discuss and score each of the 25 indicators. The self assessment
was signed off by the Learning Disability Partnership Board, and submitted to NHS London
in March 2010 together with a portfolio of evidence. The self assessment and evidence were
subsequently reviewed at a validation meeting with NHS London on 23rd March. The
detailed self assessment and evidence submitted can be provided to board members on
request.

Self assessment findings
6.     The following table provides a summary of NHS Hillingdon’s performance against the
four Top Targets following local assessment and as rated by the SHA following validation.
The over all rating for NHS Hillingdon is AMBER.

 Top target                                             Self
                                                        Assessment         Overall
                                                        Indicators         SHA Rating
                                                        2009/10
 1. Campus homes will be closed by 2010 and             2 Amber            Amber
 people who lived in long stay hospitals will have      1 Red
 moved into their new homes.
 2. The PCT is working closely with local partners so   3 Amber            Red
 that people with a learning disability can use the      6 Red
 same health services and get the same treatment
 as everybody else
 3. People with a learning disability are safe in       1 Green            Amber
 National Health Service services.                      2 Amber
                                                        1 Red
 4. Valuing People Now means we are making              1 Green            Amber
 services better and creating more opportunities for    7 Amber
 people with a learning disability.                     1 Red

7.      The self assessment and validation process highlighted areas of good practice in
Hillingdon. These included joint working with Hillingdon Hospital to improve patient care,
effective transition for service users into adult services and support for adults with
challenging behaviour. The process also highlighted a number of areas of weakness in
health services for people with learning disabilities in Hillingdon which will need to improve
during 2010 -2012. These are outlined in the assessment feedback letter Appendix 1. Key
areas for improvement will form the basis of a local program of work to be taken forward, and
overseen by the Learning Disabilities Partnership Board and Learning Disability Health
Action Sub Group.

London Overview.
8.    The London Regional Overview Report from the Performance and Self Assessment
Framework was published in May 2010. Across the 31 PCTs, 1 scored Green, 16 scored
Amber, and 14 scored Red. Almost all PCTs highlighted the following issues:
    A lack of systematic data collection, especially in the context of primary care, and
      the need to improve coding systems to ensure people with a learning disability are
      correctly identified and opportunities to offer support are not missed.
    The need to develop public health data of people with a learning disability
    The need to embed reasonable adjustments into processes and work practices
      across all providers.
    The need for workforce development, clinical leadership and training on Mental
      Capacity Act, and safeguarding adults in mainstream health and specialist learning
      disability services.

                  NHS Hillingdon Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 27 July 2010                                                        Page 2 of 3
9.      In addition to local improvement programs, it is envisaged that the completion of the
framework will lead to the development of an agreed regional program of work that will be
centred around the four main targets. Leadership support from NHS London will be offered in
two principal areas.
     To support local and regional workforce development in providing clinical leadership
        for mainstream and specialist staff. This is in order to help them with access to
        healthcare for people with learning disabilities and people who are deemed to
        challenge services.
     To develop a London- wide approach to ensure that people with learning disabilities
        derive benefits from the development of computer technology.
The full London Regional Overview Report and PCT’s RAG ratings can be provided to
board members on request.

Demonstrating Progress
10.     The PCT will be required to repeat the Performance and Self Assessment Framework
annually for 3 years, with the 2009/2010 assessment forming a baseline from which to
demonstrate improvement. An improvement plan will be completed by the Learning
Disability Partnership Board in July 2010, and subsequently monitored. This will feed into the
2010/2011 self assessment process, to be completed in February 2011. Capacity and effort
will focus on the priority red rated indicators, which are outlined in the feedback letter
Appendix 1. These also reflect the priorities of local users and their carers identified through
the ‘Big Health Check Up’ event.

11.     NHS London has requested that progress is reported to the Board at 6 monthly
intervals.




                  NHS Hillingdon Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 27 July 2010                                                         Page 3 of 3

				
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