NHS Improvement

The learning disability improvement

standards for NHS trusts.

Why do we need LD standards for NHS Trusts?

• Because care and treatment isn’t standardised!!

• Care and treatment isn’t always safe & personalised

• Some Trusts have failed to respect & protect people’s human rights

• Sometimes there are skills deficits in the workforce

• People don’t always get the same access to services or outcomes as non-disabled people

Underlying aims… (the not-so-hidden agenda!!)

• To Improve the quality of support

• Improve coordination and integration

• Reduce variation

• Improve patient satisfaction

• To improve planning

• To help understand how quality in one part of the system impacts on others.

The problem with standards…

So what are the standards based on?

Also built around a human rights based approach with special attention to:

• Human Rights Act• Articles 2, 3, 5, 8 & 14

• Equality Act

• UNCRDP

• MCA

• MHA

So what are the standards based on?

Reflects Picker institute principles of person centred care…

So how did we develop the standards?

• Structure• The right facilities, staff, supplies, policies & protocols, and finances.

• Process• Good care, on the basis of evidence / knowledge, is delivered

• Outcomes• The end result of healthcare

• The consequences of care and the actual results of health interventions

• Includes: death, disease, discomfort, disability and dissatisfaction

How many have we got; how much do we spend?

How do we support and treat people?

What difference does it make?

So how did we develop the standards?

• First draft standards prepared in response to site visits and emerging themes.

• Engagement with people and families:• Inclusion North;

• Changing Our Lives;

• Pathways Associates

• Small group of bereaved families

• Outcomes people expect if the standards are met - defined

• Standards revised and improvement measures developed

• Engagement with practitioners• Trust visits; conference presentations• Engagement with wider stakeholders• NHSE, LEDER team, PHE, CQC, BIHR• Standards and Improvement Measures refined• Metrics developed

All trusts must ensure that they meet their Equality Act Duties to people with learning

disabilities, autism or both, and that the wider human rights of these people are respected and protected, as required by the Human Rights Act.

Every trust must ensure all people with learning disabilities, autism or both and their families and carers are empowered to be partners in the care

they receive.

All trusts must have the skills and capacity to meet the needs of people with learning

disabilities, autism or both by providing safe and sustainable staffing, with effective leadership at

all levels.

Trusts that provide specialist learning disabilities services commissioned solely for the use of

people with learning disabilities, autism or both must fulfil the objectives of national policy and

strategy.

How the thing hangs together!

The learning disability improvement standards

All services

Respecting and Protecting Rights

People / family defined outcomes

5 Improvement Measures

Managers metrics

Staff metrics

Inclusion & Engagement

People / family defined outcomes

5 Improvement Measures

Managers metrics

Staff metrics

Workforce Issues

People / family defined outcomes

4 Improvement Measures

Managers metrics

Staff metrics

Specialist services only

Hospital / community

People / family defined outcomes

5 Improvement Measures

Manager’s metrics

Staff metrics

Human Rights

Reasonable adjustments

Flagging mechanisms

Learning from deaths

Protecting liberty

Anti discriminatory

practice

Inclusion & Engagement

Partners in care

Values led services

Co designed services

learning from investigations

Empowering people

Workforce

The right staff

Training and development

Addressing workforce pressures

Leadership

Specialist Services

Community based support

Reducing admissions & hospital stays

Reducing over medication

Evidence based care &

treatment

Reducing restrictive practices

StandardUser / carer

outcomesImprovement Measures

Manager’s

structure indicators

Staff process

indicators

Standard 1: Rights

All services 17 Outcomes 5 Improvement Measures

6 metrics

28 metrics

5 metrics

27 metrics

11 metrics 11 metrics

4 metrics 4 metrics4 metrics 4 metrics3 metrics 3 metrics

Standard 2: Inclusion &

Engagement

All services

21 Outcomes 5 Improvement Measures

4 metrics

19 metrics

7 metrics

17 metrics

4 metrics 4 metrics2 metrics 2 metrics6 metrics 4 metrics3 metrics 0 metrics

Standard 3: Workforce

All services8 Outcomes 4 Improvement Measures

3 metrics

14 metrics

2 metrics

13 metrics5 metrics 5 metrics3 metrics 3 metrics3 metrics 3 metrics

Standard 4: Specialist

inpatients

Specialist LD services

22 Outcomes 5 Improvement Measures

3 metrics

25 metrics

3 metrics

30 metrics

10 metrics 14 metrics2 metrics 3 metrics6 metrics 6 metrics4 metrics 4 metrics

Standard 4: Specialist

community

Specialist LD services

22 Outcomes 5 Improvement Measures

10 metrics

19 metrics

10 metrics

21 metrics

1 metric 1 metric2 metrics 4 metric2 metrics 2 metrics4 metric 4 metrics

Total 105 metrics Total 108 Metrics

Alignment to CQC KLOEs

• Overall 72% of KLOE prompts align to one of more of the NHSI standards.• The human rights focus is strongly associated with effectiveness;

• Commitment to inclusion and engagement is associated with caring and responsiveness;

• High quality specialist services are linked with safe, effective and responsiveness.

• The focus of the remaining 28% (n=43) of KLOE prompts relates to aspects of quality monitoring and regulation that lie outside of the scope of the NHSI standards.

Alignment to CQC KLOEs

The top half dozen!!

1. Making reasonable adjustments to people’s care

2. Involving people as partners in their own care

3. Providing intensive community based support

4. Having the right staff

5. Empowering people to exercise their rights

6. Electronic flagging systems

Supporting Improvement: NHSBN data collection

• NHS Benchmarking Network• Annual data collection

• First data collection commences September 2018

• Based on key metrics

• Quantitative and qualitative data

• Data from exec teams

• Short staff survey

• User / family survey (with support)

• Annual refresh

• Reports March 2019

Supporting Improvement: Tools

• Self improvement tools• First one in development – focused on preventable

deaths• Specific subset of metrics

• Questions for managers

• Questions for staff

• Independent facilitation• Performance reports and action plans generated• To be piloted in 4 NHS Hospital Trusts

Currently achieving

Confident we will achieve

within 6 months

No fully achieved but

will in the next 12 months

Not achieving and unlikely to do so in next 12 months

N/A

Improvement report

Managers’ Ratings

Staff ratings

Supporting Improvement: tools

Respecting and Protecting

People's RightsInclusion and Engagement Workforce

Anti-discrimminatory practicePartnerships with people and

familiesEnough of the right staff

Reasonable adjustments Learning from investigations The right training

Monitporing & reducing restrictions

of libertyEffective work force planning

Learning when people die in

services

Performance Measure Dashboard

Currently achieving

Within 6 months

Within 12 months

Not in forseeable

Challenges

• Data burden vs impact

• Self-improvement vs checking

• Accessing informants – staff; users / families; and execs

• Links with commissioning• Independent sector

• Links with social care

• Capacity to aggregate / disaggregate data.

• Reporting to people and families

• More tools

So what do the standards mean to you?

Why are the standards important for her, her friends and their families?