Joint Health and Social Care Self-Assessment Framework: Good practice guidance

Joint Health and Social Care Self-Assessment Framework

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.

About Improving Health and Lives

Improving Health and Lives (IHaL) was set up in April 2010 to provide high quality data and information about the health and healthcare of people with learning disabilities. The information helps commissioners and providers of health and social care to understand the needs of people with learning disabilities, their families and carers, and, ultimately, to deliver better healthcare. IHaL is a collaboration between PHE, the Centre for Disability Research at Lancaster University and the National Development Team for Inclusion. Since April 2013, IHaL has been operated by PHE. Public Health England Wellington House 133-155 Waterloo Road London SE1 8UR Tel: 020 7654 8000 www.gov.uk/phe Twitter: @PHE_uk Facebook: www.facebook.com/PublicHealthEngland Prepared by: Anna Marriott and Sue Turner For queries relating to this document, please contact: anna.marriott@ndti.org.uk © 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 psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Published January 2016 PHE publications gateway number: 2015607

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Contents

Easy read summary 4

Background 6

The process 6 Feedback about the SAF 7 Self-Assessment Framework 2015 8 The Future of the Self-Assessment Framework 8

Good practice case examples 9

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Easy-read summary

The Joint Health and Social Care Self-Assessment Framework (SAF) helps regions check that people with learning disabilities and their families get the same life chances as other people.

A lot of people said that the self-assessment framework helps to decide what is important to improve the health and lives of people with learning disabilities.

People have said that there are some problems with the SAF. It can be hard to get the right answers to the questions. Some people feel that the SAF is not being used to improve services.

No local data relating to 2015 will be collected. Public Health England is working with the Health & Social Care Information Centre so that they can get lots of good information about the numbers of people with a learning disability in England.

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There will be local review meetings for people to discuss and agree what is most important in their area. People with learning disabilities and family carers will be at these meetings.

A group of experts will be set up to look at the SAF. This group will make suggestions and give their ideas for a new form that can be used every year for the SAF. A new Joint Health and Social Care Learning Disability Self-Assessment Framework will be launched in April 2016.

It is very important that the SAF is used to improve services for people with learning disabilities.

The SAF reports we write need to lead to decisions and actions that make things better.

This report has some examples of how local areas are using the SAF results to improve services.

The pictures in this report are from Photosymbols: www.photosymbols.co.uk

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Background

The Joint Health and Social Care Self-Assessment Framework (SAF) was implemented in 2013 to monitor services for people with learning disabilities. The framework was one of more than 60 commitments made in the government’s response to the events at Winterbourne View Hospital (Transforming Care, Action 38). NHS England and the Association of Directors of Adult Social Services (ADASS) agreed that local health and social services departments should use the framework to undertake an annual assessment of services. Information from the SAF should provide accurate data about the needs of people with learning disabilities and the health and social care services available to support them. On a national level, this information will support action that improves outcomes for people with learning disabilities and their families. On a local level, this information will help clinical commissioning groups, local authorities, partnership boards, families and people with learning disabilities identify the key issues they need to address to reduce health and social care inequalities in their area. The framework also provides a robust way to monitor progress locally. The process

In accordance with Transforming Care, a template for the framework was developed by learning disability leads and members of the ADASS. The framework has two parts: numerical questions and self-rating questions. The numerical section is intended to demonstrate how services are commissioned and provided locally. The questions in the numbers section cover: • numbers of people with learning disabilities • health and healthcare • assessment and provision of social care Areas are also asked to complete a self-assessment RAG rating (red, amber, green) on a variety of indicators according to a set of specified criteria. The self-assessment exercise is divided into three sections: • staying healthy • keeping safe • living well In addition to the self-assessment ratings, partnership boards had the opportunity to provide additional text. A number of these responses were thematically analysed to gain more insight into issues faced by local areas. Data is submitted to, and analysed by, the Improving Health and Lives (IHaL) Public Health Learning Disabilities Observatory. The

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published reports and a spreadsheet of all the responses (except the personal stories) are available at www.ihal.org.uk/projects/jhscsaf2014results. Feedback about the SAF

At events during the past two years, IHaL has collected feedback about the SAF process from people involved in local submissions. It is evident that the SAF is highly valued by people with learning disabilities and family carers because it is the only opportunity they have to review and comment on the quality of local services in comparison to nationally agreed measures. However, issues have been raised about the SAF process and its content. Clearly, the aim of the SAF is to lead to improvements in health and social care services for people with learning disabilities. However, people reported they find it difficult to use the SAF to drive change. The SAF needs to be embedded in everyday work and should shape strategic priorities and direction, but many people reported a greater emphasis on the process of completing the SAF, rather than using it to drive planning. The issue of who has responsibility for actions following the completion of the framework was raised. Some people suggested that if data were collected every two years (rather than annually) this would allow more time for action to be taken and, therefore, the self-assessment process would be more likely to capture change. Others felt it was essential to keep it as an annual process. Concern was expressed that the focus is on quantity only, rather than quality aspects of services. There was general agreement that there should be greater focus on outcomes. For example, there is no benefit in more people having annual health checks (AHCs) if they are not leading to improved health, so a measure of the quality and effectiveness of these is also needed. Assessing the quality of services presents numerous challenges, but there was a consensus that greater emphasis on quality checking by self-advocates is required. It was reported that the SAF misses a lot of things that are important to people with learning disabilities. This message came from professionals, family carers and people with learning disabilities. Overwhelmingly, the main aspect it was felt that the SAF misses is around friends, relationships and social inclusion. It is clear that collecting the data required by the SAF was problematic for many localities. Following the restructuring of services in April 2013, some respondents found it difficult to identify who could provide them with the necessary data. Some areas reported issues with data sharing due to new restrictions on accessing identifiable data while other areas managed to provide the relevant data. Some of the data requested required GP practices to run searches and this had cost implications or relied on the co-operation of GPs. In some areas there was a significant lack of compliance. There is no

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mandate to ensure different agencies engage and contribute to the SAF. Providers are not contracted to collect data, for example, and people spoke of asking many times for data and not being sent the information. There were also issues with IT systems that affected the ability of areas to collate the data. Lack of co-terminous local authorities and CCGs was also identified as a problem. Accessing education and criminal justice data was particularly difficult. There was some discussion about the role of people with learning disabilities and family carers in the SAF process. Many people felt that they are not involved enough and that there should be more questions to be answered directly, and evidenced, by people with learning disabilities. Better involvement by family carers and people with learning disabilities, it was felt, would help to validate the SAF data. However, it was noted that good consultation is time-consuming and some areas had not found this manageable within the given timeframe. Self-assessment framework 2015

Public Health England (PHE) has been exploring the most efficient and effective ways of collecting numerical data relating to the SAF indicators. The Health & Social Care Information Centre is now expected to undertake a detailed national extract of data covering most of the areas of population and primary health care through the national General Practice Extraction System. This should provide anonymised CCG level information. In addition to this, a range of social care indicators and the numbers of people using psychiatric inpatient care should be available from a range of national sources. Therefore, no local data collection relating to 2015 will be required. The data extracted by GPES will need to be analysed locality by locality and senior leaders from ADASS and NHS England will be asked to establish a formal review meeting to analyse their data and information and agree local commitments to ensure progress in identified priority areas. People with learning disabilities and family carers will be central to this. Data briefings for local areas should be available by the end of January 2016 (dependent on data becoming available from the Health and Social Care Information Centre) and these should be used to inform locality improvement planning meetings. These should take place by the end of February 2016. The future of the self-assessment framework

An expert task and finish group, with representatives from Department of Health, ADASS, PHE, NHS England, the National Forum for People with Learning Disabilities and the National Valuing Families Forum, has been established. The group’s remit is to recommend a new format for the SAF that will be sustainable and deliver a robust process for self-assessment and reflection on an annual basis.

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The aim is to develop measures that will assess both the health, and the wider determinants of health and wellbeing, for people with learning disabilities. People with learning disabilities and family members must make a meaningful contribution to this work. The new Joint Health and Social Care Learning Disability Self-Assessment Framework will be launched in April 2016 for annual completion.

Good practice case studies

The SAF is a valuable tool for benchmarking and identifying local priorities to improve the health and lives of people with learning disabilities. The findings should be used to inform local action plans. The examples below show how the SAF is being used as a lever for change at national, regional and local level. For this to be successful, it is important to make a clear link between the SAF and other strategic groups and work programmes. In some local areas there are monthly meetings to monitor the progress being made in relation to the SAF indicators. Where this happens, the annual SAF submission process is reported to be much less onerous. Using the SAF strategically across the North West

There is no national guidance on how regional areas should be using the results of the SAF to drive improvements. In 2013 and 2014, NHS England North West worked with local authority colleagues to develop a process of review that will support the implementation of improvement plans based on the SAF across the region. The North West Training and Development Team (NWTDT)/Pathways Associates CIC was commissioned to undertake desktop reviews of all the submissions from the North West. This process provided a level of independent scrutiny and led to greater consistency and continuity in rating. It also strengthened communication between local and regional groups and enabled them to identify collaborative approaches to deliver improved outcomes for individuals and for organisations. Crucially, they have made clear links between the SAF and other strategic groups and work programmes. To link the SAF to local and regional improvement plans, sub-groups were established for each of the SAF’s three themes: • Being Safe and Relationship group • Staying Healthy group • Living Well group Members of the groups include professionals, family carers and self-advocates. Each sub-group has terms of reference and meets at least three times a year. Each has a

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work plan fully aligned with the relevant section of the SAF, with some additional measures. The work plans are structured to be delivered over two years, with regular opportunities provided for subscribers to change, add or amend actions. Progress is monitored and regular reports are made to the Learning Disability Reference Group. This group meets at least quarterly. It aims to have a strategic presence and effective links to relevant regional/sub-regional groups and local Learning Disability Partnership Boards. It also maintains an overview of the work of three regional sub-groups and helps to guide and co-ordinate the sub-groups’ work on cross-cutting issues and topics. Examples of some of the work being done by the different groups are provided below. The Staying Healthy group is: • facilitating and co-ordinating work with Cheshire Local Eye Health Network and a

project with NHS Greater Manchester and Lancashire to increase the uptake of annual health checks

• arranging and providing training for professionals and family carers. Mindfulness training has been provided for family carers as well as training for professionals around mental health assessments with people with learning disabilities

• supporting Transforming Care Fast Track areas with a joint training partnership approach to Positive Behaviour Support training

The Being Safe and Relationship group is: • facilitating and developing a continuous quality assurance model with providers in

the North West to support contract compliance assurance for services primarily commissioned for people with a learning disability and their family carers (relates to SAF indicator B2: Learning disability services contract compliance)

• developing documentation and training for families and advocates to ensure people with learning disabilities and families are involved and informed on how to better recruit staff (relates to SAF indicator B5: Self-advocates and carers in training and recruitment)

• disseminating the findings of their audit of self-advocacy in the North West – self-advocacy is a key element of co-production, peer support and staying safe

The Living Well group is: • continuing to raise the issue of the Earning Disregard being maintained at £20 when

the minimum wage has increased. This means people can take paid work for a reduced amount of time (relates to SAF indicator C5: Employment)

• developing the Expert Hub in the North West to provide genuine paid employment opportunities for people linked to Transforming Care (relates to SAF indicator C5: Employment)

• researching and developing an interactive information site for people to report and share information about accessible and interesting places to visit across the North West (relates to SAF indicators C2: Local amenities and transport; C3: Arts and culture; C4: Sport and leisure)

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North West – involving family members and people with learning disabilities

The SAF is a good opportunity to make sure families and people with learning disabilities are at the heart of what work is being done in local areas. The North West have involved families in a number of ways: • helping to co-produce the SAF • ensuring the right information is collected • contributing to the quality assurance peer review panels • monitoring what actually happens • challenging services in terms of what difference their work is actually making to the

lives of people with learning disabilities It is important that families are enabled to contribute, and their contribution is valued. In practical terms, this means acknowledging that family carers are busy people and ensuring they can participate in a way that does not add to their stress. Family members need to be confident that their contribution is going to make a difference and they should be asked about the ways in which they want to be involved rather than being told how this will happen. It is a challenge to meaningfully involve people with learning disabilities with the RAG ratings process and the best way to do this is via regular meetings over the year, rather than just before the SAF submission is due. In the 2014 SAF, there were two measures to be answered by self-advocates and or family carers: B6 (compassion, dignity and respect) and C8 (Carers satisfaction). Some areas in the North West were able to organise specific events or opportunities for people to comment on, and rate, these two measures, but many had to rely on general measures such as existing surveys, for example, the national carers’ satisfaction survey. However, there were several examples of good practice and commitment to involving people in the rating process: • St Helen’s undertook a specific survey with self-advocates and family members. This

included some other questions that they wanted answers to and was therefore an efficient use of people’s time

• Stockport had a session with voting pads where each rating was based on the majority vote. Family carers, professionals, GPs and some self-advocates attended

The Knowsley Being Involved Group is a group of self-advocates who volunteered to meet five times in January 2015 to validate their local SAF submission. In the first session, the self-advocates learnt what the SAF is, what ‘validation’ is and what the red, amber, green (RAG) ratings mean. They agreed a set of questions to ask to validate the SAF. They did not have time to look at all the SAF responses so they chose which areas to focus on.

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For each indicator that they reviewed, the group: • looked at what evidence there was of what had been done • had a discussion about if they agreed with the RAG rating given • identified what information was missing • considered if there was anything that could have been done differently The group did their own RAG ratings and talked about what work should be done to make the ratings green. At the last session, they gave feedback to local commissioners and shared their report. Overall, they were in agreement with the RAG ratings, but they did dispute some and had a lot of questions for commissioners about the evidence. The group felt their involvement was important to understanding what needs to be improved in their local area. Members of the groupl enjoyed the work but acknowledged it had been difficult, particularly at the beginning. Further information about the Knowsley project is available from Paula Lomas at paula.lomas@kdc.org.uk Although the level of involvement of people with learning disabilities in the SAF submission for each area varies, it is clear that the SAF is meaningful to people with learning disabilities in the North West. This was demonstrated at their conference this year. North West Regional Forum

The North West Regional Forum has run an annual conference for the past 12 years, stretching over three days. This is a very significant event for self-advocates, with more than 180 self-advocates attending in 2015. The conference provides an opportunity for people to find out what is happening in the region and is an important social event. The SAF is important to the members of the forum and they used it to plan the agenda for the conference. Keynote speeches and workshops all related to the three main SAF areas and covered topics such as: • cancer screening • assessment and treatment units • voting and the general election • sexuality and relationships On the final day of the conference, representatives from NHS England, ADASS, CCGs and local authority commissioners are invited to come and hear what has been discussed and to answer questions as part of a question time panel. It is evident that the conference is hugely important to people in the North West and members of the regional forum work hard to raise money to keep it going. Further information about the conference is available from Mark Shackleton at mark.shackleton@pathwaysassociates.co.uk

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Using the SAF at area team level – Cheshire, Warrington and Wirral

In Cheshire, Warrington and Wirral (CWW) health and social care professionals have explored how the SAF can be used to improve the quality of local services. As an initial step, in 2014, the CWW area team nursing directorate organised a Moving Forward workshop, attended by more than 50 CCG and local authority colleagues. The workshop aimed to: • share good practice and innovations • provide collective support across the area • develop a collective response Feedback from peer review panels along with the desktop reviews were used to identify four key themes for the Moving Forward day: • improving primary care responses to learning disabled people • reducing health inequalities • safe and responsive services • data collection/needs assessment Attendees were assigned to one of the four groups and asked to identify issues and barriers for each theme and the steps required to reach their ultimate goal and vision. There was an emphasis on looking at what is working well in different areas and what can be shared or standardised. This approach has continued during the implementation of an improvement plan that resulted from the workshop. Findings were shared with self-advocates at the North West Learning Disability Self Advocate and User Forum. This provided valuable insight to share with commissioners, ensuring that feedback from service users is central to their work. Three task and finish groups were also established to take forward work identified at the Moving Forward event. The Moving Forward workshop was repeated in 2015. Priorities for 2016 are: • reducing health inequalities • co-production and collaboration • safe and responsive services Each theme has a group working on delivering an action plan, and the plans have been sent to NHS England and ADASS to show that they are delivering action as a result of the SAF. So far, most progress has been made in reducing health inequalities. This has included: • introducing standardised training for GPs across Cheshire, Warrington and Wirral

and obtaining sign up for the learning disability annual health check scheme from all GPs in the area

• a Commissioning for Quality and Innovation (CQUIN) payments framework target about health inequality, mapping out support to reduce inequalities and a delivery plan

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• action to increase participation in cancer screening and a specific event for bowel screening providers in the North of England

• the start of a local mortality review process • targeted work to increase the quantity and quality of Annual Health Checks for

people in the area As part of the co-production work, Cheshire, Wirral and Warrington leads have met with self-advocates to identify groups undertaking good work. The safe and responsive services stream of work is incorporating issues from Transforming Care, including care and treatment reviews and experts by experience, as well as exploring how to make their local commissioning process more efficient and effective. Collaborative working and leadership have been crucial to this work. It has also been important to make use of system levers and hold people to account. Further information is available from Jackie Rooney (patient experience and quality manager) at jackierooney@nhs.net Wirral – using the SAF at local level In the Wirral, the SAF is being used strategically to drive forward a detailed joint action plan, with named leads and monthly meetings to review progress. While good work was being undertaken, in some areas it was not being evidenced, captured and shared. This is now being done and the SAF is being used to drive change, as it is being worked one all year round. The Wirral has started with small changes and used opportunities to link in with people and other work. For example, a health facilitator was supporting GP surgeries to make reasonable adjustments but despite considerable efforts had only managed to work with three out of 54 GP practices. A local commissioner wrote to all GP surgeries to tell them about the support the health facilitator could give them at no expense to themselves. Over the next two months, the health facilitator was able to work with 36 of the practices. This was a small effort that had an immediate effect. Another piece of work in the Wirral relates to indicator A6 (primary care communication of learning disability status to other healthcare providers). A template is being developed to capture key information prior to referral. The template records patient details as well as information about their communication, carer support, compliance, medication and environment requirements. Including the learning disability status template in every GP referral will give the secondary care provider the opportunity to make appropriate reasonable adjustments. This will potentially lead to a reduction in DNAs, length of stay and inappropriate repeat attendances and a better experience for the patient and their carers/family. The template is being piloted with a group of practices and numbers and outcomes are being monitored.

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Warrington In Warrington, the SAF data showed a red rating for the numbers of people who had an annual health check. As a result, the Let’s Check project was piloted by the 5 Boroughs Partnership NHS Foundation Trust and was implemented the following year. In 2010/11, 56% of people living in supported accommodation had been for an annual health check and by 2013/14 this had increased to 94%. Performance in the SAF was also used in a successful business case to employ a Primary Care Health Facilitator. Further information about Let’s Check can be found at http://www.5boroughspartnership.nhs.uk/lets-check-initiative-/ Halton Each GP practice within Halton has a linked nurse from the Community Learning Disability Team. Practices are actively encouraged to access advice, information and guidance to enable them to support patients with learning disabilities, especially in relation to the annual health check. In 2012/13, the SAF data showed that only 50% of people with learning disabilities had received an annual health check. Halton health sub-group recognised Patient Participation Groups were an untapped resource and so a family member of the Learning Disability Partnership Board joined the group at her practice to highlight some of the issues people with learning disabilities face. As a result, a bid was made to the CCG innovation fund to provide Saturday drop-in clinics for people with learning disabilities to receive an annual health check. Health promotion and lifestyle services are available on the day to provide information and advice to help people act on the recommendations from their annual health check. NHS East Lancashire CCG In 2014, East Lancashire rated red for the number of people who have had an annual health check. In response to this, the CCG arranged a Protected Learning Time event for GPs to support improvement in this measure. This was extremely well attended and information drawn from the North West SAF desktop reviews was used to share some of the improvement actions taking place across the region to improve uptake. SeeAbility – national level SeeAbility is a specialist registered charity working to improve the lives of people who have sight loss and other disabilities, including learning and physical disabilities, mental health difficulties, acquired brain injury and life limiting conditions. The charity looked at the SAF data about eye care for people with learning disabilities. While the charity was aware of some good work taking place across England, the SAF report highlighted examples of which it was unaware. Some areas have reported that opticians need easy-read resources and other areas are working on developing their own. SeeAbility already has a range of existing resources and so has approached IHaL to discuss how to raise awareness of these. Consequently, SeeAbility plans to produce a short document specifically for the

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attention of people completing SAF so that they have some guidance around eye care. IHaL will bring this document to the attention of people completing SAF returns. For further information, contact Stephen Kill on s.kill@seeability.org or visit https://www.seeability.org/sharing-knowledge East Midlands – regional level Following concerns that the 2012/13 SAF had not been validated, locally or regionally, the NHS Local Area Team for Lincolnshire, Leicestershire and Rutland undertook an exercise to review submissions from the wider East Midlands, working alongside the East Midlands Learning Disability Network. An independent consultant with experience of the SAF process, a commissioner and one lay representative were commissioned to review the region’s submissions and provide a report. The lay representative was a family carer with extensive experience of being involved in local Learning Disability Partnership Boards. Her report identified good practice and challenges in each local area and which SAF indicator these related to. The report then summarised universal themes and resources across the region. She concluded that there were duplicated resources across the region and that sharing ideas could save money. This review highlighted ongoing issues with the use of the Mental Capacity Act and best interest decisions. There is confusion about what is reported and/or referred and there appears to be a deficiency across the area regarding a mechanism to capture best interest decision-making outcomes. This leaves services and professionals vulnerable to legal challenge. The findings were fed back to commissioners and this led to investment in decisions related to the Mental Capacity Act and Deprivation of Liberty Safeguards across Leicester, Leicestershire, Rutland and Lincolnshire. NHS England is now funding a 12-month secondment hosted by Leicester City Council for someone to work on Transforming Care and the SAF. This role will focus on SAF and network development. Further information is available from Louisa Whait, Regional Learning Disability Network Lead Officer on Louisa.Whait@leicester.gov.uk or 0116 4541233. Leicester, Leicestershire and Rutland – local level Better Care Together (BCT) is a significant programme of work aiming to transform the health and social care system in Leicester, Leicestershire and Rutland (LLR) by 2019. It brings together partners, including local NHS organisations and councils, to ensure that services change to meet the needs of local people. Further information about Better Care Together can be found at www.bettercareleicester.nhs.uk/ This programme has eight care pathways, one of which is about people with learning disabilities. The learning disability work stream is aligned to the SAF and SAF data is used to inform the commissioning/planning of high quality appropriate services. The SAF is also being used as a tool to benchmark progress and to measure changes in:

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• physical/mental health and wellbeing for all people with a learning disability and family members

• equitable access to the right services and support at the right time – including universal services

• the experiences of people with learning disabilities and carers – these should be comparable to the general population

Further information is available from Yasmin Surti, Learning Disabilities Implementation Lead – Better Care Together, at Yasmin.Surti@leicester.gov.uk or 0116 4542387. NHS Hardwick CCG – local level In April 2014, Derbyshire County Council recruited a Learning Disability Project Officer to its commissioning team to support the Transforming Care agenda and to oversee the SAF. This post was funded by Hardwick CCG for 12 months and enabled an individual to focus on the SAF. Subsequently, RAG ratings consultations were arranged with Learning Disability Partnership Boards and Good Health groups. Across Derbyshire and Derby city, peer validation has been carried out, providing the opportunity to challenge scores and ask about the evidence for the rating. While this was effective, it is felt that that a more formal validation process would give the SAF more recognition. The approach taken is that the SAF exists to help deliver year-on-year improvements to the lives of people with learning disabilities and that the emphasis should be on this, rather than simply submitting their SAF. Consequently, local action plans based on the RAG ratings have been developed, which have been presented to the relevant partnership board and monitored through the Joint Commissioning Board. Even if an indicator is rated green, it is accepted that improvements can still be made. At partnership board meetings, people can comment on, and contribute to, the action plans. Progress is reviewed at quarterly SAF action planning meetings. From these meetings, everyone has actions to take within their own organisations and there is continual monitoring and updating of the action plans. Evidence is collected as they progress and so effectively they are already working towards the next SAF submission. One example of an action arising from this work is that the SAF showed people were not filling in the local pre-questionnaire for annual health checks. Copies of the pre-questionnaire were sent to commissioners in primary care, who cascaded them to their leads. An example of an action plan can be found at www.ihal.org.uk/adjustments/?adjustment=363 Further information is available from Tracey Sims at Tracey.Sims@hardwickccg.nhs.uk

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Stoke – local level In Stoke, an action plan was developed from the 2012/13 SAF. The priority areas were those rated red or amber. Relevant actions were identified, as well as a person responsible for the action and the timeframe for improvement. Further priority areas were included after the next two SAF submissions, again identified from the red and amber ratings. Improvements have included co-production and the establishment of stronger links between the Learning Disability Partnership Board and the health and wellbeing board. However, progress has been slow in areas such as systems, data and flagging. As new indicators have been added to the SAF, the document has inevitably got larger and there has been concern that it is becoming unmanageable. There has also been insufficient time between SAF exercises to make progress on the actions. This means that some of the objectives have been unachievable in the timeframe. Therefore, the Good Health Sub-Group (set up as an outcome from the first SAF) decided to reformat the action plan in line with the development of the next learning disability strategy and its priority areas. This will be a joint learning disability health and social care strategy to ensure integration, joined up working and outcomes for all. They have adopted a co-productive approach to facilitate progress in areas of concern and support future SAF submissions. Further information is available from Debbie Cooper at debbie.cooper@stoke.gov.uk Middlesbrough– local level The South Tees Improvement Group was set up in response to the 2013/14 SAF. This focuses on where and how local improvements can be made, and gathering evidence for the next SAF. The action plan is based around the three SAF areas (good health, keeping safe and good support) as well as a fourth area relating to friends and relationships, as this was highlighted as an important issue by people with learning disabilities. The plan identifies numerous actions within each of the priority areas. One example of how SAF outcomes are being used to drive forward local work relates to cancer screening. Working in partnership with health, social care and Middlesbrough 1st, an event to raise awareness and promote take up of cervical cancer screening was organised for women with learning disabilities. This co-presented, interactive day was funded by Middlesbrough Public Health and attended by over 50 women with learning disabilities. Information about cervical screening was shared and there were small group discussions. Feedback from the day was positive with some women who had never been for cervical screening saying that they would now go. Further information can be found at www.ihal.org.uk/adjustments/?adjustment=360 or from Linda Lord at Linda_Lord@middlesbrough.gov.uk

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Durham – local levelß Durham County Council’s commissioners, in partnership with Tees Esk and Wear Valley NHS Trust Learning Disability Health Facilitation team, hosted an event in 2014 to promote the Learning Disability Health Charter.1 As well as raising awareness, organisations that support people with learning disabilities in County Durham were encouraged to sign up and implement the Charter. Organisers of the event encouraged a partnership approach with a message “we’re all in it together”. The focus of the day was a reminder that health is everyone’s business and that social care providers have a vital role in improving health outcomes of the people they support. Durham promotes an integrated model within learning disability services and the event reinforced the supportive elements of integration and strength of co-productive partnerships. A follow up event is scheduled to showcase good practice and share examples of how the charter has improved health outcomes for people with learning disabilities. It will include stories from the perspective of self-advocates. Information from this event will be used to inform the next SAF. Further information is available from Anne Ratcliffe at Anne.Ratcliffe@durham.gov.uk or Michaela Hopps at michaela.hopps@nhs.net Gloucestershire Voices –local level Gloucestershire Voices is a user-led self-advocacy organisation for adults with learning disabilities. In relation to the SAF submission, Gloucestershire Voices run area action groups in the six localities in Gloucestershire. These provide an opportunity for people with learning disabilities to say what they think the big issues are. Additionally, these meetings act as a feedback mechanism for people with learning disabilities to hear from Gloucestershire County Council (GCC) about the work they are doing. Video messages have been used to share information at all six groups. Members of the groups were invited to two centrally located workshops in 2015 to ensure that self-advocates were able to feed into the SAF submission. For the next SAF exercise, the action area groups will be central to the submission. Gloucestershire Voices has also undertaken work related to some of the SAF indictors. This includes: B2: Learning disability services contract compliance The Gloucestershire Partnership has a quality assurance programme, which has had national recognition from the Department of Health. It consists of announced and unannounced inspections visits during the day and at night, a Quality Compass survey which asks the network of support around an individual to comment on their welfare, and a service user-led quality-checking service. These consider contract compliance issues in addition to a range of other safety, welfare, lifestyle and procedural areas. Quality intelligence is shared monthly at quality meetings with safeguarding, commissioning, and operations. Gloucestershire Voices is part of the quality-checking

1 http://www.improvinghealthandlives.org.uk/publications/1221/Health_Charter_for_Social_Care_Providers

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Joint Health and Social Care Self-Assessment Framework

programme. This provides the opportunity to fully understand the 'service user' perspective of the services people are living with. Gloucestershire Voices currently undertake: • five quality checks per month of CCG-commissioned residential care or supported

living services • one per year (for each setting where at least one person is continuing health funded

or joint funded) • two per year for each health funded out of area placement • one for each inpatient service (Hollybrook and Westridge) C2: Local amenities and transport The Better Bus Services group, run by Gloucestershire Voices, meets transport managers bimonthly to discuss issues. The group also talks to people about transport and has created a film called Travelling Well. They developed a ‘hate crime’ pack as part of training for bus drivers. C4: Sport and leisure Active Gloucestershire and Gloucestershire Voices worked with Leisure@ to carry out an audit of facilities. Gloucestershire Voices conducted a survey that showed people with learning disabilities wanted more access to sport and physical activity. This led to changes to Leisure@ and improvements in other leisure facilities in the county are being made. Further information is available from Samantha Crocker at samantha.crocker@gloucestershire.gov.uk

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