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  • 1. West Midlands SHA Good Practice and Innovations Identified in Learning Disability Health Services – The Self Assessment Framework 2009/10
  • 2. West Midlands SHA Good practice and innovation extracts from district returns DISTRICT GOOD PRACTICE CONTACT AND INFORMATION (Notes) Top Target 2: LEAD: Birmingham  See-ability campaign – eye-to-eye campaign, working with local (3x PCT) opticians to provide training and allow for reasonable adjustments. Website:  Health Facilitation Team model, many examples of good practice in service delivery, including: GP activity checklist for health checks, a template for better metrics and training materials.  Electronic templates in Primary Care, including guidance for primary care staff on an extensive range of health issues, screening tool for GPs to identify individuals with a learning disability.  GP training around health checks, including accessible information for health checks and an accessible invitation letter.  Screening and procedure materials produced in accessible format for a range of health issues, including coil fittings, canular etc. Top Target 3:  Dignity Champions in accessing acute care; trained all self-advocates in safeguarding, develop “skills for care” and linked to overarching workforce strategy.  Complaints material produced in accessible formats, providing information on how to make a complaint.  Comprehensive and multiagency approach to Six Lives and Healthcare for All in actions in implementation. Top Target 4:  The Growing Old with a Learning Disability and Dementia (GOLDD) project – multiagency approach involving service users and carers to help in the planning and developing of services for needs that arise from the ageing process and dementia. (e.g. developing accessible resources on ageing and dementia, e-learning training programme for staff)  Health Facilitation extended to Mental Health through: Policy for joint working between adult mental health services and services for people 2
  • 3. with learning disabilities in Birmingham and Solihull.  Comprehensive service specifications, i.e. for Forensic inpatients step-down model, transition and challenging behaviour service models. Top Target 2: LEAD: Coventry  H Team Model; self-advocate peer health group who feed into the Partnership Board and PCT to identify gaps in service provision and Website: barriers to accessing health services. They also deliver staff training within health and social care.  Screening tools; a range of accessible leaflets have been developed to support service users and carers for a range of health conditions. E.g. blood tests, breast screening, psychiatric, dentist, dietician, A&E and dysphagia.  Healthy Lifestyles Project to address health inequalities, pilot project extended and commenced within BME communities.  Health Buddies Project – local voluntary sector organisation Grapevine provide training and support to service users to become peer supporters for those who need help in accessing primary health care services.  Pacesetters Project; piloting electronic alert system/flagging system to improve the access and experience of service users in acute care settings.  Excellent range of collaborative protocols between PCT, Health Facilitation, Community Learning Disability Team and acute care in supporting the care of patients with a learning disability when they access acute hospital services.  Named skilled “link person” in acute hospital to improve acute services.  Good service specifications on children with learning disabilities who require continuing and long-term care.  Good model for Community Dental Services, i.e. accessible resources, training for dental staff, pre-visit questionnaire and electronic patient records.  NHS Coventry have applied flexible working style and developed systems in relation to training and toolkits to improve on reasonable adjustments in practice and wider services.  NHS Coventry provide a comprehensive approach to meet the needs of individuals with profound and complex learning disabilities; 3
  • 4. including representation on Partnership Board and comprehensive needs assessment. Top Target 3:  Health Buddies Project (Grapevine Project); providing peer-advocates support and training peer-advocates in safeguarding, access the complaint system and support to make complaints.  Six Lives Workbook and action plan implementation is detailed and impressive. Top Target 4:  Transitions – good model of transition from child to adult services.  Working in partnership with family carers i.e. involving in training, participation and engagement, peer advocacy and developing a range of information in innovative formats, e.g. DVD.  Ageing and Learning Disabilities, included within Learning Disability strategy, and commissioning plan e.g. integration with mainstream services for early onset dementia team  Autism - numerous examples of good practice, including process models and developed core strategy team.  Approaches to addressing Challenging Behaviour, Mental Health, Workforce planning and Offender Health provide good practice examples. Lead: Dudley Top Target 2:  Robust Special Needs Register database – capturing disease register / informatics team.  Screening information made accessible, e.g. bowel, breast, testicular cancer, working with radiography.  A wide range of accessible information within Primary Care, including psychology and dementia easy reads.  Smile project – supporting people to access the community dental services in the local area.  Work with BME communities; specific group for Partnership Board, monitoring of ethnicity within GP practices and the data collected is used to inform strategic developments. 4
  • 5.  Good use of IM & T in developing easy read leaflets about National Care Records Service, care plans for learning disability patients are accessible via web based tool.  A & E nurse champion for learning disabilities Top Target 3:  People with learning disabilities working as volunteers within hospital  PALS service supporting the Learning Disability Support Line – enabling people to make complaints  Good model of engaging service users, carers and voluntary sector in addressing the safeguarding, training and education agenda.  Excellent multidisciplinary approach to addressing safeguarding, complaints, DoLS and legislative compliance. Top Target 4:  Robust arrangements for monitoring Out of Area placements  Supported living for people with learning disabilities  Excellent examples of strategies, approaches and models of practice within older peoples services, Transition, Autism and Workforce. LEAD: Hereford Website: Top Target 2:  Electronic Learning Disability Register – managed by Strategic Health Facilitator  Model of Strategic Health Facilitator role in influencing service delivery and commissioning.  Good use of personal health budgets through personalized commissioning approaches.  Good model of commissioning through vertical integration working to improve transitions, care pathways and strengthening partnerships, i.e. with acute sector. Top Target 3:  People’s Union – which involves teaching and supporting individuals Caroline Wharby to make a complaints by peer-advocates.  Extending the “lessons learned” newsletter from all complaints made 5
  • 6. by service users to the PCT, which now include examples involving learning disability services, shared among the wider health economy. Top Target 4:  “Getting a Life” pilot - work in relation to transition from children to adults service; prevention and individualised planning, linking to health, further education, employment and vocation. Top Target 2: LEAD: Staffordshire (N&S) North  Good model of training of GPs in locality around learning disability awareness and reasonable adjustments. Website: http://www.staffordshire-  Robust commissioning strategy for learning disabilities, including approach to transition and older people for 2008-2012.  SNAP – Special Needs Action Plan as an evidence base for improving practice in acute care by establishing a flagging system and allowing for reasonable adjustments. South  Acute Liaison Nurse in place; good practice in local acute trust.  Linking into Health Trainers service for health promotion initiatives, extended to people with learning disabilities.  Training for doctors and midwives delivered by service users; programme has been running for 6 years and links to local University programmes.  SNAP – Special Needs Action Plan as an evidence base for commissioning for acute liaison nurse role.  Robust commissioning strategy for learning disabilities for 2008-2012. Top Target 3: North  Workforce – “My Next Patient had a Learning Disability” toolkit used to train professionals.  Easy read materials and resources around Mental Capacity Act.  Easy read materials around Six Lives and Healthcare for All. South  A citizen’s pilot project to tackle bullying in local community; 6
  • 7. workshops, training and public engagement working to address learning disability and the wider vulnerable children and adults’ agenda through a multiagency approach.  Strong work around Six Lives and Healthcare for All. Top Target 4: North  Joint work with Combined Healthcare Trust, for specialist epilepsy, hearing and sight nurse in post.  Accessible information available regarding Mental Health in Primary Care.  The bereavement project - which includes a range of components and has been well monitored.  Challenging behaviour nurse specialist in post.  Workforce – “My Next Patient had a Learning Disability” toolkit used to train professionals.  Offender Health – health needs assessment conducted at local young offenders’ institute.  Good model - Transition workers in place in Newcastle and Staffordshire Moorlands. South  Active involvement of service users and family carers through a range of workshops reflected positive approaches.  Workforce – “My Next Patient had a Learning Disability” toolkit used to train professionals.  The model to engage Offender Health through hospital communication training manual in health facilitation training in learning disabilities. * * Sandwell Top Target 2: LEAD: Shropshire  Multiple initiatives in relation to sexual health and parenting, including and a sexual health clinic, awareness training in relation to learning disability for midwives and a parenting strategy that includes people with a learning disability. 7
  • 8.  Health Access Nurse role – a much valued post and perceived favorably by service users, carers and staff.  Models of joint working and working to influence mainstream culture on how services are traditionally delivered.  Excellent Shropshire Learning Disability Strategy 2010-2013.  Large numbers of accessible resources produced for a range of health issues, e.g. sexual health, cancer screening.  “Building Bridges” – is a training organisation led by service users and carers, in partnership with the Joint Training Unit. Deliver learning disability awareness training to midwives and other health professionals.  Pilot site for the Common Assessment Framework for adults demonstrating joint partnership working and working to influence the safeguarding of vulnerable adults agenda.  Excellent models of specialist health care and clinical services are based on a multiagency approach, i.e. Health Access Team, Integrated Community Team for IAPT (Increasing Accessing to Psychological Therapies), Shropshire Integrated Teams – Community Therapy and Psychiatric services. Top Target 3:  Unannounced service visits by service users and carers have enabled the monitoring of services and are feeding into commissioning plans.  Commission “Taking Part”, a self-advocacy organisation to work on safety issues.  Community Hospital have introduced the admission to hospital guidelines for people with a learning disability.  Use of Patient Passport “All About Me” has been promoted with the involvement of Taking Part and is used widely.  Comprehensive Six Lives report and action plan.  Robust multiagency vulnerable adult safeguarding approaches, i.e. training, strategy, referral processes, involvement of users and carers.  Accessible complaints process for people with learning disabilities available online. 8
  • 9. Top Target 4:  Robust processes in place for the following: End of life, Autism, transitions, Challenging behaviour, workforce and offender health. Top Target 2: LEAD: Solihull  Collaboration with Public Health to produce screening materials on cervical screening. Establishing a collaborative service between Website: http://www.easy-read- dieticians and speech therapists to assess and help individuals with swallowing problems disability-services.aspx  Work to support individuals with challenging behavior and complex needs. This included the design of bespoke services, staff training and support Top Target 3:  Support in understanding and reporting abuse, including easy read materials.  Six Lives workbook has been implemented; including specific training for people with learning disabilities on “keeping people safe” and work in underway with the acute hospital to strengthen their approach to safeguarding. Top Target 4:  Strategic work and multiagency approach to improve transition from young peoples to adult services.  SLOT (Supported Living Outreach Team) covering out of area placements.  Care Trust funds an Autism project worker post, who addresses Autism awareness issues for the general public as well as cross sector providers.  Funding of a support group for people with Aspergers Condition.  Active Mental Health and Learning Disability group working on the Green Light toolkit; with a shadowing programme between staff from both services.  Systems in place to monitor offender health. Top Target 2: LEAD: and Stoke  Joint work with Crossroads (voluntary organisation) who hold the contract for carers register and work jointly with PCT to review and 9
  • 10. identify gaps to feed into commissioning. Website:  The SNAP (Special Needs Action Plan) project which identifies people with a learning disability when they go into hospital.  The use of service user’s stories to influence service delivery  Improved access to dental services for people with a learning disability. Top Target 3:  The SNAP (Special Needs Action Plan) project which identifies people with a learning disability when they go into hospital. Top Target 4:  The SNAP project demonstrated effectiveness of flags being used at admission for A&E.  Specialist healthcare services for people with learning disabilities are based within Combined Healthcare.  Parents and carers have been involved throughout AHDC programme from making commissioning decisions, helping with capital building developments, supporting on task and finish groups on core areas of work. Top Target 2: LEAD: Telford and Wrekin  Comprehensive strategy and working to affect cultural change in the PCT on the learning disability agenda. Website: ??  Comprehensive training packages been developed and delivered to GP practices to tackle the health inequalities among people with learning disabilities.  Creative and personalized responses to health promotion including: Fit for Men, Green Gym and Women in Motion exercises for all.  Work to meet the needs of people with a learning disability from BME communities with the appointment of a BME worker.  Innovative ways of promoting overall health and wellbeing via social events at Pussycats nightclub.  Encouraging greater involvement and engagement of people with profound and multiple learning disabilities and their family carers. 10
  • 11. Top Target 3:  Robust approach and process in place around Six Lives and Healthcare for All.  Comprehensive complaints procedure, with easy read materials, support from Taking Part and independent advocacy involvement.  Whole approach to improving safety in health services for people with learning disabilities offers many good practice examples on accessing and monitoring complaints, legislative compliance, and safeguarding issues. Top Target 4:  Creative commissioning (Autism, Challenging Behavior, older people and transitions)  Reducing “out of area” placements and improving placement monitoring, through stronger links across children’s and adult’s services and utilizing reviewing officers  Carers Partnership Board with support from Taking Part (Self- advocacy organisation)  Excellent joint approaches and models to ensuring LD agenda is addressed in mainstream Older peoples and Dementia Strategy; Transitions, Out of area placements; Challenging Behaviour through the review of Mansell 2; and New Horizons.  A range of approaches to address workforce issues and improvements around offender health. LEAD: Walsall Website: Top Target 2:  An E-learning package for staff in Primary Care  Provision of mandatory induction training for all staff at Manor Hospital in supporting and understanding people with a learning disability  Cancer screening programme provided under the auspices of Pacesetters  The running of a number of different health promotion groups, e.g. epilepsy, cervical screening, diabetes, breast screening, well-persons 11
  • 12. group and dentistry.  A range of easy read materials, DVD’s, podcasts and website documenting numerous health conditions and issues.  The appointment of a health and social care facilitator specifically for people with a learning disability from BME backgrounds  Acute liaison nurse model.  The use of “Elephant kiosks” as a means of involving service user in decision making in planning service development  Top Target 3:  The Healthy Lives Advisory group based in acute; service users and carers are invited to attend this to subsequently feed into the Partnership Board. Service users have a direct impact on health initiatives in Walsall.  Website is fully accessible and interactive and includes a safeguarding contact, details of a new hate crime advisory group and downloadable accessible reporting documents.  Whole approach to safety; Six Lives, legislation compliance, DoLS, complaints and safeguarding are robust and reliable. Top Target 4:  New CPA (Care Pathway Approach) policy for learning disabilities in Walsall Community Health is providing a seamless process through discharge and rehabilitation.  Specialist nurse for dementia and long-term conditions employed within the robust Community Learning Disability Team’s infrastructure.  Robust pathway for transitions and a dedicated team working with young people and their families who are approaching and experiencing transition.  Good practice on profound and multiple learning disabilities, challenging behaviour, mental health, autism, workforce and offender health. 12
  • 13. Top Target 2: LEAD: Warwickshire  Integrated role of acute facilitator and health facilitator working to and provide seamless services and care pathways within GP practices.  Use of electronic health templates to record and cross-code Website: information.  Excellent training for GP’s and primary care staff delivered by peer health group who utilise a role play approach to training. Top Target 3:  Health inequalities lead commissioned and in post; with lead for safeguarding.  Work around Six Lives workbook detailed and robust, with key recommendations for acute trust. Top Target 4:  Well functioning reconfiguration health subgroup that feeds into the Partnership Board.  Engagement and partnership work with service users and carers.  Carer demonstrator site. Top Target 2: LEAD: Wolverhampton  Good practice learning from LES data initiatives.  Identified GP champion to support learning disabilities.  New project commissioned with local housing association to develop Health Action Plans.  Healthy Lifestyles Project – running in day centres to promote health and wellbeing and tackle obesity by increasing exercise and awareness of healthy choice among people with a learning disability.  Use of technology to improve service delivery, including the provision of Wii Fits within day centres.  Oral health and learning disabilities project; collaboration between PCT dental services and learning disability team to improve the oral health of people with learning disabilities. Include production of easy read service information, accessible oral health checklists and action plans, training of “Oral Health Action Plans”.  Collaborative work with Public Health; post filled to conduct health screening for cardiovascular disease.  End of Life care pathway training delivered to specialist health and social care staff. 13
  • 14. Top Target 3:  Audits conducted at acute trust and following an action plan has been developed to respond to Healthcare for All.  Accessible information produced with service users about making a complaint. Regular meetings with acute trust to ensure complaints are followed up and lessons are learnt.  Excellent and varied approaches to addressing complaints, safeguarding, Six Lives and Healthcare for All.  Joint recognition by PCT and commissioning of the resources needed to complete safeguarding investigations requiring nursing expertise, for dedicated nurse practitioner time. Top Target 4:  Out of area placement work – links to Person Centered Planning and transition planning.  Autistic Spectrum Condition - Supported Living scheme.  Proactive involvement of service users and family carers in the planning, tendering and supporting delivery of services.  Systems within acute trust to flag patients with a learning disability.  Work around dementia, autism, challenging behaviour, mental health and offender health offer good practice examples to service delivery. Top Target 2: LEAD: Worcester  Acute Liaison nurse role supports service delivery across the two local acute hospitals, as well as hospital champions for learning Website: disabilities.  A Healthy lifestyle course run for six-week healthy living programme providing service users with practical information on how to make healthy lifestyle choice – run by Speak Easy now.  Associate Pacesetters site for cervical screening and testicular cancer.  Link nurses - providing a variety of support to primary care including; maintaining a GP register of people with a learning disability, staff training and advice regarding capacity and best interest  Reducing health inequalities by joint working, improving communication between local authority, NHS and acute services through the production of…Draft health pathway, “My Hospital Book” 14
  • 15. and regular reporting against the 35 health standards. Top Target 3:  “Us and Our Health” project – produced a training DVD to be used as a training resources designed to raise awareness and promote discussions about health inequalities.  “Learning from Complaints Process” is in operation with independent advocacy support on behalf of people with learning disabilities.  “Health checkers” – which involves people with a learning disability auditing other people’s experiences of health services.  Approach and model to safeguarding is comprehensive, covering commissioning and contractual arrangements, training strategy and hate crime. Top Target 4:  Care pathway approach for epilepsy management and challenging behaviour.  Work around transitions is comprehensive and links to their health care pathway.  Involvement of carers and “expert members” in recruitment and selection of staff, health subgroup plan (“58 times more likely”), assessment & treatment service redesign and the awarding of the Learning Disability Development Fund (LDDF) in 2009/10.  County-wide Challenging Behaviour Service and the Psychiatry and Psychology services provide training and mentoring to Community Service Providers to improve support to people who challenge. A forensic care pathway has also been developed.  Good practice examples in dementia, autism, mental health and workforce planning are also demonstrated. * Not validated, however areas of good practice were documented in SAF return. 15