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Why the Accessible Information Standard - Jane Fox, NHS England
The document provides information about the Accessible Information Standard developed by NHS England to ensure that patients and service users who have disabilities or sensory losses receive information and communication support. It requires health and social care organizations to identify, record, flag, share, and meet the communication needs of users. Organizations must implement the standard by identifying needs at first contact, recording them, and providing accessible information and communication assistance. The standard aims to support effective communication for patients and improve their access, choices, safety, and experience with services.
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Why the Accessible Information Standard - Jane Fox, NHS England
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- 2. www.england.nhs.uk • With partners,NHS England has developed a new ‘Accessible Information Standard’ (SCCI1605 Accessible Information). • The Standard provides direction to the health and care system on accessible information and communication support for patients, service users, carers and parents with a disability, impairment or sensory loss. Background and Scope
- 3. www.england.nhs.uk • The listof organisations which must have regard to information standards is defined within the Health and Social Care Act 2012. In effect:- • The Accessible Information Standard applies to – and therefore must be implemented and adhered to by – all providers of NHS and publicly-funded adult social care. Who does the Standard apply to?
- 4. www.england.nhs.uk • The EqualityAct 2010 places a legal duty on all service providers to make “reasonable adjustments” to support disabled people, including providing information in “an accessible format”. • Service users with communication needs often receive inaccessible information and are not provided with the communication support they need. This has implications for patient choice, safety, and experience. Why do we need the Standard?
- 5. www.england.nhs.uk To establish aframework and set a clear direction such that patients and service users who have information or communication needs relating to a disability, impairment or sensory loss receive: • ‘Accessible information’ and • ‘Communication support’ So that they can access services appropriately and independently, and make decisions about their health, wellbeing, care and treatment. Aim of the Standard
- 6. www.england.nhs.uk • The Standardapplies to service providers across the NHS and adult social care system • Effective implementation will require such organisations to make changes to: • Policy • Procedure • Human behaviour • Electronic systems Implementing the standard
- 7. www.england.nhs.uk The Standard setsout a consistent approach to: • Identify • Record • Flag • Share • Meet communication needs of users. The Process
- 8. www.england.nhs.uk These mirror theprocess: • Ask: identify / find out if an individual has any communication / information needs (relating to a disability or sensory loss) and if so, what they are. • Record: record those needs in a clear, unambiguous and standardised way in electronic and / or paper based record / administrative systems / documents. • Alert / flag / highlight: ensure that recorded needs are ‘highly visible’ whenever the individuals’ record is accessed, and prompt for action. • Share: include information about individuals’ information / communication needs as part of existing data sharing processes (and following existing information governance frameworks). • Act: take steps to ensure that individuals receive information which they can access and understand, and receive communication support if they need it. A quick overview – 5 basic steps
- 9. www.england.nhs.uk As a resultof the Standard, patients, service users, carers and parents should: • Be able to make contact with, and be contacted by, services in accessible ways • Receive correspondence and information in accessible formats, including alternatives to ‘standard’ printed forms • Be supported by a communication professional at their appointments if this is needed to enable effective, accurate two-way discussion • Receive support from health and care staff and organisations to support effective communication. Impact of the standard
- 10. www.england.nhs.uk • Approved inJune 2015 / published on 3 July 2015 • Plan for implementation by 1 September 2015 • By 1 April 2016 all organisations that provide NHS or publicly funded adult social care must have made necessary changes such that they can routinely identify and record the information and communication needs of their patients or service users (and where appropriate their carers or parents) at first registration or interaction with their service Timescales and requirements
- 11. www.england.nhs.uk • From 1April 2016 services must identify the communication or information support needs of their existing registered or known patients or service users (and where appropriate their carers or parents) during routine appointments or interactions with the service. • Full implementation required by 31 July 2016 • Mandatory for all organisations that provide NHS or adult social care. Timescales and requirements 2
- 12. www.england.nhs.uk • Provide accessto a specific budget to produce accessible documents and resources. • Use and develop existing systems that people already use • Explain to staff how it can help them assess and manage patients with additional communication needs. • Ensure the solutions are in place before you roll out the assessment • Consider ascertaining service users’ needs versus their preferences PILOT SITE TOP TIPS #1
- 13. www.england.nhs.uk • Make allgeneral information leaflets accessible for everyone • Ensure there is a process of approving, storing and reviewing patient information leaflets • Develop a formal policy on how to assess and manage communication needs within the organisation BUT provide a quick reference guide for staff to know what help to get and how. • Use terminology that is meaningful to your organisation • Involve carers. TOP TIPS #2
- 14. www.england.nhs.uk • Allow additionaltime for interactions initially • Support staff with face to face training / awareness raising. • Produce information through a collaborative process, involving the person and their circle of support, in the same way that a Communication Passport is made. TOP TIPS #3
- 15. www.england.nhs.uk • Promised inthe Implementation Plan • Aim to publish and signpost guidance and links to resources as they come available via the NHS England website pages • E-learning –planning to make an e-learning module available to support organisations in implementing the Standard. Whilst this is in development, you may be interested in the collection of modules available on the Disability Matters website NHS England central guidance, templates and resources
- 16. www.england.nhs.uk • Information governanceadvice • Checklist to support local assessment of compliance • Improving the accessibility of standard documentation • Top Implementation Tips • Quality assurance advice • Web accessibility and usability • Quick user 'How to' guides for the five steps • Supporting people with particular information or communication needs • Assistive technology • Legal guidance • Examples of different types of accessible information and communication support • Glossary of terms and definitions • Myth busters • Effective easy read information • Frequently asked questions NHS England guidance / factsheets
- 17. www.england.nhs.uk Case studies on: •benefits of accessible information and communication support • supporting mental health service users with communication needs • achieving value for money and added value Examples / Templates: • Accessible Information Policy • Patient / service user registration form • Communication passport • Posters, statements and prompts to raise awareness of AIS with staff and public NHS England templates and resources
- 18. www.england.nhs.uk • SCR isan electronic summary of key health information from the GP record • 96% of patients in England have an SCR • GP practices can enrich SCRs with additional information including communication needs. • The additional information dataset includes all the clinical codes in the Standard • Once the patient’s consent for additional information is recorded, relevant codes are automatically included in SCR. • A leaflet is available to support conversations with patients • For further resources and information on using and viewing SCRs see this website or contact scr.comms@hscic.gov.uk Summary Care Record (SCR) support for AIS
- 19. www.england.nhs.uk • The InformationStandard is a voluntary programme run by NHS England. • ‘Quality Mark’ for all information produced by your organisation • Better information for all your service users • More efficient ways of producing information https://www.england.nhs.uk/tis/ email: England.informationstandard@nhs.net The Information Standard
- 20. www.england.nhs.uk Find out more: NHSEngland Accessible Information Sign up to updates or email queries to: england.nhs.participation@nhs.net Thank you Jane Fox How can I find out more and further help?
Editor's Notes
- #2 Thank you for inviting me to present and set the national context of the Standard.
- #3 For exmale: RNIB, SENSE, CHANGE This is about equality of access to health services though communication and information Enabling and facilitating a level playing field for everyone to make decisions and be informed on their own health and care, be empowered and in control There are: estimated 10 million people with hearing loss across the UK, 14% of them have missed an appointment due to not hearing their name being called estimated to be nearly 1 million people in England with a learning disability (2% of the general population) estimated 360,000 people registered as either severely vision impaired or vision impaired in the UK (i.e. 1 in 180 adults) approximately 259,000 deafblind people in the UK.
- #4 As a general rule, if your organisation provides services (including information) on behalf of / as a result of a contract with or funding from an NHS organisation (for example a CCG) or an adult social care organisation (for example a local authority), then the Standard applies. If your organisation does not provide any services commissioned or funded by an NHS or adult social care organisation then the Standard would not usually apply. There is more information about applicable organisations in the Specification for the Standard, and I would encourage you to refer to relevant sections so that you can assure yourselves as to whether the Standard applies to your organisation or not. The above represents only general advice as it is for your organisation to judge whether you need to comply, and, if so, assure yourselves that you are doing so.
- #5 This is an existing legal duty - the mandatory Standard clarifies the actions we should already be taking Accessible format – what does that mean? - ranges from: font size on letters formatting plain English with pictorial support (Easy read) emailing and texting patients BSL Interpreting and text relay. Implications – inequality for those patinets, DNA’s by not understanding or being able to interpret the communication to attend appointments, not able to discuss healthcare or participate in their own wellbeing, miss out on routine screening opportunities.
- #6 ‘Accessible information’ IS ‘information which is able to be read or received and understood by the individual or group for which it is intended’ ‘Communication support’ IS ‘support which is needed to enable effective, accurate dialogue between a professional and a service user to take place’ Expected Benefits of implementation Be more involved in their own health and wellbeing Be more involved in decisions about their care and treatment Better able to self-manage conditions Access services appropriately and independently Make choices about treatments and procedures including the provision or withholding of consent.
- #7 Expected Benefits of implementation Be more involved in their own health and wellbeing Be more involved in decisions about their care and treatment Better able to self-manage conditions Access services appropriately and independently Make choices about treatments and procedures including the provision or withholding of consent.
- #8 A process underpins the Standard to enable the required support once identified to be in place for all future interactions Why? People shouldn’t have to re-explain their needs every time The provider has the opportunity to meet the needs and to avoid putting people in unacceptable situations where they can not communicate or be communicated with Improves the efficiency of the interaction – could reduce the amount of DNA’s or repeat appointments Underpinned by a process BUT layered with the requirement to have staff with skills in identifying needs, a change in culture to acknowledge communications and support needs and the impact this can have on the people’s experiences and in turn health outcomes.
- #9 Ask Seems simple but for these groups of people it can be difficult to identify need – Ways to do this for example: communication cards, train frontline staff to look for cues of a communication or information support need, Posters to inform users they could express a need Record A standardised code used to record need not disability Alert Should be highly visible so when data is accessed or shared people can easily see it and act upon it Share Builds into exiting governance and consent processes – not additional or separate. Act Needs skill, understanding and awareness - feeds back into the cultural change required. Awareness of needs and that if we meet them the patient will have a much better experience and outcome
- #11 Be more involved in their own health and wellbeing Be more involved in decisions about their care and treatment Better able to self-manage conditions Access services appropriately and independently Make choices about treatments and procedures including the provision or withholding of consent. Total and full inclusion and equality in access to health information is the key message underpinning this standard. It will require some work but the benefits realised from its implementation are that we can influence the experience and outcome of health decisions if not for thousands then for millions. By 1 April 2016 all organisations that provide NHS or publicly funded adult social care must identify and record information and communication needs with service users: At the first interaction or registration with their service As part of on-going routine interaction with the service by existing service users.
- #13 THESE ARE JUST SOME OF THE TOP TIPS FROM THE PILOT SITES: Provide access to a specific budget to produce accessible documents and resources. Use and develop existing systems that people already use, don’t create something new BECAUSE people resent it and won’t follow it through. Explain to people how it can help them assess and manage patients with additional communication needs. BECAUSE they will resent if it is imposed on them Ensure the solutions are in place before you roll out the assessment. FOR EXAMPLE: provide a list of common communication support needed and how to access it (e.g. easy read, large print, e-mailed documents, professional support). Consider ascertaining service users’ needs and their preferences BECAUSE in some cases, meeting their preferences ensures that we are engaging with them and their perceived ‘needs’.
- #14 Make all general information leaflets accessible for everyone BECAUSE it can save time and duplication by ensuring all leaflets are produced using symbols, images and words rather than having more than one version. Ensure there is a process of approving, storing and reviewing patient information leaflets BECAUSE: to avoid duplication and old versions of information being given out. Develop a formal policy on how to assess and manage communication needs within the organisation, BUT provide a quick reference guide for staff to know what help to get and how. Use terminology that is meaningful to your organisation FOR EXAMPLE ‘learning disability communication support worker’ was replaced with ‘Carer / support worker who knows me well’. Involve carers. BECAUSE They understand the communication needs of the person they look after and can help you
- #15 Allow additional time for interactions initially BECAUSE this emphasised the importance of the process & standard. Support staff with face to face training / awareness raising. BECAUSE: Staff who were more involved in the work or received formal or informal training, had a higher level of understanding and engagement in implementing the Accessible Information Standard. Produce information through a collaborative process, involving the person and their circle of support, in the same way that a Communication Passport is made. BECAUSE: This would help to improve the consistency of reporting and recording, the quality of the information shared, and most importantly, it would increase the likelihood of the person getting the right communication support.
- #17 AIS Documents / Guidance Schedule IG guidance on communicating with patients via e-mail and SMS; sharing of patient identifiable and other data with interpreters etc Checklist to support local assessment of preparedness and compliance with AIS Improving the accessibility of standard documentation Top Implementation Tips Quality assurance advice on: data recording translated or transcribed information interpreters, communication support workers, translators and advocates Web accessibility and usability Quick user 'How to' guides for the five steps Specific advice about supporting people with particular information or communication needs e.g. hearing loss, sightloss, deafblind, dementia or aphasia, ld Guidance on using assistive technology - virtual, remote and web-based solutions Legal guidance on duties to meet individuals' information and communication needs Examples of different types of accessible information and communication support and who might need them Glossary of terms and definitions Myth busters Guidance on effective easy read information
- #18 Case study on the benefits of accessible information and communication support Case study on supporting mental health service users with communication needs Case study on achieving value for money and added value re accessible information and communication support Example / template of Accessible Information Policy Example / template of patient / service user registration form Example / template of communication passport Examples / templates of posters, statements and prompts to raise awareness of AIS with staff and public
- #19 SCR can help support the anticipatory duty of the Act – ensuring relevant information is available for patients presenting in unscheduled, urgent or emergency care. SCR is an electronic summary of key health information from the GP record, which provides care professionals with faster access to key clinical information, to support direct care. 96% of patients in England have an SCR and the SCR is available to be viewed across the NHS in England. Over 70,000 are accessed per week. With patient consent; GP practices can enrich SCRs with additional information such as significant medical history, care plan information, patient preferences and other content including communication needs. The additional information dataset includes all the clinical codes in the SCCI1605 standard, as well as other codes related to sensory, physical and learning disability, carers, advance care planning and other preferences. Once the patient’s consent for additional information is recorded in the GP system, then the relevant codes are automatically included in SCR. A leaflet is available to support conversations with patients (also in Easy Read) For further information on the SCR additional information content see the Inclusion set overview doc at: http://systems.hscic.gov.uk/scr/additional/inclusiondataset.pdf
- #20 Why not go the extra mile? All your Health and Social Care content can display The Information Standard ‘Quality Mark’ - demonstrating that the information you produce is accessible, reliable, clear and up to date Benefits for patients / service users Helps service users to make informed decisions on their Health and Care options and their ability to self manage Benefits for organisation Enhanced organisational credibility and reputation Clarity around information production costs across your organisation Cost savings – improved internal processes leading to more efficient ways of working Reduced risk of litigation due to a clearly defined information audit trail To gain successful membership, applicants are assessed against The Information Standard’s Principle and Requirements and are encouraged to self-develop the way they produce content through the means of yearly Self-Assessments.
- #21 Please visit our webpage where there will be links to resources as these become available.