Joint Health and Social Care Self-Assessment Framework · 2014-04-02 · Joint Health and Social Care Self-Assessment Framework Healthcare Demographics You should obtain this information

Improving Health and Lives:Learning Disabilities Observatory

Joint Health and Social CareSelf-Assessment Framework

Healthcare

Demographics

You should obtain this information from general practices. You can do this directly either by the Clinical CommissioningGroup (CCG) or Commissioning Support Unit (CSU) using MiQuest queries, or by direct liaison with practices. PrimaryCare Trusts and GP practices may also know this information from routine liaison in relation to Health Checks. In someareas, primary care contracting requires information flows to support this.

You should aim to provide this data broken down by age bands and ethnicity. However, if you are unable to provide anage breakdown at this level then either report the data by the number of people of aged 0 to 17 years old and aged 18and over, Or the numbers for all ages. These are the last three options in questions 1 to 3.

Please note recorded as being from an ethnic minority means that a person's ethnic category (if declared) is different fromthe English ethnic majority. That is to say they are not 'British (White)'. This refers to the term as defined for the NHS datadictionary.

http://www.datadictionary.nhs.uk/

http://www.datadictionary.nhs.uk/

www.ihal.org.uk/projects/datacollection/pbsaf 2

1. How many people with any learning disability are there in your Partnership Board area?

1.1 Aged 0 to 13 years old

61


64


551


782

1.5 Aged 65 years old and over

122

1.6 Aged 0 to 17 years old and recorded as being from an ethnic minority

7

1.7 Aged 18 years old and over and recorded as being from an ethnic minority

36

If you are unable to provide an age breakdown at this level of detail then complete either questions 1.8 and 1.9,question OR 1.10.


125


1455

1.10 All ages

1580


2. How many people with complex or profound learning disability are there in yourPartnership Board area?

Complex or profound learning disability here means learning disability complicated by severe problems of continence,mobility or behaviour, or severe repetitive behaviour with no effective speech (i.e. representing severe autism) (Institute ofPublic Care, (2009) Estimating the prevalence of severe learning disability in adults. IPC working paper).


3


1


26


58


5


0


5



4


89

2.10 All ages

93

http://ipc.brookes.ac.uk/publications/pdf/Estimating_the_prevalence_of_severe_learning_disability_in_adults.pdf


3. How many people with both any learning disability and an Autistic Spectrum Disorder arethere in your Partnership Board area?


23


15


134


43


3


2


5



38


180

3.10 All ages

218

Screening

This information should be obtained from GP practices. This may either be done directly by the CCG or CSU usingMiQuest queries, or by direct liaison with practices. Directors of Public Health should be monitoring this routinely as anequalities issue.

The total eligible population includes people with and without learning disabilities unless otherwise stated.


4. How many women are there eligible for cervical cancer screening?

The eligible population are women aged 25 to 64 years old inclusive and who have not had a hysterectomy.The population who had a cervical smear test in the last three years (1st April 2010 to 31st March 2013 inclusive)if aged 25 to 49 years old or else in the last five years (1st April 2008 to 31st March 2013 inclusive) if aged 50 to64 years old

4.1 Number of total eligible population

74393

4.2 Number of total eligible population who had a cervical smear test

48128

4.3 Number of eligible population with learning disabilities

426

4.4 Number of eligible population with learning disabilities who had a cervical smear test

118

5. How many women are eligible for breast cancer screening?

Eligible population are women aged 50 to 69 years old, inclusive.


5.2 Number of total eligible population who had mammographic screening in the last three years (1stApril 2010 to 31st March 2013)


5.4 Number of eligible population with learning disabilities who had mammographic screening in thelast three years (1st April 2010 to 31st March 2013)


6. How many people are eligible for bowel cancer screening?

Eligible population are people aged 60 to 69 years old, inclusive.


6.2 Number of total eligible population who satisfactorily completed bowel cancer screening in thelast two years (1st April 2011 to 31st March 2013)


6.4 Number of eligible population with learning disabilities who satisfactorily completed bowel cancerscreening in the last two years (1st April 2011 to 31st March 2013)

Wider Health

This information should be obtained from GP practices. This may either be done directly by the CCG or CSU usingMiQuest queries, or by direct liaison with practices. These are routinely available measures of major health issues thatshould be monitored by Directors of Public Health.

Report how many people there were on the 31st March 2013.

7. How many people with learning disabilities are there aged 18 and over who have a record oftheir body mass index (BMI) recorded during the last two years (1st April 2011 to 31st March2013)?1024

8. How many people with learning disabilities are there aged 18 and over who have a BMI inthe obese range (30 or higher)?424

9. How many people with learning disabilities are there aged 18 and over who have a BMI inthe underweight range (where BMI is less than 15 as per Health Equalities Frameworkindicator 4C)?22

10. How many people with learning disabilities aged 18 and over are known to their doctor tohave coronary heart disease?

As per the Quality and Outcomes Framework (QOF) Established Cardiovascular Disease Primary Prevention IndicatorSet.

26


11. How many people with learning disabilities of any age are known to their doctor to havediabetes?

As per the QOF Established Diabetes Indicator Set and include both type I and type II diabetes here.

111

12. How many people with learning disabilities of any age are known to their doctor to haveasthma?

As per the QOF Established Asthma Indicator Set

143

13. How many people with learning disabilities of any age are known to their doctor to havedysphagia?28

14. How many people with learning disabilities of any age are known to their doctor to haveepilepsy?

As per the QOF Established Epilepsy Indicator Set

295

Mortality

Following the publication of the Confidential Inquiry, Directors of Public Health will want to set up mechanisms to monitorthis. Relatively few are likely to be able to answer this question this year. In the longer term this will be produced as partof the NHS Outcomes Framework.

15. How many people with a learning disability resident in your Partnership Board area diedbetween 1st April 2012 and 31 March 2013?

15.1 Aged 0 to 13 inclusive

15.2 Aged 14 to 17

15.3 Aged 18 to 34

15.4 Aged 35 to 64

15.5 Aged 65 and older

Annual Health Check & Health Action Plans


16. How many people with a learning disability aged 18 and over were agreed as eligible for anAnnual Health Check under the Directed Enhanced Scheme between 01 April 2012 and 31March 2013?1266

17. How many people with a learning disability aged 18 and over had an Annual Health Checkunder the Directed Enhanced Scheme between 01 April 2012 and 31 March 2013?734

18. How many people aged 18 and over with a learning disability have a Health Action Plan?

18.1 Total number eligible

1455

18.2 Total number completed

350

Practices participating in Health Checks

Report how many general practices there were on the 31st March 2013.

19. How many GP practices are there in your Partnership Board area?40

20. How many GP practices in your Partnership Board area signed up to a Locally EnhancedServices or Directed Enhanced Service for the learning disability annual health check in theyear 2012-2013?40

Acute & Specialist Care

Providers should know this as a result of the Compliance Framework.

Report the numbers between 1st April 2012 and 31st March 2013.

21. How many spells of INPATIENT Secondary Care were received by people identified by theprovider as having a learning disability under any consultant specialty EXCEPT thepsychiatric specialties (Specialty codes 700-715)?

Please note 21.2 has changed from "Number for people with learning disabilities as percentage of total spells". We arenow asking for the denominator value as to ensure the accuracy of the information.

21.1 Number of spells for people identified as having a learning disability

429

21.2 Total number of spells

89034


22. How many OUTPATIENT Secondary Care Attendances were received by people identifiedby the provider as having a learning disability under any consultant specialty EXCEPT thepsychiatric specialties (Specialty codes 700-715)?

Please note this changed from "Number for people with learning disabilities as percentage of total attendances". We arenow asking for the denominator value as to ensure the accuracy of the information.

22.1 Number of attendances identified as having a learning disability

22.2 Total number of attendances

23. How many attendances at Accident & Emergency involved a person with learningdisabilities as the patient?

Please note this changed from "Number for people with learning disabilities as percentage of attendances". We are nowasking for the denominator value as to ensure the accuracy of the information.

23.1 Number of attendances involving people with learning disabilities


24. How many people with a learning disability have attended Accident & Emergency morethan 3 times?

Please note this changed from "Number for people with learning disabilities as percentage of total attendances". We arenow asking for the denominator value as to ensure the accuracy of the information.

24.1 Number of people with a learning disability


Continuing Health Care and Aftercare

Your Local CCG or CSU/Function should have this information.

Report the numbers on the 31st March 2013.

25. How many people with a learning disability are in receipt of Continuing Health Care(CHC)?57


26. How many people with a learning disability are in receipt of care funded through theSection 117 arrangement of the Mental Health Act?14

Location of mental health and learning disability in-patient care

In most cases, this should be known by CCG and possibly through CSU. Your Local CCG or CSU should have thisinformation.

Report the numbers on the 31st March 2013.

27. How many people with learning disability were in-patients in mental health or learningdisability in-patient units (HES speciality function codes 700 to 715) run by providers thatprovide the normal psychiatric in-patient and community services for the CCGs in yourPartnership Board area.

Note: the impact of this question is likely to be the 'missing figures' that relate to those placed out of area and this will becompared with the Winterbourne View data collection/registers.

27.1. Number of people placed primarily due to Challenging Behaviour

27.1.1 Age 0 to 17

0

27.1.2 Age 18 or older

3

27.2. Number of people placed primarily due to Mental Health Problems

27.2.1 Age 0 to 17

0


0

27.3. Number of people placed primarily due to complex physical health needs

27.3.1 Age 0 to 17

0


0

28. How many people with learning disability were in-patients in mental health or learningdisability in-patient units commissioned by NHS England (specialised commissioning)?

Note: this question has been changed to clarify what is requested.


28.1. Located in your Partnership area or a CCG area bordering it

28.1.1. Number of people placed primarily due to Challenging Behaviour

28.1.1.1 Age 0 to 17

0

28.1.1.2 Age 18 or older

0

28.1.2. Number of people placed primarily due to Mental Health Problems

28.1.2.1 Age 0 to 17

0


7

28.1.3. Number of people placed primarily due to complex physical health needs

28.1.3.1 Age 0 to 17

0


0

28.2. Located elsewhere

28.2.1. Number of people placed primarily due to Challenging Behaviour

28.2.1.1 Age 0 to 17

0


0

28.2.2. Number of people placed primarily due to Mental Health Problems

28.2.2.1 Age 0 to 17

0


0


28.2.3. The Number of people placed primarily due to complex physical health needs

28.2.3.1 Age 0 to 17

0


0

Reasons for mental health and learning disability in-patient placements

CCG or CSU should have this information. In some cases where commissioning for this group has been partlysubcontracted to providers, this may require their input too.

29. How many people with a learning disability have been admitted once or more often to bothin-patient mental health and learning disability care (HES specialty function codes 700-715) atleast once between 01 April 2012 and 31 March 2013?

Count each individual once only.

29.1 Primarily for management of challenging behaviour

0

29.2 Primarily for other reasons

7

29.3 Total number of individuals (One individual may in the year have had admissions for bothreasons)

7

30. How many people with a learning disability were in both in-patient mental health andlearning disability care (HES specialty function codes 700-715) on 31 March 2013?


0


6

31. How many people with a learning disability were in both in-patient mental health andlearning disability care (HES specialty function codes 700-715) on 31 March 2013 who hadbeen in-patients continuously in this or other placements for more than 90 days.


0


5


32. How many people with a learning disability were in both in-patient mental health andlearning disability care (HES specialty function codes 700-715) on 31 March 2013 who hadbeen in-patients continuously in this or other placements for more than 730 days (two years).


0


1

Challenging Behaviour

CCG or CSU should have this information.

Report all NHS funded hospital care.

33. Number of people with a learning disability or autism, with challenging behaviour in NHSfunded care on the PCT register handed over to the CCG at 31st March 2013.

33.1 Number in hospital at index date

3

33.2 Number NOT in hospital at index date

0

34. Number of people with a learning disability or autism, with challenging behaviour in NHSfunded care on the CCG register at 30th June 2013.


8


0

35. Number of people in learning disability or autism in-patient beds at 1st December 2012(Publication of Transforming Care) and number of these whose care has been reviewed in linewith the Ian Dalton Letter between the beginning of December and 1st June 2013.


5


0

Assessment and provision of social care

http://www.improvinghealthandlives.org.uk/gsf.php5?f=17350&fv=18595


You should refer to your Local Authority Referrals, Assessments and Packages of Care (RAP) Return data.

Report the numbers between 01 April 2012 and 31 March 2013.

36. How many people with learning disabilities received the following between 01 April 2012and 31 March 2013?

36.1 Received a statutory assessment or reassessment of their social care need whose primaryclient type was learning disability. (A1 and assumedly knowable from sources capable of producingA6 and A7)

940

36.2 Received community-based services whose primary client type was learning disabilities (P1)

820

36.3 Received residential care whose primary client type was learning disabilities (P1)

235

36.4 Received nursing care whose primary client type was learning disabilities (P1)

0

Inclusion & Where I Live

Social services statistics unit should have this information. Please note, these are data you should have reported to theHealth & Social Care Information Centre (HSCIC) earlier in the year. They are included here so they can be seen in thecontext of the other data. They will not be published by HSCIC until March 2014.

Report the number of people with learning disability as primary client type.

Employment & Voluntary Work

Refer to Adult Social Care Combined Activity Returns data L1.

37. How many people with learning disabilities in paid employment (including self-employedknown to Local Authorities)?30

38. How many people with learning disabilities as a paid employee or self-employed (less than16 hours per week) and not in unpaid voluntary work?20

39. How many people with learning disabilities as a paid employee or self-employed (16 hours+ per week) and not in unpaid voluntary work?10

40. How many people with learning disabilities as a paid employee or self-employed and inunpaid voluntary work?5


41. How many people with learning disabilities in unpaid voluntary work only?40

Accommodation

Refer to Adult Social Care Combined Activity Returns data L2

Please note, the National Adult Social Care Intelligence Service rounds these numbers to nearest five prior topublication. As such, we will take similar precautions when publishing these data.


42. How many people with a learning disability live in or are registered as:

42.1. Rough sleeper/Squatting

0

42.2. Night shelter/emergency hostel/direct access hostel (temporary accommodation accepting self-referrals)

0

42.3. Refuge

0

42.4. Placed in temporary accommodation by Local Authority (including Homelessness resettlement)

5

42.5. Acute/long stay healthcare residential facility or hospital

5

42.6. Registered Care Home

215

42.7. Registered Nursing Home

0

42.8. Prison/Young Offenders Institution/Detention Centre

0

42.9. Other temporary accommodation

15

42.10. Owner Occupier/Shared ownership scheme

15

42.11. Tenant - Local Authority/Arm's Length Management Organisation/Registered SocialLandlord/Housing Association

155

42.12. Tenant - Private Landlord

30

42.13. Settled mainstream housing with family/friends (including flat-sharing)

395


42.14. Supported accommodation/Supported lodgings/Supported group home (accommodationsupported by staff or resident caretaker)

175

42.15. Adult placement scheme

30

42.16. Approved premises for offenders released from prison or under probation supervision (e.g.,Probation Hostel)

0

42.17. Sheltered Housing/Extra care sheltered housing/Other sheltered housing

5

42.18. Mobile accommodation for Gypsy/Roma and Traveller community

0

42.19. What is the total number of people with a learning disability known to the Local Authority?

1095

Quality

For Health Commissioning Deprivation of Liberty Safeguards refer to Omnibus data collection http://www.hscic.gov.uk/dols

Training

43. How many of Health & Social Care commissioned services implement mandatory learningdisabilities awareness training? - We have withdrawn this question.

Complaints

44. How many complaints have directly led to service change or improvement in learningdisabilities services?8

Safeguarding

45. How many adult safeguarding concerns have there been in the year to 31st March 2013concerning adults with learning disabilities?379

46. How many adult safeguarding concerns have been raised in relation to people withlearning disabilities that required escalation?19

http://www.hscic.gov.uk/dols


47. What percentage of commissioned accommodation, residential or nursing placements "inborough" have had unannounced visits in the past 12 months?0

48. How many commissioned accommodation, residential or nursing placements "out ofborough" have had unannounced visits in the past 12 months?

Note: this question has been changed. Please provide the total figure, not the percentage.

0

Mental Capacity Act, Deprivation of Liberty Safeguards and Best Interestreferrals

49. How many Deprivation of Liberty Safeguards referrals were made by local authorities in2012-13?


73

50. How many Deprivation of Liberty Safeguards referrals were made by CCGs (formerlyPCTs) in 2012-13?


2

51. How many Best Interest Decisions referrals have been made in 2012-13?6

52. What percentage and number of staff in commissioned services have undertaken DOLStraining in the last 3 years?

52.1 Percentage

52.2 Number

212

53. What percentage and number of staff in commissioned services have undertaken MentalCapacity Act training in the last 3 years?

53.1 Percentage

53.2 Number

224


Transitions

54. The total school age population in your Partnership Board area44358

55. The number of people receiving additional assistance in school because of SpecialEducational Needs, with a primary need category of moderate learning disability.27

56. The number of people receiving additional assistance in school because of SpecialEducational Needs, with a primary need category of severe learning disability.350

57. The number of people receiving additional assistance in school because of SpecialEducational Needs, with a primary need category of profound or multiple learning disability.56

58. The number of people receiving additional assistance in school because of SpecialEducational Needs, with a primary need category of autistic spectrum disorder.374

59. The number of people with a learning disability aged 14 to 17 years old who are in receiptof a co-produced transition plan.513

Self-Assessment Framework

This section allows you to rate each measure of the self-assessment framework green, amber or red. You shouldcontinually refer to the guidance in order to decide the ratings. The guidance can be downloaded here.

In addition, you can click on each measure which will take to the definition of the measure and the RAG ratings.

In order to rate yourself RED, you must meet the criteria described under this heading In order to rate yourself AMBER,you must meet the criteria described under BOTH the RED and AMBER headings In order to rate yourself GREEN, youmust meet the criteria described under the RED, AMBER and GREEN headings

For each indicator, you should provide an explanation as to why you rated it green, amber or red and a link to a webpagecontaining further evidence to support this rating.

In addition, you can also provide a positive or negative real life stories of experience that explains why you think thatindicator is strong or needs improvement.

Please note, we would like you to keep these explanations and stories concise. As such please limit these to 1,000characters (including spaces). There is a counter underneath each comment box indicating how many characters out ofthe 1,000 you have used.

Section A

https://www.improvinghealthandlives.org.uk/uploads/doc/vid_18688_Joint%20HSC%20SAF%20MEASURES%20FINALz.pdf


A1. LD QOF register in primary careRedAmberGreen

Explanation for this rating

GP Practices have identified and registered 100% of the people with learning disabilities known to Community Learning DisabilitiesTeam (CTLD). The Learning Disability (LD) register has subsequently been reviewed and updated in some cases. Recording process in practices for some groups i.e. BME but they are not stratified in every required data set.Further work needs to be done on ensuring that these are regularly updated and can provide stratified data sets.GP system called "Systmone". This is a system that 80% of the Practices in Wakefield use to record patient records. It shouldtherefore be noted in the assessment that the figures will only relate to 80% of the population. The other Practices in the District useEMIS as their system, and they do not provide remote access to this.

Web link to further evidence

Real life story

A2. Screening

People with learning disability are accessing disease prevention, health screening and health promotion in each of thefollowing health areas: Obesity, Diabetes, Cardio vascular disease and Epilepsy

RedAmberGreen

Explanation for this rating

Systmone allows for comparative analysis about people's health in primary care for all of the health areas listed. Previously data hasshowed that diagnosis of other key chronic diseases, prevalence in the LD population is recorded as higher than the Wakefieldaverage.This is a system that 80% of the Practices in Wakefield use to record patient records. It should therefore be noted in the assessmentthat the figures will only relate to 80% of the population. The other Practices in the District use EMIS as their system, and they do notprovide remote access to thisA number of health screening promotion activities are in place to help reduce health inequalities. These cover activities such ashealthy walking groups, gym, cycling clubs, healthy cooking including coproduced easy read cookbooks and gardening/growingvegetables schemes.Wakefield participated in the Every Contact Counts Training for Staff - The training gives frontline staff to skills, knowledge andconfidence to have a conversation around some of the more prominent public health issues (i.e. smoking, healthy weight etc.) and tomake first stage referrals or signpost clients into existing services. This opportunity helps staff to improve the health and wellbeing forthe people they care for or work with.

This year some or our service users, carers and providers are participating in a project run by the Leeds Institute of Health Sciencesat the University of Leeds with regard to barriers for people with LD accessing Diabetes information and support.


http://www.southwestyorkshire.nhs.uk/quality-innovation/initiatives-projects/cook-eat http://www.wakefield.gov.uk/cgi-bin/MsmGo.exe?grab_id=0&page_id=48081&query=every%20contact%20counts&SCOPE=www.wakefield.gov.uk&hiword=contact%20counts%20every%20

Real life story

http://www.improvinghealthandlives.org.uk/pages.php5?pg=3251#AnchorA1



A3. Annual Health Checks and Annual Health Check RegistersRedAmberGreen

Explanation to rating

Learning disabilities registers in some GP practices are validated on an annual basis.Strategic Health Facilitator and CTLD's are assigned to support practices when updating registers to ensure accuracy.All 40 GP Surgeries in Wakefield have signed up to AHC's and received multi agency DES training. However 11 GP Surgeries did notcomplete any health checks in 2012/13. 734 people had a health check in 2012/13 which is 58%.LD awareness sessions delivered to all 40 GP Practices in Wakefield to encourage take up. Additional bespoke training provided as required and annual class room session also delivered.Uptake of AHC's are monitored through the DES and CCG contracting to make sure these are being undertaken.Paper taken to CCG to obtain support to increase % of practices signed up to the DES.

Evidenced through schedule of GP visits, briefing paper to CCG - Agenda for Primary Care Champion Day CCG Paper.Strategic Health Delivery Group minutes and delivery plan.LD minutes and presentations.


www.wakefieldldpb



Real life story

Going for My Annual Health Check I have put together my story about going for an annual health check what the experience was like and the feedback I got. I have beenpresenting this going for an annual health check presentation at the health event back in June.My experience at my annual health check. I received a letter from the doctors asking me to go down for an annual health check they gave me a time and date but theappointment was no good for me so they made me another appointment for me to go down which I did. I was not happy at first! Then the doctor said no need to get worried it's just a routine health check and a chance to discuss any healthchanges I may like to make. My sister came along with me for support we waited in the doctor's waiting room together for about 20 minutes I was then called intothe doctors room and then the doctor started the health check which included a few tests.

*Height *Weight *Urine Test*Pulse *Blood pressure

(I also had a blood test but I went to Pontefract Hospital to have this done as my veins are rubbish to find I really do not like it, as I amscared of needles)My doctor then asked me some more questions about my health she asked me if I was in a relationship with anyone. I got this feedback back from my doctor and want I need to do to improve this I then went away and did the following things. Thedoctor suggests that I should.

*Eat healthy*Cut down on my food*Plenty of exercise *Drink plenty of water *Eat five portions of fruit and vegetables I have started to do some jogging, walking to places I love to swim and doing aerobics myself ( dancing to music) and am going tokeep this up this is really important for my health then I can go back to the doctors and I can tell her what I have done to improve myhealth. I have even cut down on my food not eating too much and having a small portion not a full portion.I will set some more goals myself and these are.

*Cut down on my foods *To eat a healthy balanced diet*Exercise each day *Eat 5 portions of fruit a day*Drink plenty of water *Dance to music (aerobics)I can tell the changes I have made are now paying off

C

A4. Health Action Plans

Health Action Plans are generated at the time of Annual Health Checks (AHC) in primary care and these include a smallnumber of health improving activities. Refer to RCG guidance around health action plans.

RedAmberGreen




Work has started on integrating AHC's and Health Action Plans (HAP's). Currently 350 people have got new health passports andhealth action plan sheets. This number is expected to rise to over 750 in 2013/14. There is some evidence that health improvementaction plans are being completed and acted upon by support workers and CTLD's. Further work needs to be done with providers toencourage take up. This will be monitored through contract management.The DES LD awareness training included information around health action planning and how to set goals to improve health. All CTLD's have staff allocated to link with all GP practices to provide support with health checks and HAPs. A review of HAP's and VIP cards has been undertaken. The new plans have been co-produced with practice staff, nurses, socialworkers, the LD Patient Experience Group and LD Advocacy reps.Information on Annual Health Checks and Health Action Plans are shared with the LD Partnership Board regularly. Service usershave also attended the LD Partnership Board to share their experience of undertaking a Health Check.Evidence: Records of Health Action Plans.Annual Health Check launchAnnual Health Check and VIP passport templates LD Minutes and presentations.Information on Health Checks - Midyorks website


www.wakefieldldpb.org.uk/WorkOfBoard/HealthGroup/OtherInformation/default.htm www.midyorks.nhs.uk

Real life story

Feedback from Rainbow Advocacy Group: I worked with the health trainer about my weight and drinking, she was good, she didn't push me and didn't make me feel bad aboutmyself

A5. Screening

Comparative data of people with learning disability vs. similar age cohort of non-learning disabled population in eachhealth screening area for:

a) Cervical screening

b) Breast screening

c) Bowel Screening (as applicable)RedAmberGreen



Explanation for rating

Comparative data is not routinely collected for all health screening areas so assessed as red. Work has been done on improving ratesand with making reasonable adjustments in some areas. Cervical Screening Equality Audit has been completed and reported to Public Health Consultant responsible for screening. Cancer screening workshops have been introduced to help improve screening rates and make structured and reasonableadjustments in relation to consent, best interests and involvement of practices. National screening awareness event held for LD providers in Wakefield. This was open to all LD providers within Wakefield District(support workers, key workers, health facilitators, service managers). Health facilitation and links to contract monitoring commenced. Next steps to develop health facilitation education and awarenesspack.Some of our commissioned LD support providers have signed up to Josephine & Jack: creative sexual health and wellbeing resourcefor people with learning disabilities. Staff have been trained in how to use these for use in a number of scenario's includingdemonstrating breast and testicular self examinations and explaining cancer screening. Feed back from the LD SAF Health Event - There is some evidence of reasonable adjustments being made by some GP's but this isnot consistent across all practices.Users and carers rated red.

Evidence: Strategic Health Delivery Group minutes and delivery plan.Training workshop programme and presentation.LD SAF Event Report


ww.wakefieldldpb

Real life story

Feed back from the LD SAF Health Event:GP made good adjustments to accommodate breast screening at the surgeryBowel cancer information is difficult to understand even if you do not have a learning disabilityMore help needed for people to attend health screening - example when daughter received letter for cervical screening no help oradvice given to carer to look at how can achieve this. Daughter has LD, Autism and Challenging Behaviour.

Josephine and Jack Training1 person attended the training to enable her to share her experience amongst her friends and peers. This lady interacted with'Josephine' and with other people on the day and she has shared what she has learned as she aspired to do. More importantly thetraining supported staff to be more aware of issues raised within the training e.g. breast awareness (lump in breast) and what to lookout for/what to do in the event of finding unusual abnormalities.

1 lady attended the training to support her with proposed health investigations. The lady found the experience less distressing as shehad been supported to develop an increased understanding of her body and was also more aware of the procedures she was toundergo and the implications of having this done. It also supported staff's knowledge around the person's needs enabling them tosupport her in managing and reducing her anxieties. Overall the training enabled the lady to have a much more positive hospitalexperience and the investigations were successfully undertaken.

A6. Primary care communication of learning disability status to other healthcare providersRedAmberGreen




The QOF system allows for the identification of adults with a learning disability. Electronic flagging system in place within Mid Yorks Hospital Team (MYHT) that identifies patients as having a Learning Disability.This is to allow for adjustments to care packages and identify what reasonable adjustments are required. LD Champions are in placethrough out the hospital settings to assist with ensuring reasonable adjustments are in place. Champions receive training for their role.Order/entry software (ICE) system in place enables GPs to make direct referrals to Acute Liaison Nurse.Introduction of a clinical information system (RIO) has allowed for more seamless delivery of care within South West YorksPartnership Foundation Trust (SWYPFT).The Patient Experience Group have supported with the production of easy read leaflets - Nil by Mouth, Out Patients and Going toSleep. These can be found on the Midyorks Hospital website.Further work is being done within A&E to be able to identify LD users. During June 2012 the Trust also took the opportunity, as part of Learning Disability Week, to launch a three-month "TotalCommunication" pilot in MYHT, which consists of communication awareness on use of a new Communication Tool Box. This initiativeaimed to improve and increase staff awareness of communication difficulties some vulnerable groups may have.

Evidence LDPB minutes and presentation - Reasonable AdjustmentsLD Champion Training - involves users and carers.Leaflets.Communication Tool Box.


www.wakefieldldpb www.midyorks.nhs.uk

Real life story

A7. Learning disability liaison function or equivalent process in acute setting

For example, lead for Learning disabilities.

Known learning disability refers to data collated within Trusts regarding admission - HES data.RedAmberGreen


We have a full time designated LD Acute Liason Nurse in place. This post has been in place for a number of years and more recentlymade permanent. The post links to LD data captured locally within Mid Yorks Hospital Trust. The post is line managed by theStrategic Health Facilitator LD, work plan is managed and monitored by Strategic Health Group, which is a subgroup of LDPB. Thepost sits within the Safeguarding Team within MYHT and its function managed by the safeguarding adult lead. Evidence - Role/Job description and flyer

Feedback from LDSAF Health Event - Positive feedback has been received from Carers. The service puts service users at ease in situations they do not feel comfortablewith.It has made going to the hospital a lot better than it was 3 / 4 years ago.Service users and carers rated Green.




Real life story

Feedback from LDSAF Event:I had to go to hospital for an ultrasound scan. Peter arranged it so I could go straight through and didn't have to wait in the waitingroom. He knows who to speak to and the issues. Very good service. Need to have the same service in other hospitals.A service user with challenging behaviour was to go into hospital for an ultrasound scan. Peter arranged for a bed on the ward to beavailable so she could be sedated before being taken down for the scan. She was made to feel very comfortable. If this had not havehappened the service user would not have had the scan and the issue found would not have been discovered.

A8. NHS commissioned primary and community care

* Dentistry

* Optometry

* Community Pharmacy

* Podiatry

* Community nursing and midwifery

This measure is about universal services NOT those services specifically commissioned for people with a learningdisability.

RedAmberGreen


Work on improving access to universl services has been taking place over a number of years. There are some examples of whereservices have made reasonable adjustments within opticians, dentists, pharmacy, podiatry and midwifery.The Health Facilitater LD helps with providing other professionals with advice about how information and services can be provided ina manner that is likely to be accessible to a person with a learning disability or difficulty. Part of the CTLD role is to also help facilitatethe access of individuals with a learning difficulty or learning disability to universal services that are being provided by other agenciesto ensure that in future their needs are flagged.

One recent example is a protocol developed within midwifery -'Protocol for Integrated Working between Midwives and Community Team Learning Disabilities to Safeguard Children where ParentalLearning Disability / Difficulty is a Factor in Parenting Ability'. This is for use within the maternity service to promote collaborative working between professionals to meet the needs of pregnantwomen with learning disabilities/difficulties and used in conjunction with the Common Assessment Framework process.


Real life story

Feedback from LDSAF Event:The optician comes to my house has I have anxiety issues. It's the same lady that comes I like her.My Dentist is good they will write to my Doctors when I need a blood test before I have anaesthesia. They are very good. My Doctortalks to me and makes me feel comfortable when I have a blood test as I do not like blood tests.I go to Homestead Dentist. They have special times for people with LD. They go out of their way to accommodate me. I wait in the carbecause it is difficult to wait in the waiting area and when it is my turn they come out to the car to get me.The Special Needs Dentists are very good but the Castleford one is poor as it is upstairs so it is not accessible. If you live inCastleford and you cannot get upstairs you have to go to the Pontefract one and this is difficult to get to as it is too far.The Chemist is accessible and they offer to deliver and order my medication too. It is a very good service.

A9. Offender Health & the Criminal Justice SystemRedAmberGreen





There is a LD nurse who works in Wakefield prison and provides support in accessing resources. The Prison Health Quality and Performance Indicator (PHQPI) -Services for People with Learning Disabilities within Wakefield wasrated Green for 2012/13.

We have worked with the Probation Service on piloting a screening tool and raising awareness amongst Probation Staff this resultedin a booklet on services for staff to use.

The Strategic Health facilitator has been working with the CJS on LD screening, Health Action Plans and sharing of awarenessraising sessions for prison staff.


Real life story

Section B

B1. Regular Care Review

Commissioners know of all funded individual health and social care packages for people with learning disability across alllife stages and have mechanisms in place for on-going placement monitoring and individual reviews.

Evidence should describe the type (face to face or telephone etc.)RedAmberGreen


A rolling 12 month review process of all care packages is in place. Personal budgets reviewed at the same time as care package.CCG and Adult Social Care meet every two weeks to discuss joint and Continuing Health Care LD cases. At this meeting pathwaysand responsibilities for each are agreed. The LA has a joint assurance process in place to monitor reviews for people who are placed out of district or in patient beds thisincludes ensuring that reviews have taken place. All service users have access to independent advocates and individuals and family are involved in decision making via personcentred reviews. Reviews are undertaken in the majority by face to face however some telephone reviews do take place.

Former PAF indicator D40 - reviews completed during the year (2012/13) :Service users with LD (aged 18+) : 942 completed out of 1056 service users = 89.2% (Compared to 83.4% for all service users)

Evidence:Winterbourne Local StocktakeDMT Report - Winterbourne ViewLDPB minutes


www.wakefieldldpb

http://www.improvinghealthandlives.org.uk/pages.php5?pg=3251#AnchorB1


Real life story

Feedback from LD SAF Health Event:Annual care reviews involve service users, staff and family carers. The service user is always involved in discussions.

Community Nurses involve family and carers in any discussions.

B2. Contract compliance assurance

For services primarily commissioned for people with a learning disability and their family carersRedAmberGreen


The LA and Health undertakes regular contract management meetings with commissioned service providers that include qualityassurance based on outputs and outcomes. We also undertake Quality Improvement Framework monitoring visits in partnership with care managers where appropriate. Additionalassurance is completed jointly by social care and CCG commissioners as appropriate for new providers and where concerns aboutindividuals are raised. Commissioners routinely attend Safeguarding meetings for both in and out of area placements. The LA, aspart of its commissioning transformation, has reviewed most of its contracted services and support, looking at reconfiguring andinnovative ways of improving health and wellbeing and tackling health inequalities to offer more local and community based choice. The outcomes of reviews have been presented to Directorate Management Team.Evidence:DMT/Cabinet Report - Strategic ReviewCopies of Quality improvement Framework outcomes.Contract management Meeting minutes.


Real life story

B3. Assurance of Monitor Compliance Framework for Foundation Trusts

Supporting organisations aspiring towards Foundation Trust Status

Governance Indicators (learning disability) per trust within the localityRedAmberGreen


SWYPFT - the provider report in their quarterly Quality report their compliance with the Monitor Compliance Framework, and anyareas of risk or non-compliance are discussed at the Quality Board meeting between CCG commissioners and the provider.MYHT - the provider is aspiring to gain foundation trust status by 2016, and in order to do this have identified a set of priority actionsto improve quality and safety and to become financially sustainable. Part of these actions include undertaking a self assessmentagainst the Monitor quality governance framework. The outcome from this self-assessment will be shared with commissionersthrough quality contracting arrangements.

Evidence - Quality Accounts and Annual Reports 2012/13


www.southwestyorkshire.nhs.uk/quality - www.midyorks.nhs.uk

Real life story




B4. Assurance of safeguarding for people with learning disability in all provided services and support

This measure must be read in the context of an expectation that ALL sectors, Private, Public and Voluntary / Communityare delivering equal safety and assurance.

RedAmberGreen


Local Safeguarding is a joint process. The Safeguarding Adults Board has appropriate representation to ensure effective workinglinks internally to and with external partners. The Local Authority and Health partners share information on all safeguarding and reportable concerns. There is an Independent Chair in place for the multi-agency Safeguarding Adults Board who provides objective scrutiny to ensure thatpartners on the board continue to work together effectively. There is a two year Business Plan in place and multi agency subgroups around training, mental capacity, quality and performanceand reportable concerns. Key points and learning is shared within these sub groups.Assurance for service and support providers is embedded into all contract monitoring. Commissioners routinely attend SafeguardingMeetings where contractual concerns are raised for both in and out of area placements.Safeguarding is included in all LA and NHS contracts The NHS contract includes safeguarding standards based on the DH SAAF SWYPFT are key members of the SAB and are undertaking a strategic review of the LD services which includes quality, safety andsafeguarding. SA is included in all NHS provider and commissioner governance arrangements with reports at least on annual basis to theBoards. NHS providers have established safeguarding forums at which commissioners routinely attend NHS commissioning board and CCG also have a safeguarding forum.Although there has been no SCR commissioned there has been a lessons learnt review of two cases, section 117 after care and self-neglect with dissemination of any lessons learnt.

Users and Carers rated amber at the LDSAF event.

Evidence;Wakefield and District Safeguarding Adults Board Annual Report 2012 to 2013.Wakefield LSAB Minutes


www.wakefield.gov.uk - Wakefield and District Annual Safeguarding Report 2012/13

Real life story

Feedback from LDSAF event:Hospital - people that had been in hospital felt safe and were treated well

B5. Training and Recruitment - InvolvementRedAmberGreen





All LA commissioned LD specific services are required to provide evidence thought contract monitoring of service user involvement inrecruitment, monitoring and delivery of services. All services commissioned via the NHS National Contract required to produce evidence of service user involvement in planning andrunning of services together with evidence of Person Centred Planning in place within the organisation. A number of Service Users are trained as Quality Checkers and complete checks within services to ensure standards of service arehigh and that the needs of Service Users are met in accordance with their needs. The Learning Disabilities Patient Experience Group (PEG) are actively involved in training and awareness raising for CCG staff andnew MYHT Learning Disability Champions and existing members of the group. Training topics include, 'This is my life' and 'Listeningto the experts'.Evidence:Mid Yorks Training AgendaContract Management minutesFramework contractsProvider reports.


Real life story

LD Awareness Training.I am a family carer and help deliver Learning Disability Awareness training for the Hospital Trust LD Champions. I speak candidly toNHS Staff about my experiences, both good and bad as a carer of someone with SLD, Autism and complex health needs. We are now rolling out this training across primary care and to members of the CCG. The uptake of places has been veryencouraging. There are some gaps in staff from certain health centres. The inclusion of a carer and user in training sends a powerfulmessage to NHS staff who attend and challenges their views about LD. M.

Learning Disability Awareness Sessions for Hospital Staff - My involvement I am involved in the running of the learning disability awareness sessions for hospital staff in MYHT.My involvement in the day is to register people, meet and greet them on arrival.I have put together a presentation called "All about me" this is based on my life story, my achievements, and qualifications and wheremy career has taken me i.e. paid employment. I have found that the people on the course have found my presentation they interesting and they really enjoy hearing about everythingthat I have achieved in my life. The people ask me questions and also they give me feedback about my presentation. My presentation always evaluates very well asit is a true story.I support Marie Gibb with the training session I give out the certificates to the people at the end of the training session along with thelearning disability awareness pack and also the evaluation forms and summary of the day. The learning disability awareness team were nominated for an award at the Excellence Awards (2011/12) we got a certificate forcoming up runner up for Service User and Carer involvement. I felt so happy to hold this certificate on the behalf of the team C.

B6. Commissioners can demonstrate that providers are required to demonstrate that recruitment and management ofstaff is based on compassion, dignity and respect and comes from a value based culture.

This is a challenging measure but it is felt to be vital that all areas consider this.RedAmberGreen





We have some evidence of commissioning practice - In terms of our framework agreements for supported living and support andenablement services, our commissioning activity incorporates an approach to the procurement of such services that explores andevaluates service providers' approach, deployment and results achieved by their services regarding a range of aspects of servicedelivery linked to their values base. Examples include:-* How does your Organisation / Company ensure that the provision of care and support empowers Service Users and treats them withrespect and dignity? * How does your Organisation / Company ensure that the provision of care and support gives Service User choice and control, andresponds flexibly to Service Users wishes and changing needs? * How does your Organisation/ Company ensure that the health and wellbeing of Service Users is promoted and maintained? * How does your Organisation / Company ensure your services are delivered by competent staff?

Evidence:Framework AgreementContract monitoring minutes/reports.


Real life story

Feedback from LDSAF Event:

Emma and Peter are involved in training staff in their home in dignity, respect, equality, independence. This covers good and badthings and how service users should be treated.

Emma would like to be involved in other groups / boards but finds it difficult due to them not having the right facilities to support herpersonal needs. This impedes on her dignity.

J has recently moved house and he was involved with the process along with his Sister who cares for him.J talked to staff about the move and wanted to make sure that there was a place for his scooter to go and that he could take his TV.He also wanted to make sure that transport links were good so that his Sister can visit him.

B7. Local Authority Strategies in relation to the provision of support, care and housing are the subject of Equality ImpactAssessments and are clear about how they will address the needs and support requirements of people with learningdisabilities.

RedAmberGreen


Impact assessments are an integral part of our Corporate Performance Management Framework. This is a Council requirement andhas to be done for developing, writing, revising a new strategy or policy. This applies to all strategies not just LD. The Council and Joint Public Health Unit have worked together to draw up a comprehensive model for impact assessment. This is inorder to minimise the impact on services, meet our various legal duties and avoid duplication. It also ensures that all aspects ofpotential impacts are considered as part of the development process for all our plans, strategies, policies and major projects orprogrammes. Needs analysis are also undertaken as part of strategy development and service reviews to assess current and future demand. Someof these involve and are shared with individuals who use services and their families. Commissioning for Transformation and Market Position Statement are being refreshed for 2014. The previous strategy had an EIA inplace.The Commissioning Strategy has been shared with service users and carers at the LDPB and Carers Sub Group. There is a new Strategic Housing Needs Strategy that includes the needs of people with LD. A full CIA has been completed andsigned of Corporate Management Team.

Evidence:Commissioning for Transformation Strategy 2011Market Position Statement 2011Autism Strategy.Housing Strategy






www.wakefield.gov.uk

Real life story

B8. Commissioners can demonstrate that all providers change practice as a result of feedback from complaints,whistleblowing experience

RedAmberGreen


There is some evidence of changes to practice by providers as a result of feedback from complaints and whistleblowing. Our contractual arrangements for services require service providers to seek and act on the views of service users and operatecomplaints procedures. Dedicated resources within the Directorate engage with contracted service providers to ensure that suchprocesses are implemented and that service provider action planning occurs based upon the findings of their service userengagement activity. Our contracts have explicit contracts clauses requiring Service providers to have and operate whistle-blowingprocedures. We have evidence of working with service providers proactively on whistle-blowing matters.Improvements in the way we report learning from complaints is to be reviewed for 2013/14.

The number of complaints regarding Adult Social Care received during 2012/13 was 45; this is an increase of only 5 complaints sincelast year. The majority of complaints received were due to dissatisfaction of a decision. Across the whole of Social Care during2012/13 less than half of all complaints were upheld.


Real life story

B9. Mental Capacity Act & Deprivation of LibertyRedAmberGreen


The safeguarding process, related to DoLS, is monitored. This includes a training needs analysis and the development andimplementation of a comprehensive training programme for MCA/DOLS across the statutory and independent sector. The work of BIA's is overseen by the DOLS Lead which includes individual mentoring and a peer support group. All assessments are scrutinised for accuracy and 'lawfulness', as to the Act and Codes of practice, by the DOLS Lead before they areaccepted and authorised by the Supervisory Body. The DOLS Lead ensures all statutory provisions are met regarding the ability of assessors to carry out assessments.The work of the DoLS lead is overseen by the Service Manager for Personalisation.MYHT, SWYFT, CCG and WMDC work in partnership to achieve Mental Capacity Awareness training. Staff are trained in both theMCA and 'Adults at Risk' at varying levels and there is a clear pathway as to how this is implemented. Wakefield, at present, does notrecord the level of best interest meetings taking place but this is being reviewed.

Evidence:

Records of Best Interest Meetings.Policies Training plan






Real life story

Case studyThe case of MT was subject to a DoL that was later terminated on the subsequent review.M.T has a mild to moderate Learning Disability and is 42 years of age. He had lived in Supported Living for ten years prior to hisplacement in residential care. He came to be known to social services, as he had been placed on Guardianship by the court due to anoffence committed against a child. His Supported Living placement had been successful, in that it had been providing him with aservice that was meeting his needs and he was engaging well wiht. There were occasions where he fell out with the tenants and staffbut nothing that wasn't manageable or resulting in placement breakdown. M.T was assessed as lacking capacity to consent to theGuardianship Order or making a legal challenge to a tribunal. Therefore, an application was made to the First Tier Tribunal, as a bestinterest requirement, due to the length of time M.T had been placed on Guardianship. M.T was very anxious about the Tribunal takingplace as he perceived this as something bad was going to happen and had said he did not want to be taken off the Guardianship ashe believed it helped him to remain safe or free from getting into trouble with the police. The Tribunal felt M.T's care plans were not consistent with the powers of Guardianship and were a 'deprivation of his liberty' anddischarged him. M.T then later absconded from his Supported Living placement and there were concerns not only for his safety 'as anadult at risk' but he was a known risk to children. The police later found M.T and were concerned his care needs and risk hepresented could not be managed effectively in the supported living home. M.T was placed in a residential home, where the MA felt his care plans would constitute a Deprivation of his liberty. The MA (Managing Authority) made a referral for an Urgent Authorisation to enable a lawful deprivation of liberty . Due to the natureof the move (i.e. M.T was taken to the residential home, without his consent, as he lacked capacity to consent) and the level ofrestrictions in place, although they were felt to be a proportionate response and in M.T's best interests, therefore, the DoL wasauthorised and a timescale of three months set. Standard Authorisations are 'reviewed' well in advance of the expiry date.The Best Interest Assessor, felt M.T had settled really well at the home where the level of restrictions in place were not felt toconstitute a DoL. M.T continued to have 1:1 support on access to the community due to his vulnerability and risk to others but therewas no objections from him to this and he was fully compliant with all care plans. M.T advised the BIA he would not want to be out inthe community without support as he felt he couldn't manage this and would not be safe. As MT had no family to act as his RPR. an IMCA was appointed.

Section C

C1. Effective Joint WorkingRedAmberGreen


There have been robust S75 arrangements in place for a number of years. Due to the ongoing commitment by the LA and CCG tothis funding the format and function of existing S75 agreements are being examined and reviewed in light of the transfer of fundingfrom health to social care that took place in 2011. The LA has lead responsibility for commissioning LD and intentions are agreedthrough the Joint Strategic Commissioning Board.

The Joint Strategic Commissioning Board manages the pooled budget arrangements and joint performance related issues.

Wakefield Council and the South West Yorkshire Partner Foundation Trust (SWYPFT) are committed to working together to improvelearning disability services. Good working arrangements and joint protocols currently exist between health and social care staff. Wehave recently strategically reviewed the commissioned specialist treatment and assessment services and this has highlighted someareas that need to be improved in relation to the interface and roles and responsibilities between specialist services and communityservices.


Real life story

C2. Local amenities and transportRedAmberGreen

http://www.improvinghealthandlives.org.uk/pages.php5?pg=3251#AnchorC1




There are a number of accessible venues to enable individuals to participate fully in culture, leisure, sport and social activities. In thepast Wakefield through Aiming High capital has provided additional equipment at locations across the district that includes rooms withshowers, electric hoists, and height adjustable changing beds. All facilities are open to all members of the public and not just confined to those using the facilities. Facilities are spread across thedistrict however service users and carers said that not all facilities have been well communicated. To improve communication LeisureServices have recently developed a Wakefield Disability Sports Directory. Wakefield is working towards a Safer Place Scheme. This will include vulnerable young people and adults, including learningdisabilities, autism and dementia.

Users and Carers at the LDSAF Event rated amber overall.

Some individuals with the help of their support staff have been helped to travel by bus and train so that they can go shopping, meetfriends or go to work. However not all buses are wheelchair friendly and not all individuals feel safe travelling on public transportwithout support.


Real life story

Feedback from LDSAF Event:P has used the train to go to London with support. The trip went very well. Staff made them aware of his disability when they bookedthe ticket and someone was there to help them when they arrived at Kings CrossC's friend works in Leeds. The Social Worker helped at first but they now catch the bus on their own. Once they got on the wrongbus but the bus driver helped them get on the right bus. Even though they had a difficult experience they still feel confident enough totravel on their own.M goes shopping with support and they also support her when she uses the bus or the train so she feels safe.Gaining Independence.S, a very able young woman with learning disabilities, lived at home with her family but was viewed as someone who couldn't doanything for herself and received no support to learn new skills or activities. S was not allowed to go to college and was given 50pper day spending money as it was thought she couldn't manage her money. The Shared Lives Scheme helped S to find a 'host'family where she was supported and encouraged to make meals, go to the shops and gain her independence. S now has her ownbank account, buys her own clothes, travels independently to college every day and works in a charity shop on a voluntary basis. When she is ready and able, the Shared Lives Scheme will support S to move into supported living; into a flat of her own.

C3. Arts and cultureRedAmberGreen


There are local facilities that enable people with learning disabilities to participate fully and build/maintain social networks. People areable to go to the cinema, theatre, shopping centres, leisure parks and leisure centres. Local cinema's offer autism friendly viewingsonce a month and carers go free. Reasonable adjustments are made to lighting, sound and seating.

A number of our woodlands and parks have accessible pathways/walks in place and some have changing facilities available - AnglersCountry Park, Haw Park wood, Newmillerdam.

A new Art Gallery, The Hepworth, opened in 2012 and is fully accessible. The local Theatre Royal is popular with service users andproviders take groups of individuals to shows and concerts and other leisure activities such as bowling and bingo. Although somevenues are accessible for some individuals some buildings have restricted access particular for wheelchair users. The main local shopping centres and leisure centres have changing places facilities. The LDSAF Event users and carers rated this green for the district as a whole.


www.wakefield.gov.uk/CultureAndLeisure/ParksAndOpenSpaces/HawPark/



Real life story

Feedback from LDSAF Event:J and some of the other LD advocacy reps from the Rainbow Group were invited to new art gallery, The Hepworth, to help make thegallery more accessible for people of all disabilities. This included looking at heights of pictures, lifts, toilet facilities, informationsheets. J and the others were then invited to the official opening.

Some good Changing Places but don't know if all places have these facilities.

Carers Wakefield District - We are developing a buddying scheme to support people at local rugby matches.

C4. Sport & leisureRedAmberGreen


There are facilities at a number of our leisure services including Normanton Swimming Pool, Thornes Park Stadium, Featherstone,Pontefract and Minsthorpe Swimming Pools, the Ridings Shopping Centre, Junction 32 shopping and leisure centre and AnglersCountry Park. A brand new swimming pool opened in Wakefield in summer 2012. This includes a changing place and otheradaptations to ensure fully accessible. Thornes Park also meets the Inclusive Fitness Initiative (IFI) as an IFI accredited facility theyprovide a selection of equipment that ensures a user, regardless of their disability or impairment, will be able to have a full bodyworkout. There is a programme of activities for people to get involved in from walking groups, bowling clubs, football teams, cycling, art anddrama clubs. Some of these are organised through providers and some have experienced facilitators with learning disability expertisein place. There are also a number of local voluntary clubs that support people with undertaking sports.


www.soable2.org.uk/ www.wakefield.gov.uk/CultureAndLeisure/SAL/Facilities/SunLane/default.htm www.wakefield.gov.uk/CultureAndLeisure/SAL/Disability/default.htm

Real life story

Cycling for Success

D, has learning difficulties and mobility issues which inhibit his access to the community, he is blind in one eye and has a cataract inthe other. D, is currently participating in the Cycling For All project where he is encouraged to cycle for as long as he feels comfortable. D, isnow independent in this activity and cycles without any support.Since participating in this project, D has:* Seen an improvement in his health and wellbeing;* Become more mobile;* Has greater self confidence when in the community; and* Seen an improvement in his blood pressure.D, now looks forward to this activity on a weekly basis.

A provider of care and support services for people who have Learning Disabilities living in the community - People using the servicetold the CQC that they looked forward to, 'going to the gym and watching Manchester United', 'Going to church,peddle power, Monday night disco and having visitors' another reported 'I like going to my voluntary job, seeing my girlfriend, doing abit of gardening. 'I like having support workers and I like it when it is sunny and I can sit in the garden and watch the birds'.

C5. Supporting people with learning disability into and in employmentRedAmberGreen





Data is collected and available. The number of adults with learning disabilities and mental health needs supported into employment has fallen and compared to otherauthorities this is low.5% to 4.7%.Locally we have seen Remploy factories close and the cessation of a social enterprise where a number of adults with LD wereemployed leading to a loss in jobs. We have commissioned an Employment Support Service for a number of years. This service supports individuals either intoemployment, with job retention or work based experience. The service is due to be re-tendered for 2014. Individuals and carers havebeen consulted on what a new service should look like and the recommendations from this have been built into a new specification.Support also includes for people with Autism and Hidden Impairments.SWYPFT is working towards becoming an exemplar employer. They have launched a toolkit to support managers with recruitmentand retention of staff. In 2013 an Employment Delivery Group was restarted to work on improving the support for people. This groups reports to the LDPB.

EvidenceLDPB MinutesEmployment Subgroup, minutes, TOR and action plan.


www.southwestyorkshire.nhs.uk/employmentmatters www.wakefieldldpb

Real life story

P was born with a condition called Mosaic Down Syndrome, but he has never let this hold him back in anything he does, from passinghis driving test first time to joining his local gym. He is extremely motivated to find paid employment and since he joined theemployment support service he has become a committed volunteer for West Yorkshire Police. Peter says his ultimate goal is to findmeaningful paid work.

D joined the employment support service in 2011 via his GP. He worked with an Employment Coach who supported him to look atdifferent vacancies that suited his interests and abilities. In August 2012 D completed a work placement in Wakefield as a Cleaning Operative at ICES (Integrated Community EquipmentServices) a service that provides wheelchairs and other mobility equipment. Alongside this, D also applied for and was offered a part-time position as a School Crossing Patrol Warden for 5 hours per week. InSeptember 2012 D was invited to an interview at ICES for a part-time paid position and was offered the job. D says: "I was reallypleased as the hours ICES wanted me to work fit around my job as a School Crossing Patrol Warden".

C6. Effective Transitions for young people

A Single Education, Health and Care Plan for people with learning disabilityRedAmberGreen


There is a transition process in place from Children's social services to Adult social services. Parents/carers and young person(depending on level of understanding) are involved in this process. The referral process ties in with Year 11 Annual EducationReviews which are person centred and are holistic in nature. The allocated adult social worker is involved with the reviews includingEducation Reviews during the transition period.There is a Multi Agency Transition Steering Group. This has representatives from social services, local secondary care services(Children and Adult Services), Commissioners and Education.

A Special Educational Needs (SEN) and Transformation board has been established to oversee the implementation of integratededucation, health and social care plans. The integrated process will cover a number of workstrands

Evidence:TOR - Transition Steering GroupWakefield Council and Wakefield PCT Transition: A Professional's Guide March 2012 Minutes of meetings




Real life story

C7. Community inclusion and CitizenshipRedAmberGreen


While the JSNA references the Community Safety Strategic Assessment which contains measures of hate crime and wellbeing thereis no reference of indicators specifically for LD. Data on hate crime incidents for disability are provided by West Yorkshire Police and shared through the Community SafetyPartnership.

West Yorkshire Police have been working on improving disability hate crime reporting and police support and have signed up to theMencap 'Stand by Me' Police promise.

Last years Learning Disability Week centred on the continuation of the Hate Crime agenda, Mid Yorks Hospitals Trust hosted anawareness stand in the three hospital sites. The aim of the events was to raise awareness of Disability Hate Crime, how to report itand signpost people appropriately.

Presentations have also been made to the LDPB and to the Hear Our Thoughts (HOT) Advocacy Group about staying safe and whatto do in an emergency.

With regard to commissioning intentions we have for a number of years undergone a significant transformation of in-house servicesand modernisation of Day Services for adults with learning disability, resulting in closure of large day centres to smaller units thatsupport community based activities and the move towards more independence through supported living, in line with the valuingpeople principals.

Our Frameworks for Supported Living and Support and Enablement have recently been re-commissioned and requires that serviceusers are supported and enabled to participate in their Community, Society and the delivery of their Service. Outcomes towards thisare measured as part of contract monitoring.

Other support is in place to assist access to the local community. For example support to access paid employment, voluntary workand training opportunities.

Evidence:Hate crime data.LDPB minutes and presentations.


http://www.westyorkshire.police.uk/contact-us/hate-crime-hate-incidents www.wakefieldjsna.co.uk/wider-determinants/crime/



Real life story

J story dialling 999. I came out of the supermarket and saw a young lady unconscious on the ground. I didn't move her because Iknew it might hurt her. I went back in the store and told the ladies working there to call 999.

A Celebration of Ability Day was held at a local Church on 21 June. Ten acts performed at the event; the acts were made up of theself-advocacy groups and activity groups from around Wakefield. All of the groups devised their own performances aimed atshowcasing the talents of people with learning disabilities. The acts ranged from Makaton Choirs, to dances, singers, a puppet show,a comic act a theatrical performance etc. In excess of 80 people attended the event.

Stand By Me Campaign - Sept 2012West Yorkshire Police has signed up to the Mencap Stand By Me Police promise and Beverley's job is to engage with vulnerablepeople in the community and help them to feel safer where they live. She also wants to make it easier for everyone to understandinformation. Leaflets have been produced in easy read. The Police want to make sure people know who their Neighbourhood PoliceOfficers are and the Neighbourhood Police Team, so that they know where to get help if need it.To find out more about your Neighbourhood Police Team goto www.westyorkshire.police/npt and put your postcode in.

C8. People with learning disability and family carer involvement in service planning and decision making includingpersonal budgets

This measure seeks to stimulate areas to examine what co-production means and demonstrate clear and committed workto embedding this in practice.

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Co-production within Adult Social Care is evidenced through Wakefield Councils 'Making it Real' commitment to Personalisation. Ourthree priorities were decided upon co-productively with service users and carers, including people with a learning disability. Some ofour local providers have also committed to the MIR for their organisations.A user-led network has been developed to ensure service users have a single point of contact and offering a single gateway forconsultation and involvement and/or service delivery for commissioners. A co-production design team has been developed to produce this years 'Local Account' for Adult Social Care. The design teamincludes service users, carers and providers from across all vulnerable adult groups not just LD.The LDPB, its sub groups and advocacy reps are regularly consulted on about changes to services across health and care. Commissioners also hold events open to users, carers and providers to discuss changes to services - i.e. Healthwatch, Employment,Personalisation Event.

Commissioners are working towards supporting 'user-driven commissioning' and moving towards a culture that accepts co-production .We are aware that there needs to be a move from delivering services to facilitating services and from facilitating andenabling rather than a one-way process of providing care.

The LDPB representatives completed a co-production toolkit in 2012 about involvement with the board. This was shared with theboard and a number of improvements implemented as a result.

LDPB minutes, presentation and report.

The proportion of carers who report that they have been included or consulted in discussion with the person they support was 78.2%.This was good performance compared to England, Yorkshire and other similar local authorities.

Adult Social Care Outcomes Framework indicator 1(c) : The number of adults receiving self directed support during the year as apercentage of all clients receiving community based services LD only (aged 18-64) 2012/13 outurn : 552 / 759 = 72.7%(Compared to 41.6% for all service users)


www.wakefield.gov.uk/ Wakefield Local Account www.wakefieldldpb www.thinklocalactpersonal.org.uk/Browse/mir/




Real life story

Feedback from LD SAF event:

Most service users were involved in discussions around personal budgets along with their carers. Service users were asked how theywant to use their personal budgets.

The PEG group is really good at involving carers and service users and consulting on various things. Changes are then made a grassroots level which is what really matters.

Consultation is improving but there are still issues with timescales and deadlines being short.

In 2012, the Learning Disability Partnership Board service user and carer representative's completed the co-production self reflectiontoolkit from Inclusion North. The overall outcome from the toolkit rated the Partnership Board as amber. The areas highlighted forimprovement were appreciating the representatives for their contribution, experience and wealth of knowledge, accepting them asequal members of the Board and including them decisions made at Board meetings.

Training needs were also identified and Wakefield Family Service's are now working in partnership with other Council departments toaddress the training needs of the representative's. Family Services have also listened to the needs of carers and how they would liketo share their experience and knowledge with social workers and other teams within Family Services and will be supporting carers tovisit staff teams to share this information.

The following achievements have also been made following the use of the Toolkit:*The board membership has been reviewed.*New members have been identified and will be invited to the Carers Delivery Group and Rainbow Group.*All representative's have the opportunity to be involved in setting the agenda for the Board meetings.*An additional sheet is included with the minutes to highlight any actions.*The representative's have provided a presentation on their work to the partnership board.*The representatives have attended equality and diversity training, and plans are in place for training around the personalisationagenda.

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We have clear information on the number of registered carers in the locality and those in receipt of a carers assessment. Former National Indicator NI135 : The number of carers whose needs were assessed or reviewed during the year who received aspecific carer's service, or advice and information in the same year as a percentage of people receiving a community based service inthe year (2012/13) :LD (aged 18+) : Carers assessed (248) / Community based service users (821) = 30.2% (Compared to 27.4% for all service users)

More carers in Wakefield reported that choice and control over important things in their life had got better or much better (56%), ahigher proportion than carers in other parts of England (46%). A carers strategy is in place and was developed in consultation with carers. A carers implementation group is in place to monitordelivery of the action plan.The strategy is due for refresh in 2014. The strategy will be co-produced with carers. The LA commissions a carers support organisation to engage with carers within the district. There is a Learning Disability CarersSupport Worker who offers one-to-one advice, guidance and support for carers looking after someone with learning disabilities.Carers development days are held annually to discuss changes and service developments subjects included Personalisation andDWP changes to benefits.Carers take an active part in the LDPB. There is a Carers subgroup that feeds back issues into the LDPB.

Evidence of one service improvement is the expansion of a local respite service to include young people with complex needs. Thiscame via the Carers group and was raised at the LDPB. This involved commissioners, providers, families and carers working togetherto develop an appropriate offer.


www.wakefieldldpb www.wakefield.gov.uk - carers



Real life story

Feedback The mechanisms are there to get involved in planning but these are not always sustainable as carers don't always have the time. Themain priority is the actual 'care'.

Carers Development Day- April 2012:'Reasons to be cheerful',Over 50 people there* A dozen information stands* A full and varied programme of presentations...including, a Recipe for Success, Creative Minds and The Power of Music andPersonalisation success stories.Feedback "The best one yet" "Really enjoyable. Something to interest everyone"

Have you looked at the PDF output and agree that all the answers as they appear on it are correct?To do this, click Return to front page then click on 'View' under Start Questionnaire.

This marks the end of principal data collection and at the closing date (currently set as 30th November) we will lock thequestions in the principal entry against further change.

Yes

https://www.improvinghealthandlives.org.uk/projects/datacollection/pbsaf/index.php

Documents

Joint Health and Social Care Self-Assessment Framework · 2014-04-02 · Joint Health and Social Care Self-Assessment Framework Healthcare Demographics You should obtain this information