determining outcomes. winterbourne view policy focus on outcomes policy focus on equalities ...
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Determining Outcomes
Winterbourne View
Policy focus on outcomes
Policy focus on equalities
Changing structures – CCG’s
Financial restraints
Challenging demographics
Strengthening the Commitment
6C’s
Learning disabilities nurses, their managers and leaders should develop and apply outcomes-focused measurement frameworks to evidence their contribution to improving person-centred health outcomes and demonstrating value for money. This may require a specific piece of work to scope current frameworks.
Local accountability, not top down targets
Measuring outcomes, not process
Quality improvement
Improved transparency and accountability
Reduction in inequalities
UK Learning Disability Consultant Nurses Network working group
Initial concept and outline discussed with DH
Discussed with Learning Disability Professional Senate
Broader approach and commissioning framework – support from NDTi and IHaL
Initiation of CQUIN in Gloucestershire
Tested with local teams
Discussed with National Valuing Families Forum and groups of people with learning disabilities
Social
Genetic and biological
Behavioural
Communication and health literacy
Service access/quality(Emerson and Baines 2010)
05
101520253035404550
%
Area of Need
Percentage Prevalence of Needs
0
10
20
30
40
50
60
0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-18
No. S
ervic
e Us
ers
HEF Scores
Distribution of HEF Scores
Each determinant has a set of indicators
Each indicator has a description
Each indicator has a set of ratings that describe different levels of impact
Let’s look at an example….
Social Accommodation Employment and meaningful activities Financial support Social contact Additional marginalising factors (such as
ethnicity) Safeguarding issues
And here are the impact ratings for accommodation….
A. AccommodationThe quality of living standards for people with learning disabilities can vary widely. When considering accommodation it is important to consider the physical and the social environment. Risks may exist because of the physical environment (extreme damp, unsafe electrics, lack of adaptation around mobility problems etc.) or arise from the social environment (overcrowding, bullying, aggression from others, etc.)
Impact Level & Indicator Statement Descriptor
4AAccommodation presenting high risk, or in hospital / prison with no discharge accommodation identified or homeless
This level applies to a person who has no settled accommodation, who is in temporary short term accommodation with no appropriate move-on accommodation identified, or is in accommodation that is directly impacting on their health and wellbeing. This includes those who are living in restrictive settings such as hospitals or prison. There may be serious safeguarding concerns in relation to accommodation.
3AInappropriate accommodation / accommodation at risk of breakdown
This level applies to a person whose accommodation is contrary to their identified health and social need, or where the accommodation is fragile and likely to be lost (e.g. due to negative relationships with peers / neighbours, lack of suitably skilled support, offending behaviour, or where notice has been served by the accommodation provider).
2AShared accommodation with others / family – not by choice
This level applies where accommodation is shared and has not been either selected by the individual, or through an appropriate best interest process. Similarly, where individuals are living with their family even though they or their family would prefer alternative accommodation that would provide greater independence.
1ASettled single accommodation or shared with self-selected others
This level applies where a person Is in accommodation of their choice or through appropriate best interest processes, either on their own or with others they have chosen to share with. This may however be in some form of registered care or where they may not have full control over tenancy, care or support.
0ASettled family accommodation or own tenancy / ownership reflecting personal choice
This level applies where a person is in settled accommodation of their choice or appropriate best interest process; either with their family or where they have control over their own tenancy, care and support.
Individual ‘before’ and ‘after’ HEF profile
Individual profiles anonymised case load profiles
Case load profiles anonymised team case load profiles
Team case load profiles anonymised service case load profiles
For an individual:Easy read guide and scoring sheetsFamily carer guidePractitioners can use to set
priorities and monitor what happensPractitioners can use to show what
they have done – what difference it has made
For a service:AllocationsCaseload analysisPerformance managementDemonstration of valueWorkforce planning / development
For commissioners:Gather information on population
needInform Joint Strategic Needs
Assessment and Joint Health and Wellbeing Strategy (through Health and Wellbeing Board)
Set priorities for specialist servicesMonitor impact of servicesContribute to Equality Delivery
System
5 determinants and evidence base
Role of specialist services
Case study examples
Explanation of HEF process and scoring
CQUIN template
Determinants of health inequalities
Related National Outcome Framework domains
Evidence of health inequalities in population
Priority outcomes
Plans to reduce health inequalities
Evidence of change
http://www.ndti.org.uk/publications/other-publications/health-equality-framework-HEFguide/ Crispin Hebron – [email protected]
Mobile 07836 556778Dave Atkinson - [email protected]
Mobile 07445924252Gwen Moulster - [email protected]
Mobile - 07813402039