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National AAC Dissemination Seminar Monday 22nd April 2013 Prince Philip House, London Funded by London & South East.

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Presentation on theme: "National AAC Dissemination Seminar Monday 22nd April 2013 Prince Philip House, London Funded by London & South East."— Presentation transcript:

1 National AAC Dissemination Seminar Monday 22nd April 2013 Prince Philip House, London Funded by London & South East

2 a framework for equitable and effective commissioning The findings of the DfE funded AAC Grants S S E E R R V V I I C C E E S S A A A A C C The future of In England

3 To assist organisations’ transition to new commissioning arrangements. Applications invited from organisations in March Project ran from April 2012 to 31 March 2013 Outcome of the project is a report intended to inform the commissioning of the recommended ‘hub and spoke’ model of AAC services. Purpose of the DfE AAC Grants B B A A C C K K G G R R O O U U N N D D DfE AAC Grants

4 DfE AAC Grant Regions B B A A C C K K G G R R O O U U N N D D DfE AAC Grants

5 North B B A A C C K K G G R R O O U U N N D D DfE AAC Grants Ace Centre Barnsley AT Service CandLE Ltd

6 Midlands & East B B A A C C K K G G R R O O U U N N D D DfE AAC Grants ACT Birmingham

7 London B B A A C C K K G G R R O O U U N N D D DfE AAC Grants Royal Hospital for Neuro-disability Great Ormond Street Hospital UCL ACS – CLCH Trust CENMAC

8 South B B A A C C K K G G R R O O U U N N D D DfE AAC Grants Bristol Communication Aid Service Kent CAT Chailey Heritage Dame Hannah Rogers trust

9 The Objectives 1.Stakeholder involvement ALL Regions Involving all stakeholders – patients, families, staff, commissioners 2.Mapping ALL Regions Mapping existing services 3.Guidelines North Writing good practice guidelines for AAC provision 4.AAC Care Pathway North Planning the AAC Care Pathway 5.Database London Developing specifications for data recording for AAC provision 6.Procurement Midlands & East Developing processes for managing and procuring equipment 7.Remote assessment South Determining how technology could help assess and support remotely 8.Training/learning London Scoping current learning provision for AAC B B A A C C K K G G R R O O U U N N D D DfE AAC Grants

10 Stakeholder engagement All regions O O B B J J E E C C T T I I V V E E O O N N E E

11 First meeting identified stakeholders. O O B B J J E E C C T T I I V V E E O O N N E E Stakeholder engagement

12 Where possible materials have been adapted to make them accessible with symbolisation and Easy Read. Thanks to Widgit for supporting the project with Widgit Literacy Symbol. O O B B J J E E C C T T I I V V E E O O N N E E Stakeholder engagement

13 Expression of interest A database was developed so that people could be further consulted on objectives of specific interest to them. O O B B J J E E C C T T I I V V E E O O N N E E Stakeholder engagement

14 Survey A survey of AAC users was developed by the Midlands & East Region with over 80 responses by the end of the project. O O B B J J E E C C T T I I V V E E O O N N E E Stakeholder engagement

15 Service mapping Data collection by all regions Collation and analysis by Simon Judge and Sheffield University O O B B J J E E C C T T I I V V E E T T W W O O

16 Audit & mapping tool Designed to map services providing AAC at a local level Developed from CM – Research Matters project work Referenced against the CM service standards Inclusion criteria, procedure and definitions key. O O B B J J E E C C T T I I V V E E T T W W O O Mapping

17 Coverage 263 services mapped 70 further services identified 308 further catchment services identified Whilst we can not say that the gaps in coverage are definitely gaps, we can say they are more likely to be. O O B B J J E E C C T T I I V V E E T T W W O O Mapping

18 What does a typical service look like? O O B B J J E E C C T T I I V V E E T T W W O O Mapping

19 What does a typical service look like? O O B B J J E E C C T T I I V V E E T T W W O O Mapping

20 Variation by region and sector O O B B J J E E C C T T I I V V E E T T W W O O Mapping

21 Variation by region and sector O O B B J J E E C C T T I I V V E E T T W W O O Mapping

22 Prevalence O O B B J J E E C C T T I I V V E E T T W W O O Mapping

23 Caveats: Initial analysis of data. Health bias to provision but significant provision in other sectors. Variation across regions and sectors Significant demand for AAC services. Information to promote equitable provision and to manage local networks. Explore the data yourself: communicationmatters.org.uk/dfe-aac-project/objective-2 Summary & Implications O O B B J J E E C C T T I I V V E E T T W W O O Mapping

24 Good practice guidelines North Region Andrea McGuinness O O B B J J E E C C T T I I V V E E T T H H R R E E E E

25 Consultation findings Lots of documentation out there People using the service need to know their service is a good quality Commissioners know the service is equitable with the rest of country Those involved in service delivery need to have consistent standards to work to and have supportive resources to do this Roles need to be defined for hub and spoke service Short!! O O B B J J E E C C T T I I V V E E T T H H R R E E E E Good practice guidelines

26 Purpose and audience Provide structure Team Assessment protocols Give information Definitions Background information Measurement tool Efficacy of the service, outcome measurement Who to monitor Individuals using AT, professionals, families, others... O O B B J J E E C C T T I I V V E E T T H H R R E E E E Good practice guidelines

27 How does it look? Short document outlining roles / responsibilities Supporting documentation Glossary CM National standards CM outcome measurements AAC competencies in development O O B B J J E E C C T T I I V V E E T T H H R R E E E E Good practice guidelines

28 National AAC Care pathway North Region Anna Reeves O O B B J J E E C C T T I I V V E E F F O O U U R R

29 A brief history Significant lobbying over many years as technology has evolved and the number of children and adults who need AAC has increased Bercow Review acknowledged “that there was no consistent or equitable system (locally, regionally or nationally) for ensuring that those who need communication aids receive them” Former Communication Champion developed a comprehensive business case for the ‘Hub and Spoke’ model for AAC provision O O B B J J E E C C T T I I V V E E F F O O U U R R AAC care pathway

30 A changing policy landscape Health and Social Care Act and Children and Families Bill In September 2012, specialised AAC services were included within a list of services to be commissioned directly by the NHS Commissioning Board This necessitated the challenge to define who is eligible to access specialised AAC services and what services should also be provided by local commissioning arrangements O O B B J J E E C C T T I I V V E E F F O O U U R R AAC care pathway

31 Specialised AAC commissioning Severe physical disability especially of the upper limbs. Additional sensory impairment to the communication impairment. In need of specialist switch access, which may need to be bespoke. In need of a device that integrates spoken and written communication, as well as environment control. Able to understand the purpose of a communication aid. Developed beyond cause and effect understanding. Multiple disabilities which in combination impact on the individual’s ability to communicate. Communication technology needs beyond the competence of the local AAC service. Experience of using low tech AAC which is insufficient to enable them to realise their communicative potential. O O B B J J E E C C T T I I V V E E F F O O U U R R AAC care pathway

32 Local AAC commissioning No/mild physical disability. Communication technology needs within the competence of the local AAC workforce. Co-morbid conditions that do not impact on the individuals’ communication disability. Minimal upper limb impairment. Language commensurate with cognitive skills. Preverbal communication skills. Not achieved cause and effect understanding. O O B B J J E E C C T T I I V V E E F F O O U U R R AAC care pathway

33 O O B B J J E E C C T T I I V V E E F F O O U U R R

34 Database specification London Region Gary Derwent O O B B J J E E C C T T I I V V E E F F I I V V E E

35 O O B B J J E E C C T T I I V V E E F F I I V V E E Database There is currently no consistent method of collecting, managing and analysing data relating to the provision and use of AAC in England. Information gathered by Sheffield University as part of the Communication Matters : Research Matters project showed a wide range of methods of data collection regarding AAC assessment and provision. 92 AAC services throughout England were asked “Which database system do you use to record your data?” 25.0% Named a specific clinical database such as Rio, Lorenzo or SystmOne. 21.7% Listed only standard office databases or spreadsheets (Access / Excel). 15.0% Did not answer or provided unclassifiable answers. 10.8% Indicated a probable major database using generic initials (ie PAS / CRS). 10.8% Specified a combination of a major database and local desktop databases. 6.5% Listed a local or custom database without stating how it was implemented. 5.4% Stated that they used paper systems only. 4.3% Named a specific education database such as B-Squared or DataBridge. Current picture

36 O O B B J J E E C C T T I I V V E E F F I I V V E E Database To identify potential users of data who will benefit from accessing data on AAC provision. To identify the requirements of each of these potential users of data. To identify broad categories of data that would need to be managed. To identify permissions for each user type to view each category of data at either an individual identified level or anonymous aggregated level. To propose potential data items, data types and coding systems within each data category. To identify members of the AAC community at all levels who would be interested in continuing to provide feedback beyond the DfE project, should the NHS wish to utilise this. Changing aims

37 O O B B J J E E C C T T I I V V E E F F I I V V E E Database Table 1A. Potential users of data by role 1. Service user and family 1.1 Service userChild service user, Adult service user 1.2 Parent / guardian / next of kinParent / guardian of child, Next of kin of adult 2. Organisations with contact with the service user 2.1 AAC Hub StaffHub clinical staff, Hub technical support staff, Hub admin staff, Hub management 2.2 AAC Spoke StaffSpoke clinical staff, Spoke technical support staff, Spoke admin staff, Spoke management 2.3 Local NHS community teamLocal team clinical staff, Local team technical support staff, Local team admin staff, Local team management 2.4 SchoolSchool SENCO, School technical support staff, School admin staff, School Head / Management 2.5 GP surgeryGP, GP admin staff 2.6 Environmental controls serviceEC service clinical staff, EC service technical support staff, EC service admin staff, EC service management 2.7 Wheelchair serviceWch service clinical staff, Wch service tech support staff, Wch service admin staff, Wch service management 2.8 Local authority social services2.8.1 Local authority social worker 3. Commissioning and other statutory services without client contact 3.1 Area Team (AT)Area Team commissioner, Area Team Admin staff 3.2 Clinical Commiss. Group (CCG)CCG commissioner, CCG Admin staff 3.3 Local authority education deptLocal authority education management, Local authority education admin staff 4. Equipment suppliers Equipment supplier staff 5. Research organisations Researcher Potential data users

38 #Data group nameDescription 1IdentifierA unique identifier for the service user. NHS Number. 2Service user nameService user’s name. 3Demographic dataUsers demographic data. 4Service user contact detailsAddress, telephone, . 5Family / Next of Kin contact detailsAddress, telephone, . 6Other services contact detailsContact information for all involved parties 7Diagnosis detailsPrimary diagnosis resulting in communication needs and any relevant secondary diagnoses 8Referral to SpokeInformation provided to the spoke when referral received. 9Referral to HubInformation provided to the hub when referral received from spoke. 10Remote connection detailsFields to record details of video-conferencing and remote support facilities for the service user. 11Contact log / progress notesFields to track day to day interactions. 12Goals / aims / targetsFields to record the goals of intervention. 13Assessment / review informationInformation generated by the assessment (at spoke or hub level). 14Assessment / review conclusionsRecommendations made by the assessment (at spoke or hub level). 15Workload planning / task managementFields to record tasks required (at spoke or hub level) 16Loan episode detailsFields to record a loan of assessment equipment to a service user. 17Loan episode conclusionsFields to analyse outcome of a loan episode. 18Equipment issueFields to record the issuing of the service user’s own equipment. 19Equipment returnFields to record the return of the service user’s own equipment with reasons. 20Current AAC device / techniqueThe AAC device or technique the service user is currently using. 21History of AAC devices / techniques usedList of previous techniques and equipment used. 22Other related equipmentList of other equipment used, such as environmental controls and wheelchairs. 23Clinical OutcomesFormal outcome measures & other data with a function in measuring outcomes (TOMs, GAS etc) 24Service user satisfaction dataResults of user satisfaction surveys and questionnaires. 25Contracting outcomesContracting outcomes, eg CQUINS. 26Tariff details O O B B J J E E C C T T I I V V E E F F I I V V E E Database

39 Procurement Midlands & East Region Clive Thursfield O O B B J J E E C C T T I I V V E E S S I I X X

40 Activity within the AAC field has been focused on where and how aid funding can be achieved. Little room for broader considerations such as “what is the most cost effective way of procuring AAC equipment” and “how can we make best use of this, often, very expensive equipment”. The establishment of AAC as a National Commissioning Board Specialist Service affords us an opportunity to devise a new system which is defined by: Procurement, maintenance, recycling O O B B J J E E C C T T I I V V E E S S I I X X Procurement

41 Equipment is made available to assessing professionals when and where they need it Minimum administration needed to obtain equipment Minimum administrative and logistical costs Maximum use of equipment (minimum redundancy) Maximum use of equipment (optimised technical maintenance) Maximum purchasing power Sustainability for suppliers Optimising innovation A new system which is defined by: O O B B J J E E C C T T I I V V E E S S I I X X Procurement

42 Three ‘models’ considered rental agreements outright purchase: 1. A single national procurement centre 2. A sub set of specialist centres procure on behalf of all specialist centres 3. All specialist centres procure for their own needs Three ‘models’ considered rental agreements outright purchase: 1. A single national procurement centre 2. A sub set of specialist centres procure on behalf of all specialist centres 3. All specialist centres procure for their own needs O O B B J J E E C C T T I I V V E E S S I I X X Procurement Equipment is made available to assessing professionals when and where they need it Minimum administration needed to obtain equipment Minimum administrative and logistical costs Maximum use of equipment (minimum redundancy) Maximum use of equipment (optimised technical maintenance) Maximum purchasing power Sustainability for suppliers Optimising innovation

43 A National Framework Agreement which includes all AAC equipment including ancillaries and supporting equipment should be established via the OJEU process which will meet Public Procurement and NHS Standing Financial Instructions. On behalf of the NCB it would be led by the NHS Supply Chain who will represent and coordinate with the AAC Specialist Services. This National Framework will be an opportunity for negotiations on best value for money and for suppliers to properly represent the totality of their product/service. O O B B J J E E C C T T I I V V E E S S I I X X Procurement Recommendations

44 Recommendations (cont’d) Procurement should be the responsibility of each Specialist Service which is defined by the NCB and the AAC Specialist Service Specification, operating with and within the National Framework Agreement. Each Specialist Service should have a technical capacity to enable it to ensure that the AAC equipment in their catchment area is maintained to optimise its use and avoid unnecessary redundancy. The technical maintenance of the equipment will be a combination of ‘in- house’ capacity and liaison and collaboration with suppliers to ensure the most cost effective approach. Similarly, the technical capacity will ensure that uncommitted equipment is made ready for recycling. O O B B J J E E C C T T I I V V E E S S I I X X Procurement

45 A national data source should be provided and a network between the Specialist Centres be established to promote and facilitate recycling of equipment on as wide a basis as possible but should only apply to equipment where recycling costs are less than the equipment cost. The costs of recycling should be built into Specialist Services contract costs. Recommendations (cont’d) O O B B J J E E C C T T I I V V E E S S I I X X Procurement

46 Remote Access & video conferencing South Region Judith De Ste Croix O O B B J J E E C C T T I I V V E E S S E E V V E E N N

47 Updated literature review Surveys were undertaken to determine current AAC remote access technology use An information pack was created to standardise trial methodology and provide information for those involved. Remote access and videoconferencing trials were carried out with professionals and service users. Remote access and Video conferencing products were evaluated and a evaluation tool was developed. O O B B J J E E C C T T I I V V E E S S E E V V E E N N Remote access and video conferencing

48 Literature review 20 published papers were included Selection of clients Remote service delivery not appropriate in all circumstances or for all clients. More robust evidence needed Technology Hardware/software Network Client acceptance Generally good in all the studies. Professional acceptance Tended to be more sceptical. Training Lack of comprehensive training in this area. Information governance and data security A number of issues outlined that need to be considered Costs Cost of installing and setting up a service Increased demand for services. Long term costs of delivery may be less than cost of establishing services. No definitive data re this. O O B B J J E E C C T T I I V V E E S S E E V V E E N N Remote access and video conferencing

49 Survey The questionnaire collected quantitative data and identified: suitable technology for evaluation best practice models barriers, limitations and problems experienced current pathways, standards and documentation used potential participants current costings 80 professionals and 8 service users responded O O B B J J E E C C T T I I V V E E S S E E V V E E N N Remote access and video conferencing

50 Information pack information sheets were provided to include: An introduction to videoconferencing and remote access How to prepare for sessions How a session would take place What would be expected of the AAC user Videoconferencing etiquette and how it differs from face to face communication Advantages of remote sessions Consent forms Guides to the specific software packages being used with set-up instructions Also questionnaires were designed and used to collect quality and cost data to inform the outcomes of the project. O O B B J J E E C C T T I I V V E E S S E E V V E E N N Remote access and video conferencing

51 Trials A total of 14 trials were carried out. Aims Identify suitable technology to carry out sessions Identify and assess suitable services and users for sessions Assess professional and service user acceptance of remote service delivery Identify barriers, limitations and solutions for remote service delivery Assess cost comparisons of remote sessions and face to face appointments Outcomes Supported trials and showed that remote service delivery successful for: Training Review appointments Appointments for those with in-tact cognitive skills Appointments for those who struggle in new environments and/or with unfamiliar people O O B B J J E E C C T T I I V V E E S S E E V V E E N N Remote access and video conferencing

52 Costs: video conferencing Video conferencing clinical trial savings Video conferencing trial percentage savings O O B B J J E E C C T T I I V V E E S S E E V V E E N N Remote access and video conferencing

53 Costs: remote access O O B B J J E E C C T T I I V V E E S S E E V V E E N N Remote access and video conferencing

54 Evaluation tool An online tool was developed to ensure consistency and objectivity in analysis and comparison of system features when selecting remote access software Scoring system was applied to easily identify suitable products based on user requirements. Criteria for analysis based on The project specification Product features required for successful AAC interventions Clinical governance influence Security requirements The tool is divided into 5 sections. Product features Security requirements Ease of use Network requirements Costing tool The score is determined by requirements selected as Essential or desirable and if the feature is available on that system. O O B B J J E E C C T T I I V V E E S S E E V V E E N N Remote access and video conferencing

55 Training & Learning London Region Mike Clarke O O B B J J E E C C T T I I V V E E E E I I G G H H T T

56 Training Provision 1. To investigate regional variation in availability of training to professionals supporting people using AAC in England 2. To examine the amount and type of training currently provided, and priorities for future training O O B B J J E E C C T T I I V V E E E E I I G G H H T T Training and learning

57 Regional variation in availability of training n=187 O O B B J J E E C C T T I I V V E E E E I I G G H H T T Training and learning

58 Professionals receiving training n=107 O O B B J J E E C C T T I I V V E E E E I I G G H H T T Training and learning

59 Subject areas in which training is delivered n=84 O O B B J J E E C C T T I I V V E E E E I I G G H H T T Training and learning

60 Levels at which training is provided n=72 O O B B J J E E C C T T I I V V E E E E I I G G H H T T Training and learning

61 National AAC Dissemination Seminar Monday 22nd April 2013 Prince Philip House, London Funded by London & South East


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