Always Events The right behaviours always and everywhere David McNally NHS England

Action Areas Action Area 1: Helping people to stay independent, maximising well-being and improving health Action Area 2: Working with people to provide a positive experience of care Action Area 3: Delivering high quality care and measuring impact Action Area 4: Building and strengthening leadership Action Area 5: Ensuring we have the right staff, with the right skills, in the right place Action Area 6: Supporting positive staff experience

What are Always Events? Always Events are aspects of the care experience that are so important to patients, service users and carers that health care providers must perform them consistently for every patient, every time. Successfully delivering the Always Event programme provides: A foundation for partnering with patients, service users and their carers; Actions that will ensure optimal care experiences and improved outcomes; and A unifying force for all that demonstrates an ongoing commitment to person and family centred care.

About the initiative NHS England, in collaboration with Picker Institute Europe and the Institute for Healthcare Improvement (IHI) have developed a programme to pilot and test the Always Events framework and create guidelines and a toolkit for implementing Always Events within the NHS in England. The programme will run until April 2016 and will comprise 10 provider pilot sites in England. The purpose of the programme is to evaluate Always Events in these locations and assess the impact on improvement of quality in healthcare settings.

National approach + local determination Recognition (local decision) - transparent local feedback/ measurement National tools– with patients & professionals Local always events – with patients & professionals

How are Always Events different to other initiatives? Always Events are not done ‘for’ patients – they are co-designed with patients, families and carers to ensure changes are happening in areas which really matter to service users. Always Events are not simply the opposite of Never Events – Never Events focus primarily on breaches in patient safety and operational issues. Always Events focus on making changes to standard working procedures and behaviours which have real impact on the quality of patient experience. They are not isolated, provider-specific initiatives – the programme is designed to foster learning between healthcare providers so innovative solutions can be easily disseminated.

Always Events at Lancashire Care

The New Quality Strategy – Expected outcomes

Engaging staff – gaining momentum: We are looking for a team who will be willing to participate in this exciting and innovative national pilot of Always Events over the coming months The team will receive support from the Quality Improvement and Experience Team within LCFT, IHI and Picker If you would like to nominate a team or discuss this further please contact Helen Lee Action Area 2: Working with people to provide a positive experience of care

Making learning disability services better The Learning Disability Services want to get better at what we do. Your ideas are important and will help us get better at what we do. We asked people that use the services about their ideas, what they liked about the service and the things we could be better at.

What we did and how we did it We asked 22 people about what they did with a staff member and what they thought about work. We met with people for an interview to get their ideas. We showed each person a picture of the staff member to make sure they remembered them.

What you told us you liked Good things staff members did: Helped people to feel relaxed so they could talk to them Explained things clearly and slowly Made eye contact, listened and wrote things down Gave their office number so people could contact them Gave people a choice about where they were seen Having someone to talk to

Using drawing and pictures to help explain or understand things Getting on with the staff member Having privacy and feeling comfortable Being listened to and understood Learning skills and feeling more confident Practical support

What you told us you didn’t like: Three people said they sometimes found it hard to understand the staff member Some people found it hard to talk about difficult feelings Some people said they missed the staff member when they stopped seeing them.

What we will do to get better Use simple language and questions Find out how people communicate best Plan endings well so people still feel supported

Tell us about your experience when you have stopped seeing your community nurse or therapist? I was really sad It was OK because someone else form the team came to see me It made me unhappy – she was my friend I had a telephone number of someone to contact I can’t think about them not coming to see me – I will always need help I was a bit worried but I started to see someone else

‘How can we make ending your support from Learning Disability Services better for you?’ A place or person to contact if we need help A fridge magnet telling me who to contact (I lose pieces of paper and business cards) A photograph of the new person coming to see me Warning in advance that my support will be ending and the person is leaving or being replaced Being told who you are going to see if the person you normally see is not available Keeping in touch with the service. Coffee mornings, catch up events The person leaving introducing me to another worker I can contact

Tell us the best way to communicate with you? Write it down and then read it to me Don’t use doctor language Use bigger type Face to face Sign language or symbols Pictures Talk slowly – don’t rush or talk too fast Use kind respectful words Give plenty of time to take things in Ask me to repeat back so you know I have listened and understood Have someone who knows me with me Make sure you know how to communicate with me, sometimes what you say may make me worry Make sure my support is available before you start the consultation Find a quiet place to talk to me

How would we like our treatment to end? Face to face With notice it is going to happen to give me time to think Photograph of the person on our letters so we know who you are talking about Contact number of a person we can speak to if we are worried (on a fridge magnet or key fob) Letters that are easy read with symbols and no difficult language

Contact Card

Letter

Process Flowchart

Always Event discharge tracking Commencing 1 July 2015 Name and NHS No Date of Discharge Nurse or Therapist Date Letter and contact card sent Date of follow up telephone call Comments Record:  Any comments made  No response to call  If planning to attend ‘Pop in and Chat’

Pop-in and chat invitation

Co-Design Always Event Wording Were you given enough notice about when you were going to be discharged? Were you told in enough time that you were ready to move on? We will always support you in transitions of care We will always support you in moving on in care

Pop in and chat

Early days… Julie Clift: Clinical lead said: ‘Being involved in Always Events has enabled the learning disability service to really respond to the needs of our service users in a meaningful way. This is collaborative working at its very best. People with learning disabilities know what they want from us as a heath provider. These little enhancements to the way we work will have real meaningful impact on how our service users feel about the care we provide’

Early days… Amanda Thornton: Clinical Director said: We are working hard in Lancashire Care to learn from our experts – those who use our services. Our teams working with and for people with Learning Disabilities were quick to seize the offer of involvement in Always Events and quickly recognised with user input two service ‘touch points’ that needed improvement. The ideas generated by those who use our services have been informed, innovative and have frankly left us thinking ‘why didn’t we spot that’! We are delighted to be a part of the Always Events initiative and are learning lots that we can put into practise elsewhere too. Thank you!