1. Determining Outcomes

3.  Winterbourne View  Policy focus on outcomes  Policy focus on equalities  Changing structures – CCG’s  Financial restraints  Challenging demographics  Strengthening the Commitment  6C’s

4. 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.

5.  Local accountability, not top down targets  Measuring outcomes, not process  Quality improvement  Improved transparency and accountability  Reduction in inequalities

6.  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

7.  Social  Genetic and biological  Behavioural  Communication and health literacy  Service access/quality (Emerson and Baines 2010)

11.  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….

12.  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….

13. A.Accommodation The 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 StatementDescriptor 4A Accommodation 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. 3A Inappropriate 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). 2A Shared 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. 1A Settled 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. 0A Settled 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.

17.  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

18.  For an individual:  Easy read guide and scoring sheets  Family carer guide  Practitioners can use to set priorities and monitor what happens  Practitioners can use to show what they have done – what difference it has made

19.  For a service:  Allocations  Caseload analysis  Performance management  Demonstration of value  Workforce planning / development

20.  For commissioners:  Gather information on population need  Inform Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy (through Health and Wellbeing Board)  Set priorities for specialist services  Monitor impact of services  Contribute to Equality Delivery System

21.  5 determinants and evidence base  Role of specialist services  Case study examples  Explanation of HEF process and scoring  CQUIN template

22.  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

24. http://www.ndti.org.uk/publications /other-publications/health-equality- framework-HEFguide/  Crispin Hebron – crispin.hebron@glos.nhs.ukcrispin.hebron@glos.nhs.uk Mobile 07836 556778  Dave Atkinson - datkinson66@btinternet.comdatkinson66@btinternet.com Mobile 07445924252  Gwen Moulster - gweneth.moulster@haringey.gov.uk gweneth.moulster@haringey.gov.uk Mobile - 07813402039