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

National AACDissemination Seminar

Monday 22nd April 2013Prince Philip House, London

Funded by

London & South East

a framework for equitable and effective commissioning

The findings of the DfE funded AAC Grants 2012 - 2013

SS EE RR VV II CC EE SSAA AA CCThe future ofThe future of

In EnglandIn England

To assist organisations’ transition to new commissioning arrangements.

Applications invited from organisations in March 2012.

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

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DfE AACGrant Regions


North


Ace CentreBarnsley AT ServiceCandLE Ltd

Midlands & East


ACT Birmingham

London


Royal Hospital for Neuro-disability Great Ormond Street Hospital UCL ACS – CLCH Trust CENMAC

South


Bristol Communication Aid Service Kent CAT Chailey Heritage Dame Hannah Rogers trust

The Objectives1. Stakeholder involvement ALL Regions

Involving all stakeholders – patients, families, staff, commissioners

2. Mapping ALL RegionsMapping existing services

3. Guidelines NorthWriting good practice guidelines for AAC provision

4. AAC Care Pathway NorthPlanning the AAC Care Pathway

5. Database LondonDeveloping specifications for data recording for AAC provision

6. Procurement Midlands & EastDeveloping processes for managing and procuring equipment

7. Remote assessment SouthDetermining how technology could help assess and support remotely

8. Training/learning LondonScoping current learning provision for AAC


Stakeholder engagement

All regions

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First meeting identified stakeholders.

OO BB JJ EE CC TT II VV EE OO NN EEStakeholder engagementStakeholder engagement

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.


Expression of interest

A database was developed so that people could be further consulted on objectives of specific interest to them.


Survey

A survey of AAC users was developed by the Midlands & East Region with over 80 responses by the end of the project.


Service mappingData collection by all regions

Collation and analysis by

Simon Judge and Sheffield University

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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.

OO BB JJ EE CC TT II VV EE TT WW OOMappingMapping

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.


What does a typical service look like?


Variation by region and sector


Prevalence


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


Good practice guidelines

North Region

Andrea McGuinness

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Consultation findingsLots 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!!

OO BB JJ EE CC TT II VV EE TT HH RR EE EEGood practice guidelinesGood practice guidelines

Purpose and audienceProvide structure

TeamAssessment protocols

Give informationDefinitionsBackground information

Measurement toolEfficacy of the service, outcome measurementWho to monitor

Individuals using AT, professionals, families, others...


How does it look?Short document outlining roles / responsibilities

Supporting documentation

Glossary

CM National standards

CM outcome measurements

AAC competencies in development


National AAC Care pathway

North Region

Anna Reeves

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A brief historySignificant 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

OO BB JJ EE CC TT II VV EE FF OO UU RRAAC care pathwayAAC care pathway

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


Specialised AAC commissioningSevere 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.


Local AAC commissioningNo/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.


Database specification

London Region

Gary Derwent

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OO BB JJ EE CC TT II VV EE FF II VV EEDatabaseDatabase

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


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


Table 1A. Potential users of data by role1. Service user and family1.1 Service user Child service user , Adult service user1.2 Parent / guardian / next of kin Parent / guardian of child, Next of kin of adult2. Organisations with contact with the service user2.1 AAC Hub Staff Hub clinical staff, Hub technical support staff, Hub admin staff, Hub management

2.2 AAC Spoke Staff Spoke clinical staff, Spoke technical support staff, Spoke admin staff, Spoke management

2.3 Local NHS community team Local team clinical staff, Local team technical support staff, Local team admin staff, Local team management

2.4 School School SENCO, School technical support staff, School admin staff, School Head / Management

2.5 GP surgery GP, GP admin staff

2.6 Environmental controls service EC service clinical staff, EC service technical support staff, EC service admin staff, EC service management

2.7 Wheelchair service Wch service clinical staff, Wch service tech support staff, Wch service admin staff, Wch service management

2.8 Local authority social services 2.8.1 Local authority social worker

3. Commissioning and other statutory services without client contact3.1 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 dept Local authority education management, Local authority education admin staff

4. Equipment suppliers Equipment supplier staff5. Research organisations Researcher

Potential data users

# Data group name Description1 Identifier A unique identifier for the service user. NHS Number.2 Service user name Service user’s name.3 Demographic data Users demographic data.4 Service user contact details Address, telephone, email.5 Family / Next of Kin contact details Address, telephone, email.6 Other services contact details Contact information for all involved parties7 Diagnosis details Primary diagnosis resulting in communication needs and any relevant secondary diagnoses

8 Referral to Spoke Information provided to the spoke when referral received.

9 Referral to Hub Information provided to the hub when referral received from spoke.

10 Remote connection details Fields to record details of video-conferencing and remote support facilities for the service user.11 Contact log / progress notes Fields to track day to day interactions.

12 Goals / aims / targets Fields to record the goals of intervention.

13 Assessment / review information Information generated by the assessment (at spoke or hub level).14 Assessment / review conclusions Recommendations made by the assessment (at spoke or hub level).15 Workload planning / task management Fields to record tasks required (at spoke or hub level)16 Loan episode details Fields to record a loan of assessment equipment to a service user.

17 Loan episode conclusions Fields to analyse outcome of a loan episode.18 Equipment issue Fields to record the issuing of the service user’s own equipment.

19 Equipment return Fields to record the return of the service user’s own equipment with reasons.20 Current AAC device / technique The AAC device or technique the service user is currently using.

21 History of AAC devices / techniques used List of previous techniques and equipment used.22 Other related equipment List of other equipment used, such as environmental controls and wheelchairs.23 Clinical Outcomes Formal outcome measures & other data with a function in measuring outcomes (TOMs, GAS etc)24 Service user satisfaction data Results of user satisfaction surveys and questionnaires.

25 Contracting outcomes Contracting outcomes, eg CQUINS.26 Tariff details


Procurement

Midlands & East Region

Clive Thursfield

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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

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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:


Three ‘models’ consideredrental agreementsoutright 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’ consideredrental agreementsoutright 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


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 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.


Recommendations

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.


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)


Remote Access & video conferencing

South Region

Judith De Ste Croix

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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.

OO BB JJ EE CC TT II VV EE SS EE VV EE NNRemote access and video conferencingRemote access and video conferencing

Literature review 20 published papers were includedSelection of clients

Remote service delivery not appropriate in all circumstances or for all clients.More robust evidence needed

TechnologyHardware/softwareNetwork

Client acceptanceGenerally good in all the studies.

Professional acceptanceTended to be more sceptical.

TrainingLack of comprehensive training in this area.

Information governance and data securityA number of issues outlined that need to be considered

CostsCost of installing and setting up a serviceIncreased demand for services.Long term costs of delivery may be less than cost of establishing services. No definitive data re this.


SurveyThe 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


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.


TrialsA 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


Costs: video conferencing

Video conferencing clinical trial savings

Video conferencing trial percentage savings


Costs: remote access


Evaluation toolAn 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.


Training & Learning

London Region

Mike Clarke

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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

OO BB JJ EE CC TT II VV EE EE II GG HH TTTraining and learningTraining and learning

Regional variation in availability of training

n=187


Professionals receiving training

n=107


Subject areas in which training is delivered

n=84


Levels at which training is provided

n=72


National AACDissemination Seminar

Monday 22nd April 2013Prince Philip House, London

Funded by

London & South East

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

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