Freedom of reasonable adjustments
- Winning idea
What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?
On average, people with a learning disability live 18 years less than the general population, (LEDER review). Evidence shows people with a learning disability struggle to access timely Annual Health Checks (AHCs). Covid-19 has compounded this as healthcare professionals have struggled to adapt to meet reasonable adjustments.
Surrey and Sussex ICSs adapted services to meet the needs of people with learning disabilities. They strengthened partnerships with third sector and voluntary organisations such as Active Prospects, Post-19, Speak Out and Impact Advocacy.
In recognising digital reasonable adjustments to ensure person centred care, positive changes included:
- collaborative discussions to restart AHCs
- Surrey awarded exemplar site status
- Learning Disability liaison champions identified
- promoting reasonable adjustments underpinned by Sussex’s Quality Kite mark
- pathway redevelopment to support triaging and assessment, face to face or virtually
What does your project aim to achieve?
We aim to empower people to choose their preferred appointment format, use care passports and access existing life skills programmes delivered by our voluntary partners.
- co-produce pathways with service users, working in partnership with the Surrey People’s group, Sussex’s Learning Disability Program Board and the KSS Learning Disability Community of Practice
- support GP practices restarting AHCs, by applying learning from digital appointment use cases
- promote staff proactiveness with reasonable adjustments, using the pre-assessment questionnaire to support virtual appointments or ensuring wheelchair scales are accessible
- expand My Social Time model, a virtual social engagement forum for young adults, focussed on emotional health and wellbeing. The model’s success will be strengthened by group consultations, run by SEN co-ordinators, Learning Disability Liaison Nurses and GP champions underpinned by peer to peer support for emotional health and wellbeing
How will the project be delivered?
We will report to: Surrey People’s group, Sussex’s Learning Disability Program Board and the KSS Learning Disability Community of Practice on our project steps of:
- Launching a GP practice campaign, using the right team and skill mix, to stratify practices with low numbers of completed AHCs to recruit to the project by May 2021
- Starting to train staff and blend existing training materials by June 2021, focusing on:
- highlighting reasonable adjustments and individual needs
- identifying champions
- establishing the adapted My Social Time model
- Produce recommendations in a full report by May 2022, building on quarterly feedback from staff, people with learning disabilities, their families and carers in collaboration with the Applied Research Collaborative Kent Surrey Sussex. Staff will also feedback on reasonable adjustments in practice and facilitation of AHCs underpinned by the integrated My Social Time model.
How is your project going to share learning?
We will support AHCs using a blended approach of digital training and innovative social models. Only 53% of people with a learning disability have a health check (NHS digital data, 2016-2017), but this figure relates to those who are on their GP’s learning disability register. This is despite evidence (Mencap) that health inequalities for people with a learning disability result in 1,200 avoidable deaths and has worsened during Covid (ONS).
Our aim is to prove the concept of blending digital skills and reasonable adjustment training with the My Social Time model, prioritising emotional wellbeing and reducing social isolation to holistically deliver AHCs. We will share best practice to inform coproduced pathway redesign with the wider system and Q members. Other vulnerable groups who may benefit from transferrable learning include those with Serious Mental Illness or long term health conditions. The Q community will also be invaluable in providing constructive feedback about the project.
How you can contribute
- - Helpful challenge on the idea and approach
- - Insights and ideas on co-design of evaluation with service users
- - Link up ideas
- - Promote and share the interim and final report on social media, as well as offer critical comments
- - Two way sharing of example training material from this project and similar projects in relation to ‘reasonable adjustments’ and individualised needs
- - Raise awareness of our Learning Disability 'Call To Action':
|3 May 2021||GP Awareness campaign|
|30 Jun 2021||Right team and skills|
|31 Aug 2021||Training for staff|
|30 Nov 2021||Recommendations for changed practice (interim)|
|31 May 2022||Analysis patients/healthcare staff|
|31 May 2022||Recommendations for changed practice (full report)|
30 Sep 2021
The Freedom of reasonable adjustments project was formally launched in June 2021, ahead of Learning Disabilities Awareness Week 2021.
The story so far…
The first project group meeting brought together representatives from system partners including Kent Surrey Sussex Academic Health Science Network (KSS AHSN), Sussex Clinical Commissioning Group (CCG), Surrey Heartlands Health and Care Partnership, and voluntary and third sector partners including Active Prospects: a provider of support for people with learning disabilities, mental and physical health needs and My Social Time: a virtual social engagement forum for young adults with learning disabilities.
Communications and engagement
During Learning Disabilities Awareness Week 2021, the following article was circulated via the KSS AHSN Twitter account (https://kssahsn.net/news/improving-health-check-access-for-people-with-learning-disabilities/). As a result, we were approached by a GP Federation in Surrey who are looking to improve their current Annual Health Check (AHC) pathway. We have also been approached by two sister AHSNs who have identified local needs relating to AHCs.
Subsequent project group meetings have helped to strengthen the relationships within the project group and through the combined knowledge of the project group we have:
- Stratified GP practices with high/medium/low AHC completion rates through the creation of a data dashboard. Members of the project team provided local insights into the factors affecting AHC completion rates. We used Learning Disabilities health check scheme data made available by NHS Digital and utilised data visualisation tools (Tableau) to depict trends
- Established a need for a ‘menu of resources’ that clinicians completing AHCs can signpost patients to ahead of/following their AHC.
- Recognised other related projects and key stakeholders to engage with including the Surrey Heartlands Digital & Learning Disabilities Blended Programme. Surrey Heartlands has commenced work as an early adopter of the NHS’s Reasonable Adjustment Flag.
- Identified local people with Learning Disabilities to engage with.
Next steps over the coming months?
Over the coming months we are planning the following next steps:
- Promote the project and recruit service users for user surveys/interviews from the Surrey Peoples Group. The Surrey Peoples Group is for people with lived experience of learning disability, autism and acquired brain injury. Their goal is to become a Surrey wide user-led network where voices are heard, and they connect to make real change. To do this the group is supported by Pro-Active Community ambassadors. They meet monthly via Zoom and have a range of guest speakers on important and topical issues, that affect people living with disabilities.
- Identify & engage with GP practices in Sussex. Further engagement with GP practices in Surrey.
- Development & rollout of interviews/questionnaires to better understand
a) GPs / health professionals
- Training needs & gaps (including staff proactiveness with reasonable adjustments)
- Information needed from voluntary partners to improve quality of AHCs
- Types of resources they would like to signpost to
b) Patients / service users / carers & parents
- Types of resources they would like to be signposted to
- Levels of digital confidence
- If/how they choose their preferred appointment format
- If they use care passports
- If they access existing life skills programmes
- What matters to them as individuals/families
This is with a view to establishing a baseline across other relevant data elements (both quantitative and qualitative) and to inform evaluation themes from the outset
4) Co-design and development of Health and Wellbeing MOT, signposting menu, and training materials based on outcomes from interviews/questionnaires. Feedback from Health care professionals and patients / service users / carers & parents.
5) GP Awareness campaign & training for staff
6) Pilot & Evaluation
What have you learned so far, either from the successes you have had or from where things haven’t gone to plan?
There is a large amount of work taking place in the Learning Disabilities space, especially as the NHS Long Term Plan aims to improve people’s health by making sure they receive timely and appropriate health checks, while improving the level of awareness and understanding across the NHS of how best to support them as patients. Therefore to reduce duplication of efforts the project group worked together to identify other similar projects and key stakeholders at local, regional and national level.
What could others learn from your experience of working with a range of stakeholders and collaborating across boundaries (geographical, professional, sector) – including what is working well and any challenges you have faced?
- The importance of transparency early on i.e. openly recognising any risks, challenges and issues: This has helped manage ours and project members expectations. Due to system pressures and resourcing limitations the project launch date was slightly pushed back and therefore initial timelines were adjusted to accommodate this. Timelines have been further adjusted as we have identified local priorities that are helping to shape the project and sense-checked. To that end, we also have a standing agenda item titled ‘Sense-checking’
- You can still have a ‘collaborative vibe’ without brown paper and post-its: In the absence of a shared physical space, brown paper and post-its, we have utilised the gift of technology as our very own ‘reasonable adjustment’ by employing tools like Jamboards. to gather insights and canvas ideas. We have two standing agenda items, namely ‘Identifying’ identifying interdependencies and any blind spots and ‘Generating’ to focus on ideation.
- The importance of safe collaborative spaces must not be understated: At the start of the project, we made sure we acknowledged the project launch delay in the spirit of transparency, whilst inviting contributions from project team members to express and reaffirm our respective motivations in making this work. As the project has progressed, our group has been growing in trust and we continue to afford ourselves the necessary psychological safety to speak freely and openly in the spirit of collaboration and co-production. Our next critical step is to do the same and more with service users and health, care and wellbeing service providers
How can the wider community get involved?
To get involved in the Freedom of reasonable adjustments project please email George Anibaba (firstname.lastname@example.org) & Catherine Young (email@example.com).