Joint Health and Social Care SelfAssessment Framework:

Good practice guidance

Joint Health and Social Care Self-Assessment Framework

About Public Health England

Public Health England exists to protect and improve the nation's health and
wellbeing, and reduce health inequalities. It does this through world-class
science, knowledge and intelligence, advocacy, partnerships and the delivery of
specialist public health services. PHE is an operationally autonomous executive
agency of the Department of Health.

About Improving Health and Lives

Improving Health and Lives (IHaL) was set up in April 2010 to provide high
quality data and information about the health and healthcare of people with
learning disabilities. The information helps commissioners and providers of
health and social care to understand the needs of people with learning
disabilities, their families and carers, and, ultimately, to deliver better
healthcare. IHaL is a collaboration between PHE, the Centre for Disability
Research at Lancaster University and the National Development Team for
Inclusion. Since April 2013, IHaL has been operated by PHE.
Public Health England
Wellington House
133-155 Waterloo Road
London SE1 8UR
Tel: 020 7654 8000
www.gov.uk/phe
Twitter: @PHE_uk
Facebook: www.facebook.com/PublicHealthEngland
Prepared by: Anna Marriott and Sue Turner
For queries relating to this document, please contact: anna.marriott@ndti.org.uk
Crown copyright 2016
You may re-use this information (excluding logos) free of charge in any format
or medium, under the terms of the Open Government Licence v3.0. To view this
licence, visit OGL or email psi@nationalarchives.gsi.gov.uk. Where we have
identified any third party copyright information you will need to obtain
permission from the copyright holders concerned.
Published January 2016
PHE publications gateway number: 2015607
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Joint Health and Social Care Self-Assessment Framework

Contents
Easy read summary

Background

The process
Feedback about the SAF
Self-Assessment Framework 2015
The Future of the Self-Assessment Framework
Good practice case examples

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Easy-read summary
The Joint Health and Social Care
Self-Assessment Framework
(SAF) helps regions check that
people with learning disabilities
and their families get the same life
chances as other people.
A lot of people said that the selfassessment framework helps to
decide what is important to
improve the health and lives of
people with learning disabilities.

People have said that there are

some problems with the SAF. It
can be hard to get the right
answers to the questions.
Some people feel that the SAF is
not being used to improve
services.

No local data relating to 2015 will

be collected.
Public Health England is working
with the Health & Social Care
Information Centre so that they
can get lots of good information
about the numbers of people with
a learning disability in England.

Joint Health and Social Care Self-Assessment Framework

There will be local review

meetings for people to discuss and
agree what is most important in
their area. People with learning
disabilities and family carers will
be at these meetings.
A group of experts will be set up to
look at the SAF. This group will
make suggestions and give their
ideas for a new form that can be
used every year for the SAF.
A new Joint Health and Social
Care Learning Disability SelfAssessment Framework will be
launched in April 2016.
It is very important that the SAF is
used to improve services for
people with learning disabilities.
The SAF reports we write need to
lead to decisions and actions that
make things better.

This report has some examples of

how local areas are using the SAF
results to improve services.

The pictures in this report are from Photosymbols: www.photosymbols.co.uk

Joint Health and Social Care Self-Assessment Framework

Background
The Joint Health and Social Care Self-Assessment Framework (SAF) was implemented
in 2013 to monitor services for people with learning disabilities. The framework was one
of more than 60 commitments made in the governments response to the events at
Winterbourne View Hospital (Transforming Care, Action 38). NHS England and the
Association of Directors of Adult Social Services (ADASS) agreed that local health and
social services departments should use the framework to undertake an annual
assessment of services.
Information from the SAF should provide accurate data about the needs of people with
learning disabilities and the health and social care services available to support them.
On a national level, this information will support action that improves outcomes for
people with learning disabilities and their families. On a local level, this information will
help clinical commissioning groups, local authorities, partnership boards, families and
people with learning disabilities identify the key issues they need to address to reduce
health and social care inequalities in their area. The framework also provides a robust
way to monitor progress locally.

The process
In accordance with Transforming Care, a template for the framework was developed by
learning disability leads and members of the ADASS. The framework has two parts:
numerical questions and self-rating questions. The numerical section is intended to
demonstrate how services are commissioned and provided locally. The questions in the
numbers section cover:
numbers of people with learning disabilities
health and healthcare
assessment and provision of social care
Areas are also asked to complete a self-assessment RAG rating (red, amber, green) on
a variety of indicators according to a set of specified criteria. The self-assessment
exercise is divided into three sections:
staying healthy
keeping safe
living well
In addition to the self-assessment ratings, partnership boards had the opportunity to
provide additional text. A number of these responses were thematically analysed to gain
more insight into issues faced by local areas. Data is submitted to, and analysed by, the
Improving Health and Lives (IHaL) Public Health Learning Disabilities Observatory. The
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published reports and a spreadsheet of all the responses (except the personal stories)
are available at www.ihal.org.uk/projects/jhscsaf2014results.

Feedback about the SAF

At events during the past two years, IHaL has collected feedback about the SAF
process from people involved in local submissions. It is evident that the SAF is highly
valued by people with learning disabilities and family carers because it is the only
opportunity they have to review and comment on the quality of local services in
comparison to nationally agreed measures. However, issues have been raised about
the SAF process and its content.
Clearly, the aim of the SAF is to lead to improvements in health and social care services
for people with learning disabilities. However, people reported they find it difficult to use
the SAF to drive change. The SAF needs to be embedded in everyday work and should
shape strategic priorities and direction, but many people reported a greater emphasis
on the process of completing the SAF, rather than using it to drive planning. The issue
of who has responsibility for actions following the completion of the framework was
raised. Some people suggested that if data were collected every two years (rather than
annually) this would allow more time for action to be taken and, therefore, the selfassessment process would be more likely to capture change. Others felt it was essential
to keep it as an annual process.
Concern was expressed that the focus is on quantity only, rather than quality aspects of
services. There was general agreement that there should be greater focus on
outcomes. For example, there is no benefit in more people having annual health checks
(AHCs) if they are not leading to improved health, so a measure of the quality and
effectiveness of these is also needed. Assessing the quality of services presents
numerous challenges, but there was a consensus that greater emphasis on quality
checking by self-advocates is required.
It was reported that the SAF misses a lot of things that are important to people with
learning disabilities. This message came from professionals, family carers and people
with learning disabilities. Overwhelmingly, the main aspect it was felt that the SAF
misses is around friends, relationships and social inclusion.
It is clear that collecting the data required by the SAF was problematic for many
localities. Following the restructuring of services in April 2013, some respondents found
it difficult to identify who could provide them with the necessary data. Some areas
reported issues with data sharing due to new restrictions on accessing identifiable data
while other areas managed to provide the relevant data. Some of the data requested
required GP practices to run searches and this had cost implications or relied on the cooperation of GPs. In some areas there was a significant lack of compliance. There is no
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mandate to ensure different agencies engage and contribute to the SAF. Providers are
not contracted to collect data, for example, and people spoke of asking many times for
data and not being sent the information. There were also issues with IT systems that
affected the ability of areas to collate the data. Lack of co-terminous local authorities
and CCGs was also identified as a problem. Accessing education and criminal justice
data was particularly difficult.
There was some discussion about the role of people with learning disabilities and family
carers in the SAF process. Many people felt that they are not involved enough and that
there should be more questions to be answered directly, and evidenced, by people with
learning disabilities. Better involvement by family carers and people with learning
disabilities, it was felt, would help to validate the SAF data. However, it was noted that
good consultation is time-consuming and some areas had not found this manageable
within the given timeframe.

Self-assessment framework 2015

Public Health England (PHE) has been exploring the most efficient and effective ways
of collecting numerical data relating to the SAF indicators. The Health & Social Care
Information Centre is now expected to undertake a detailed national extract of data
covering most of the areas of population and primary health care through the national
General Practice Extraction System. This should provide anonymised CCG level
information. In addition to this, a range of social care indicators and the numbers of
people using psychiatric inpatient care should be available from a range of national
sources. Therefore, no local data collection relating to 2015 will be required.
The data extracted by GPES will need to be analysed locality by locality and senior
leaders from ADASS and NHS England will be asked to establish a formal review
meeting to analyse their data and information and agree local commitments to ensure
progress in identified priority areas. People with learning disabilities and family carers
will be central to this. Data briefings for local areas should be available by the end of
January 2016 (dependent on data becoming available from the Health and Social Care
Information Centre) and these should be used to inform locality improvement planning
meetings. These should take place by the end of February 2016.

The future of the self-assessment framework

An expert task and finish group, with representatives from Department of Health,
ADASS, PHE, NHS England, the National Forum for People with Learning Disabilities
and the National Valuing Families Forum, has been established. The groups remit is to
recommend a new format for the SAF that will be sustainable and deliver a robust
process for self-assessment and reflection on an annual basis.

Joint Health and Social Care Self-Assessment Framework

The aim is to develop measures that will assess both the health, and the wider
determinants of health and wellbeing, for people with learning disabilities. People with
learning disabilities and family members must make a meaningful contribution to this
work.
The new Joint Health and Social Care Learning Disability Self-Assessment Framework
will be launched in April 2016 for annual completion.

Good practice case studies

The SAF is a valuable tool for benchmarking and identifying local priorities to improve
the health and lives of people with learning disabilities. The findings should be used to
inform local action plans. The examples below show how the SAF is being used as a
lever for change at national, regional and local level. For this to be successful, it is
important to make a clear link between the SAF and other strategic groups and work
programmes. In some local areas there are monthly meetings to monitor the progress
being made in relation to the SAF indicators. Where this happens, the annual SAF
submission process is reported to be much less onerous.

Using the SAF strategically across the North West

There is no national guidance on how regional areas should be using the results of the
SAF to drive improvements. In 2013 and 2014, NHS England North West worked with
local authority colleagues to develop a process of review that will support the
implementation of improvement plans based on the SAF across the region.
The North West Training and Development Team (NWTDT)/Pathways Associates CIC
was commissioned to undertake desktop reviews of all the submissions from the North
West. This process provided a level of independent scrutiny and led to greater
consistency and continuity in rating. It also strengthened communication between local
and regional groups and enabled them to identify collaborative approaches to deliver
improved outcomes for individuals and for organisations. Crucially, they have made
clear links between the SAF and other strategic groups and work programmes.
To link the SAF to local and regional improvement plans, sub-groups were established
for each of the SAFs three themes:
Being Safe and Relationship group
Staying Healthy group
Living Well group
Members of the groups include professionals, family carers and self-advocates. Each
sub-group has terms of reference and meets at least three times a year. Each has a
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work plan fully aligned with the relevant section of the SAF, with some additional
measures. The work plans are structured to be delivered over two years, with regular
opportunities provided for subscribers to change, add or amend actions. Progress is
monitored and regular reports are made to the Learning Disability Reference Group.
This group meets at least quarterly. It aims to have a strategic presence and effective
links to relevant regional/sub-regional groups and local Learning Disability Partnership
Boards. It also maintains an overview of the work of three regional sub-groups and
helps to guide and co-ordinate the sub-groups work on cross-cutting issues and topics.
Examples of some of the work being done by the different groups are provided below.
The Staying Healthy group is:
facilitating and co-ordinating work with Cheshire Local Eye Health Network and a
project with NHS Greater Manchester and Lancashire to increase the uptake of
annual health checks
arranging and providing training for professionals and family carers. Mindfulness
training has been provided for family carers as well as training for professionals
around mental health assessments with people with learning disabilities
supporting Transforming Care Fast Track areas with a joint training partnership
approach to Positive Behaviour Support training
The Being Safe and Relationship group is:
facilitating and developing a continuous quality assurance model with providers in
the North West to support contract compliance assurance for services primarily
commissioned for people with a learning disability and their family carers (relates to
SAF indicator B2: Learning disability services contract compliance)
developing documentation and training for families and advocates to ensure people
with learning disabilities and families are involved and informed on how to better
recruit staff (relates to SAF indicator B5: Self-advocates and carers in training and
recruitment)
disseminating the findings of their audit of self-advocacy in the North West selfadvocacy is a key element of co-production, peer support and staying safe
The Living Well group is:
continuing to raise the issue of the Earning Disregard being maintained at 20 when
the minimum wage has increased. This means people can take paid work for a
reduced amount of time (relates to SAF indicator C5: Employment)
developing the Expert Hub in the North West to provide genuine paid employment
opportunities for people linked to Transforming Care (relates to SAF indicator C5:
Employment)
researching and developing an interactive information site for people to report and
share information about accessible and interesting places to visit across the North
West (relates to SAF indicators C2: Local amenities and transport; C3: Arts and
culture; C4: Sport and leisure)
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Joint Health and Social Care Self-Assessment Framework

North West involving family members and people with learning disabilities
The SAF is a good opportunity to make sure families and people with learning
disabilities are at the heart of what work is being done in local areas. The North West
have involved families in a number of ways:
helping to co-produce the SAF
ensuring the right information is collected
contributing to the quality assurance peer review panels
monitoring what actually happens
challenging services in terms of what difference their work is actually making to the
lives of people with learning disabilities
It is important that families are enabled to contribute, and their contribution is valued. In
practical terms, this means acknowledging that family carers are busy people and
ensuring they can participate in a way that does not add to their stress. Family members
need to be confident that their contribution is going to make a difference and they
should be asked about the ways in which they want to be involved rather than being told
how this will happen.
It is a challenge to meaningfully involve people with learning disabilities with the RAG
ratings process and the best way to do this is via regular meetings over the year, rather
than just before the SAF submission is due.
In the 2014 SAF, there were two measures to be answered by self-advocates and or
family carers: B6 (compassion, dignity and respect) and C8 (Carers satisfaction). Some
areas in the North West were able to organise specific events or opportunities for
people to comment on, and rate, these two measures, but many had to rely on general
measures such as existing surveys, for example, the national carers satisfaction
survey. However, there were several examples of good practice and commitment to
involving people in the rating process:
St Helens undertook a specific survey with self-advocates and family members. This
included some other questions that they wanted answers to and was therefore an
efficient use of peoples time
Stockport had a session with voting pads where each rating was based on the
majority vote. Family carers, professionals, GPs and some self-advocates attended
The Knowsley Being Involved Group is a group of self-advocates who volunteered to
meet five times in January 2015 to validate their local SAF submission. In the first
session, the self-advocates learnt what the SAF is, what validation is and what the red,
amber, green (RAG) ratings mean. They agreed a set of questions to ask to validate the
SAF. They did not have time to look at all the SAF responses so they chose which
areas to focus on.

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For each indicator that they reviewed, the group:

looked at what evidence there was of what had been done
had a discussion about if they agreed with the RAG rating given
identified what information was missing
considered if there was anything that could have been done differently
The group did their own RAG ratings and talked about what work should be done to
make the ratings green. At the last session, they gave feedback to local commissioners
and shared their report. Overall, they were in agreement with the RAG ratings, but they
did dispute some and had a lot of questions for commissioners about the evidence.
The group felt their involvement was important to understanding what needs to be
improved in their local area. Members of the groupl enjoyed the work but acknowledged
it had been difficult, particularly at the beginning. Further information about the
Knowsley project is available from Paula Lomas at paula.lomas@kdc.org.uk
Although the level of involvement of people with learning disabilities in the SAF
submission for each area varies, it is clear that the SAF is meaningful to people with
learning disabilities in the North West. This was demonstrated at their conference this
year.

North West Regional Forum

The North West Regional Forum has run an annual conference for the past 12 years,
stretching over three days. This is a very significant event for self-advocates, with more
than 180 self-advocates attending in 2015. The conference provides an opportunity for
people to find out what is happening in the region and is an important social event.
The SAF is important to the members of the forum and they used it to plan the agenda
for the conference. Keynote speeches and workshops all related to the three main SAF
areas and covered topics such as:
cancer screening
assessment and treatment units
voting and the general election
sexuality and relationships
On the final day of the conference, representatives from NHS England, ADASS, CCGs
and local authority commissioners are invited to come and hear what has been
discussed and to answer questions as part of a question time panel. It is evident that
the conference is hugely important to people in the North West and members of the
regional forum work hard to raise money to keep it going.
Further information about the conference is available from Mark Shackleton at
mark.shackleton@pathwaysassociates.co.uk

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Using the SAF at area team level Cheshire, Warrington and Wirral
In Cheshire, Warrington and Wirral (CWW) health and social care professionals have
explored how the SAF can be used to improve the quality of local services. As an initial
step, in 2014, the CWW area team nursing directorate organised a Moving Forward
workshop, attended by more than 50 CCG and local authority colleagues. The
workshop aimed to:
share good practice and innovations
provide collective support across the area
develop a collective response
Feedback from peer review panels along with the desktop reviews were used to identify
four key themes for the Moving Forward day:
improving primary care responses to learning disabled people
reducing health inequalities
safe and responsive services
data collection/needs assessment
Attendees were assigned to one of the four groups and asked to identify issues and
barriers for each theme and the steps required to reach their ultimate goal and vision.
There was an emphasis on looking at what is working well in different areas and what
can be shared or standardised. This approach has continued during the implementation
of an improvement plan that resulted from the workshop.
Findings were shared with self-advocates at the North West Learning Disability Self
Advocate and User Forum. This provided valuable insight to share with commissioners,
ensuring that feedback from service users is central to their work. Three task and finish
groups were also established to take forward work identified at the Moving Forward
event. The Moving Forward workshop was repeated in 2015. Priorities for 2016 are:
reducing health inequalities
co-production and collaboration
safe and responsive services
Each theme has a group working on delivering an action plan, and the plans have been
sent to NHS England and ADASS to show that they are delivering action as a result of
the SAF. So far, most progress has been made in reducing health inequalities. This has
included:
introducing standardised training for GPs across Cheshire, Warrington and Wirral
and obtaining sign up for the learning disability annual health check scheme from all
GPs in the area
a Commissioning for Quality and Innovation (CQUIN) payments framework
target about health inequality, mapping out support to reduce inequalities and a
delivery plan
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action to increase participation in cancer screening and a specific event for bowel
screening providers in the North of England
the start of a local mortality review process
targeted work to increase the quantity and quality of Annual Health Checks for
people in the area

As part of the co-production work, Cheshire, Wirral and Warrington leads have met with
self-advocates to identify groups undertaking good work. The safe and responsive
services stream of work is incorporating issues from Transforming Care, including care
and treatment reviews and experts by experience, as well as exploring how to make
their local commissioning process more efficient and effective. Collaborative working
and leadership have been crucial to this work. It has also been important to make use of
system levers and hold people to account. Further information is available from Jackie
Rooney (patient experience and quality manager) at jackierooney@nhs.net
Wirral using the SAF at local level
In the Wirral, the SAF is being used strategically to drive forward a detailed joint action
plan, with named leads and monthly meetings to review progress. While good work was
being undertaken, in some areas it was not being evidenced, captured and shared. This
is now being done and the SAF is being used to drive change, as it is being worked one
all year round.
The Wirral has started with small changes and used opportunities to link in with people
and other work. For example, a health facilitator was supporting GP surgeries to make
reasonable adjustments but despite considerable efforts had only managed to work with
three out of 54 GP practices. A local commissioner wrote to all GP surgeries to tell them
about the support the health facilitator could give them at no expense to themselves.
Over the next two months, the health facilitator was able to work with 36 of the
practices. This was a small effort that had an immediate effect.
Another piece of work in the Wirral relates to indicator A6 (primary care communication
of learning disability status to other healthcare providers). A template is being
developed to capture key information prior to referral. The template records patient
details as well as information about their communication, carer support, compliance,
medication and environment requirements. Including the learning disability status
template in every GP referral will give the secondary care provider the opportunity to
make appropriate reasonable adjustments. This will potentially lead to a reduction in
DNAs, length of stay and inappropriate repeat attendances and a better experience for
the patient and their carers/family. The template is being piloted with a group of
practices and numbers and outcomes are being monitored.

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Warrington
In Warrington, the SAF data showed a red rating for the numbers of people who had an
annual health check. As a result, the Lets Check project was piloted by the 5 Boroughs
Partnership NHS Foundation Trust and was implemented the following year. In 2010/11,
56% of people living in supported accommodation had been for an annual health check
and by 2013/14 this had increased to 94%. Performance in the SAF was also used in a
successful business case to employ a Primary Care Health Facilitator.
Further information about Lets Check can be found at
http://www.5boroughspartnership.nhs.uk/lets-check-initiative-/
Halton
Each GP practice within Halton has a linked nurse from the Community Learning
Disability Team. Practices are actively encouraged to access advice, information and
guidance to enable them to support patients with learning disabilities, especially in
relation to the annual health check. In 2012/13, the SAF data showed that only 50% of
people with learning disabilities had received an annual health check. Halton health
sub-group recognised Patient Participation Groups were an untapped resource and so a
family member of the Learning Disability Partnership Board joined the group at her
practice to highlight some of the issues people with learning disabilities face. As a
result, a bid was made to the CCG innovation fund to provide Saturday drop-in clinics
for people with learning disabilities to receive an annual health check. Health promotion
and lifestyle services are available on the day to provide information and advice to help
people act on the recommendations from their annual health check.
NHS East Lancashire CCG
In 2014, East Lancashire rated red for the number of people who have had an annual
health check. In response to this, the CCG arranged a Protected Learning Time event
for GPs to support improvement in this measure. This was extremely well attended and
information drawn from the North West SAF desktop reviews was used to share some
of the improvement actions taking place across the region to improve uptake.
SeeAbility national level
SeeAbility is a specialist registered charity working to improve the lives of people who
have sight loss and other disabilities, including learning and physical disabilities, mental
health difficulties, acquired brain injury and life limiting conditions. The charity looked at
the SAF data about eye care for people with learning disabilities. While the charity was
aware of some good work taking place across England, the SAF report highlighted
examples of which it was unaware.
Some areas have reported that opticians need easy-read resources and other areas are
working on developing their own. SeeAbility already has a range of existing resources
and so has approached IHaL to discuss how to raise awareness of these.
Consequently, SeeAbility plans to produce a short document specifically for the
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attention of people completing SAF so that they have some guidance around eye care.
IHaL will bring this document to the attention of people completing SAF returns.
For further information, contact Stephen Kill on s.kill@seeability.org or visit
https://www.seeability.org/sharing-knowledge
East Midlands regional level
Following concerns that the 2012/13 SAF had not been validated, locally or regionally,
the NHS Local Area Team for Lincolnshire, Leicestershire and Rutland undertook an
exercise to review submissions from the wider East Midlands, working alongside the
East Midlands Learning Disability Network. An independent consultant with experience
of the SAF process, a commissioner and one lay representative were commissioned to
review the regions submissions and provide a report.
The lay representative was a family carer with extensive experience of being involved in
local Learning Disability Partnership Boards. Her report identified good practice and
challenges in each local area and which SAF indicator these related to. The report then
summarised universal themes and resources across the region. She concluded that
there were duplicated resources across the region and that sharing ideas could save
money.
This review highlighted ongoing issues with the use of the Mental Capacity Act and best
interest decisions. There is confusion about what is reported and/or referred and there
appears to be a deficiency across the area regarding a mechanism to capture best
interest decision-making outcomes. This leaves services and professionals vulnerable
to legal challenge. The findings were fed back to commissioners and this led to
investment in decisions related to the Mental Capacity Act and Deprivation of Liberty
Safeguards across Leicester, Leicestershire, Rutland and Lincolnshire. NHS England is
now funding a 12-month secondment hosted by Leicester City Council for someone to
work on Transforming Care and the SAF. This role will focus on SAF and network
development. Further information is available from Louisa Whait, Regional Learning
Disability Network Lead Officer on Louisa.Whait@leicester.gov.uk or 0116 4541233.
Leicester, Leicestershire and Rutland local level
Better Care Together (BCT) is a significant programme of work aiming to transform the
health and social care system in Leicester, Leicestershire and Rutland (LLR) by 2019. It
brings together partners, including local NHS organisations and councils, to ensure that
services change to meet the needs of local people. Further information about Better
Care Together can be found at www.bettercareleicester.nhs.uk/
This programme has eight care pathways, one of which is about people with learning
disabilities. The learning disability work stream is aligned to the SAF and SAF data is
used to inform the commissioning/planning of high quality appropriate services. The
SAF is also being used as a tool to benchmark progress and to measure changes in:
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physical/mental health and wellbeing for all people with a learning disability and
family members
equitable access to the right services and support at the right time including
universal services
the experiences of people with learning disabilities and carers these should be
comparable to the general population

Further information is available from Yasmin Surti, Learning Disabilities Implementation

Lead Better Care Together, at Yasmin.Surti@leicester.gov.uk or 0116 4542387.
NHS Hardwick CCG local level
In April 2014, Derbyshire County Council recruited a Learning Disability Project Officer
to its commissioning team to support the Transforming Care agenda and to oversee the
SAF. This post was funded by Hardwick CCG for 12 months and enabled an individual
to focus on the SAF. Subsequently, RAG ratings consultations were arranged with
Learning Disability Partnership Boards and Good Health groups.
Across Derbyshire and Derby city, peer validation has been carried out, providing the
opportunity to challenge scores and ask about the evidence for the rating. While this
was effective, it is felt that that a more formal validation process would give the SAF
more recognition.
The approach taken is that the SAF exists to help deliver year-on-year improvements to
the lives of people with learning disabilities and that the emphasis should be on this,
rather than simply submitting their SAF. Consequently, local action plans based on the
RAG ratings have been developed, which have been presented to the relevant
partnership board and monitored through the Joint Commissioning Board. Even if an
indicator is rated green, it is accepted that improvements can still be made.
At partnership board meetings, people can comment on, and contribute to, the action
plans. Progress is reviewed at quarterly SAF action planning meetings. From these
meetings, everyone has actions to take within their own organisations and there is
continual monitoring and updating of the action plans. Evidence is collected as they
progress and so effectively they are already working towards the next SAF submission.
One example of an action arising from this work is that the SAF showed people were
not filling in the local pre-questionnaire for annual health checks. Copies of the prequestionnaire were sent to commissioners in primary care, who cascaded them to their
leads. An example of an action plan can be found at
www.ihal.org.uk/adjustments/?adjustment=363 Further information is available from
Tracey Sims at Tracey.Sims@hardwickccg.nhs.uk

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Stoke local level

In Stoke, an action plan was developed from the 2012/13 SAF. The priority areas were
those rated red or amber. Relevant actions were identified, as well as a person
responsible for the action and the timeframe for improvement. Further priority areas
were included after the next two SAF submissions, again identified from the red and
amber ratings.
Improvements have included co-production and the establishment of stronger links
between the Learning Disability Partnership Board and the health and wellbeing board.
However, progress has been slow in areas such as systems, data and flagging.
As new indicators have been added to the SAF, the document has inevitably got larger
and there has been concern that it is becoming unmanageable. There has also been
insufficient time between SAF exercises to make progress on the actions. This means
that some of the objectives have been unachievable in the timeframe. Therefore, the
Good Health Sub-Group (set up as an outcome from the first SAF) decided to reformat
the action plan in line with the development of the next learning disability strategy and
its priority areas. This will be a joint learning disability health and social care strategy to
ensure integration, joined up working and outcomes for all. They have adopted a coproductive approach to facilitate progress in areas of concern and support future SAF
submissions. Further information is available from Debbie Cooper at
debbie.cooper@stoke.gov.uk

Middlesbrough local level

The South Tees Improvement Group was set up in response to the 2013/14 SAF. This
focuses on where and how local improvements can be made, and gathering evidence
for the next SAF. The action plan is based around the three SAF areas (good health,
keeping safe and good support) as well as a fourth area relating to friends and
relationships, as this was highlighted as an important issue by people with learning
disabilities. The plan identifies numerous actions within each of the priority areas.
One example of how SAF outcomes are being used to drive forward local work relates
to cancer screening. Working in partnership with health, social care and Middlesbrough
1st, an event to raise awareness and promote take up of cervical cancer screening was
organised for women with learning disabilities. This co-presented, interactive day was
funded by Middlesbrough Public Health and attended by over 50 women with learning
disabilities. Information about cervical screening was shared and there were small
group discussions. Feedback from the day was positive with some women who had
never been for cervical screening saying that they would now go.
Further information can be found at www.ihal.org.uk/adjustments/?adjustment=360 or
from Linda Lord at Linda_Lord@middlesbrough.gov.uk

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Durham local level

Durham County Councils commissioners, in partnership with Tees Esk and Wear
Valley NHS Trust Learning Disability Health Facilitation team, hosted an event in 2014
to promote the Learning Disability Health Charter. 1 As well as raising awareness,
organisations that support people with learning disabilities in County Durham were
encouraged to sign up and implement the Charter. Organisers of the event encouraged
a partnership approach with a message were all in it together. The focus of the day
was a reminder that health is everyones business and that social care providers have a
vital role in improving health outcomes of the people they support. Durham promotes an
integrated model within learning disability services and the event reinforced the
supportive elements of integration and strength of co-productive partnerships.
A follow up event is scheduled to showcase good practice and share examples of how
the charter has improved health outcomes for people with learning disabilities. It will
include stories from the perspective of self-advocates. Information from this event will
be used to inform the next SAF. Further information is available from Anne Ratcliffe at
Anne.Ratcliffe@durham.gov.uk or Michaela Hopps at michaela.hopps@nhs.net
Gloucestershire Voices local level
Gloucestershire Voices is a user-led self-advocacy organisation for adults with learning
disabilities. In relation to the SAF submission, Gloucestershire Voices run area action
groups in the six localities in Gloucestershire. These provide an opportunity for people
with learning disabilities to say what they think the big issues are. Additionally, these
meetings act as a feedback mechanism for people with learning disabilities to hear from
Gloucestershire County Council (GCC) about the work they are doing. Video messages
have been used to share information at all six groups. Members of the groups were
invited to two centrally located workshops in 2015 to ensure that self-advocates were
able to feed into the SAF submission. For the next SAF exercise, the action area groups
will be central to the submission.
Gloucestershire Voices has also undertaken work related to some of the SAF indictors.
This includes:
B2: Learning disability services contract compliance
The Gloucestershire Partnership has a quality assurance programme, which has had
national recognition from the Department of Health. It consists of announced and
unannounced inspections visits during the day and at night, a Quality Compass survey
which asks the network of support around an individual to comment on their welfare,
and a service user-led quality-checking service. These consider contract compliance
issues in addition to a range of other safety, welfare, lifestyle and procedural areas.
Quality intelligence is shared monthly at quality meetings with safeguarding,
commissioning, and operations. Gloucestershire Voices is part of the quality-checking

http://www.improvinghealthandlives.org.uk/publications/1221/Health_Charter_for_Social_Care_Providers

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programme. This provides the opportunity to fully understand the 'service user'
perspective of the services people are living with.
Gloucestershire Voices currently undertake:
five quality checks per month of CCG-commissioned residential care or supported
living services
one per year (for each setting where at least one person is continuing health funded
or joint funded)
two per year for each health funded out of area placement
one for each inpatient service (Hollybrook and Westridge)
C2: Local amenities and transport
The Better Bus Services group, run by Gloucestershire Voices, meets transport
managers bimonthly to discuss issues. The group also talks to people about transport
and has created a film called Travelling Well. They developed a hate crime pack as
part of training for bus drivers.
C4: Sport and leisure
Active Gloucestershire and Gloucestershire Voices worked with Leisure@ to carry out
an audit of facilities. Gloucestershire Voices conducted a survey that showed people
with learning disabilities wanted more access to sport and physical activity. This led to
changes to Leisure@ and improvements in other leisure facilities in the county are
being made. Further information is available from Samantha Crocker at
samantha.crocker@gloucestershire.gov.uk

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