Provision of Communication Equipment and Support: Part 4 of the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016: progress report 2019

Annex C

Contributions From Health Boards Who Hold the Legislative Duty

The following are examples intended to reflect the views of boards across Scotland and describe the following:

• Recognition of the duty and actions in response.
• Items that highlight support.
• Concerns that respond to the key issues raised by stakeholders, namely finance, timeliness, equity and awareness.

NHS Ayrshire and Arran

"The AAC Executive Lead within Ayrshire and Arran has ensured the legislation awareness is targeted across NHS services, the three Health and Social Care Partnerships and Integration Joint Boards with a reach to our partners in education, social care and the independent sector. This builds on the success of the service established since 1996, to provide effective communication support to the residents of Ayrshire and Arran. Our focus now is establishing recurring funding to ensure a robust and modern equipment bank and to develop a governance framework to assure equity of equipment provision".

To underpin this work through sharing good practice, Ayrshire and Arran are working on the local development of an AAC scrutiny tool, to support AAC Assessment.

NHS Borders

"As part of our cost-pressures process this year, and rather than dealing with demands on a case by case package of funding we have allocated £220,000 into communication equipment and staffing as a response to the AAC implications. Currently this is not recurrent as we need to continue to map additional need and continuing costs. Of this allocation roughly £100k is for additional staffing to support user of the service."

NHS Dumfries and Galloway

• NHS Dumfries and Galloway welcomed the legislation, however the local context is there is a long history of supporting people who need and use communication equipment
• A local multi-agency AAC group was in place involving all key partners and this has continued
• A speech therapist working in Children's Services has been awarded an AHP career fellowship to explore the use of low tech AAC use in schools with a focus upon symbolic core vocabulary and aided language stimulation
• Processes for allocation of resources/funding of communication equipment have been reviewed, and as before, when there is an identified need equipment is provided and users supported in their use of that equipment".

NHS Fife

"This has been an exciting year for AAC across Scotland providing us lots of opportunities to continue to raise awareness of the impact of speech, language and communication needs as well as the need for AAC.

Fife AAC Team (est. 1987) continues to provide a one stop shop for AAC assessment, provision of equipment and support.

Over the past year there has been heightened awareness of AAC at both an individual and professional level which has led to a small but steady (2 to 3 year on year) increased number of referrals to the service. That is why sustained capacity building undertaken locally, has been so important to ensure support is available to those who need it.

To ensure consistency we have incorporated the National AAC core pathway into systems which support the need for capacity building in professionals working with clients in the initial stages before referral to the service".

NHS Forth Valley

"NHS Forth Valley conducted a survey of staff, to explore their awareness of the legislation within the Speech and Language Therapy Workforce. The results of that work were shared with the National AAC Advisory Group as an example of good practice. Forth Valley AHP Senior Managers have since built on this work in the following ways:

• delivered refresher training and continue to plan for ongoing updates
• refreshing staff's awareness of the FV AAC Pathway
• encouraging greater use of and engagement at an earlier stage with the FV Team of AAC Champions who are available to support and provide guidance to all SLT staff
• continuing to explore access to greater technical support including programming of devices"

NHS Greater Glasgow and Clyde (NHS GGC)

"The legislation has provided us with the impetus to address health inequalities experienced by people who are unable to speak. Communication is a human right and if a person requires support or equipment to speak in NHSGGC we will ensure this is received in a timely, person centred way" - Julie Murray - Chief Officer East Renfrewshire HSCP, NHSGGC AAC Executive Lead.

The work underway in NHSGGC is to review its provision of AAC equipment and support ensuring compliance with the legislation. This is overseen by an AAC Co-ordinating group established in April 2018, with membership from each HSCP, Acute and SCTCI. The remit is to:

• Oversee the implementation of the legislation locally and identify implications
• Refresh and develop the clinical pathways/practice guidance
• Look at issues of equity and funding
• Improve communication
• Improve access to equipment, including recycling
• Improve data collection and reporting

NHS Grampian

As a direct result of the legislation, NHS Grampian and the 3 Health and Social Care Partnerships within the Board have acknowledged the legal duty of the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 Part 4 and associated documents which came into effect from 19^th March 2018.

All sectors across the Grampian health system now have clear arrangements in place to provide or secure communication equipment and support in using that equipment for anyone who has lost their voice or has difficulty speaking.

These arrangements ensure that individuals who require or use AAC are provided with the necessary and most appropriate equipment to meet their reasonable requirements and that support and assistance is provided to allow the individual to take advantage of the equipment and be able use it properly enabling them to meet their needs.

AAC is now included as an integral part of core service provision.

NHS Lanarkshire

One year on from the enactment of the legislation NHS Lanarkshire are proud to have achieved the following:

Convening a steering group to: promote awareness of Augmentative and Alternative Communication (AAC);

Revision of the existing AAC Pathway; devise and implement a training schedule, including coordinating peer support following training;

A dedicated speech and language therapy AAC Coordinator has been employed to coordinate the work from the steering group.

Over 35 pieces of highly specialist equipment funded for individuals since the legislation was enacted, with requests continuing to be fulfilled.

The AAC Pathway for Lanarkshire revisions are under consultation across a wide range of agencies and professions to ensure it is in line with the national core pathway and with our vision for Lanarkshire. It details the journey an individual will take from identifying their need for AAC to them being able to use their AAC system well and participate in society to the best of their ability. The pathway relaunch is planned for late 2019.

Looking to work that is beyond the legislation, NHS Lanarkshire is also proud to be the first board in Scotland to be involved with Communication Access UK (CAUK), a project that trains businesses and services to be accessible for people with communication difficulties. We have several mystery customers trained across Lanarkshire and have recently awarded the first service in Scotland, HOPE for Autism, the symbol for Communication Access as they have completed the staff training and signed an early adopter agreement.

Communication Access Symbol:

This project will continue to be rolled out across services in Lanarkshire over the coming years.

NHS Lothian

There has been no significant change in the numbers coming forward who require communication equipment and support in accessing services. It is noted individuals have more information on their rights and how to obtain communication equipment.

To further build the board's capacity, staff new to NHS Lothian have the opportunity to attend within their induction a session on using AAC with a wide variety of patients. Modular workshops have also been delivered to both health and education staff throughout the year including an Introduction to AAC and Using AAC within a school environment.

"Parents as Active Partners" Project started in 2018 to enhance support for parents and families of AAC users from an early stage. Working in partnership with the local authority's Head Teachers from Additional Support Needs (ASN) establishments, specialist AAC services have provided information to parents of children with complex needs through workshops such as Using AAC in the home, and an evening exhibition sponsored by City of Edinburgh Council Education Department. The "parents as active partners" workshops involved 25 families from across NHS Lothian. The exhibition of around 15 stands with services and third sector agencies, was attended by 50 people.

Additionally, work started in 2018 on a new CODES Framework (the previously developed effectiveness measuring tool) for use when working with Adults with Acquired Communication needs, is now being piloted for 6 months in 2019 as a further step in streamlining provision to people who need and use communication equipment. The Literacy and AAC Users Framework, being developed across NHS Lothian, was presented at the Communication Matters Best Practice Literacy Study Day in May 2019, with attendees from across Scotland.

NHS Lothian has further supported this national programme of work by contributing to multiple working groups throughout the year, including that to produce the national guidance.

NHS Orkney

"NHS Orkney is fully cognisant of the duty placed upon us by the Act. In support of this we have taken steps to publicise the intent and the relevant elements of the Act to our staff at all levels and in particular our SLT staff. There is a clear process of how to utilise the Act in support of our patients and importantly the process for escalation of concerns where services or equipment are not routinely available but required. Those patients who present with needs covered within the Act will receive appropriate assessments, treatments, equipment and support to meet their communications needs".

NHS Shetland

We welcome the legislation and recognise the duty on NHS Shetland to comply with the Act.

• Equipment will be funded where a need is defined in line with recommendations.
• Access to specialist advice as required is available from SCTCI (Scottish Centre of Technology for the Communication Impaired), although we have no formal contract in place, advice is available.

NHS Tayside

Existing arrangements for provision of equipment and the previous equipment bank were reviewed. This introduced sharing across all three (speech and language) services (children, adults and learning disability) in NHS Tayside and streamlined the available stock across the board area.

NHS Tayside has now allocated £50,000 on a recurring basis for the ongoing provision of Communication Equipment – the allocation is closely monitored on an ongoing basis, and will continue to be reviewed annually.

NHS Western Isles

NHS Western Isles advised a mixed impact, with some care groups (ASD and LD) considering minimal impact. However, for adult services a moderate positive impact is reported by practitioner, with better links forged with procurement and therefore necessary equipment, both hardware and software, can be acquired more promptly.

Practitioners and managers felt that staff are more confident about assessing a patient's AAC needs earlier in their journey so that they can be more fully prepared and familiar with the technology, as reflected in the patient story for Vital Voices (from January 2019) https://acipscotland.files.wordpress.com/2019/05/vital-voices-patient-stories.pdf.

NHS Western Isles also highlight:

1. Having the guidance and the support of the Assisted Communications team has encouraged us to 'keep on track' with implementing the Guidance and progressing our local plan.

2. Systems for the procurement of software have been revised with amendments to our local AAC pathway to include information about procurement. A review and improvement of the AAC loan documentation database has taken place.

3. Awareness raising related to AAC and the Guidance is a feature of all the regular communication training sessions delivered to Health, Care, and Education staff. An AAC awareness raising opportunity was part of our Speech and Language Therapy Open Day and a Local user of AAC, is raising awareness of the duty.

4. In progressing learning and development:

• All Speech and Language Therapy, qualified and support staff, have now completed the IPAACKS self-assessment.
• A member of the local Speech and Language Therapy team has been supported to complete the Talking Mats Trainer course and subsequently arranged training for Health, LA and third sector staff. This work is ongoing.

5. The team continue to engage with the national network of Speech and Language

NHS State Hospitals Board for Scotland (SHBS)

The SHBS are very aware of the duty and engaged in the program of work, but recognise the number of users is very small. Within the SHBS arrangements to highlight individual requirements, including communication needs are in place for all residents as part of the pre-admission. The AAC Pathway will be followed for all those who need and use communication equipment.