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

Annex E

Population Analysis – Further Detail on Policy Engagement and Activities

Strategic Planning and Clinical Priorities – Neurological and Long Term Conditions

There has been ongoing engagement with the above team, where several organisations representing service users who have conditions that are prevalent amongst people who use AAC (such as MND, Stroke, and Cerebral Palsy). The publication of the National Neurological action plan recognises a similar picture of infrastructure constraints that cannot, within existing arrangements quickly, easily nor without adversely impacting on service delivery be addressed. It is not known if stakeholders support the pursuit of data at the expense of operational service delivery and this question needs to be raised.

Stroke

A proposal to explore the possibility of a stroke sprint audit was put forward by the Director of Services from Chest Heart Stroke Scotland at the AAC National Advisory Group meeting on the 13^th June 2018. Discussion took place the following week (25^th June) which clarified the necessary stages in progressing this as being:

• key stakeholders being involved from a stroke perspective
• AAC Exec Lead(s) being best placed to support this work
• seeking support from said Exec Lead
• inclusion of some historical learning that could inform the approach taken in this new proposal for a stroke sprint audit.

Following this a discussion took place with the AAC Executive Lead in NHS Lanarkshire on the 29^th June, with the advice being:

• to formulate the necessary questions
• to describe the associated challenges and potential outcomes, engaging with the national clinical nurse lead for stroke to scope out operational detail
• to set out the desired outcomes, and;
• the consideration of what further steps may be in relation to unexpected outcomes.

The AAC Exec Lead, having considered the information, could then consider taking forward the questions with the chair of the national stroke audit group to explore feasibility, amendment and possible outcomes.

Engagement with the clinical nurse lead for stroke to determine the operational feasibility of carrying out such an exercise, and to understand the strategic priority revealed this approach was not currently feasible. The following challenges would require to be addressed:

• to become a priority for the national stroke audit group
• consistent recording of information
• identification of the data items to be captured and;
• an agreed, recognisable location within the patient record for the recording of any recognition of AAC or communication need, assessment or intervention with that individual
• training and advice to the workforce in the necessary recording actions
• training and advice to the stroke audit nurses, or others identified to carry out any future audit.

Priorities within the stroke audit have historically been targeted at acute care, however there is to be a future focus on provision within the community.

Further work is required both to consider the feasibility of the proposal and to set out the detail of the broad range of preparatory work that would be required to underpin any audit plans.

Strategy and Delivery for Dementia

Engagement with dementia policy colleagues resulted in an invitation to attend the National Dementia Strategy Group, seeking the advice and expertise of that group to advise on ways to support this program of work.

Further discussions have taken place with the adults with incapacity policy leads and National AHP Lead for Dementia to raise awareness of the legislative duty.

Education Analysis - Pupil Census

Meeting with the pupil census team enabled better understanding of the drivers for their capture of information, clarifying:

• local authorities participating in the pupil census were reporting on information they were already gathering, consequently there was no additional impact
• the legislative framework for the local authority to report that information was in place (as evidence of meeting their duty within the Education (Scotland) Act 2016^[14]
• there is no additional requirement to report on AAC equipment, which would require significant additional work at an operational level to carry out and create an additional pressure to local authorities
• amendment to systems used to capture information would require to be identified and supported (i.e. SEEMIS –see below for further information)

Links to SEEMiS

SEEMiS Group is an Education Management Information System (MIS) provider. As the standard MIS within Scottish Education, all local student data is processed and managed by SEEMiS software offering interfaces with external agencies such as ScotXed.

SEEMiS is owned and operated by the 32 Local Authorities who are their membership. Engagement with their business analysts clarified the type of data being sought by Scottish Government was within the ScotXed census area (the pupil census). Further guidance and information on what is collected is available from the ScotXed website.

However, SEEMiS captures an enormous amount of data related to students, varying by local authority and is dependent on what areas of the application available from SEEMiS they use.

Once a functionality is developed, it is for LAs to choose and to what extent it is used. However, all LAs without exception maintain student basic records and all census information within the application.

In response to the specific request from Scottish Government, the limitations identified from SEEMiS recording of school age children with communication needs was that it does not capture those who use equipment specifically. Therefore such a request would be a new requirement to capture additional information and on specific equipment.

Requests from out with their Local Authority membership, if approved, are prioritised by the Governance groups within the SEEMiS work programme alongside the other work commitments and completed as charged pieces of work. Submissions should be supported by robust detailed evidence and if available, short tests of change that provide baseline proof.

E-Health/Digital

Advice from the policy team has signposted the team towards advice from Primary Care; Professional advisors and the National Lead for TrakCare. This engagement is ongoing.

NHS National Services Scotland (NSS)

Broad engagement has taken place with NSS in the development of the work on data and evidence, from early discussions on the development of new community based solutions; the role ISD have within NSS; the governance arrangements to protect confidentiality; the consultation on the development of the AHP Operational measures; advice and guidance on data and support to commission a "Scoping the Possible" report.

Health colleagues within the Welsh Government

Welsh Government and NHS Wales operational services colleagues have advised on their countrywide single model approach that includes environmental control provision, sharing learning from establishing a new service from scratch.

Commissioned services in England

Engagement resulted in a better understanding of the system differences. In England a set of key performance indicators are in place as part of contractual arrangements within the commissioning of the specialist AAC hub services.

The hub and spoke model is replicated across regional areas in England with a range of independent and NHS providers delivering this service to a set of agreed access criteria. A supporting infrastructure is a necessary requirement to enable monthly reporting to the commissioner, providing components of a national overview.

Reflections of both the Welsh and English areas highlight the differences in service models, both geographically, contractually and in the range of services provided.

Census 2021:

The Census team have developed a proposal for the online version of the questions, to include additional guidance within the question using the functionality of a digital platform. The additional guidance will be in the form of pop-up screens with a list of most commonly known and/or prevalent health conditions within each category. This is to aid respondents in choosing the most relevant response option to describe their long-term health condition(s). For example, if a respondent was not sure if they should select 'learning disability' to describe their health condition, they would click on additional guidance with a list commonly known conditions under this category, which will help them to decide whether to select that response option or not.

The lists are not exhaustive as these should be kept at a manageable length taking into account that people will be filling in the whole questionnaire, so that it does not significantly impact of the time spent scrolling through a large list of conditions.

The Census team have continued to work with policy officials to ensure the largest possible participation of people within the census.

The category for 'Full or partial loss of voice' is slightly different from other categories in that it includes a list of equipment used to aid speaking (as opposed to conditions only).