Quality Indicator 1
Promoting Health and Well Being
Strongly Disagree Disagree Agree Strongly Agree Not Relevant Don’t Know
PRINCIPLE: Services are responsive to promoting health and well being of people with physical disabilities
1.1 Staff are familiar with the Disability Discrimination Act (1995) (DDA) guidance and legislation.
1.1.1 Department of Health Guidance and the Disability Rights
Commission Code of Practice is followed. X
1.1.2 Staff are aware of requirements and duties. X Xp
X* 1.1.3 An audit of DDA compliance has been carried out and there is an
action plan for tackling any deficits. X
1.1.4 There is an ‘Improvement Plan’ for DDA compliance, as required. X Commentary
Work is progressing across NHS Greater Glasgow in relation to implementing DDA legislation. In general we found staff had variable awareness of the major provisions of DDA legislation and guidance with respect to NHS responsibilities. Staff working within specialist physical disability services are best informed
NHS Trusts are at different stages regarding audit of DDA compliance and improvement plans are still to be developed and actioned. The focus to date has mainly been on physical access rather than wider access issues such as information, communication support etc.
X – across NHS Greater Glasgow Xn – specific to North Glasgow University Hospitals Trust Xc – specific to children’s services Xs – specific to South Glasgow University Hospitals Trust
Strongly Disagree Disagree Agree Strongly Agree Not Relevant Don’t Know
Disability Awareness
1.2 There is an up to date strategy for disability awareness and disability equality training which takes account of staff training requirements in this area.
1.2.1 Service users are involved in the development and delivery of
training. X
1.2.2 There is a lead person for the Trust and in the LHCC. X 1.2.3 There is ongoing training for all health staff, which takes account
of national standards. 23 X
1.2.4 Disability awareness/equality training is mainstreamed into all
elements of staff training. Xn
Xc Xs
XP
1.2.5 There is evidence of disability awareness/equality training in
Health Plans, Locality Plans. X
Commentary
The Centre for Independent Living in Glasgow has been commissioned to develop and deliver disability equality training for NHS Greater Glasgow and social work staff. The training programme commenced in September 2002 and is being rolled out across Glasgow.
There are lead people identified for the four NHS Trusts who are actively involved in this work. We found less clarity at LHCC level with nominal rather than proactive lead.
Disability awareness/equality training is included in induction training for all staff in the Primary Care Trust but this is still to be applied systematically for all staff employed by the North and South University Hospitals NHS Trusts and Yorkhill NHS Trust.
There is no reference to DDA in the health plan or locality plans we reviewed.
23 Not currently available
X – across NHS Greater Glasgow Xn – specific to North Glasgow University Hospitals Trust
Strongly Disagree Disagree Agree Strongly Agree Not Relevant Don’t Know
1.3 People can safely access health service settings.
1.3.1 An access audit of health premises has been conducted. X 1.3.2 There is an improvement plan and strategy based on the audit
which takes account of 2004 DDA compliance. 24 X 1.3.3 There is adequate parking and designated drop off points within
reasonable reach of destinations. X
1.3.4 Arrangements are in place for personal support to be provided
within reasonable reach of destinations. X
1.3.5 Arrangements are in place for personal support to be provided – eg
a guide. X
1.3.6 Interpreters are available. X
1.3.7 Environmental adaptations are in place eg disabled toilets, ramps,
height adjustments, access to telephone etc. X
Commentary
Pilot audits have been conducted and a start has been made on larger scale audits by each of the four Trusts.
Some remedial work has already been put in hand. It was reported that, taking account only of the major properties operated by the NHS Board, the resources required for DDA compliance are substantial. There are issues also in relation to GP and dental premises. We were concerned to hear that some new buildings, for example at the GRI, do not meet DDA standards.
Improvement plans require to be developed across NHS Greater Glasgow. The intention is to consult on priorities, once the results of the access audits are available, with both patients/user representatives and staff, before improvement plans and strategies are submitted to the NHS Greater Glasgow.
Drop off points and parking places for transport for people with disabilities appear to be widely available, but there is still scope for improvement. WE observed some misuse of disabled parking spaces by staff and members of the public during the visit.
Arrangements for support are made locally at patient/carer request. Information is available at key locations on what help is available and how to request it. However, there does not appear to be a NHS-wide policy for systematically informing prospective patients or carers about what arrangements are available. Some users reported difficulty in getting appropriate support when required.
Interpreters are available and some NHS staff have been trained in the use of British Sign Language.
There is work in progress to improve environmental adaptations. However, during the visit we came across a number of examples which indicates that much is still to be done.
24 Legal requirement from 2004
X – across NHS Greater Glasgow Xn – specific to North Glasgow University Hospitals Trust Xc – specific to children’s services Xs – specific to South Glasgow University Hospitals Trust
Strongly Disagree Disagree Agree Strongly Agree Not Relevant Don’t Know
1.4 There is an accessible Complaints Procedure
1.4.1 There is a clear and accessible NHS complaints procedure, which
is available to service users. X
1.4.2 Support is available for service users to use the complaints
procedure, including access to independent advocacy. X X*
1.4.3 There are opportunities for users and carers to give views, and/or
express concerns. X
1.4.4 There is a system in place to ensure appropriate action and
outcomes are addressed. X
Commentary
NHS Trusts operate the NHS complaints policy. The general complaints leaflets and information is available across NHS settings although, outwith the specialist services, there were few examples of information being available in a range of different formats for people with physical or sensory impairments. The PDRU and Spinal Injuries Unit at the Southern General Hospital provide examples of good practice in this area. Support arrangements are in place for addressing issues raised by patients, and for dealing with ‘informal complaints’. At present, independent advocacy is limited and is not systematically available across NHS Greater Glasgow.
There is a range of fora through which users and carers are invited to express their views or voice their concerns.
These include formal bodies (eg the Disability Empowerment Group, Joint Strategy Group Impact of Disability on Children, Young People and their Families), a range of internal support services, research collecting patient and carer data, and explicit consultations by the Board and Trusts.
There are systems in place to review formal complaints received by each Trust, and monitor the progress of each complaint to final outcome. We note that none of the four Trusts achieved a 70% response rate to complaints for the quarter ending September 2002.
X – across NHS Greater Glasgow Xn – specific to North Glasgow University Hospitals Trust
Strongly Disagree Disagree Agree Strongly Agree Not Relevant Don’t Know
Independent Advocacy
1.5 There is an NHS Board specification for advocacy services for people with physical disabilities
1.5.1 Health Plans/Joint Community Care plans identify the need for
advocacy services, and include a service specification. X 1.5.2 There is a service specification for services to people with
physical disabilities X
Xc
1.5.3 Scottish Executive guidance is followed. X
Commentary
The local health plan does not identify a priority need for independent advocacy, but it is directly addressed in the Glasgow City Adult draft physical disability strategy (February 2003).
A draft service specification has been developed by NHS Greater Glasgow in conjunction with Glasgow City although funding needs to be addressed. The Joint Strategy Group for Children’s Services has developed a service specification for independent advocacy for children and young people who are in hospital.
There are two advocacy services that provide specific support for people with physical disabilities but this is limited by resources available and geographical coverage.
Action is being taken on Scottish Executive guidance and strategies are being developed. Issues of funding have yet to be solved.
1.6 There is a process for monitoring and evaluating access to, and use of advocacy services
1.6.1 Staff are aware of the way in which advocacy services are
monitored and evaluated. X Xc
1.6.2 There is an identified person responsible from the NHS Board or Trust for the co-ordinating and monitoring of advocacy services commissioned by the NHS Board.
X Xc
Commentary
There is a range of fragmented small scale advocacy services in operation in the NHSGG area. There is not yet a systematic strategy of monitoring and evaluation at NHS Greater Glasgow level. To date there is no advocacy service for children although work is underway to address this.
The Advocacy Projects publish annual reports and provide information on range of activities etc.
X – across NHS Greater Glasgow Xn – specific to North Glasgow University Hospitals Trust Xc – specific to children’s services Xs – specific to South Glasgow University Hospitals Trust
Strongly Disagree Disagree Agree Strongly Agree Not Relevant Don’t Know
1.7 There is an ongoing training programme for staff and advocates.
1.7.1 Clear responsibility is allocated for co-ordination of training for
NHS staff. X
1.7.2 There is a training programme for staff. X
1.7.3 Relevant training is made available to advocates on service issues. X
1.7.4 There is an allocated budget. X
Commentary
Advocacy services provide training for people taking on the role of advocates.
There is limited training available to staff across NHS settings on the role of advocacy services although some ad hoc training is provided to staff in PDRU and Glenburnhill Unit by The Advocacy Project (TAP).
The Community Physical Disability Teams have provided some input to advocacy training.
There is no dedicated budget for staff training in this area.
1.8 Advocacy services commissioned by the NHS Board/Trust or services separately funded are supported by the Trust in a positive way.
1.8.1 There is sufficient privacy available to advocates and their
partners. X
1.8.2 There are arrangements in place to enable issues of concern to be
raised with managers and staff. X
Commentary
Where advocacy services are available arrangements are made to ensure privacy.
There are opportunities for advocates to raise issues of concern with staff. Staff, generally, are supportive of advocacy service.
While there is no advocacy service for children and young people, the Family Support and Information Service based at RHSC offers emotional and practical support to children and families.
X – across NHS Greater Glasgow Xn – specific to North Glasgow University Hospitals Trust
Strongly Disagree Disagree Agree Strongly Agree Not Relevant Don’t Know
1.9 There is a system in place, which facilitates service users, and carers access to advocacy services.
1.9.1 There is a referral protocol available setting out how the service
may be accessed. X
1.9.2 Information is available in a range of formats – eg large print tape
etc. X
1.9.3 The number of people with identified advocates and range of
needs being met is known. X
Commentary
Advocacy services have a referral protocol but because of the limited availability of advocacy services for people with physical disabilities, information on referral criteria and how to access the service is not well disseminated throughout NHS services in Greater Glasgow. The specialist services such as PDRU, Glenburnhill Unit and the Community Physical Disability Teams provide information on advocacy to individuals known to the service.
TAP has information available in a range of formats and this is good to see.
1.10 Information is available to services users, carers and staff indicating eligibility criteria and referral procedures.
1.10.1 A range of media has been employed eg leaflets, posters, direct
communication with user group to ensure maximum awareness. X Commentary
Information is available but active dissemination is limited across NHS Greater Glasgow primary care, community and in-patient services.
1.11 All information provided is accessible to target groups through the use of plain English, non verbal approaches, and translations
1.11.1 Information is available in a range of formats eg large print, tape
etc. X
Commentary
Advocacy services provide a range of accessible information.
X – across NHS Greater Glasgow Xn – specific to North Glasgow University Hospitals Trust Xc – specific to children’s services Xs – specific to South Glasgow University Hospitals Trust
Strongly Disagree Disagree Agree Strongly Agree Not Relevant Don’t Know
Health Promotion
1.12 The NHS Board, Trusts and LHCCs have an agreed policy on health education and health promotion activities which takes account of the diverse needs of people with physical disabilities.
1.12.1 A range of media has been employed eg leaflets, posters, direct
communication with user group to ensure maximum awareness. X Xc X*
1.12.2 Staff training programmes are in place. Xc
X X* 1.12.3 There is evidence of health promotion activities in Health Plans
and Locality Plans X
1.12.4 There is attention to gender issues, sexuality and sexual health. X X* Xc 1.12.5 There is a health education policy in place, which ensures
educational materials are available and utilised. X
Commentary
We found limited attention to the specific needs of people with physical disabilities within general health promotion programmes. There is no member of the health promotion department with a specialist remit in this area. There are some good examples of information such as the availability of information on smoking cessation in Braille and other material. However, there is no systemic dissemination across the range of settings.
Child and specialist services such as PDRU, Spinal Injuries and Community Physical Disability Teams provide a focus on health promotion and there are examples of good practice ion these areas.
Other than the specialist services, we found limited attention to staff training needs in this area.
X – across NHS Greater Glasgow Xn – specific to North Glasgow University Hospitals Trust
Strongly Disagree Disagree Agree Strongly Agree Not Relevant Don’t Know
1.13 Information on primary and secondary health promotion is available in an appropriate format.
1.13.1 There are health promotion programmes in place. X Xc 1.13.2 Information is available in a range of formats. Xc X 1.13.3 There is easy access for generic or specialist advice by other
agencies. Xc
X 1.13.4 Opportunities are available for people with physical disabilities
to participate in activities, which promote a healthy lifestyle. Xc X Commentary
There is a range of health promotion programmes available to children and young people but not targeted specifically at children and young people with physical disabilities.
General health promotion programmes can be accessed by people with physical disabilities. The social work Disability Resource Centres support a range of groups such as ‘Living with Arthritis’ and ‘Living with Stroke’.
While opportunities exist mainstream services are not wholly accessible or inclusive. A pilot project involving Culture and Leisure Services, Health Promotion, Community Physical Disability Teams and Glasgow Council for Voluntary Services to support people with physical disabilities to participate in a range of activities is an example of good practice.
1.14 There is appropriate and accessible health screening and secondary health promotion activities.
1.14.1 People with physical disabilities have access to health screening
programmes. X
Xc 1.14.2 People with physical disabilities have access to secondary health
promotion. Xc
X 1.14.3 Department of Health Guidelines on consent to
treatment/screening/examination are followed. Xc
X 1.14.4 Adults with Incapacity Legislation is applied and supported by
training. X X*
Commentary
Services report that this is in place. The last SHAS report identified an issue around the lack of well woman, well man screening for people in continuing care NHS services. Services are now in place.
Appropriate screening is available for children and young people and there are appropriate guidelines on consent to treatment relevant to the needs of children and young people.
Adults with Incapacity legislation is being implemented although staff awareness is patchy with some staff having very little knowledge about the Act and implications for medical treatment (part 5) and financial matters (part 4). There are particular issues for GPs which require to be addressed nationally.
X – across NHS Greater Glasgow Xn – specific to North Glasgow University Hospitals Trust Xc – specific to children’s services Xs – specific to South Glasgow University Hospitals Trust
Strongly Disagree Disagree Agree Strongly Agree Not Relevant Don’t Know
1.15 There are adequate and appropriate arrangements for patient transport.
1.15.1 The NHS Board contract with the Scottish Ambulance Service
covers quality standards and monitoring arrangements. X 1.15.2 The NHS Board ensures service users’ complaints are monitored
and necessary action is taken. X
1.15.3 There is a Trust/Patient transport services liaison group. X 1.15.4 Guidelines for use of patient transport are agreed and
implemented. X
1.15.5 Vehicles re accessible by wheelchair users. X
1.15.6 There is evidence of joint working with other agencies. X Commentary
A consultation exercise with the Scottish Ambulance Service (SAS) involving users views on the range of vehicles available has informed the provision of patient transport in Glasgow. Issues identified in the last SHAS report around difficulties in transporting wheelchairs and long delays for transport are being addressed and improvements noted. However there continues to be a lack of monitoring of complaints jointly between the NHS services in Glasgow and the SAS.
1.16 The needs of people with physical disabilities are considered in relation to general transport services.
1.16.1 The NHS Board is involved in appropriate forums, with local
authorities and others, which address general transport issues. X
1.16.2 Health Plans address this area. X
Commentary
General transport issues are identified in the Glasgow Physical Disability draft strategy. Accessible transport is a significant barrier to individuals and requires to be addressed on an interagency basis.
Community care plans address this area and specific work was undertaken on transport by NHS Greater Glasgow as part of the acute services review.
X – across NHS Greater Glasgow Xn – specific to North Glasgow University Hospitals Trust
Strongly Disagree Disagree Agree Strongly Agree Not Relevant Don’t Know
Information
1.17 Information is available on the range of health services available.
1.17.1 Information is available in GP surgeries, health centres, day
services, and hospital units. X Xp
Xc 1.17.2 There is active dissemination of information to meet the needs of
people with a range of physical disabilities. Xc
X X* 1.17.3 There is an identified person in the Trust and LHCCs who is
responsible for co-ordinating and updating information. Xc X 1.17.4 Information is available in a range of formats. X Xc
X* Commentary
Yorkhill NHS Trust has information available in a range of formats and languages. A Family Information Leaflet Editorial Service (FILES) ensures that all information meets set standards before circulation. There are three ‘in touch’ health information kiosks with touch screen operation. An information officer post is currently being recruited to ensure systematic collection, evaluation review and recording of all Trust information for children and families.
Except for the specialist services we found limited evidence of information being available in a range of formats in the clinical areas and services visited. The PDRU provides an information newsletter.
Primary care services through Royal College General Practice (RCGP) accreditation are addressing information needs of patients. LHCCs are also working to CNORIS and QIS generic standards in relation to patient information. Information is being made available in a range of formats including audio.
X – across NHS Greater Glasgow Xn – specific to North Glasgow University Hospitals Trust Xc – specific to children’s services Xs – specific to South Glasgow University Hospitals Trust
Quality Indicator 2 The Patient Journey
Strongly Disagree Disagree Agree Strongly Agree Not Relevant Don’t Know
Strongly Disagree Disagree Agree Strongly Agree Not Relevant Don’t Know