Update from NHS England on the Accessible Information Standard for theLocal Authority/Association of Directors of Adult Social Services (ADASS) Physical and Sensory Impairment and HIV/AIDS Network Meeting on20 May 2016
1.Overview
The Accessible Information Standard was published by NHS England, following approval as a new ‘information standard’ for the NHS and adult social care system, in July 2015.
Officially called SCCI1605 Accessible Information, the Accessible Information Standard (‘the Standard’) directs and defines a specific, consistent approach to identifying, recording, flagging, sharing and meeting individuals’ information and communication support needs, where those needs relate to a disability or sensory loss.
2.Scope
a.Applicable organisations
All providers of NHS and / or publicly-funded adult social care must follow the Standard in full by 31 July 2016 (in line with section 250 of the Health and Social Care Act 2012). The Act defines those organisations legally obliged to follow ‘information standards’, including the Accessible Information Standard, and the relevant section is copied at appendix 1.
NHS and adult social care commissioning organisations are also required to support implementation of the Accessible Information Standard by providers from whom they commission services.
b.Required actions
The Specification for the Standard sets out a series of requirements which organisations that provide NHS or publicly-funded adult social care must follow. These required actions can be summarised as five key steps, which all ‘applicable organisations’ must complete. They must:
- Ask people if they have any information or communication needs, and find out how to meet their needs.
- Record those needs clearly and in a set way.
- Highlight or flag the person’s file or notes so it is clear that they have information or communication needs and how to meet those needs.
- Share information about people’s information and communication needs with other providers of NHS and adult social care, when they have consent or permission to do so.
- Take steps to ensure that people receive information which they can access and understand, and receive communication support if they need it.
The Implementation Guidance offers a range of advice for organisations about how they may wish to approach implementation. This includes acknowledging both the appropriateness of differing approaches, relevant to the differing ‘starting position’ and demands of different services, and also that in many cases the changes needed may relate to the process of the Standard (and requirements for consistent identifying, recording, flagging and sharing of needs), as meeting individuals’ needs may already be embedded, including as part of personalised care.
c.Required outcomes
The Standard requires that organisations ensure that patients and service users (and where appropriate their parents and carers) with information and / or communication needs relating to a disability or sensory loss receive:
- ‘Accessible information’ (‘information which is able to be read or received and understood by the individual or group for which it is intended’); and
- ‘Communication support’ (‘support which is needed to enable effective, accurate dialogue between a professional and a service user to take place’).
The Standard does not necessarily require the provision of information in a patient’s ‘preferred’ format; rather it requires the provision of information in a format that the patient can read or otherwise access and understand. It is the patient’s information and communication ‘needs’ which must be met, which may differ from their preferences. The ‘judgement’ or ‘assessment’ about whether this requirement has been fulfilled lies with the individual patient themselves, i.e. can they read, access and understand the information? Can they ‘use’ the information as it was intended? If they can, then the organisation has met this aspect of its obligations under the Standard.
In the context of person-centred care, organisations may wish to be mindful of patients’ preferences, and best practice would of course be to accommodate them, however it is not a requirement of the Standard.
d.Affected service users
The Standard is expected to have particular impact for people who have a learning disability, who are d/Deaf, blind or deafblind, and / or who have hearing or visual loss. However, it is intended to benefit all patients and service users with information and / or communication needs relating to a disability or sensory loss, including, for example, people who have had a stroke or brain injury, and people with dementia.
e.Timescales
From 01April 2016, organisations must identify and record individual’s needs. They must implement the Standard in full by 31July 2016, and then continue to follow it on an ongoing basis.
3.Funding arrangements
It is acknowledged that funding arrangements for the production of alternative formats and provision of professional communication support differ significantly, both across different organisation types and across different geographies / local health and care economies. The Accessible Information Standard does not provide direction about how accessible information and communication support should be funded (as this would be out of the scope of an ‘information standard’).
Organisations should be mindful of their ‘reasonable adjustment’ duties, as set out in the Equality Act 2010, and, for local authorities, settlement arrangements as part of the Care Act 2014. Advice to service providers with concerns or questions is to liaise with their commissioning organisation as appropriate.
4.Organisational compliance
It is hoped that organisations will recognise the significant benefits to their patients and service users of implementing the Standard, and recognise that compliance is in line with commitments to equitable, high quality, accessible and personalised care. Organisations that do not implement the Standard are at risk of failing to effectively provide healthcare to individuals with information and / or communication needs, and potentially denying them the rights to confidentiality and independence when accessing healthcare.
As compliance with the Standard is a legal duty (section 250 Health and Social Care Act 2012), organisations that do not comply with the Standard leave themselves open to legal challenge. Non-compliant organisations should also be aware of the risk of complaints, investigation and negative media coverage.
Whilst there is no requirement for organisations to report on their adherence to the Standard (and no national audit or dataset is being created), the Standard includes requirements for organisations to publish or display an accessible communications policy which explains how they will follow the Accessible Information Standard, and an accessible complaints policy. The inclusion of these requirements is intended to support ease of compliance assessment by interested organisations, and to ensure that people with information and communication support needs are able to provide feedback to organisations about their experiences.
The Specification also makes clear that commissioners must support providers to comply with the Standard, including through contracts, tariffs, frameworks and performance-management arrangements. Commissioners must also seek assurance from providers in this regard.
In addition, the Care Quality Commission (CQC) have stated that, for adult social care services, “As part of our inspection work, CQC will look at evidence of how services implement the Accessible Information Standard when we make judgements about whether services are responsive to people’s needs and whether they are well led.”
5.Supporting implementation of the Standard
NHS England has published an Implementation Plan for the Standard, setting out a range of actions which will be taken at a national level to support effective implementation of the Standard by provider organisations.
Actions completed by NHS England to date include:
- Communications to raise-awareness of the Standard with health and care professionals, and, in partnership with voluntary sector organisations, with patients, carers and the public;
- In partnership with the Health and Social Care Information Centre (HSCIC):
- Authoring and release of new READ and SNOMED CT codes to enable accurate recording of individuals’ information and communication support needs;
- Adjustments to Summary Care Records (SCR)such that they include information about patients’ information and communication needs, where they have consented for ‘additional information’ to be included in their SCR;
- In partnership with Health Education England (HEE), development and launch of e-learning on the e-learning for health platform;
- Hosting a series of regional implementation events, attended by approximately 770 people;
- Publication of a range of tools and resources on the NHS England website, including templates, infographics, an interactive guide and microsite.
Ongoing actions include:
- Engagement with provider representative bodies, including Pharmacy Voice, The Optical Confederation, the British Medical Association (BMA), and the National Ambulance Diversity Forum;
- Liaison with GPIT systems suppliers – who are contractually obliged to update systems in line with the Standard – including with a view to standardising ‘flags’;
- Working with NHS England and HSCIC colleagues to embed the Standard within the NHS eReferral System, including seeking to increase automation and improve visibility of recorded needs;
- Developing and supporting the development of additional resources, advice and guidance to support implementation, for publication on the NHS England website.
6.Next steps
NHS England and partners will be undertaking a range of communications and other activities in support of the implementation deadline of 31 July 2016. Messages will focus on celebrating success and recognising the positive impact of the Standard, alongside promoting the actions which should be taken by organisations that have not yet fully implemented the Standard.
A review of the Standard is scheduled to take place later in 2016. This will include consideration of impact – on service providers and service users – and any requirements for revision or refresh.
Individuals and groups who wish to be directly informed about the review – and other news – are advised to join the distribution list for the Standard, so that they receive updates directly. To join the mailing list with ‘Accessible Information Standard’ in the subject line, or telephone01138253002.
Appendix 1Section 250 Health and Social Care Act 2012
250Powers to publish information standards
1)The Secretary of State or the National Health Service Commissioning Board (referred to in this Chapter as “the Board”) may prepare and publish an information standard.
2)For the purposes of this Part “an information standard” is a document containing standards in relation to the processing of information.
3)The Secretary of State may exercise the power under subsection (1) only in relation to information concerning, or connected with, the provision of health services or of adult social care in England.
4)The Board may exercise the power under subsection (1) only in relation to information concerning, or connected with, the provision of NHS services.
5)An information standard must include guidance about the implementation of the standard.
6)The following must have regard to an information standard published under this section—
a)the Secretary of State;
b)the Board;
c)any public body which exercises functions in connection with the provision of health services or of adult social care in England;
d)any person (other than a public body) who provides health services, or adult social care in England, pursuant to arrangements made with a public body exercising functions in connection with the provision of such services or care.
7)In this section—
- “adult social care”—
a)includes all forms of personal care and other practical assistance provided for individuals who, by reason of age, illness, disability, pregnancy, childbirth, dependence on alcohol or drugs, or any other similar circumstances, are in need of such care or other assistance, but
b)does not include anything provided by an establishment or agency for which Her Majesty's Chief Inspector of Education, Children's Services and Skills is the registration authority under section 5 of the Care Standards Act 2000;
- “health services” means services which must or may be provided as part of the health service in England; and for that purpose “the health service” has the same meaning as in the National Health Service Act 2006 (see section 275(1) of that Act);
- “NHS services” means services the provision of which is arranged by the Board or a clinical commissioning group under the National Health Service Act 2006 (including pursuant to arrangements made under section 7A of that Act) or section 117 of the Mental Health Act 1983 (after-care);
- “processing” has the same meaning as in the Data Protection Act 1998 (see section 1 of that Act);
- “public body” means a body or other person whose functions—
a)are of a public nature, or
b)include functions of that nature,
but in the latter case, the body or person is a public body to the extent only of those functions.
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