ࡱ> ~}q` 0|,bjbjqPqP J::b$(((((((<84<Xyj...xxxxxxx$zh*}^x(/"//x((..y333/(.(.x3/x33ah ((n.  qSmj:x(y0Xyj}}tnn&}(n( 3I|jxxdXy////<<<<<<<<<((((((  British Institute of Learning Disabilities Campion House Green Street Kidderminster DY10 1JL Telephone 01562 723010 enquiries@bild.org.uk www.bild.org.uk Factsheet quality Summary Quality is an important focus of the White Paper and other government documents. Quality can be defined in many ways, but the most important aspect of quality is the quality of life of people with learning disabilities. The experience of people with learning disabilities should be the main focus of work on quality. Organisations should have a quality strategy in place, setting out what information on quality is to be collected and how it will be used for continuous quality improvement. General Introduction: What is Quality? Quality is an important issue in today's services for people with learning disabilities. Government guidance for England, Scotland and Wales all emphasise the importance of ensuring that people not only get support, but get support of high quality. We can think of quality in terms of inputs, processes and outcomes. Inputs are the resources which go into services (such as budgets, staffing levels, buildings). Processes are the ways that services are delivered (such as person centred planning, the way staff interact with people, the activities which are organised). Outcomes are the impact which services have on people's lives (such as increased independence, being part of the community, being treated with respect). Ultimately the quality of a service needs to be judged in terms of outcomes - is the service helping people to achieve decent quality lives? In England, the Government White Paper Valuing People stresses the need for quality to be assessed in terms of outcomes. The Government objective is to 'ensure that all agencies commission and provide high quality, evidence-based and continuously improving services which promote both good outcomes and best value' (page 90). The White paper is based on four key principles of Rights, Independence Choice and Inclusion. It says that 'the challenge for agencies working in the learning disability field will be to: develop a better approach to measuring quality, which emphasises improved outcomes as informed by the best quality research; work in partnership with other agencies in developing benchmarks for measuring performance; enable people with learning disabilities to lead lives safe from harm and abuse; put the needs and wishes of the person using the service at the centre of their quality assurance systems.' The Scottish policy document The Same as You? describes a better quality of life in terms of: 'People with learning disabilities will use independent advocacy and direct payments to give them more control over their lives and the services they receive. People with learning disabilities will be much more part of the community; living in the community, working in the community, enjoying education' leisure and recreation in the community Measures will be introduced to reduce bullying and harassment of people with learning disabilities. People with learning disabilities will enjoy better health and being part of routine screening programmes.' The Welsh Assembly has produced a consultation document Fulfilling the Promises which is based on the following principles: 'people with learning disabilities: are full citizens equal in status and value to other citizens of the same age have an equal right to expect a high quality of life - in practice this means having exactly the same expectations of decent health, education, housing, safety and financial security, protection from harm, positive social relations and roles within family and community, employment opportunities, personal development, emotional well-being and civic rights have a right to decide for themselves and to join in all decision-making which affects their lives, with support if necessary have access to the support of their families and the communities, of which they are a part, and to general and specialist public services to improve their chosen quality of life.' Definitions of Quality There are a number of ways of defining quality in terms of outcomes. Two which are commonly used in services in Britain are: The five accomplishments, defined by John O'Brien . These include: community presence; choice; competence; respect; community participation. A set of ten outcome statements, used by the Quality Network. These include: I make everyday choices I make important decisions about my life People treat me with respect I take part in everyday activities I have friendships and relationships I am part of my local community I get the chance to work People listen to my family's views I am safe from bullying and abuse I get help to stay healthy How is Quality Assessed? There is a wide range of approaches to the assessment of quality. Some of those most commonly used include: Inspection visits, such as those to be carried out by the new National Care Standards Commission in England. Independent inspectors visit services and assess the quality of service according to defined criteria. Much of the emphasis is on processes, but some focus is on outcomes. There have been a number of reviews of services carried out by people with learning disabilities. These usually focus on key issues identified by people with learning disabilities, such as choice, respect, independence and the quality of support provided. Qualitative self-reviews, such as those undertaken by organisations within the Quality Network, involve a review team spending time with individuals in order to get a detailed picture of their experience of life on a day-to-day basis. Interviews and questionnaires can be a useful way of asking people about their quality of life. The drawback is that they require good communication, and may not get the views of more disabled people. If staff answer on behalf of people with learning disabilities, the questionnaires may tend to reflect staff views. Complaints and other consumer feedback offer useful information about quality. Some organisations routinely collect complements, comments and complaints, for example as part of monthly monitoring visits. This may require people to be sufficiently articulate and confident to express views about the service. Reviews of person centred planning should provide good evidence of how services are helping people to achieve the outcomes they have identified for themselves. It is important to remember that a great deal of information about quality will be gathered informally by staff and others as they interact with people on an everyday basis. Quality Systems There is little point in collecting information on quality if nothing is to be done with it. Organisations need to have a quality strategy in place, defining their approach to quality and the steps they will take to ensure that the organisation changes and learns. One simple way of viewing such a strategy is to think of the answer to the following questions: What do we know about the quality of people's lives? (Collecting information) What does this tell us about services? (Interpreting the information) What do we need to do to improve quality? (Action planning) Are we doing it and learning from it? (Review) This is the basis of a strategy of continuous quality improvement. Organisations routinely collect information about quality and use this information to learn and improve the service they offer. It is worth noting that Valuing People says that: 'the Learning Disability Partnership Boards will need to ensure the development of an integrated quality framework that applies across all agencies. This should make people with learning disabilities its central focus with their voices clearly heard and services clearly accountable to them.' Key Government Papers Department of Health (2001); 'Valuing People A New Strategy for Learning Disability for the 21st Century,' HMSO Scottish Executive (2001) The Same as You? A Review of Services for People with Learning Disabilities Learning Disability Advisory Group Report to the National Assembly for Wales (2001); Fulfilling the Promises, Proposals for a framework for services for people with learning disabilities Department of Health (2001); Planning with People: Towards Person Centred Approaches Department of Health (2000); A Quality Strategy for Social Care Department of Health (1998); A First Class Service: Quality in the New NHS References O'Brien, J. (1987) 'A guide to lifestyle planning: Using the activities catalog to integrate services and natural support systems' in Wilcox, B. and Bellamy, G.T. (eds) (1987) A Comprehensive Guide to the Activities Catalog: An alternative curriculum for youth and adults with severe disabilities Baltimore: Paul H Brookes For more information about the Quality Network, see www.bild.org.uk See Planning with People: Towards Person Centred Approaches - Guidance For Implementation Groups. 2002. Guidance produced by the Valuing People Implementation Support Team. Authors: Charlotte Sweeney, Helen Sanderson 20 February 2002 BILD has made every effort to ensure the accuracy of the information contained within its factsheets, but cannot be held liable for any actions taken based on the information provided.      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