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The Royal College of Psychiatrists Improving the lives of people with mental illness

AIMS

What is AIMS for inpatient learning disability services?


We work to assure and improve the quality of inpatient services for adults with learning disabilities and mental health needs from assessment and treatment to rehabilitation services. Staff, carers and service users are engaged in a comprehensive process of review, through which good practice and high quality care are recognised and services are supported to identify and address areas for improvement. 

 

Accreditation assures staff, service users and carers, commissioners and regulators of the quality of the service being provided.

 

AIMS-LD is an initiative of the College Centre for Quality Improvement.

Important changes to the project


Signing up

AIMS-LD is now closed for new registrations. Services willing to participate in this scheme are encouraged to join Quality Network for Inpatient Learning Disability Services (QNLD) first, with an opportunity to progess towards accreditation and become members of AIMS-LD after two years' membership providing the unit meets key standards.

 

Following discussions with a wide range of stakeholders, we found that the AIMS process did not suit all of the wide range of learning disability services in our membership, many of which found it difficult to engage with the process. As a result, QNLD was launched to allow less strict entry criteria and a more supportive, less stringent and less time-limited process initially. Wards can use the process to identify and make improvements necessary to achieve accreditation through AIMS.

 

QNLD is a standards-based quality network for inpatient learning disability services that provides an opportunity for learning disability services to share good practice and facilitate quality improvement.

For more information, please click here.

Why focus on inpatient learning disability services?


  • Over the last 3 years, the learning disability field has been rocked by a series of reports highlighting inadequacies of care. These have included reports from Mencap, the Department of Health and the Local Government Ombudsman (for a full list please see ‘Other resources’). These reports consistently highlighted the inequality of care for people with learning disabilities, the neglect of this population and services for them and how this culture had led to abuse in some cases.
  • The most recent audit by the Care Quality Commission, published earlier this year, stated there were, ‘now even more fundamental concerns’ (p2). Issues included services not offering basic choices, access to advocacy, lack of person-centred and health action plans, lack of monitoring, staff shortages, and variable levels of training. They had to escalate more causes of concern than in the previous audit.
  • The Department of Health has signified that learning disabilities will have a clear position in the new performance frameworks for the NHS and local authorities, that there will be a comprehensive range of data sets and reporting mechanisms, and the increased focus from regulators such as the Care Quality Commission requires better data and information
  • In line with this commitment, the systems of inspection and the sanctions for failing to deliver effective, safe services have been strengthened, making it increasingly important that trust are able to demonstrate that their services are being delivered equitably and in accordance with legislation.
  • AIMS LD exists to help services ensure and demonstrate that they are effective, safe, fair, personalised, transparent, and comply with all aspects of the Disability Discrimination Act
 

Why accreditation is important


  • Services are able to demonstrate the quality of care they provide to service users and carers, their wider organisation and commissioners.
  • Services are able to demonstrate that they meet national guidelines, standards and legislation as set out in publications such as Valuing People and Healthcare for All, and in legislation such as the Disability Discrimination Act.  This can form part of the information they provide to regulatory bodies, as recommended by the National Quality Board.
  • Information gathered through the accreditation process can be used in trust quality accounts, as recommended by the National Quality Board, and mandatory for the first time this year.
  • Achievement of accredited status may support services to reduce their financial contribution to the NHSLA.

 

The standards we use


Making a difference to patients

We believe that it is important that our standards reflect the issues which make a difference to the experience of the person using the service.  For this reason, the standards follow a patient pathway through care and how the service interfaces with other services.  In addition, particularly for long-stay services, we have incorporated a wider evidence-base that considers quality of life.  As far as possible, standards are written from the service user perspective, with an emphasis on a purposeful admission.

 

Meeting national requirements

We recognise that services are under increased pressure to demonstrate that they comply with national policies and guidelines.  For this reason our standards incorporate requirements and recommendations set out nationally.  This means that the process of accreditation will enable your service to demonstrate where it is currently meeting national requirements and will support the service to meet them where it is not currently.

 

Specifically:

  • Valuing People;
  • the findings of inquires such as Mencap Death by Indifference;
  • NICE guidance;
  • recommendations by NHS Estates and the Royal College of Psychiatrists about design;
  • NHS National Patient Safety Agency Listening to people with learning difficulties and family carers talk about patient safety;
  • Healthcare Commission (2007) A life like no other: a national audit of specialist inpatient healthcare services for people with learning difficulties in England;
  • Healthcare Commission (2005) Draft three-year strategic plan for assessing and encouraging improvement in the health and healthcare of adults with learning disabilities 2006-9, Consultation;
  • Healthcare Commission (2008) Joint investigation into the provision of services for people with learning disabilities at Cornwall Partnership NHS Trust the Welsh and Scottish Governments. 

 

Reflecting the views of those in the field

We know that those who are in the field have the best understanding of the issues and challenges that they face in providing high quality care.  The standards that we use are underpinned by a core set of values developed by our expert Steering Group, and have been refined in consultation with front-line staff, service users, carers, other interested groups such as national charities, and professional bodies.

 

Keeping up-to-date

We review the standards each year to ensure that they continue to reflect developments in policy and practice and any issues identified through the accreditation process.

 

What the standards cover

 

The standards cover eight domains:

  • the physical environment and ward facilities;
  • staffing, including leadership and training;
  • access, admission and discharge;
  • care and treatment processes;
  • factors that relate to security and to resident and staff safety;
  • “the service user/resident day” and access to therapies;
  • links with other elements of service, including community services;
  • service user rights and safeguards, including the use of the Mental Health Act.

 

The standards describe organisational processes rather than patient activity or clinical outcomes.

 

The complete set of standards is aspirational; we do not expect services to meet every standard, and services can still be accredited as excellent without meeting all the standards.

 

How we measure performance against the standards

 

We recognise that wards are diverse and that, for example, high quality care does not necessarily require a new purpose-built ward.  Therefore, services are categorised against each standard at one of three levels:

 

Level 1: failure to meet these standards could result in a significant threat to the safety,

rights or dignity of service users and/or would breach the law;

 

Level 2: standards that an accredited ward would be expected to meet;

 

Level 3: standards that an excellent ward should meet or standards that are not the direct responsibility of the ward.

 

Click here to download a copy of the AIMS-LD standards

Click here to download an "easy read" version of the AIMS-LD standards

Click here to download the First National AIMS-LD Report (2009-2012)

 

 

Resources  

Services for people with learning disabilities and challenging behaviour or mental health needs (DH, 2007)

In 1993, DH published 'Services for People with Learning Disabilities and Challenging Behaviour or Mental Health Needs'. To update this, Professor Mansell's report aims to support commissioners in developing local services for people whose behaviour presents a significant challenge. The report makes recommendations on commissioning for service development and implementing models that meet individuals' needs in the local community.


Healthcare for All: Report of the Independent Inquiry into Access to Healthcare for People with Learning Disabilities (2008)

This report summarises the findings of the independent inquiry based on a public consultation, a review of research, and evidence gathered from witnesses and stakeholders, and sets out a series of recommendations for action to ensure adults and children with learning disabilities receive appropriate medical treatment in the NHS.

Valuing People Now (DH, 2009)
Valuing People Now sets out the Government’s strategy for people with learning disabilities for the next three years following consultation. It also responds to the main recommendations in Healthcare for All, the Independent Inquiry into access to healthcare for people with learning disabilities.

Specialist inpatient learning disability services: Follow-up audit of services 2008/09 (Care Quality Commission, 2010)

Six Lives: the provision of public services to people with learning disabilities (Local Government Ombudsman, 2009)


Death by indifference (Mencap, 2007)


People First


For resources relating to AIMS in general, click here

 

 

Contact us


If you would like to find out more about AIMS-LD/QNLD, and how your service can get involved, please contact Justina Kaselionyte:

Tel: 020 3701 2657

Email: jkaselionyte@rcpsych.ac.uk

Where next...


AIMS
21 Prescot Street, London E1 8BB
Email: aims@rcpsych.ac.uk

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