LeDeR Quarterly Report Overview - Coventry & Warwickshire
This report provides an overview of LeDeR activity in Coventry and Warwickshire from April 1, 2024, to June 30, 2024. It includes notifications, completed reviews, progress updates, local priorities, and national impact actions.
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Learning from the Lives and Deaths of People with a Learning Disability and Autistic People(LeDeR) Quarter 1 Report - 1stApril 2024 30th June 2024
Purpose This report provides an overview of LeDeR activity in Coventry and Warwickshire during Quarter 1, 1st April 2024 -30thJune 2024, where Q1 is utilised hereafter, it is with reference to this period. It includes a summary of notifications to LeDeR, LeDeR reviews completed, and an update on progress made in relation to learning identified. Context Learning from the Lives and Deaths of people with a learning disability and autistic people (LeDeR) has been established since 2017 and is a national service improvement programme overseen by NHSE. Responsibility to deliver a LeDeR programme is devolved to local Integrated Care Systems (ICSs). In Coventry and Warwickshire, the programme is delivered with collaboration between partners across health, care services, public health and the community and voluntary sector. From 1st January 2022 the LeDeR programme was extended to also include the review of Autistic adults who have died from this date onwards. 2
Local Priorities Through our 2023/24 annual report we recognised the key themes that were being highlighted by our reviews. No area is more deserving of time than another however we were also realistic in the limitation of the subgroup and need for prioritisation of resources. We will continue to conduct focused reviews where the death was attributed or due to pneumonia or constipation along with the nation requirement to conduct focused reviews for all autism only referrals, referrals for a person from a black and minority ethnic background and any reviews that we could ascertain further learning from. This will be reviewed at the end of Q4. Key Themes 2023/24 National Priorities 2024/25 The national LeDeR team have set out several high-level impact actions for all local LeDeR teams to address in 2024/25. 1 Reduce avoidable mortality in the 3 clinical priority areas for Learning Disability and Autism 2 Focus on co- morbidities associated with premature death and Advanced Care Planning including DNACPR / ReSPECT 3 Assure and Sustain Performance 4 Improve the quality of LeDeR reviews and actions from learning 5 Improve access and understanding of the importance of LeDeR review 6 Improve accuracy of Learning Disability Registers We will dovetail our local priorities into the national priority actions, see from page 8. 3
Notifications and Completed Reviews Notifications received Q1 15 Learning Disability or Combined Learning Disability and Autism 1 Diagnosis of Autism Only 1 Ethnicity of black or ethnic minority background 2 Out of Scope Open Reviews as of 30.06.24 Completed Reviews in Q1 Of the completed focused reviews: 0 Constipation 38 Open Reviews 11 Completed Reviews 6 Pneumonia Of these 38 reviews, 10 reviews remain on hold awaiting outcomes of external investigations including safeguarding, police, and seriousincident reporting. 0 COVID-19 0 Autism Year of Notification 5 from 22/23 18 from 23/24 15 from 24/25 0 Black, Asian, or Minority Ethnic Year of Notification 11 from 23/24 6 Focused 4 Initial 18 Focused 20 Initial 0 Detained under the Mental Health Act in last 5 years 0 Other learning to be taken 4
Quality of Care All reviews are graded on the quality of care and availability and effectiveness of services. The table below details the gradings for Q1. Positive practice examples Definition Quality of the care the person received Availability & effectiveness of services 1 During Q1 we have seen some good examples of the use of Deprivation of Liberty Safeguards (DoLS) the Mental Capacity Act (MCA) and the ReSPECT process, where regular reviews of these have ensured that holistic care was delivered. 6 - Excellent and exceeded the expected standard 5 - Good and met the expected standard 1 7 6 4 - Fell short of the expected standard, but this did not significantly impact on the person s wellbeing 3 - Fell short of the expected standard and did impact on well-being but did not contribute to the cause of death 2 - Fell short of the expected standard and did impact on well-being and/or had the potential to contribute to the cause of death 1 - Fell short of the expected standard, and this contributed to the cause of death 2 2 0 1 We also saw evidence of good multi-disciplinary team working with holistic, person-centered care was provided by everyone involved. 0 0 0 0 Avoidable Deaths No Deaths reviewed during Q1 were seen to be avoid able. 5
Review Data Cause of death Gender 8 6 4 were females 4 7 2 2 1 0 6 were males GASTRO INTESTINAL CANCER RESPIRATORY Respiratory continues to be the leading cause of death with 6 of the 7 respiratory deaths due to pneumonia. Age The median age was 63 years, ranging from 52 83 years of age. 6
Focused reviews NHSE KPI s The NHSE KPI is for a minimum of 35% of reviews to be focused. As of June 2024, Coventry and Warwickshire are performing at 59%. COVENTRY AND WARWICKSHIRE 59% MIDLANDS 36% ENGLAND 31% Timescales The NHSE KPI is for all reviews to be completed within 6 months of notification. Coventry & Warwickshire have completed 94% of reviews within 6 months, as of June 2024. COVENTRY AND WARWICKSHIRE 94% MIDLANDS 63% ENGLAND 37% 7
Coventry and Warwickshire 2024/25 Key Aims, Measurables and Progress. National Aim Reduce avoidable mortality in the 3 clinical priority areas for Learning Disability and Autism Coventry and Warwickshire Key Aims Measurables Progress during Q1 To explore trends and data for deaths where respiratory, cardiovascular & cancer are the main cause Deaths recorded Subgroup work during Q1 has focused on Coventry and Warwickshire's leading cause of death, pneumonia and aspirational pneumonia. We are currently working on an easy read document for Pneumonia, Aspiration Pneumonia and the Pneumococcal Vaccine. This work will continue in Q2 . Avoidable deaths To continue to support other work programmes to allow for the LD/A voice and their needs to be heard Collaborative working with CWPT cancer project continues. LeDeR Subgroup to explore and action what work is needed in these areas Systemwide work has commenced on the back of the new NHSE guidelines for health and care passports. This will be held in our LeDeR Subgroup. 8
National Aim Focus on co-morbidities associated with premature death and DNACPR/ ReSPECT Coventry and Warwickshire Key Aims Measurables Progress during Q1 To explore local available data on the prevalence of co-morbidities for people with a learning disability and autistic people in Coventry & Warwickshire e.g. epilepsy, obesity, mental health Review data AHC Uptake: The latest official data published by NHS Digital England along with figures obtained from our local SitRep, show a cumulative figure of 510 for April June (Q1), which is 90 more than at the same stage of 2023/24. Local DNACPR / ReSPECT audits AHC Quality: Our report detailing the 2023/24 Quality & Under-served Population project is going through the ICB governance process to be signed off, after which we will circulate it throughout the system. To collect data on co-morbidities within our LeDeR reviews to notice any local trends and themes Continue to link in with systemwide Advance Care Planning including DNACPR/ReSPECT work programmes Scoping commenced to be able to better identify those with a learning disability who are end of life and how to improve end of life care planning for those individuals. Completed reviews have identified the need for dedicated work around weight management and this will be included in subgroup work for Q2, starting with looking at a mapping and gap analysis of services. LeDeR intelligence will continue to feed learning themes into Palliative and End of Life Care work programmes. 9
National Aim Assure and Sustain Performance Coventry and Warwickshire Key Aims Measurables Progress during Q1 All reviews to be completed within 6 months Reviews completed Coventry and Warwickshire LeDeR team continues to meet national KPI s (see page 7) The NHSE KPI is for all reviews to be completed within 6 months of referral. Coventry & Warwickshire have completed 94% within 6 months, as of June 2024. At least 35% of completed reviews to be focused Focused reviews complete The NHSE KPI is for a minimum of 35% of reviews to be focused. As of June 2024, Coventry and Warwickshire are performing at 59%. Recruitment is underway to ensure a sustainable LeDeR programme team. 10
National Aim Improve the quality of LeDeR reviews and actions from learning Coventry and Warwickshire Key Aims Measurables Progress during Q1 Partake in peer review opportunities Quality of reviews Allied Health professionals identified to join the LeDeR Local Governance Group Feedback learning from peer review into LeDeR programme team Two Clinical Lead Learning Disability GPs have been appointed to work alongside the LeDeR programme, as well as the wider LDA workstreams in the clinical transformation team Strengthen the quality of reviews by including allied health professionals and primary care in the review process and governance group Recruitment of another expert by experience has been secured to further inform the LeDeR programme Our Local Area Contact continues to partake quarterly in peer supervision with other ICB s across the midlands Peer supervision for senior reviewers with other ICB s across the Midlands will commence in Q2 11
National Aim Improve access and understanding of importance of LeDeR review Coventry and Warwickshire Key Aims Measurables Progress during Q1 Continue to promote LeDeR across all underserved communities Ethnicity reporting Autism reporting Links with Coventry and Warwickshire Provider Forum established. Continue to link in with other work programmes to help promote LeDeR The LeDeR programme has linked in with lead MEOs in all acute trusts to help improve accuracy of reporting especially for those with a diagnosis of autism or from ethnic minority backgrounds Our Annual Report will highlight key messages and spread awareness for underserved communities Intersectionality working group continues to explore local available data Our AHC Quality report has key recommendations around the importance of accessible and accurate ethnicity data this will be shared nationally in Q2. 12
National Aim Improve accuracy of Learning Disability Registers Coventry and Warwickshire Key Aims Measurables Progress during Q1 Use gold standard GP practice to create tool kit for improving learning disability registers including list cleansing Number on learning disability register measured per practice LD Awareness Sessions (for GP Practices): The first of four 2024/25 virtual LD Awareness sessions is taking place on 18th July. Delivered by LD nurses from CWPT s Community LD Team, the content includes key AHC messages, along with the importance of reasonable adjustments and findings from the LeDeR programme, amongst other important areas regarding supporting people with a learning disability in a GP practice setting. Use those accredited with the Learning Disability Friendly Badge to pilot tool kit Continue to explore local population data LD Friendly Badge: Our first panel meeting took place in April, with different members of the ICS in attendance, along with an expert by experience and project workers from the local charity, Grapevine. Seven practices have been awarded the Learning Disability Friendly Badge, on the back of the applications reviewed at the panel. The next panel meeting will take place on 19th July to look at new applications sent in from practices. We will continue to support practices and cascade messages around issues with inaccurate coding on Learning Disability registers Collaborative working with the ICB Quality team to help create a resource pack for practices on how to improve the uptake and quality of AHCs AHC Quality: Our report detailing the 2023/24 Quality & Under-served Population project is going through the ICB governance process to be signed off, after which we will circulate it throughout the system. 13
Glossary AHC Annual Health Check CWPT Coventry and Warwickshire Partnership Trust DNACPR Do Not Attempt Cardiopulmonary Resuscitation DoLS Deprivation of Liberty Safeguards GP General Practitioner ICB Integrated Care Board ICS Integrated Care System KPI Key Performance Indicator LeDeR Learning from the lives and deaths of people with a learning disability and autistic people LD Learning Disability LD/A Learning Disability and Autistic People MCA Mental Capacity Act NHSE National Health Service England Quarter 1: 1st April - 30th June Q1 Quarter 2: 1st July - 30th September Q2 Quarter 3: 1st October - 31st December Q3 Quater4: 1st January 31st March Q4 ReSPECT Recommended Summary Plan for Emergency Care and Treatment 14
