From The AAC Subgroup, Advisory Group for the Complex Disability Equipment Clinical Reference Group:
In April 2013, 'Liberating the NHS' changes came into effect with most local health services in England provided by Clinical Commissioning Groups (CCGs).
Specialised AAC Services are to be funded by NHS England and will provide assessment, review and equipment for those with the most complex communication needs, and/or those who require a high tech powered communication aid. This is likely to equate to approx. 10% of the AAC population. The remaining 90% of children and adults who need AAC will be supported by local AAC services, which will be commissioned by Clinical Commissioning Groups (CCGs), education and social care commissioners and overseen by Health and Wellbeing Boards that have been established in every Local Authority in England.
The Remit of the Specialised AAC Services
Part of the remit of the specialised services will be to establish services where there are none, and further develop services where they exist. Their role will be:
- To provide specialist AAC advice and information and training to individuals, families and professionals involved in the delivery of local AAC services
- To support the establishment, training and development of local AAC servicesTo support the development of effective local AAC teams and care pathway procedures by which to manage referrals to specialised AAC services.
- To provide Regional co-ordination of care planning, service standard development, quality assurance and improvement of local AAC teams.
- An ability to educate and train a wide range of stakeholders from the user, families, spoke service members and local team members.
- Work with local health and social care professionals in areas where service uptake is low to facilitate referral of those who could benefit from communication aids.
The specialised AAC services will work with the developing local AAC teams to provide training to develop the competencies and skills locally. The specialised services will need to establish a collaborative approach with the local teams to outcomes measurement and data gathering on which to base quality assurance, service development and to inform future commissioning practice.
Specialised AAC services will work with their local AAC teams to build their capacity to manage directly the needs of 90% of the region's AAC population and to jointly manage the needs of the 10% of the region's population that require powered communication aids or specialised AAC assessment.
Local AAC services will be able to access provision of some powered communication aids via the specialist AAC service, and will be supported to provide these devices where appropriate and where the competence of the local team to do so has been assessed.
The Criteria for Referral to a Specialised AAC Service
An individual who would access a specialist AAC service would have the following:
- a severe/complex communication difficulty associated with a range of physical, cognitive, learning, or sensory deficits
- a clear discrepancy between their level of understanding and ability to speak.
In addition, an individual must:
- be able to understand the purpose of a communication aid;
- have developed beyond cause and effect understanding;
- have experience of using low tech AAC which is insufficient to enable them to realise their communicative potential.
Exclusion criteria would be:
- preverbal communication skills;
- not having achieved cause and effect understanding;
- have impaired cognitive abilities that would prevent the user from retaining information on how to use equipment.
The Remit of a Local AAC Service
A local AAC service would provide:
- An expertise in non-complex low-tech AAC strategies and techniques
- A more limited multi-disciplinary team including at least SLT, OT and teachers where appropriate
- Ability to modify equipment and software using only facilities within the equipment itself, not requiring workshops and engineering skills
- A loan bank of the more common and less expensive AAC devices
- An ability to contribute to data collection using data systems managed by the specialised service
- Training of the team around an individual
- Ongoing support for individuals referred to the specialised service, with responsibility for re-referral if and when appropriate
- An ability to pass on training materials
- An ability to identify where co-morbidity issues influence AAC and pass on this information to the specialised service
- Simpler and cheaper non customised solutions
A local AAC service would also undertake the following activity:
- Local awareness raising of the need and benefits of AAC interventions with primary and community care teams, schools and colleges, NHS consultants and hospital based teams, social service teams, residential and care homes, etc.;
- Establishing local funding arrangements between health, social care, education and other relevant commissioners including the negotiation of an appropriate version of the care pathway process with their specialised AAC teams;
- Managing the receipt of referrals and making appropriate onward referrals to specialised AAC teams and other services;
- Undertaking assessment for low tech AAC and for those clients with non-complex needs, including establishing the goals and outcome measures by which to assess the impact of the intervention;
- Trial and long term provision of low tech AAC equipment;
- Implementation and support for trial and long term provision of low and high tech AAC systems, including technical training for individual AAC users, their families and communication and support networks;
- Monitoring and recording outcome measures using the regional database and, using information extracted from the database, reviewing the impact of individual care plans and analysing and reporting data in relation to the local AAC population to commissioners at local and regional levels;
- Collaboratively co-ordinating the care of their AAC population with their regional specialised AAC services.
There needs to be a close interdependence required between local teams and specialised teams. Specialised AAC services are not viable without local AAC services that will be the source of all referrals to the specialised AAC services.
Commissioning of Local AAC Services
For those individuals who do not meet the criteria for specialised AAC commissioning but who need AAC, provision should be met by local health (CCG), education and social care commissioners. Health and Wellbeing Boards are ultimately responsible for ensuring that local AAC services exist and/or are maintained or established to meet the needs of the local community. Health and Wellbeing Boards have been set up to:
- improve local joint commissioning arrangements
- enable local services to meet local need ensure that health inequalities are reduced.
Included on every Health and Wellbeing Board is a Healthwatch representative who is responsible for ensuring the voices of people who use local health and social care services are heard. Ideally, local AAC services should be jointly commissioned for children and adults. However, if no local AAC service is available, contact should be made with the CCG via a GP or other health professional, or alternatively an approach could be made to the local Healthwatch representative. Information about Healthwatch representation can be found here: www.healthwatch.co.uk in order to raise awareness of this need with the Health and Wellbeing Board.
Lobbying for Better AAC Services
Communication Matters has commissioned Whitehouse Consultancy to provide a Lobbying Toolkit for AAC services (April 2014):