West Midlands
Partnership for
Developing
Quality
Care Pathway
for young people and adults with
learning disabilities who may have a
WAYSHTAP ERAC
HWAYSTAP ERAC
THWAYSAP ERAC
ATHWAYSP ERAC
PATHWAYS ERAC
E PATHWAYS RAC
RE PATHWAYS AC
ARE PATHWAYS C
CARE PATHWAYS
CARE PATHWAYS
ARE PATHWAYS C
RE PATHWAYS AC
E PATHWAYS RAC
Hearing
Impairment
Implementation Guide
PATHWAYS ERAC
ATHWAYSP ERAC
THWAYSAP ERAC
HWAYSTAP ERAC
WAYSHTAP ERAC
© Birmingham & Black Country Strategic Health Authority (BBC StHA) 2003
West Midlands
Partnership for
Developing
Quality
Introduction to the Care Pathways in Learning
Disabilities Initiative
The West Midlands Partnership for Developing Quality (PDQ) has supported
organisations across the region to develop tools to facilitate improvements in
care for people with learning disabilities.
The general role of PDQ is to support the West Midlands healthcare
community in the development of improved quality services for patients. It is a
NHS organisation funded through a levy on the 13 Health Authorities across
the West Midlands.
This collaborative venture has been supported by a range of enthusiasts and
dedicated individuals from a range of geographical areas, with a variety of
experiences and expertise.
The ambition of this collaboration is to work towards provision of services that
are fair and equitable regardless of postcode, which meet the specific needs
of individuals with learning disabilities.
Together we decided that Integrated Care Pathways would be a simple and
effective approach to adopt to focus on areas where services are inequitable
and a cause for concern. The areas we chose were:

Hearing Difficulties

Challenging Behaviour – Response to a crisis situation

Epilepsy
We have also commenced work on a Care Pathway for the transition from
young person to adulthood.
We were fortunate to have the support of Kathryn De Luc, Care Pathways
expert who has challenged and guided us throughout this process and helped
to ensure that what we have achieved so far has been considered and robust.
Ashok Roy
Linda Dunn
Stephanie Bissaker
West Midlands
Partnership for
Developing
Quality
Contents
Section
Page
Background to Integrated Care Pathways (ICPs)
1
Why is a Care Pathway necessary?
3
‘Getting Started’: Care Pathway development
6
Mission Statement and Aims
8
Process Map
10
Care Pathway stages
11
The Responsibilities of the Care Pathway Co-ordinator
14
Co-ordinator checklist
16
Frequently Asked Questions
19
Training and Communication with staff and those involved
21
Contact list
22
Documentation
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Background to Integrated Care Pathways (ICPs)
Integrated Care Pathways (ICPs)
Integrated Care Pathways are structured multidisciplinary tools which detail
essential steps in the care of people with a specific problem. Care Pathways
take the form of an ‘expected’ plan of care and can be part or all of the
person’s clinical record. The ICP enables care provided by a multidisciplinary
team to be monitored and outcomes measured.
The use and benefits of ICPs are well established and documented in health
services but are relatively new in the field of learning disabilities. The
benefits, however, are well recognised and make the use of ICPs attractive to
both health and social care services. These benefits include:
 Clarification of roles and responsibilities in multidisciplinary service
 Consistency of service for the client based on recognised good practice
 Definition of anticipated course of action allowing for variation
 Streamlined and standardised documentation
 Quality monitoring of service delivery against agreed standards thereby
meeting many of the requirements of clinical governance and the Best
Value initiative.
Principles of a Care Pathway for people with learning disabilities whose
hearing may be impaired
Many people with learning disabilities have greater health needs than the rest
of the population. They are more likely to experience sensory disabilities. The
Governments objective is to enable people with learning disabilities to have
access to a health service designed around their individual needs, with fast
and convenient care delivered to a high standard and with additional support
where necessary, (Valuing People; Department of Health, 2001).
Specialist services should be planned around the needs of the individual,
ensuring continuity of provision and appropriate partnership between different
agencies and professionals.
From the outset, the Care Pathways Initiative generated interest from
organisations across the West Midlands. It was evident that hearing services
and resources varied greatly across the region and many areas expressed
concern at the lack of co-operation from GPs in particular with regards to
hearing screening of adults with learning disabilities. However, many GPs lack
skills for screening audiometry and most of them will lack the equipment, time
and experience to apply special methods to non-cooperative people,
(Evenhuis et al, 1997).
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Studies of sensory impairment in adults with an intellectual disability show that
there is a marked lack of self-report, commonly expressed as inactivity,
deterioration of speech, irritability, inflexibility or autistic form behaviour.
Therefore, active screening, using formal tools is strongly recommended,
(Consensus Hearing Impairment, 2000).
Some organisations across the West Midlands have already begun to set
minimum standards of care and good practice guidelines for their own service
and recognised the needs to standardise services across the West Midlands
and to share good practice with others.
Developing a Care Pathway which incorporates evidence based minimum
standards of care based around the needs of the individual and which can
cross organisational boundaries; addressing barriers to appropriate services
being offered was seen to be the way forward.
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Why is a Care Pathway necessary?
People with severe and profound learning disabilities often have other
associated health problems such as sensory disability. They will almost
always require a greater level of health care support than is usually available
from the primary health care team. Members of the specialist learning
disability service should provide additional support to the primary health care
team to help them manage the complex needs of those with multiple
disabilities, (Valuing People; Department of Health, 2001).
Sensory loss is often overlooked or not recognised in adults with learning
disabilities and therefore appropriate assessment and management of the
problem is not always offered. Studies of adult residents in group homes
showed hearing loss in 25 - 42% (Wilson & Haire, 1990; Beange et al, 1995;
Mul et al, 1997). These problems were previously undiagnosed and were not
considered by caretakers in up to 80% of cases, (Mul et al, 1997). Ear health
studies have also shown that causes of conductive hearing loss in children
and adults with intellectual disability are often overlooked. Crandell & Roeser
(1993) found that a considerably higher incidence of excessive cerumen (wax)
and cerumen impaction in adults with an intellectual disability (28%) than in
the general population (2 - 6%), both in people with and without Down’s
Syndrome.
Due to the high incidence of hearing loss in adults with learning disabilities,
the ‘Hearing Care Pathway working group’ decided that:

Standards should be developed to address the inequalities in access to
hearing services for this target group;

Work should focus on building upon existing protocols already in place for
the hearing screening of children with learning disabilities.
Although many areas across the region had appropriate specialist hearing
services very few had a co-ordinated response that included multiprofessionals and offered an effective referral route for screening. Many were
not appropriate for individuals with severe or profound disabilities. The
Hearing Care Pathway aims to identify previously undiagnosed hearing loss
by the use of a co-ordinated, needs led service that incorporates established
screening methods.
Evaluation Results
A unique aspect to the PDQ Care Pathways initiative is its evaluation. The
PDQ contracted from outside the organisation an independent audit facilitator.
The evaluation was divided into two stages. Stage one consisted of gathering
information about the services at the pilot sites prior to implementation of the
pilot. This involved gaining information mainly from clinical records. Stage two
consisted of looking at the impact of the Care Pathways on the service users,
their carers and health professionals. Key to the evaluation was the
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comparison of the services before and after implementation. We were able to
demonstrate the following:

Improvement in aspects of risk assessment recording

Sharing and recording of information

Improvements in ascertaining consent

Increased satisfaction of service users



Acceptability of the Care Pathway process to health professionals, cares
and service users
Avoidance of duplication
Improved knowledge of service users and their cares with respect to their
clinical needs
Commissioners and service managers may find it helpful to read the full copy
of the evaluation report, this available through the PDQ on request.
Hearing Impairment Care Pathway Evidence
Each Care Pathway has been developed through:

Using existing ‘recognised’ standards and guidelines where available

Drawing from up to date evidence – as far as this is available – through
literature searches

Expert opinion channelled through regular and facilitated meetings

Consultation with interest parties including service users, through letters,
visits, and wider forum meetings
Further information on all of these is available from West Midlands
Partnership for Developing Quality.
Reference and Reading List:
 British Association of Otolaryngology and British Society of Audiology
(1983), Method for assessment of hearing disability, British Journal of
Audiology, 17,203-212.
 Consensus Hearing Impairment (2000), Hearing Impairment consensus
document, 1-12.
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 Crandell C.C & Roeser R.J. (1993), Incidence of excessive/impacted
cerumen in individuals with mental retardation: a longitudinal investigation.
American Journal on Mental Retardation 7, 568 - 574.
 Department of Health (2001), Valuing People Document: A New Strategy
for Learning Disability for the 21st Century, NHS Executive, Dept. of Health,
London.
 Department of Health (1999), Once a Day, NHS Executive, Dept. of Health,
London.
 Evenhuis H.M, Mul M, Lemaire E. K. G & Wijs J. P. M. de (1997), Diagnosis
of sensory impairment in people with intellectual disability in general
practice, Journal of Intellectual Disability Research, 41, 422 - 429.
 Focus Fact Sheets - A range of factsheets for staff working with adults with
visual and hearing disabilities, available from RNIB Information and
Practice Development Service, London.
 Mul M, Veraart-Schretlen W. I. M & Bierman A. (1997), Hearing Impairment
in adults with an intellectual disability in general practice, Huisarts 7
Wetenschap 40, 301 - 304.
 Welsh Health Planning Forum (1992), Protocol for investment in health
gain; mental handicap (learning disabilities). Welsh Office. NHS
Directorate.
 Wilson D.N & Haire A. (1990), Health Care Screening for people with
mental handicap living in the community. British Medical Journal, 301,
1379-1381.
 Yeates S, The incidence and importance of hearing loss in people with
severe learning disability: the evolution of a service, British Journal of
Learning Disabilities, 1995, Volume 23.
Acknowledgements are due to the following organisations for participating in
the pilots.
S. Birmingham PCT (Formerly Birmingham Specialist Community NHS Trust)
North Staffordshire Combined Healthcare NHS Trust
North Warwickshire NHS Trust
City Hospital NHS Trust
Susan Brady
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‘Getting Started’: Care Pathway Development
The development and successful implementation of any new initiative is
dependant on several key factors. Organisations need to be committed at all
levels and provide support to those individuals involved in the Care Pathway
development and implementation. Without this support enthusiasts may
generate interest but are unlikely to be able to effectively change services.
Step 1
The process should begin with the formation of ‘focus or working groups’.
Individual organisations should include interested multi-professionals,
stakeholders, service managers, carers, service users and user
representatives / advocates.
The purpose of the focus group is to examine existing services and set some
minimum standards of care as well as looking at what ‘the ideal service’
should be for this area.
The focus group provides a forum in which ideas, opinions and discussions
can be formulated and suggestions for future service planning exchanged.
The focus groups should meet on a monthly basis to ensure effective
communication between members of the group, and to enable the
development process to be closely monitored.
Initial meetings of the group should be used as ‘brain storming’ sessions;
providing an opportunity to generate ideas and discussions, which in turn can
highlight practical ways to improve existing services, whilst at the same time
addressing any service barriers or deficits in service provision.
Step 2
Once ideas have been generated, a ‘process map’ should be drawn up by the
focus group. This will provide an outline of the key Care Pathway stages (see
figure.1: Hearing Impairment Process Map). It may be useful for the focus
group to develop a ‘mission statement’. This should form the basis for future
documentation. Organisations should think about, ‘What is likely to be
achieved by producing a Care Pathway?’ and ‘What benefit is it to service
users or target group?’.
The process map stages should be numbered in order of significance,
showing a beginning and an end point for the Care Pathway. This process can
be developed further to include more stages as appropriate. It is sometimes
necessary to develop several versions of a process map before the final
version has been agreed upon by the group. This should be seen as part of
the normal process of development.
Step 3
The Care Pathway documentation should be adapted to meet the needs of
the service area and should relate to the key stages identified on the Process
Map. Whether an existing Care Pathway model is being used or an
organisation is developing their own version, it is important to always consider
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issues of consent and to incorporate minimum standards of care and variance
recording within the documentation.
Step 4
Once the documentation is completed and ready to be implemented, it is
essential that professionals, service managers, service users and carers are
made fully aware of the Care Pathway purpose, process and implementation.
Teaching/training sessions could be provided to raise awareness and improve
communication within organisations.
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Mission Statement and Aims
The hearing Care Pathway aims to identify previously undiagnosed hearing
loss in people who have learning disabilities, enabling continuity of an
appropriate quality service for young people during transition into adult
services and throughout adult life, and facilitating better access to appropriate
hearing services for individuals with a known hearing loss; therefore
promoting better health and quality of life for the individual.
Objectives
Overall the Care Pathway aims to:

Facilitate both an improvement and access route for hearing impairment
services
 Network and build partnerships for support from hearing service providers
and members
 Early identification of problems to prevent the development of more serious
problems
 Research and develop screening tool for hearing impairment for adults with
learning disabilities
 Identify and make links with key stakeholders for hearing impairment
services
 Work with carers, individuals and multi-agencies who will be involved in the
Care Pathway
 Identify documentation to be used for the pathway
 Educate and facilitate training to professionals, carers and individuals as
required
Process
The process map shows the individual’s journey through the Care Pathway
and the stages involved. The Care Co-ordinator is identified at the referral
stage and plays a central role in ensuring the pathway proceeds correctly
through all eight stages of the Care Pathway and that all documentation is
completed.
Stage 1: Initial referral and allocation of Care Co-ordinator
Stage 2: Identify appropriate services involved
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Stage 3: Ear examination
Stage 4: G.P./ENT
Stage 5: Hearing assessment
Stage 6: Preparation for referral
Stage 7: Referral to specialist service
Stage 8: Review cycle
Anticipated Outcomes
By encompassing evidence-based health care and adherence to government
policy, the Care Pathway will initiate a multi-agency co-ordinated response to
the care management of individuals with learning disabilities that have a
hearing impairment.
The Care Pathway will be person centred in its approach and will identify
present barriers in accessing appropriate quality services; making
recommendations for future services by setting minimum standards of care for
this client group.
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Process Map
1
Allocation of care
co-ordinator
Initial Referral
2
Evidence of
known loss
Yes
Identify Appropriate
Services Involved
No
Yes
No
3
8
Problems
Identified
Ear Examination
Review
Cycle
4
G.P./ENT
Problem
Resolved
No Problems
5
Within normal
limits
Hearing Assessment
Not within normal limits
or uncertainty
6
Preparation for referral
7
Referral to specialist service
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Care Pathway Stages
Care Pathway Stages
1. Initial Referral
Consent from the
individual/carer is
required for referral to be
made
2. Engage with Appropriate Services
(As required)
Professional Actions
‘Referral Form’ to be completed and forwarded to local
service for audiological screening.
Referral to be acknowledged and contact made with the
referrer.
Allocation of Care Co-ordinator
Timescales
Within 1 week of referral
Professionals receiving the referral should liase with any
hearing impairment service currently involved in the care of
the individual to establish any ‘known hearing
difficulties/treatment plans.
Relevant information relating to ‘known hearing loss’ to be
collated as required to provide a history of any known
difficulties the individual has.
Decision to proceed forward to ‘ear examination’ to be
made at this point.
Initial appointment for ‘ear examination’ to be made. Letter
to be sent out to individual/carer with appointment details.
3. Ear Examination
To be conducted by
 Audiologist
 GP/Nurse
 Specialist Nurse
 Community Nurse
‘Ear Examination Form’ to be completed by professional
conducting screening.
Outcome of examination to be documented as indicated on
form and any referrals made.
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Within 2 weeks of referral
Within 4 weeks of referral
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Care Pathway Stages
Care Pathway Stages
4. GP/ENT
(Input as required)
Professional Actions
Referral for treatment/investigation to be made (if indicated)
as a result of ear examination
Timescales
Within 1 week of ear
examination
Once investigation/or treatment is completed the ear
examination should be repeated before the ‘Hearing
Assessment’ is offered.
Appointment for ‘Hearing Assessment’ to be made. Details
should be entered on the ear examination form as
indicated.
Within 8 weeks of referral
Letter with appointment details to be sent to the
individual/carer.
5. Hearing Assessment
‘Hearing Assessment Form’ to be completed
To be conducted by
Audiologists
GP/Nurse
Specialist Nurse
Community Nurse
Method for assessment will be:
 Oto Acoustic Emissions (OAE)
 Speech Discrimination
 Pure Tone Audiometry
 Other
Within 10 weeks of referral
Method details, summary and results to be recorded on
‘Hearing Assessment’ and ‘Hearing Status Summary’
forms.
If results within normal limits a follow up review will be
arranged as appropriate to the individual.
Refer to Review Guidelines
If results not within normal limits or uncertainty a follow up
assessment may be required the ‘screening checklist’ will
need to be completed.
Within 12 weeks of referral
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Care Pathway Stages
Care Pathway Stages
6. Preparation for Referral
Professional Actions
‘Screening Checklist’ to be completed to provide additional
information for the referral to an appropriate specialist
hearing impairment service.
Timescales
Within 12 weeks of referral
7. Referral to Specialist Service
Consent for referral to be obtained from
individual or carer.
8. Review Cycle
An appropriate ‘Referral Form’ to the local specialist
hearing impairment service should be completed and sent
along with the screening checklist. Details of the referral
should be documented on the screening checklist form
along with the signatures/date of signing of the assessor,
individual and carer.
Individual to be reviewed by local audiology or specialist
service as required throughout adult life.
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Within 12 wekks of referral
Minimum of 3 years
(refer to individual guidelines)
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Responsibilities of the Care Pathway Co-ordinator
The Care Co-ordinator plays a central role in ensuring that the Care Pathway
proceeds correctly; making sure the individual passes through the 8 stages of the
pathway and that all the documentation has been completed.
The co-ordinator can be any health care professional who is part of the community
learning disability team for the community, special needs education or part of the
multi disciplinary team for inpatients. They can be actively involved in any or all of
the stages of the pathway but don’t have to be. Any individual can take on the coordinators role, e.g. a designated key worker.
The Care Co-ordinator is identified once it is decided that the individual who has
been referred will be entering the Care Pathway for screening. It will be the coordinators responsibility to ensure that somebody is designated to replace them if
they relinquish their Care Co-ordinator role and that the ‘allocation of the Care Coordinator form’ within the Care Pathway documentation has been completed.
The Importance of Variation Recording
Variation Recording, also known as variance or exception report, is simply a note
made when the Care Pathway is not followed in terms of the standards and/or
documentation.
Variations may occur for many reasons, both positive and negative:

Professional judgement

The individuals preference

A resource issue

A timing issue

Error
The most important part about variations – regardless of reason – is that they are
recorded. They must be recorded for:

Professional accountability

Identifying trends

Highlighting service deficiencies

Highlighting Care Pathway deficiencies
They can be a very useful part of the Care Pathway in terms of looking at quality of
service and evaluating the Care Pathway implementation.
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It is vital that local decisions are made about how to keep track of the variation
recording to ensure that they are quickly picked up and monitored for trends. An
information flow can be agreed for this, linking to management and clinical
governance.
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Co-ordinator checklist
* To be completed by the Care Co-ordinator on an ongoing basis more detailed recording of
variations at the end of each stage of pathway.
Timeline
Stage (1)
Within 1 week of
referral
Stage (2)
Within 2 weeks of
referral
Stage (3)
Within 4 weeks of
referrals
Has standard
and timeline
been met?
(yes or no)
Standard
Has consent from
individual or carer
been sought
Is an independent
advocate to represent
individual referred
available if needed?
Has referral form
been completed?
Has individual been
made aware of ‘ear
examination
appointment details?
Have appropriate
services involved with
the individual been
identified?
Has any relevant
information re: known
hearing loss been
collated?
Has appointment for
‘ear examination’
been made and letter
sent to
individual/carer?
Has ear examination
form been
completed?
Has outcome of
examination been
documented as
indicated on form?
Have any referral
required been made?
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Detail of variation
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Timeline
Has standard
and timeline
been met?
(yes or no)
Standard
Has referral to G.P/
ENT for treatment
/investigation been
made if indicated?
Has G.P form been
sent out for second
opinion?
Stage (4)
Within 7 weeks of
referral
Has G.P/ENT
returned form
following
investigation/
treatment?
Has ear examination
been repeated
following treatment?
Has appointment for
hearing assessment
been made?
Has appointment
letter with details
been sent to
individual/carer?
Has an appropriate
hearing assessment
method been
identified?
Stage (5)
Within 10 weeks of
referral
Have results from any
methods used been
documented on the
hearing status
summary form?
If results are within
normal limits has a
follow up review been
arranged appropriate
to the individuals
hearing status?
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Detail of variation
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Timeline
Stage (6)
Within 12 weeks of
referral
Stage (7)
Within 12 weeks of
referral
Has standard
and timeline
been met?
(yes or no)
Standard
If results are not
within normal limits
has the ‘screening list’
in preparation for
referral to specialist
service been
completed?
Has an appropriate
referral form and the
completed ‘screening
checklist’ been sent to
the local specialist
hearing impairment
service?
Has the individual/
carer and assessor
signed screening
checklist prior to
referral?
Stage (8)
Within 3 years
(refer to individual
guidelines)
Has the individual
received a follow up
review date for their
next hearing
screen?
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Detail of variation
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Frequently Asked Questions
Q.
Do we have to use all the documentation for the Care Pathway?
You need to use all the documentation within the Care Pathway in place of any
documentation you use within your service at present. However the ‘sensory
checklist’ is an optional tool to be used if required as supporting information when
referring onto the specialist service at the end of the screening process.
Q.
What happens if we do not complete all the stages within the allocated
time-scales?
Don’t worry if this happens, it is expected that this is likely to happen in some
instances. Any deviations from the Care Pathway should be documented on the
‘variance form’ for that particular stage and also documented on the co-ordinators
checklist.
Q.
Why are we using this particular definition for hearing impairment:
hearing loss is defined as the average hearing loss at 1000Hz, 2000Hz
and 4000Hz, measured by pure tone audiometry?
As there are so many variations to definitions for hearing impairment it was decided
that we should use a definition that relates to the particular screening methods that
will be used within the Care Pathway. This definition relates to hearing loss
measured by pure tone audiometry. It is currently used in the Netherlands because
of its high relevance to speech discrimination. It also corresponds to the standard
proposed by the British Association of Otolaryngology and British Society of
Audiology (1983).
Q.
Will we still be using our standard appointment letters and referral forms
to G.P, or specialist service as required?
You will still be required to inform individuals of appointment details. The Care
Pathway documentation will guide you as to when individuals and carers should be
contacted. Any contact with the G.P will require the Care Pathway ‘G.P Form’ to be
sent as well as any standard letter that the pilot sites may wish to send out.
Q.
When should I fill in the documentation - I will not have all the
information at the first assessment, should I fill in the pathway before I
have all the information?
Rarely will you have all the information you need early on in your assessment. Fill in
as much of the pathway as possible, as you get more information this can be added
to the document. Remember that at the review the co-ordinator will update the
document in light of any changes or new information.
Q.
In my Trust we are using other documents that we find helpful, should
we stop using them?
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No, if you find using other documents in conjunction with the pathway helpful you
should continue to use them. However you should still complete the Care Pathway
documentation and where appropriate note the link to the other documents.
Q.
Do I need to gain consent before using the Care Pathway?
It is good practice to seek consent, and/or gauge capacity to consent, prior to any
intervention with a person; the Care Pathway is no exception to this. However it is
vital that people are not consenting to ‘the Care Pathway’ per se as it should be
applied when appropriate i.e. at each stage of intervention. It is important to follow
your Trust policy on this - most Trusts now have a consent or capacity document and
this should provide useful guidance for you. There is also recent national guidance
available on www.doh.gov.uk. Please refer to local guidance.
Q.
If I disagree with using a particular part of the pathway what
should I do?
Your first responsibility is to the welfare of the person you are helping. If at any point
you feel that your actions maybe compromised by using the pathway you must use
your judgement in disregarding the pathway. All we ask is that you document your
reasons in the ‘variations’ section.
Q.
Who will be responsible for the audit of the Care Pathway?
This will be a decision taken by the agencies implementing the Care Pathway. Audit
departments or monitoring and evaluation departments may well have a role to play
here but even without those, the ongoing monitoring of a service’s performance
should be built into everything we do. The Care Pathway variation tool enables
service managers to monitor how far the service is meeting the standards agreed. A
plan of implementation is completed and signed by the site leads, head of service
and the Care Pathway Facilitator to ensure that everyone involved is aware of their
own and others responsibilities.
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Training and Communication with staff and those involved
In order to successfully implement the Care Pathway it is essential that a number of
stages of communication and agreement be reached first:
1. Director or local Team
manager
2. Director or local Team
manager
Agreement needed
3. Agree system changes
needed in order to
implement
Agreement of
changes
identified
4. Senior Managers/
Department Head




5. Senior Managers/
Department Head
6. Inform and consult:
Service User and Carer
representatives
Partnership Board
Clinical Governance & Audit Depts.
Community Teams
7. Joint Training &Communication
with teams involved  Basic principles of pathway
 Detail of use of pathway
8. Adapt documentation
as needed and implement
detail of system changes
9. Implementation
11. Audit of service
in relation to
Care Pathway
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10. Ongoing monitoring
& review with teams
West Midlands
Partnership for
Developing
Quality
Contact List
Susan Brady
5th Floor
Waterlinks House
Richard Street
Nechells
Birmingham
B7 4AA
Tel: 0121 255 7013
Email: susan.brady@southbirminghampct.nhs.uk
Dr Ashok Roy
Consultant Psychiatrist
Brian Oliver Centre
Brooklands
Coleshill Road
Marston Green
Birmingham
B37 7HL
Tel: 0121 329 4927
Email: ashok.roy@nw-pct.nhs.uk
Stephanie Bissaker
Salisbury Unit
Moseley Hall
Alcester Road
Moseley
Birmingham
B13 8JL
Tel: 0121 442 3311
Email: stephanie.bissaker@southbirminghampct.nhs.uk
Linda Dunn
Partnership for Developing Quality
27 Highfield Road
Edgbaston
Birmingham
B15 3DP
Tel: 0121 245 2500
Email: linda.dunn@wmpdq.org.uk
From 31st March 2003:
Directorate of Organisational Development
Birmingham & Black Country StHA
St. Chads Court
213 Hagley Road
Edgbaston
Birmingham
B16 9RG
Tel: 0121 695 2267
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