{"text_format":"1","workbook":"xlsx","n_sheets":8,"sheets":["Control Panel","PID","sudb","scoresdb","Reports","Log","question descriptions","St Dev"],"not_rendered":{"charts":6,"images":3,"macros":1,"external_links":0,"defined_names":45,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Control Panel","index":0,"n_rows":30,"n_cols":2,"rows_kept":30,"cut":false,"hidden":false,"merged":[]}
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[null,"HEF+"]
[null,"Health Equalities Framework v2.1"]
[null,"© Atkinson, Boulter, Hebron & Moulster 2015"]
[]
[null,"Conditions of use:"]
[]
[]
[null,"This work is licensed under the Creative Commons "]
[null,"Attribution-NonCommercial-NoDerivatives 4.0 International License. "]
[null,"To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/."]
[]
[null,"The HEF+ can be freely downloaded, shared and used. It must be attributed to the authors;"]
[null,"it must not be modified or used for commercial gain."]

{"sheet":"PID","index":1,"n_rows":13,"n_cols":10,"rows_kept":13,"cut":false,"hidden":true,"merged":[]}
[null,null,null,"Bradford","Asian British","mild","prison","First (new referral)","stable","Yes"]
[null,null,null,"Gloucester","Asian Other","moderate","hospital detained","First (existing case)","increased","No"]
[null,null,null,"Haringey","Black British","severe","hospital informal","Follow-up (previous HEF v.1)","decreased"]
[null,null,null,"Surrey","White British","profound","care home with nursing","Follow-up"]
[null,null,null,null,"White Other","not known","care home without nursing","Final"]
[null,null,null,null,"Other",null,"supported accommodation"]
[null,null,null,null,"Unknown / Not Given",null,"living with family carers"]
[null,null,null,null,null,null,"own home"]
[null,null,null,null,null,null,"shared care placement"]
[null,null,null,null,null,null,"short break service"]
[null,null,null,null,null,null,"homeless"]
[null,null,null,null,null,null,"hostel"]
[null,null,null,null,null,null,"other"]

{"sheet":"sudb","index":2,"n_rows":1,"n_cols":34,"rows_kept":1,"cut":false,"hidden":true,"merged":[]}
["suid","nhs","LIN","pic","team","first","last","pilot","gender","ethic","dob","age","post","dld","Mental health issues","Challenging Behaviour","Autism","Sleep Problems","Dementia","Respiratory Problems","Coronary Heart Disease","Visual Impairment","Hearing Impairment","Dysphagia","Continence Needs","Nutritional problems","Physical Impairments / reduced mobility","Wheelchair User","Chronic Pain","Oral Health Problems","Epilepsy","Endocrine Disorder","Cancer","datemodif"]

{"sheet":"scoresdb","index":3,"n_rows":1,"n_cols":68,"rows_kept":1,"cut":false,"hidden":true,"merged":[]}
["Score ID","SUID","Practitioner ID","Team","Name","Gender","Ethnic","Age","Degree of LD","Mental health issues","Challenging Behaviour","Autism","Sleep Problems","Dementia","Respiratory Problems","Coronary Heart Disease","Visual Impairment","Hearing Impairment","Dysphagia","Continence Needs","Nutritional problems","Physical Impairments / reduced mobility","Wheelchair User","Chronic Pain","Oral Health Problems","Epilepsy","Endocrine Disorder","Cancer","Score Date Day","Score Day Month","Score Day Year","Entered Date Day","Entered Date Month","Entered Date Year","UEA","HEF scoring","Accom Type","1 to 1 Hrs. of support per week","Level of Support Available","Social Q1","Social Q2","Social Q3","Social Q4","Social Q5","Social Q6","Generic Q1","Generic Q2","Generic Q3","Generic Q4","Generic Q5","Generic Q6","Commin Q1","Commin Q2","Commin Q3","Commin Q4","Commin Q5","Behaviour Q1","Behaviour Q2","Behaviour Q3","Behaviour Q4","Behaviour Q5","Behaviour Q6","Quality Q1","Quality Q2","Quality Q3","Quality Q4","Quality Q5","Quality Q6"]

{"sheet":"Reports","index":4,"n_rows":87,"n_cols":19,"rows_kept":87,"cut":false,"hidden":false,"merged":[[31,15,31,16],[31,17,31,18],[79,15,79,16],[79,17,79,18],[56,15,56,16],[56,17,56,18],[68,15,68,16],[68,17,68,18],[44,15,44,16],[44,17,44,18],[27,1,28,7],[29,1,30,7],[5,1,5,7],[6,1,6,7],[38,13,38,14],[37,13,37,14],[36,13,36,14],[35,13,35,14],[34,13,34,14],[33,13,33,14]]}
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,"Accommodation"]
[null,null,null,null,null,null,null,null,null,"Activities"]
[null,null,null,null,null,null,null,null,null,"Finances"]
[null,null,null,null,null,null,null,null,null,"Socialising"]
[null,"Score ID","Social","Genetic","Behaviour","Communication","Service Quality",null,null,"Marginalisation"]
[null,null,null,null,null,null,null,null,null,"Safeguarding "]
[]
[null,null,null,null,null,null,null,null,null,"Assessment "]
[null,null,null,null,null,null,null,null,null,"Review "]
[null,null,null,null,null,null,null,null,null,"Planning"]
[null,null,null,null,null,null,null,null,null,"Crisis/hospital"]
[null,null,null,null,null,null,null,null,null,"Medication"]
[null,null,null,null,null,null,null,null,null,"Specialist services "]
[]
[null,null,null,null,null,null,null,null,null,"Diet"]
[null,null,null,null,null,null,null,null,null,"Exercise "]
[null,null,null,null,null,null,null,null,null,"Weight "]
[null,null,null,null,null,null,null,null,null,"Substance use "]
[null,null,null,null,null,null,null,null,null,"Sexual Health"]
[null,null,null,null,null,null,null,null,null,"Risky Behaviours "]
[]
[null,null,null,null,null,null,null,null,null,"Body / pain awareness "]
[null,null,null,null,null,null,null,null,null,"Communicating needs "]
[null,null,null,null,null,null,null,null,null,"Carers awareness"]
[null,null,null,null,null,null,null,null,null,"Carers response"]
[null,null,null,null,null,null,null,null,null,"Understanding & choice"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(m_sc1=\"\",\"\",\"Selection 1\")","v":""},null,{"$f":"IF(m_sc2=\"\",\"\",\"Selection 2\")","v":""}]
[null,null,null,null,null,null,null,null,null,"Organisation",null,null,null,null,null,"Mean","St.Dev","Mean","St.Dev"]
[null,null,null,null,null,null,null,null,null,"Consent",null,null,null,"Accommodation",null,{"$f":"IF(K7=\"\",\"\",K7)","v":""},{"$f":"IF(COUNTA('St Dev'!A:A)>1,STDEV('St Dev'!A:A),\"\")","v":""},{"$f":"IF(K13=\"\",\"\",K13)","v":""},{"$f":"IF(COUNTA('St Dev'!AE:AE)>1,STDEV('St Dev'!AE:AE),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,"Transitions",null,null,null,"Activities",null,"",{"$f":"IF(COUNTA('St Dev'!B:B)>1,STDEV('St Dev'!B:B),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AF:AF)>1,STDEV('St Dev'!AF:AF),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,"Screening & promotion",null,null,null,"Finances",null,"",{"$f":"IF(COUNTA('St Dev'!C:C)>1,STDEV('St Dev'!C:C),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AG:AG)>1,STDEV('St Dev'!AG:AG),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,"Primary & Secondary care",null,null,null,"Socialising",null,"",{"$f":"IF(COUNTA('St Dev'!D:D)>1,STDEV('St Dev'!D:D),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AH:AH)>1,STDEV('St Dev'!AH:AH),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,"Non health services",null,null,null,"Marginalisation",null,"",{"$f":"IF(COUNTA('St Dev'!E:E)>1,STDEV('St Dev'!E:E),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AI:AI)>1,STDEV('St Dev'!AI:AI),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Safeguarding ",null,"",{"$f":"IF(COUNTA('St Dev'!F:F)>1,STDEV('St Dev'!F:F),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AJ:AJ)>1,STDEV('St Dev'!AJ:AJ),\"\")","v":""}]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(m_sc1=\"\",\"\",\"Selection 1\")","v":""},null,{"$f":"IF(m_sc2=\"\",\"\",\"Selection 2\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Mean","St.Dev","Mean","St.Dev"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Assessment ",null,{"$f":"IF(L7=\"\",\"\",L7)","v":""},{"$f":"IF(COUNTA('St Dev'!G:G)>1,STDEV('St Dev'!G:G),\"\")","v":""},{"$f":"IF(L13=\"\",\"\",L13)","v":""},{"$f":"IF(COUNTA('St Dev'!AK:AK)>1,STDEV('St Dev'!AK:AK),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Review ",null,"",{"$f":"IF(COUNTA('St Dev'!H:H)>1,STDEV('St Dev'!H:H),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AL:AL)>1,STDEV('St Dev'!AL:AL),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Planning",null,"",{"$f":"IF(COUNTA('St Dev'!I:I)>1,STDEV('St Dev'!I:I),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AM:AM)>1,STDEV('St Dev'!AM:AM),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Crisis/hospital",null,"",{"$f":"IF(COUNTA('St Dev'!J:J)>1,STDEV('St Dev'!J:J),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AN:AN)>1,STDEV('St Dev'!AN:AN),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Medication",null,"",{"$f":"IF(COUNTA('St Dev'!K:K)>1,STDEV('St Dev'!K:K),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AO:AO)>1,STDEV('St Dev'!AO:AO),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Specialist services ",null,"",{"$f":"IF(COUNTA('St Dev'!L:L)>1,STDEV('St Dev'!L:L),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AP:AP)>1,STDEV('St Dev'!AP:AP),\"\")","v":""}]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(m_sc1=\"\",\"\",\"Selection 1\")","v":""},null,{"$f":"IF(m_sc2=\"\",\"\",\"Selection 2\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Mean","St.Dev","Mean","St.Dev"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Diet",null,{"$f":"IF(M7=\"\",\"\",M7)","v":""},{"$f":"IF(COUNTA('St Dev'!M:M)>1,STDEV('St Dev'!M:M),\"\")","v":""},{"$f":"IF(M13=\"\",\"\",M13)","v":""},{"$f":"IF(COUNTA('St Dev'!AQ:AQ)>1,STDEV('St Dev'!AQ:AQ),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Exercise ",null,"",{"$f":"IF(COUNTA('St Dev'!N:N)>1,STDEV('St Dev'!N:N),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AR:AR)>1,STDEV('St Dev'!AR:AR),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Weight ",null,"",{"$f":"IF(COUNTA('St Dev'!O:O)>1,STDEV('St Dev'!O:O),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AS:AS)>1,STDEV('St Dev'!AS:AS),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Substance use ",null,"",{"$f":"IF(COUNTA('St Dev'!P:P)>1,STDEV('St Dev'!P:P),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AT:AT)>1,STDEV('St Dev'!AT:AT),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Sexual Health",null,"",{"$f":"IF(COUNTA('St Dev'!Q:Q)>1,STDEV('St Dev'!Q:Q),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AU:AU)>1,STDEV('St Dev'!AU:AU),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Risky Behaviours ",null,"",{"$f":"IF(COUNTA('St Dev'!R:R)>1,STDEV('St Dev'!R:R),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!AV:AV)>1,STDEV('St Dev'!AV:AV),\"\")","v":""}]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(m_sc1=\"\",\"\",\"Selection 1\")","v":""},null,{"$f":"IF(m_sc2=\"\",\"\",\"Selection 2\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Mean","St.Dev","Mean","St.Dev"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Body / pain awar.",null,{"$f":"IF(N7=\"\",\"\",N7)","v":""},{"$f":"IF(COUNTA('St Dev'!S:S)>1,STDEV('St Dev'!S:S),\"\")","v":""},{"$f":"IF(N13=\"\",\"\",N13)","v":""},{"$f":"IF(COUNTA('St Dev'!AW:AW)>1,STDEV('St Dev'!AW:AW),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Comm. needs ",null,{"$f":"IF(N8=\"\",\"\",N8)","v":""},{"$f":"IF(COUNTA('St Dev'!T:T)>1,STDEV('St Dev'!T:T),\"\")","v":""},{"$f":"IF(N14=\"\",\"\",N14)","v":""},{"$f":"IF(COUNTA('St Dev'!AX:AX)>1,STDEV('St Dev'!AX:AX),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Carers awareness",null,{"$f":"IF(N9=\"\",\"\",N9)","v":""},{"$f":"IF(COUNTA('St Dev'!U:U)>1,STDEV('St Dev'!U:U),\"\")","v":""},{"$f":"IF(N15=\"\",\"\",N15)","v":""},{"$f":"IF(COUNTA('St Dev'!AY:AY)>1,STDEV('St Dev'!AY:AY),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Carers response",null,{"$f":"IF(N10=\"\",\"\",N10)","v":""},{"$f":"IF(COUNTA('St Dev'!V:V)>1,STDEV('St Dev'!V:V),\"\")","v":""},{"$f":"IF(N16=\"\",\"\",N16)","v":""},{"$f":"IF(COUNTA('St Dev'!AZ:AZ)>1,STDEV('St Dev'!AZ:AZ),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Underst. & choice",null,{"$f":"IF(N11=\"\",\"\",N11)","v":""},{"$f":"IF(COUNTA('St Dev'!W:W)>1,STDEV('St Dev'!W:W),\"\")","v":""},{"$f":"IF(N17=\"\",\"\",N17)","v":""},{"$f":"IF(COUNTA('St Dev'!BA:BA)>1,STDEV('St Dev'!BA:BA),\"\")","v":""}]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(m_sc1=\"\",\"\",\"Selection 1\")","v":""},null,{"$f":"IF(m_sc2=\"\",\"\",\"Selection 2\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Mean","St.Dev","Mean","St.Dev"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Organization",null,{"$f":"IF(O7=\"\",\"\",O7)","v":""},{"$f":"IF(COUNTA('St Dev'!X:X)>1,STDEV('St Dev'!X:X),\"\")","v":""},{"$f":"IF(O13=\"\",\"\",O13)","v":""},{"$f":"IF(COUNTA('St Dev'!BB:BB)>1,STDEV('St Dev'!BB:BB),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Consent",null,"",{"$f":"IF(COUNTA('St Dev'!Y:Y)>1,STDEV('St Dev'!Y:Y),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!BC:BC)>1,STDEV('St Dev'!BC:BC),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Transitions",null,"",{"$f":"IF(COUNTA('St Dev'!Z:Z)>1,STDEV('St Dev'!Z:Z),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!BD:BD)>1,STDEV('St Dev'!BD:BD),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Screening & prom.",null,"",{"$f":"IF(COUNTA('St Dev'!AA:AA)>1,STDEV('St Dev'!AA:AA),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!BE:BE)>1,STDEV('St Dev'!BE:BE),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Primary & Sec. care",null,"",{"$f":"IF(COUNTA('St Dev'!AB:AB)>1,STDEV('St Dev'!AB:AB),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!BF:BF)>1,STDEV('St Dev'!BF:BF),\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Non health serv.",null,"",{"$f":"IF(COUNTA('St Dev'!AC:AC)>1,STDEV('St Dev'!AC:AC),\"\")","v":""},"",{"$f":"IF(COUNTA('St Dev'!BG:BG)>1,STDEV('St Dev'!BG:BG),\"\")","v":""}]

{"sheet":"Log","index":5,"n_rows":1,"n_cols":3,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["Date/Time","User","Activity"]

{"sheet":"question descriptions","index":6,"n_rows":146,"n_cols":5,"rows_kept":146,"cut":false,"hidden":true,"merged":[]}
["Group","Section","Score","Heading","Description"]
["Social","A","4","Accommodation presents a high risk. Imminent threat of loss of home; or in hospital / prison with no discharge accommodation identified; or homeless.","The person has no settled accommodation; or accommodation arrangements are precarious; or the person has no, or low, security of tenure / residence and so may be required to leave at very short notice; or they are in temporary short term accommodation with no appropriate move-on accommodation identified; or in accommodation that is having significant negative impact on their health and wellbeing; or in accommodation within an environment that cannot safely support the person's needs. This includes people who are living in restrictive settings such as hospitals or prison. Problems with accommodation may have given rise to safeguarding concerns."]
["Social","A","3","Inappropriate accommodation; or accommodation is at risk of breakdown.","The person lives in a setting which is not consistent with their identified health and social care needs; or their accommodation is fragile and likely to be lost (e.g. due to negative relationships with peers / neighbours, lack of suitably skilled support, changes in family's / services' ability to cope, changes in needs, offending behaviour, or where notice has been served by the accommodation provider)."]
["Social","A","2","Accommodation is shared with others / family but not by choice.","Accommodation is shared and is not of the person's choosing; or if they lack the ability to choose where to live, it has not been identified following an appropriate best interests process. Alternatively the person may be living with their family, despite the fact that they or their family would prefer an alternative living arrangement that would give them more independence (it may be that it was initially a continuation of living with family from childhood, where no best interest process for choosing from options was felt necessary)."]
["Social","A","1","Living in settled, single accommodation; or shared with chosen others. No control over tenancy however, with care and accommodation by single provider.","The person lives in accommodation of their choosing (or if they lack the capacity to make a choice, an appropriate process was followed to determine it was in their best interests). They may be living on their own, or with others they have chosen to share with. However the accommodation is some form of registered care or other setting where the person doesn't have full control over tenancy and which lacks separate arrangements for care and support."]
["Social","A","0","Settled family accommodation; or tenancy / ownership reflecting personal choice / best interests. Separate arrangements for accommodation and support.","The person lives in settled accommodation of their own choosing; either with their family, or in an arrangement where they have security of tenure / residence over the medium to long term, as well as separate control over their care and support. (If the person lacks capacity to make a choice about where to live, accommodation was identified following an appropriate 'best interests' decision making process; or it was a continuation of living with family from childhood and no best interest process was considered necessary)."]
["Social","B","4","No meaningful activities / engagement.","The person has no access to physical, social and leisure activities that are meaningful to them; or if activities are available, the person does not engage with them. It is likely the person will be spending long periods of time with minimal stimulation or restricted engagement; or they may be engaging in activities that are not meaningful to them. Problems with activities may have given rise to safeguarding concerns."]
["Social","B","3","Highly restricted activity / engagement levels.","Access to meaningful activities is extremely restricted, being available to the person for only for very short periods of time, or very irregularly. It may be that it has been very difficult to identify / secure access to appropriate activities. Activities may only be provided within the person’s home or there may be either no, or very restricted, opportunities to access the wider community."]
["Social","B","2","Limited meaningful activities / engagement.","The person engages in some activities that are meaningful to them; or activities are identified and available but access to them is limited, inconsistent and / or unpredictable."]
["Social","B","1","Regular voluntary work, or other structured meaningful activity / engagement.","The person regularly accesses a range of available, meaningful, structured activities; this may be a combination of formal and informal activity; or for people who are able to work, may include opportunities to participate in voluntary work."]
["Social","B","0","Fully engaged in activities suited to needs and preferences, typically including paid employment and / or education.","The person consistently engages in a range of physical, social and leisure activities that are tailored to their needs and preferences. Such activities include paid employment, or education of their choosing; and / or engagement in a range of meaningful activities across different environments and with different people."]
["Social","C","4","Minimal or no financial support; or significant debts; or being financially abused.","The person is either not in receipt of any, or has extremely limited financial support. This could be because of significant debts; financial exploitation by others; benefits not being claimed, having been withdrawn, or being withheld. There may be serious safeguarding concerns in relation to finances."]
["Social","C","3","Highly restricted access to adequate financial support and / or significant restrictions on spending decisions.","The person has highly restricted financial support and / or significant restrictions of choice and control over how they spend their money (where the person lacks the ability to make their own decisions, no best interests process has been followed). This could also be because some benefits are not being claimed, or access to full entitlements is for some other reason being restricted."]
["Social","C","2","Limited financial support with consequent restrictions on spending choices.","The person's financial / material support is limited; there may be enforced restrictions on spending choices; or others may be controlling their financial resources. If the person has difficulties making choices about money, others may be making decisions without recourse to appropriate best interests decision making processes. This could include situations where a person does not meet eligibility criteria for a wider range of benefits; or could be limited because benefit payments only cover essential requirements."]
["Social","C","1","Full financial support / benefits accessed allowing a reasonable quality of life.","The person accesses their full benefit entitlement and this provides adequate financial support to allow them to enjoy a reasonable quality of life in accordance with their preferences. If the person lacks the capacity to make choices about how to spend their money, decisions are made in accordance with recognised best interests processes."]
["Social","C","0","Sufficient financial support to maintain good quality of life.","The person has sufficient financial support and / or material resources to maintain a good quality of life, with finances being sufficient to support their choices, self determination and to maintain their security."]
["Social","D","4","Minimal, or no, appropriate social contact. Largely socially excluded / isolated.","The person has very little or no appropriate social contact. This may mean that the person has been removed from societal contact and is isolated, with little or no contact other than with paid workers and other users of the same service. It may also mean that social contacts are limited to individuals who are coercive and potentially abusive. There may be serious safeguarding concerns in relation to limited or existing social contact."]
["Social","D","3","Fragile social networks.","There are opportunities for the person to access appropriate social contact but it is fragile and / or is at risk of being lost. This may be for a wide range of reasons including behaviour, living situation, risk, staffing levels, etc."]
["Social","D","2","Social contact reliant on paid support or restricted.","The person has some appropriate social contact but this is reliant on paid support. Alternatively, there may be restricted choice and control over social contact."]
["Social","D","1","Access to some non paid social networks.","The person has a range of appropriate social contacts and a well established social network, perhaps supported by the use of a personal budget. However such contacts may be limited (and this is not of the person's choosing) perhaps due to limited social networks, geographical remoteness, lack of access to alternative social media, etc."]
["Social","D","0","Engages with a wide range of established, non paid social networks.","The person has a wide range of appropriate social contacts and a well established social network. The person is able to independently interact socially according to their own choices and preferences, this includes those demonstrated by simple responses e.g. smiling, laughing, maintaining eye contact in accordance with the complexity of their cognitive ability."]
["Social","E","4","Marginalising factor(s) having major impact on, or leading to, a highly restricting lifestyle.","Either one or more additional marginalising factors (consider gender, age, sexual orientation, disability, ethnicity, religion, chronic illness, etc.) over and above the person's learning disability, having major impact on the person's quality of life and / or safety; or a combination of several marginalising factors resulting in the person living a highly restricted lifestyle."]
["Social","E","3","Additional marginalising factors present leading to isolation and having significant impact.","Readily identifiable marginalising factors (consider gender, age, sexual orientation, disability, ethnicity, religion, chronic illness, etc.) noted to be causing isolation and to be having significant impact on the person's freedoms, choices and quality of life, with little support or action being taken to reduce their impact."]
["Social","E","2","Some additional marginalising factors but impact on quality of life is minimal.","Some identifiable marginalising factors over and above the person's learning disability (consider gender, age, sexual orientation, disability, ethnicity, religion, chronic illness, etc.) . The factors have some impact on quality of life but support systems are in place within the person's current social / cultural context to reduce and minimise their impact."]
["Social","E","1","Minimal additional marginalising factors with no discernible impact; appropriate support is in place and effective.","No discernible negative impact of minimal additional marginalising factors over and above the person's learning disability (consider the impact of gender, age, sexual orientation, disability, ethnicity, religion, chronic illness, occupation, etc. in relation to the person's current cultural and societal context) due to effective coping mechanisms; appropriate, effective and inclusive support (either formal or informal); or extensive engagement with a compatible peer group."]
["Social","E","0","No additional marginalising factors over and above learning disability.","No additional marginalising factors over and above the person's learning disability."]
["Social","F","4","Major concerns that abuse may be taking place.","This level applies where there are current and major concerns that abuse may be taking place and there is currently no effective and agreed multiagency plan by which to protect the person."]
["Social","F","3","Significant concerns that the person is at risk of actual abuse.","There is a high degree of concern that the person is at risk of actual abuse and a coordinated, multiagency plan to reduce risks has been agreed, is being implemented and monitored. There may be additional indicators of possible ongoing abuse or risks to others, that require monitoring; however recording, monitoring and transparency within support systems may be considered to be ineffective."]
["Social","F","2","Some concerns that the person is at risk of abuse.","There are indirect indicators or suspicions of risks of abuse that may impact on the person or others. This could be where the person is in shared accommodation where abuse (sexual, physical, psychological, domestic, discriminatory, financial or neglect) of another individual has been identified. There may be cultural issues within the support environment or the person's social network which need to be addressed. There is a coordinated approach to monitoring the situation, sharing concerns and taking action to establish a protection plan."]
["Social","F","1","Minimal safeguarding risks, though vulnerable.","Potential threats to the person's wellbeing exceed their ability to cope with those threats - they are therefore vulnerable but the current risks to safety and wellbeing are minimal as a result of effective support, transparent recording and monitoring."]
["Social","F","0","No safeguarding concerns.","There are no current safeguarding concerns and any risks are minimal and well managed. The person (and / or those who care for and support them) has well established strategies by which to cope with potential future threats."]
["Genetic","A","4","Physical and or mental health not assessed. Little or no understanding of needs.","There has been no appropriate or effective assessment of needs; and / or no annual health check; and / or the person has had highly restricted access to health screening. The person may be experiencing regular serious untoward health incidents and unplanned hospital admissions with no consensus having been formed around the needs that are associated with these. Health problems may be seen as part of the learning disability (diagnostic overshadowing). There may be a lack of health surveillance for people who have problems communicating. There may be serious safeguarding concerns in relation to the assessment of health needs."]
["Genetic","A","3","Assessment has commenced. Only superficial needs recognised. Ongoing delays due to multiple obstacles.","This level applies where needs assessment has commenced but there are significant delays in completing it due to multiple obstacles, these might include difficulties accessing history, lack of physical examination and investigations. Only a superficial understanding of needs has been articulated. In the absence of a fuller understanding, the person may have continuing, occasional, unplanned hospital admissions."]
["Genetic","A","2","Superficial assessment completed but delays accessing treatment or further assessment.","A superficial assessment has been carried out but there are delays in accessing investigations or more specialist assessment without which full identification of needs, potential diagnosis and access to treatment are likely to be delayed. It is not possible to advance the assessment process in the absence of these investigations."]
["Genetic","A","1","Assessment completed but not fully informed. Needs have been described.","An assessment has been completed and a range of needs described however the assessment is based on a limited history; without being fully informed by all relevant investigations; in the absence of a full range of physical examinations; and / or without full input / consultation from clinicians with specialist knowledge related to the person’s known health conditions; and / or where the person has been unable to consent to the assessment and it has been determined to be in their best interests, without appropriate consultation with family, advocate and / or carers."]
["Genetic","A","0","Physical and / or mental health needs comprehensively assessed and fully understood.","There has been a recent, comprehensive assessment of health and social care needs which included consideration of needs known to be specifically associated with the cause of the person's learning disability. There will have been an Annual Health Check (where the person is eligible for one) and the person will have accessed any relevant nationally available health screening programmes. The assessment will have been informed by consideration of the person’s history, an appropriate range of investigations and discussion with the person, their family, carers or advocates as appropriate. The views of any appropriate specialist clinicians will have been taken into account."]
["Genetic","B","4","No effective ongoing review mechanisms.","The person has needs requiring specific actions but no care plans are in place. As such there is no mechanism by which to review and evaluate the effectiveness of care and support given and the person may not be getting adequate support with their health needs. There may be serious safeguarding concerns in relation to care planning."]
["Genetic","B","3","Inadequate arrangements for reviews.","Some care plans are in place to address specific known conditions however care plans are not reviewed by people competent to do so; or are reviewed according to an administrative cycle rather than in response to changes in presentation; there may be an absence of objective measures by which to review plans; and there may be differing views / disagreement regarding the effectiveness of current plans."]
["Genetic","B","2","Care plans reviewed but not inclusive of all relevant parties.","Care plans are regularly reviewed according to a predictable cycle. Reviews are undertaken by a single practitioner without appropriate liaison with the person, family, advocate and / or carers. It is apparent that reviews commonly lead to revision and refinement of care plans."]
["Genetic","B","1","Regular, effective, appropriate and responsive reviews undertaken.","There are known assessed needs for which specific care plans exist. The care plans are regularly and effectively reviewed by a person / team with the necessary knowledge and skills to evaluate them; this is done in consultation with the person, their advocates, families and carers as appropriate. In addition to regular review cycles there are also responsive reviews when health needs or status changes."]
["Genetic","B","0","No significant health needs, review not required.","This level applies where there is no requirement for care plans as a full and thorough assessment has not identified any significant health needs and the person has easy access to primary healthcare services should they be needed."]
["Genetic","C","4","No Care plans / Health Action Plans in place.","This level applies where the person has needs requiring specific actions but no care plans are in place. This means that the person is not getting adequate support with their health needs and the lack of planning could result in serious ill health; there may be serious safeguarding concerns in relation to lack of care planning."]
["Genetic","C","3","Non condition specific care plans / Health Action Plans in place (not in accordance with evidence base e.g. NICE guidance).","This level applies where a person has care plans in place but they do not adequately address the specific conditions that are known to exist. For example someone with Down’s syndrome who does not have thyroid function testing identified in their care planning, or someone with epilepsy who does not have a care plan for the management of seizures that is in line with best practice recommendations (e.g. NICE guidance). Alternatively it may be that those implementing care plans lack the skills to effectively do so."]
["Genetic","C","2","Condition specific, generic care plans / Health Action Plans in place. Plans may be incomplete.","This level applies where care plans are in place to address specific known conditions, however the plans may be generic and not individualised or person centred. Plans may be incomplete in that they do not adequately meet all areas of need, or cover anticipatory healthcare needs or health promotion; or include monitoring of indicators of efficacy."]
["Genetic","C","1","Condition specific person centred care plans and Health Action Plans in place.","There are some known needs for which specific care plans exist. These may form part of a Health Action Plan, or may constitute a more detailed plan of specific care and treatment for a particular issue. Plans are in keeping with current evidence and are based around the specific needs of the person in a personalised way. Care plans address presenting health needs, anticipatory healthcare needs and health promotion. Clear measures of effectiveness are incorporated."]
["Genetic","C","0","No care plans or Health Action Plans required.","This level applies where there is no requirement for planned care as a full and thorough assessment has not identified significant needs. The person has ready access to primary care as and when needed. Health Action Plans provide a record of current health status."]
["Genetic","D","4","Despite clear evidence of need, no crisis, emergency or relapse plans; or hospital passport (where appropriate) in place.","This level applies where there are no plans to respond to a crisis of health need. A hospital passport has not been completed. There may be serious safeguarding concerns in relation to crisis or emergency planning."]
["Genetic","D","3","Crisis / emergency / relapse plans and hospital passport inadequate, not person centred or reviewed; or consistently not utilised.","Crisis and or emergency plans, and a hospital passport have been completed but are inadequate, incomplete or out of date, this may be because they are not person centred, not robust or fit for purpose; or, it may be that those providing care and support consistently fail to make use of these plans in support of health related appointments and hospital attendances."]
["Genetic","D","2","Crisis / emergency / relapse plans and hospital passport as appropriate in place, not reviewed or occasionally not utilised.","Crisis and or emergency plans, and a hospital passport are person centred but have not been reviewed. There may be occasions where those providing care and support fail to routinely take hospital passports (or equivalent) when attending hospital or other health appointments."]
["Genetic","D","1","Crisis / emergency / relapse plans and hospital passport in place as appropriate, are person centred, routinely used and reviewed.","Crisis, emergency and, where appropriate, relapse plans and a hospital passport are all in place. These plans are person centred, individualised, up to date and regularly reviewed."]
["Genetic","D","0","No crisis / emergency plans required, appropriate person centred information in place.","This level applies where a person does not require any emergency or crisis plans; they are likely to have good networks of support and good communication. Where appropriate a hospital / communication passport is complete, person centred and up to date."]
["Genetic","E","4","Unlicensed / contraindicated use of medication. Extremely hazardous medication regime; or, administration errors.","Medication is being used that is not in keeping with the individual’s identified needs e.g. not prescribed for a diagnosed and / or licensed use, or in excess of recommended dose limits. Medication recommended for short term use may have been taken for prolonged periods without regular review (e.g. benzodiazepine anxiolytics, prophylactic antibiotics); or medication which has hazardous side effects and a narrow therapeutic window. There may be frequent medication administration errors without subsequent action to prevent recurrences. There may be serious safeguarding concerns in relation to medication."]
["Genetic","E","3","Potentially hazardous medication regime without adequate reviews and monitoring. Significant compliance issues.","Despite significant poly-pharmacy, or high dosages, medication continues to be administered without routine specialist reviews; and the effectiveness, or side effects are not being adequately monitored. Medications may be known to have especially hazardous side effects which are not readily apparent without specialist knowledge or vigilant monitoring. Those providing support are not managing medication appropriately, there are significant problems with compliance."]
["Genetic","E","2","Medication reviewed but not regularly monitored; maybe with inconsistent use of 'as required' medication.","Medication may be being reviewed (perhaps annually) but there is poor on-going monitoring of effectiveness and / or side effects. Those providing support are not monitoring or recording medication effectively or there may be occasional issues / problems with compliance. There may be inconsistencies in the use of ‘as and when required’ medication."]
["Genetic","E","1","Small amount of medication, regularly reviewed and effectively monitored.","The person takes a small number of medications (including prescribed dietary supplements and artificial feeds) which have readily discernible side effect profiles. In the case of 'as and when required' medications, the prescriber has clearly described under what circumstances they should be taken, as well as any required precautions. The therapeutic and adverse effects of medication are carefully monitored and recorded by those providing care and support, with regular and appropriate reviews. There are minimal problems with compliance. Medication is all within BNF limits and prescribed for indicated uses only. Medication is administered safely and appropriately."]
["Genetic","E","0","No medication.","This level applies where there is no current medication required."]
["Genetic","F","4","No specialist learning disability service provision available.","A specialist learning disability service is not available to an individual. This may be because there is a lack of specialist service provision locally or that access is being denied or withheld. There may be serious safeguarding concerns in relation to the lack of appropriate specialist service provision."]
["Genetic","F","3","Restricted specialist learning disability services available, not able to meet all identified needs.","Some specialist learning disability services are available but access may be restricted by referral criteria or pathways; delayed due to prolonged waiting times; or some key elements (therapies or therapists) may not be available; or some elements are not available locally. There may be a lack of support to access the service available. There may be areas of identified need that cannot be met."]
["Genetic","F","2","Limited specialist learning disability service available.","A limited specialist learning disability service is available locally and is being provided but there may be limitations in terms of the capacity, responsiveness, consistency, quality or scope of the service available. There may be limited support to access the service."]
["Genetic","F","1","Full specialist learning disability service available and accessed in accordance with identified needs.","A full high quality specialist learning disability service is available and is being accessed by the person in accordance with their assessed needs and care plans. There is adequate support to access the service but there may be short delays in timely response to referral."]
["Genetic","F","0","Full specialist learning disability service available but not currently required.","A full, high quality and appropriate specialist learning disability service is accessible and available but not currently required. As a minimum, such services will include learning disability nurses, psychiatrists, psychologists, occupational therapists, physiotherapists and speech and language therapists. There will be transparent referral pathways and timely responses."]
["Communication","A","4","Major restrictions of bodily awareness, pain responses. Needs very difficult to discern.","This level applies where a person is completely unable to recognise abnormal body sensations and is able to show little or no discernible response to pain; they receive no appropriate support with identifying needs. There may be serious safeguarding concerns in relation to body awareness, pain responses and communication support."]
["Communication","A","3","Significant restrictions of bodily awareness and pain responses and inadequate support to identify needs.","The person is significantly restricted in their capacity to recognise abnormal body sensations and signs of ill health including pain and distress; or receives inadequate appropriate support with identifying needs."]
["Communication","A","2","Some restrictions of bodily awareness and pain responses with limited support to recognise needs.","The person has some limitations in recognising abnormal body sensations and signs of ill health, including pain. They receive limited support from others with identifying needs."]
["Communication","A","1","Some restrictions of bodily awareness and pain responses but appropriate support to help identify needs.","The person has some limitations in terms of their body awareness and their ability to recognise signs of ill health but shows largely normal responses to pain / distress. They receive appropriate support with identifying needs."]
["Communication","A","0","No identified difficulties with bodily awareness and pain responses.","The person has good body awareness, recognises signs that could indicate ill health and shows normal adaptive responses to pain / distress."]
["Communication","B","4","Major restrictions to person's ability to communicate about their health. No support in place.","There are major difficulties, as a result of highly complex needs in relation to a person’s communication, such that the person is completely unable to communicate in a way that others recognise. There may be no support or resources to aid communication of health needs; or where these exist, they make little difference. There may be serious safeguarding concerns in relation to communication of health needs. Non-verbal indicators of pain / distress are extremely difficult to discern."]
["Communication","B","3","Despite support, there are significant restrictions to person's ability to communicate with others regarding their health.","There are significant difficulties as a result of complex needs and an extremely limited ability to effectively communicate information about their health experiences to others. The support they receive is relatively ineffective in enabling them to adequately communicate health needs. Those who know the person best may recognise important subtle communications both verbal and non-verbal but these are not always acted on."]
["Communication","B","2","Notable restrictions with the person's ability to communicate about their health.","There are some difficulties as a result of complex needs and the person's limited verbal communication. This impacts significantly when the person attempts to communicate about complex and highly subjective health related experiences. They may be heavily reliant on appropriate support from people who know them well, as well as the use of customised communication tools / aids."]
["Communication","B","1"," Minimal restrictions with the person's ability to communicate about their health with others but appropriate support in place.","There are minimal difficulties as a result of a person’s ability to communicate with others. The person may struggle to communicate some aspects or detail of their health issues but they have appropriate support and resources to aid communication."]
["Communication","B","0","No identified restrictions with the person's ability to communicate about their health.","There are no identified difficulties related to the person’s ability to communicate with others. They can articulately describe their signs, symptoms, health history, concerns and health needs to others."]
["Communication","C","4","Major difficulties with the ability of those providing support to recognise pain / distress.","This level applies where there are major health risks associated with a failure on the part of those providing care and support to recognise pain, distress or ill health resulting in a significant deterioration of physical and / or mental health and wellbeing. There may be serious safeguarding concerns relating to the recognition of needs / pain."]
["Communication","C","3","Significant difficulties with the ability of those providing support to recognise pain / distress.","There are significant difficulties associated with the failure of those providing care and support to recognise signs of pain, distress or potentially serious ill health (physical and / or mental). This may have resulted in failure to access early treatment, episodes of serious ill health or hospital admissions. Those providing support have received little if any training around the health needs of people with learning disability."]
["Communication","C","2","Consistent difficulties with the ability of those providing support to recognise pain / distress.","There are consistent minor difficulties associated with the ability of those providing care and support to recognise signs of potential ill health (physical and / or mental). This may include inconsistent recognition and treatment of pain and distress; and an inability to use bespoke pain recognition tools. Those providing support have received only basic training around the health needs of people with learning disabilities."]
["Communication","C","1","Occasional difficulties with the ability of those providing support to recognise pain / distress.","There are occasional difficulties in terms of recognising potential ill health (physical and / or mental), on the part of those providing care and support. It may be that just a few people who provide support may know the person well enough recognise potential distress (e.g. families). There may be occasional misinterpretations or failures to recognise or appreciate the significance of signs and symptoms indicating pain, distress or ill health insofar as they relate to relatively minor health conditions. Paid carers providing support have received training specifically relating to the health needs of people with learning disabilities."]
["Communication","C","0","No identified restrictions with the ability of those providing support to recognise pain / distress.","There are no identified difficulties associated with the ability of those who provide care and support to recognise signs and symptoms (or expressions) indicating pain, distress or ill health (physical and / or mental). They may be proficient in using bespoke, individualised pain recognition tools that are not dependent on the person having advanced verbal communication skills."]
["Communication","D","4","Major difficulties related to the ability of those providing support to respond to emerging health problems.","This level applies where there are major difficulties resulting from the failure of people who provide care or support to respond appropriately and promptly to signs of seriously ill health (physical and / or mental). There may be serious safeguarding concerns relating to carers abilities in this area."]
["Communication","D","3","Significant difficulties related to the ability of those providing support to respond to health problems.","This level applies where there are significant difficulties arising from the inability of those who provide care or support to respond to signs of ill health (physical and / or mental). Despite signs of ill health being recognised by carers, it may be that their potential seriousness is not; and that consequently prompt and urgent responses fail to occur. Alternatively appropriate responses may be inhibited due to service issues, information or knowledge issues, language, cultural issues; or the person or their carer's values, beliefs, attitudes and preferences."]
["Communication","D","2","Consistent difficulties related to the ability of those providing support to respond to emerging health problems.","There are consistent minor difficulties resulting from the ability of those providing support to respond to emerging health problems (physical and / or mental). It may be that they fail to follow advice or previously agreed crisis plans, or that they delay before instigating them. They may not know how to access additional support or approach the wrong agencies. There may be a lack of clarity around their role, difficulties prioritising appropriately, or concerns about approaching professionals. There may also be failings to provide appropriate support and reassurances to the person concerned."]
["Communication","D","1","Occasional concerns related to the ability of those providing support to respond appropriately to emerging health problems.","There are occasional difficulties relating to the ability of those who provide care or support to respond to emerging health problems (physical and / or mental). Although there may be occasional lapses, they largely know who to contact, do so in a timely manner, maintain good observations and relay critical health related information to inform further health needs assessment. They also offer basic reassurance and advice to the person, using appropriately modified communication."]
["Communication","D","0","No identified concerns regarding the ability of those providing support to respond to emerging health problems.","There are no identified difficulties related to the ability of people who provide care or support to respond appropriately and promptly to emerging health problems (physical and / or mental). Hospital passports and Health Action Plans have been established and guide responses to changes in health status."]
["Communication","E","4","Major restrictions related to the person's capacity to access and understand health information and make choices.","There are major difficulties resulting from a person’s complete lack of understanding and awareness of health information. This threatens to undermine the success of treatment and care plans. There is little or no support that can increase understanding or involvement and the person (or those who know them best) are excluded from decisions relating to their own health and wellbeing. There may be serious safeguarding concerns relating to understanding health information and making choices."]
["Communication","E","3","Significant restrictions related to the person's ability to access and understand health information.","There are significant difficulties’ resulting from a highly restricted understanding and awareness of health issues and information. There is limited support to enable the person to make their own decisions (and limited inclusion in this process of those who know them best) in relation to health and wellbeing, support available is only partially effective. Basic information is used to help the person anticipate and cope with health related procedures although for many areas of decision making a suitable best interests’ decision making process is not being followed."]
["Communication","E","2","Consistent difficulties related to the person's ability to access and understand health information and make choices. With good support can make some decisions.","There are consistent minor difficulties resulting from a person’s restricted awareness of health issues and lack of understanding of health information. The use of modified communication and literature as well as the support of skilled communicators who know the person well improves understanding, leading to increased involvement in decision making. It also encourages a healthier lifestyle."]
["Communication","E","1","Some restrictions related to the person's ability access and understand health information but with good support they are able to make choices.","There are occasional difficulties resulting from a person’s lack of awareness of health issues and / or problems understanding health related information. This may cause problems in terms of understanding the need to take treatments, to maintain a healthy lifestyle and to make informed choices. However, with good support and the use of accessible information in accordance with the person’s needs they can be fully included in making choices about their health."]
["Communication","E","0","No identified restrictions related to the person's ability to access and understand health information and to make choices on the basis of these.","There are no identified difficulties related to an individual’s understanding and awareness of health information and they are fully involved in planning for good health."]
["Behaviour","A","4","Major concerns about eating and drinking which place the person's safety and well being at imminent risk.","The person has known swallowing difficulties but does not have consistency of food modified; or takes little or no food or fluid without considerable encouragement which is not readily available; or eats hazardous (otherwise inedible) items with no restrictions; or eats foods hazardous to known health status e.g. high sugar foods if diabetic or foods contraindicated by medication with no support to modify; or there are serious safeguarding concerns."]
["Behaviour","A","3","Restrictions to healthy eating and drinking which compromise the person's long term safety and wellbeing. Little support to address these issues.","Food consistency is not wholly safe; or fluid intake is excessive or minimal; or diet has a complete omission of one or more essential component (e.g. fruit, veg or dairy products); or an extreme excess of an unhealthy constituent of food (e.g. salt, sugar or saturated fat, etc.); or wholly inadequate calorific intake. With little support to modify. Amount of food taken is a significant concern."]
["Behaviour","A","2","Some notable difficulties maintaining healthy eating and drinking. Some support in place to address these.","The person takes a mix of grain based foods, milk, meat, veg and fruit though widely discrepant from normal recommended daily amounts – some support to address these issues and support healthy intake. If food consistency is an issue there may be occasional lapses of stringency in support."]
["Behaviour","A","1","Relatively minimal restrictions to healthy eating and drinking.","The person takes adequate food and fluid of safe and appropriate consistency. There may be relative excesses or limitations of some key areas of nutritional intake. Meals may lack variety or have modestly excessive salt or sugar content. Support is available to address known issues."]
["Behaviour","A","0","No restrictions to healthy eating and drinking.","The person takes a healthy balanced diet consistent with their needs and prepared in a manner which can be taken without risk, including supported feeding systems. They take 6-8 glasses of water (or other fluids or prescribed hydration through supported feeding) per day and carers are well informed and provide support regarding public health recommendations on healthy eating."]
["Behaviour","B","4","Major restrictions related to appropriate physical activity / exercise putting safety and well being at risk.","The person takes little or no exercise of an even mild intensity, appropriate to age and health condition. May be immobile or just sedately mobilising around living environment. Poses risks to skin integrity, cardiovascular system, bones and joints. Alternatively may undertake high intensity, vigorous activity despite significant underlying medical conditions which mean excessive cardiovascular work load should be avoided. No appropriate support with exercise in place. There may be serious safeguarding concerns in relation to exercise."]
["Behaviour","B","3","Significant lack of engagement in physical activity / exercise.","The person takes little or no moderately vigorous exercise; or undertakes energetic activity, appropriate to age and health condition for brief periods only, no more than once or twice a week. Restricted access to support, understanding in relation to exercise of those providing support is minimal."]
["Behaviour","B","2","Some restrictions engaging in healthy regime of physical activity / exercise.","The person takes less than a weekly total of an hour and a half of moderately vigorous activity, appropriate to age and health condition. Takes such exercise on less than four days per week. Support available but not appropriately implemented or utilised."]
["Behaviour","B","1","Few concerns related to the person's engagement in physical activity / exercise.","The person undertakes moderate intensity activity on four or five days per week, or for less than 30 minutes in a day, appropriate to age and health condition. Appropriate support and encouragement is provided."]
["Behaviour","B","0","No restrictions related to engaging in healthy regime of physical activity / exercise.","The person takes a degree of exercise of a nature and quantity appropriate to age and general health condition. A mixture of aerobic and muscle strengthening activities on five or more days per week. No support required."]
["Behaviour","C","4","Major concerns about the person's ability to achieve / maintain an appropriate weight, placing them at risk of serious health problems.","BMI is less than 15 or over 40; or there is unplanned loss of more than 10% weight over 3-6 months. No support available to achieve or maintain appropriate weight. There may be serious safeguarding concerns in relation to weight."]
["Behaviour","C","3","Significant difficulties achieving / maintaining appropriate weight.","BMI is between 15-16 OR BMI 35-40; or there is unplanned loss of 5-10% weight over 3-6 months. Restricted access to support to achieve or maintain appropriate weight."]
["Behaviour","C","2","Notable difficulties / restrictions on ability to achieve / maintain an appropriate weight.","BMI is between 16-18.5 OR BMI 30-35; or there is unplanned loss of less than 5% weight over 3-6 months. Support available but not appropriately implemented or utilised to achieve or maintain appropriate weight."]
["Behaviour","C","1","Some difficulties achieving / maintaining an appropriate weight.","BMI is between 25-30. Weight is stable. Appropriate support and encouragement is provided to achieve or maintain appropriate weight."]
["Behaviour","C","0","No difficulties maintaining appropriate weight.","BMI is between 18.-25. Weight is stable. No support is required to achieve or maintain appropriate weight."]
["Behaviour","D","4","Dependence on drugs, alcohol, or other harmful substances.","There is evidence of a strong compulsion to take the desired substance, where a withdrawal state is associated with abstinence. There may be evidence of tolerance (indicated by increasing quantities of the desired substance being required to achieve the desired effect). Alternative pleasures are neglected. No support or access to services in place. There are serious safeguarding concerns in relation to substance use."]
["Behaviour","D","3","Harmful use of drugs, alcohol, tobacco or other substances.","There is an evident pattern of substance use which has significantly contributed to physical, psychological or social harm. Limited support or access to services."]
["Behaviour","D","2","Hazardous use of drugs alcohol, tobacco or other recreational drugs but no evidence of actual harm at this stage.","Consumption is at a level associated with a significantly increased risk of harm, albeit that there is currently no evidence of actual harm; or there is a minimal level of recreational drug use. Some support provided."]
["Behaviour","D","1","Largely safe use of alcohol. No use of recreational drugs.","There is evidence of some risky behaviour in relation to the use of alcohol. Behaviours demonstrated are considered to pose a limited risk to the person’s health and wellbeing with potential for morbidity. E.g. where the person generally keeps alcohol consumption to a safe level, but occasionally drinks an excessive amount. Support available if needed."]
["Behaviour","D","0","No harmful use of alcohol. No use of other substances.","There is no use of substances other than alcohol and drinking is within Public Health recommended safe limits; or there is no use of alcohol. Consumption poses a minimal risk to health and wellbeing. E.g. Where the person consumes alcohol regularly but the amount is considered acceptable (Per week: at least two alcohol-free days, Men: no more than 21 units & no more than four units a day, Women: no more than 14 units, & no more than three units a day)."]
["Behaviour","E","4","Very high risk sexual behaviours (may be consensual or not). Sexual abuse or sexual offending.","In an abusive / exploitative sexual relationship; or engages in sexual offending behaviour; or has unprotected sex with people who are at high risk for sexually transmitted disease. No support provided. There are serious safeguarding concerns in relation to sexual health."]
["Behaviour","E","3","Unsafe and risky sexual behaviours (may be consensual or not).","Has frequent unprotected sex of a nature that is hazardous to health, poses serious safeguarding issues or is illegal; or has been exposed to sexually inappropriate role models; or has had (and failed to detect) chronic sexually transmitted disease. Restricted support provided or limited access to services."]
["Behaviour","E","2","Inappropriate sexual behaviours (may be consensual or not) increasing vulnerability.","Has limited awareness of sexual rights / norms though is sexually active. Has limited access to sexual health services. Limited understanding of what constitutes safe sex. Has had a lack of sexually positive role models. Lives in an environment where others display sexually inappropriate behaviours. Sexually active but not using contraception. Some support provided."]
["Behaviour","E","1","Healthy (consensual) sexual behaviours. Sexually isolated.","Healthy sexual behaviours. May be interested in sex, though is sexually isolated. Has accessed contraceptive advice both to avoid pregnancy and the risk of sexually transmitted diseases. Appropriate support provided."]
["Behaviour","E","0","No hazardous sexual behaviours.","Does not to engage in sexual activity (by choice in the case of people with capacity). Easy access to sexual health screening services."]
["Behaviour","F","4","Major health implications related to presentation of severe behavioural disturbance.","The person presents behaviours which are of a frequency, severity or intensity that there is a high risk that either they or someone else will require unplanned hospital attendances due to severe injury; or the person’s behaviours mean they have no access to usual health provision; or the person’s situation is such that they are exposed to abusive contingencies. The factors that predict the occurrence or, and maintain behaviours are unknown."]
["Behaviour","F","3","Behaviours / routines have significant impact on health status.","The person presents behaviours for reasons which are poorly understood; which mean that either they, or someone else, commonly requires first aid or occasionally suffers more serious illness / injury which requires medical attention. There may be occasional dramatic escalations in the severity / frequency of behaviours of concern. In an attempt to manage risks the person may be subjected to restrictive environment or hazardous treatments."]
["Behaviour","F","2","Behaviours / routines have notable impact on health.","The person presents with a range of behaviours of concern. Causative factors have been partially assessed and are partly understood. Access to routine healthcare provision may be difficult to arrange or investigations not pursued as not perceived to be in the person’s best interests. The impact of behaviours is relatively stable and their frequency / severity is neither increasing nor reducing."]
["Behaviour","F","1","Behavioural presentation has minimal impact on health status.","The person presents occasional hazardous behaviours or has some rigidity of behaviour however these have been assessed and a package of proactive and reactive strategies agreed. These are consistently implemented and the outcomes of these strategies are closely monitored and regularly reviewed. The person has unimpaired access to an appropriate range of local health provision."]
["Behaviour","F","0","No presentation of risky behaviours / routines.","The person does not present culturally abnormal behaviours which place themselves or others safety / wellbeing in jeopardy or risk the person being denied access to ordinary community facilities."]
["Service Access","A","4","Organisational barriers causing major restrictions completely preventing access to services. No reasonable adjustments are in place.","There are major difficulties in accessing services resulting from an organisation and / or its staff showing a complete lack of understanding and awareness about the nature of learning disabilities, there is a complete lack of recognition of diagnostic overshadowing and no evidence of reasonable adjustments being made. The attitude of staff towards the person may be unacceptable and discriminatory. Services are refused or inaccessible. Treatment or intervention is withheld, delayed or inappropriate. There is no support to access or even register with services. There may be serious safeguarding concerns in relation to organisational barriers to services."]
["Service Access","A","3","Organisational barriers causing significant restrictions in access to services. Limited evidence of reasonable adjustments being made.","There are significant difficulties resulting from an organisation’s limited understanding and awareness about the nature of learning disabilities. There is poor recognition of diagnostic overshadowing and limited evidence of reasonable adjustments being made. Service provision is inadequate or difficult to access. There is very little support to access services. Frequent unreasonable delays in treatment or intervention. There is no training available."]
["Service Access","A","2","Organisational barriers causing consistent restrictions in access to services. Reasonable adjustments are limited and inconsistent.","There are consistent difficulties in accessing services which arise as a result organisational constraints and barriers. The understanding and awareness of those providing support about the nature of learning disabilities, the recognition of diagnostic overshadowing and the implementation of reasonable adjustments is limited and inconsistent. Limited awareness training or support is in place, occasional unreasonable treatment delays. There is limited support to access services."]
["Service Access","A","1","Organisational barriers causing occasional restrictions in access to services. Reasonable adjustments are in place but may have some limitations.","There are occasional difficulties in accessing services that are due to organisational barriers / inflexibility of care pathways. Organisations and their staff show a reasonable understanding and awareness of the nature of learning disabilities, its impact on health and the impact of diagnostic overshadowing. Reasonable adjustments are made though may be limited in range, scope and individualisation. Awareness training is in place for staff, although is not mandatory and some key staff have not been trained leading to some inadequacy and inconsistency in service provision. There is some support to access services."]
["Service Access","A","0","No organisational barriers causing restrictions in access to services. Full reasonable adjustments are in place.","There are no difficulties associated with organisational barriers in accessing services. Services and their staff show a good understanding and awareness about the nature of learning disabilities, its impact on health, the need to avoid diagnostic overshadowing and the importance of reasonable adjustments to ensure timely access to assessment, investigations, diagnosis and treatment. Mandatory learning disability awareness training is in place for all staff. There is adequate support to access services."]
["Service Access","B","4","Consent or best interest process not in place or not being implemented.","This level applies where there are major difficulties resulting from major procedural breaches in gaining consent, assessing capacity where required, or in following appropriate best interest procedures; or, the person’s care and treatment amounts to a deprivation of liberty which has not been lawfully authorised. No training is in place. There may be serious safeguarding concerns in relation to consent."]
["Service Access","B","3","Consent or best interest processes in place but being ignored or wrongly applied.","There are significant difficulties resulting from treatments or practices being carried out without lawful consent; or from procedural lapses which lead to delays, inappropriate withholding of treatment, or the person’s rights not being upheld; or no training in place."]
["Service Access","B","2","Consent and best interest processes in place and being applied but with consistent lapses of rigour.","There are consistent minor difficulties resulting from inconsistent approaches and procedural lapses in assessing capacity and gaining consent; or in following appropriate best interest processes; or in respecting the person's choices - these have not however placed the person at risk of harm. Restrictions of liberty may be in use following best interests’ decision processes for a person who lacks capacity but these do not amount to a deprivation of liberty. Training is in place but is not mandatory."]
["Service Access","B","1","Consent and best interest processes in place and generally being applied effectively, with occasional lapses.","There are occasional minor difficulties or misunderstandings resulting from inconsistencies in involving the person in making their own decisions regarding their healthcare, in gaining their consent to any specific procedures that are to be undertaken and to properly assessing their capacity if this is questioned. If people are unable to consent to a treatment there may be minor lapses in terms of following appropriate best interests decision making processes. These lapses have not led to treatment being given without authority, has not incurred undue delays and has not placed the person at risk of harm. Mandatory training for staff is in place."]
["Service Access","B","0","Consent and best interest processes are robust and rigorously applied.","There are no difficulties related to consent issues. The person is supported to make their own choices where they are able, and these are respected. If it has been determined that the person lacks capacity to make a particular decision an appropriate and transparent best interest decision making process is followed (with full family and where appropriate advocacy involvement). If a person’s care and treatment includes continuous supervision and control and they are not free to leave; and they don’t have the capacity to agree to this then there is a clear lawful authorisation of this Deprivation of Liberty. Mandatory training around supporting decision making is in place, monitored and fully complied with."]
["Service Access","C","4","Complete breakdown in transition arrangements between services.","This level applies where there are major difficulties resulting from poor practices in transition processes. There will be no named coordinator to enable transition and policies protocols will be non-existent or completely inadequate. This may result in no appropriate service or completely unsafe services being provided and serious delays in the effective transition of services. There may be serious safeguarding concerns in relation to transition between services."]
["Service Access","C","3","Regular and significant breakdown in transition between services.","This level applies where there are significant difficulties resulting from poor practices in transition processes. There will be very little coordination available to support transition; policies and protocols are flawed, ineffective and require updating. Communication is poor and difficulties with information sharing seriously undermine effective support planning. This results in unsafe or unsatisfactory services being provided and significant delays in the effective transition of services."]
["Service Access","C","2","There are consistent difficulties with transition between services.","There are consistent minor difficulties resulting from poor practices in transition planning. There may be a named coordinator available to support transition but the role may not be effective; policies and protocols may require updating. This may result in unsafe or inadequate services being provided and significant delays in effective transitions between services."]
["Service Access","C","1","Transition between services is successful, given appropriate additional support.","There are occasional minor difficulties with transition processes. There will be a named coordinator available to support transitions; and relevant policies and protocols are current. Minor difficulties may relate to information sharing, communication, administrative arrangements or support for the person. These difficulties are likely to give rise to occasional delays in effective transitions between services requiring additional support."]
["Service Access","C","0","Transition between services is successful and well coordinated, with no additional support required.","This level applies where there are no identified difficulties related to transitions between services. There will be a named person to coordinate arrangements and support the transition. Their role is embedded within local policies / protocols. Local services are well placed to ensure smooth and effective transition pathways. No additional support is required."]
["Service Access","D","4","Major restrictions in the quality of, or access to, health promotion / screening.","Health screening / promotion programmes, health checks and activities are not available to meet identified needs. This may be because there is a lack of service provision or support or that access is being denied or withheld. Those providing support have no training and skills to promote and support good health. There may be serious safeguarding concerns in relation to health screening or health promotion."]
["Service Access","D","3","Significant restrictions in the quality of, or access to, health promotion / screening.","Health screening / promotion programmes, health checks and activities are available but access or support may be restricted, delayed or not available. It is likely that no reasonable adjustments are in place. Those providing support have very little training or skills to promote and support good health. There may be areas of identified need that are not being met."]
["Service Access","D","2","Some limitations in the quality of or access to health promotion / screening.","Health screening / promotion programmes, health checks and activities are being provided but there are limitations in the scope of the service or support available and the degree or effectiveness of reasonable adjustments. Those providing support have limited training and skills to promote and support good health."]
["Service Access","D","1","Minimal restrictions in the quality of, or access to, health promotion / screening.","Health screening / promotion programmes, health checks and activities are available to meet identified needs and are being accessed with minimal restrictions. There are some accessible materials. Those providing support have some training and skills to promote and support good health. Reasonable adjustments are negotiated and implemented."]
["Service Access","D","0","No identified restrictions in the quality of, or access to, health screening / promotion.","There is full access and support to health screening / promotion programmes, health checks and activities. There are accessible materials, and person centred reasonable adjustments. Those providing support are adequately trained and skilled to promote and support good health."]
["Service Access","E","4","Major restrictions in the quality of primary / secondary care.","This level applies where primary and secondary care services are not available to meet a range of identified needs. This may be because there is a lack of service provision locally or that support to use the service is being denied, or withheld. There may be serious safeguarding concerns in relation to primary or secondary health care services."]
["Service Access","E","3","Significant restrictions in the quality of primary / secondary care.","This level applies where some primary and secondary care services are available to meet identified needs but support to use services may be restricted, are delayed, or not available locally. It is likely that very few relevant and individualised person centred approaches in place. There may be areas of identified need that are not being met. There may be poor communication and differences of opinion between primary and secondary care providers."]
["Service Access","E","2","Some restrictions in the quality of primary / secondary care.","There are some limitations to the range of primary and secondary care services that are available locally to meet identified needs. Where such services are being provided, there are limitations in the scope of the service, the support available and the degree or effectiveness of person centred approaches; or a limited service is available but the individual has good support and access is good."]
["Service Access","E","1","Minimal restrictions in the quality of primary / secondary care.","This level applies where full high quality primary and secondary care services are available locally and are being accessed with appropriate support, despite some occasional and minimal restrictions. Person centred approaches are negotiated and implemented. There is good liaison between primary and secondary care and an appropriate level of support to the individual."]
["Service Access","E","0","No identified restrictions in the quality of primary / secondary care.","This level applies where full high quality primary and secondary care services are available locally to meet identified needs and these are being accessed with no restrictions. Service are person centred and effective. Communication between primary and secondary care is prompt, efficient and effective."]
["Service Access","F","4","Major restrictions in the quality of person centred non-health services.","This level applies where no non-health services (e.g. community social groups, leisure facilities, libraries, etc.) are available to meet identified needs that cannot otherwise be met. This may be because there is a lack of service provision locally or that access or support is being denied or withheld. No effective person centred approaches are in place. There may be safeguarding concerns in relation to non-health services."]
["Service Access","F","3","Significant restrictions in the quality of person centred non-health services.","This level applies where only a few local non-health services are available (e.g. community social groups, leisure facilities, libraries, etc.) to meet identified needs; access or support may be restricted or delayed. It is likely that very few relevant and individualised person centred approaches are in place. There may be areas of identified need that are not being met."]
["Service Access","F","2","Some restrictions in the quality of person centred non-health services.","This level applies where a limited range of non-health services are available locally (e.g. community social groups, leisure facilities, libraries, etc.), the person accesses them to meet identified needs but there are limitations in the scope of the services, or in the nature of support available and/or the degree or effectiveness of person centred approaches."]
["Service Access","F","1","Minimal restrictions in the quality of person centred non-health services.","A wide range of good quality non-health services are available which can meet some areas of a person’s identified needs (e.g. community social groups, leisure facilities, libraries, etc.) and these are being accessed as required, with appropriate support and minimal restrictions. Person centred approaches are negotiated and implemented."]
["Service Access","F","0","No identified restrictions in the quality of person centred non-health services.","This level applies where there is a wide range of high quality non-health services available to meet identified needs (e.g. community social groups, leisure facilities, libraries, etc.). These are being accessed, as required, without restrictions. Services are effective and person centred."]

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