Co-designing Always Events in Adult Learning Disability Services (ARCHIVED)

Lancashire Care are proud to be part of the national Always Event (AE) pilot which was funded as part of the Compassion in Practice Strategy by NHS England. Always Events are co-designed with people who use services, their families and carers and staff at the point of care. The Always Event is developed based on an understanding of what matters most to those using the service, their families and carers


  • From start: Yes
  • During process: Yes
  • In evaluation: Yes


  • Peer: Yes
  • Academic: Yes
  • PP Collaborative: Yes

Find out more

What We Did

Lancashire Care are proud to be part of the national Always Event (AE) pilot which was funded as part of the Compassion in Practice Strategy by NHS England working in partnership with Picker (Europe) and the Institute for Healthcare Improvement (IHI) – Always Events® is registered trademark and ‘owned’ by IHI.  Always Events (AEs) are defined as those aspects of the care experience that should always occur when patients and family members interact with healthcare professionals and the health care delivery system. IHI’s Always Events framework provides a strategy to help health care providers identify, develop, and achieve reliability in a person- and family- centered approach to improve individual’s experiences of care.

An Always Event is a clear, action-oriented, and pervasive practice or set of behaviours that: Provides a foundation for partnering with patients and their families; Ensures optimal patient experience and improved outcomes; Provides a common platform for all that demonstrates a continuing commitment to person and family centred care

The opportunity to be part of the national pilot was timely as Lancashire Care had committed to developing Always Events as part of Our Vision and Quality Plan. The pilot enabled us to access the support and guidance from experts and raise the profile of experience.

Wider Active Support

As part of the NHS England Always Event Pilot we have worked closely with NHS England, the Institute for Healthcare Improvement and Picker Europe. Picker Europe have supported the evaluation of the Always Event. This involved fortnightly telephone calls with our partners to discuss progress and plan for the next steps. It has also involved presenting at national conferences and at a IHI webex conference to share our learning


Always Events are co-designed with people who use services, their families and carers and staff at the point of care. The Always Event is developed based on an understanding of what matters most to those using the service, their families and carers.  The  Adult Learning Disability Team in Blackburn with Darwen were eager to be involved. We co-designed our Always Event with people who use services and their carers, to understand what matters to them.

Together, thinking sessions were facilitated and the co-design team identified the Always Events: I will always be supported in moving on in care (transitions in care)

Ideas were generated from the co-design team, which would enable the Always Events, including: The development of a contact card on discharge from the service; Notification of proposed staff changes / transfers by letter, with photographs of new staff; A monthly “pop-in and chat” support session 
These ideas have been developed and in summer 2015 testing commenced using Plan, Do, Study, Act improvement methodology.
Co-design has been fundamental to the development of our Always Events with people who use our services and their carers involved throughout, developing an Always Event in their own words, co-designing the evaluation questions and presenting to senior leads within the organisation and colleagues from NHS England, Picker Europe and the IHI.

Feedback from people who use services who have been members of the co-design team: “The photo on the letter and the contact card help people feel safe and not fear that they are going to be on their own”; “I keep the card on the fridge with a magnet – so I see it all the time”; “My idea was chosen…I feel good”

Looking Back/Challenges Faced

A couple of months into the pilot the clinical lead left the Trust and this presented a challenge as she had been leading the Always Event work within the team. There was a slight hiatus in team leadership until the Team Leader was identified as the replacement. This did impact on a slight delay in some of the telephone follow up evaluation telephone calls to people who had been discharged. However, this was quickly resolved with the Team Leader engaging the wider team, including the team administrator, in the Always Event implementation. 
This highlighted the importance of leadership, at all levels. The organisational support and sponsorship from the Director of Nursing ensured that the central leadership support from the Trust’s Quality Team remained constant throughout this time and was able to work with the co-design team and the Network to resolve the challenges. In hindsight it would have been better to engage the wider team in leading the implementation earlier rather than the leadership locally be focused on one person.

Initially the staff team were anxious that involvement in the pilot would lead to lots of work for them that would have time implications to them as team, and they were anxious about their ability to meet the demands. This was overcome through the co-design process. Staff, with people who use services, their families and carers shared a thinking space about how people could be better supported in moving on in care. The co-design team then developed ideas about how they could make things better. From this long list of ideas a small number were selected to be tested. This involved the co-design team designing the contact card and new style letters with photographs and developing the ‘pop in and chat’ sessions. The improvement was not ‘done too’ people who use services or staff, it was designed together, with people, so it was designed to work!

In the Preliminary Findings Report Picker Europe (February 2016) wrote: “Implementing the Always Event activities appears to have had minimal impact on the individual workload of staff members. Part of the success of implementing the Always Event activities appears to be because they have been easily incorporated into staff member’s everyday work.

Feedback from staff from video interviews: ‘‘Co-design made the implementation feel real and right the way target driven things aren’t’’; “To do something that makes a difference is inspiring especially when its’ ongoing and people have been willing to step up and get involved and it’s reminded us what a good spirit the team has”; “I was worried that it was going to be difficult to do but it’s not at all. It’s a small investment of time to have a big impact”; “The changes suggested by the people who use the service is simple and we wonder why we didn’t think of them”; “We can’t always meet people expectations and it’s been great because this time we have”
Another challenge faced was that attendance at the pop in and chat session was lower than had been anticipated. The venue of the session was a local centre. The co-design team proactively considered this and are now testing having the pop in and chat at the health centre, a building that is familiar to those moving on in care


In the Preliminary Findings Report Picker Europe (February 2016) commented that staff feel that the Always Event activities are sustainable because they have a good process set up which is straightforward for staff, even new staff members, to follow and does not take up too much of staff time.

Feedback from staff:
“I think because it’s been handled really well and well thought out and well planned amongst the team, I think that that’s something that will be relatively easy for us to continue … new staff that have come in and things, they’ve just taken it and been able to run with it because it’s all sort of set up.”

The new ways of working are now well established throughout the team and are now “just the way we do things”. With the team able to see the positive impact the changes have for people using services


The Always Event has been evaluated by Picker Europe.
*July 2015 -Early Jan 2016 26 people were discharged following the new procedure (new letter, contact card, pop in and chat invitation)
*A follow up contact call was made 2 weeks later by either a healthcare support worker or the Speech and Language Assistant (people opted out)
*Cases were discussed at the team weekly discharge meeting
*86% people reported they were told in enough time that they were ready to move on *81% of people stated they were involved in making choices in moving on 
*96% of people know who to contact if they were worried about their health following moving on from the team *91% of people received the contact card with details about how to contact the team 
*17% of people said they would attend a pop in and chat session, 38% said they would not attend, 25% were not sure if they would attend and 21% felt it was not appropriate. 6 interviews with staff were carried out by Picker Europe: *Initially some challenges during leadership transition *Now there is a clear understanding and the team feel the process is straightforward and works well *Clinician discusses discharge with the person moving on, making them aware of the follow up call and pop in and chat
*Team administrator sends new discharge letter, contact card, pop in and chat invitation (next 3 dates)

Summary of findings (to date) ) *The process evaluation shows that Lancashire Care are proactive in making changes to how their Always Event activities are implemented in order to ensure its success and sustainability. As commented by a member of staff “any processes like this, and other ones that kind of involve with it, is that it has to be constantly reviewed, it can’t stand still.”

Some of the key reasons for the successful implementation of the Always Event activities are:
it has not created a lot of additional work for staff and it is seen as part of their everyday work; a strong team approach to the work has been undertaken
o staff can see its value in terms of improving both staff and service users’ experiences of the discharge process; Follow-up calls: changes to the process of how the calls are conducted have ensured that these are now successfully carried out as planned. However, the wording of the questions are being reviewed in order to ensure that the information gathered from the calls is meaningful; Pop in and chat sessions: these have been successful in engaging service users with making improvements to the service and offer potential benefits to those service users attending.

The key benefits of the pop in and chat sessions are: providing service users with ongoing support and a chance for them to keep in touch with the service and friends; giving service users a voice to make suggestions on how the service can be improved

However, the team are considering how the pop in and chat can be improved to ensure that the attendance at the group is improved and that it also provides support to those recently discharged from the service. Other ‘unintended outcomes’ from implementing the Always Event pilot:
Weekly intake meeting now includes a discussion of upcoming discharges; It has increased the amount of joint working between different members of staff within the team which has been beneficial

To improve the Always Event pilot further, the team could:
share and discuss the collated findings from the follow-up calls with staff at monthly team meetings so that all staff are kept informed of service users’ experiences of being discharged which will help to identify if any improvements are needed over time; focus on ensuring that service users and/or their family/carers are involved in making choices about moving on in care. The follow-up calls could be used to explore the reasons why service users may not feel they have been involved. A meeting could then be held with those service users involved in the co-design of the programme (perhaps at a pop in and chat) to discuss the findings from the calls and to better understand how this aspect of care could be improved.
o get a better understanding of why some service users do not want to attend the pop in and chat session to see if there is anything that could be changed to improve the uptake.

The co-design team have reviewed these findings and responded e.g. the venue of the pop in and chat has been moved to test if this was a barrier to attendance


As part of the national Always Event pilot we are committed to share our experience and learning with others. To date this has included: Speaking at NHS Expo in September 2015; Interviewed for an article published in The Guardian to support NHS Expo; Presenting at Always Event conferences in London in October 2015 and April 2016; Presenting at a King’s Fund Conference November 2015; Presented on IHI webex November 2015; Speaking at the Chief Nursing Officers Summit December 2015; Interviewed for an article published in The Nursing Standard January 2016; Recognised for our work by the IHI and Picker, with our work included on their websites AlwaysEvents.aspx ;Shortlisted for the 2015 PENN Awards – poster presentation shared


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