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1. Always Events
The right behaviours always and everywhere
David McNally
NHS England

2. Action Areas
Action Area 1:
Helping people to
stay independent,
maximising
well-being and
improving health
Action Area 2:
Working with
people to provide
a positive
experience of care
Action Area 3:
Delivering high
quality care
and measuring
impact
Action Area 4:
Building and
strengthening
leadership
Action Area 5:
Ensuring we have
the right staff,
with the right
skills, in the right
place
Action Area 6:
Supporting
positive staff
experience

3. What are Always Events?
Always Events are aspects of the care experience that are so important to patients,
service users and carers that health care providers must perform them consistently for
every patient, every time.
Successfully delivering the Always Event programme provides:
• A foundation for partnering with patients, service users and their carers;
• Actions that will ensure optimal care experiences and improved
outcomes; and
• A unifying force for all that demonstrates an ongoing commitment to
person and family centred care.

4. About the initiative
• NHS England, in collaboration with Picker Institute Europe and the
Institute for Healthcare Improvement (IHI) have developed a programme
to pilot and test the Always Events framework and create guidelines and a
toolkit for implementing Always Events within the NHS in England.
• The programme will run until April 2016 and will comprise 10 provider pilot
sites in England. The purpose of the programme is to evaluate Always
Events in these locations and assess the impact on improvement of
quality in healthcare settings.

5. National approach + local determination
Recognition
(local decision) -
transparent
local feedback/
measurement
National tools–
with patients &
professionals
Local always
events–
with patients &
professionals

6. How are Always Events different to other initiatives?
• Always Events are not done ‘for’ patients – they are co-designed
with patients, families and carers to ensure changes are happening in
areas which really matter to service users.
• Always Events are not simply the opposite of Never Events –
Never Events focus primarily on breaches in patient safety and
operational issues. Always Events focus on making changes to
standard working procedures and behaviours which have real impact
on the quality of patient experience.
• They are not isolated, provider-specific initiatives – the
programme is designed to foster learning between healthcare
providers so innovative solutions can be easily disseminated.

7. Always Events at Lancashire
Care

8. The New Quality Strategy 2015-2019
– Expected outcomes

11. Engaging staff – gaining momentum:
• We are looking for a team who will be willing to participate in this exciting
and innovative national pilot of Always Events over the coming months
• The team will receive support from the Quality Improvement and Experience
Team within LCFT, IHI and Picker
• If you would like to nominate a team or discuss this further please contact
Helen Lee
Action Area 2:
Working with
people to provide
a positive
experience of
care

12. Making learning disability services better
• The Learning Disability Services want to get better at what we do. Your ideas
are important and will help us get better at what we do.
• We asked people that use the services about their ideas, what they liked
about the service and the things we could be better at.

13. What we did and how we did it
We asked 22 people about what they did with a staff member
and what they thought about work.
We met with people for an interview to get
their ideas.
We showed each person a picture of the staff member to make sure they
remembered them.

14. What you told us you liked
Good things staff members did:
• Helped people to feel relaxed so they could talk to them
• Explained things clearly and slowly
• Made eye contact, listened and wrote things down
• Gave their officenumber so people could contact them
• Gave people a choice about where they were seen
• Having someone to talk to

15. • Using drawing and pictures to help explain or understand things
• Getting on with the staff member
• Having privacy and feeling comfortable
• Being listened to and understood
• Learning skills and feeling more confident
• Practicalsupport

16. What you told us you didn’t like:
• Three people said they sometimes found it hard to understand the staff
member
• Some people found it hard to talk about difficult feelings
• Some people said they missed the staff member when they stopped
seeing them.

17. What we will do to get better
• Use simple language and questions
• Find out how people communicate best
• Plan endings well so people still feel supported

18. Tell us about your experience when you have stopped seeing your
community nurse or therapist?
• I was really sad
• It was OK because someone else form the team came to see me
• It made me unhappy – she was my friend
• I had a telephone number of someone to contact
• I can’t think about them not coming to see me – I will always need help
• I was a bit worried but I started to see someone else

19. ‘How can we make ending your support from Learning Disability
Services better for you?’
• A place or person to contact if we need help
• A fridge magnet telling me who to contact (I lose pieces of paper and business
cards)
• A photograph of the new person coming to see me
• Warning in advance that my support will be ending and the person is leaving
or being replaced
• Being told who you are going to see if the person you normally see is not
available
• Keeping in touch with the service. Coffee mornings, catch up events
• The person leaving introducing me to another worker I can contact

20. Tell us the best way to communicate with you?
• Write it down and then read it to me
• Don’t use doctor language
• Use bigger type
• Face to face
• Sign language or symbols
• Pictures
• Talk slowly – don’t rush or talk too fast
• Use kind respectful words
• Give plenty of time to take things in
• Ask me to repeat back so you knowI have listened and understood
• Have someone who knows me with me
• Make sure you know how to communicate with me, sometimes what you say may make me worry
• Make sure my support is available before you start the consultation
• Find a quiet place to talk to me

21. How would we like our treatment to end?
• Face to face
• With notice it is going to happen to give me time to think
• Photograph of the person on our letters so we know who you are talking about
• Contact number of a person we can speak to if we are worried (on a fridge
magnet or key fob)
• Letters that are easy read with symbols and no difficult language

22. Contact Card

23. Letter

24. Process Flowchart

25. Always Event discharge tracking
Commencing 1 July 2015
Name and
NHS No
Date of
Discharge
Nurse or
Therapist
Date
Letter and
contact
card sent
Date of
follow up
telephone
call
Comments
Record:
 Any comments
made
 No response to call
 If planning to
attend ‘Pop in and
Chat’

26. Pop-in and chat invitation

27. Co-Design
Always Event Wording
Were yougiven
enough notice
about when you
were going to be
discharged?
Were you told in
enough time that
you were ready
to move on?
We will always
support you in
transitions of
care
We will always
support you in
moving on in
care

28. Pop in and chat

29. Early days…
Julie Clift: Clinical lead said:
‘Being involved in Always Events has
enabled the learning disability service to
really respond to the needs of our service
users in a meaningful way.
This is collaborative working at its very
best. People with learning disabilities know
what they want from us as a heath
provider. These little enhancements to the
way we work will have real meaningful
impact on how our service users feel
about the care we provide’

30. Early days…
Amanda Thornton: Clinical Director said:
We are working hard in Lancashire Care to learnfrom
our experts – those who use ourservices.
Our teams workingwithand forpeople with Learning
Disabilities were quick to seize the offer of
involvement in Always Events and quickly recognised
with userinput two service ‘touchpoints’that needed
improvement. The ideas generatedby those who use
our services have been informed,innovative and have
frankly left us thinking ‘why didn’t we spot that’!
We are delighted to be a part of the Always Events
initiative and are learning lots that we canput into
practise elsewhere too.
Thank you!