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Appendix 4 Transforming Your Care: Vision to Action Improving Northern Ireland’s Health and Social Care NIPEC – Children’s Nursing Network 15 February 2013 Pamela McCreedy To set out what Transforming Your Care: Vision to Action is and what it says To focus on proposals related to children’s services Why are we here? To discuss some of the opportunities / challenges presented by Transforming Your Care To consider the role for the Children’s Nursing Network in taking forward the transformation agenda What is “Transforming Your Care”? We want to get better at prevention Improving the health and wellbeing of people by More care and services without having to visit a good health decisions, hospital promoting – either at home, or close to you preventing ill health in the first place, Giving you more choice about the services achieving better outcomes when ill health does occur & Being at the forefront of new technology to help you enabling people to live healthily and independently for as care for yourself and be independent long as possible. Making the best use of the resources we have – not cutting what we have Why? We can’t do nothing More care should be delivered in GP surgeries, local centres or our own homes – where it can be accessed easier Health professionals should be more ‘joined up’ We need to listen to what we hear Want to be independent – support to live at home as much as possible Want more say in what and how services are provided for us Staff need to be supported to make the changes Services must be safe and high-quality Making real change happen 1. Review completed in December 2011, giving us a strong vision for what the future could be 2. Draft Plans written on how we can take action to improve services on the ground and deliver change across our system 3. Completed a period of public consultation and engagement in January 2013, and will make recommendations to the Minister once we have analysed the responses 4. Making the changes will take time, effort and commitment – around 3 to 5 years, £70m funding and everyone’s involvement 5. Some difficult choices ahead – this will take strong leadership at all levels, in all organisations Health & Wellbeing End of life care Joined up local services Older People Long Term Conditions • Just providing more and more acute care isn’t going to fundamentally improve our healthPhysical and wellbeing Learning Mental Disability & • Disability We want to promote good health decisionsSensory to Health prevent ill health Impairment • More prevention, screening and immunisation programmes Maternity & Child Health • We all have a responsibility for keeping well if Working Family Acute Care we can & Child Care (Hospitals) with other countries Health & Wellbeing Joined up local services Older People Long Term Conditions • Integrated Care Partnerships – doctors, nurses, social workers and Physical everyone providing your care working closer togetherDisability to agree how& End of life Learning Mental place caretreatment takes Disability Health Sensory • Move 5% of money and resources out of hospitals and into primary Impairment and community care • Supported by major investment in local Health and Care Centres • Means you will get quicker access to specialist treatment and less Maternity Working & Acute Care likely to haveFamily to go to hospital & Child with other Child Care (Hospitals) Health countries Health & Wellbeing Joined up local services Older People Long Term Conditions • People are living longer and their needs have changed Physical • This is a good thing but has implications for how we care for people – we can and should plan for this nowMental of life Learning Disability & End care Disability Sensory • Despite a rising elderly population, Health demand for residential care is falling - people want to stay at home and remain independent Impairment More joined up assessment of needs, with self-directed support and individual budgets, and choice over your care More support for carers MaternityBetter use of technology and helpful devices / tools Working Family & Acute Care & Child with other • Review intermediate care and more ‘re-ablement’ services Child Care (Hospitals) Health countries • At least 50% reduction in number of statutory residential homes (does not include EMI, Learning or Physical disability facilities) Health & Wellbeing Joined up local services Older People Long Term Conditions • Those with conditions which cannot be cured but can be Physical controlled by medication, such as diabetes, asthma, respiratory of life Mental Disability & disease Learning End care • Disability Health Sensory Appropriate follow-up and regular review with GP or specialist Impairment nurse to help prevent deterioration and identify problems earlier • Investment in ‘telemonitoring’ at home • Fewer emergency visits to hospital but when you need to, this Maternity Working means youFamily could avoid having to go through A&E & Acute Care & Child with other Child Care (Hospitals) Health countries Health & Wellbeing Joined up local services Older People Long Term Conditions • We want to have better quality of care to ensure that people can die with dignity End of life care Physical • Shift towards greater choice and support about how Learning Mental to be treated and preferred place to die Disability & Health Sensory • Disability Specialist palliative support out of hours, including to nursing homes and into people’s homes Impairment • Working more closely with the voluntary and community sector Maternity & Child Health Family & Child Care Acute Care (Hospitals) Working with other countries Health & Wellbeing End of life care Maternity & Child Health Joined up local services Learning Disability Family & Child Care Older People Long Term Conditions • Accelerating and giving impetus to the Bamford Action Plan • Reduce number of people in Physical long stay institutional care • Mental Disability & Improved access toSensory respite with Health a wider range of day care Impairment opportunities • More involvement of carers, with more choice, self-directed support and individual budgets Working Acute Care (Hospitals) with other countries • Joined up Health & local Wellbeing Be more joined up in services how we Older People Long Term Conditions Mental Health Physical Disability & Sensory Impairment Acute Care (Hospitals) Working with other countries provide services • Reduce number of people in long stay institutional care: so these units may close or End of life Learning change how they are used care Disability • 6 Acute Mental Health Units • Better support for carers • Promote uptake of self-directed support and individual budgets Maternity & Child Health Family & Child Care Health & Wellbeing Joined up local services Older People • Support people with disabilities to have more choice and independence, looking at alternative ways to provide day activities and supported living Endarrangements of life Learning Mental • care Promote uptake ofDisability self-directed support and Health individual budgets, which can be used with a large range of service providers across all sectors Long Term Conditions Physical Disability & Sensory Impairment • More respite and support for carers Maternity & Child Health Family & Child Care Acute Care (Hospitals) Working with other countries Health & Wellbeing Joined upcommunity rather than hospital • More care in Older Long • Term local People Conditions Less time in hospital after birth where appropriate services • More access to midwife led care End of life care • Continue to review the demand for our current maternity services across all our hospitals to Physical ensure they remain safe and sustainable • Learning Mental Disability & Establish Family Nurse Partnership to Disability Health Programmes Sensory improve health and wellbeing of most disadvantaged Impairment children and families Maternity & Child Health Family & Child Care Acute Care (Hospitals) Working with other countries Health & Wellbeing Joined up Older Long Term local People Conditions • Embed Family Support Hubs promote positive services parenting, and children's communications skills • Be more joined up across different government bodies about how we can prevent children having to be Physical separated from their families End of life care Learning Mental • More foster carers Maternity & Child Health Disability & • Improve Child and Adolescent Mental Health Services Disability Health Sensory (CAMHS) Family & Child Care Acute Care (Hospitals) Impairment Working with other countries • • Evidence shows that, for many conditions, if you are taken to a specialist unit where they handle larger Joined up volumes this can Healthimprove & Older significantly your outcome local Wellbeing People Investment in regional networks – e.g. Cardiac with 2 PCI services Long Term Conditions sites (RVH and Altnagelvin), expansion of orthopaedics in Southern, Western and Belfast • Networking each hospital – not every hospital can provide every service as this is not safe. This will mean developing hospital networks across the region. End of life Learning Mental o “right care, right place, right time, right outcome” care Disability Health o Alternatives to going to hospital and most clinically appropriate destination o Direct Admissions where appropriate Maternity & Child Health Family & Child Care Acute Care (Hospitals) Physical Disability & Sensory Impairment Working with other countries Joined up Health & Older Long • Sometimeslocal people from Northern Ireland may travel to Term Wellbeing Republic of Ireland or Great Britain People Conditions to get specialist services treatment if its not available here • Also people from Republic of Ireland may come here for treatment, particularly in the border areas Physical • We wantLearning to have more formal discussions End of life Mental and Disability & arrangements to reflect what is already happening on a care ad hoc basis, Disability Health for better Sensory and look for opportunities Impairment working in future Maternity & Child Health Family & Child Care Acute Care (Hospitals) Working with other countries What people are saying Telemonitoring County Antrim pensioner Michael Howard who suffers from shortness of breath, says: “Taking my pulse, blood pressure, temperature and blood glucose readings at home by remote telemonitoring is so simple. Without this I’d be running back and forward to the GP’s surgery to have things checked out.” More services provided locally Dr Keith McCollum, a GP from County Armagh, says: “Transforming Your Care heralds a whole new way of working for GPs and other community professionals. They will contribute more to how services will be delivered, to manage more patients closer to home using new technologies to enable better co-ordination of their care.” Investing in technology William Pullins from Ballymartin who has been using remote access via a robot to monitor his condition, says: “The robot is just brilliant and was very easy to talk to. It’s wonderful that we are here at Daisy Hill Hospital and are able to talk to a specialist in Craigavon Hospital!” Supported living 86-year old Joan McGibney, from Newtownabbey, says: “After a fall in my home, I’m very happy to have carers to come four times a day to assist me in my daily living. Having a personal alarm makes me feel much safer.” Family Nurse Partnership Programme Eibhlinn McGowan, a young mother from Derry / Londonderry says: “The Family Nurse Partnership Programme is personal – one to one – it provides support to young mothers from early pregnancy to your child is 2 years old.” Moving forward There are no neutral decisions and we need to transform to ensure safe and resilient services into the future The model of care sets the individual at the centre, and gives them greater choice and control Shift of resources and re-investment in primary and community care – “home is hub” Building the capacity and capability of HSC organisations and their delivery partners to design, implement and sustain these changes will be key Implications for HR and staff CAPACITY : Workforce planning integral to planning and delivery of reforms: right people, right place THE ‘SHIFT LEFT’ : - shifting resources - supporting staff (incl VR / VER) - role of non-statutory sector Building capacity and capability across the HSC system is vital CAPABILITY : All staff groups will feel a sense of changing role, and will get the training and development to build capability ENGAGEMENT : Staff at the forefront of leading transformation across all HSC and partner organisations Update Consultation closed on 15th January 2013 We have received 2,242 responses Widespread engagement – – 835 people attended either a public or stakeholder meeting; – 156 ‘mentions’ on Twitter – 25,762 hits on our website Some elements already progressing (if not subject to consultation) e.g. implementation of changes to palliative care Subject to Ministerial decision, will quickly progress with the ‘new’ elements of TYC; e.g. Integrated Care Partnerships Need to get real and tangible changes on the ground to build momentum Consultation Feedback to date Family and Child Care – Significant support for proposals. – Early intervention and prevention should not only apply to – – – – acute services but social care Support for increased funding for early year services Calls for greater support for families with limited parenting skills Increase in specialist foster parents- for example young parent who are in care, bail placements and short term /emergency placements Needs to be a smoother transition from child services to adult services Consultation Feedback to date Maternity and Child Health – Mixed views on proposals – Support for antenatal care closer to home – Lack of support for stand alone midwifery led units. – Calls for a regional perinatal mental health unit for mothers and babies – Greater funding for specialist midwives, e.g. obesity specialist midwives – Need to encourage breastfeeding in teenage mothers – Need to take steps from an early age to help tackle childhood obesity Next Steps Consultation Report and Minister for Health’s Statement to the Assembly Implementation 3-5 yrs Engagement with NIPEC