1. 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

2. Version 0.4 To set out what Transforming Your Care: Vision to Action is and what it says To focus on proposals related to children’s services 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 Why are we here?

3. Version 0.4 What is “Transforming Your Care”? We want to get better at prevention More care and services without having to visit a hospital – either at home, or close to you Giving you more choice about the services Being at the forefront of new technology to help you care for yourself and be independent Making the best use of the resources we have – not cutting what we have Improving the health and wellbeing of people by promoting good health decisions, preventing ill health in the first place, achieving better outcomes when ill health does occur & enabling people to live healthily and independently for as long as possible.

4. Version 0.4 Why? We can’t do nothing

5. Version 0.4 We need to listen to what we hear Want more say in what and how services are provided for us 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’ Want to be independent – support to live at home as much as possible Services must be safe and high-quality Staff need to be supported to make the changes

6. Version 0.4 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

7. Version 0.4 Joined up local services Older People Long Term Conditions End of life care Learning Disability Mental Health Physical Disability & Sensory Impairment Maternity & Child Health Family & Child Care Acute Care (Hospitals) Working with other countries Health & Wellbeing Just providing more and more acute care isn’t going to fundamentally improve our health and wellbeing We want to promote good health decisions to prevent ill health More prevention, screening and immunisation programmes We all have a responsibility for keeping well if we can

8. Version 0.4 Joined up local services Older People Long Term Conditions End of life care Learning Disability Mental Health Physical Disability & Sensory Impairment Maternity & Child Health Family & Child Care Acute Care (Hospitals) Working with other countries Health & Wellbeing Integrated Care Partnerships – doctors, nurses, social workers and everyone providing your care working closer together to agree how treatment takes place Move 5% of money and resources out of hospitals and into primary and community care Supported by major investment in local Health and Care Centres Means you will get quicker access to specialist treatment and less likely to have to go to hospital

9. Version 0.4 Joined up local services Long Term Conditions End of life care Learning Disability Mental Health Physical Disability & Sensory Impairment Maternity & Child Health Family & Child Care Acute Care (Hospitals) Working with other countries Health & Wellbeing Older People People are living longer and their needs have changed This is a good thing but has implications for how we care for people – we can and should plan for this now Despite a rising elderly population, demand for residential care is falling - people want to stay at home and remain independent More joined up assessment of needs, with self-directed support and individual budgets, and choice over your care More support for carers Better use of technology and helpful devices / tools Review intermediate care and more ‘re-ablement’ services At least 50% reduction in number of statutory residential homes (does not include EMI, Learning or Physical disability facilities)

10. Version 0.4 Joined up local services End of life care Learning Disability Mental Health Physical Disability & Sensory Impairment Maternity & Child Health Family & Child Care Acute Care (Hospitals) Working with other countries Health & Wellbeing Older People Long Term Conditions Those with conditions which cannot be cured but can be controlled by medication, such as diabetes, asthma, respiratory disease Appropriate follow-up and regular review with GP or specialist 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 means you could avoid having to go through A&E

11. Version 0.4 Long Term Conditions Older People Joined up local services Learning Disability Mental Health Physical Disability & Sensory Impairment Maternity & Child Health Family & Child Care Acute Care (Hospitals) Working with other countries Health & Wellbeing End of life care We want to have better quality of care to ensure that people can die with dignity Shift towards greater choice and support about how to be treated and preferred place to die Specialist palliative support out of hours, including to nursing homes and into people’s homes Working more closely with the voluntary and community sector

12. Version 0.4 End of life care Long Term Conditions Older People Joined up local services Mental Health Physical Disability & Sensory Impairment Maternity & Child Health Family & Child Care Acute Care (Hospitals) Working with other countries Health & Wellbeing Learning Disability Accelerating and giving impetus to the Bamford Action Plan Reduce number of people in long stay institutional care Improved access to respite with a wider range of day care opportunities More involvement of carers, with more choice, self-directed support and individual budgets

13. Version 0.4 Learning Disability End of life care Long Term Conditions Older People Joined up local services Physical Disability & Sensory Impairment Maternity & Child Health Family & Child Care Acute Care (Hospitals) Working with other countries Health & Wellbeing Mental Health Be more joined up in how we provide services Reduce number of people in long stay institutional care: so these units may close or change how they are used 6 Acute Mental Health Units Better support for carers Promote uptake of self-directed support and individual budgets

14. Version 0.4 Mental Health Learning Disability End of life care Long Term Conditions Older People Joined up local services Maternity & Child Health Family & Child Care Acute Care (Hospitals) Working with other countries Health & Wellbeing Physical Disability & Sensory Impairment Support people with disabilities to have more choice and independence, looking at alternative ways to provide day activities and supported living arrangements Promote uptake of self-directed support and individual budgets, which can be used with a large range of service providers across all sectors More respite and support for carers

15. Version 0.4 Physical Disability & Sensory Impairment Mental Health Learning Disability End of life care Long Term Conditions Older People Joined up local services Family & Child Care Acute Care (Hospitals) Working with other countries Health & Wellbeing Maternity & Child Health More care in community rather than hospital Less time in hospital after birth where appropriate More access to midwife led care Continue to review the demand for our current maternity services across all our hospitals to ensure they remain safe and sustainable Establish Family Nurse Partnership Programmes to improve health and wellbeing of most disadvantaged children and families

16. Version 0.4 Maternity & Child Health Physical Disability & Sensory Impairment Mental Health Learning Disability End of life care Long Term Conditions Older People Joined up local services Acute Care (Hospitals) Working with other countries Health & Wellbeing Family & Child Care Embed Family Support Hubs promote positive parenting, and children's communications skills Be more joined up across different government bodies about how we can prevent children having to be separated from their families Improve Child and Adolescent Mental Health Services (CAMHS) More foster carers

17. Version 0.4 Family & Child Care Maternity & Child Health Physical Disability & Sensory Impairment Mental Health Learning Disability End of life care Long Term Conditions Older People Joined up local services Working with other countries Health & Wellbeing Acute Care (Hospitals) Evidence shows that, for many conditions, if you are taken to a specialist unit where they handle larger volumes this can significantly improve your outcome Investment in regional networks – e.g. Cardiac with 2 PCI 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. o “right care, right place, right time, right outcome” o Alternatives to going to hospital and most clinically appropriate destination o Direct Admissions where appropriate

18. Version 0.4 Acute Care (Hospitals) Family & Child Care Maternity & Child Health Physical Disability & Sensory Impairment Mental Health Learning Disability End of life care Long Term Conditions Older People Joined up local services Health & Wellbeing Sometimes people from Northern Ireland may travel to Republic of Ireland or Great Britain to get specialist treatment if its not available here Also people from Republic of Ireland may come here for treatment, particularly in the border areas We want to have more formal discussions and arrangements to reflect what is already happening on a ad hoc basis, and look for opportunities for better working in future Working with other countries

19. 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!” 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.” 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.” What people are saying

20. Version 0.4 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

21. Version 0.4 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 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 Building capacity and capability across the HSC system is vital

22. Version 0.4 Update Consultation closed on 15 th 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

23. Version 0.4 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

24. Version 0.4 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

25. Version 0.4 Next Steps Consultation Report and Minister for Health’s Statement to the Assembly Implementation 3-5 yrs Engagement with NIPEC