1. Transforming Your Care
Mary Hinds

2. Vision and Scope of the Review
Undertake a strategic assessment across all aspects of HSC services;
Undertake appropriate consultation and engagement on the way ahead;
Make recommendations to the Minister on the future configuration and delivery of services; and
Set out a specific implementation plan for the changes that need to be made in HSC

3. Case for Change
Northern Ireland is becoming an older society. While the absolute size of our population is estimated to increase over the next 10 years, of greater significance to the demand for Health and Social Care is the likelihood that the average age of our population will also continue to increase at a faster rate.
Estimates are that between 2008 and 2020 the Northern Ireland population will increase by 142,000 people (8%). The number of people over 75 years will increase by 40%.
Health and Social Care in NI faces a considerable financial challenge over the next three years. The NI Budget settlement for the four year period 2011 to 2015 provides all health, social care and public safety organisations with a 2% annual growth in resources to £4.65bn by 2014/15. It is anticipated that the funding
requirement with no change to services would be £5.2bn by 2014/15, creating a funding gap of £600m. In 2012/13 HSCB and PHA face a funding gap of £230m, excluding non cash costs, that needs to be addressed.
Transforming Your Care provides a renewed impetus to reform and modernisation of health and social care in NI. This is necessary to ensure our services are sustainable into the future.
Implementing TYC is about improving the quality and accessibility of services and meeting the challenges and demands of having a growing and aging population.
It will mean difficult decisions – but these will be planned and considered decisions. To do nothing now – to allow the system to continue as it is, will mean that in future years those decisions will still be difficult, but the planning of them and the time-tabling of them may well be out of our hands. We cannot drift into a future where we are continually fire fighting because we have baulked at hard decisions now. 3

4. Key reasons for Change 4 1 Better at preventing ill health
2 Importance of patient centred care
3 Increasing demand in all POC
4 Current inequalities in the health of the population
5 Giving our children the best start in life
6 Sustainability and quality of hospital services
7 Need to deliver high quality services based on evidence
8 Need to meet the expectation of the people of NI
9 Making best use of resources available
10 Maximising the potential of technology
11 Supporting our workforce 4

5. Principles for Change
Placing the individual at the centre of any model
Using outcomes and quality evidence to shape services
Providing right care in the right place at the right time
Population-based planning of services
Focus on prevention and tackling inequalities
Integrated care - working together. 5

6. Principles for Change Promoting independence & personalisation of care
Safeguarding the most vulnerable
Ensuring sustainability of service provision
Realising value for money
Maximising the use of technology
Incentivising innovation at a local level

7. Future Model for Integrated Health and Social Care

8. Where are we now?
Draft Population Plans from each Local Commissioning Group area, and an overarching Strategic Implementation Plan
Consultation

9. Themes
Integrated Care Partnerships, focussing at first on frail elderly and long term conditions
Diversity of provision of services and more services closer to home
Re-configuration of some services and hospitals working as networks
A change in use of residential care
Greater role for community and voluntary sector
Diversity of provision of service, and more service provision closer to home: this is at the core of Transforming Your Care. People don’t want to travel for miles to go into hospital for extended periods. Implementing TYC will mean a significant shift from the provision of services in hospitals to provision of services in the community where it’s safe and appropriate to do so. Services will regard “home as the hub of care” and be enabled to ensure that people can be cared for at home. We also want to make the service people receive more visible to the patient and give them greater choice over where and how they receive it, again where it’s safe and appropriate to do so. In particular this will be enabled by Connected Health, a key focus for TYC
Reconfiguration of some services: One of the objectives of the transitional funding is to enable the development of more services closer to home – for example, (1) diagnostics within GP practices; (2) outpatient clinics with joint working between the GP, the Consultant and nurses in a primary care setting; and (3) chronic condition management (with Connected Health) enabling people to have more self-management and support to manage their condition at home. The outworking and as a result of this over a 3-5 year period is that the requirement of how our hospital services will inevitably change. It is important that we demonstrate this increased access to services locally before we make any changes to hospital services. Then as this re-configuration starts to occur the focus will be on a sustainable and resilient service within our hospitals, where the focus will be on the more complex or acute medical conditions.
A change of use for residential care: this is a continuation of
a trend, we would see the type of use for residential accommodation changing – more short term use, rather than long term residents. This may mean some residential homes will close especially where they are nearing their end of use anyway; others will adapt.
A greater role for the voluntary and community sector: I
want to see more co-operation with the voluntary and community sectors. I believe these sectors have much to offer in terms of their expertise and experience and can be a valuable resource. To enable this we need to see greater visibility of recurrent funding year on year to allow them to plan better, and support them in building their capacity and capability.
Establishment of 17 Integrated Care Partnerships: Services provided by different parts of the health and social care system need to be better integrated to improve the quality of experience for patients and clients as well as improving safety and outcomes. A key aspect of this is making it simpler to use the system.
Integrated Care Partnerships will join together the full range of health and social care services in each area including GPs, community health and social care providers, hospital specialists and representatives from the independent and voluntary sectors. 9

10. Nursing? Ready for the challenge? Ready for the change? My role ?
Your role ?

11. The Law of Constituent Balance.
Demand
Capacity
The Law of Constituent Balance.
The system is generally in balance. 11

12. Change nothing and capacity
Demand
Change nothing and capacity
cannot meet demand
When things get out of blance – we canot meet demand – we blame – we have a power struggle – we punish
Where possible the imbalance should be exploited to create situations for change. 12

13. The Law of Leverage “Give me a lever long enough and a fulcrum
on which to place it,” said Archimedes,
“and I shall move the world.”
Maximising the return on effort by changing the things that will produce the greatest results
Finding tyhe right lecvres and psuhing them hard enough
To exploit the law of leverage you must begin with a wide field
Most of us are blind in one eye – others change not us 13

14. Demand
Capacity
Change the context
Change the practice

15. Demand
Capacity
Maintain the Fulcrum
Maintain the Values

16. My Role – Your Role Courage in the face of challenge
Help change the context
Maintain the fulcrum
Courage in the face of challenge

17. The Change The law of momentum – liberating the energy to drive change
Change is work – work requires energy
Where do we get the energy from?
How do we get restarted?
How do we create sources of energy as well as results?
Change must build sources of energy as well as produce results
If you don't go forward you will slip back 17

18. The Change The Law of feedback and adjustment
There are limits to the predictability of change
Bottlenecks to improvement will create new bottlenecks
You may gain or lose courage!
Need to look at response and adjust
Never loose sight of the impact on others

19. The Change The Law of Leadership
Exploiting imbalance +
Focusing on high leverage opportunities +
Generating momentum
Are intensified and accelerated by the personal example of a change leader
In chemistry small amounts of catalst intensify and accelerate reactions in much larger masses. 19

20. The Caution
We pay too much attention to grand themes and too little on fleeting moments’
If we were to combine all of those little changes, we would end up with a different and better world’
(Gladwell 2006)

21. What do we need to do? Design person centred services
Work in partnership
Recognise the value of innovation
Prompt change in service and practice
Nurture and energise talent
Plan for the future – succession planning
Hold to each other account
Create a safe space for innovation – allow some risk taking
Enable organisational agility – gives employees room to explore their full potential
Broadening perspectives – elicts new ideas
Promote and reward collaboration
Celebrate success and learn from setbacks
Push boundaries

22. What do you need to do? Open your mind to new ways of working
Set high expectations
Remember small things matter
Draw a line
Not once….

23. Transforming Your Care
Some is not a number
Soon is not a time
(Berwick 2008)