A Review of Health and Social Care in Northern Ireland 1 Transforming Your Care

Case for Change 2

Key reasons for Change 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 3

Principles for Change 1.Placing the individual at the centre of any model 2.Using outcomes and quality evidence to shape services 3.Providing right care in the right place at the right time 4.Population-based planning of services 5.Focus on prevention and tackling inequalities 6.Integrated care- working together 7.Promoting independence and personalisation of care 8.Safeguarding the most vulnerable 9.Ensuring sustainability of service provision 10.Realising value for money 11.Maximising the use of technology 12.Incentivising innovation at a local level. 4

Model – Integrated Health & Social Care 5

6 Key Recommendations – Population health and wellbeing Renewed focus on health promotion and prevention to materially reduce demand for acute health services. An expanded role for community pharmacy in the arena of health promotion both in pharmacies and in the community. Maintenance of existing and implementation of new screening and immunisation programmes where supported by clinical evidence. Support for the health promotion and prevention role played by Allied Health Professionals, particularly with older people. Incentivisation of Intergrated Care Partnerships to support evidence based health promotion, for example, clinician-led education programmes in the community.

Key Recommendations – Older People Move towards independent living – at home or in supported housing. Promotion of Direct Payments scheme. Reduce nursing and residential places. Increase support services for carers. Extension of reablement schemes to reduce hospital stays for older people. Increase the use of Independent/Voluntary sector. 7

Key Recommendations – People with long term conditions Emphasis on prevention and the promotion of healthy living options. More focussed use of GPs with a special interest (GPSIs). Support for self-care approaches.Use of new technology – telemedicine/ electronic care record (ECR). Personal care planning.GP direct hospital admissions. A multi-disciplinary approach – coordinated through GP surgeries. 8

Key Recommendations – Physical Disability Greater role for the voluntary and community sectors in providing support services. Promote Direct Payments. Joined-up approach, working with other Government departments. Increased support for carers. 9

Key Recommendations – Maternity and child health An increase in choice for women for childbirth. A regional review of inpatient paediatric care. A need to address public health and social issues for women. An extension of childhood screening programmes. Better education to support good parenting. Closer working between hospital and community paediatricians. 10

Key Recommendations – Family and child care Emphasis on new Headstart programme for 0– 5 years. Strengthening CAMHS services. Early intervention – family support model. Increase use of fostercare resulting in a move away from residential care. Promotion of positive parenting. 11

Key Recommendations – People using mental health services Greater emphasis on early intervention. An increased role for the voluntary/ community sectors. Better access to information on services. Continued resettlement from institutional settings resulting in the closure of longstay institutions – savings re-invested in community programmes. Better promotion/ uptake of Direct payments. 12

Key Recommendations – People with a learning disability Increased emphasis on early intervention. The development of a wider range of day support services. The promotion of Direct Payments to provide a greater level of financial control for individuals. The closure of longstay institutions by The development of better information resources. 13

Key Recommendations – Acute care Establish a Northern Ireland-wide trauma network with RVH as the hub, RVH should become a regional trauma centre. Consider establishment of emergency telephone number other than 999; professional advice, redirect to appropriate service. Move towards having between 5 and 7 acute hospital facilities or networks. A managed clinical pathway for pathology. Better, more targeted communications on the range of unscheduled services, appropriate to need. Range of care services available closer to home – GPs to handle some outpatient appointments. Direct admissions for chronic conditions. More procedures undertaken as day cases. Pivotal emergency care management role for NIAS. Clinical networks supported by use of new technology – diagnostics/ telemedicine. 14

Key Recommendations – Palliative and end of life care The development of a palliative care register. Introduce electronic patient records. Reduce inappropriate hospital admissions for those approaching end of life. Additional palliative care support for the nursing home sector. 15

Roadmap for the Future Population Planning Process 16