Corporate Plan 2013/14-2015/16

Corporate Plan 2013/14-2015/16 1

Contents 1 Introduction...3 2 Overview of the Trust 6 3 Our Vision, Values, and Principal Objectives...9 4 Strategy for Health and Social Care Services.12 - Long Term Conditions - Promoting Health and Well Being - Services for Older People - Mental Health and Disability Services - Childrens Services - Maternity and Child Health Services - Acute Hospital Services - Palliative care & End of Life Services 5 Quality and Standards. 35 - Quality and Risk Management - Standards and Targets - Productivity and Efficiency - Workforce and Skills - Communication and Involvement 6 Workforce and Skills.39 7 Communication and Involvement..42 8 Financial Strategy.......46 9 Capital Development...48 10 Publication and Further Information.52 Appendix I Action Plan and Timescales 54 II III Accountability Arrangements and Monitoring Progress 73 Trust Board, Directors and Committees...74 2

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1. Introduction The Northern Health and Social Care Trust is responsible for the delivery of safe and effective health and social care services to the population of the Northern Trust area in Northern Ireland (a map of the Trust area is on page 7). This requires, above all else, the commitment of a highly skilled and professional workforce. Health & Social Care services are delivered against the backdrop of a growing and ageing population and increasing demand for services as our population, like N Ireland as a whole, faces an increasing level of long-term conditions such as diabetes and respiratory disease. Our population is also better informed than ever before, and seeks access to the best interventions in health & social care. This means we must work with our staff to adopt best practice throughout our services, and with our partners to provide high quality services that provide good experience for patients and clients, and represent provide good value for money for the substantial investment made by the taxpayer. The recent regional review of health and social care services, Transforming Your Care (TYC), sets out the strategic direction for change in the way services are delivered. TYC describes why services need to change regionally and how they will change, and the Trust along with the Northern Area Local Commissioning Group, have developed a local service change plan that will see those changes delivered locally, taking account of local needs and particular local issues. This Corporate Plan sets out the service changes planned that will be subject to local consultation and looks at the arrangements needed to ensure we create an environment that enables the changes to happen. This includes effective support to staff, underpinning governance and risk management and maintaining service continuity. This plan continues to build on work that commenced in 2009, including a range of significant changes in the delivery of health and social care in the Northern area. For hospital services, we need to ensure that acute hospital resources are focused on patients with acute needs. Antrim Hospital has had little investment since its construction, but is set to benefit from investment in a new 24 bedded ward and a new Emergency Department, due to open in April and July 2013 respectively. This will provide much needed additional physical space for the development of alternatives to hospital admission. This will sit alongside a strong working partnership with GP colleagues to develop stronger community services that better support high quality, responsive care at or close to home, and reduce demand for hospital services. For Causeway Hospital, at the time of writing, the Minister has confirmed that there will be an option appraisal process on the future of Causeway, to be complete within 6 months. The Trust believes that the future of Causeway is best served by remaining part of the Northern Trust, providing acute services to over 100,000 people all year round. We will represent that view during the option 4

appraisal process, and will continue to work to develop services at Causeway that best serve our population, irrespective of whether management responsibility for Causeway changes following the option appraisal process. Some of the most far reaching changes in service are required in community based services to ensure we can continue to meet the needs of our population in the years ahead. Transformation has begun in Mental Health services, with increased community based support and care, and fewer hospital admissions; this will continue. Similarly, increased independence for those with a physical disability, or a learning disability requires a shift towards better, more varied support for independent lives. Our transformation journey has begun; there is a way to go. This picture presents in all services, with increased appetite for independence and the variety that individuals require, rather than reliance on one size fits all institutional services. We are confident in the skills, professionalism and compassion of our workforce. We acknowledge the challenge of harnessing their passion, and working with our staff and partners in care to ensure we constantly improve services in ways that make sense to staff, partners, and to patients, clients and carers. Bob McCann Chairman Sean Donaghy Chief Executive 5

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2. Overview of the Trust The Northern Health and Social Care Trust was established on 1 April 2007 under the Northern Health and Social Services (Establishment) Order (Northern Ireland) 2006. The Headquarters of the Trust are located at The Cottage, 5 Greenmount Avenue, Ballymena, Co Antrim, BT43 6DA. Map of NI showing the Northern Health and Social Care Trust The Health and Personal Social Services (Northern Ireland) Order 1991 Article 10(1) defines the nature and function of the Trust. As well as being the primary provider of health and social care in the area, the Trust is also a major employer with over 12,000 directly employed staff and many more involved through service contracts with independent providers such as Nursing Homes. The Trust provides a wide range of hospital, community and primary care services. Working in collaboration with General Practitioners (GPs) and other agencies, staff deliver locally based services in Trust premises, in people s own homes and in community facilities. The Trust contracts for the provision of a wide range of mainly social care services including domiciliary care, residential and nursing care, provided from a large number of independent and community /voluntary sector organisations. Under these arrangements the Trust continues to carry responsibility for the delivery of the services. 7

The majority of the services provided by the Trust are provided in peoples own homes and in community settings including day centres, health centres and community hospitals. In total the community facilities are in excess of 200 locations. Acute hospital services are provided from Antrim Area Hospital, and Causeway Hospital in Coleraine. A range of hospital services are also provided from the Mid Ulster Hospital (Magherafelt), Whiteabbey Hospital, Dalriada (Ballycastle), Moyle (Larne) and Robinson (Ballymoney) hospitals. Holywell Hospital is an in-patient psychiatric hospital based in Antrim. It is the base for a wide range of mental health and addiction services. The Trust also provides mental health services from the Ross Thompson Unit in Causeway Hospital. Delivering safe and effective services which are accessible and responsive to the needs of patients, clients and carers is central to the Trust s role and we have a duty to ensure equality issues are taken into account in service planning and delivery. The Trust will ensure that the obligations set out under Section 75 of the Northern Ireland Act 1998 and the Human Rights Act 1998 are taken account of in Trust directly delivered services and reflected in contractual arrangements made with independent providers. The Trust also has the power to exercise statutory functions which embrace much of the activities undertaken by the Trust including the recruitment and employment of its staff, financial arrangements, contracted-out services and staff training, maintenance of its property and the delivery and development of services, including the purchase of equipment and facilities needed to do this. The Trust carries out its business in the following ways:- undertake assessment of needs developing strategies to address those needs setting and monitoring quality and performance standards carrying out reviews of service areas resource allocation and financial management developing service agreements with Commissioners of services human resource management in relation to its staff, and corporate, clinical and social care governance, ensuring and underpinning safe practices. The Trust has an annual budget of 600m and employs approximately 12,000 people. Funding is secured from a range of commissioners, the main commissioner being the Northern Ireland Regional Health and Social Care Board (HSCB). 8

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3. Our vision, values and principal objectives Our Vision Our vision is to provide for all, the quality of service we expect for our families and for ourselves so that people using our services (and their families) are happy with the care they have received and our staff want to work in and have pride in our Trust. Our Values Patients/clients first: Everything we do in the organisation is ultimately for the benefit of our patients and clients. Excellence: We will be recognised for the provision of safe, high quality, continually improving services. How we do business: We treat each other, our services users, carers and external partners with respect, dignity, honesty and humanity Principal Objectives We have established principal corporate objectives to give a structured, consistent and concentrated focus to our efforts: Objective 1: To provide safe and effective care Objective 2: To create a culture of continuous improvement that supports the delivery of health and social care that exceeds recognised quality standards and meets performance targets. Objective 3: To use all of our resources wisely Objective 4: To have a professional management culture with effective leadership, development of staff and teams that deliver Objective 5: To involve and engage service users, carers, communities and other stakeholders to improve, shape and develop services As we take forward this Corporate Plan for the next 3 years, we will aim to ensure that these objectives are met through: developing plans for local service reform that is in keeping with best practice and the direction set out in the regional plan Transforming Your Care ; 10

a continued focus on quality and effective governance and assurance; effective management and use of our funding ; empowering and supporting our staff; and effective engagement with services users and stakeholders. 11

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4. Strategy for health and social care services Introduction and context Transforming Your Care (TYC) is the regional strategic review of the delivery of health and social care services across Northern Ireland (published in December 2011). A public consultation process recently completed has sought views on the radical reshaping of services detailed in TYC. The recent publication of the Francis report, detailing the fundamental care failings at Mid-Staffordshire Trust, is a powerful reminder to ensure that the quality of care we provide is our over-riding concern and priority, and must be the overriding concern and priority of every team and individual working for the care of the population of Northern area. We believe that quality care is best driven by placing clinicians and care professionals at the centre of service development and oversight. We will continue to develop strong clinical and professional leadership in the Trust, working alongside GP leaders to place care quality at the centre of all our decisions. Transforming Your Care sets out key proposals for change across a range of service areas including mental health services, statutory residential homes, acute hospital services and primary care. The review outlines the reasons why the health and social care system needs to change, based on evidence of what is the most effective models of service. It promotes a model for integrated health and social care to drive the future shape and direction of the service. It identifies how a focus on prevention, earlier interventions, and the promotion of personalised care could enable more services to be provided in the community, closer to people s homes where possible, and achieve optimum outcomes for individuals and communities. We will work hand in glove with GP colleagues to manage the development of services together, and to govern our shared services for patients clients and carers with GPs to ensure they are high quality, cost effective and provide good experience for all those who rely on them. A key part of this is the development of local fully integrated teams that serve populations they know. This integrated local working is fundamental to securing the best value from the taxpayers investment. Local, integrated teams, acting with the authority of the full team to manage their resources locally, will be best placed to ensure services respond to local needs quickly and appropriately. The review details the impact of the new service model across a range of areas including the overall population health and wellbeing, services for older people, long-term conditions, physical disabilities, maternity and child health, family and child care, mental health services, learning disabilities, acute care and palliative and end of life care. It describes the implications for the health and social care system, and indicates how change would be implemented over a five year period. 13

This Corporate Plan considers the direction of travel set out by Transforming Your Care and describes how the Trust intends to shape those service changes locally, underpinned by strong staff and partner involvement in the reshaping of services. We are also committed to the meaningful involvement of patients, clients and carers in planning the future of Health & Social Care services in the Northern area. 14

Long term conditions: Moving services and resources to primary care and community settings Vision: Support people living with long term conditions to be actively involved in the management of their condition, and provide services at home and in local community settings by shifting resources away from hospitals to enable investment in community health and social care services Living with a long-term condition such as diabetes or heart disease brings challenges and it's important for the individual to have the confidence, support and information to take control of the condition, whether that s taking medicine prescribed or doing some regular exercise. This is an approach referred to self care and doesn't mean leaving the individual to manage on their own but is focused on empowering the individual by putting much more emphasis on providing support to individuals to help them cope with and manage the condition. People living with long term conditions can often need to attend hospital if they experience deterioration in their condition or have a number of other added complications. To help reduce or avoid the need for hospitalisation and improve the quality of life for the individual, more preventative and support services will be targeted towards individuals living with these conditions. Initial efforts will focus on heart failure, respiratory conditions, diabetes and stroke. A priority will be the frail older person, often living with multiple long term conditions, including dementia, and may also be at risk of a fall, with significant consequences. This emphasis on providing support to people with long term conditions outside of hospital will result in less people attending hospital emergency departments and needing admission. As a result we plan to shift the resources that would have been used in hospital to invest in more home based and community based services. To achieve this we need to reshape existing care pathways for long term conditions. This will require better co-ordination between services, particularly GPs and services provided by the Trust, as well as more explicit and deliberate use of the community and voluntary sector. The key way of achieving better integration between services will be the development of new formal partnerships called Integrated Care Partnerships (ICPs). ICPs will involve GPs, community specialists such as community nurses and occupational therapists and secondary care professionals, such as hospital Doctors. The ICP will set up a formal arrangement that will aim to better organise 15

care and services around the individual. It will focus on the local community, seeking to make the best use of all local community assets, through working with a range of partner organisations such as community pharmacies, independent sector providers, and local community/voluntary organisations. The Trust is supportive of capital investment to focus on local services through the development of up to 10 Health and Care Centres to act as hubs for community based services. This improved integration of services with a community and local approach, will allow more people to be supported at home and in their local community. This will be better for the individual and make better use of resources, both in the community and in the acute hospitals. Playing our part in the development of ICPs is a critical part of the Trust Corporate Plan over the next 3 years. 16

Promoting health and wellbeing Vision: Place more emphasis on preventing avoidable ill health and enable individuals to take greater responsibility for their health and wellbeing The earlier we start to promote healthier life styles, the more impact we will have to secure healthier future generations. Much of the ill health we treat comes from conditions that can be avoided or reduced by healthier life style choices. In the Northern area, approximately 1,000 people die prematurely each year due to preventable ill health. Based on the Northern Ireland Continuous Household Survey 2009/10, 24% of people aged 16 years and over within the Northern area smoke. While this is similar to the overall rate for Northern Ireland, it is a key area we must continue to tackle. The Northern area had the highest proportion of obesity related deaths when compared to other Trust areas (during the period 2006 to 2010), and alcohol misuse continues to account for a large proportion of all emergency healthcare attendances. These are just a few examples of areas that if effectively addressed can have a positive impact on both the quality of life for individuals and on future demand for healthcare. The Trust will work with other sectors including local communities, housing providers and educationalists to provide preventative support services and more education about the impact of life style choices such as smoking cessation and weight management. 17

Services for Older People Vision: Develop a greater range and choice of services for older people which will promote positive ageing, provide support to live independently at home and support to assist in managing a range of complex needs. Our population is growing and growing older. By 2020 we will see a 40% increase in the number of people aged over 75 years. While we are living longer we are living with more chronic conditions, including dementia. Acknowledging the changing profile of our population and reflecting older peoples expressed wishes, we plan to expand the range of services available to older people with an emphasis on supporting people to live at home. The expanded range of services will collectively aim to support people to live at home, avoiding the need for hospitalisation and long term permanent care. The range of services will focus on a number of levels: prevention; reablement and support; and response at times of crisis. Examples of the types of services being developed in each of these areas are described in the diagram below. 18

Preventative Services The vision for enabling and supporting our growing older population to live well, independently at home and in their local community, sees an increasing need to develop local community and voluntary sector organisations to provide targeted support to older people within their local community. The Trust plans to support the already established community and voluntary sector organisations across the area, with a focus on identifying and networking these local community initiatives towards supporting older people in local communities and within district council areas. The types of services provided include schemes such as befriending, help with managing the household and budgets, reminders about medications and appointments and reducing isolation. The evidence indicates that good social support and networks has a positive impact on quality of life and a sense of positive health and wellbeing. This is a vital part of a broad range of services all aimed at enabling positive aging. In order to know about and make best use of all our community resources and services, the Trust is exploring the design and development of a Contact Centre which will provide a point of contact that can provide fast and simple expert advice. Staff and the wider population will be directed to appropriate community and voluntary groups and other agencies, or directly to health and social cares teams for assessment and where appropriate, the provision of services. Reablement and Support Reablement is a short term, intensive care and support service delivered to people in their own home, generally accessed following a hospital admission or in the event of a health or social care crisis at home. The Trust will continue to provide domiciliary care services for those who need ongoing support at home and in these instances we will rely more on the independent sector for these services with the Trust in-house services concentrating more on the intensive short term reablement services. Intermediate Care provides a bed based service as a step-down from the acute hospital, particularly for older people who may need an intense period of recovery and reablement after an injury or illness. It can also be used as a step-up for someone who has been living at home but needs a short period of intensive support. The Trust plans to use a smaller number of intermediate care bed based facilities, moving from approximately 20 locations currently to 6 or 7 locations with a reduced number of beds. 19

Benchmark information from across the UK shows that our current intermediate care bed numbers ( 31 beds per 100,000 population) is higher than the GB average, which is 17 intermediate care beds per 100,000 (though these range from 15 to 27 per 100,000 depending on area). A new way of delivering the service will aim to reduce the beds numbers to a figure of approximately 24 beds per 100,000 population (a total of about 115 beds) and so we expect further phases beyond the initial steps will aim to reduce bed numbers further by providing more reablement and support at home. With dedicated input from medical, nursing and other allied health professionals, and a focus on enabling people who no longer require acute medical input, intermediate care facilities provide a short period of accommodation based reablement, assisting the individual to regain confidence and mobility. This type of service has a positive impact on patient outcomes as well as reducing the existing pressures on acute hospital beds, avoiding delaying the patient in an acute hospital when they no longer need that level of acute care. The Trust s community hospitals, Dalriada (Ballycastle), Robinson (Ballymoney), and Moyle (Larne), as well as some intermediate care provision at Mid Ulster Hospital (Magherafelt) and Whiteabbey Hospital provide the main facilities for delivering intermediate care services. These are added to use of independent sector based beds (private nursing homes) and some use of Trust residential care homes where beds are available. The local community hospitals will continue to play an active role in local care provision, along side some use of the independent sector, while local Integrated Care Partnerships get established and begin to consider how they can best provide services locally. While buildings are important our emphasis will be about developing local services that are accessible and responsive, and meet local needs. ICPs will no doubt seek to take account of, and make best use of all local community assets, including buildings and infrastructure and through working with a range of partner organisations such as community pharmacies, independent sector providers, and local community/voluntary organisations. While the independent sector will continue to provide residential care, in keeping with Transforming Your Care, the Trust intends to move away from providing Trust run residential care homes. The results of a needs assessment exercise indicated that the majority of people being admitted into residential care could have been maintained in their own home if appropriate support had been available. Through more home care services there will be a reduced need for residential care and across the Northern area there are already a significant number of residential care homes provided by the independent sector. There are currently nine Trust run residential homes providing services for older people with 154 residents. Our homes are highly valued and have served 20

the population well for many years and so great sensitively will be taken in managing the transition away from Trust run facilities. Significant progress has already been made in a number of localities to provide alternative home based services and develop new supported living facilities. Plans are well progressed in Ballycastle and Greenisland to develop supported living schemes to provide accommodation, with care and support, for frail older people. A process of consultation will be planned across the other localities with existing Trust run residential care homes to help identify the requirements for future services in each locality, working closely with older people, their families and carers. Throughout the process great care will be taken in reassuring existing residents about our commitment to their continued care. An on-going programme of modernisation of day care services will ensure the adoption of a reablement ethos within day care. Historically day care has been seen as a long term care service and while some people will continue to need and benefit from long term access to day care, it too can adopt a reablement, independence focused approach so that some people may make use of it for a short period to help them regain independence. Over time as services change and people use them in new ways, we will review the use of the buildings to ensure we are making effective use of these resources. Technological advances add a further level of support to people living with long term conditions and those with physical or cognitive impairment. With the number of people over 75 years in Northern Ireland expected to rise by 40% by 2020 and the population of over 85 year olds increasing by 58% by 2020 we will seek to make best use of advances in technology to help people live well and safely at home. This allows individuals living at home for example to monitor and submit readings (such as blood pressure, heart rate) to specialists who can interpret these and determine if any adjustment to treatment is needed. Crisis Response For an older person managing to live well and independently at home, a crisis such as bereavement, the loss of carer or a brief illness can have significant consequences. Permanent decisions about a person s future needs should not be made on the basis of a crisis. A prompt response and support could allow the person to become independent again very quickly. Primary care, community services and acute services will work together to develop a range of services that can respond promptly to particular needs, such as toileting support or enabling the individual to get a small piece of equipment. Another option is access to an intermediate care bed for a short period. These are examples of ways of giving some immediate support to help get through the crisis, so that longer term decisions can be made when the person is back to their best. 21

When older people do need to have an admission to hospital we will aim to help get them home as soon as their medical needs have been met, as evidence shows that this provides the best outcome for individuals. Mental health services will develop and provide Psychiatric Liaison Services for older people who are in hospital to ensure improved inpatient care for example for people living with dementia - and as a result, improve the patient s experience of hospital and achieve a more timely discharge. This expanded range of services will collectively aim to support older people to live well and independently at home, with support when needed, and reduce the need for hospitalisation and long term permanent care. 22

Palliative Care and End of Life Services Vision: Develop a person-centred, integrated and holistic approach to service planning and delivery in relation to palliative and end of life care with the key focus to ensure that all patients receive high quality reliable care and retain control, choice and dignity to the end of their life. To achieve this we will be guided by the recommendations outlined in Living Matters, Dying Matters a Palliative and End of Life Strategy for Adults in Northern Ireland (DHSSPSNI, 2010), reflected in, and sustained through, the NHSCT Palliative and End of Life Service Improvement Plan. Whilst the strategy provides a vision and direction for service planning and delivery, to make this vision a reality and to drive forward the service improvement expectation, requires ownership, leadership and engagement at all levels of policy, planning, commissioning, education and delivery. Significant progress has already been made in all of the areas outlined within the strategy. These include raising public awareness, education for staff involved in providing care, and the development of systems and processes to support patients and families in receipt of palliative care services. Our sustained focus will seek to ensure that patients, from diagnosis to the advanced non-curative stage of disease and for all long term conditions and cancer diagnosis in any setting, live well and die well. This will enable patients and families to retain control, dignity and choice in how and where their care is delivered. Integrated Care Partnership development will provide a mechanism for integration which will support the development of interdependency between services across primary and secondary care, independent sector and local community and voluntary organisations. 23

Mental Health and Disability Services Vision: Provide person centred services that offer appropriate treatment, therapies, care and support to enable people with a wide range of mental health problems and disabilities to live more independent and fulfilling lives. Mental Health Services The reform of mental health services has been driven for a number of years by the vision of the Bamford Review. Much has already been achieved and we will continue to develop improved community based services, helping people to remain at home or in their own communities whilst they receive treatment and support. This means working closely with primary care to maximise opportunities for early interventions, enhancing services for people with severe and enduring mental health problems, reducing dependence on hospital admissions through appropriate community services and the resettlement of individuals who have lived for lengthy periods in hospital. Early Intervention There will continue to be an emphasis on early interventions, and a shift away from over reliance on medications towards a greater range of therapeutic interventions for people with mental health conditions. A focus on early intervention will include developing an Early Intervention in Psychosis Service targeted at those aged 16 to 35. Appropriate Hospital Facilities Where hospital treatment is required, then inpatient care must be of a high quality and provided within a therapeutic environment. To this end we will complete a business case to secure capital funding for a replacement acute inpatient mental health facility. To date an outline case has been agreed for a 160 bedded inpatient facility in the Antrim area. A full business case will now be developed. Meanwhile we will continue to improve the quality of recovery based inpatient care through the development of ward based teams and advocacy support services. The number of inpatient beds will continue to reduce as we develop alternative community services which reduce demand for hospital admissions and support people resettled from long term hospital care. 24

Community Mental Health Services To support the shift towards home and community based provision of care, community mental health teams for adult older people (to include people with dementia) will be further developed so that assessment, treatment and support can be effectively provided within community settings, both in terms of longer term support and in response to crisis situations. We will work with the voluntary and community sectors, to strengthen recovery pathways and to support service user involvement in their own recovery. Residential and Supported Living We will work with the Northern Ireland Housing Executive and Supporting People to maximise opportunities to extend existing provision including the use of floating support models (support to people in their own home). We will develop a range of supported living options working with statutory and independent sector partners. This will include replacement accommodation for the current Ballymena and Antrim supported living accommodation, a new supported living scheme in Magherafelt and the development of a new supported living scheme in Newtownabbey to replace the current residential accommodation in Moylinney House. A consultation on this latter proposal commenced in February 2013. We will also work with statutory and independent sector partners to develop modern and innovative supported living options to suit the individual needs of people who have lived for a long time in Holywell hospital. This will be prioritised to achieve the regional objective of no one living in a hospital setting by 2015. Learning Disability Services The reform of learning disability services is underpinned by the Bamford Vision as set out in its Equal Lives report. Much has already been achieved with the resettlement of individuals living in long stay hospitals and the development of community learning disability services including respite and day opportunities. Much remains to be done and future plans will continue to aim to empower people with a learning disability and support their carers based on the principles of social inclusion and community integration. A number of service changes will be taken forward across the following areas. Day Opportunities Day opportunities and centre based services will be further reviewed and refined to meet the needs and wishes of service users and their carers. In 25

addition, work will be undertaken with service users and carers to ensure staff skills reflect the changing needs of service users. We will review the provision of buildings based services commensurate with the levels of activity, demand and locations. Respite Respite is a vital and valued resource for carers. We will review the range of respite provision in the Trust so that we develop more choice and flexibility for respite users. We plan to do this by increasing the development of host carers and other innovative options and as a consequence there will be a reduced reliance on bed based respite placements. Where bed based respite is used it will be increasingly focused on patients with complex health needs including challenging behaviour. Community Living There will be an increased focus on the use of adult placements which will include moving clients who do not have specific assessed needs for institutional care into long term family placements, as appropriate to the needs of the individual. A number of patients currently living in Muckamore Abbey Hospital who could benefit from resettlement into the community have been identified. Suitable placements will be commissioned and sourced within the Northern area, based on the principle that everyone should live in their own home in the community, with the exception of individuals assessed as specifically requiring nursing or residential care. Physical and Sensory Disability Services There is a need for improved integrated planning across the statutory and independent sectors that ensures recognition of disability, promotes social inclusion in all aspects of life to enable people with disability to participate more fully within society. The Trust plans to take forward a number of service changes that will aim to further enable and empower people living with disability. Partnerships We plan to further develop partnerships with statutory bodies such as Supporting People (Housing Executive) to maximise housing support options such as floating support services and peripatetic services. We will also work together to ensure 26

the wide spread recognition of disability equality and the promotion of social inclusion, to enable people with a disability to participate fully within society This partnership working extends to the community and voluntary sector that play a vital role in supporting individuals and we plan to further develop services such as befriending and support networks. Empowerment Direct Payments (or personal budgets) is one way that enables individuals to create and buy their own service packages, enabling choice and independence. We plan to extend this option and help people to use this approach if they would wish to. More use of home based services to assist individuals in managing their medical conditions will be pursed. This will include the increased use of telehealth and telecare solutions at home. Access continues to be an issue for people with physical and sensory impairment. We will continue work to improve access to statutory buildings, services and amenities and appropriate parking and access at service delivery facilities. 27

Children s Services Vision: Place a focus on preventative services that support children to flourish within family settings, where parents are helped to develop the skills and abilities to care for themselves and their families, and those children vulnerable to abuse are protected and effectively supported In order to protect and nurture our children, health and social care must focus on the needs of children and the needs of the family, acting to support the child in the family setting as far as possible, and taking steps to protect children when that is not possible. Evidence indicates that a shift of focus from crisis management and interventions to preventative services can be more effective in these aims and this is the direction of travel we intend to develop. This will necessitate a change in the skill mix of the social care workforce, on the basis that social care staff will increasingly undertake preventative work with families and children. Providing care and support in family settings As preventative interventions increase, there will be a reduced need for residential care homes for children and young people in the Northern area. There will be a continued drive to engage more foster carers and in supporting foster carers to develop a broader range of foster caring skills, in order to provide supportive family environments for children and young people within their own local communities. There will be improved utilisation of existing bed based respite services and we intend to expand capacity in family based respite services for children with complex and disability needs. Mental health services for children A strategic review will be undertaken within the Child and Adolescent Mental Health Service (CAMHS) to review the current service model and compare it with models of best practice. This local review will take on board the recommendations outlined in the Regional Quality Improvement Authority (RQIA) CAMHS Review (2012) and the forthcoming DHSSPS Policy Guidance for CAMHS. 28

The reshaping of the service will require a focus on prevention and early intervention, along with the establishment of Crisis Response and Intensive Home Treatment Service as part of Tier 3 (intensive intervention service) services. There is a need to take steps to further streamline and integrate the CAMHS services with Child Development and Behavioural Services so that children's health and social services are developed into a more coherent, collaborative system of care. 29

Maternity and Childhealth Services Vision: Develop a model of local maternity services that is safe and sustainable in the long term and provides mothers with a range of choices depending on their particular needs, working to the strengths of community midwifery led services where appropriate, and consultant led services where necessary to support more complex needs. The future model of inpatient services must take account of links between maternity and paediatric services and the links between the broader acute hospital profile including anaesthetics and critical care. Maternity Services The Regional Maternity Strategy leads towards what s termed the normalisation of birth, with more choice for women with each consultant-led unit having an 'alongside' midwife-led unit. 'Normalisation' of pregnancy and birth has the potential to reduce unnecessary interventions and improve outcomes for mother and baby. The Trust currently has consultant led units at both the Antrim and Causeway Hospitals. The service on both sites is currently safe for the immediate future. Given the number of births and the development of a greater range of choices for women and the need to promote and support the normalisation of birth, the Trust must consider if the two sites can continue to be sustained in the longer term. In the interim, the Trust will explore the development of midwife-led care on both sites to provide accessible, high quality, sustainable and effective maternity care. In-patient Maternity Services Pregnancies that have the potential to present complication for mother and baby can be best provided for in consultant led units. For other cases, midwife led care at home or within a midwife led unit is promoted. Consultant led units are reliant on working closely with acute hospital paediatrics and anaesthetics services and so the overall profile of services at a hospital site has implications for a range of services. The Trust plans to review maternity provision for the Northern area identifying the most appropriate configuration of services to meet the needs of the local population and develop choice for women. This will include midwife led units alongside consultant led units and will take on board guidelines set out in the Regional Maternity Strategy. 30

The local maternity review will consider the co-dependencies between maternity services, paediatrics and anaesthetics and seek to promote the involvement of GPs and other professionals within an Integrated Care Partnership model to create local sustainable services and will also consider the regional pathway for specialist services. While we review the model of services for the longer term, we plan to introduce a quality and service improvement programme within obstetrics services that will include a focus on reduced interventions (such as caesarean section), and improved productivity and efficiency overall. Midwifery Led Care We plan to develop midwife led ante-natal clinics as a step towards mid wife led care for appropriate pregnancies (low-risk expectant mothers). Discharge from hospital will be suited to the individual needs of each woman. On leaving hospital women will continue to receive maternity care from their community midwives until discharged to the care of the health visitor when the midwife is content that this is appropriate. Paediatric Services Volumes of admissions are an important factor in the provision of training for professionals supporting acute paediatric units. Causeway Hospital has 1,500 paediatric admissions per year, with Antrim Area Hospital having 3,200 per year. As we look to the future we will need to consider staffing models that take account of skill mix, reduced reliance on training grade doctors, and a greater emphasis on community based paediatrics, with inpatient facilities to meet expected numbers of admissions. A review of paediatric services in Northern Ireland, with a particular focus on inpatient services, is expected to be taken forward and concluded by the regional Board (HSCB) over the next six to nine months. The model of in-patient paediatric services will need to take account of its links with maternity services. We plan to review the current service model for in-patient paediatrics with a greater emphasis on community based paediatric services and the development of an improved, dedicated acute in-patient paediatrics facility to meet the needs of children. 31

Acute Hospital Services Vision: Recognising that more non acute care will be provided outside of acute hospital in local community settings, and the need to ensure acute hospital services are able to meet demand and required care standards, we will aim to reprofile acute hospital services to develop a two hospital site model that is sustainable in the longer term and makes best use of local and regional acute resources Acute hospital services are a vital part of the overall profile of health and social care delivered by the Trust. Currently acute hospital services are mostly delivered on two hospital sites: Antrim Area Hospital and Causeway Hospital, Coleraine although day surgery, endoscopy, outpatient and diagnostics are provides on other sites across the Trust boundaries. Northern area residents also access acute hospital services in Belfast and, to a lesser extent, Craigavon and Altnagelvin. The challenge is to provide a model of acute services that is accessible, safe, sustainable and efficient so that the population of the Northern area can be assured of access to services that can deliver the quality outcomes and patient experience that must be achieved across the whole of the Northern Ireland acute hospitals network. While patients access services on an individual basis, it is very often the links between services that are key to ensuring effective, safe delivery and outcomes. For example, emergency surgery has a clear dependence on anaesthetics and critical care, and there are interdependencies between maternity services, anaesthetics and paediatrics referred to in other parts of this Plan. It is important too that the acute hospital service model is also seen within a regional context, on the basis that a regional approach will be required for some specialist services to secure the professional staff who can deliver the quality and optimum outcomes for patients. These include Trauma, Orthopaedics and Cancer services for example. Transforming Your Care (TYC) also makes it clear that that new ways of working will be fundamental to transforming the way we deliver services. Much closer working between hospitals and primary care for example will be essential to achieving the vision set out. Most significantly, delivering services outside of hospital settings where it is safe to do so will ensure acute hospitals services are focused on those patients with acute needs. 32

While we look to the future, we must still continue to make progress and therefore the planned expansion at Antrim Area Hospital must continue, as this both protects existing services and will provide additional infrastructure that will enable new ways of working and support improved patient experience. The new Emergency Department and 24 bedded ward will be complete at Antrim Hospital in spring of 2013. Work will then progress on using vacated space to enhance the delivery of acute hospital care. Furthermore a new build expansion is required to enhance outpatients, endoscopy and increase volumes and complexity of day surgery The regional TYC consultation has referred to the challenges faced by acute services, the challenges of meeting Accident and Emergency 4 and 12 hour performance standards in Antrim Hospital for example, and to the desire to find ways of sustaining services at the Causeway Hospital site. The Minister has committed to undertaking an option appraisal that will consider the future management arrangements of the Causeway Hospital. While there is no immediate threat to maintaining the current model, staffing issues on the Causeway Hospital site in particular have been identified as a potential risk, and this needs to be factored into our planning to ensure the continuation of safe services. The Northern Trust will be supportive of and seek to be actively involved in the option appraisal / review as it is in the interests of the whole health system to secure a service profile that can be sustained and effective. In the meantime the Northern Trust is committed to actively seeking to sustain Causeway Hospital as part of a two site acute hospital network to meet the needs of the population. The review of the future alignment of the Causeway Hospital is expected to commence and conclude in June 2013. In the meanwhile, the Trust will continue to pursue service improvements across both acute services sites, while mindful to this context. We will take forward the following plans: Unscheduled care The opening of the new 24 bedded ward and new Emergency Department at Antrim Hospital in spring of 2013, which will contribute to a programme to address the challenges of unscheduled care, particularly in improving performance against 4 and 12 hour targets in Accident and Emergency Acute and post acute rehabilitation We will review and plan to develop acute and post acute rehabilitation services to ensure we are maximising the opportunities for early commencement of rehabilitation so as to achieve the best possible outcomes for patients and to improve throughput in acute hospitals by reducing hospital lengths of stay. 33