Transforming Your Care
Strategic Overview –
turning the vision
into action
Emma Holden
May 2014
What is “Transforming Your Care”?
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.
What is our vision?
Putting the
individual at centre
Accessing services
in a different way
Population and
evidence based
planning of
services
Focussing on
prevention and
tackling
inequalities
Integrated CareWorking Together
Promoting
independence and
personalisation of
care
Making best use of
our resources and
ensuring
sustainability
Incentivising
innovation at a
local level
Maximising the use
of technology
SocialCareProcurement
How are we delivering the vision?
AcuteInpatientMentalHealthUnit
Community Information
Integrated Care Partnerships
MaternityStrategy
Community Capacity
Service/WorkforceModelling
• 17 Integrated Care Partnerships established across Northern Ireland
Reablement
HealthAnalytics
Carers
Day Opportunities
• Collaborative Networks
• Trust AHP representation on each ICP committee
Radiology
• AHP Input to the ICP Multi Disciplinary groups
PhysiotherapySelfReferral
• AHP Federation NI arePrimaryCardiacInterventionServices
members of the ICP stakeholder
ProjectEcho
reference group
Ambulance Protocols
WebPortal
Project Echo Western Area
Stroke
• Focus on Clinical Priorities –
some examples of recent investment:
IntegratedCarePartnerships
IntermediateCare
DomiciliaryCareReview
Southern Area
7DayWorking DeliveringChoicesProgramme
• Temporary appointment of
• Appointment of a Diabetic
NeedsAssessmentforOlderPeople
SelfDirectedSupport
two Physiotherapists to the
Podiatrist to provide
PrimaryCareInfrastructure
Respiratory
Early
educational training
and Foster Carers
Specialist
HospitalNetworks
Supported Discharge e-Health awareness
to GP Practices.
StatutoryResidentialHomes
ElectronicCareRecord
team
How are we delivering the vision?
AcuteInpatientMentalHealthUnit
SocialCareProcurement
Community Information
Health and Care Centres
Stroke
MaternityStrategy
Reablement
HealthAnalytics
Community Capacity
Service/WorkforceModelling
Carers
Day Opportunities
• Investment in primary care infrastructure through Hub and Spoke
configuration
• Many services that currently require a hospital visit will be available
locally at the hub, such as:
Radiology
PhysiotherapySelfReferral
• outpatient assessments
for
long
term
condition
clinics
PrimaryCardiacInterventionServices
ProjectEcho
• minor surgery
Ambulance Protocols WebPortal
• diagnostics (such as x-ray and ultrasound)
IntegratedCarePartnerships
• range of AHP services
IntermediateCare
DomiciliaryCareReview
• Project
Portadown,
Belfast,
on-going
development
Ballymena,
Banbridge,
Echo
Omagh, Newry and Lisburn7DayWorking DeliveringChoicesProgramme
NeedsAssessmentforOlderPeople
• SelfDirectedSupport
For example, new HCC inPrimaryCareInfrastructure
Newry will see investment in specialist
Specialist Foster Carers
facilitiesHospitalNetworks
for Physiotherapy,e-Health
Hydrotherapy, Podiatry,
Dietetics,
ElectronicCareRecord
Speech and Language Therapy, OrthopticsStatutoryResidentialHomes
SocialCareProcurement
Community Information
7 Day Service
AcuteInpatientMentalHealthUnit
How are we delivering the vision?
MaternityStrategy
Reablement
HealthAnalytics
Community Capacity
Service/WorkforceModelling
• Aim to introduce 2014/15 at each large hospital site, including 7 day
proactive management
IntegratedCarePartnerships
Stroke
Carers
Day Opportunities
Radiology
• Support from
PhysiotherapySelfReferral
• 7 day diagnostic service
PrimaryCardiacInterventionServices
ProjectEcho
• Social Care
Ambulance Protocols WebPortal
• Allied Health Professionals
IntermediateCare
• Benefits
DomiciliaryCareReview
Project
• Echo
Support early discharge
7DayWorking DeliveringChoicesProgramme
• Improve patient flow NeedsAssessmentforOlderPeople
SelfDirectedSupport
• Improvements
in morbidity
and mortality
PrimaryCareInfrastructure
Specialist Foster Carers
HospitalNetworks
ElectronicCareRecord
e-Health
StatutoryResidentialHomes
AcuteInpatientMentalHealthUnit
SocialCareProcurement
How are we delivering the vision?
MaternityStrategy
Community Information
• Benefits
Project
Echo
• Progress
Carers
• What is self referral?PrimaryCardiacInterventionServices
to date
Radiology
PhysiotherapySelfReferral
ProjectEcho
Ambulance Protocols
TYC WebPortal
IntegratedCarePartnerships
IntermediateCare
Stroke
HealthAnalytics
Day Opportunities
• Regional Context
Reablement
Community Capacity
Service/WorkforceModelling
Self Referral Physiotherapy
DomiciliaryCareReview
7DayWorking DeliveringChoicesProgramme
SelfDirectedSupport NeedsAssessmentforOlderPeople
HospitalNetworks PrimaryCareInfrastructure Specialist Foster Carers
• Opportunities
e-Health
StatutoryResidentialHomes
ElectronicCareRecord
How are we delivering the vision?
MaternityStrategy
Community Information
Ambulance Protocols
Community Capacity
Service/WorkforceModelling
• Supporting people to remain at home
AcuteInpatientMentalHealthUnit
SocialCareProcurement
Reablement
• AHPs key to success - led by Occupational Therapists
HealthAnalytics
Carers
Day Opportunities
• Aims to help people accommodate their illness or condition by
Radiology
relearning skills necessary for daily living
PrimaryCardiacInterventionServices
PhysiotherapySelfReferral
ProjectEcho
Stroke
• Benefits
Reablement
WebPortal
• On discharge from the
reablement service, users
need less/no
IntegratedCarePartnerships
support than when they
initially contacted HSC services
IntermediateCare
DomiciliaryCareReview
• Promotes independence
Project Echo
• Improves outcomes7DayWorking DeliveringChoicesProgramme
NeedsAssessmentforOlderPeople
• Avoidance of unnecessary
hospital admission
SelfDirectedSupport
HospitalNetworks PrimaryCareInfrastructure Specialist Foster Carers
e-Health
• Full coverage in Northern/Belfast/South
Eastern Trust areas,
StatutoryResidentialHomes
ElectronicCareRecord
partial in Southern/Western
How are we delivering the vision?
AcuteInpatientMentalHealthUnit
MaternityStrategy
SocialCareProcurement
Reablement
Day Opportunities
Improves patient safety
HealthAnalytics
Community Capacity
Service/WorkforceModelling
Improves Quality of Patient Care
Community Information
Connecting Health and Social Care across Northern Ireland
Radiology
PhysiotherapySelfReferral
PrimaryCardiacInterventionServices
Stroke
Carers
• 10,000 registered users
ProjectEcho
• Currently 8% users made up of AHPs
Ambulance
Protocols
• Used in the
provision of WebPortal
care to over
Reduction in Duplication of
diagnostic laboratory and
250,000 unique patients - around 14% of
IntegratedCarePartnerships
radiological testing
the N.I. population.
IntermediateCare
DomiciliaryCareReview
•
Initial
focus
on Acute- now branching out
Project Echo
Reduction in phone calls required
in
7DayWorking
DeliveringChoicesProgramme
to community teams
accessing clinical information
SelfDirectedSupport NeedsAssessmentforOlderPeople
• 250,000 Radiology Reports Viewed
Specialist
Foster
Carers
• 2.5 million Cumulated
Laboratory
results
HospitalNetworks PrimaryCareInfrastructure
e-Health
• 800,000 Episodic
Encounters accessed
StatutoryResidentialHomes
ElectronicCareRecord
Better Clinical Outcomes
PrimaryCardiacInterventionServices
AcuteInpatientMentalHealthUnit
MaternityStrategy
SocialCareProcurement
Community Information
Reablement
Radiology
PhysiotherapySelfReferral
ProjectEcho
Ambulance Protocols WebPortal
IntegratedCarePartnerships
IntermediateCare
Stroke
HealthAnalytics
Community Capacity
Service/WorkforceModelling
Project Echo
Carers
Workforce
Day Opportunities
How are we delivering the vision?
DomiciliaryCareReview
7DayWorking DeliveringChoicesProgramme
SelfDirectedSupport NeedsAssessmentforOlderPeople
HospitalNetworks PrimaryCareInfrastructure Specialist Foster Carers
e-Health
StatutoryResidentialHomes
ElectronicCareRecord
How do you contribute to change?

Vital to our system

Be the voice to support change

No neutral decisions – standing still isn’t an option

Change takes time

Show clinical leadership – everybody's
responsibility or no-one’s