With permission Mr Speaker, I wish to make a Statement to the Assembly on the outcome of the consultation exercise on the proposals contained in 'Transforming Your Care: Vision to Action'.
Members will recall that I first presented the ‘Transforming Your Care', report to this Assembly on 13 December 2011.
Since then there has been considerable work taken forward to develop these proposals into detailed plans which would provide the basis for the transformation set out in TYC over the next 3 to 5 years.
These draft plans were made available publicly when I made my Statement to the House in July. Following a process of quality assurance I announced the launch of the public consultation to this Assembly on 9 October 2012.
The consultation closed on 15 January this year and I now want to share with members the outcome of that consultation and outline the key stages moving forward.
Need for change
Firstly - let me remind members what Transforming Your Care is about – and why reform is needed.
In Northern Ireland, as in all health and social care systems, there are significant pressures which can only be addressed by radical change: a growing and ageing population; a growth in chronic conditions; a growth in demand and an over-reliance on hospital beds. There are also advances in medicines and technology which require us to innovate; we need to address growing public expectations about the need for high quality and compassionate health and social care services.
The Transforming Your Care report presented a compelling case for the reform of health and social care services and demonstrated a clear need to tackle the demand for services, which is predicted to continue to grow by around 4% a year until 2015.
The report set out strategic proposals that have the potential to make a huge difference to how we plan and deliver health and social care services both in the medium and the longer term. It described a new model for the delivery of integrated health and social care services focused on prevention initiatives and earlier interventions, and on promoting health and well-being. It also highlighted that more services should be provided in the community, closer to people’s homes where possible and that there should be more personalised care.
As I said in this House on 13 December 2011 in setting my vision for Health and Social Care Services my overriding concern was to drive up the quality of care for clients and patients, improve outcomes, and ensure that the patients and clients of our services have the best possible experience in every aspect of their care. I have not wavered from any aspect of that. I was clear when I made that first statement and I remain clear now, that this means that we need to think differently about how and where we deliver our services in face of increasing and changing demands. We need to stop doing those things that don’t work, we need to challenge out of date practices and we need to ensure the best value from every penny available to us and maximise the use of our skills bases, particularly in prevention and early intervention.
The Francis Report provides a stark reminder that quality of care must be consistently at the front and centre of all that we do. We all want the best quality care for our families – and that means care which is focussed on achieving the best outcomes for our patients and service users. This is embedded in the aims of Transforming Your Care and is at the core of my vision for our health and social care system.
In the face of these pressures and this compelling need for change, I believe that local commissioning has a critical and a powerful role to play in driving change and innovation. We need to ensure that care is provided in the right place at the right time by the right people. This means providing care nearer to the home and shifting services from the secondary setting into the primary and community setting.
Everything that has come to attention since the launch of the consultation reinforces the need for change - this is what TYC was about.
At its simplest this is about basic good management and planning. Unplanned change, and a lack of preparation, will inevitably result in poorer care and treatment with poorer health outcomes. Without a planned and coherent approach, we will not be able to meet future health needs and we will fail both patients and our workforce.
Healthcare is universal. It is one of the very few things which touch the lives of just about everyone in our population. The TYC proposals present a landmark change in the delivery of that care. Therefore, in order to drive change, we needed to listen - to patients and carers, to doctors and nurses, to staff and managers, indeed to everyone who felt they had something to say on the future delivery of health and social care. And that is exactly what we’ve done.
In October, I launched Transforming Your Care: Vision to Action. I asked people to seize the opportunity to make their voice heard as part of the consultation. After three months of engagement where every household in Northern Ireland was offered the chance to take part and where thousands participated through public meetings and through social media, the Health and Social Care Board has captured, analysed and summarised the public response in the post consultation report which is published today and is now available on the HSCB website. I have been heartened by the reaction and by the public endorsement of the transformation proposals.
It was very encouraging to see the number of professional bodies, voluntary and community sector representatives and other representative groups that took the time to canvass their membership and respond on the proposals.
I am grateful to all those who have taken the time to respond to the ‘Transforming Your Care: Vision to Action’ consultation.
The consultation revealed overwhelming support - some 97% of those who responded to the questionnaire – on the need for change. It also provided insight into the concerns of those who provide the services and the concerns of those who use the services.
The post consultation report which the HSCB has produced details the Board’s proposed responses to the views expressed in the consultation process. There are a number of areas in which I believe it is important to take immediate action now to drive transformation in key areas. In some other areas we need to take time to reflect on the views which have been expressed before final decisions are made – and I will say more about those shortly. But let me be absolutely clear that I do not want to see the transformation process slowed down in any way. Time is not on our side and we need to take action now to effect the changes that are so critically needed – and I intend to ensure that happens.
The consultation exercise has demonstrated clear support for the concept of changing the way in which health and social care is delivered in Northern Ireland. In many of the areas of the consultation the majority of respondents endorsed the need for change – but they also highlighted important issues that need to be addressed, to ensure effective transformation.
For example, there was recognition of the importance of promoting health and well- being and early intervention, building on “Fit and Well – a Ten Year Public Health Strategic Framework for Northern Ireland”.
The importance of the implementation of existing strategies and plans such as “Living Matters, Dying Matters”, the Palliative and End of Life Care Strategy for Adults in Northern Ireland” and the continued implementation of the Bamford Review were also highlighted.
Consultees also highlighted the importance of early, local intervention in relation to Mental Health issues and in that context I am pleased to be able to say that some £13 million is intended to be invested over the 3 years to 2014-15 to support the development of community care, prevention and early intervention activities and to continue the resettlement of existing long stay residents.
I am also pleased to advise that the HSCB now has plans in place for the completion of the resettlement of those in long term institutional care with Learning Disabilities by 2015. It is intended that £20 million will be invested over 3 years to cover the resettlement programme as well as in services to support the development of community care, prevention and early intervention activities. Care will of course be taken in resettlements to ensure this is done sensitively and in consultation with the individuals and their families.
As well as endorsing the need for change, the consultation highlighted several overarching issues that would need to be addressed to ensure full and effective transformation.
These included the need to enhance our support for carers. Consultees told us that we need to provide more information, provide more support and ensure the needs of the carers are considered fully when designing services. I will look to the Health and Social Care Board to ensure that this happens.
I can inform the House that at this point targets have been developed and set for 2013/14 to monitor the number of carers identified; the number of assessments offered; and the number accepted. In addition to this £500,000 has been invested to encourage innovation in the area of respite and short breaks.
The need to ensure that new service models were adequately funded and established before withdrawal of any services was also highlighted. This will need to be at the heart of the planning process moving forward so that, from a whole systems perspective, the transition to new arrangements will be as seamless as possible. I also want to assure our service users that even though today I am announcing a further step forward to the implementation stage of Transforming Your Care there will be no major service change without further specific consultation where that is appropriate.
Our workforce are key to our Health and Social Care services. The workforce is the single most important enabler for the delivery of transformation. We have a workforce to be proud of and it is incumbent on us to ensure we make best use of that workforce in this new model of care. It will be absolutely key to the success of this transformation that we give priority to ensuring that our staff are fully informed of service changes through meaningful engagement.
We already have in place a Regional Workforce Planning Group to co-ordinate this important work. A key element of that work will be the assessment of implications of proposed changes on training and development for various professions. A Service and Workforce Planning Tool will be introduced for use across all health and social care organisations to assist in this process. We need full and effective planning to ensure our workforce is equipped and trained to work in a new environment, where that is the case.
A further important issue raised was the need for more coordinated cross government working to monitor the impact of proposed Welfare Reforms on the lives of some service users and their health and social care services needs. Others have suggested that there should be closer working with local government or other bodies to improve service delivery and tackle health inequalities.
I agree fully that these are important issues which will require attention to ensure effective and coordinated delivery of services. Good communication, working together, learning from and encouraging each other are essential for effective service delivery.
Integrated Care Partnerships
One of the key recommendations in Transforming Your Care was the introduction of Integrated Care Partnerships – or ICPs. ICPs will enable local health and social care professionals and the voluntary and community sector organisations to work more closely together on a collaborative basis to improve efficient and effective service delivery. These multi-sector collaborative networks will include statutory, independent and voluntary and community practitioners and organisations in their membership and will come together to respond innovatively to the assessed care needs of local communities, provide support for service users closer to home; and avoid unnecessary visits to hospital.
There has been much work done to ensure clarity on how the ICPs will operate and where they will focus their energies in their formative stage. I have decided that their initial focus will be on the frail elderly and aspects of long term conditions for all ages – namely diabetes, stroke care and respiratory conditions.
ICPs will initially undertake two key strands of work. At a strategic level they will focus on improving care pathways locally and at an individual level they will undertake case management for those most at risk, improving their overall care.
I expect the HSCB to establish the first nine ICPs over the next few months and for all 17 ICPs to be in place by this time next year, providing full regional coverage. To enable this, it is intended that we will invest over £15m in the development of ICPs and improvement over the Budget period.
The leadership of the ICPs will reflect their multidisciplinary makeup.
I am aware of concerns raised by General Practice in regard to proposed revisions to the General Medical Services Contract for next year, combined with concerns about potential workload increases from a transfer of care under TYC from secondary to primary and community care. Each year there is an annual negotiation of revisions to the Contract involving the four Health Departments in the UK and the General Practitioners Committee of the BMA. Unfortunately it was not possible to reach agreement nationally with the General Practitioners Committee last year and each Health Department has therefore engaged separately with their respective GPCs on proposed changes for next year. I wish the dialogue with the GPC in Northern Ireland to continue in an effort to reach an acceptable agreement. I acknowledge the professionalism and efforts of GPs in Northern Ireland. It is vital that they play a full part in the transformation process to ensure it is a success. It is in the interests of patients, GPs and the Health sector as a whole.
I want to make it clear that my focus is to secure the best services for patients and clients across Northern Ireland. It is essential that every sector of the health and social care system plays a full and positive role to achieve the best possible outcomes for patients. GPs have an invaluable contribution to make to this process.
Residential Care Homes
A further area which attracted significant interest in the consultation process was the needs of Older People. Over 70% of respondents to the questionnaire agreed with the service proposals, however there was considerable interest over the provision of statutory residential care.
Our focus is on delivering better, targeted care for older people closer to home, which will enable them to stay at home and remain independent where possible. This will provide better services that people want and will reduce demand for residential care. I propose to reduce the number of statutory residential homes by around 50% over the next three to five years. As it stands today, some of our existing homes are no longer able to provide a sustainable service while others struggle to meet modern standards expected throughout the sector and require expensive capital work that would be better spent on models which offer a choice to older people.
This does not mean a reduction in residential homes provided by the independent sector. Where there continues to be a demand for these services, they should continue to be provided. However the planned reduction in the number of residential homes does signal our commitment to thinking outside of an institution led approach to health and social care provision, and to considering new opportunities for ensuring that care provision is service user led and committed to supporting our citizens to be able to stay at home where possible.
The majority of respondents told us that our older people prefer to be closer to home and we have set about making this possible. We intend to invest £3.2m in social care reform, including re-ablement over three years 2012-13 to 2014-15; we will provide an additional 479 supported living places over the same period; and we intend to invest £1m to train staff in nursing homes to support people at the end of their life.
I recognise the concerns of the public where facilities are proposed for closure. I know that for many individuals this is their home and the transition must be managed sensitively and with appropriate consultation with families and carers. As I have stated before, suitable alternatives must be in place before services are removed.
I know also that some people have expressed concern about the possibility of having to pay top up fees if they are transferred to an alternative residential home. I want to assure you that where a Trust is unable to secure a statutory residential place at the core rate of £550 and uses a higher rate place within the independent sector - then the Trust will pay the difference in costs.
In relation to mental health Vision to Action proposed the development of six in-patient acute mental health units for those aged 18 and over, with one sited in the Northern, Southern, South Eastern and Belfast areas and two in the Western area. It recommended that following clinical Best Practise and in order to reduce stigma and ensure good access to acute care, mental health hospitals should be located close to acute hospital provision where possible.
Based on these criteria it was proposed that the second location in the Western LCG area would be in the proximity of the new South West Acute Hospital.
This matter has attracted a mixed reaction and in light of that I want to take more time to consider the issues raised before I reach a final decision on the way forward. A business case will be produced which examines fully the options and I have asked for this work to begin now.
The proposals on acute hospital care in Transforming Your Care are about putting the patients and service users front and centre in our care provision and ensuring that services are safe, of high quality, resilient and sustainable. Members will be only too well aware of the challenges facing our hospital services – notably in our Emergency Departments. I acknowledge the good work that has been done to move towards eliminating 12 hour breaches but there is still some way to go. There must be an increased focus on improving the 4 hour performance. This is not a target to strive for – it is a standard that users of our system should expect and deserve. We need to make sure that every effort is made to achieve that standard across all our Emergency Departments.
In tackling unscheduled care waiting times it is evident that this is not a problem which rests solely with the Emergency Departments. It requires improvement and enhancement across the whole hospital as well as the involvement of community health and social care services.
Another key issue in Transforming Your Care was the proposal for the development of 5-7 acute hospital networks. These include hospitals of different sizes working with each other to deliver the fullest range of hospital services that we should expect.
For our hospitals the change from an “individual - institution based” approach to a more sustainable “networked” approach will undoubtedly involve a change in culture – but this is an essential change to ensure greater engagement, communication and more effective delivery of those services which are appropriate to the secondary sector. The network approach is by no means new to our hospitals, for example at the High Dependency Unit at the Daisy Hill hospital, the telepresence robot enables intensive care specialists from Craigavon hospital to talk with and support patients in another geographical location. Something which made national news headlines – and it happened here in our hospital. It is this “without walls” approach that I want to see replicated across Northern Ireland as we work together, not as individual institutions but as networked services which respond flexibly to our patients and service users needs.
The optimisation of service configurations and location within Trusts and hospital networks will be an ongoing process, responding to current and predicted needs in a local area. In that context I am pleased to be able to tell you that it is intended that £8 million will be invested in additional Cardiac Catheterisation Service over the current budget period; and that £7million will be invested in additional Orthopaedics capacity in the Southern, Western and Belfast Trusts by March 2015 to reduce waiting times and improve outcomes and we will move ahead with the implementation of the proposed neo natal transport arrangements.
It is my belief that as we secure the major benefits of successful prevention, early intervention and more effective integration with primary and community care, we can expect to see our secondary care institutions – our hospitals – evolve and change in response to this shift in the provision of care and treatment. By helping people to stay at home where possible and to access services in their local communities, we will be working to prevent the development of conditions which might later require hospitalisation.
In relation to the Causeway Hospital I know that the uncertainty has been unsettling for patients, service users and staff. There was significant support in the consultation that action needed to be taken. I want to remove that uncertainty and ensure there is stability in the way forward. For that reason I am asking officials to begin work now to take forward a detailed options appraisal as outlined in the consultation document. It will consider the future management arrangements for Causeway Hospital (whether it should remain with the Northern Trust or transfer to the Western Trust) and this work will begin straight away with a view to completing the appraisal within six months. The responses also indicated it should include community services.
In conclusion Mr Speaker, in my Statement today I have outlined to the House the overwhelming public support for the new service proposals, some of the challenges involved to deliver the transformation and the effort and dedication needed from all involved to provide a safe and sustainable health and social care service which is fit for the future.
We must ensure that we keep our service users and patients at the front and centre of this process and ensure provision of safe, sustainable, resilient and effective services provided in the right place at the right time by the right people
I would ask Members to consider the report and endorsement for change. I am determined that we will now move forward on the specific actions that need to be taken to implement these proposals, finalise the action plans and engage locally on proposals for specific changes to improve the quality of care in our community.
I commend this Statement to the House.