Intermediate Care Provision in North Down and Ards. Consultation Document. January 2015

Intermediate Care Provision in North Down and Ards Consultation Document January 2015

Contents Page number 1.0 INTRODUCTION AND BACKGROUND 6 2.0 ABOUT THE TRUST 7 3.0 CONTEXT 8 4.0 OVERVIEW OF PROCESS 10 5.0 OVERVIEW OF INTERMEDIATE CARE 11 6.0 OVERVIEW OF PROPOSAL 16 7.0 RECOMMENDATIONS 19 8.0 HOW TO RESPOND TO THE CONSULTATION 19 Appendix 1 Equality Screening Appendix 2 Consultation Response Questionnaire Appendix 3 Option Appraisal 2

How to receive a copy of this proposal If you want to receive a copy of Intermediate Care Provision in North Down and Ards, please contact: Tania Gibson Strategic & Capital Development Department South Eastern Health and Social Care Trust Kelly House Ulster Hospital Phone: 028 9055 0434 Textphone: 028 9151 0137 Or, you can email: consultation@setrust.hscni.net If you ask, we can provide any of our official documents in a choice of languages or a range of other formats, including: in large print; on audio cassette; in Braille; on computer disc; in ethnic-minority languages; in easy-read form; in DAISY; and an electronic version. (This is not a full list.) You can also find this document on our website, www.setrust.hscni.net 3

FOREWORD This summary document sets out our proposals for the future intermediate care services in the North Down and Ards area. It has been developed at a particularly challenging time for Health and Social Care. We are all aware of demographic changes and the growing and ageing population; increasing demand and an historical reliance on hospital beds; importance of the management of long term conditions; advances in technology and medical interventions and increasing public expectations. Intermediate care provides a valuable service to people who need provide a period of recovery and rehabilitation after a spell of acute illness or trauma. These inpatient beds are mainly used by patients after they have had a stay in an acute hospital and no longer need acute medical input but are not quite ready to go home. In reviewing the model, we want to ensure that we get the right balance between intermediate care, acute care and care provided at home. The Trust is well aware of the need to reform emergency care as a result of the implementation of the proposals outlined in Transforming Your Care (TYC) and in line with the commissioning direction. TYC recommendations called for Trusts to include more care delivered in the home; changing care packages for people in nursing homes; enhancing the role of the GP and primary care; increased role of pharmacy in medicines management and prevention; increased use of community and social care services to meet people s needs; and greater integration of acute services with those in the community and a need to modernise the model of hospital care in Northern Ireland. The entire health and social care sector is facing unprecedented financial challenges in the current year with a shortfall in funding estimated at 200m. A significant element of this, approximately ( 160m) has been resolved regionally in year; however, the remaining 30m - 40m rests with the health and social care trusts to deliver. The South Eastern Trust was required to implement a series of contingency measures to deliver 5m of savings in order to achieve financial breakeven for the 2014/15 financial year. The implementation of contingency plans has accelerated the Trust s existing process for reviewing the model of intermediate care. We need to look at the needs of the local population 4

and consider opportunities for more integrated urgent care and treatment that meet modern standards. This consultation is about how we deliver intermediate care services as close to home as possible. As a Trust, we are committed to improving the quality of care for patients and clients; improving outcomes and patient experience; and changing our services to meet the needs of our population. In order to do so, we need to engage with a range of key stakeholders. We want to hear your views on the proposals contained within this consultation exercise. We believe this is the best model for the future of Intermediate Care in the North Down and Ards area. We are keen to listen to all the views expressed in order to ensure that we make the best decision possible within the resources available. I encourage you to participate in the consultation process; details of how to do this are contained at the end of this document. Hugh McCaughey Chief Executive 5

1.0 INTRODUCTION AND BACKGROUND In this consultation document, the Trust is seeking views on the proposed model for intermediate care provision for the North Down and Ards area. Intermediate care is an inpatient stay in one of the Trust s Intermediate Care beds. These beds provide a period of more intensive recovery and rehabilitation for a patient after a spell of acute illness or trauma. The beds are mainly used by patients after they have had a stay in an acute hospital and no longer need acute medical input but are not quite ready to go home, needing some more therapy or rehabilitation. The Trust is implementing new service initiatives, supported through Integrated Care Partnerships to deliver the recommendations of Transforming Your Care, in that patients will have rapid access to diagnosis and treatment and receive enhanced care services in their own homes. Coupled with unscheduled care reform and an internal review of the beds purchased in the Independent Sector, the Trust believes that this review of Intermediate Care is timely. This is in-line with the future service model for intermediate care services, along with the current model, which are described in Section 5 of the document. This document provides an overview of the proposals, a summary of the option appraisal process and an assessment of potential equality implications. The Option Appraisal is contained within a separate document, which is an appendix to this document and available separately on the Trust website as detailed at Section 8 of this document. Very importantly, this document also tells you how you can have your say on the Trust s preferred option. This document will explain our plans and then outlines how you can put forward your views on the preferred choice for the service. 6

2.0 ABOUT THE TRUST The South Eastern Health and Social Care Trust s vision is to be a leading provider of health and social care for our patients, clients and carers. We will achieve this, in partnership with others, by making sure that our services are safe and effective, improving and providing a positive outcome and experience. The South Eastern Health and Social Care (HSC) Trust was established on 1 st April 2007 and is one of five such Trusts within Northern Ireland. The Trust is an integrated organisation, incorporating acute hospital services and community health and social services. The Trust covers the local government districts of Ards, North Down, Down and Lisburn, serving a resident population of 349,618 (source: Northern Ireland Statistics and Research Agency (NISRA) 2013 Mid-Year Population Estimates). In addition, acute services at the Ulster Hospital serve a wider population of circa 440,000, which includes parts of East Belfast and Castlereagh. The Trust has an annual budget of approximately 560m and directly employs approximately 12,000 staff. The South Eastern Health and Social Care Trust has one Acute Hospital at the Ulster Hospital, Dundonald, supported by Local Hospitals at Downe and Lagan Valley, and Community Hospitals at Bangor and Ards. Community bases are located in many local towns and villages from Moira in the west to Portaferry in the east and from Bangor in the north to Newcastle in the south. In addition to its geographical spread, there is also a noticeable diversity in its population characteristics, embracing areas of relative wealth and prosperity as well as pockets of considerable deprivation and need. 7

3.0 CONTEXT 3.1 Strategic Context The Trust s strategic direction has largely been influenced by a number of drivers for change. These include Transforming Your Care (TYC), December 2011 and the commissioning intentions as indicated by the Health and Social Care Board (HSCB) through the Commissioning Plan and Commissioning Specifications 2013/14 and the Commissioning Plan and Commissioning Specifications of 2014/15. Transforming Your Care (December 2011) The Review of the Provision of Health and Social Care Services in Northern Ireland announced by the Minister for Health, Social Services and Public Safety in June 2011, has produced a report which offers an assessment of all aspects of health and social care, and includes 99 recommendations. It outlines a clear direction of travel as follows: starting with the individual looking to a greater focus on prevention maintaining care close to home re-designing primary care re-shaping hospitals Health and Social Care Board (HSCB) Commissioning Plan and Commissioning Specifications of 2014/15 The 2014/15 Health and Social Care Board and Public Health Agency Commissioning Plan highlights the Commissioner s intention for further reform of the urgent care model in the South Eastern Trust. The document states, at section 8.2, that: 8

The South Eastern Local Commissioning Group (SELCG) views our primary and community care service hubs in the Downe Hospital, the Ards Hospital site and the Lagan Valley Hospital site as key enablers to ensuring good community access to future local services. Section 8.4.1, of the plan indicates that the Ulster Hospital should continue as the main provider of consultant-led 24/7 emergency care services, whilst new care arrangements in Downpatrick, Lisburn and North Down and Ards should now begin to evolve. Specifically the South Eastern Health and Social Care Trust is expected to develop intermediate care services in line with the delivery of appropriate clinical care for patients in order to meet the shift left objective of Transforming Your Care, that is to provide care at home. 3.2 Financial Context All Trusts have a statutory breakeven duty (contained in circular HSS (F) 25/2000) by the end of each financial year (1 April to 31 March). During this financial year 2014/15, the South Eastern Trust recognised a shortfall in the funding to meet all the costs of delivering services due to increasing financial pressures and the lateness of the budgetary settlement for the NI Executive. A number of factors, including an ageing population, complexity of conditions and an increase in demand for our services have contributed to these pressures. The entire health and social care sector is facing unprecedented financial challenges in the current year with a deficit forecast at around 200m. A significant element of this, approximately ( 160m) has been resolved regionally in year; however, the remaining 30m - 40m rests with the health and social care trusts to deliver. The South Eastern Trust was required to implement a series of contingency measures to deliver 5m of savings in order to achieve financial breakeven for the 2014/15 financial year. In its contingency plan, the Trust identified a number of proposals that would contribute to achieving the required savings by the end of the year. When developing the proposals, the Trust s top priority was ensuring patient and client safety. The Trust had to focus both on areas that could result in reduced spend quickly and, where possible, on areas in line with strategic direction of travel. Meeting the savings targets outlined in contingency plans is extremely challenging. 9

One of the contingency measures proposed by the Trust was the temporary closure of 20 inpatient beds in Bangor Hospital, which was introduced to assist the Trust to achieve financial breakeven. This was approved by the HSCB / PHA / and the Minister of the Department of Health, Social Services and Public Safety on 30 October 2014 and the temporary closure took effect on 1 December 2014. Whilst it was not feasible to carry out a consultation on the temporary closure, the Trust is committed to consulting on a permanent arrangement for intermediate care provision in North Down and Ards. The Temporary closure will remain in place until the public consultation and associated decision making processes are concluded. For the 2015/16 financial year the current estimated deficit identified for the South Eastern Trust is 17.5m. The Trust is therefore required to implement a range of savings plans to ensure financial break even. One of the proposals the Trust is considering and which this document addresses, is the review of intermediate care services for the North Down and Ards area. 4.0 OVERVIEW OF PROCESS A Project Team comprising clinical, nursing, GP, staff side, Finance, Human Resources and Equality representatives, have been exploring options for the model of intermediate care for North Down and Ards. The Team undertook a non-financial assessment of options. Details are contained within a separate Option Appraisal document which is an appendix to this document. Following announcement of contingency plan proposals on 30 October 2014, the Trust engaged with stakeholders on the temporary measures implemented to ensure the Trust would achieve financial breakeven by 31 March 2015. Throughout January 2015, Trust representatives engaged with a range of stakeholders to ensure that key issues had been addressed and that the proposals were in keeping with the strategic direction of the Trust, Health and Social Care Board and the Department of Health, Social Services and Public Safety. The Trust is now embarking on a 13 week public consultation exercise from 28 January 2015 until 29 April 2015. As part of this process, the Trust will hold public meetings that are set out in section 8 of this document. There will be a range of other opportunities for service users, staff and key stakeholders to give their views on the proposal (these are also detailed at 10

section 8). Following the public consultation, the preferred option will be reviewed in light of comments received and the final proposal presented to Trust Board. 5.0 OVERVIEW OF INTERMEDIATE CARE The Health and Social Care Board in 2013 issued guidance on Principles for Medical Cover for Intermediate Care Beds this guidance outlines the King s Fund definition of Intermediate Care as follows: A short-term intervention to promote and preserve the independence of people who might otherwise face unnecessarily prolonged hospital stays, or inappropriate admission to hospital or residential care. The care is person centred, focused on rehabilitation and delivered by a combination of professional groups with either a therapeutic or specialist medical lead where required. The Trust has agreed a number of general principles in its approach to reviewing Intermediate Care services. These include: Services will be safe, sustainable, person-centred. They will be planned, implemented and evaluated in partnership with users and carers. Services will promote independence, recovery and rehabilitation, supporting people to live at home. Everyone has the right to experience the same level of service regardless of location. To ensure appropriate access to Intermediate Care services based on assessed need. Services will be provided in an environment which is fit for purpose with the appropriate level of medical intervention. The services we deliver will be evidence-based, of high quality, and provide improved outcomes for patients and clients. Staff will be supported in their professional and personal development. Services will be delivered in an efficient and effective manner. Services will promote positive health, wellbeing and early intervention. 11

Transforming Your Care outlined a shift from the provision of services in hospitals to the provision of services within the community, in the GP surgery and closer to home. It is anticipated that Intermediate Care beds should be provided as close to the patient s home as possible, with enhanced Community Stroke Rehabilitation, Reablement and Intermediate Care services. A Reablement programme will assist the Trust in driving the transformation outlined in the population plan by promoting greater independence for older people at home using short-term support services following a hospital admission or health or social care crisis at home and reduce referrals for long term domiciliary care support. This approach will ensure that older people receive the level of support required to maximise independence. The development of a new integrated model of care for community and hospital services reflects the recommendations within Transforming Your Care 2011(TYC). The focus is on placing the individual at the centre of the model with services becoming increasingly accessible in the local community which will promote a better outcome for the user, carer and their family. By redesign of primary, community services, links to the local hospital network and an Acute Hospital, the Trust intends to develop integrated care which fosters positive working relationships. This model will be a significant shift from the provision of services in hospitals to the provision of services within the community, in the GP surgery and closer to home, where it is safe and effective to do this. This will result in the delivery of a quality service which provides safe and effective care for the patient/client. Throughout the review that informed Transforming Your Care, people expressed their preference for care at home or as close to home as possible. In response to this, any new model should provide more support to help people who are sick or frail to maintain their independence and stay in their own homes for as long as possible. This applies whether that home is the family home, supported housing, nursing home or residential home. As mentioned previously, since its formation in 2007, the Trust has developed a strategic vision for a Single Acute Hospital at the Ulster Hospital site, and a local hospital model for Downe and Lagan Valley Hospitals. 12

The Trust is committed to the development of specialist Primary and Community Care Centres in each of the four Trust sectors: Downpatrick, Lisburn, North Down and Ards. This is in keeping with the Bamford Review, Older People s Strategy and Regional Dementia Strategy. The Trust will continue to progress the development of two primary and community care hubs for North Down and Ards with one urgent care centre within the hub in Newtownards. 13

Figure 2 South Eastern Trust/Local Commissioning Group Primary and Community Care Centres The new model focuses on providing opportunities to integrate care which crosses professional boundaries to benefit patients, clients and families. The emphasis has been placed on creating an environment to maximise multi-disciplinary and multi-professional team working and encourage shared opportunities for developing links within Health and Social Care and with external health care partners. The 2013 South Eastern Local Commissioning Group s Strategic Commissioning Statements in regards to Primary and Community Care Infrastructure Service Requirements notes that: Bangor also has a community hospital which includes 20 step-up/step-down beds as well as a range of clinical and diagnostic facilities. There is no capacity within this site for further development. As part of TYC, Integrated Care Partnerships (ICPs) will be bringing forward a range of plans to manage many of the conditions for which patients use the Bangor Hospital. The document also reflects the Trust s future vision for North Down and Ards. Locality meetings with GPs confirmed their support for the suggested development of four South Eastern Trust Hubs in Lisburn, Downpatrick, Newtownards and Bangor. There was, however, some initial discussion around the potential for a single hub that might serve the populations of Newtownards, Bangor and Comber, together with the more dispersed population of the 14

Ards peninsula. However, after further consideration and engagement on this option, there was general consensus that these localities merited separate hubs based on the geographical spread and demographic profile of the population - though given their close proximity the service model should be carefully considered to avoid unnecessary duplication of services. (Source: SELCG Strategic Commissioning Statement re Primary and Community Care Infrastructure Service Requirements July 2013). The Trust s vision articulates a model of four Primary and Community Care Centre Hubs, two of which will be located in North Down and Ards. The Trust will continue to progress the development of two primary and community care hubs for North Down and Ards, with one urgent care centre within the Ards Hub. These new build facilities have been included by the Trust in its Strategic Capital Priorities Review 2013-21 to the DHSSPSNI, outlining the key projects / capital investments required for the Trust to deliver its strategic objectives, based on the recommendations of Transforming Your Care. The HSCB Commissioning Plan 2014/15 confirms the intention to support the Trust in the provision of three urgent care centres within Lisburn, Downpatrick and Newtownards. 15

6.0 OVERVIEW OF PROPOSAL The aim of the exercise was to identify the most effective and efficient way to provide Intermediate Care Services in the North Down and Ards areas in line with available resources and Regional Principles of Medical Cover. In order to achieve this, the project objectives were identified as follows- Objective 1 Strategic Direction - To facilitate a structure that will result in a high quality of service with improved outcomes and improved service efficiency in terms of use of resources. Objective 2 - Medical Cover - To ensure that the Trust has adequate Intermediate Care Provision in the locality with the appropriate level of medical cover which complies with the Regional principles for Medical Cover. Objective 3 Flexibility / Sustainability - To provide a service which is sufficiently flexible to respond to future changes in service delivery and volumes. Objective 4 Speed and Ease of Implementation - To minimise disruption and disturbance to on-going patient care. As part of the appraisal process, the Trust considered the following options: 1 Status Quo - Do Nothing. 2 Do minimum This option is to continue to provide all 125 intermediate care beds, with the current medical model in place in the North Down and Ards area as follows- 29 Consultant led fracture rehabilitation beds Currently Domnall 22 Independent Provider block purchased Beds with GP GMS Medical support 20 beds in Ards Hospital 10 with GP Medical Support and 10 with Consultant support 20 Beds in Bangor Hospital with GP Medical Support 14 Beds in Northfield House with GP GMS Medical Support. Up to 20 spot purchased beds on a temporary basis when demand requires This option is to provide up to 95 beds, the same number of beds provided following the temporary closure in Bangor Hospital. 29 Consultant led fracture rehabilitation beds - Currently Domnall 22 Independent Provider Beds with GP GMS Medical support 20 beds in Ards Hospital 10 with GP Medical Support and 10 with Consultant support 14 Beds in Northfield House with GP GMS Medical Support. Up to 10 spot purchased beds on a temporary basis when demand requires. Please note that there would be no intermediate care beds at Bangor Hospital within this option and would therefore result in a permanent closure of the 20 beds at Bangor Hospital. 16

3 This option is to provide up to 95 beds, the same number of beds provided following the temporary closure in Bangor Hospital. 29 Consultant led fracture rehabilitation beds - Currently Domnall 22 Independent Provider Beds with GP GMS Medical support 20 beds in Bangor Hospital 10 with GP Medical Support and 10 with Consultant support 14 Beds in Northfield House with GP GMS Medical Support. Up to 10 spot purchased beds on a temporary basis when demand requires Please note that there would be no intermediate care beds at Ards Hospital within this option and would therefore result in a permanent closure of the 20 beds at Ards Hospital. 4 This option is to provide up to 95 intermediate care beds in the North Down and Ards area as follows 29 Consultant led fracture rehabilitation beds Currently Domnall 2 Independent Provider Beds with GP Medical support 20 beds in Ards Hospital 10 with GP Medical Support and 10 with Consultant support 20 Beds in Bangor Hospital with GP Medical Support 14 Beds in Northfield House with GP GMS Medical Support. Up to 10 spot purchased beds on a temporary basis when demand requires Please note that the option would result in a reduction in the Trust block purchase of beds from the independent sector. 5a This option is to provide up to 105 intermediate care beds in the North Down and Ards area as follows 29 Consultant led fracture rehabilitation beds Currently Domnall 22 Independent Provider Beds with GP Medical support 20 Consultant led Beds in Bangor Hospital 14 Beds in Northfield House with GP GMS Medical Support. Up to 20 additional spot purchased beds on a temporary basis when demand requires. Please note that there would be no intermediate care beds at Ards Hospital within this option and would therefore result in a permanent closure of the 20 beds at Ards Hospital. 5b This option is to provide up to 105 intermediate care beds in the North Down and Ards area as follows 29 Consultant led fracture rehabilitation beds Currently Domnall 22 Independent Provider Beds with GP Medical support 20 beds in Bangor Hospital with GP Medical Support 14 Beds in Northfield House with GP GMS Medical Support. Up to 20 additional spot purchased beds on a temporary basis when demand requires. Please note that there would be no intermediate care beds at Ards Hospital within this Option and would therefore result in a permanent closure of the 20 beds at Ards Hospital. 6a This option is to provide up to 105 intermediate care beds in the North Down and Ards area as follows 29 Consultant led fracture rehabilitation beds - Currently Domnall 22 Independent Provider Beds with GP Medical support 20 Consultant led beds in Ards Hospital 14 Beds in Northfield House with GP GMS Medical Support. Up to 20 additional spot purchased beds on a temporary basis when demand requires. Please note that there would be no intermediate care beds at Bangor Hospital within this Option 17

and would therefore result in a permanent closure of the 20 beds at Bangor Hospital. 6b This option is to provide up to 105 intermediate care beds in the North Down and Ards area as follows 29 Consultant led fracture rehabilitation beds - Currently Domnall 22 Independent Provider Beds with GP Medical support 20 beds in Ards Hospital 10 with GP Medical Support and 10 with Consultant support 14 Beds in Northfield House with GP GMS Medical Support. Up to 20 additional spot purchased beds on a temporary basis when demand requires. Please note that there would be no intermediate care beds at Bangor Hospital within this Option and would therefore result in a permanent closure of the 20 beds at Bangor Hospital. 7 This option is to provide up to 105 intermediate care beds in the North Down and Ards area as follows 29 Consultant led fracture rehabilitation beds - Currently Domnall 22 Independent Provider Beds with GP Medical support 10 Consultant led beds in Ards Hospital 10 Consultant led Beds in Bangor Hospital 14 Beds in Northfield House with GP GMS Medical Support. Up to 20 additional spot purchased beds on a temporary basis when demand requires. Please note that this option would result in the permanent closure of 10 beds at Ards Hospital and 10 beds at Bangor Hospital A detailed explanation of all options is contained within the Option Appraisal. Following a weighting and scoring exercise, a preferred qualitative option was identified. This is Option 6a, which will provide up to 105 beds configured as follows: 29 Consultant led fracture rehabilitation beds - Currently Domnall 22 Independent Provider Beds with GP Medical support 20 Consultant led beds in Ards Hospital 14 Beds in Northfield House with GP GMS Medical Support. Up to 20 additional spot purchased beds on a temporary basis when demand requires. The Trust also carried out a quantitative assessment of all of the shortlisted options to assess the financial impact of the options and to ensure that any preferred option would not result in a financial loss to the Trust. The proposed option offers the highest saving of all the do something options. This option offers annual savings of 840k per annum, and is the most beneficial option in qualitative terms, enabling the Trust to deliver its future model of care for intermediate care services for North Down and Ards as outlined at section 5. In addition, this option will ensure: 18

The services we provide will be in line with strategic direction and the commissioning plan 2014/15 That services will be safe, sustainable, and person-centred. They will be planned, implemented and evaluated in partnership with users and carers. That services will promote patient choice, independence, recovery and rehabilitation, supporting people to live at home. Everyone has the right to experience the same level of service regardless of location. That appropriate access to Intermediate Care services will be based on assessed need. That the Trust can continue to progress the development of two primary and community care hubs for North Down and Ards with one urgent care centre within the hub in Newtownards. 7.0 RECOMMENDATIONS The South Eastern Trust proposes to implement its preferred option for intermediate care provision in North Down and Ards (as described above). As required under Section 75 of the Northern Ireland Act 2998, the Trust undertook an equality and human rights screening exercise on the proposal, which is appended to this document. This proposal will be subject to on-going equality screening. 8.0 HOW TO RESPOND TO THE CONSULTATION This document sets out the Trust plans for intermediate care in the North Down and Ards area. The Trust welcomes all feedback regarding this proposal. A consultation questionnaire is appended to this document. A summary of feedback will be provided to all respondents. Public meetings The Trust is planning to hold a series of public meetings across the North Down and Ards areas to ensure that the public have the opportunity to contribute to the consultation process. Alderman George Green Community Centre, Rathgill Parade, Bangor on Tuesday 3 March 7.00pm Kircubbin Community Centre, Church Grove, Kircubbin on Tuesday 10 March 7.00pm McWhinney Hall, Ards Hospital, Newtownards on Wednesday 11 March 3.00pm 19

Booking is not essential, but if you would like to register your attendance, please contact Tania Gibson on tel: 028 9055 0434 or email: consultation@setrust.hscni.net. You can also send your comments to the Trust by a variety of means, including: in writing by email by telephone by text phone by fax via our website Additional copies of this document and the consultation questionnaire are available from the South Eastern Health and Social Care Trust website by clicking on Involving You. Please return your response by 29 April 2015 to: Hugh McCaughey Chief Executive South Eastern Health and Social Care Trust Trust Headquarters Ulster Hospital Dundonald BT16 1RH Telephone: 028 90564733 Textphone: 028 91510137 Email: consultation@setrust.hscni.net Website: www.setrust.hscni.net The consultation on the proposals will last for 13 weeks, from 28 January to 29 April 2015. A recommendation to Trust Board will be made once all feedback is analysed. 20

Appendix 1 Equality, Good Relations and Human Rights Screening Template ***Completed Screening Templates are public documents and will be posted on the Trust s website*** See Guidance Notes for further background information on the relevant legislation and for help in answering the questions on this template (follow the links). (1) Information about the Policy/Proposal (1.1) Name of the policy/proposal Intermediate Care Provision in North Down and Ards (NDA) Area (1.2) Is this a new, existing or revised policy/proposal? New (1.3) What is it trying to achieve (intended aims/outcomes)? This option is to provide up to 105 intermediate care beds in the North Down and Ards area as follows 29 Consultant led fracture rehabilitation beds - Currently Domnall 22 Independent Provider Beds with GP Medical support 20 Consultant led beds in Ards Hospital 14 Beds in Northfield House with GP GMS Medical Support. Up to 20 additional spot purchased beds on a temporary basis when demand requires. This will enable the Trust to save 840,000 and will ensure that the service can be sustained over the long term and will improve quality of care, patient experience and is in line with strategic direction. Please note that there would be no intermediate care beds at Bangor Hospital within this proposal. 1

(1.4) Are there any Section 75 categories (see list in 3.1) which might be expected to benefit from the intended policy/proposal? Currently the service is mainly used by Older People and Stroke Patients This proposal will be subject to public consultation which will include representatives from the Section 75 categories. (1.5) Who owns and who implements the policy/proposal - where does it originate, for example DHSSPS, HSCB? The Trust, with approval from the DHSSPS and HSCB. (1.6) Are there any factors that could contribute to/detract from the intended aim/outcome of the policy/proposal/decision? (Financial, legislative or other constraints?) Financial implications if proposal not implemented Factors related to timeframe for implementation GP resistance Mixed views from Service Users and Families / Carers Local Community resistance Local Elected representatives views Staff resistance Impacts on other services Feedback from Engagement Sessions 2

(1.7) Who are the internal and external stakeholders (actual or potential) that the policy/proposal/decision could impact upon? (staff, service users, other public sector organisations,, trade unions, professional bodies, independent sector, voluntary and community groups etc) Service Users, Families and Carers Local Community Voluntary / Community Sectors Local Elected Representatives GPs Staff Other Trust services e.g. ED at the Ulster Hospital Friends of Bangor Hospital Committees Local Stroke Association Group Trade Unions and Professional Bodies HSCB DHSSPS NIAS PPI Sub-committee Age NI Cruse Bereavement GP Out of Hours Service (1.8) Other policies with a bearing on this policy/proposal (for example regional policies) - what are they and who owns them? TYC Remodelling of Services Hospital Performance Policies / Targets DHSSPS Policies eg length of stay HSCB Commissioning Plan 2013/2014 and 2014/2015 IPT Frail Elderly The SE Local Commissioning Group Strategic Commissioning Statements in regard to Primary and Community Care Infrastructure Service Requirements (2) Available evidence Evidence to help inform the screening process may take many forms. What evidence/information (both qualitative and quantitative) have you gathered to inform this policy? Specify details for relevant Section 75 categories. 3

Details of evidence/information Option Appraisal Document (January 2015) Application for Judicial Review re: Bangor Community Hospital November 2014 Information from Pre-engagement Sessions Service data Human Resources data Financial data Complaints / Comments 4

(3) Needs, experiences and priorities (3.1) Taking into account the information above what are the different needs, experiences and priorities of each of the Section 75 categories and for both service users and staff. Category Needs, experiences and priorities Service users Staff Gender Majority women Majority women Age Generally over 75 50% under 45 50% over 45 Religion Majority Protestant Majority Protestant Political Opinion Marital Status Dependent Status Two Council Areas return a Unionist Majority All status Service Users have a level of dependency Council Area returns a Unionist Majority Majority married Correlation women and caring responsibilities. 44% of staff work part-time Disability Level of disability e.g. stroke Under-reporting in the workforce NI average, 20% Ethnicity Majority White Majority White Sexual Orientation 6-10% LGB&/T 6-10% LGB&/T (3.2) Provide details of how you have involved stakeholders, views of colleagues, service users and staff etc when screening this policy/proposal. Trust wide Staff meetings on 30 th October 2014 and Briefing from Chief Executive to all staff related to Contingency Plans Human Resources meeting with staff on 7 th November 2014 (re: Bangor GP Beds) Direct meetings with staff on 11-12 th November 2014 (re: Bangor GP beds) Meetings with Trust Executive Management Team and local Elected Representatives Option Appraisal Process - January 2015 Pre-engagement with key stakeholders, including local representatives, trade union representatives, GPs, voluntary and community sector and other interested parties (4) Screening Questions 5

You now have to assess whether the impact of the policy/proposal is major, minor or none. You will need to make an informed judgement based on the information you have gathered. (4.1) What is the likely impact of equality of opportunity for those affected by this policy/proposal, for each of the Section 75 equality categories? Section 75 Details of policy/proposal impact Level of impact? category Minor/major/none Services Users Gender Majority women affected by Proposal. This reflects Service User profile. Age Proposal impacts on Older People Service Users majority over 75 Religion Majority Protestant reflects Trust s Political Opinion geographical area Unionist Majority in Council areas affected by Proposal -3 of the 4 Council areas covered by Trust returning Unionist Majority. Staff Majority women affected by Proposal. This reflects Trust s Workforce Gender Profile 81% of staff are women. Majority Protestant which reflects Trust s Workforce Profile Unionist Majority in Council area which reflects Trust s Workforce Profile Minor / Minor Minor Minor / Minor Minor / Minor Marital All status Majority married reflects None/Minor Status general Workforce numbers Dependent Service users/patients Correlation women and Minor / Minor Status have level of caring responsibilities dependency 44% work part-time flexible working arrangements Disability Service users/ patients General under reporting Minor/Minor have a level of disability in workforce, disability e.g. stroke issues taken in account in one to one staff meeting. Ethnicity Majority White Majority White None/None Sexual Orientation 6-10% LGB&T 6-10% LGB&T None/None 6

(4.2) Are there opportunities to better promote equality of opportunity for people within Section 75 equality categories? No Section 75 category Please provide details Gender Engagement with service users/carers/key stakeholders and staff. Staff training Age Engagement with service users/carers/key stakeholders and staff. Staff training Religion Engagement with service users/carers/key stakeholders and staff. Staff training Political Opinion Engagement with service users/carers/key stakeholders and staff. Staff training Marital Status Engagement with service users/carers/key stakeholders and staff. Staff training Dependent Status Engagement with service users/carers/key stakeholders and staff. Staff training Disability Engagement with service users/carers/key stakeholders and staff. Staff training Ethnicity Engagement with service users/carers/key stakeholders and staff. Staff training Sexual Orientation Engagement with service users/carers/key stakeholders and staff. Staff training (4.3) To what extent is the policy/proposal likely to impact on good relations between people of different religious belief, political opinion or racial group? minor/major/none Good relations Details of policy/proposal impact Level of impact Minor/major/none category Religious belief None Political opinion Racial group None None (4.4) Are there opportunities to better promote good relations between people of different religious belief, political opinion or racial group? NR Good relations category Please provide details Religious belief Staff Training Political opinion Racial group Staff Training Staff Training and Interpreting / Translation services 7

(5) Consideration of Disability Duties (5.1) How does the policy/proposal encourage disabled people to participate in public life and promote positive attitudes towards disabled people? Trust Disability Action Plan promotes these two duties Variety of patients e.g. some return to their own home, whilst others move to a residential / nursing care setting (6) Consideration of Human Rights (6.1) Does the policy/proposal affect anyone s Human Rights? Complete for each of the articles Article Article 2 Right to life Positive impact Negative impact = human right interfered with or restricted Neutral impact Article 3 Right to freedom from torture, inhuman or degrading treatment or punishment Article 4 Right to freedom from slavery, servitude & forced or compulsory labour Article 5 Right to liberty & security of person Article 6 Right to a fair & public trial within a reasonable time Article 7 Right to freedom from retrospective criminal law & no punishment without law Article 8 Right to respect for private & family life, home and correspondence. Article 9 Right to freedom of thought, conscience & religion Article 10 Right to freedom of expression Article 11 Right to freedom of assembly & association Article 12 Right to marry & found a family 8

Article 14 Prohibition of discrimination in the enjoyment of the convention rights 1 st protocol Article 1 Right to a peaceful enjoyment of possessions & protection of property 1 st protocol Article 2 Right of access to education Please note: If you have identified potential negative impact in relation to any of the Articles in the table above, speak to your line manager and/or Equality Unit. It may also be necessary to seek legal advice. (6.2) Please outline any actions you will take to promote awareness of human rights and evidence that human rights have been taken into consideration in decision making processes. Discussions through Screening Engagement with service users, carers, staff and other key stakeholders Promotion of training including e-learning module on Equality and Human Rights (7) Screening Decision (7.1) Given the answers in Section 4, how would you categorise the impacts of this policy/proposal? Major impact Minor impact No impact (7.2) Do you consider the policy/proposal needs to be subjected to ongoing screening Yes No (7.3) Do you think the policy/proposal should be subject to and Equality Impact Assessment (EQIA)? Yes No 9

(7.4) Please give reasons for your decision and detail any mitigation considered. Major impact not identified on-going screening recommended. The Contingency Plan Screening of key proposals on 29 October 2014 when on-going Screening was recommended. The proposal regarding the temporary closure of Bangor GP Beds was re-screened on 13 November 2014 when on-going screening was recommended and the learning has been incorporated into the assessment of the impact of this proposal. This proposal will promote patient choice, independence, recovery and rehabilitation, supporting people to live at home for as long as possible. Services will be safe, sustainable, and person-centred. They will be planned, implemented and evaluated in partnership with users and carers. This proposal will contribute to the development of the service hub in North Down and Ards, in line with commissioning direction and the Trust s strategic priorities. (8) Monitoring Please detail how you will monitor the effect of the policy/proposal for equality of opportunity and good relations, disability duties and human rights? Primary Care Data Hospital Services data Hospital Performance Statistics Feedback from Engagement Sessions Staff follow up GP Engagement Complaints / Comments Approved Lead Officer: Position: Nicki Patterson Director of Primary Care, Older People & Nursing Date: 19 January 2015 Policy/proposal screened by: Mark Armstrong / Suzanne McCartney/ Elaine Campbell 10

Appendix 2 Intermediate Care in North Down and Ards (NDA) CONSULTATION RESPONSE QUESTIONNAIRE You can respond to the consultation document by e-mail or letter. Responses should be sent to: E-mail: consultation@setrust.hscni.net Written: Intermediate Care Provision NDA Consultation South Eastern Health and Social Care Trust Trust Headquarters Ulster Hospital Dundonald BT16 1RH Tel: (028) 9055 0434 Responses must be received no later than 29 April 2015 I am responding: Name: Job Title: Organisation: Address: as an individual on behalf of an organisation (please tick a box) Tel: Email: 1

1. Do you agree that the Trust s future service model for older people should: Enhance & maintain the health, wellbeing & independence of older people Provide a range of integrated services that will promote faster recovery from illness Prevent unnecessary acute hospital admission & premature admission to long term residential care Support timely discharge from hospital and maximise independent living Yes Comment No 2

2. Do you agree or disagree with the Trust s preferred option, which will provide 105 intermediate care beds in North Down and Ards as follows: 29 Consultant led fracture rehabilitation beds - currently Domnall 22 Independent Provider Beds with GP Medical support 20 Consultant led beds in Ards Hospital 14 Beds in Northfield House with GP GMS Medical Support. Up to 20 additional spot purchased beds on a temporary basis when demand requires. Please note that there would be no intermediate care beds at Bangor Hospital within this Option, and would therefore result in a permanent closure of the 20 beds at Bangor Hospital. Agree Comment Disagree 3

2a. If you disagree, could you suggest an alternative option that would meet the criteria set for intermediate care provision in North Down and Ards within available financial resources? Yes No Comment 4

3. Are you aware of any indication or evidence that the proposals may have an adverse impact on equality of opportunity or good relations? If yes, please state the reasons why and suggest how these might be mitigated. Yes No Comments: 4. Any further comments Thank you for taking the time to give feedback. Please return your feedback no later than 29 April 2015. A summary of feedback will be produced once the consultation closes. If you would like a summary of all feedback received, please ensure we have your contact details on the first page. Confidentiality of Consultation Responses FREEDOM OF INFORMATION ACT 2000 CONFIDENTIALITY OF CONSULTATIONS The Trust will publish a summary of responses following completion of the consultation process. Your response, and all other responses to the consultation, 5

may be disclosed on request. The Trust can only refuse to disclose information in exceptional circumstances. Before you submit your response, please read the paragraphs below on the confidentiality of consultations. They will give you guidance on the legal position about any information given by you in response to this consultation. The Freedom of Information Act gives the public a right of access to any information held by a public authority, namely, the Trust in this case. This right of access to information includes information provided in response to a consultation. The Department cannot automatically consider, information supplied to it in response to a consultation as confidential. However, it does have the responsibility to decide whether any information provided by you in response to this consultation, including information about your identity, should be made public or be treated as confidential. This means that information provided by you in response to the consultation is unlikely to be treated as confidential, except in very particular circumstances. The Lord Chancellor s Code of Practice on the Freedom of Information Act provides that: The Trust should only accept information from third parties in confidence if it is necessary to obtain that information in connection with the exercise of any of the Department s functions and it would not otherwise be provided; The Trust should not agree to hold information received from third parties in confidence which is not confidential in nature; and Acceptance by the Trust of confidentiality provisions must be for good reasons, capable of being justified to the Information Commissioner. For further information about confidentiality of responses please contact the Information Commissioner s Office (or see website: http://www.informationcommissioner.gov.uk/) 6

Appendix 3 Option Appraisal The Provision of Intermediate Care Services in the North Down and Ards Areas January 2015

Contents Section 1.0 Introduction 3 Page number 2.0 Background 3 3.0 Future Service Model 8 4.0 Strategic Context 18 5.0 Existing Service Profile 25 6.0 Objectives and constraints 41 7.0 Formulation and Evaluation of Options 45 8.0 Non-Financial Benefits Appraisal 54 9.0 Quantitative Analysis 71 10.0 Conclusion 73 2

1.0 Introduction This document presents the strategic context and options appraisal process for the future provision of intermediate care services for the North Down and Ards localities in the South Eastern Health and Social Care Trust (SET). The current service profile section describes the existing service provision; and the strategic context section identifies the case for change through analysis of regional, national and local policy context and the requirement for future service provision. This paper details the appraisal process undertaken by the Trust including the establishment of project objectives, an explanation of constraints, the generation of options to meet objectives and an evaluation of costs and benefits of shortlisted options, financial evaluation and the identification of the preferred option. 2.0 Background On 1 April 2007, the South Eastern Health & Social Care Trust (SET) was established amalgamating the former Down &Lisburn and Ulster Community & Hospitals HSS Trusts. The SET is a community and acute hospitals Trust that provides integrated health and social services to the population of North Down, Lisburn, Down and Ards Council areas and acute services to a wider catchment, which takes in parts of east Belfast. The Trust provides acute and community services to a resident population of 349,618 in the above local government districts (source: Northern Ireland Statistics and Research Agency (NISRA) - 2013 Mid-Year Population Estimates). 3

The South Eastern Health and Social Care Trust vision is to be a leading provider of high quality health and social care for our patients, clients and carers. We will achieve this, in partnership with others, by making sure that our services are safe and effective, improving and providing a positive outcome and experience. 2.1 Financial Context All Trusts have a statutory breakeven duty (contained in circular HSS (F) 25/2000) by the end of each financial year (1 April to 31 March). During this financial year 2014/15, the South Eastern Trust recognised a shortfall in the funding to meet all the costs of delivering services due to increasing financial pressures and the lateness of the budgetary settlement for the NI Executive. A number of factors, including an ageing population, complexity of conditions and an increase in demand for our services have contributed to these pressures. The entire health and social care sector is facing unprecedented financial challenges in the current year with a deficit forecast at around 200m. A significant element of this, approximately ( 160m) has been resolved regionally in year; however, the remaining 30m - 40m rests with the health and social care trusts to deliver. The South Eastern Trust was required to implement a series of contingency measures to 4

deliver 5m of savings in order to achieve financial breakeven for the 2014/15 financial year. In its contingency plan, the Trust identified a number of proposals that would contribute to achieving the required savings by the end of the year. When developing the proposals, the Trust s top priority was ensuring patient and client safety. The Trust had to focus both on areas that could result in reduced spend quickly and, where possible, on areas in line with strategic direction of travel. Meeting the savings targets outlined in contingency plans is extremely challenging. One of the contingency measures proposed by the Trust was the temporary closure of 20 inpatient beds in Bangor Hospital, which was introduced to assist the Trust to achieve financial breakeven. This was approved by the HSCB / PHA / and the Minister of the Department of Health, Social Services and Public Safety on 30 October 2014 and the temporary closure took effect on 1 December 2014. Whilst it was not feasible to carry out a consultation on the temporary closure, the Trust is committed to consulting on a permanent arrangement for intermediate care provision in North Down and Ards. The Temporary closure will remain in place until the public consultation and associated decision making processes are concluded. For the 2015/16 financial year the current estimated deficit identified for the South Eastern Trust is 17.5m. The Trust is therefore required to implement a range of savings plans to ensure financial break even. One of the proposals the Trust is considering and which this document addresses, is the review of intermediate care services for the North Down and Ards area. 2.2 Service Context Intermediate care is an in-patient stay in one of the Trusts Intermediate Care beds. These beds provide a period of recovery and rehabilitation for a patient after a spell of acute illness or trauma. The beds are mainly used by patients after they have had a stay in an acute hospital and no longer need acute medical input but are not quite ready to go home. The Health and Social Care Board in 2013 issued guidance on Principles for Medical Cover for Intermediate Care Beds this guidance outlines the King s Fund definition of Intermediate Care as follows 5

A short-term intervention to promote and preserve the independence of people who might otherwise face unnecessarily prolonged hospital stays, or inappropriate admission to hospital or residential care. The care is person centred, focused on rehabilitation and delivered by a combination of professional groups with either a therapeutic or specialist medical lead where required. The current service model for Intermediate Care services is provided at section 5 of this report. The Trust is in the process of implementing new service initiatives, supported through Integrated Care Partnerships (ICP) to deliver the recommendations of Transforming Your Care, in that patients will have rapid access to diagnosis and treatment and receive enhanced care services in their own homes. Coupled with unscheduled care reform and an internal review of the beds purchased in the Independent Sector, the Trust believes that this review of Intermediate Care is timely. This is in-line with the future service model for intermediate care services which is described in full at section 3 of this report. 6

3.0 Future Service Model This section outlines the proposed model of care for the future development of health and social care delivery for the South Eastern Trust. The service model is patient centred and based on a five level approach: Level 0 Patient Home; Level 1 Local Health and Care Centres ( Spoke ); Level 2 Primary and Community Care Centres ( Hub ); Level 3 Local Hospitals; and Level 4 Acute Hospitals. Figure 1 South Eastern Trust Model of Care Patient Level 1 - Health Centres (spokes) Local GP Practices. District Nursing Specialist Nursing. Treatment Room Nursing. Health Visiting. Level 2 - PCCCs (hubs). Community Mental Health. Family Planning (including Sexual Health). Shared Services - Diagnostics. Imaging. Cancer-supportive and chemotherapies. AHP. ICATS. Social Services. Psychology. Rehabilitation. Marie Curie. One Stop Assessment. Patient experience Level 3 - Local/Sub Acute Hospitals ED/Enhanced GP Out of Hours. Day Surgery. Endoscopy. Specialist Investigations testing. Level 4 - Acute Hospital General Surgery. General Medicine. Gynaecology. Cardiology. Trauma and Orthopaedic Surgery. Plastic Surgery. Maxillofacial Surgery. Healthcare for Elderly. ED. Critical Care services. Paediatric Medicine (including infectious diseases). Paediatric Surgery Renal Services. Haematology. Chemotherapy. Comprehensive range of outpatient services The development of a new integrated model of care for community and hospital services reflects the recommendations within Transforming Your Care 2011(TYC). 7

The focus is on placing the individual at the centre of the model with services becoming increasingly accessible in the local community which will promote a better outcome for the user, carer and their family. By redesign of primary, community services, links to the local hospital network and the Acute Hospital the Trust intends to develop integrated care which fosters positive working relationships. This model will be a significant shift from the provision of services in hospitals to the provision of services within the community, in the GP surgery and closer to home, where it is safe and effective to do this. This will result in the delivery of a quality service which provides safe and effective care outcomes for the patient/client. Throughout the review that informed Transforming Your Care, people expressed their preference for care at home or as close to home as possible. In response to this, any new model should provide more support to help people who are sick or frail to maintain their independence and stay in their own homes for as long as possible. This applies whether that home is the family home, supported housing, nursing home or residential home. Since its formation in 2007, the Trust has developed a strategic vision for a Single Acute Hospital at the Ulster Hospital site, and a local hospital model for Downe and Lagan Valley Hospitals supported by a Primary and Community Care Centre in each of the four Trust localities. The Trust is committed to develop specialist centres of chronicity, through the provision of a Primary and Community Care Centre or Hub in each locality. This is in keeping with the Bamford Review, Older People s Strategy and Regional Dementia Strategy. 8

Figure 2 South Eastern Trust Hubs The new model focuses on providing opportunities to integrate care which crosses professional boundaries to benefit patients, clients and families. The emphasis has been placed on creating an environment to maximise multi-disciplinary and multiprofessional team working and encourage shared opportunities for developing links within Health and Social Care and with external health care partners. The success of this model will be dependent on the ability to maximise the use of appropriate technology to promote service integration thereby improving patient outcomes. This model will be integral to the Trust s four significant change areas as outlined in the Trust s Population Plan in response to Transforming Your Care: Early Intervention and the promotion of disease prevention models to improve health and wellbeing. Acute reconfiguration to deliver hospital services in the South Eastern Locality that improve quality and optimise the use of resources. Greater service integration and a shift of services from secondary to primary care settings to promote patient centred care. Supporting our older population to help them live independently in their own homes for as long as possible. 9

Model of Care for Level 3 Local Hospital Services Down Hospital Lagan Valley Hospital Emergency Department / Enhanced GP Out of Hours; Day Surgery; Endoscopy; Specialists Investigations e.g. Cardiology, Imaging, Pulmonary Function testing; Inpatient Medical Beds including Endocrine, Respiratory, GI, Cardiology, Care of Elderly and Stroke; Midwife Led Unit; Mental Health (Adult); Dementia Inpatient Beds; Rehabilitation; Ambulatory Care; and Specialist Outpatients. Model of Care for Level 2 PCCC Hub Bangor PCCC GP Practices; District Nursing/Specialist Nurses; Treatment Room Nursing; Health Visiting; Community Mental Health; Psychology Services; Family Planning (including Sexual Health); Social Care for Older People; Children s Centre (including CAMHS); Cancer Health and Wellbeing Centre; Voluntary Groups; 10

Complementary therapies; Bookable space for use by e.g. Maternity services, Integrated Clinical Assessment and Treatment Services (ICATS), Outpatient clinics; Dentistry; Allied Health Professionals including Physiotherapy, Occupational Therapy, Podiatry, Speech and Language Therapy; ICATS; and Health Development. Model of Care for Level 2 PCCC Hub including Urgent Care Centre Lisburn PCCC Downe PCCC Ards PCCC The following services will be included within three of the four Trust PCCC Hubs: Reference: HSCB Commissioning Plan 2014/15 Section 8.2 and 8.4.1. These services should be co-located to maximise clinical integration and efficiencies and together will form an urgent care centre within the PCCC Hub. Minor Injuries Intermediate Care Beds GP Out of Hours (GPOOHs) It is the Trust s view that intermediate care beds should be consolidated and collocated with both Minor Injuries and GP OOHs services, in order to maximise clinical adjacencies. Shared / Integrated Services The opportunity for integrated care for the patient will be considered through the access to and use of the following: Diagnostics; Imaging; Cancer- supportive and chemotherapy treatments; 11

Allied Health Professions (Dietetics, Dental, Physiotherapy, Occupational Therapy, and Speech and Language Therapy); ICATS; Social Services; Psychology; Rehabilitation; Voluntary sector; One Stop Assessment; and Patient Experience. Ultimately, it is anticipated that this service model will: Ensure that the professionals providing health and social care services will be required to work together in a much more integrated way to plan and deliver consistently high quality care for patients; Ensure that most services will be provided locally, for example, diagnostics, outpatients and urgent care, and local services will be better joined up with specialist hospital services; Reduce inpatient surgical beds and reconfigure medical inpatient beds; Increase day surgery/endoscopy; Increase screening/ prevention therapies; Increase ambulatory care to include Outpatients/Diagnostic services; Develop Emergency /GP Out of Hours Urgent Care Model integration; 3.1 North Down & Ards Supporting Information The 2013 South Eastern Local Commissioning Group s Strategic Commissioning Statements in regards to Primary and Community Care Infrastructure Service Requirements notes that: Bangor also has a community hospital which includes 20 step-up/step-down beds as well as a range of clinic and diagnostic facilities. There is no capacity within this site 12

for further development. As part of TYC, ICPs will be bringing forward a range of plans to manage many of the conditions for which patients use the Bangor Hospital. The document also reflects the Trust s future vision for the North Down and Ards area. Locality meetings with GPs confirmed their support for the suggested development of four South Eastern Trust Hubs in Lisburn, Downpatrick, Newtownards and Bangor. There was, however, some initial discussion around the potential of a single hub that might serve the populations of Newtownards, Bangor and Comber together with the more dispersed population of the Ards peninsula. However, after further consideration and engagement on this option, there was general consensus that these localities merited separate hubs based on the geographical spread and demographic profile of the population - though given their close proximity the service model should be carefully considered to avoid unnecessary duplication of services. (Source: SELCG Strategic Commissioning Statement re Primary and Community Care Infrastructure Service Requirements July 2013). The Trust s vision clearly articulates a model of four Primary and Community Care Centre Hubs, two of which will be located in North Down and Ards localities. As noted above, the Bangor facility will be a PCCC Hub whist the Ards facility will encompass a PCCC including Urgent Care Centre. The ongoing Primary Care Infrastructure Development programme has been established to facilitate the required investment in community facilities to enable the shift of services outlined in TYC. Both new build facilities required by the Trust have been included in its Strategic Capital Priorities Review 2013-21 to the DHSSPSNI, outlining the key projects / capital investments required for the Trust to deliver its strategic objectives, based on the recommendations of Transforming Your Care. 3.2 Future Service Model for Older People In line with the recommendations from Transforming Your Care 2011 for the Future Model for Integrated Health and Social Care, the Trust s vision for services for older people in the future has been developed. The Trust model of care for older people, aims to encapsulate the wide range of statutory and community based services, as a continuum of care, spanning health and wellbeing, social care, rehabilitation and reablement linking through to long term care and acute care. This model will be 13

better at preventing ill health, will provide patient-centred care, will help manage demand for services, will tackle health inequalities, deliver high-quality evidence based services, and ensure sustainability and value for money. The model has four key pillars:- The model builds on the care already being provided focusing on Improving the health and wellbeing of older people through the development of a targeted range of health and wellbeing services that will address the specific locality based needs of the older population. This will be via a coordinated local network model with a single access point for all services including, falls prevention, social isolation, physical activity, nutrition, information and medication. Better and more responsive care at home to manage those with complex health and social care needs in the most appropriate place. This will be through multi-disciplinary community based services, such as Enhanced Care at Home, working with Integrated Care Partnerships and General Practitioners aiming to avoid hospital admission and ensure direct access for General Practitioners to the appropriate diagnostic services. An ethos of reablement and rehabilitation so that older people regain the maximum level of independence possible and are able to remain in their own home safely. 14

Sustaining the continuum of care (of which intermediate care is a function) that incorporates a wide range of services, to support the local population to receive acute care when necessary, to receive on-going care as appropriate and to access specialist care at the right time and in the right place. The provision of rapid access to assessment and treatment for older people and bridge the gap between Primary and Secondary Care services by creating the opportunity for same day discussion and support on patient management and treatment options between General Practitioners and Senior Hospital Doctors. This also will link with initiatives to develop one stop assessment centres for older people and with the development of a frailty unit, which would ensure the comprehensive assessment of older people seeking emergency care. Increased focus on the role of technology to support our services and service users to manage and support their health and wellbeing. This would be through maximising the use of Telehealth and Telecare services that support a range of long term conditions and help ensure a person s safety at home. Innovation and service development, will be enabled through working in partnership with local industry and through research and development to seek out new and innovative ways to support older people to live independent lives, while remaining safe and confident to manage their health and wellbeing. This model will enhance and maintain the health and wellbeing and independence of older people and provide a range of integrated services that will promote faster recovery from illness, prevent unnecessary acute hospital admission and premature admission to long-term residential care, support timely discharge from hospital and maximise independent living. 15

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