May 2016 Volume 1, Issue 1 New Directions A blueprint for future health and social care delivery in Belfast Trust The purpose of New Directions is to determine, with Trust Teams, the future shape of services for the population of Belfast and across the region (where appropriate) to sustain service safety and quality. Having delivered significant change from New Directions (2008-2012), following a series of public consultations, the Trust focus is now on meeting the health and social care needs of the population we serve for the next decade. Adult Acute Care Representatives What s next for New Directions? The Adult Acute Care are visiting the four main hospitals sites to update staff on New Directions. If you are available, why not come along? -Belfast City Hospital (Friday 27 May 2016, 1:00pm-2:00pm, Boardroom, A Floor, BCH) -Mater Infirmorum Hospital (Thursday 2 June 2016, 12:30pm-1:30pm, Atrium, MIH) -Royal Victoria Hospital (Friday 3 June 2016, 1:30pm-2:30pm, Boardroom, KEB, RVH) -Musgrave Park Hospital (Thursday 16 June 2016, 12:30pm-1:30pm, Conference Room, Regional Acquired Brain Injury Unit, MPH) Stephen Austin (Lead, Non-Emergency Surgical Care ), Niall Herity (Lead, Non-Emergency Medical Care ), Janet Johnson, Kevin McMahon, Bernie McQuillan, Danny McWilliams, John Maxwell (Lead, Emergency Care ) & Martin Dillon (Chair, Adult Acute Care ) Service User, Carer & Community Reference Planning Support Teams; Clinical Support Teams Non-clinical Support Teams Workforce & Education Plan Capital Development Plan Communication Plan Emergency Care Chart showing New Directions Project Structure Trust Board Project Board Adult Acute Care Non-Emergency Surgical Care Children s & Community Services Non-Emergency Medical Care Key Stakeholder / Strategic Partnership The Teams Project Board is responsible for decision making on the delivery of New Directions, ensuring that teams are appropriately structured, resourced with clear accountability and reporting arrangements. The Adult Acute Care has reviewed the data on current activity and identified four key themes for future service delivery, i.e. Emergency Care, Short Stay Surgery, Inpatient Elective Surgery (with supporting Medical Specialties) and Ambulatory Medical Care Services. Early work is underway within the teams leading their reviews.
The Teams The Children s & Community Services is currently working on developing a separate vision for the Trust for community services. The group will be working in partnership with other statutory, voluntary & community Organisations. The User, Carer & Community Reference represent service users, community and voluntary Organisations whose input is essential to the project. The Key Stakeholder includes Belfast Trust partner organisations, whose role is to support the understanding of the wider environment in which we work. Overarching Principles for New Directions. Taking account of feedback received from staff, service users and keystakeholders; one set of principles have been developed, as the guiding Overarching Principles for BHSCT. We will place safety and quality Draft Principles at the centre of our services; We will work with our partners to improve health and social wellbeing, reduce inequalities and support communities to develop local solutions; We will deliver a caring and compassionate service user and carer experience, safeguarding the most vulnerable; We will focus on prevention and early intervention; We will provide alternative pathways to ED attendance and hospital admission at every opportunity; We will improve accessibility to services for everyone, promote equality and recognise diversity; We will recognise value and support the role of carers, families & volunteers; We will fully engage with, and respect, service users views and needs in service planning and delivery on an on-going basis; We will embrace openness, transparency in the service of accountability, trust and the growth of knowledge; We are committed to excellence in teaching & training; We will continually innovate & improve our services within available resources, encourage research and development & communicate effectively. Strategic Environment Workshop Workshops A workshop was held on Wednesday 13 January for New Directions to identify key technological, workforce, social and economic changes which will impact on the future delivery of health & social care services. Trust Teams 1 June 2015 Overarching Principles 9 June 2015 Maternity Services & Children Services 18 August 2015 Mental Health Services 19 August 2015 Older People Services & Acute Services 20 August 2015 Speakers included; Mr Nigel Edwards, Chief Executive of the Nuffield Trust Professor Stuart Elborn, Queen s University Belfast Ms Sharon McNicholl, Belfast City Council Mr Iain Deboys, LCG, Health and Social Care Board Strategic Environment 2025 13 January 2016 If you would like to find out more information about New Directions, or wish to comment, please contact; Dr Sloan Harper, Primary Care, Health and Social Care Board There was a detailed discussion about the potential impact on New Directions of the planned commissioning changes with the devolvement of HSCB functions and the recommendations from the Expert Panel reviewing NI Health & Social Care. Newdirections@belfasttrust.hscni.net
A blueprint for future health and social care delivery in Belfast Trust v2.5 A blueprint for future health and social care delivery in Belfast Trust New Directions 2 for Belfast Trust Terms of Reference 1.0 Overall Objective Develop, consult and deliver on a Strategic Services Plan for BHSCT s integrated health and social care service for the next 3-5 years, underpinned by robust workforce, activity and financial models, which will deliver the right care in the right place, resulting in safe, high quality outcomes for our population. 2.0 Context/Approach In 2007/8 two important steps were taken the development of The Belfast Way, designed to explain the purpose of the newly formed BHSCT, its values and behaviours, performance management and key actions which would be taken over the first 5+ years of the new Trust. Secondly, New Directions 1 outlined the principles and proposals for major service change across hospital and community services in Belfast, based on delivering co-ordinated, person-centred services at key stages of people s lives. Widespread support for these proposals, from patients and service users, families, carers, Trades Unions, Commissioners and key stakeholders, led to the successful implementation of major service changes (known as Strategic Services Review Workstream, SSRW) with a Review of New Directions Achievements 2007/8 2013/4 completed in March 2014. 1 The development of New Directions A blueprint for future health and social care delivery in Belfast Trust will enable the Belfast Trust and its partners to identify and address the key strategic changes which will be required to ensure the Trust s readiness to meet the challenges. A blueprint for future health and social care delivery in Belfast Trust will bring together staff, patients and service users, carers, families and a wide range of partners with the Trust to develop and lead proposals for transforming health and social care in Belfast across the next decade. BHSCT will also take account of other national and regional initiatives, including the Donaldson Report 2 recommendations, the NI Programme for Government (OFMDFM) and relevant service, workforce and commissioning papers. 3.0 Timescales (*depending on level of site modelling and Site impact overview required for acute & community plans) 3.1 Engagement & team establishment 3.2 Engagement with Service Teams 3.3 Development of Strategic Proposals 3.4 Consultation & Implementation Plans Autumn 2015 2016/17 2017/18 tbc 1 A summary of achievements from New Directions 1, Review of New Directions 2007/8-2013/14), March 2014 2 The Right Time Right Place - An expert examination of the application of health and social care governance arrangements for ensuring the quality of care provision in Northern Ireland, Sir Liam Donaldson et al
4.0 Project Structure 4.1 Stakeholder involvement from the outset is essential to ensure early engagement, commitment and delivery on the recommendations of the New Direction Project Board, which will be subject to public consultation. 4.2 The proposed Project Board Structure (Appendix 1): a) New Directions 2 Project Board (draft Key Tasks in Appendix 3). Project Board oversees New Directions Project Team, reporting to Trust Board on a regular basis. b) New Directions 2 Project s (draft Key Tasks in Appendix 3). 1. Children & Community Services, including 1a Mental Health Services 1b Older People Services & Physical/ Sensory Disability 1c Learning Disability Services 1d Children s Services (including Maternity Services) 2. Adult Acute Care, including 2a Emergency Care 2b Non- Emergency Surgical Care 2d Non- Emergency Medical Care Other specific work in relation to the following will be required & Representatives included in the above groups 3. Clinical Support Plan: Theatres, CCU/ICU & Clinical Support, Diagnostics, Outpatients etc 4. Non-Clinical Support Plan eg Medical Records, Patient and Client Services, Information Communication and Technology services etc. 5. Workforce and Education Plan 6. Capital Development Plan including Estates 7. Communication/Engagement Plan 4.3 Project Methodology Project methodology will be utilised to ensure the above framework is delivered within the time and budgetary constraints of the project. 5.0 Methodology A framework for the development of Creating our future Health & Care Together is proposed to enable BHSCT and partners to review, assess and determine proposals within a wider health and social care context. Framework Steps Actions Lead 1. Ensure patients and service users, families, carers and key stakeholders are fully involved in strategy Step 1. Frame: Agree on development. the important strategic 2. Identify the strategic questions we need to answer. decisions to be made, and 3. Review and amend existing principles from New identify the principles, criteria Directions 1 (See Appendix 4) and identify criteria for and constraints for making decision making process. them. (See appendix 2). 4. Sign off PID (Project Initiation Document). Service User, Carer & Community Reference Project Board supported by Project Team/s Page 2 of 9
Step 2. Diagnose: Establish detailed insight on the BHSCT s starting position and what determines performance 1. Review Service demand/capacity and identify potential service changes. 2. What are our agreed key indicators of performance? 3. What is Trust baseline for key indicators? Are there gaps in information required? Key Stakeholder supported by Project Team/s Step 3. Forecast: Create a clear view of the potential future (s) in which the BHSCT might operate. Step 4. Generate Options: Develop, explore and evaluate strategic ideas and options for change. Step 5. Prioritise: Make choices about the set of strategic ideas for change and build them into one effective coherent strategy. 1. Complete and review forecast (Political, Capital, Workforce, Economic, Social, Technological influences) with key stakeholders. 2. Define likely Service Environment 2015-2025. 1. Determine Strategic Direction for Community and Hospital Services. 2. Identify Options Long List, assess, develop short list and evaluate. 3. Consider overall impact of options. 1. Ensure Strategy cohesion. 2. Develop Consultation and Equality paper and Communications Plan. 3. Identify potential implementation timeframe. Key Stakeholder supported by Project Team/s/Strategic Partnership Project Board, supported by Teams/s Project Team/s, led by Project Board Step 6. Consult & Deliver: Consult and create/ communicate the action plan and allocate resources to deliver the goals of the strategy. 1. Deliver detailed and extensive Consultation and Engagement. 2. Prepare draft Implementation Plans, amending as required from Post-Consultation feedback and agree timeframes/resources/change tools. 3. Deliver detailed implementation against agreed success criteria/kpi s. Project Team/s, led by Project Board Step 7. Evolve: Monitor the impact of the strategy and recommit, refresh or recreate when needed. 1. Proactive project management throughout. 2. Post Project evaluation, including performance review. Project Team/s, led by Project Board 6.0 Governance Arrangements Governance of the New Directions 2 is demonstrated in Project Structure Appendix 1, with New Directions Project Team reporting directly to the New Directions Project 7.0 Timescales (indicative only, TBC) Page 3 of 9
TASKS 2015/6 2016/7 2017/8 Q1 Q2 Q3 Q4 Terms of Reference & PID agreed Project Team & s work underway Communication Plan Staff engagement Stakeholder engagement Development of Proposals Agree Consultation Process & Next Steps 8.0 Membership See Appendix 2 for draft membership 9.0 Meeting Frequency Proposed: New Direction Project Board New Direction Project Team: Adult Acute Care : Children s & Community Services User, Carer & Community Reference Strategic Partnership Bi-Monthly Monthly As required As required As Required As Required Page 4 of 9
Appendix 1: Project Structure and Reporting Arrangements Page 5 of 9
Appendix 2.1 New Direction Project Board Key Tasks 1. Establish a Project Structure, setting Terms of Reference for Adult Acute Care & Children s & Community Service & other Supporting s, ensuring early engagement with key external partners and ensure internal communication arrangements are effective. Ensure that the project is adequately structured, resourced, with clear accountability and reporting arrangements. 2. Review and sign off Project Objectives, Strategic Questions & Revised Guiding Principles. 3. Identify the strategic decisions to be taken by BHSCT with partners, taking account of the national and regional strategic direction for services. 4. Consider proposals from Project s & develop Trust-wide proposals for wider consideration 5. Lead and support the delivery of a comprehensive Consultation where appropriate and engagement across the population before, during & after the Consultation Period. 6. Sign off the Consultation Feedback Paper for Trust Board. 7. Maintain a Risk Register through the project. Regularly review project arrangements to ensure these remain agile. 8. Review and assess Implementation Plan in conjunction with Project Team, including: list of all activities, milestones, measurements, key performance indicators a Project Plan for the series of service changes and for all associated Risks a Clinical Support Plan a non-clinical Support Plan a Workforce and Education Plan for the service changes affecting staff a Capital Development Plan to support the overall Plan a Communication/Engagement plan to support the overall Plan Review & prioritise the risks & independencies in services moves 9. Lead Implementation via Project Team & Supporting s. 10. Report regularly to Trust Board on Project Plan. 11. Maintain effective working relationships with all stakeholders, including staff representatives and professional associations, representatives for patients, clients and local communities, commissioners, the Department of Health, and Political representatives. * If site modelling of options and site impact overview developed at this stage, additional project time will be required. Page 6 of 9
2.2 Project Key Tasks 1. Establish membership and review Terms of Reference, ensuring early engagement with key external partners and ensure internal communication arrangements are effective. 2. Ensure that the project is adequately structured, resourced, with clear accountability and reporting arrangements. 3. Develop Project Plan to deliver Project Objectives 4. Review learning from outcome of New Directions 1. 5. Contribute to the Commissioner overview of Service demand/capacity and identify potential changes, taking into account the assessment of BHSCT s current performance (quality, operational, financial and workforce) against national benchmarking and best in class Trusts. 6. Engage fully with Key Stakeholder / User, Carer & Community Reference s. 7. Identify proposals for consideration by Project Board 8. Develop, if required, the Site Modelling and Site Impact Overview*. 9. Make recommendations to the New Directions Project Board and work with Project s to develop Consultation/EQIA paper for formal Consultation process where appropriate. 10. Develop, in conjunction with Project s, the Implementation Plan and undertake monitoring arrangements. * if site modelling of options and site impact overview developed at this stage, additional project time will be required. 2.3 Key Stakeholder key tasks (Draft 1) 1. Establish membership and review Terms of Reference, ensuring early engagement/ communication arrangements are effective. 2. Contribute to the development of strategic decisions to be taken by BHSCT. 3. Guide and direct on the development of Overarching and Service Principles. 4. Provide an overview of BHSCT Service demand/capacity and identify potential changes 2015-2025, taking into account the assessment of BHSCT s current performance (quality, operational, financial and workforce) against national benchmarking and best in class Trusts. 5. Identify, with Trust s, the opportunities to redesign services to better meet patient/client needs) and define Service environment 2015-2025. 6. Contribute to the consideration of service delivery change proposals. 7. Contribute to the pre-consultation and Consultation of New Directions 2, where appropriate. Page 7 of 9
New Direction 2 Service User, Carer and Community Reference Background High quality engagement with, and involvement of patients, clients, service users, carers and communities can have positive impact on the delivery of care and the outcome of services. Effective involvement is central to the delivery of quality care and can lead to improvements in the experience of using services. Involvement of patients, clients, services users, carers and communities is a statutory requirement, and should be an integral part of service planning, delivery and evaluation across the organisation. The Trust is about to begin the process of developing New Directions 2. The development of New Directions 2 Creating out future health and care together, will enable the Belfast Trust and its partners to identify and address the key strategic changes which will be required during the period 2015-2025, to ensure the Trusts readiness to meet the challenges. The Trust has established a Service User, Carer and Community Reference to support and inform the development of New Directions 2. This group will sit as part of the overall project management structure. Purpose of the To provide a service user, carer and community perspective on the development of New Directions 2 To provide a forum for the discussion of progress To influence the content of New Directions 2 Membership To be involved in discussions and make recommendations on the development of New Directions 2 To provide constructive feedback and offer an alternative perspective and challenge when necessary To seek the views of the wider community as and when necessary To provide guidance on regional involvement as and when necessary To help shape and inform wider involvement as and when necessary Maximum of 20 representatives drawn from a range of service user. Community, voluntary and carer groups to ensure a broad range of conditions and geographical spread. Page 8 of 9
Appendix 3 Guiding Principles for New Directions 2 The approach to reviewing and reorganising the services of the Trust must be guided by some general principles. These principles are as follows: 1. We will place safety and quality at the centre of our services. 2. We will work with our partners to improve health and social wellbeing, reduce inequalities and support communities to develop local solutions. 3. We will deliver a caring and compassionate service user and carer experience, safeguarding the most vulnerable. 4. We will focus on prevention and early intervention. 5. We will improve accessibility to services for everyone, promote equality and recognise diversity. 6. We will provide alternative pathways to ED attendance and hospital admission at every opportunity. 7. We will recognise, value and support the role of carers and families & volunteers. 8. We will fully engage with, and respect, service users views and needs in service planning and delivery on an ongoing basis. 9. We will embrace openness, transparency in the service of accountability, trust and the growth of knowledge. 10. We are committed to supporting, training and developing our current and future workforce. 11. We will continually innovate & improve our services within available resources, encourage research and development & communicate effectively. Page 9 of 9