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Quality care – for you, with you

Southern Health & Social Care Trust

Three Year Strategic Plan 2015-2018

‘Improving Through Change’

Trust Board 22nd October 2015

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Contents

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Section 1: Why have we produced a Strategic Plan for the next three years?

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Section 2: About the Southern Health & Social Care Trust 4

Section 3: Our Vision & Values 7

Section 4: Our Strategic Priorities 10

Section 5: Making Our Vision Happen 12

Section 6: Recognising staff as our most important resource 42

Section 7: Communicating Our Strategy 44

Section 8: Equality & Human Rights Considerations 45

Section 9: Rural Proofing 48

Section 10: Managing, Monitoring & Adapting Our Plans 49

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Section 1:

Why have we produced a Strategic Plan for the next three years?

Health and social care is constantly changing. This is driven by the changing needs of local people, by new technologies and ways of delivering care and by the resources made available to the Trust by our local assembly. It is important that we anticipate and plan for these changes and that we openly engage with our local communities and staff on how we plan to develop and improve the services we provide in the future. This strategic plan explains how we would like Trust services to look three years from now. Alongside this strategic plan we will tell you what we plan to do in detail each year in our Trust Delivery Plan and Corporate Plan. All of these plans aim to ensure that there is clarity and transparency on the priorities we are setting for achievement. They ensure that our local communities know what to expect from us, that all of our staff are aware of their role in delivering on these priorities and that we can demonstrate improvements and progress by the end of each year. The views of all our stakeholders are important to us and so we carried out a public consultation exercise and refined our plan in light of comments received during the consultation process. Further detail can be found in the ‘Outcome of Public Consultation on SHSCT Three Year Strategic Plan 2015-2018’ which has been published on the Trust web site.

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Section 2:

About the Southern Health & Social Care Trust

The Southern Health and Social Care Trust (the Trust) was established on the 1st April 2007 and is one of six organisations that provide a wide range of health and social care services in Northern Ireland. The Southern Trust covers the council areas of Armagh, Banbridge, Craigavon, Dungannon, South Tyrone and Newry and Mourne – a population of some 366,000. The acute hospital services provided by the Trust from Craigavon Area Hospital and Daisy Hill Hospital are also used by people from other areas in Northern Ireland.

The Trust employs approximately 13,000 staff, has an income of approximately £532m and spends almost £1.5m per day delivering care to local people.

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In delivering this commitment the Southern Trust, working with our Commissioner and local partners in Integrated Care Partnerships over recent years, has put a wide range of new and improved services in place in our community and in our hospitals. These include: -

The Trust is committed to supporting people to live at home for as long as possible, with as much choice as possible over how their needs are met. We want to be a partner in care – with individuals, families and communities – to deliver the best quality of care to meet those needs.

Our Total Population is: 366,000 Each year across our 2 acute hospitals the Southern Trust treats:

50,000 Inpatients

120,000

Emergency department patients

190,000

Outpatient appointments

= 5,000 patients Each year across the Southern Trust we support people to remain independent in the community through: 6,000 People supported by Domiciliary Care Services in their own Home 2,223 Residential and Nursing Home Placements £1.5 million Annual expenditure on community equipment to support people to remain

independent in the community

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• Specialist community teams and new technology, including telemedicine and telecare, to help people to better understand and manage their long term conditions and avoid the need for emergency care.

• Specialist local ‘one stop’ clinics where older people can receive rapid assessment and treatment when they experience deterioration in their health.

• Reablement service that supports people in their own home to regain their ability to live as independently as possible.

• Delivery of a Support and Recovery model that ensures people with mental health needs receive the support they need to live as independently as possible within the local community with a reduced reliance on hospital care.

• Prevention and early intervention with children and families to ensure children have the best start in life with more children benefiting from improvements in early years.

• Increased and enhanced domiciliary care services, now supporting 6,000 people at home.

• The launch of a new service in 2014 to provide acute care to older people in the community (in their own home and in nursing/residential homes) via a rapid response Geriatric consultant led service to avoid the need for hospital based care where appropriate.

• More specialist care in our acute hospitals, providing local access and an increase in Outpatient procedures, ambulatory/day clinical care and an increase in day surgery cases over the last five years.

At the same time as our developments in community based care, advances in hospital care are transforming how patients receive care when they need to be in hospital. Many services can now be provided without the need for an overnight stay. Increasingly, hospital stays are for a short time, for patients who are acutely ill and need the specialist care that can only be provided in a hospital.

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Section 3:

Our Vision & Values

Our vision is to deliver safe, high quality health and social care services, respecting the dignity and individuality of all who use them. This vision is underpinned by the Trust’s values which shape what we do

and how we do it. These values are:

We encourage a culture of trust and openness by ensuring transparency in our processes and decision making.

1. We will treat people fairly and with respect

2. We will be open and honest, and act with integrity

3. We will put our patients, clients, carers and

community at the heart of all we do 4. We will value and give recognition to staff, and

support their development to improve our care 5. We will embrace change for the better

6. We will listen and learn

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Our corporate objectives reflect our priorities for the delivery of health and social care services to our local population:

Achieving our objectives and delivering safe, quality care and services, which are accessible and responsive to our patients and carers will remain our central focus. The challenge will be to continue to improve our services and meet changing and increasing demands within the current climate of no financial growth. To do this, we need to continue to make the best use of our existing resources which will mean changes to the way we currently provide services.

Corporate

Objectives

Promoting safe, high

quality care Maximising

independence and choice for

our patients and clients

Being a great place to work,

valuing our people and

clients Making the best use of

resources

Being a good social partner

within our communities

Supporting people and

communities to live healthy lives and to improve their health and

wellbeing

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In meeting these challenges and continuing our journey of improvement, we have been looking at opportunities to reshape our services in a way that can improve patient’s experience and the quality of care they receive. We believe we can do this by changing how we do things, including making the most of new technology; adopting best practice; treating people at an earlier stage and enabling them to improve their own health and wellbeing; and working differently with communities and other providers of services.

The key local factors contributing to the need for change in how we deliver health and social care include: Growing & ageing population

Population growth of 18% between 2000 and 2011 (NI average 7%) & projected growth of 15% by 2023 compared to NI average of 7%

21% increase in births since 2001 compared to NI average of 15%

By 2023 there will be a 69% increase in Trust’s population aged over 75, compared to NI average of 55%

• Increased numbers of people with one or more long term conditions.

• Increased demand, increasing expectations and over reliance on hospital services.

• Increased Black and Ethnic Minority population with specific needs. • Highest level of children with statements of educational need in NI. • Ensuring safety and quality in service provision and meeting

national standards and locally defined commissioning criteria. • Financial challenges with no growth in funding at the same time as

demand is increasing. • Aligning availability of the right workforce skills and number of staff

with growing demand. • Availability of technological opportunities to improve access to care.

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Section 4:

Our Strategic Priorities

This three year plan builds on the Trust’s “Changing for a Better Future 2013-15” which summarised what some of our key areas of change would be. These areas of change were described under four key themes which continue to underpin the Trust’s future model of care across our services. We have now added a fifth key theme to improve the safety and quality of our services that will focus on the recommendations of the Donaldson Review “The Right Time: The Right Place” (published in December 2014). Our Key themes are: In 2014 we consulted with you on three important proposals to improve how hospital based care and treatment is delivered in the future over the next two to three years. We would like to take the opportunity to thank those of you who shared your experiences with us as part of this consultation. Your views on our proposed changes were invaluable in providing for better informed decisions and in November 2014, following extensive consultation and consideration of all issues raised, Trust Board decisions were reached: -

• Promoting early intervention, prevention and “wellness” and better enable self-care

• Enabling choice, independence and care in your local community

• Primary, hospital and community care working more closely

together and collaboratively with other care delivery partners

• Making the most of our hospital network

• Improving the safety and quality of our services

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• To develop a dedicated specialist acute stroke unit at Craigavon Area Hospital.

• To consolidate all inpatient non-acute hospital services for older people at Daisy Hill and Craigavon Area Hospitals.

• To relocate Dementia Assessment Inpatient Care from the Gillis Unit in Armagh to a new fit for purpose unit on the Craigavon site.

We have now started the planning and communication processes necessary to enable us to deliver on these changes and we know, because we will need to invest in our infrastructure at Craigavon Area Hospital, that it will take us at least two to three years to implement these plans. This implementation will remain as a priority in this strategic plan. Some of the key areas of change we expect to deliver on over the next 3 years will require public consultation. Following on from what we previously indicated in “Changing for a Better Future 2013-15”, the specific proposals that the Trust will wish to consult with you on over the coming months include those relating to: -

• Trust Acute Strategy • Learning Disability Short Breaks • Minor Injuries Services • Children’s Residential Care • Statutory Residential Care for Older People • Changes to Day Care & Social Centre Provision for Adults and

Older People

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Section 5:

Making Our Vision Happen

As part of our strategic planning work, we have worked with our Trust staff, service users, Senior Management Team, Trust Board, Commissioners and local partners to look in more detail at what our priorities for the future should be in line with our vision and core values. We have been engaging with our staff on an ongoing basis through our corporate planning processes to inform our strategic priorities and agree how best we can deliver on these. We were pleased to be able to hear more from our staff and from local stakeholders during the consultation to inform this final strategy document. We are continuing to look at how we can further develop how services are delivered across the Trust. Some of this work will be informed by public consultations and more detailed thinking and planning will be important to ensure any changes we make deliver improved outcomes for our patients and their carers. We will also be continuing to review our plans in the context of wider Health and Social Care changes, including how the recommendations of the Donaldson Review “The Right Time: The Right Place” (December 2014) are to be progressed. The following sections set out our proposals for each of our 5 key strategic themes, identify our specific aims over the next 3 years and what actions we propose to take to deliver on these aims:

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Table 1: Strategic Priorities, Plans for Delivery & Outcomes 1. Promoting early intervention, prevention and “wellness” and better enable self-care

What do we want to achieve over the next 3 years?

How do we plan to deliver this?

• Give children the best start in life so that they will have a better opportunity to achieve life and educational goals, improving outcomes for children and their families.

• Promote uptake of screening and

prevention programmes.

• Promote independence for people with mental health and disabilities.

• Improve access to a range of

information, support and advice to help older people better meet health and social care needs.

We will continue to support children and families through a range of prevention and early intervention and safeguarding initiatives and safeguarding to promote good health and healthy behaviours, particularly in the early years. This will include the delivery of the Family Nurse Partnership programme to teenage mothers to provide intensive support during the first 2 years of their child’s life. A range of family support and safeguarding services will be provided to all children in need. This will include early intervention partnerships within the local voluntary sector to develop local community Hubs. Gateway Teams have been established to provide a single point of entry to safeguarding services and these will continue to be promoted throughout the Trust. We will enhance support for physical, mental and emotional wellbeing through strengthening our locally based (family) support hubs. We are in the process of developing our networks through better partnership working with the community and voluntary sector which will mean we can deliver locally available services which best meet the needs of service users and families.

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• Work in partnership with those who need our services, their families, local communities and other providers to promote healthy lifestyles and early intervention services which will reduce health inequalities by tackling the causes of poor health.

We will promote screening and prevention programmes, including the implementation of any new vaccination programmes for children. We will be offering the ‘Healthy Child Healthy Future’ programme and baby friendly initiatives to all families with new born babies with a particular focus on populations/areas of low uptake of healthcare services. We also will work in partnership with Housing and other community providers in extending a range of supported housing and day opportunities to promote independence for people with mental ill health and disabilities. We will further develop our Access & Information Service for older people and primary care to provide a single point of access to support assessment and onward referral to a range of health and social care services including an electronic directory of services and stronger links with the Community and Voluntary sector to ensure that older people at risk of social isolation are appropriately signposted to local support and opportunities to participate. We will continue to encourage and support the development of options to provide for local involvement and innovation in the future delivery of our services, including community skills development and the expansion of social economy businesses. We plan to consult with you on potential changes to the training and development opportunities we currently provide for adults with a learning disability through two of our

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How do we plan to deliver this? schemes on the Bannvale site in Gilford (Zest coffee shop and the Horticulture Unit). We are currently exploring options to lease these facilities to an external provider, including the potential for development of a social enterprise, to increase the number and diversity of training and development opportunities available. This would enable these services to act as an important stepping stone to other day opportunities within the community, including accredited further education, volunteering and paid supported employment. We will also consult with you on the future options for delivering day opportunities for persons with disabilities in the future. Having undertaken ‘Community Conversations’ in Keady, Fivemiletown, Dromore, Craigavon and Kilkeel where we have listened to the issues and concerns raised by older people about their community, we have established local implementation groups in these areas to help us build on our community development approach to local issues, such as home safety and security, road safety and transport. We will use this approach to enable local communities to grow their potential to develop social enterprises that deliver services for their local population, working closely with new Councils via Community Planning processes.

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How do we plan to deliver this? We plan to work with our statutory, community and voluntary partners to ensure effective collaborative approaches which will address the needs of our local communities. This will include: -

- Increase volunteering opportunities through the targeted recruitment of volunteers and the development of new volunteer roles to address a range of needs in the community and enhance patient experience through befriending and social support.

- Support capacity building, training and fund-raising with the community and voluntary sector.

- Deliver a range of targeted health improvement and wellbeing programmes to jointly address the wider social determinants of health such as poverty and disadvantage, housing, lifestyle, environment and educational attainment. This will include the development of programmes such as the Verve network of healthy living centres in Craigavon and the Community Health Champion programme which has been developed in partnership with DSD, BIG and local community and voluntary sector groups.

- Develop an infrastructure, in partnership with CV sector, local councils and other stakeholders, for better navigation of older people and those living with dementia to ensure appropriate and timely access to community and voluntary sector services within their local area.

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The outcomes we expect from these actions will include: -

• Improved health outcomes will increase length of life and the number of years that people spend free from disease, illness and disability.

• Increased access to early advice and support will make sure that people get to the right place to get what they need as soon as possible.

• Creating “Good Neighbourhoods for Ageing Well” and developing and strengthening social partnerships where

better use of all of the resources across local communities, statutory organisations, voluntary and private providers, will provide for a more joined up approach to preventive care and tackling health inequalities.

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2. Enabling choice, independence and care in your local community



• Improve the range of community based support and services available to give people more choice and control about the type of care they can access.

• Engage patients and their families/carers in service planning design and delivery of services.

• Work in partnership with independent, community and voluntary partners to provide a greater range of supported housing options with appropriate support.

• Work with the community and

voluntary sector to develop a range of day and short break opportunities to support people with disabilities and their carers,

We will fully implement our reablement service for older people across the Trust area We established a new reablement service in 2011 to provide support for older people to help build their skills and confidence so they are able to remain at home for longer and more independently. This service is in place in 5 of our 7 geographical areas and, as we roll this service out into our 2 remaining areas and across our services, we will build on learning to ensure continuous improvement in service delivery to optimise outcomes for the patient. A review into making the best use of the Intermediate care rehabilitation and reablement resources available for older people will be completed. We will be introducing changes in the delivery of domiciliary care services, working with our independent sector partners to ensure we streamline access and quality of service delivery providing for better outcomes for the patient. The Trust will test out new models of domiciliary care delivery to support better client centred care and flexibility in meeting client need. We will implement the regionally agreed Mental Health Core Care Pathway to ensure people are fully involved in decisions on their own care from referral through to discharge which will involve some changes to how we currently deliver our services. The changes we plan will improve awareness of the services we deliver, provide for better communication and

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enabling them to move away from traditional forms of care.

more user-friendly methods of engagement and involvement of people with a mental health illness. We will review and improve dementia care to deliver more joined up services across the Trust. This will include implementation of the recommendations of the Regional Dementia Strategy with a focus on training, information and support to carers and people with dementia and development of shortbreaks. This will provide for improved screening, identification of early diagnosis and support for patients and family/carers. We will fully implement the Stepped care model for Children Adolescent Mental Health Services. This will include integration of Child Development, Intellectual Disability and Mental Health CAMHS Services to ensure the provision of a seamless child and family focused service which will ensure rapid access to diagnostic and treatment/support services. We will develop multi-disciplinary team working to support the needs of children with disabilities and complex healthcare needs. This will enable us to streamline our current processes, providing for a single point of referral to services and improved planning so that we can best meet the care needs of children through to adulthood. We are committed to increasing our placement choices for children in care. We plan to further develop our front-line fostering scheme and specialist foster care scheme. This will help prevent children needing to

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How do we plan to deliver this? access long-term residential care services and provide them with greater opportunities through supporting them to grow up in a family setting. We will provide care around the needs of the individual through individual care plans that support increasing numbers of people using personalised budgets to access a greater range of care services across a range of providers. This will be developed through the establishment of a Self-Directed Support (SDS) team, further training and support for Community Teams and promotion of the SDS model in line with regional guidance across the population with targets set for uptake We are committed to maximising opportunities presented by advancements in technology to enable people to have greater control of their lives. We will continue to promote access to monitoring equipment through the further development of telehealth services for patients with long term conditions at home. Almost 1,400 people in the Southern area have already benefited from this service over the past 3 years and we plan to roll out these services into new areas to provide support to a new diabetic model, smoking cessation, acute discharge pathway models and GP monitoring models. We plan to review our existing use of telecare services to help create capacity to further extend this service to a greater number of patients. We plan to work with the Housing Executive and Southern Local Commissioning Group (LCG) to further develop Supported Housing in

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How do we plan to deliver this? line with assessed need. We will work with the Housing Executive to develop housing options for adults with mental health and disabilities and to provide for a range of flexible options for children who are leaving care. We will support the completion of a new housing scheme for older people in Kilkeel and plan to bring forward schemes for older people in Craigavon/Banbridge and Armagh/Dungannon localities. Work is also ongoing to provide a new range of help and support within a person’s own home. This will include the enhancement of floating support services across the Trust which will support older people to continue living in their existing accommodation reducing the need for placement in a residential/nursing home. The practical support offered can provide help to older people to maintain security and safety in their home, with personal budgeting or assistance with shopping which will promote social inclusion in their local community. The Trust, by working with other partners to make alternative housing and support available for older people, may consult on the future provision of statutory residential care homes. We plan to modernise Day Services for people with learning & physical disabilities and also for people with mental health issues. Following the HSCB Public Consultation on Day Opportunities and the support given for the proposed approach, the Trust wishes to enhance the range of day opportunities available in local communities and ensure our

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How do we plan to deliver this? Day centres provide care and support for people with complex healthcare needs and challenging behaviours. We will be working with our service users and carers to develop more person-centred opportunities in work, leisure, training and education and we will provide support to individuals who could benefit from these services in moving from centre based care. We will consult with you on any service changes we would propose to local day care provision as a result of these plans. We are planning to develop new purpose-designed facilities which will enhance environments for people attending our day centres, enabling us to refocus the role of our day centres to provide rehabilitation and care to those with the most challenging behaviour and complex healthcare needs. We plan to open a new Day Care Centre for adults with a learning disability (46 places) and adults with a physical disability (20 places) in Banbridge in 2015/16. This new centre will replace day care currently provided from Ballydown and Loughbrickland Social Education Centres (both of which will continue to provide temporary accommodation until the new building opens). Plans are well progressed for new day care centres for adults with a learning disability in both Crossmaglen and Dungannon and we are hopeful

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How do we plan to deliver this? that funding approval will be provided to enable us to commence these projects in the near future. We plan to enhance the availability of Short Breaks for adults with a learning disability. We plan to improve the range, accessibility, flexibility and availability of short breaks which are tailored to meet individual assessed need. This will include additional overnight accommodation to meet the increasing demand on services. We will consult with you on any service changes we would propose to local provision as a result of these plans.


• People will be supported to live in their own homes and stay as independent as possible for as long as possible.

• Individuals will have greater access to a greater range of care services across a range of providers which will give them improved choice about where and how they are cared for.

• Care will be brought closer to home for people most at risk through enhanced access to a range of community

based assessment and treatment services.

• Clients or Service Users and their families will feel cared for and empowered as a result of increased involvement in decision-making about their care.

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3. Primary, hospital and community care working more closely together and collaboratively with other care delivery partners



• Work with GPs to identify people in their practices ‘at risk’ of being admitted to hospital and improve joined up care planning and support for these individuals. This will include specific support for people with palliative and end of life care needs.

• The expertise of specialist

hospital based staff will be made available to provide more care and advice in the community to patients and professional staff supporting their care.

• Support the development of

Integrated Care Models that join up the planning and delivery of care by primary, independent, voluntary and acute teams, particularly for frail older people

We will fully implement a seven day week Acute ‘hospital at home’ service for older people across the Trust area which provides acute medical care at home as a viable alternative to hospital admission for patients who are not critically unwell. This will enable referrals to be made from hospital settings and GPs for patients in their own home and Nursing and Residential homes. The referrer will speak directly to the Consultant or Specialty Doctor who will provide an immediate decision regarding appropriateness of referral and agree a pathway to best meet the patient’s needs. This may include a home visit (within two hours of referral) by a member of the multidisciplinary Team or assessment at a rapid access clinic (on day of referral where possible). We have already shown early successes having commenced a pilot service to test the model in some localities. We want to develop 7 day working across our Specialist Community Teams to ensure patients have improved access to appropriate community services. We plan to put this in place in the first instance for patients with Chronic Obstructive Pulmonary Disorder (COPD) and will work with our Commissioner towards enhancing Early Supported Discharge and 7 day therapy and rehabilitation to support people who have had a stroke.

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and people of all ages with chronic diseases such as diabetes, respiratory conditions and who have had a stroke.

• Improve accessibility to primary and community services by continuing to develop Community Treatment & Care (CTCC) hubs at Lurgan and South Tyrone Hospital.

• Make effective use of technology to improve patient care and communication.

• Improve sustainability within the GP Out of Hours service.

The Trust will continue to work as a delivery partner with GPs, pharmacists and other primary care practitioners through Integrated Care Partnerships (ICPs) and GP federations to improve care. This will include the identification of patients, who due to their condition and co-morbidities are at risk of ill health, and sharing relevant information with GPs to enable them to provide a more proactive and responsive service to these individuals. This will enable those patients identified to remain independent and in their own home and local community, preventing deterioration of existing conditions and reducing their need for hospital care. To support this, the Trust will be exploring the potential for the development of a ‘Living Well’ model which will centre around a navigator or ‘pioneer’ post who would be employed by a community or voluntary sector organisation and who would be a member of a multidisciplinary team in GP Practices alongside GPs, District Nurses and Social Workers. The role of the ‘pioneer’ will be to ensure that older people receive more co-ordinated services and support and help them build social networks in their local community. We have made good progress in changing our model of care in mental health services, shifting from inpatient to community based services, which has enabled us to reduce our inpatient beds. We will continue to develop ‘Personal Recovery’ focused mental health services working in partnership with service users and carers to promote recovery for people with mental health problems, to maintain and build their support networks of families, friends and communities. Service Users

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How do we plan to deliver this? and carers can expect to be more informed and involved in their own care and recovery with the support they need to live as independently as possible. We will be enhancing our community teams and developing new ways of working across services to increase capacity, particularly in primary mental health care, to ensure people are provided with timely access to the right service at the right time. This will include working with our local GPs and voluntary sector providers to deliver services for people with less severe mental health needs. We want to ensure that we are able to respond appropriately to the needs of people with dementia and their families, recognising individual needs and circumstances and ensuring that when a period of admission to a specialist dementia inpatient service is required that care is provided in the right place, within the right environment and with access to a range of specialist support. We are committed to the delivery of inpatient dementia services as part of an integrated pathway of dementia care in which our community and hospital based staff work together to deliver the best possible care and treatment for people with dementia. Our future services will be provided on the basis of individual need, with a person-centred approach being applied regardless of age. This will result from improved interfaces across our Older People Services, Psychiatry of Old Age and Acute services, all of which are essential to addressing the fragility and complexity of patients with dementia.

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How do we plan to deliver this? The further development of community dementia services will be a priority over the next 3 years, including progressing plans to develop a Community Intensive Support Team to provide the key link between the community and inpatient services. Work will also be undertaken to develop options in the community for long term placements for people who have prolonged periods of behavioural disturbances associated with their dementia and their behaviours remain very challenging. We plan to modernise and enhance Child & Adolescent Mental Health Services by improving access to emergency services and developing a CAMHS Day Hospital Service. This will include the development of roles to support specialised needs of children and adolescents with a learning disability, including improved access to out-of-hours crisis response services and to psychiatry and psychology services. The Day Hospital will provide both an early response service and compliment the Regional in patient unit to prevent admission or to facilitate early discharge. We will improve access to advice and support from specialists in palliative care, including during the out of hours period. This will include the enhancement of our existing Palliative Care Team to provide a multi-disciplinary approach and improve access to specialist advice in decisions on care and treatment. Following the conclusion of the Regional Review of Paediatric Services we will consider improvements we can make to ensure we best meet the palliative care needs of children.

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How do we plan to deliver this? We plan to progress the development of ‘one stop shop’ Community Treatment & Care Centres (CTCCs) which will be purpose designed to support the delivery of the most optimum model of primary and community care relevant to the local population. These buildings will provide for high quality patient environments and will enable integrated working to support staff to deliver their best care. In March 2010 we opened our first CTCC in Portadown. The new Banbridge CTCC is due to open during 2015/16 and work is well progressed on the procurement and business case approval processes which will provide for a new CTCC in Newry in 2017/18. We have completed some early scoping work and a feasibility study to inform how primary and community care services could be best provided on the South Tyrone Hospital and Lurgan sites. We are keen to work with our Commissioners to move forward with our plans and secure the necessary funding for new centres on these sites. We will increase the use of technology to connect primary, community and hospital staff to enable them to avail of remote advice to effectively plan and co-ordinate care to best suit the needs of the individual and to connect patients to support and advice to help them manage their own care.

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How do we plan to deliver this? Examples include: -

- Implementation of the Community Information System across Trust services which alongside the NI Electronic Care Record will provide an integrated care record to support the care of patients who receive a range of services.

- Establishing virtual fracture clinics where the Consultant will link with staff in nursing home settings to review patients with fractures whose care is best provided in a community setting during their rehabilitation phase and who would otherwise have remained in a hospital ward. A Post-Acute fracture pathway will be developed to ensure patients receive a high quality of service through effective partnership working between acute, non-acute and community services to meet the needs of fracture patients.

- We have developed virtual Speech and Language clinics at Kilkeel Health Centre and Daisy Hill Hospital to support stroke rehabilitation and will explore options to further enhance and extend this model to other services.

- Exploring the use of remote consultations in our GP Out of Hours and Acute Care at Home services.

- Ensuring we make best use of available technology through the development of a patient portal in the NI Electronic Care Record and through the establishment of multi-disciplinary meetings between hospital and community/GPs, as well as increasing timely access to diagnostics results across a range of community staff.

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We plan to improve the sustainability of our GP Out of Hours service by ensuring full capacity of GP cover within the service, through offering additional salaried shifts and by exploring IT solutions which could facilitate GPs to triage calls from their home. There is also a locally enhanced service to provide additional cover until 9pm weekdays in place until March 15, and this will also be discussed to evaluate the impact. We have recruited additional nursing staff both as nurse advisors and advanced nurse practitioners and to roll out a pilot pharmacy service until Sep 15 to provide cover at weekends and bank holidays which will be evaluated.


• Seamless, joined up planning and delivery of health and social care services will ensure patients receive safer, better quality services. Improved access and sharing of quality information about patient care between services and with patients will avoid duplication of information and repetition for the patient.

• A more proactive approach to identifying patients who would benefit from joined up care planning and support and by making more effective use of technology, less ‘unplanned’ hospital admissions and improved outcomes for people with more complex needs.

• Improved access to locally available primary and community care services, increasing the number of people

having a positive experience of better and more integrated care in the community outside of hospital.

• More care in the community will support people with palliative or end of life care needs to die at home or in a

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community setting of their choice.

• Improved sustainability through more efficient and cost effective service delivery will mean the Trust will be able to demonstrate to its Commissioners, local communities and partner organisations that it makes the best use of its existing resources.

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4. Making the most of our hospital network



• Continued modernisation of our 2 acute hospitals – Craigavon Area Hospital and Daisy Hill Hospital - to create the necessary capacity to allow more services to be provided locally to better meet demand and improve waiting times. This will include increasing capacity for Trauma & Orthopaedic Services and Urology Services.

• Deliver on our plans to increase

inpatient provision at Craigavon Area Hospital which will support the delivery of services that have previously been consulted on. These include:

o The centralisation of stroke inpatient acute and rehabilitation services at CAH;

o The consolidation of inpatient non-acute

We plan to consult with you on changes we are proposing to the way in which we provide acute services in the future The Trust plans to develop an Acute Strategy which will set out our vision for the delivery of acute services which we believe will reshape services in a way that can improve patients experience and the quality of care they receive. We will consult with you on any service changes we would propose to local provision as a result of these plans. There has been only limited investment in our hospital buildings and we continue to be constrained by the condition, configuration and capacity of the present accommodation at Craigavon Area Hospital. This means we are unable to support the level of change which would be required to facilitate necessary clinical adjacencies, meet increasing demands and support the development of new models of care on this site without significant investment. We plan to submit an Outline Business Case to DHSSPS seeking approval for the Redevelopment of Craigavon Area Hospital under the HSC capital build programme. This business case will be informed by the outcome of our consultation on the future delivery of acute services as above. We know that due to current financial pressures it may take some years before we have fully implemented our new hospital at Craigavon. In the

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hospital services for older people at CAH and DHH; and

o The transfer of dementia assessment beds to CAH from the Armagh site.

This will provide our patients with equal access to specialist services; better access to a range of diagnostic services; and 24 hour pharmacy and laboratory support.

meantime, we are planning solutions to enable us to enhance capacity to meet immediate needs. These will include: Upgrade of the electrical infrastructure at Craigavon Area Hospital to

support future estates development. Development of a new Pharmacy Aseptic Unit for the preparation of

cancer drugs and biologic therapies. Facilitate the expansion of Trauma & Orthopaedic services by providing

more theatre capacity at CAH and provision for fracture and orthopaedic outpatient capacity at DHH.

Implement a new medical model of care to streamline the patient pathway and help address current pressures in our Emergency Department and Medical Assessment Unit. Our plans include the expansion of our Clinical Decision Unit for patients who are unlikely to be in hospital more than 24 hours, increased availability of General Medical beds and the development of an ambulatory care unit adjacent to the Emergency Department.

Implement 7 day working across Senior clinical and Allied Health Professional areas, (particularly in physiotherapy, occupational therapy, radiology and speech & language therapy), to help reduce inpatient stays and support earlier discharge from hospital.

Implementation of a 2nd CT Scanner at Craigavon Area Hospital to enhance access to diagnostic services.

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• Modernisation of paediatric services in line with the Trust’s ‘Changing for Children Strategy’. Planned paediatric surgery will be centralised at Daisy Hill Hospital in a new paediatric centre on the 6th floor which will include a theatre dedicated to elective surgery for children and adolescents. Emergency surgery, paediatric inpatient medicine and ambulatory care and also neonatology services will continue to be provided at both Craigavon Area and Daisy Hill Hospitals.

• Implement plans to expand daycase services and to further develop outpatient services through the use of virtual clinics and one stop assessment that will enable a patient to receive their diagnostic test, diagnosis and a clinical action plan on the

We plan to develop our hospital based paediatric and neonatal services across Daisy Hill and Craigavon Area Hospitals. We have commenced the design of new paediatric centres at CAH and DHH which are due to open in 2016/17. This will enable the Trust to extend inpatient services to include treatment for children up to 18 years old and support plans for the further development of ambulatory care services at Craigavon Area Hospital to enhance access to services and reduce the need for children to be admitted to hospital. We will further develop day surgery so people don’t have to stay overnight in hospital and can recover at home. We have already made significant progress in the development of day surgery, with an increase of 31% over the last five years, and believe there is further potential to increase day surgery in ENT and Urology. Additional accommodation will be needed to fully meet our requirements and we will continue to pursue this as part of our wider hospital redevelopment plans.

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same day.

• To continue to develop and improve how we respond to unplanned (unscheduled) care needs ensuring we maximise use of the specialist skills of clinical staff, deliver safe care and support Patients in ‘Choosing Well’ where to get the right care for the situation

We need to consider the best arrangement for our outpatient clinics to balance local accessibility of services, through provision of a range of outpatient clinics in primary and community care settings, with the most effective use of available resources. We plan to further develop our one stop assessment clinics so that patients see a consultant and have any diagnostic tests they need during a single visit rather than needing multiple appointments. We have implemented this in urology and symptomatic breast services. We plan to consult with you on our plans for changes in our Minor Injuries Services The Minor Injury Unit in Armagh was closed temporarily in November 2014 in line with Trust contingency measures. We have been closely monitoring the impact of the temporary closure to ensure that risks are minimised. We have seen that most people who decide they need advice or treatment for a minor injury are going to the MIU at South Tyrone Hospital which is now seeing on average 7 patients per hour with 99.9% having been assessed and treated within 4 hours of arrival. The experienced Emergency Nurse Practitioner staff who worked in the Armagh Unit have been helping manage the significant increasing demands at our Emergency Department at Craigavon Hospital. It has been important during these busy winter months that our experienced nursing staff are

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How do we plan to deliver this? available to see and treat as many patients as possible in our busiest units. The temporary closure of Armagh MIU was extended beyond the end of March 2015 and is currently out for public consultation to decide on the longer-term future of the service.


• Services provided across our hospital sites will be re-balanced to provide for more centralised or specialised care. More focused care can lead to, safer, better quality services with improved outcomes for the patient.

• The consolidation of all inpatient beds on our two acute hospital sites will enable us to ensure the best use of clinical and professional skills in the delivery of the most effective, evidence-based care, helping us to meet national standards, provide centres of excellence and more equitable access to services which will enhance quality of patient outcomes.

• Increasing the range of services available as day or ambulatory (walk in/out) care and enhancing access to

these services will provide for more responsive services, ensuring patients get the right advice and treatment quickly when this is needed.

• Increased use of technology and innovative solutions will maintain local access to care where possible,

including the use of virtual clinics.

• The creation of additional capacity will enhance the availability of locally based acute services avoiding the need for some patients to travel outside the Southern Trust area for their care.

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• Meet growing demand for traditional hospital services through new ways of providing care in primary and

community care settings and providing more outpatient and diagnostic services outside the hospital.

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5. Improving the safety and quality of our services What do we want to achieve over the next 3 years?


• Develop a Quality Improvement Framework to ensure an integrated and co-ordinated approach to improving the safety and quality of Trust services.

• Build and strengthen capacity and capability in leadership for quality and safety at all levels of the organisation.

• Build on the already strong

culture of safety and continuous quality improvement in the Trust, including the development of systems and processes to support continual learning and improvements in patient care.

• Deliver effective governance structures, accountability and risk management arrangements, ensuring that systems and

We plan to develop and implement a quality improvement framework that will set out our approach and priorities for ensuring safe, personal and effective care in an integrated approach. This framework will harness the collective resources and energy within the Trust to drive a whole systems approach to quality improvement, engaging clinical leaders and champions and patients and service users, taking cognisance of Quality 2020 and the Donaldson Review outcomes. We will develop a range of integrated metrics that focus on safe, personal and effective care, complementing our existing hospital benchmarking capacity, and support our quality improvement framework and enable effective assessment of quality and safety measures. We will continue to build capacity and capability at all levels within the organisation ensuring every member of our staff knows there is no improvement too small. To do this, we will provide a range of general and tailored service improvement tools and supports to enable staff to develop and embed skills and attributes in quality improvement. This will include:

• Ongoing development of bespoke training programmes for leaders at all levels in supported environments to build capacity and culture with a focus on quality improvement project outcomes;

• Development and launch of a bespoke suite of e-learning products based on a LEAN approach, tailored to the needs of Trust staff, to

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processes are in place to support ongoing registration requirements and regulatory standards.

• Ensure we are systematic in our

recording, reporting, reviewing and learning from any major investigations into shortfalls in standards and incidents arising throughout the Trust and from the experience of other organisations to reduce avoidable harm to patients.

• Ensure openness, transparency

and satisfactory responsiveness to complaints.

• Optimise patient and carer involvement and engagement in decision-making.

support quality improvement and improve accessibility to, and awareness of quality improvement approaches.

We will continue to promote listening, learning and sharing of best practice throughout the Trust through the development of information and sharing hub and continued recognition and promotion of quality and safety improvement initiatives. We will continue to develop our Governance Structures to ensure that effective organisational data/intelligence is available throughout the organisation to identify and effectively manage patient safety and service quality at all levels of the organisation. We will continue to develop and improve reporting systems to ensure that the learning from major investigations both internally and externally is identified and acted upon to reduce avoidable harm to patients. We will provide our staff with the skills required to recognise when avoidable harm has occurred and the improvement tools to minimise reoccurrence. We will achieve this by developing and delivering a range of targeted training opportunities and reviewing how we can maximise the way we use the information we collect with regards to incidents and shortfalls in standards to reduce avoidable harm. We will continue to ensure that we communicate openly with patients and families when incidents occur. Our governance training and development programmes will be underpinned by the Trust’s commitment to do this and evidence of our communication with

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How do we plan to deliver this? families and patients involved in incidents will be included in our governance assurance mechanisms. We will continue to engage with our services users in reviewing and improving the processes in place to manage complaints. We will further develop our reporting systems and will involve our Patient Client Experience Committee in further developing our complaints reports in presenting both quantitative and qualitative complaints information to ensure the patients’ experience and involvement are optimised in decision-making at all levels. We will provide our staff with the information and skills required to use complaints to support improvement and prevent avoidable harm. We will continue to prioritise Personal and Public Involvement (PPI) within all aspects of our business and reflect this in the governance, management and reporting mechanisms that we have established. This will include the coordination, development, implementation and monitoring of the Trust’s PPI Action Plan, including the Patient Client Experience Standards and Complaints and Compliments. We are committed to hearing from service users, partners and the wider public about how we can improve our services and ensure that there are many and varied opportunities for people to become involved in the planning and development of the services and interventions that we provide.

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• Implementation of patient safety initiatives that will evidence improvements in the safety and quality of Trust services.

• Improvements in patient experience of care and better outcomes.

• Increased learning from local, national and international health systems.

• Improved management of complaints.

• Service user, partner and wider public involvement in decisions on the planning and development of our services.

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Section 6:

Recognising staff as our most important resource

We recognise the need for a robust workforce plan if we are to effectively change our ways of working and develop new models of care. Clear workforce planning in line with our future direction of travel will ensure we can continue to recruit, retain and develop suitably skilled and experienced staff who are motivated and committed to the delivery of the highest quality services that meet the changing needs of our local population. Our workforce plan will enable us to: Promote good clinical leadership and engagement. Clinical Leads

will be provided with opportunities to lead on improvement projects with the support, resources and training provided that they need to translate innovation and research into practice.

Foster the growth and development of staff to ensure they have the skills & capabilities to deal with the patients they encounter.

• Encourage staff commitment to continuous service improvement. • Implement best practice in change management and health and

well-being strategies to equip, engage and support the workforce through service transformation.

• Ensure that workforce capacity and new ways of working are in line with future service plans and with quality standards.

• Ensure customer care and what quality means to patients and the public remain central to the delivery of services.

We plan to:

• Develop specific strategies to address recruitment challenges particularly within the nursing profession across the hospital and community sector and to become an employer of choice.

• Introduce skill mix within Community Paediatric Services to facilitate the development of a streamlined diagnostic service through the development of advanced nursing and AHP roles.

• Develop support worker training strategy including the establishment of posts which facilitate staff development and

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improved patient care particularly in social care, nursing, psychology and allied health professions.

• Work with the Public Health Agency and the DHSSPS to train and recruit Advanced Nurse Practitioners initially in emergency departments, urology and paediatric services.

• Test, quality-assure and implement the proposed arrangements locally which the Nursing and Midwifery Council (NMC) has developed for the revalidation of all nursing and midwifery staff nationally.

• Train all supported living staff in learning disability in relation to the delivery of person centred care and support within supported living homes.

• Continue to explore effective ways of engaging with our staff in order to seek their views and support on how to effectively and efficiently deliver our services.

• Ensure that we align the pattern of service delivery to the changing needs of our patients and clients.

• Ensure our Health and Well Being Strategy is responsive to the needs of our staff and we continue to explore ways of ensuring that staff are supported in their physical, mental, health and wellbeing.

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Section 7:

Communicating Our Strategy

The Trust has sought the views of all our key stakeholders with respect to the overall direction set out in this Strategic Plan. The Trust engaged widely in the development of the strategic direction and priorities set out within our Plan. The Trust also discussed the plans with the Southern Local Commissioning Group that includes health and social care professional, GP and elected representatives and local Integrated Care Partnerships.

A 15 week consultation period was provided to enable effective engagement and consideration of the proposals by interested parties. A presentation, summary leaflet and flyer which highlighted the key service changes and how the full documents could be accessed, was issued to elective representatives. Meetings were held with a number of elected representatives. The Plan was also placed on the Trust internet site, social media sites and statements were issued to the press. Staff information sessions were held in each locality and the Plan was also cascaded via team meetings throughout the Trust. Leaflets were distributed to all Trust facilities and placed in patient waiting areas. They were also distributed to GP surgeries. An article was published in the staff newsletter.

The Southern Health and Social Care Trust wishes to extend its thanks and sincere appreciation to all those individuals, elected representatives groups and organisations who responded to the consultation process. The Trust also wishes to thank all those who met or contacted Trust representatives to express views.

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Section 8:

Equality & Human Rights Considerations

Section 75 Equality Duties The Southern Trust is committed to fulfilling its statutory equality duties as set out in Section 75 of the Northern Ireland Act 1998 (the Act) which requires public authorities, in carrying out their functions relating to Northern Ireland, to have due regard to the need to promote equality of opportunity and regard to the desirability of promoting good relations. In carrying out our functions relating to Northern Ireland we are required to have due regard to the need to promote equality of opportunity between:

• persons of different religious belief, political opinion, racial group, age, marital status or sexual orientation

• men and women generally • persons with a disability and persons without • persons with dependants and persons without.

In addition, without prejudice to the obligations above, in carrying out our functions in relation to Northern Ireland we are required to have regard to the desirability of promoting good relations between persons of different religious belief, political opinion or racial group. In developing our Equality Scheme, the Trust fully adopted the model scheme devised by the Equality Commission for Northern Ireland – the purpose and intent of which is to set out best practice. In so doing we commit to having effective internal arrangements in place for ensuring our effective compliance with the Section 75 statutory duties and for monitoring and reviewing our progress. We realise the important role that the community and voluntary sector and the general public have to play to ensure the Section 75 statutory duties are effectively implemented. Our Equality Scheme demonstrates how determined we are to ensure there are opportunities, for people affected by our work, to positively influence how we carry out our functions in line with our Section 75 statutory duties.

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Human Rights The Trust is also mindful of the Human Rights Act, which came into effect on 2 October 2000, makes it unlawful to act in a way which is incompatible with the European Convention on Human Rights. Disability Duties The Trust when carrying out its function will also pay due regard to the need to:

• promote positive attitudes toward disabled people; and • encourage participation of disabled people in public life.

Equality Screening In keeping with the commitments in its Equality Scheme the Trust has carried out a preliminary equality screening of its Strategic Plan the outcome of which was the decision to subject the Plan to ‘on-going screening’ given its strategic nature - which is in line with the Equality Commission for NI Guidelines which state that .. “for more detailed strategies or policies that are to be put in place, through a series of stages, a public authority should then consider screening at various times during implementation”. The Trust is committed to subjecting the proposals contained within this Plan to further robust equality screening and fuller Equality Impact Assessment (EQIA), where necessary and appropriate, and as they further develop. The Trust fully accepts its obligations to take appropriate steps to mitigate any adverse impacts and to consider alternative policies in furthering its section 75 statutory equality duties. Consultation Given the strategic importance of this Plan, as already noted, a 15 week consultation period was provided to enable effective engagement and consideration of the proposals by interested parties. The Trust has taken into account views provided during the consultation process in informing this final version of the Plan. The Trust recognises the importance of engagement and is committed to carrying out consultation in accordance with the principles contained in its Equality Scheme together with the arrangements detailed in its PPI Strategic Action Plan.

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It is therefore planned that there will be a full consultation process undertaken as part of any service change proposal following from this Strategic Plan. The Trust Equality Scheme and a copy of the Equality Screening template for this proposal are available upon request, in alternative format or in languages for those who are not fluent in English by contacting the Equality Assurance Unit as follows: Mrs Lynda Gordon Head of Equality Assurance Unit Southern Health and Social Care Trust Hill Building St Luke’s Site Loughgall Road Armagh BT61 7NQ Tel: 028 3741 2522 Email: [email protected] Alternative Formats The Strategic Plan can be made available on request in alternative formats e.g. easy-read, electronic version, Braille, computer disc, audio format, large font, DAISY and in other languages to meet the needs of those who are not fluent in English – see contact details above. Management of Change In order to manage and mitigate any potential differential impact of any service change proposals on existing staff the Trust will adopt a project management approach. As part of this approach a project management group will include a human resources and trade union representative(s) so as to ensure robust, fair and agreed human resources processes are in place to manage any future staff changes. The Trust’s Management of Change Framework is the main vehicle for effecting change within the Trust.

mailto:[email protected]

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Section 9:

Rural Proofing

The Department of Agriculture and Rural Development has published guidelines for rural proofing in the development of new policies or policy proposals. The Trust remains committed to the principles set out in these guidelines and routinely consider the impact of any of its service change proposals on staff, patients and the wider public. The Trust’s Strategic Plan for the next 3 years provides an overview of the strategic direction of the Trust. Any specific service changes proposed will be subject to a formal public consultation process which will involve a review of specific information on those areas or communities which may be impacted by the proposal. Consideration will be given to any adverse differential impact that proposals may have on people living in rural areas, how any differential impact could be addressed and the costs and benefits of doing so. Where the outcome of equality screening necessitates the need for full Equality Impact Assessments to be undertaken for specific service change proposals, the Trust will identify any accessibility issues for staff and patients and include consideration of issues such as ease of access to services for service users and availability of transport and telecommunications infrastructures.

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Section 10:

Managing, Monitoring and Adapting our Plans

Planning over a 3 year period is challenging given the complexities that exist in the management and delivery of health and social care services. The Trust expects its plans to evolve as we develop and implement changes and as we adapt to changes in the environment around us. We will continue to maintain high quality, safe care to meet identified need within the financial envelope available to us.

We will be checking our progress regularly to ensure we keep on track and consider any action required where work is not going to plan. We will be incorporating the plans in this document and reflecting any changes to these in our yearly Corporate Plans. We continue to report on performance to our Senior Management Team and Trust Board through a range of performance reports and bi-annual updates on progress against our Corporate Plan.

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