TYC making progress
The Health Minister sees a continued shift from hospitals to the community as the only way to resolve the A&E crisis in the long term. agendaNi sums up his update on Transforming Your Care.
Edwin Poots has given a comprehensive update on Transforming Your Care to the Assembly, with an emphasis on a better balance between services inside and outside hospitals.
Referring to the recent extra pressures on A&E, he pointed out that one in five patients attending English A&E departments had admitted that they did not need to be there. That group of people needed to be diverted to more appropriate services: a process helped by earlier intervention before their condition worsened and better self-management by patients.
The reform process was “a three-to-five year journey with the emphasis on getting it right, in a safe manner, rather than rushing blindly ahead.” Safety had to be “at the heart” of the process and unnecessary bureaucracy avoided.
“Of course, the best treatment is prevention,” the Minister added. Smoking, for example, was one of the key causes of preventable ill-health and early death. Support services to help people stop smoking are available in pharmacies, GP surgeries, hospitals, schools and workplaces.
Seventeen family support hubs were in operation across four trust areas with another five hubs to be set up by the end of March. The hubs help families who do not need full-time support from a social worker.
They run alongside three family nurse partnership teams in the Western, Southern and Belfast areas. This involves voluntary home visits for first-time mothers aged under 20 from early in the pregnancy until the child is two years old.
Fionnuala McAndrew, who is leading the review of state-run residential care homes, has just finished a consultation on the subject. Alternatives to care homes are being provided by a ‘hubs and spokes’ model i.e. bringing together a range of disciplines to provide services such as diagnostics that meet local needs. Five of these projects are planned for Newry, Lisburn, Ballymena, Banbridge and Omagh, and will receive a total of £150 million in capital investment.
The Banbridge and Ballymena projects are to be completed by the summer of 2015. Work in Omagh will start “shortly” and successful bidders for Lisburn and Newry would be announced later this year.
Cardiac catheterisation services will ensure that heart attack patients go straight to a catheterisation lab for “immediate, appropriate treatment” rather than going through A&E. The first one is now operational in the Belfast Health and Social Care Trust and a complementary service for the west (based at Altnagelvin) is due to be rolled out by the autumn. Altnagelvin will undergo more modernisation when its £73.5 million north wing is completed in 2016. The new £97 million Omagh local hospital will offer 40 intermediate care beds, a renal dialysis unit, an urgent care and treatment centre, and a women’s health department.
The Royal Group of Hospitals’ £150 million critical care building will start operating next January and provide emergency and trauma services to the most severely injured casualty patients from across the region. The Royal’s £46 million new maternity building is due for completion in mid-2017.
Mental health
Poots was keen to emphasise that care does not depend on large buildings.
The Bamford review envisaged that most mental health care will take place outside hospitals and closer to the person’s family and friends. At that point, the ratio between hospital and community-based spending in mental health was 60:40. Last year, it was 44:56.
Practically, this has involved setting up crisis response teams and increasing the use of home treatment teams and community mental health teams. People who do need inpatient treatment can now be discharged sooner as they will get better support outside hospital.
The new ambulatory unit at Craigavon Area Hospital takes referrals from A&E and GPs to treat children for a wide range of conditions. It therefore avoids stressful hospital admissions and reduces their overall length of stay. Dermatology patients are now able to use video-conferencing facilities for a consultation, either from home or in their GP’s surgery.
In Belfast, a consultant-led ‘urgent care pathway’ for older people is being developed as an alternative to A&E attendance or hospital admission. Three GP practices have started to serve as ‘first responders’ and 36 patients to date have received acute care at home.
On a similar note, the trust has developed an ambulatory care centre at Musgrave Park Hospital which treats older people for falls rather than sending them to A&E.
Services for people with learning disabilities are shifting from day centres to community-based ‘day opportunities’ with work placements being offered in the Southern area. They are encouraged to be independent by travelling by taxi or public transport to their work.
The Minister has allocated £2 million in suicide prevention funding to help local communities develop and deliver bereavement support, counselling, awareness and intervention training, and complementary therapies.
Poots formally announced that the self-referral physiotherapy service will be available throughout the South Eastern area from April 2014 and rolled out regionally by March 2015. The plans were reported in agendaNi late last year (issue 62, page 68).
Reablement
He also gave an example of reablement – which will be an increasingly common term for new support system for older people recovering from illness or injury.
A normally confident older lady in Armagh had broken her leg and, after discharge from hospital, found the basic everyday tasks of washing, dressing and making food difficult to manage.
“This left her feeling vulnerable,” Poots remarked. “However, when she sat down with her occupational therapist, they were able to figure out together what was needed to help her to regain her confidence. Through [the therapist] providing the right support and encouragement, she was able to get back to coping with everyday tasks.”
All of these examples depended on “good communications” between healthcare professionals and between healthcare providers and patients and the emergence and application of technology is “a key enabler for good communication and healthcare transformation.”
In conclusion, Poots commended A&E staff for their work under pressure but added that a longer term solution “can come only from implementing” Transforming Your Care.
Northern Ireland was not unique and health services in Britain were facing similar challenges and adopting similar solutions.
He stated: “It is important that we continue to drive forward and complete the transformation journey to deliver the right care, at the right time, in the right place, for every patient while remaining true to the core principles of the National Health Service.”
