consultation · web viewthe trust believes strongly that supporting carers in their role is...

Consultation

Questionnaire

Please use this questionnaire to give us your views on Transforming Your Care. Please send your responses to:

Transforming Your Care Programme Team,3rd Floor,HSCB HQ,12-22 Linenhall Street,Belfast,BT2 8BS

Website: www.TYCconsultation.hscni.netEmail: [email protected]: 02890 553790Textphone: 18001 02890 553790Fax: 02890 553625

However you choose to give us your views, we want to hear from you. Please send us your comments by 15 January 2013.

Alternative formats of this document including EasyRead, Braille, audio formats, large print or minority languages (for those not fluent in English) are available on request. Please contact as above with your request.

mailto:[email protected]

http://www.TYCconsultation.hscni.net/

Transforming Your Care:Consultation Response Questionnaire: Downloadable Form

Introduction

To have your say, please complete the questionnaire below.Further information on the Transforming Your Care consultation is available on the ‘What we are consulting on’ page.

Note: Questions marked with an asterisk (*) indicate required information.

Freedom of Information – Please Read

The HSCB will publish a summary of responses following completion of the consultation process. Your response, and all other responses to the consultation, may be disclosed on request under the terms of the Freedom of Information Act 2000. The HSCB can only refuse to disclose information in exceptional circumstances. The HSCB cannot automatically consider as confidential information supplied to it in response to a consultation. However, it does have the responsibility to decide whether any information provided by you in response to this consultation, including information about your identity should be made public or be treated as confidential. This means that information provided by you in response to the consultation is unlikely to be treated as confidential, except in very particular circumstances.

If you do not wish information about your identity to be made public please select the 'Yes' option below to request that your response be treated as anonymous.

*Please indicate if you wish your response to be treated as anonymous.

Yes / No

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About you or your organisation:

*Are you responding (please tick): On behalf of yourself?

On behalf of someone else?

*Are you/they (please tick): a) over 65;

b) under 65;

c) disabled;

d) a carer;

e) a parent;

f) other?

Organisation(if applicable):

Western Health and Social Care Trust

Name Mr Gerard Guckian

Job Title

(if applicable):

Chairman

Postal Address: Trust Headquarters

MDEC Building

Altnagelvin Hospital Site

Glenshane Road

Londonderry

Email Address: [email protected]

Contact Telephone 02871 611197

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Number:

*Please fill in any boxes marked with an asterisk, this will allow us to ensure that we have received a cross section of responses

Question 1. Do you agree that our health and social care services need to change in order to meet the needs of the community and promote health and well-being through prevention and early intervention so that as much acute illness as possible is avoided?

Strongly agree Strongly disagree Have no opinion Agree Disagree

Comments:

The WHSCT believes that a substantial impact on the quality of people’s lives can be made by investing in early intervention and prevention of ill-health. This requires HSC bodies to work with a range of stakeholders with a shared agenda and/or common targeted audience.

Much partnership work is already ongoing across the West and these models need to be strengthened and maintained to ensure local needs are met. Critical to this is targeting those populations who experience the greatest inequalities and where there have been inter-generational issues around poor health and social well-being. A range of social and economic issues underpin people’s lifestyle choices and behavioural risk factors.

Strong co-ordinated action will make a real impact on people’s lives. We are of the view that prevention and early intervention are of paramount importance, and have a profound impact on later adult health and wellbeing. Supporting the community, particularly children and their families, to improve their health and wellbeing is vital if they are to live healthy and prosperous lives, irrespective of their social background, and if they are to achieve their fullest potential in adulthood and avoid acute and chronic illnesses.

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Question 2.Do you agree that people who need care and support should have control over how their assessed care and support needs should be met?


Comments:

The Trust supports the proposal that people should have control over how their assessed care and support needs are met. This will require a partnership approach to delivery of care across primary, community, acute, voluntary and independent (or private) sector and should be clearly understood by the public.

As referenced earlier the Trust firmly believes that self-determination and control are essential prerequisite to continue to build real partnership approaches to the delivery of care within our local communities.

Question 3.Do you feel the provision of individualised budgets and self-directed support should be more widely promoted?

Yes No

Comments:

Individualised budgets are a concept supported by the Trust. However while research within the Trust’s Nursing Directorate demonstrates that clients who access direct payments are very positive about the experience, there is an administration associated with the process that is significant. If the concept is to be further developed it is important that the process is as simple for clients as it can be.

Further legislative guidelines may also be required. The current guidance does require to be updated to take into account the knowledge that has been gained from the delivery of Direct Payments since their inception. The guidance also needs to strengthen to ensure there is absolute clarity in this of its gravitas particularly in light of the previous experience of legal challenges.

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Question 4.Do you agree we should organise our services to enable people to stay at home for as long as possible and / or be cared for at home?

Strongly agree Strongly disagree Have no opinionAgree DisagreeComments:

The Western Trust fully supports the concept of maximising independence and maintaining people at home, across all Programmes of Care.

One of the key components to facilitating this is the contribution of carers (clients who are cared for by families). The Trust believes strongly that supporting carers in their role is fundamental.

Information, advice and training for carers will be required. Appropriate respite care that is relevant, flexible and proactive is also fundamental. This will require reviewing how we provide respite/short breaks in ways that are innovative and flexible and best use the resources available.

Question 5.Given the choice, who would you like to provide your care and support in your home?

1. Statutory bodies2. Voluntary and community groups3. Independent sector4. A mixture of the above5. You would prefer to receive

the money yourself to choose

Comments:

The community and voluntary sector have a key role to play in building sustainable communities and supporting people to be maintained at home, along with supporting carers. There is a need to describe a clearly defined and sustainable role for the community and voluntary sector. The role and contribution of smaller community and voluntary groups also needs to be recognised.

The Trust is committed to continuing to work in partnership with communities to build capacity and develop appropriate community support programmes such as the Neighbourhood Renewal model.

The contribution of the independent sector should also be recognised and the concept of social enterprise models further developed.

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It is also important that we continue to provide our citizens with choice and in particular, where appropriate, to be able to self-determine and be in control of purchasing the care and support they require.

Question 6.Do you agree that Integrated Care Partnerships could make a positive contribution to the delivery of care closer to home rather than in hospitals?


If your response is ‘disagree’ or ‘strongly disagree’, do you think there are any alternative ways to deliver care closer to home? Please provide details

The Western Health & Social Care Trust welcomes the focus on partnership working and primary and secondary care collaboration that the introduction of Integrated Care Partnerships (ICPs) facilitates. The Trust is keen that the development of ICPs should build on the existing good practice and good relationships developed between primary care and the Trust through the existing Local Commissioning Group (LCG) and Primary Care Partnerships (PCP).

Further it is important that the role of the LCG in relation to the ICPs is understood and that local Commissioning influence is not compromised.

The Trust believes that administration and overhead costs should be kept to a minimum. The creation of a potential 17 stand-alone organisations would be excessive and should be avoided. The membership of ICPs should be fluid and pathway/condition specific and fixed professional membership should be avoided.

It is also important that a mechanism is developed to maximise shared learning and best practice across all ICP areas.

Governance and accountability structures require further detail and clarity and performance indicators need to be developed across pathways.

In relation to the delivery of care via an ICP, the Trust has the following points to make in relation to ensuring maximum positive contributions:-

Their focus needs to be on patient pathways.

The risk stratification and management approach is welcomed.

Resources should be targeted at identified and agreed risks rather than “projects”.

Cognizance needs to be given to the potential for unintended consequences associated with the development of patient pathways and stratification of risk around individual conditions given the complexity and co-morbidities of many older people. It is important that new silos are not created.

ICPS are designed to facilitate the avoidance of admission to hospital. As such they must have the capacity to meet service needs 7 days a week.

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There must be appropriate out-of-hours cover across all disciplines and cover must be aligned. The patient pathway must be the same out-of-hours as it is in-hours if they are to deliver the desired outcomes.

There is a need to ensure appropriate training for primary care and community based staff to fully equip them for their roles. The importance of all professional disciplines in delivering the TYC agenda needs to be fully considered included the role of specialist nurses and the requirement of social workers in the older people’s agenda.

Primary care infrastructure and equipment should complement the acute setting and the need for local access to all specialist equipment carefully considered.

Electronic Care Record will be key to sharing information across sectors and between in and out of hours services.

We should build on existing good practice of creating virtual clinics using technology e.g. the virtual tissue viability nurse clinics and the concept of treatment hubs supported by technology.

Question 7.Do you agree with the proposals set out in respect of older people’s services?


Do you believe there are better alternatives? Please provide details

The Trust supports the proposals for older people’s services as outlined in response to previous questions.

The Trust supports the introduction of the reablement model of care as a key vehicle for maximising independence and in providing alternative models of care beyond institutionalised care.

The Trust is committed to providing alternatives to care beyond the residential setting. There are key links between the Health and Social Care delivery system which supports people being cared for at home and the “Supporting People” programmes; these links need to further strengthened and developed.

As noted earlier, appropriate support is required for carers, including ageing carers.

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Question 8.With regard to Long Term Conditions, would it be helpful to

a) make more information and education available to help those with a long term condition to monitor and manage their own condition?

Yes No

b) enable those with long term conditions to make more use of technology in their home to help problems be identified earlier, and reduce the need for avoidable visits to hospital or the doctor?

Yes No

Comments:

The Trust supports the proposals for the management of Long Term Conditions.

In particular the proposal to further develop information and education to support people to manage their own condition is welcomed.

The Trust is committed to the use of technology to ensure the successful implementation of many aspects of Transforming Your Care and supports the greater use of technology in the home to support long term conditions management.

The Electronic Care Record is a key enabler in risk stratification and information sharing.

Question 9.Do you agree that the proposals set out in respect of palliative and end of life care would support you to be cared for in a place of your choice?



The Trust supports the proposals for palliative and end of life care, building on the existing good work that is being developed in this area.

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Question 10.Do you agree with the proposals set out in respect of mental health services?



The Trust welcomes the proposal that mental health services must be more joined up, especially between secondary care and GP and other primary care providers.

The Trust’s resettlement plans are progressing in line with the Bamford recommendations and the Trust is on target to have all existing long-stay residents living in the community by 2015.

The Trust welcomes the proposed development of 6 inpatient acute mental health units for those aged 18+ and the proposal that there will be two units in the Western area recognising the particular geography of our area.

In relation to the proposed siting of the 2 units the Trust has given very careful consideration to the suggestion that one should be co-located on the South West Acute Hospital site. The Trust has considered the literature in respect of this issue and has also discussed the proposal with an expert nominated by the HSCB. Following this the Trust’s view remains that the service should continue to be based in Omagh (adjacent to the Local Enhanced Hospital).

The Trust fully considered the respective cases for locating the 26 Acute Mental Health beds in Omagh or on the SWAH site at our Board meeting in April 2012. At that time the views of our staff and including those of our consultant psychiatrists were considered. Trust Board received a report on any evidence supporting the case for siting such a unit within or adjacent to an acute hospital site, including evidence from professional bodies or elsewhere. The evidence outlined reasons for either option, with no firm direction given. The ‘Not just bricks and mortar’ report from the Royal College of Psychiatrists, which we understand also forms the basis of the recommendations of this review, concludes: “The Working Party acknowledged the strengths of both these views and judged this to be an issue where local circumstances and traditions are particularly likely to influence the decision.” In this case we submit that the local circumstances and traditions support the siting of the unit in Omagh.

In the last 30 years there have been dramatic changes in how mental health services are delivered. The most fundamental of these has been the shift from hospital to community-based services. There have been major policy and strategic changes which have created the vision and established direction for further change and development of services outside hospital settings, such as High Fidelity Crisis Resolution and Home Treatment models.

Since 1990 hospital beds at the Tyrone & Fermanagh Hospital have reduced from 585 to 95, with further reductions planned over 2013/14.

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Developing Better Services (DBS) proposed a model of 93 beds on the Tyrone and Fermanagh site, 26 of which were identified for acute mental health provision.

Plans are underway for the relocation of 18 beds, which were identified for adults with enduring mental health problems to be relocated to a community new build. This would leave approximately 40 beds for Psychiatry of Old Age, which would be co-located with Acute Mental Health on a new build adjacent to the Local Enhanced Hospital.

The Trust has been unable to identify definitive evidence in support of the co-location of acute mental health beds on a General Hospital site either prior to our consideration of the issue in April 2012 or since the TYC consultative document was published. The expert nominated by the HSCB to advise the Trust on this issue has not identified any such evidence over and above that already considered by the Trust.

In the absence of any new, more definitive evidence suggesting the need for co-location on an acute hospital site, the Trust recommends that the new local enhanced hospital in Omagh would be the preferred site.

In reaching this view, the Trust has also taken account of a number of other factors.

The Trust’s view is that moving the acute provision to Enniskillen would jeopardise the continued provision of Old Age Psychiatry on the Omagh site and make the DBS model untenable. By separating Acute Mental Health and Old Age Psychiatry, both senior and junior medical cover would be required across two sites, at Enniskillen and Omagh and this could not be achieved within existing medical staffing levels. It would also compromise the Trust’s ability to provide a safe and sustainable on-call rota across both sites.

Given the long history of the Tyrone & Fermanagh site in Omagh, a specialist mental health skill base has developed in the Omagh area which would be difficult to replicate in Enniskillen.

As part of the resettlement programme, the majority of long-stay relocation from the Tyrone and Fermanagh Hospital has taken place within the Omagh area, as close to the hospital site as possible. This cohort of residents in the Omagh area will continue to rely on mental health services and will require services which are responsive and within their own community setting. Alongside this the geographical spread of current facilities between Derry, Omagh and Enniskillen provides the Trust with the opportunity to place individuals appropriately according to their assessed need within a reasonable range for carer support and safe discharge follow-up.

The number of emergency transfers between mental health and acute hospitals is reducing. In the Western Trust in the last five years the total number of transfers has reduced from 25 in 2007 to 10 in 2011. All transfers have taken place safely and successfully.

The Trust is also mindful of the Ministerial decision taken to proceed with Phase 1 of the Omagh Enhanced Local Hospital which is now seen as the exemplar for TYC and the holistic integration of Health Services within the community. The infrastructure investment and work to date will allow a future Phase 2 Mental Health development and this would represent Value for Money.

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In terms of alternative options for the use of the South West Acute Hospital, the current design and configuration of services leaves the new hospital facilities unsuitable for adaptation to suit the proposed transfer of acute mental health services to this site. This would only be possible with significant investment in terms of re-siting existing ward facilities and the adaptations necessary to establish an acute mental health ward. The financial complexities associated with the £100m bullet payment and a significant variation to the contract payments introduce considerable risks to the Department in relation to the on/off balance sheet rules.

In addition the necessity to progress with this development on the PFI managed site would require a negotiation with the PFI provider and makes the Trust’s obligation to achieve and demonstrate value for money more challenging.

Finally, the availability of a suitable adjacent site for the relocation of acute mental health facilities may also prove problematic given the topography of the surrounding lands and planning restrictions.

The recommendation has already recognised the provision of acute mental health beds in the Western Trust area as an exceptional case, requiring two units. In this context it is entirely consistent to adopt a general policy of locating acute mental health units in Northern Ireland at or adjacent to acute hospitals whilst accommodating the clear and compelling reasons for a local solution in the Western Trust area.

Question 11.Do you agree with the proposals set out in respect of learning disability services?



These proposals support the Bamford Vision for Learning Disability services and progress towards them is already under way. However there is a wide range of presenting need within the term learning disability.

TYC describes disinvestment from acute hospital settings into the community but it needs to be more specific about the level of investment for services which GPs and primary care do not traditionally take forward as “community services”.

TYC needs to drive forward the need for integrated working across other government departments to effect the changes proposed.

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Question 12.Do you agree with the proposals set out in respect of physical disability and sensory impairment services?



The Trust supports the proposals for physical disability and sensory impairment, as described in responses to previous questions. The proposals are in line with the Physical and Sensory Disability Strategy.

The input of physical disability in long-term conditions management and palliative and end of life care should be recognised.

Support for people with complex health care needs should be specified. Domiciliary care and specialist provision for very complex individuals account for a very high proportion of cost.

Support for carers, families and flexible appropriate respite is of fundamental importance.

Question 13.Do you agree with the proposals set out in respect of Family and Child Care?



The Trust supports the proposals in respect of family and child care.

The Trust believes the consultation presented an opportunity for an overall strategic direction for children’s services and in particular infant mental health and this appears to have been an opportunity for transformational reform that has not been as well developed.

While there has been a focus on early intervention for 0-3 years the Trust believes that it needs to be strengthened and expanded to include the 3-18 years age profile and in particular with a focus on emotional health and well-being being supported with the earliest intervention at every stage of development.

The Trust firmly believes that the Children and Young People Strategic Partnership is the appropriate vehicle to ensure that there is a joined up approach across agencies and service to the better planning and delivery of Childrens’ Services.

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The new and emerging evidence highlights the need for organisations and agencies to work together to build sustainable resilient communities. This work must begin at the earliest possible stage in terms of human development. Childrens future relationships, their ability to fulfil their potential both educationally and in the workplace are threatened by enhancing levels of child poverty. There is a direct and evidenced correlation between complex social problems, mental ill health and chronic disease.

The Trust firmly believe that clear policy direction does need to be developed and that all agencies who have a responsibility for the wellbeing of children commit to plans through the Children and Young People Strategic Partnership if we are to improve outcomes.

Question 14.Do you agree with the proposals we have set out in respect of maternity and child health services?



The Trust supports the proposals set out in respect of maternity and child health services.

The Trust welcomes the review of acute paediatrics.

Because of our geographic location at a distance from tertiary centres, the Trust has a particular concern that dedicated neo-natal and paediatric transport services should be progressed as promptly as possible.

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Question 15.Do you agree with our proposals in respect of acute hospital services?



The Western Trust has undertaken significant reform of its acute hospital services since 2007 and has a safe and sustainable model of acute care.

The Trust believes that, for each hospital site across Northern Ireland, there should be a clear description of the profile of services which can be safely delivered and that this should be articulated to, and clearly understood by, the public.

The Trust supports the concept of transferring care to the lowest appropriate cost setting however, the Trust believes that what should and should not be treated in a hospital setting should be determined and stated publicly. There also appears to be an assumption that all Trusts are starting from the same baseline however in some cases there has already been a significant shift in care to lower cost settings. Capital investment in day case infrastructure will be required in order to fully achieve the transfer of cases from inpatient to daycase and from daycase to “outpatients with procedure”.

Closer access for patients, where possible, is supported. However, access needs to be balanced against other elements that determine quality of service, for example, safety, and efficiency once the service model has been agreed, Service and Budget Agreements should reflect travel time and the number of Programmed Activities required to deliver the model.

The Trust supports the key role for NIAS in the reform agenda and in the further development of destination protocols and an urgent care service.In relation to the options outlined for Causeway hospital, the Trust acknowledges that there are already strong, well- established and successful clinical links and networks between Causeway and Altnagelvin Hospitals. These apply to a wide range of services which include Trauma, Oral Maxillo-Facial surgery, Ophthalmology, Breast Services and Urology. These links will be further enhanced with the opening of the Radiotherapy Centre, the expansion of 24/7 primary Percutaneous Coronary Intervention and further investment in Orthopaedics. Regardless of the outcome of the consultation the Trust believes that, as a minimum, these clinical links should be further developed and strengthened.

The overwhelming view of Trust staff across all Directorates is that if the consultation concludes that the management of Causeway Hospital is to transfer to the Western Trust then the management of community services must also transfer. Governance and accountability must follow the patient pathway and it would be very difficult to ensure

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reform (shift left) and effective patient flow in the absence of management of community services.

Question 16.Do you agree that the criteria set out in Appendix 1 against which acute services have been assessed remain the most appropriate criteria?


If you disagree or strongly disagree, please provide specific details on what you see are more appropriate criteria. Please give reasons for your comments.

The criteria provide a useful framework against which acute services can be assessed at this point in time and provide a reasonable starting point for regional consistency.

Question 17.To what extent do you agree we should develop closer working relationships with the Republic of Ireland and Great Britain?


Comments:

The Trust remains strongly committed to the further development of closer working relationships with the Republic of Ireland. The Trust has a long and well established history of cross border working across acute, community, mental health and children’s services many of which have been facilitated by the Cooperation and Working Together cross border health and social care partnership.

The opening of the Radiotherapy Centre at Altnagelvin will see this relationship develop further. A cross border approach to the planning and delivery of services is welcomed and more sustainable and mainstreamed approaches to this need to be considered, including a move from cost per case to population based commissioning.

Question 18.Are the proposals set out in this consultation document likely to have an adverse impact on any of the nine equality groups identified under Section 75 of the Northern Ireland Act 1998? If yes, please state the group or groups and provide comment on how these adverse impacts could be reduced or alleviated in the proposals.

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Comments:

The Equality Screening document completed by HSCB reflects the strategic nature of the proposals outlined. It is at a local level that the Trust will be able to assess impacts more fully.

Question 19.Are you aware of any indication or evidence – qualitative or quantitative – that the proposals set out in this consultation document may have an adverse impact on equality of opportunity or on good relations? If yes, please give details and comment on what you think should be added or removed to alleviate the adverse impact.

Comments:

Question 20.Is there an opportunity to better promote equality of opportunity or good relations? If yes, please give details as to how.

Comments:

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Question 21.Are there any aspects of the proposals where potential human rights breaches may occur?

Comments:

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