Health and care services

Planning for a population’s health

daisy hill ct scanner

The Transforming Your Care reform programme is underpinned by planning for the needs of each trust’s population. Peter Cheney analyses the plan for the Southern area as an example of how health and care services are undergoing change.

Health is an issue that affects everyone is society but the needs of the population and the ways in which services are delivered vary across different communities. The Southern Health and Social Care Trust is one of five geographic health and social care trusts in Northern Ireland and includes a large area of countryside as well as several large towns.

The trust covers the whole borough of Armagh, Banbridge and Craigavon, and also the former Newry and Mourne and Dungannon council areas. As of July last year, it was home to 369,000 people, including:
• 94,000 young people aged under 18 (27 per cent);
• 201,000 adults aged between 18 and 60 (54 per cent); and
• 69,000 older people aged 60 and over (19 per cent).

The population plan for the area was drawn up by the Southern Local Commissioning Group which includes councillors, GPs and other health professionals, and representatives from the Health and Social Care Board, the Public Health Agency, and the voluntary and community sector.

The plan was published in 2012 and runs until 2017 although its financial scope is (by necessity) limited to the 2011-2015 Budget. Services are commissioned by the group and then delivered by the Southern trust and other providers e.g. general practices, pharmacies and community groups.

Acute care is provided at Craigavon Area Hospital and Daisy Hill Hospital (Newry), supported by two non-acute hospitals: South Tyrone Hospital (Dungannon) and Lurgan Hospital. As in other areas, the ‘shift left’ model will transfer an increasing number of services from acute hospitals to facilities in (or near to) local communities.

Vision
The Southern trust and its commissioning group want to see “strong, resilient communities” where everyone has good health and well-being and where people “look out for each other and have community pride in where they live.”

The plan’s overall aim is to provide “safe, quality care” that results in positive feedback from the people using services in the area. The commissioning group and the trust will be open and transparent regarding any proposed service changes.

Facilities should be safe and clean with services delivered by appropriately qualified and trained staff. Services should be delivered locally where possible, affordable, and based on the best use of available resources.

The vision refers to “meaningful relationships with local stakeholders” i.e. a willingness to listen to local people and to ensure that their views and experiences influence how services are organised. A “culture of innovation and continuous improvement” will be encouraged, especially with the help of new technologies.

Services will be provided on a universal basis but prevention and early intervention efforts will be focused on people who are most in need. Staff will seek to balance medical intervention and self-care whereby people can take steps to improve their own health and well-being. This ties in with the strong focus on community development, which includes support for volunteering and strong “partnership working” with other sectors outside the health and social care system.

Why change?
Five reasons for changing health and care services are clearly set out.

Firstly, the population is growing and ageing. The Southern area’s population expected to increase by 13.5 per cent between 2011 and 2020, including a 12.6 per cent increase among under-18s. This represents by far the largest population increase in Northern Ireland, driven by a high birth rate.

The prevalence of long-term conditions is also increasing: a 30 per cent rise is anticipated over the 2007-2020 period. Many of these conditions are preventable but a patient with more than one condition will require ongoing management and treatment for several years.
A further (and related) pressure comes from rising demand for acute hospital services from an increasing population which expects to receive the best available treatment.

Acute services must be “safe and sustainable”. Meeting this requirement depends on maintaining a skilled workforce and rethinking how and where some acute services are provided.

Finally, there is a need for greater productivity and value for money.

The starting budget was £623 million in 2012-2013 and, as expected, this has not increased in line with the projected growth in service demand. The trust was also expected to deliver £58.3 million in savings over the Budget period.

Shift left
The new model of care will be based on four principles: early intervention, prevention and wellness; citizenship; integrated care; and optimising the hospital network.

The first principle means that staff who provide health services will focus on giving children the best start in life, use screening and prevention programmes, and improve how they support carers. Citizenship, in practice, will involve more people living at home and being able to use a greater range of community-based services (e.g. reablement).

On a related note, the concept of integrated care involves primary, secondary and community care staff working more closely together to reduce demand for hospital services and to help more people to manage their long-term conditions.

The Southern trust has three integrated care partnerships: Armagh and Dungannon; Craigavon and Banbridge; and Newry and Mourne. Each one covers around 100,000 people and has a responsibility to improve the clinical pathway i.e. the routes that a patient takes from their first contact with a member of health and social care staff to the completion of their treatment.

Where possible, care should be provided at a local level to ensure that the specialist resources in hospitals are used more effectively. The number of inpatient beds will be reduced and more ambulatory, day case and one-stop care services will be provided within hospitals. Specific objectives are set out in the adjoining boxes.

Specific needs
Over 5,000 children are born in the Southern area each year and the trust has Northern Ireland’s highest birth rate. This is related to the increasing number of births by Eastern European women while the number for mothers born in the British Isles has remained relatively constant.

The proportion of male smokers (26 per cent) is slightly above average while the proportion of female smokers (19 per cent) is slightly below average; the regional figure in each case is 24 per cent.

Obesity is slightly above average for both genders with 28 per cent of adults in the area being obese compared to 24 per cent regionally. The percentage of obese children (4.9 per cent) is close to the regional average (5.1 per cent) and the area has a lower than average proportion of underweight children:

3.6 per cent compared to 5.4 per cent.

Accidental injuries are slightly more common in the area: 201 per 100,000 compared to 190 per 100,000 across Northern Ireland.

Immunisation rates, however, are among the best in the region. Rural isolation is also a problem on the periphery of the trust’s boundary with Katesbridge and Clogher being most distant from services.

Early intervention etc.
• Reduce the need for health and social care support
• Improve health outcomes
• Reduce health inequalities

Citizenship
• Provide more domiciliary care through non-trust providers
• Reduce state-provided residential care
• Reduce the need for state-provided day care
• End long-stay hospital care for people with mental health problems and learning disabilities
• Reduce the need for local addiction in-patient beds

Hospital networks
• Balance between localised and centralised services
• Retain consultant obstetric care and midwife-led units at both acute hospitals
• Reduce number of inpatient beds
• Move up to 25 per cent of agreed referral/elective activity out of secondary care
• Improve local access to sub-regional services (e.g. orthopaedics)
• Modernise outpatient delivery (e.g. straight to diagnostics pathways)
• Prevent unnecessary admissions
• Maintain quality and safety

Integrated care
• Move care closer to home (including palliative and end-of-life care)
• Fewer people requiring hospital admission
• Reduce duplication of information and testing
• More efficient and effective prescribing
• Two more community treatment and care centres

tubes credit johannes jannsson nordic council

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