Contacting GP out of hours

In the past two years the Northern Health and Social Services Board has embarked on a highly ambitious project to develop a five-year Equity Strategy which would, among other things, examine whether or not Health and Personal Social Services resources are fairly shared across Board populations, our local resident populations and Programmes of Care (such as the Elderly). It also makes recommendations, where required, for the "direction of travel" needed to ensure equity.

Equity Strategy 2005 - 2010 - Executive Summary

Following the publication of "Ringing the Changes - the Board’s strategy for older people" in December 2002, Board officers have been working to implement many of the recommendations made in this document. Investment in core services such as domiciliary care and community nursing continues to form a substantial part of the Board’s annual investment. In addition, a range of new and innovative schemes to help people to be cared for in their own homes rather than in a hospital or care home setting were commissioned.

These included the creation of new Community Rehabilitation Teams in the East Antrim and Antrim/Ballymena areas and a Community Stroke Rehabilitation Team in the Mid Ulster area. In the Causeway area the formation of an Orthogeriatric Rehabilitation Team will mean a shorter length of stay in hospital for older people who have sustained a fracture. It is the Board’s intention to build on this progress and make further investments in subsequent years.

The benefits of a healthy lifestyle cannot be emphasised enough. Recognising this, the Board invested in health promotion staff to focus specifically on the needs of older people. During the year, a workshop to identify the needs of younger people with dementia took place. This event brought together users, carers, as well as staff from the statutory and voluntary sectors. A comprehensive needs assessment has been produced and will inform the Board’s future commissioning intentions.

People with mental health problems should receive care and support within the community wherever possible - this is the Board’s vision for the development of mental health services for people outlined in "Commissioning a Modern Mental Health Service", published in 1999.

In keeping with this vision, a greater investment in community based services has taken place, including the development of innovative community based Crisis Response and Assertive Outreach Teams in the Homefirst Community Trust area. Other community services prioritised for investment were generic Community Mental Health Teams;

child and adolescent mental health services; community addictions services including the development of substitute prescribing and residential services as part of the resettlement of long-stay patients from Holywell Hospital. Planned future developments include eating disorders and community forensic services.

When admitted to hospital, people with mental health problems should receive care in a modern therapeutic environment. This is the principle underpinning the new Ross Thomson Unit in Causeway Hospital and the refurbished Tobernaveen Wards in Holywell Hospital. The refurbishment of Holywell’s Psychiatric Intensive Care Unit, the development of an inpatient Addictions Unit and the forthcoming Challenging Behaviour ward are further examples.

It is hoped that the principles established will be extended further into practice through the findings and recommendations of the Northern Ireland wide Review of Mental Health and Learning Disability. Potential future priorities include mental health services for older people, daycare, child and adolescent mental health services and the further development of the generic community mental health teams.

"Promoting Ability - the Board’s strategy for commissioning learning disability services" launched in 1998, has been reviewed in order to identify what has been achieved, what still needs to be done and, perhaps more importantly, to take account of changing needs, pressures and ways of delivering services. There has been much emphasis in recent years on specialist hospital services such as provided at Muckamore Abbey and the need to support patients to move into the community.

A strategic review undertaken by the Northern Board highlighted the need to support and enhance community staff and to increase the availability of services such as respite and daycare which provide valuable support for families.

Additional resources have been provided to increase social work and nursing staff and Allied Health Professionals. The first phrase in establishing a Boardwide challenging behaviour service is underway. Funding has also been provided to address pressures on adult and day centre provision for school leavers. This has led to the development of innovative projects with Appleby Trust and Triangle Employment Services. A new purpose built respite facility for children has opened in Ballymena and the first phase of a new and much smaller hospital fit for the 21st century is being built at Muckamore. It is hoped that the learning from the year under review has helped to position the Board particularly well for any future challenges which may arise from the current regional review of this service.

Board officers have been working with local trusts, voluntary groups and other bodies to implement the wide-ranging recommendations from "New Directions: New Opportunities - the Board’s strategy for people with a physical disability/sensory impairment", which was launched in 2003. Focus has centred on promoting well-being and independence, improving support services for patients and carers and developing specialist services. As a result, the Board has been able to focus investment to enhance the transition from children to adult services, review the availability of appropriate day support services, improve carer support and develop a range of community services. Local community support for people who have suffered a brain injury has been further developed to enhance regional rehabilitation opportunities.

Board officers are also working together to monitor investments aimed at improving rehabilitation and domiciliary support services and enhancing the availability of direct payments as an option for patients and carers. Vocational rehabilitation was identified as a major issue during consultation and a successful workshop involving a range of agencies was held in March 2004 to examine the opportunities for those with a disability.

Services for individuals with a sensory impairment are being reviewed to assess the level of need and investment required. A four-Board Group has been established to ensure a consistent approach to the future development of regional and local services and investment priorities.

Improving responsiveness of acute services and reducing waiting times for patients were key objectives for the Board during 2003/04. Although a gap exists between available resources and the growing demand for services, it is the Board’s role to ensure this gap is reduced as much as possible. The Board continued to work intensely with Trusts and other organisations, for example private hospitals, to respond more quickly to patients’ acute needs.

Key developments included:

• Ensuring additional beds, staff and support services were in place to meet increased winter demands.

• The number of patients waiting 18 months or more for hospital treatment continued to be reduced - by 55% since June 2002. Overall, the waiting list was reduced by 23% during 2003/04 - the largest percentage reduction by any Board.

• 857 patients were offered a transfer to a private hospital for treatment which was accepted by 57 patients.

• Ensuring vital services like renal services keep up with growing demands.

• 126 additional cardiac surgery patients received their treatment at a private hospital outside Northern Ireland reducing the waiting list to 60 at the end of March 2004.

• Implementing revised guidelines to improve services for gynaecological cancer.

The Northern Board continued to work to secure improved access to specialist services. Significant investment was made in cancer, cardiac surgery and other regional services such as additional beds in the regional Intensive Care Unit and extra staff for the paediatric pathology service.

The Department of Health, Social Services and Public Safety consultation document “Developing Better Services Modernising Hospitals and Reforming Structures” proposes a new pattern of hospital services for Northern Ireland. Following its endorsement by the then Minister in February 2003 the four Boards were asked to produce a Strategic Context and Implementation Framework document outlining in more detail the range of services that would be provided in local acute and community hospitals in the future. This framework was submitted to the Department of Health, Social Services and Public Safety in January 2004.

A Regional Steering Group has now been established to oversee the implementation of these changes provincewide. Within the Northern Board, an Area Programme Board comprising Board and Trust Chief Executives and other senior officers, has been set up to co-ordinate developments locally.

The implementation will, over a period of 10-15 years, see a further increase in the services and infrastructure at Antrim Area Hospital as well as consolidating and developing a modern, innovative range of services at local hospitals in the Whiteabbey, Magherafelt, Larne, Ballymena, Ballymoney and Ballycastle areas.

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