Subject: Transforming Your Care BSO Progress Update

Paper BSO 80/2014

To: BSO Board From: Chief Executive Subject: Transforming Your Care – BSO progress update Status: For Noting Date of meeting: 28 August 2014

1.0 Background The BSO is continuing to consider how Transforming Your Care (TYC) is and will impact on the organisation and the role of the organisation in ‘making the vision real’. A BSO working group was established in January 2014 to raise awareness of the impact of TYC on BSO services and to scope the TYC programme of work. The purpose of this paper is to discuss the role of the BSO in implementing TYC and to report on progress of the work required by the BSO to support and facilitate the delivery of TYC initiatives. Updates will be provided to the BSO Board on a quarterly basis in accordance with one of the DHSSPS Requirements within the BSO Business Plan 2014-15.

2.0 Transforming Your Care In June 2011, the Minister for Health, Social Services and Public Safety, Mr Edwin Poots MLA, announced a review of the provision of health and social care services in Northern Ireland. The Review Team concluded that the case for change was unquestionable and put forward 99 recommendations across a number of key areas. The key changes include:  More diverse provision of services, delivered closer to home  A focus on delivery of services through Integrated Care Partnerships  Reconfiguration of the hospital network to ensure safe, resilient and quality services into the future  Greater personal choice and control for patients  Greater use of technology  Increased involvement and role for the independent, voluntary and community sectors In October 2012, the Minister launched Transforming Your Care: Vision to Action to provide information to help all citizens of Northern Ireland to contribute to the debate on the future of our Health and Social Care. It set out the proposed service changes, within and aligned to existing policy frameworks, in response to the TYC Report published in December 2011. The document broadly covered four key themes: 1. Individual - what Health and Social Care can do to keep individuals healthy and how HSC could help you improve your own health and wellbeing. 2. Delivering health and social care services as locally as possible – making the home or the community the hub of care, reducing the need for avoidable visits to the hospital. 3. Safety and Quality of acute care in hospital settings - the need to ensure that emergency care and planned specialist care provided in hospitals is safe and sustainable and meet the best quality standards.

1 4. How HSC can collaborate better with our neighbouring jurisdictions - In some cases the very best care may not be in Northern Ireland, where there is low volume or the treatment is very specialised. An over-arching Transforming Your Care Programme plan is currently being developed by the Health and Social Care Board. The role of the BSO in TYC will develop in line with this programme plan. 3.0 TYC in the BSO - Enabling transformation The role of the BSO in TYC currently predominately lies in the enablement of transformation across a number of key themes; capability, engagement, technology, Integrated Care Partnerships and Social Care Procurement. 3.1 Capability 3.1.1 Training The CEC is also delivering regional training relating to infant mental health (Solihull programme funded by PHA) and has increasing capacity to deliver Advanced Communication Skills training in the area of Palliative Care. The Leadership Centre has also developed a “Delivering and Sustaining Change in Health and Social care” programme for those leading TYC projects. Two cohorts have been delivered, with a further six planned over the year. Design of a programme on “Leading Transformation in Health and Social Care” is also underway and is due to run in Autumn 2014. 3.1.2 Skills Stations The Clinical Education Centre (CEC) has successfully bid for the development of improved skills stations in each site which will enhance capability in supporting the HSC to provide the range of clinical competencies that TYC will demand in a wide variety of settings. Education programmes have also been developed to support the transition of care from acute hospitals to community settings. 3.1.3 Knowledge Exchange The Leadership Centre has developed an online resource known as the Knowledge Exchange which shares best practice, the latest thinking on health and social care subjects and provides the basis for an online community in the HSC.

3.2 Consultancy and Advice 3.2.1 Equality

The Equality Unit has provided support and advice to the HSC Board’s Transforming Your Care team in relation to screenings and Equality Impact Assessments (EQIAs). This has included the EQIA on ‘Making Choices: Meeting the current and future accommodation needs of older people - Proposed Criteria for the assessment of statutory residential care homes for older people’. Current work relates to the Review of Domiciliary Care. Work will continue as requested, based on the TYC programme of work. 3.2.2 Integrated Care Partnerships Integrated Care Partnerships (ICPs) are a key element of Transforming Your Care, and will be a new way of working for the health service in Northern Ireland to transform how care is delivered. ICPs are collaborative networks of care providers, bringing together doctors, nurses, pharmacists, social workers, hospital specialists, other healthcare professionals and the Paper BSO 80/2014 voluntary and community sectors, as well as service users and carers, to design and coordinate local health and social care services. There are 17 ICPs across Northern Ireland. Organisational development support sessions for each of the 17 ICP committees are being delivered by the HSC Leadership Centre, with positive feedback. The Leadership Centre is also holding two Regional events to share learning and to discuss clinical pathway redesign. The first regional event took place on 4 June 2014 and the second is planned for September 2014. Specific support has also been put in place for chairs of the ICP committees around chairing skills.

3.2.3 Social Care Procurement

Effective Social Care procurement is key to the ability of the HSC to ‘shift left’ to the independent sector as part of TYC. Currently social care procurement, at an approximate value of £800m, is delivered operationally by the five HSC Trusts, the Health and Social Care Board (HSCB) and the Public Health Agency (PHA). Each HSC organisation undertakes individual procurement activities through approaching providers (private, community and voluntary) in a range of sectors across a range of markets with limited advice and guidance from BSO PaLS. There are varying levels and skill mix of staff involved in these activities across each of the organisations. Consequentially, there are varying approaches and techniques adopted by each of these organisations to the procurement of social care services.

A review of social care procurement was undertaken in October 2011. The findings identified a number of weaknesses in procurement and contracting activity that leaves HSC organisations vulnerable from an audit perspective and open to legal challenge.

Public procurement is regulated throughout the European Union and historically Social Care services were exempt from the full rigour of procurement legislation. A new EU Directive, agreed in February 2014, will, however, create a new regime for health (and social care) contracts. The change in Procurement Legislation will require all services over €750,000 to be advertised in the Official Journal European Union (OJEU), which suggests competitive tendering. This is currently expected to be implemented from December 2014. A Task & Finish Group has been established to ensure the HSC sector is ready to address the implications of the forthcoming legislative changes associated with procurement. The role of the Task and Finish group is to:  Scope the impact of the new EU procurement legislation on the HSC (for both HSC organisations and other providers);  Compile an implementation/action plan for each key challenge;  Ensure the implementation plan is conducted in accordance with key milestones and targets; and  Report progress to the Regional Procurement Group. The BSO is continuing to work closely with the HSCB and the wider HSC as part of this group to agree arrangements for social care procurement. This will inform any formal strategy that emerges following the work of the Social Care Procurement Task and Finish Group. It is anticipated that the introduction of competitive tendering to social care procurement will result in savings.

3 3.3 Information, Analysis and Technology 3.3.1 NI Electronic Care Records The NI Electronic Care Records (NIECR) is an HSC web-based portal system delivered by BSO Information Technology Services (ITS) in conjunction with supplier Orion Health. The system was launched in July 2013 with the aim of providing accurate and accessible patient records across Northern Ireland. NIECR should improve the speed, quality and efficiency of healthcare delivery and benefit every person in Northern Ireland. More timely access by healthcare professionals to more complete information will benefit all patients, reduce duplication and wasted time, and improve safety. There are currently 12,000 users registered on the system. Since its launch, 1.27 million patient records have been accessed and over 15 million clinical documents have been uploaded into the system. 3.3.2 Honest Broker Service

The new Honest Broker Service provided by the BSO puts in place better and more secure processes for the sharing of unidentified health and social care data within the HSC family. This service aligns with the aims of Transforming Your Care, allowing for a more patient-centred model of care by enabling healthcare professionals to access patient information from multiple sites across the healthcare setting.

3.3.3 Primary Care GP Network

The replacement of the Primary Care GP Network has been completed. Changes being made to the GP network will mean increased bandwidth for access to services. It will also enable teleconferencing and provide wireless “hotspots” in practices and health centres. Work is underway to seek funding for a community pharmacy network.

3.3.4 Electronic Document Transfer Project The Electronic Document Transfer Project aims to transfer clinical documents from secondary to primary care using the same mechanism used for labs and radiology. The first target of this project will be the electronic transfer of discharge letters. Software to load documents into GP practice management was implemented in March 2014.

4.0 Recommendations The Board is asked to:  Note the progress made by BSO towards TYC to date.  Note that on-going updates will be provided on a quarterly basis in accordance with the Business Plan 2014-15.