#PathfinderWest
Moving from TALK to ACTION #PathfinderWest ANNE KILGALLEN Chief Executive What matters to us #PathfinderWest
As a Trust, our ambition is to give life to
Health and Wellbeing 2026: Delivering Together, the strategy for health and social care approved by the NI Executive in 2016 and we believe this work is a means to do so. What matters to me #PathfinderWest What matters to me #PathfinderWest
KIERAN DOWNEY Deputy Chief Executive Early influences in our approach #PathfinderWest OUR AMBITIONS… #PathfinderWest
Build our four strategic themes into all our thinking & planning ACHIEVING CHANGE TOGETHER #PathfinderWest
Which pieces of the Jigsaw can we bring COLLECTIVE together which will LEADERSHIP complete the puzzle
And make the difference? E-HEALTH ENGAGING WITH OUR PEOPLE
The starting point on the Pathfinder Journey was to TALK… Meet our People… ENGAGE OUR COMMUNITY, OUR STAFF – ALL Stakeholders
1. Pre Engagement Meetings – October/November 2018
2. Intensive Engagement – December ‘18 – March ‘19
3. Meet ALL Stakeholders – Visit our Communities ENGAGING WITH OUR PEOPLE
We travelled on a most compelling, thought provoking and humbling journey across Fermanagh and West Tyrone. Example…
STAFF Enniskillen Irvinestown Belcoo Gortin
Belleek Boho HRCC Omagh Tara Centre, Omagh
Teemore STAFF Omagh
Ballinamallard Roslea ENGAGING WITH OUR PEOPLE 17 Pre-Engagement Sessions 62 Engagement Sessions 2,200 People ENGAGING WITH OUR PEOPLE What We Heard Gaps in fundamental services particular Domiciliary Care Some communities are more community orientated and resilient than others Growing workforce challenges in key staff groups Build a model that moves a system centred around hospitals to a system focused on community strengths. ENGAGING WITH OUR PEOPLE What
We Heard If you always do
Hospital and Community services are “what you always fragmented and not well connected. We need to refine ‘Pathways’ to achieve a greater synergy of did, you will “ services All our services are currently struggling to meet always get what need Needs to be greater cohesion between Health and you always got other Agencies – particularly with Road Services, Rural Transport, Broadband and Education Community are anxious around the resilience of Primary Care services. Albert Einstein ENGAGING WITH OUR PEOPLE
What We Heard Important for the Build our links with the Education Trust to have Sector: “ Post Primary Schools the right staff, 2nd Level Colleges “ Universities at the right time, with Learning Communities Skills Academy the right skills! Work Experience
ALSO… Primary School – Primary 7 Health Champions Teams Approach our young people earlier Building Our Future Heroes in Health… YEAR 10 and… • Wed 8 May: Omagh Leisure Complex PRIMARY SCHOOLS • Thurs 9 May: Lakeland Forum, Enniskillen LOOKING AT DESIGN
Our thinking should be influenced by… 1 People own what they help create
2 Real change takes place in
MYRON’S real work 3 The people who do the work “ do the change Maxims 4 Start anywhere, follow it everywhere Revealing the Dynamics that Create Enduring 5 Connect the system to more “ Capacity for Change of itself RONAN O’HARE Assistant Director for Acute Services South West Acute & Omagh Hospitals CONNECTED COMMUNITIES
So how do we do this? COMMUNITY PLANNING #PathfinderWest
ROBERT GIBSON Director of Community, Health and Leisure, Fermanagh and Omagh District Council COMMUNITY PLANNING #PathfinderWest WHAT THE DATA TELLS US #PathfinderWest
DERMOT HUGHES Medical Director Caring with Intelligence #PathfinderWest
• Relatively poor area
• 3rd highest proportion of population with income below 60% NI median
• 65 plus cohort is the poorest in NI
• This cohort has the greatest burden of ill-health Caring with Intelligence #PathfinderWest • 21.2 % of the population is employment deprived
• Highest proportion of unfit domestic dwellings in NI
• Highest proportion of domestic dwellings in a state of disrepair
• Effects elderly population disproportionately Caring with Intelligence #PathfinderWest • GCSE outcomes are 2nd • Lowest number of school best in NI leavers not in education, training or employment in NI Caring with Intelligence #PathfinderWest
128,220 people 6.9% NI population
33,700 km2 25% NI area
Fermanagh and Omagh Local Government District has the lowest population density - some border areas have 15 people / km2 Caring with Intelligence #PathfinderWest • The area benefits from its geography but is also challenged by it • 25 out of 49 Super Output Areas are ranked in the lowest quintile for access to services • 81% of the Super Output Areas have access worse than the NI median What the DATA tells us #PathfinderWest
DECLAN BRADLEY Consultant in Public Health Medicine Public Health Agency Caring with Intelligence #PathfinderWest
1,640 births in 2018 Stable for 5 years
53% breastfed on Start 10% women smoked leaving hospital in pregnancy NI: 47 Life NI: 13%
Low maternal vaccination: 64% whooping cough 43% flu Caring with Intelligence #PathfinderWest
15% fewer teeth extracted than rest of NI
Life expectancy for 25% Overweight or girls in deprived F&O Start obese in P1 areas: 83 to 79 in 4 Life (UK 90 Method) years NI: 25%
35% Overweight or obese in Year 8 (UK 90 Method) NI: 36% Caring with Intelligence #PathfinderWest
Few teen births: F&O 4.3/1000 NI: 9.6
Smoking deaths: Alcohol admissions: F&O: 161/100,000 Live F&O: 634/100,000 NI: 160 Well NI: 691 F&O Deprived: 215 Omagh: 1,105
Drug admissions: F&O: 167 /100,000 NI: 202 / 100,000 Enniskillen 244 Omagh 288 Caring with Intelligence #PathfinderWest
The lowest prescription rate for mood & anxiety
1/100 has a Live F&O suicide rate = NI serious mental Average illness - High Well 16 / 100,000
High suicide rate in Enniskillen 35 / 100,000 Caring with Intelligence #PathfinderWest
Cancer incidence 584/100,000 NI 596 F&O deprived 737
Cancer deaths <75 Cancer deaths <75 y Live 140/100,000 Up 30% in 5 y NI 149 in F&O deprived Well F&O deprived 187
Cancer up 20% Lung cancer up 60% in F&O deprived in 5y Caring with Intelligence #PathfinderWest
1,022 people with dementia
In 2030 there will be Grow 8/1,000 7,500 Old Second highest in NI
In 2017 there were 4,000 aged >80 Caring with Intelligence #PathfinderWest
The Pathfinder area has 82 GPs in 21 practices, who have 140,764 registered patients 0.58 per 1,000 patients
The rest of Northern Ireland has 1,232 GPs for 1,843,013 patients 0.67 per 1,000 patients
11,300 patients are registered at 3 practices each with 1 permanent GP in the Pathfinder area
(Not accounting for less than full-time working) People in Fermanagh Emergency admissions: and Omagh are the most 10,600 / 100,000 population likely in Northern Ireland to be admitted to hospital NI: as an emergency or for 9,200 / 100,000 population any reason All admissions: 26,700 / 100,000 population NI: 24,000 / 100,000 population Caring with Intelligence #PathfinderWest
South Admission Type Number % West Emergency 10,313 55 Acute Elective 5,192 28 Hospital, Other 1,613 9 Maternity 2018 1,551 8 Source: PAS
Omagh Admission Type Number % Emergency 3,918 34 Hospital, Elective 7,083 62 2018 Other 462 4 Caring with Intelligence #PathfinderWest
People aged 70 years and older accounted for 35% of emergency admissions
And 67% of emergency bed days
Of 94,939 occupied bed days 9,648 (10%) were occupied by people who were medically fit for discharge Source: PAS Caring with Intelligence #PathfinderWest Reasons for Delayed Discharges SWAH and Omagh Hospital, 2018 Reason Discharges Days No domiciliary package available 254 3201 No EMI bed available 45 1683 Care planning 140 1468 No nursing home bed available 32 634 Hospital assessment 74 519 Nursing/residential home resistance 20 304 Source: PAS Caring with Intelligence #PathfinderWest
Primary care: resilience and rural access
Longer-term care Secondary care: needs of growing Future Improving systems at number of older needs? entrance and exit people
Health effects of urban deprivation in Enniskillen and Omagh The Next Steps #PathfinderWest
ANNE DONAGHEY Assistant Director The Next Steps #PathfinderWest
EBE: ‘Expert by Experience’
“The EBE chair will sit in this Strategic Group” “All working groups will have EBE representation”. The Next Steps #PathfinderWest
It has been proposed that principles contained within the two Nuffield Trust documents
Shifting The Balance of Care and
Rethinking Acute Medical Care in Smaller Hospitals will be utilised. The Next Steps #PathfinderWest Our Principles… Building Capacity in Communities & Prevention
• Time limited initiatives and admissions and facilitating discharge from hospital • Managing at risk populations particularly end of life care and dementia • Support for people to care for themselves and access community resources (connected care) Connected Communities • Create effective networks • Community and primary care collaboration The Next Steps #PathfinderWest Our Principles…
Enhancing Support in Primary Care
• Changes in emergency and urgent care pathways • Managing at risk populations particularly end of life care and dementia • Specialist advice through new “on call” arrangements • Investment in diagnostics and other support services (Mega Big Foot & Mega Big Hand Clinic) • Create effective networks The Next Steps #PathfinderWest Our Principles… Reforming Hospital and Community • Changes in elective care pathway • Changes in emergency and urgent care pathway • Establish slick process at front door of hospital • Clear plans for dealing with high risk patients • Create continuity of care • Investment in diagnostics and other support services. • Create effective networks. The Next Steps #PathfinderWest Our Principles… Organising Ourselves To Deliver • Time limited initiatives to avoid admission or facilitate discharge • Create a single front door team • Redefining care pathways (carve out) (Collective Leadership) • Specialist advice through new “on-call” arrangements. • Innovative approach to staffing (Obstetrics) • Create effective networks (e health and obstetrics) The Next Steps #PathfinderWest The Model The Next Steps #PathfinderWest The Fundamentals...
Co production
Co production
Co production The Next Steps #PathfinderWest
‘Experts by Experience’ Seven ‘Experts by Experience’ appointed to help guide planning and delivery of services in Fermanagh and West Tyrone into the future The Next Steps #PathfinderWest
The Fundamentals Collective Leadership 1.Leadership being the responsibility of all 2.Shared leadership in and across teams 3.Interdependent and collaborative system leadership 4.Compassionate leadership RACHEL ARMSTRONG Nurse Practitioner Older Person Liaison Service (OPALS) A Great Place to Grow Older #PathfinderWest
A Great Place to Grow Older… A Great Place to Grow Older #PathfinderWest What is Frailty? Frailty is not an illness, but a syndrome that combines the effects of natural ageing with the outcomes of multiple long-term conditions, a loss of fitness and reserves (Lyndon 2014). A Great Place to Grow Older #PathfinderWest Frailty Big Room A Great Place to Grow Older #PathfinderWest Ronald’s Story Board A Great Place to Grow Older #PathfinderWest Next Steps… Frailty Big Room is keeping Ronald’s Story at the heart of their work. • Ultimate aim is to achieve a pathway that wouldn’t have resulted in a Hospital admission for Ronald. • Currently, we have implemented and tested a screening tool to recognise frailty in the Hospital setting. Frailty big room is now focusing upon what actions the tool initiates. • Learning to be shared with community teams/groups so that we have earlier recognition and preventative measures for people living with frailty. JENNY IRVINE Chief Executive Officer of “the ARC” CONNECTED COMMUNITIES
• Embedding wellbeing in Fermanagh and West Tyrone
• Measuring wellbeing using an outcomes based population health approach • Creating communities that are compassionate and where kindness becomes the underpinning philosophy • Rebuilding community cohesiveness at three different levels: • Community • Health and • How we organise? ALL COMMUNITIES HAVE RESOURCES #PathfinderWest
Community…
Recognising communities have resources (social capital) Investing in place, resourcing that “natural resource”
• Make the invisible visible, harness the kindness and compassionate that exists, nurture and grow don’t replace or displace. • Our communities already provide lifeboats for the lonely…don’t flood them, support them to become cruise ships for the hopeful
Nurture and grow what exists - don’t replace or displace. CONNECTED COMMUNITIES #PathfinderWest
Community…
Create and establish Community Connectors
What is a Community Connector? They are like a light house, they help others find their way…. • A Community Connector helps friends, family, neighbours and colleagues find support in communities. • They help lots of people by signposting to services that are available, eg… • Health • Housing • Education • Exercise • Employment • Debt Management You can TRAIN as a Community Connector CONNECTED COMMUNITIES #PathfinderWest
Health Connectors…
Through the Health Connectors, in partnership with the GP Practice and relevant Community group(s), you can book free sessions with a Health Connector to listen to your Health story.
They can give you information about local support: • eg. Health and wellbeing programmes
Health Connectors can also run a number of small groups to help people set: - A number of health goals for themselves - Help empower them to manage their own long term health conditions CONNECTED COMMUNITIES #PathfinderWest
ORGANISATIONAL Connectors…
This will be the programme manager appointed to have community oversight and authority to: • Lead and co-ordinate organisations to complement each other • Oversee community and health training • Use population health data to inform design and where the emphasis should be placed • And create a strategic alliance to maintain the energy • The role of the Organisational connector CONNECTED COMMUNITIES #PathfinderWest How will we do it quickly?
• FUTURE SEARCH: Future search is a unique planning method that allows diverse groups to: • Validate the concept with all key stakeholders • Take responsibility for actions • Develop commitment to implementation • To create a shared picture of the future • www.futuresearch.net CONNECTED COMMUNITIES #PathfinderWest Social relationships have a value…
How this connects to what we heard and what the data tells us…
• Your health and wellbeing must be cherished • Community capital is the key driver in building a Connected Community • Working strategically and inclusively with communities nurtures resilience • Connected Communities will reduce social isolation and loneliness CONNECTED COMMUNITIES #PathfinderWest
PEOPLE: Passionate happy people, proud of their health and social care system & their role in it
PERFORMANCE: Health is improving & we can prove it (great data) What does POUNDS: Financially secure health & social care system
POLICY: Communities are influencing and shaping good GREAT public policy look like? PRESS: Our health & social care system is loved & regarded as the very best
PROGRESSIVE: Maximized relevant rural research & technology to lead change and improve population health CONNECTED COMMUNITIES #PathfinderWest
Gaps in provision?
Map of Northern Ireland showing every GP Practice with a red star
This area highlighted is the Pathfinder region of Fermanagh & West Tyrone
The shaded areas show travel distance to GP Practice RED: 12-15 miles White: > 15 miles
Significant gaps shown in these Pathfinder areas HIDDEN HEROES of the Western Trust #PathfinderWest
Highlighting the MANY HEROES of the Western Trust
Promotional Campaign launches in MAY 2019 – stay tuned…
Showing the VALUE of a career in Health and Social Care in the Western Trust
Get Involved! Nominate your WTHeroes…
Use #WTHeroes when promoting on Social Media Email us at [email protected] #WTHeroes
#PathfinderWest
PROFESSOR RAFAEL BENGOA #PathfinderWest QUESTIONS and ANSWERS #PathfinderWest
Website: www.westerntrust.hscni.net
Email: [email protected] Evaluation by Email YOU#PathfinderWest