TRUST DELIVERY PLAN
2018/19
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Contents
Section 1.
Introduction .............................................................................. 1
Section 2.
Local Context ........................................................................... 2
Section 3.
Detailed Delivery Plans ......................................................... 7
Section 3.1 Trust Response to DOH Commissioning Plan Direction .....12
Section 3.2 TRUST RESPONSE TO REGIONAL COMMISSIONING
PLAN PRIORITIES ........................................................................................70
Section 3.3 WESTERN TRUST RESPONSE TO LOCAL
COMMISSIONING PLAN PRIORITIES (15) ............................................. 187
Section 4.
Resource Utilisation ........................................................... 201
Section 4.1 Financial Strategy / Measures to Break Even .................... 201
4.2
Workforce Strategy ............................................................................ 222
Section 4.3 Capital Investment Plan ........................................................ 227
Section 4.4 Plans for Shift Left of Resources and Other
Transformation Initiatives ............................................................................ 230
Section 5.
Governance .......................................................................... 237
Section 6.
Promoting Well-being, PPI and Patient Experience ...... 244
6.1
Promoting Well-being......................................................................... 244
6.2
PPI ....................................................................................................... 246
6.3
Patient Experience ............................................................................. 249
Section 1. Introduction
This Trust Delivery Plan for the Western Health and Social Care Trust is in response
to the draft Commissioning Plan 2018/19 issued by the Health and Social Care
Board and Public Health Agency. The Plan sets out the key actions that will be
taken forward by the Trust in 2018/19 to support achievement of the aims, outcomes
and objectives for Health and Social Care (HSC) identified in the Department of
Health (DoH) draft Commissioning Plan Direction (CPD) 2018/19 as well as the
commissioning programme of care priorities detailed in the draft Commissioning Plan
2018/19. The Trust’s responses can be found in Sections 3.1, 3.2 and 3.3.
The Plan is underpinned by the Trust’s financial plan for 2018/19 and reflects the
very challenging financial position that the Trust and wider Health and Social Care
(HSC) system is facing. Section 4.1 sets out the Trust’s financial strategy for
2018/19 which provides details on the Trust’s income sources and expenditure areas
and also information on the pressures facing the Trust and the savings plans
developed to support these.
The Trust Delivery Plan is set in the context of a wider strategic reform agenda for
HSC and the planned transformation and modernisation of services in line with
Delivering Together. It sets out the Trust’s plans for the non-recurrent funding
allocated as part of the Confidence and Supply Agreement to support the
transformation agenda in Section 4.4 and these plans are also reflected in the
sections responding to the CPD and Commissioning plan objectives and priorities.
The Trust will continue to work within the wider service transformation programme
and will also advance its own reform priorities in order to address increasing demand
for services and the range of financial and workforce challenges facing the Trust and
the wider HSC system. In addition the Trust will work closely with the public, primary
care providers and partner organisations as part of delivering on the Community
Plans in the Western area.
WHSCT TRUST DELIVERY PLAN 2018/19 1
Section 2. Local Context
Strategic Planning – Since late 2017, the Trust has been undertaking work to
refine our vision and define our key strategic priorities so that our staff and the
population we serve can easily identify and engage with the outcomes we want to
achieve. The resulting Trust vision sets out four inspiring objectives which aim to
make the Trust a Great Place to Start in Life, a Great Place to Grow Older, a
Great Place to Live Well and a Great Place to Work. These are underpinned by
a further cross cutting objective of providing the Right Care First Time. As we
take this work forward, we have been engaging with our staff to help build our
shared purpose. For example, a number of have been participating in Discovery
Groups linked to the four themes and their findings will be used to inform our
strategic plan as it develops alongside feedback from all our staff who are being
provided with opportunities to test and help shape the plan.
Demography - The Western Trust is one of five Health and Social Care (HSC)
Trusts in Northern Ireland which provide health and social care services across the
province. The Trust employs approximately 12,000 staff and has an annual budget
of approximately £687 million to provide health and social care services to a
population of approximately 300,000 across a geographical area of 4842 km2
encompassing the council areas of Derry City and Strabane District Council,
Fermanagh and Omagh District Council and Limavady in the Causeway Coast and
Glens Council. The Western Trust population represents 16.1% of the overall
population of Northern Ireland. Based on NISA 2016-based population projections,
by 2028 the Trust’s population is expected to increase by 1.2% to 305,595 and, in
common with the rest of Northern Ireland, the greatest increases are projected in the
over 65 (+27%) and over 85 (39%) age groups. In terms of the 0-15 years age
group, a 5% reduction from 65,050 to 61,601 is projected by 2028.
Rural Needs Act - The Rural Needs Act came into operation for public authorities on
1 June 2018 and places a duty on public authorities to have due regard to rural
needs when developing, adapting, implementing or revising policies, strategies and
plans and designing and delivering public services. A need is something that is
WHSCT TRUST DELIVERY PLAN 2018/19 2
essential to achieve a standard of living comparable with that of the population in
general, eg access to key public services such as health. The Act classifies
settlements with fewer than 5,000 residents together with open countryside as rural.
The Western Trust is one of the most rural Trust areas in Northern Ireland with
extensive rural communities and a small number of densely populated urban areas.
The Trust has traditionally taken cognisance of the impact of this on service delivery
and accessibility when planning its services and we will continue to ensure that rural
needs are considered in our planning and decision making.
Deprivation - Deprivation and health inequalities are associated with a range of
health issues and behaviours, such as reduced life expectancy, increased mental
health issues and suicide rates, low birth weight rates, obesity levels, higher levels of
looked after children, smoking and drugs and alcohol misuse. The Northern Ireland
Multiple Deprivation Measures 2017 show that deprivation is a key population health
factor for the Trust with five of the top 10 most deprived areas for the multiple
deprivation measure located in the Derry and Strabane area (East, located in Derry
City & Strabane, is the most deprived SOA according to the MDM), and 10 of the top
20 most deprived areas in terms of access located in Fermanagh and Omagh. In
terms of income, 24 of the top 100 most deprived areas are in Derry City & Strabane
and for health and disability there are 22 areas in the top 100. The 2018 Health
Inequalities Annual Report shows that within the Western Trust area, deprivation
inequality gaps narrowed for 6 indicators but remained unchanged for 24 indicators
and widened for 7 indicators. The largest deprivation inequality gaps for the Trust
are deaths related to drugs, drug misuse and alcohol and alcohol and drug related
admissions.
This level of deprivation is reflected in life expectancy figures for the Western Trust
which are lower than for three of the other five Trusts and in the expected healthy
living age which is lower than all of the other Trusts. This means that in the Western
Trust we are supporting those who are not well earlier and for longer. There are also
impacts on our children and young people with one in three children in the Western
Trust area living in poverty and with high levels of looked after children.
A key challenge will be to address the ongoing impacts of this deprivation both in
rural and urban areas so as to narrow the gap between our most and least deprived
WHSCT TRUST DELIVERY PLAN 2018/19 3
communities. The Trust believes there is an increasing need for population/place
based services in order to address these deprivation and associated health
inequality issues. We will continue to work in partnership with the Public Health
Agency to implement the strategies and actions set out in Making Life Better and
with our Local Government partners to implement the Community Plans in order to
improve the health and wellbeing of all our population
Workforce Challenges – The Trust has previously highlighted the increasing level
of medical workforce shortages at consultant and middle grade level across a range
of specialties including emergency medicine, paediatrics, care of the elderly, acute
medicine, palliative care, radiology and general surgery. In addition to this, the Trust
has historically received allocations of trainee doctors which have not kept pace with
the changes in our services, and these allocations have also been difficult to fill.
These shortages have led to a reliance on locum doctors, and in some areas that
reliance is significant, leading to real challenges to manage these services and
deliver high quality care and a growing financial pressure on the Trust.
Similarly, there are workforce challenges being experienced in other areas,
particularly in nursing, psychology and this has resulted in an ongoing challenge to
ensure appropriate staffing levels to deliver our services.
The Trust has put in place a wide range of initiatives to address these issues,
including continuation of the international medical recruitment initiative and
participation in a regional international nurse recruitment programme as well as an
active recruitment programme for pre-registration nurses in their final year of training,
which is part of the Trust’s nurse workforce stabilisation project.
Work is also due to commence on a pathfinder project through which we will work in
partnership with the local population to develop health and care services across
Fermanagh and in the South West Acute Hospital to ensure that they meet the
needs of the community in a safe and sustainable way. This work will be sponsored
by the Department of Health and will be informed by learning from the successful
involvement of staff and communities in the approach at Daisy Hill Hospital, Newry in
2017.
WHSCT TRUST DELIVERY PLAN 2018/19 4
Performance – There are a number of performance targets within the draft
Commissioning Plan Direction which, due to the current level of performance and the
wider financial and workforce challenges, will not be achievable in 2018/19. The
Trust has developed Performance Improvement Trajectories for Unscheduled Care
(4 hour target and complex discharges within 48 hours), Elective Care (delivery of
core activity for inpatients, day cases, new outpatients and endoscopy), Cancer
waiting times and waiting times to access mental health, psychological therapy and
radiology services. These trajectories set out the expected level and pace of
improvement that Trusts believes it can expect to deliver in 2018/19. These will
form the basis of accountability processes with the HSCB in 2018/19 and are
captured in this Trust Delivery Plan. The Trust will also endeavour to maximise
opportunities arising from non-recurrent waiting list initiative funding to create
additional capacity to improve access to elective care, AHP and mental health
services.
Learning Disability – The Trust has previously prioritised investment in Learning
Disability and this will continue in 2018/19. The Trust has initiated an active
programme to increase involvement with families, carers and advocate groups to
plan how that investment will be deployed and to agree processes for their
involvement in service planning and delivery going forward.
Looked After Children – The Trust has been experiencing continued increases in
the numbers of looked after children, and this is primarily due to the increasing
number of children in ongoing kinship care. Alongside this, there has also been an
increase in the complexity of these cases. This has resulted in considerable
additional financial and workforce pressures in this service. The Trust is also striving
to return a small number of children who are being cared for outside the Trust
geography to care placements within the Western area.
Transformation and Reform - The Trust has strong relationships with primary care
providers in the Western area. The Trust has been successful in securing funding
for one of two Northern Ireland projects for establishing multi-disciplinary teams in
primary care and looks forward to working with the GP Federation to implement this
initiative. A substantial transformation programme will get underway in 2018/19 and
WHSCT TRUST DELIVERY PLAN 2018/19 5
the Trust will work closely with HSCB, PHA, LCG and other bodies as required to
ensure the successful implementation of the agreed investment programme.
Work continues to advance on the programme of change being taken forward under
the auspices of the Transformation Implementation Group (TIG), including work on
pathology services, breast assessment services, stroke services. During 2018/19,
we will continue to work within the regional programmes to take forward reforms in
relation to elective care, care pathways, outpatient services and adult social care, all
of which are focussed on a patient-centred approach to care, and improving how
resources are used across primary and secondary care.
Major developments - The Trust is continuing to work on planned developments
such as the new North Wing of Altnagelvin Hospital and to optimize the use of day
surgery at Omagh Hospital. The Trust will also focus on a small number of Primary
Care and Community Infrastructure and Mental Health developments, in line with its
Estates Strategy and the changing requirement for new infrastructure in the
community.
Finance – The Trust has faced a challenging financial environment for the past few
years and this continues to be the situation in 2018/19. The Trust has quantified its
opening deficit at £58.8m for 2018/19 and has worked closely with the DoH/HSCB to
secure additional funding which has revised the forecast year-end deficit to £24.4m.
The Trust has been in discussions with the DoH/HSCB and has agreed that the
Trust cannot address this deficit in-year and has allowed a deficit control limit for
2018/19. The DOH has requested that the Trust develop a Financial Recovery Plan
over a three year timescale commencing on 1 April 2019 with the objective of
achieving financial breakeven in the 2021/22 Annual Accounts.
Capitation Issues – In relation to demography, the Trust’s allocation for 2018/19
represents 13% of the total amount available due to the relatively lower population
growth projections in the Western Trust Area compared to the other Trusts.
However, the Trust has highlighted a number of cost pressures which would indicate
that the funding for demographic growth does not take account of increasing
premiums in areas of service growth such as Looked After Children services and
medical and nursing staffing.
WHSCT TRUST DELIVERY PLAN 2018/19 6
Section 3. Detailed Delivery Plans
This section of the Trust Delivery Plan details the Trust’s plans to deliver against the
objectives and goals for improvement contained within the DoH draft Commissioning
Plan Direction 2018-19 which are set out under four overarching strategic aims
linked to Delivering Together as follows:
(i) To improve the health of our citizens.
(ii) To improve the quality and experience of health and social care.
(iii) To ensure the sustainability of health and social care services provided.
(iv)To support and empower staff delivering health and social care services.
Section 3.1 sets out the Trust’s response to the DoH draft Commissioning Plan
Direction 2018/19 and the actions that will be taken forward by the Trust to contribute
to achievement of the key outcomes and associated objectives identified under each
of the above aims.
Sections 3.2 and 3.3 detail the actions the Trust will take to progress relevant
regional and local priorities identified under each programme of care within the draft
HSCB/PHA Commissioning Plan 2018/19.
Commissioning Plan Direction Strategic Aims
i)
To improve the health of our citizens
During 2018/19, the Trust will continue to work in partnership with the Public Health
Agency and the HSCB to take forward initiatives aimed at reducing the health
inequalities experienced in our communities, maintaining and expanding screening
programmes and ensuring the health of our citizens is protected through robust
immunisation and infection protection and control programmes.
The Trust is committed to achieving the objectives/goals for improvement associated
with this outcome. While delivery of a number of these objectives requires a multi-
sectoral approach led by the PHA, the Trust has assessed the measures it can take
to contribute to their achievement in its response. The Trust has identified some
WHSCT TRUST DELIVERY PLAN 2018/19 7
challenges that could impact on full delivery in a number of areas and a material risk
has been identified in relation to Target 1.12.
Objective/Goal 1.12: By September 2018, to have advanced the implementation of
revised substitute prescribing services in Northern Ireland, including further
exploration of models which are not based in secondary care, to reduce waiting
times and improve access. This is an important element in the delivery of the strategy
to reduce alcohol and drug related harm and to reduce drug related deaths.
Additional resources will be required in order to implement revised substitute
prescribing.
A detailed response to each objective/goal is provided in Section 3.1.2.
ii)
To improve the quality and experience of care
The Western Trust continually strives to provide a safe environment for the people
who use our services and ensure that they are protected from harm. For a number
of years we have had a robust quality improvement programme and during 2018/19
our focus will be on developing and strengthening this through continued
implementation of regional quality improvement plans (QIPs) in falls, pressure ulcers,
venous thrombosis embolism, national early warning scores and sepsis as well as
progressing projects as part of the Flow Academy initiative and taking forward a
range of local quality improvement initiatives. We will also continue to take forward
implementation of the Quality 2020 strategy including learning from incidents and
ensuring that this is shared so that practice can be continually improved.
We also remain committed to improving patient experience and to ensuring that
service user, carer and public involvement are embedded in our service planning
and quality improvement initiatives as we take forward development of our Personal
and Public Involvement (PPI) Plan 2018-2021.
The Western Trust is committed to achieving the outcomes/goals for improvement
associated with this strategic aim. However a material risk has been identified to the
achievement of the following:
WHSCT TRUST DELIVERY PLAN 2018/19 8
Objective/Goal 4.4: By March 2019, 95% of patients attending any type of 1, 2
or 3 emergency department are either treated and discharged home, or
admitted, within four hours of their arrival in the department; and no patient
attending any emergency department should wait longer than 12 hours.
A programme of reform and service improvement is underway and a performance
improvement trajectory has been developed, however this target will not be met in
2018/19.
Objective/Goal 4.10: By March 2019, 50% of patients should be waiting no
longer than 9 weeks for an outpatient appointment and no patient waits longer
than 52 weeks.
The Trust has capacity gaps across a range of specialties which means that this
target cannot be met without significant additional waiting list funding.
Objective/Goal 4.12: By March 2018, 55% of patients should wait no longer
than 13 weeks for inpatient/day case treatment and no patient waits longer
than 52 weeks.
The Trust has capacity gaps across a range of specialties which means that the
ministerial target cannot be met without significant additional waiting list funding.
Objective/Goal 4.13: By March 2018, no patient waits longer than 9 weeks to
access child and adolescent mental health services; 9 weeks to access adult
mental health services; 9 weeks to access dementia services and 13 weeks to
access psychological therapies (any age).
Staffing issues, particularly in relation to availability of psychology staff, are
impacting on the ability to achieve access targets in relation to adult mental health,
dementia and psychological therapies.
Objective/Goal 5.3: By March 2019, no patient should wait longer than 13
weeks from referral to commencement of treatment by an allied health
professional.
The Trust expects to achieve the 13 target across all areas except occupational
therapy where there will continue to be a backlog despite the additional waiting list
activity in 2018/19.
WHSCT TRUST DELIVERY PLAN 2018/19 9
A detailed response to each objective/goal is provided at Section 3.1.2.
iii) Ensure the sustainability of the services delivered
The Trust endeavours to maximise delivery of its core funded services despite
challenges experienced due to workforce availability. Performance improvement
trajectories have been developed for 2018/19 in relation to core outpatient, inpatient
and day case activity which aim to achieve an improvement on level of core activity
delivered in 2017/18. However, sustaining the planned level of activity and
protecting it during surges in unscheduled activity, particularly in the winter period,
remains a challenge. The Trust also has a well-established Quality Improvement
Cost Reduction (QICR) Plan setting out plans to maximise productivity and deliver
efficiencies which will continue to implemented during 2018/19.
The Trust is committed to achieving the objectives/goals for improvement under this
strategic goal, however a material risk to the full or substantial achievement of the
following objectives has been identified:
Objective/Goal 7.4: By March 2019, to reduce the percentage of funded
activity associated with elective care service that remains undelivered.
The Trust’s ability to fully deliver core activity is affected by the ability to recruit and
establish stable clinical teams in certain specialties, constraints in respect of
backfilling vacancies and cover for sickness absence and maternity leave and the
impact of increases in unscheduled demand on elective work.
Objective/Goal 7.5: By March 2019, ensure that 90% of complex discharges
from an acute hospital take place within 48 hours, with no complex discharge
taking more than seven days; and all non-complex discharges from an acute
hospital take place within six hours.
The Trust has faced significant challenges to deliver on this target. An improved
performance was achieved in 2017/18 and a performance improvement trajectory
has been developed for 2018/19 which is aiming to improve further on this.
However, in-year this target will not be met.
WHSCT TRUST DELIVERY PLAN 2018/19 10
Objective/Goal 7.6: By March 2019, to have obtained savings of at least £90m
through the 2016-19 Regional Medicines Optimisation Efficiency Programme,
separate from PPRS receipts.
This is a combined primary and secondary care target and the work is being
managed through the Medicines Optimisation Regional Efficiency Programme. This
will be challenging to achieve and will require further clinician engagement
particularly in primary care.
A detailed response to each objective/goal is provided in Section 3.1.2.
iv) Support and empower staff delivering health and social care services
The Western Trust recognises and values the contribution of its workforce to the
provision of high quality, safe and effective services and is committed to taking
forward strategies to make the Trust a great place to work. An Investing in Your
Health group has been in place for a number of years and in 2018/19 the work of this
group will be extended. The Trust will also participate in regional work to implement
the regional Workforce Strategy. We are keen to listen to our staff and hear their
views on what will improve their working environment. We have taken on board the
findings of the 2015 Staff Survey and are taking steps to implement improvements.
The Trust has identified four overarching strategic themes which will underpin
everything we do, one of which is to make the Trust a Great Place to Work.
We are also committed to having a trained workforce that is fully equipped to deliver
high quality services. We are also keen to support staff to develop enhanced roles,
eg consultant breast radiographer, enhance AHP roles, eg first contact
physiotherapy in primary care, further training of nurse endoscopists, enhanced
pharmacy roles, etc
The Trust is committed to achieving the outcomes/goals for improvement identified
under this strategic aim. No material risks have been identified. A detailed
response to each objective/goal is provided in Section 3.1.2
WHSCT TRUST DELIVERY PLAN 2018/19 11
Section 3.1 Trust Response to DOH Commissioning Plan Direction
Summary of Assessment of Achievability
Rag Status Index
Target is achievable and affordable – GREEN STATUS
G
Target is near achievement or will be achieved in year – AMBER
A
STATUS
R
Target is unlikely to be achieved / affordable - RED STATUS
Aim: To improve the health of the population
Outcome 1: Reduction of health inequalities
Rag
Rating
Associated Objectives / Goals for Improvement
Population Health
By March 2020, in line with the Department’s ten year “
Tobacco Control
G
1.1
Strategy”, to reduce the proportion of 11-16 year old children who smoke to 3%;
reduce the proportion of adults who smoke to 15%; and reduce the proportion of
pregnant women who smoke to 9%.
By March 2019 to have expanded the “
Weigh to a Healthy Pregnancy” to now
include women with a BMI over 38. This programme is one element of the
G
1.2
Departmental strategy “
A Fitter Future for All”, which aims by March 2020, to
reduce the level of obesity by 4 percentage points and overweight and obesity
by 3 percentage points for adults, and by 3 percentage points and 2 percentage
points for children.
By March 2019, through continued promotion of breastfeeding to increase in the
G
1.3
percentage of infants breastfed, (i) from birth, and (ii) at 6 months. This is an
important element in the delivery of the “
Breastfeeding Strategy” objectives for
achievement by March 2025.
By March 2019, establish a minimum of 2 “Healthy Places” demonstration
1.4
G
programmes working with General Practice and partners across community,
voluntary and statutory organisations.
By March 2019, to ensure appropriate representation and input to the
1.5
PHA/HSCB led Strategic Leadership Group in Primary Care to embed the Make
N/A
Every Contact Count approach.
WHSCT TRUST DELIVERY PLAN 2018/19 12
By March 2019, to establish a baseline of the number of teeth extracted in
G
1.6
children aged 3-5 years - as phase 1 of the work to improve the oral health of
young children in Northern Ireland over the next 3 years and seek a reduction in
extractions of 5%, against that baseline, by March 2021.
G
Supporting Children and Young People
By March 2019, to have further developed, and implemented the “
Healthier
1.7
G
Pregnancy” approach to improve maternal and child health and to seek a reduction
in the percentage of babies born at low birth weight for gestation.
By March 2019, ensure the full delivery of the universal child health promotion
programme for Northern Ireland, “
Healthy Child Healthy Future”. By that date:
1.8
The antenatal contact will be delivered to all first time mothers.
A
95% of two year old reviews must be delivered.
These activities include the delivery of core contacts by Health Visitors and
School Nurses which will enable and support children & young adults to become
successful, healthy adults through the promotion of health and wellbeing.
By March 2019, ensure the full regional roll out of Family Nurse Partnerships,
ensuring that all teenage mothers have equal access to the family nurse
G
1.9
partnership programme. The successful delivery of this objective will directly
contribute to PfG Outcome 14 “We give our children and young people the best
start in life”.
By March 2019:
G
a) the proportion of children in care for 12 months or longer with no placement
change is at least 85%; and
1.10
b) 90% of children, who are adopted from care, are adopted within a three year time
A
frame (from date of last admission). The aim is to secure earlier permanence for
looked after children and offer them greater stability while in care.
Improving Mental Health
By March 2019, to have further enhanced out of hours capacity to de-escalate
individuals presenting in social and emotional crisis, including implementation of
1.11 a “street triage” pilot and a “Crisis De-escalation Service” pilot. This work builds
G
on previous investments in community mental health crisis teams and is an
important element of the work to reduce the suicide rate by 10% by 2022 in line
with the draft “
Protect Life 2 Strategy”.
By September 2018, to have advanced the implementation of revised substitute
prescribing services in Northern Ireland, including further exploration of models
1.12 which are not based in secondary care, to reduce waiting times and improve
R
access. This is an important element in the delivery of the strategy to reduce
R
R
alcohol and drug related harm and to reduce drug related deaths.
WHSCT TRUST DELIVERY PLAN 2018/19 13
Supporting those with Long Term Conditions
By July 2018, to provide detailed plans (to include financial profiling) for the
1.13 regional implementation of the diabetes feet care pathway. Consolidation of
G
preparations for regional deployment of the care pathway will be an important
milestone in the delivery of the “
Diabetes Strategic Framework”.
Aim: To improve the quality and experience of health and social care.
Outcome 2: People using health and social care services are safe from
Rag
avoidable harm
Rating
Associated Objectives / Goals for Improvement
Safe in All Settings
By March 2019 all HSC Trusts should have fully implemented phases 2, 3 and 4
2.1
A
of
Delivering Care, to ensure safe and sustainable nurse staffing levels across
all emergency departments, health visiting and district nursing services.
By 31 March 2019:
Ensure that total antibiotic prescribing in primary care, measured in items per
STAR-PU, is reduced by a further 2%, as per the established recurring
A
annual targets, taking 2015/16 as the baseline figure; and
Taking 2017/18 as the baseline figures, secure in secondary care:
o
a reduction in total antibiotic use of 1%, measured in DDD per 1000
admissions;
o
a reduction in carbapenem use of 3%, measured in DDD per 1000
admissions;
o
a reduction in piperacillin-tazobactam use of 3%, measured in DDD per
2.2
1000 admissions, and
o
EITHER
that at least 55% of antibiotic consumption (as measured in DDD per
1000 admissions) should be antibiotics from the WHO Access
AWaRe* category,
OR
an increase of 3% in use of antibiotics from the WHO Access
AWaRe* category, as a proportion of all antibiotic use.
With the aim of reducing total antibiotic prescribing (DDD per 1000
population) by 10% by 31 March 2021.
Safe in Hospital Settings
By 31 March 2019 By 31 March 2019 secure an aggregate reduction of 11% of
2.3 Escherichia coli,
Klebsiella spp. and
Pseudomonas aeruginosa bloodstream
G
infections acquired after two days of hospital admission, compared to 2017/18.
In the year to March 2019 the Public Health Agency and the Trusts should secure
2.4
a reduction of 7.5% in the total number of in-patient episodes of
Clostridium
G
difficile infection in patients aged 2 years and over, and in-patient episodes of
WHSCT TRUST DELIVERY PLAN 2018/19 14
Methicillin-resistant
Staphylococcus aureus (MRSA) bloodstream infection
compared to 2017/18.
Throughout 2018/19 the clinical condition of all patients must be regularly and
2.5
G
appropriately monitored in line with the NEWS KPI audit guidance, and timely
action taken to respond to any signs of deterioration.
2.6 By March 2019, review and regionally agree standardised operational definitions
G
and reporting schedules for falls and pressure ulcers.
By March 2019, all Trusts must demonstrate 70% compliance with the regional
Medicines Optimisation Model against the baseline established at March 2016
A
2.7
and the HSC Board must have established baseline compliance for community
pharmacy and general practice. Reports to be provided every six months through
the Medicines Optimisation Steering Group.
Safe in Community Settings
During 2018/19 the HSC, through the application of care standards, should
continue to seek improvements in the delivery of residential and nursing care and
2.8
G
ensure a reduction in the number of (i) residential homes, (ii) nursing homes,
inspected that (a) receive a failure to comply, and (b) subsequently attract a notice
of decision, as published by RQIA.
Outcome 3: Improve the quality of the healthcare experience
Rag
Rating
Objectives / Goals for Improvement
By March 2019, all patients in adult inpatient areas should be cared for in same
3.1
G
gender accommodation, except in cases when that would not be appropriate for
reasons of clinical need including timely access to treatment.
During 2018/19 the HSC should ensure that care, permanence and pathway plans
3.2
G
for children and young people in or leaving care (where appropriate) take account
of the views, wishes and feelings of children and young people.
3.3 By March 2019, patients in all Trusts should have access to the Dementia portal.
G
By March 2019, to have arrangements in place to identify individuals with
3.4 palliative and end of life care needs, both in acute and primary settings, which will
G
then support people to be cared for in their preferred place of care and in the
manner best suited to meet their needs.
By March 2019 the HSC should ensure that the Co-production model is adopted
3.5
when designing and delivering transformational change. This will include
A
integrating PPI, co-production, patient experience into a single organisational
plan.
WHSCT TRUST DELIVERY PLAN 2018/19 15
Outcome 4: Health and social care services are centred on helping to
Rag
maintain or improve the quality of life of people who use them
Rating
Objectives / Goals for Improvement
Primary Care Setting
4.1
By March 2019, to increase the number of available appointments in GP N/A
practices compared to 2017/18
4.2
By March 2019, to have 95% of acute/ urgent calls to GP OOH triaged within 20 N/A
minutes.
4.3
From April 2018, 72.5% of Category A (life threatening) calls responded to within N/A
8 minutes, 67.5% in each LCG area.
Health Care Setting – Acute Care
By March 2019, 95% of patients attending any type 1, 2 or 3 emergency
4.4
department are either treated and discharged home, or admitted, within four
R
hours of their arrival in the department; and no patient attending any emergency
department should wait longer than 12 hours.
4.5
By March 2019, at least 80% of patients to have commenced treatment,
G
following triage, within 2 hours.
4.6
By March 2019, 95% of patients, where clinically appropriate, wait no longer
A
than 48 hours for inpatient treatment for hip fractures.
4.7
By March 2019, ensure that at least 15% of patients with confirmed ischaemic
G
stroke receive thrombolysis treatment, where clinically appropriate.
4.8
By March 2019, all urgent diagnostic tests should be reported on within two days
A
During 2018/19:
A
All urgent suspected breast cancer referrals should be seen within 14 days;
At least 98% of patients diagnosed with cancer should receive their first
4.9
G
definitive treatment within 31 days of a decision to treat;
And at least 95% of patients urgently referred with a suspected cancer
should begin their first definitive treatment within 62 days.
A
Hospital Care Setting – Elective Care
4.10 By March 2019, 50% of patients should be waiting no longer than 9 weeks for an
R
outpatient appointment and no patient waits longer than 52 weeks.
WHSCT TRUST DELIVERY PLAN 2018/19 16
By March 2019, 75% of patients should wait no longer than 9 weeks for a
4.11
A
diagnostic test and no patient waits longer than 26 weeks.
4.12 By March 2019, 55% of patients should wait no longer than 13 weeks for
R
inpatient/daycase treatment and no patient waits longer than 52 weeks.
G
By March 2019, no patient waits longer than:
9 weeks to access child and adolescent mental health services
R
4.13
9 weeks to access adult mental health services
9 weeks to access dementia services
A
13 weeks to access psychological therapies (any age) (Adult MH & LD /
Children)
R
Outcome 5: People, including those with disabilities, long term conditions, Rag
or who are frail, receive the care that matters to them
Rating
Objectives / Goals for Improvement
Increased Choice
5.1
By March 2019, secure a 10% increase in the number of direct payments to all
G
service users.
5.2
By March 2019, all service users and carers will be assessed or reassessed at
G
review under the Self Directed Support approach, and will be offered the choice
to access direct payments, a managed budget, Trust arranged services, or a mix
of those options, to meet any eligible needs identified.
Access to Services
5.3
By March 2019, no patient should wait longer than 13 weeks from referral to
R
commencement of treatment by an allied health professional.
5.4
By March 2019, have developed baseline definition data to ensure patients have
G
timely access to a full swallow assessment.
5.5
By March 2019, Direct Access Physiotherapy service will be rolled out across all
A
Health and Social Care Trusts.
5.6
By May 2018, to have delivered the Children & Young People's Developmental
A
& Emotional Wellbeing Framework along with a costed implementation plan
Care in Acute Settings
WHSCT TRUST DELIVERY PLAN 2018/19 17
During 2018/19, ensure that 99% of all learning disability and mental health
5.7
discharges take place within seven days of the patient being assessed as
A
medically fit for discharge with no discharge taking more than 28 days.
Outcome 6: Supporting those who care for others
Rag
Rating
Objectives / Goals for Improvement
By March 2019, secure a 10% increase (based on 2017/18 figures) in the
6.1
G
number of carers’ assessments offered to carers for all service users.
By March 2018, secure a 5% increase (based on 2017/18 figures) in the number
A
6.2
of community based short break hours (ie non-residential respite) received by
adults across all programmes of care.
By March 2019, to create a baseline for the number of young carers receiving
G
6.3
short breaks (ie non-residential respite).
Aim: Ensure the sustainability of health and social care services provided
Outcome 7: Ensure the sustainability of health and social care services
Rag
Rating
Objectives / Goals for Improvement
Primary and Community Setting
By March 2019, to have commenced implementation of new contractual
7.1
N/A
arrangements for community pharmacy services.
By March 2019 to establish an outcomes reporting framework for Delegated
7.2
Statutory Functions (DSF) that will demonstrate the impact and outcome of
G
services on the social wellbeing of service users and the baseline activity to
measure this.
Hospital Setting
By March 2019, to establish a baseline of the number of hospital cancelled,
7.3
consultant led, outpatient appointments in the acute programme of care which
G
resulted in the patient waiting longer for their appointment and by March 2020
seek a reduction of 5%.
7.4
By March 2019, to reduce the percentage of funded activity associated with
R
elective care service that remains undelivered.
WHSCT TRUST DELIVERY PLAN 2018/19 18
By March 2019, ensure that 90% of complex discharges from an acute hospital
take place within 48 hours, with no complex discharge taking more than seven
7.5
R
days; and all non-complex discharges from an acute hospital take place within
six hours.
By March 2019, to have obtained savings of at least £90m through the 2016-19
7.6
R
Regional Medicines Optimisation Efficiency Programme, separate from PPRS
receipts.
Aim: Support and empower staff delivering health and social care services
Outcome 8: Supporting the HSC Workforce
Rag
Rating
Objectives / Goals for Improvement
Implementing the Workforce Strategy
8.1
By June 2018, to provide appropriate representation on the programme board
G
overseeing the implementation of the health and social care Workforce Strategy.
Attracting, Recruiting and Retaining Staff
By June 2018, to provide appropriate representation on the project board to
8.2
G
establish a health and social care careers service
Effective Workforce Planning
8.3
By March 2019, to have completed the first phase of the implementation of the
G
domiciliary care workforce review.
8.4
By June 2018, to provide appropriate representation to the project to produce a
G
health and social care workforce model.
Build on, Consolidate and Promote Workforce Health and Wellbeing and
Staff Engagement
By March 2019, to provide appropriate representation and input to audits of
8.5
G
existing provision across the HSC, in line with actions 10 – 14 of the Workforce
Strategy.
Improving Business Intelligence
By December 2018, to provide the information required to facilitate the proactive
8.6
A
use of business intelligence information and provide appropriate personnel to
assist with the analysis.
Supporting Our Staff
8.7
By December 2018, to ensure at least 40% of Trust staff (healthcare and social
A
care staff) have received the seasonal flu vaccine.
WHSCT TRUST DELIVERY PLAN 2018/19 19
8.8
By March 2019, to reduce Trust staff sick absence levels by a regional average
A
of 5% compared to 2017/18 figure.
By March 2019, to have an agreed and systematic action plan to create a
8.9
healthier workplace across HSC and to have contributed to the Regional
G
Healthier Workplace Network as part of commitments under PfG.
8.10
By March 2019 to pilot an OBA approach to strengthen supports for the social
G
work workforce
Investing in our Staff
By March 2019, 50% of the HSC workforce should have achieved training at
8.11
A
level 1 in the Q2020 Attributes Framework and 5% to have achieved training at
level 2 by March 2020.
By March 2019, to have developed and commenced implementation of a training
8.12
plan on suicide awareness and suicide intervention for all HSC staff with a view
G
to achieving 50% staff trained (concentrating initially on frontline staff) by 2022 in
line with the draft Protect Life 2 strategy.
8.13
By March 2019, Dysphagia awareness training designed by speech and
G
language therapy to be available to Trust staff in all Trusts.
WHSCT TRUST DELIVERY PLAN 2018/19 20
Total
Detailed Delivery Plans
R
A
G
Aim: To improve the health of the population
9
18
36
Outcome 1: Reduction of health inequalities
COMMISSIONING PLAN DIRECTION OUTCOME
PROVIDER RESPONSE
RAG
1.1 By March 2020, in line with the Department’s ten year The PHA has overall responsibility for reporting on this target. The
“
Tobacco Control Strategy”, to reduce the proportion
Trust will contribute to achievement of the target through a range of
G
of 11-16 year old children who smoke to 3%; reduce
initiatives as outlined below:
the proportion of adults who smoke to 15%; and
reduce the proportion of pregnant women who smoke
Smoking cessation support will continue to be provided to
to 9%.
motivated quitters across the Western Trust with particular
emphasis on meeting/exceeding the KPIs for identified priority
groups.
Delivery of regionally consistent Brief Intervention Training to
identified areas, including GP practice nurses, hospital
specialist nurses in heart and respiratory disease, diabetes and
cancer, staff working with looked after children and midwives
A nurse addresses smoking cessation and other health related
issues for the looked after children (LAC) population. This
includes completion of a health assessment on each child that
is admitted to residential Care, including screening in relation to
smoking and offering advice, education and support as
necessary based on the assessment. This nurse also acts in
an advisory capacity to social workers in residential care.
Smoking is also discussed at LAC Medicals.
WHSCT TRUST DELIVERY PLAN 2018/19 21
Delivery of weekly community outreach smoking cessation
clinics in 5 locations throughout the WHSCT area facilitated by
Nurse Prescribers.
Pregnant women are referred to the smoking cessation advisor
from booking clinics when midwives become aware that they
smoke. All pregnant smokers referred will received smoking
cessation information and signposted to Drop-In Clinics /
Pharmacies. They will also have carbon monoxide testing
carried out by the midwife and will be referred to smoking
cessation as appropriate. The NIMATS system automatically
refers all women to smoke to the Smoking Cessation service.
WHSCT will revamp its Smoke Free – No Vaping Policy in 18-
19. Staff and managerial roles are more clearly defined with
responsibility for implementation of the policy. Additional staff
support through development and promotion of staff training
videos made available.
Development and delivery of Brief Intervention training
programmes to all WHSCT staff will be strengthened during
2018/19.
Health Visitors will receive training on smoking cessation with a
particular emphasis on pregnant women and support them in
stopping, especially during antenatal visits.
1.2 By March 2019 to have expanded the “
Weigh to a
Women with a BMI over 38 from April 2018 have been included in
G
Healthy Pregnancy” to now include women with a BMI the programme since April 2018.
over 38. This programme is one element of the
Departmental strategy “
A Fitter Future for All”, which
aims by March 2020, to reduce the level of obesity by
WHSCT TRUST DELIVERY PLAN 2018/19 22
4 percentage points and overweight and obesity by 3
percentage points for adults, and by 3 percentage
points and 2 percentage points for children.
1.3 By March 2019, through continued promotion of
The PHA has overall responsibility for reporting on this target. The
G
breastfeeding to increase the percentage of infants
Trust will contribute to achievement of the target through a range of
breastfed, (i) from birth, and (ii) at 6 months. This is
initiatives as outlined below:
an important element in the delivery of the
“
Breastfeeding Strategy” objectives for achievement
A 3 year action plan has been devised in response to a scoping
by March 2025.
exercise of breast feeding services. This also involves setting
up of a Task and Finish Group to develop a joined up approach
to the delivery of peer support to antenatal and breast feeding
mothers in the hospital and community setting.
A 6 month pilot commenced in June 2018 to measure the
impact of having a healthcare assistant from the health visiting
team providing additional support to breastfeeding mothers as
soon as possible after discharge from hospital.
Continued provision of peer support link workers in both
Altnagelvin and South West Acute Hospitals. This has been
funded non-recurrently through the PHA for a number of years
and has been made recurrent from April 2018. The recurrent
funding also enables an increase in the number of hours
provided. In support of this, two update events for 50 peer
support volunteers will be co-ordinated and a Level 3 OCN peer
support training programme will be delivered.
A part time Neonatal Breastfeeding Co-ordinator is now in post
at Altnagelvin Hospital.
The Trust contributed to the development of a funding bid
WHSCT TRUST DELIVERY PLAN 2018/19 23
through the PHA for additional resource for a breastfeeding lead
for the community, primarily for the Limavady, Derry and
Strabane areas.
World breastfeeding awareness week will be widely promoted
throughout the WHSCT
Using the map on
www.breastfedbabies.org to identify areas
with low uptake of the Welcome Here Scheme, work will be
undertaken to promote the scheme as appropriate across the
WHSCT & Council areas.
1.4 By March 2019, establish a minimum of 2 “Healthy
This target relates to the Local Government Community Plans.
Places” demonstration programmes working with
G
The Trust will ensure representation and support to contribute to
General Practice and partners across community,
achievement of this target as require.
voluntary and statutory organisations.
1.5 By March 2019, to ensure appropriate representation
This target relates to primary care but the Trust will ensure
and input to the PHA/HSCB led Strategic Leadership
representation and input as required.
N/A
Group in Primary Care to embed the Make Every
Contact Count approach.
1.6 By March 2019, to establish a baseline of the number Since April 2018, the Trust has been collecting data on the number
of teeth extracted in children aged 3-5 years - as
of children seen aged 3 to 5 years and the number of teeth
G
phase 1 of the work to improve the oral health of
extracted for this age group and therefore will be able to provide
young children in Northern Ireland over the next 3
baseline data for 2018/19 at the end of March 2019. Once the
years and seek a reduction in extractions of 5%,
baseline is established, an assessment will be made on the
against that baseline, by March 2021.
achievability of a 5% reduction in extractions in this age group by
March 2021.
1.7 By March 2019, to have further developed, and
The Getting Ready for Baby programme has been rolled out Trust-
implemented the “
Healthier Pregnancy” approach to
wide from September 2017. This incorporates the Solihull
G
improve maternal and child health and to seek a
approach to delivering messages to prepare both women and their
WHSCT TRUST DELIVERY PLAN 2018/19 24
reduction in the percentage of babies born at low birth partners for birth and transition to parenthood.
weight for gestation.
Saving Babies Lives has been implemented since January 2017
which involves provision of serial scanning from 28 weeks for
women identified with risk factors. This will improve detection rates
of small for gestation age (SGA) and Intrauterine Growth Restricted
babies (IUGR).
1.8 By March 2019, ensure the full delivery of the
The Trust has recently successfully recruited twelve health visitor
universal child health promotion programme for
posts, however there remains a 4.36 WTE shortfall to fully meet
A
Northern Ireland, “
Healthy Child Healthy Future”. By
normative staffing levels in health visiting which will not be able to
that date:
be addressed until September 2019 when nine student Health
The antenatal contact will be delivered to all first Visitors qualify. Therefore, full delivery of the universal child
time mothers.
health promotion programme will be a challenge in 2018/19. The
95% of two year old reviews must be delivered. delivery of the antenatal contact to first time and vulnerable
These activities include the delivery of core contacts
mothers however will be prioritised and will be achievable
by Health Visitors and School Nurses which will
throughout the Trust.
enable and support children & young adults to
become successful, healthy adults through the
promotion of health and wellbeing.
1.9 By March 2019, ensure the full regional roll out of
Family Nurse Partnership has now been rolled out across the
Family Nurse Partnerships, ensuring that all teenage
Derry, Limavady and Strabane areas of the Trust and there are
G
mothers have equal access to the family nurse
plans to incrementally roll this out Trust wide.
partnership programme. The successful delivery of
this objective will directly contribute to PfG Outcome
14 “We give our children and young people the best
start in life”.
WHSCT TRUST DELIVERY PLAN 2018/19 25
1.10 By March 2019:
a) In 2017/18, the Trust achieved 86% against this target and
a) the proportion of children in care for 12 months or
expects to continue to achieve it in 2018/19 subject to numbers of
G
longer with no placement change is at least 85%; and looked after children remaining stable. The following measures will
b) 90% of children, who are adopted from care, are
continue to be implemented in support of this target:
adopted within a three year time frame (from date of
Continue to ensure effective matching to reduce placement
last admission). The aim is to secure earlier
breakdown.
permanence for looked after children and offer them
Continue to focus on foster placements at risk of break down
greater stability while in care.
via the Placement Under Pressure Panel chaired by the
Assistant Director of Corporate Parenting.
Via the Trust’s Kinship Fostercare Team, there will be
continued focus on increasing the number of assessments for
approval for kinship carers as placement with kinship carers
will further enhance placement stability and prevent
placement breakdowns.
b) In 2017/18, 74% of children were adopted within the 3 year
A
time-frame and the Trust expects to this in year 18/19
1.11 By March 2019, to have further enhanced out of
CRHT is well established across the entire Trust providing 24/7
hours capacity to de-escalate individuals presenting
Crisis Response to Out of Hours and the ED departments of the
G
in social and emotional crisis, including
Acute Hospitals. The Trust has also been instrumental in advising
implementation of a “street triage” pilot and a “Crisis
supporting and part funding the development of a pilot community
De-escalation Service” pilot. This work builds on
project for individuals who find themselves in emotional or social
previous investments in community mental health
crisis providing de-escalation intervention and engagement. In
crisis teams and is an important element of the work
addition, Rathview House will come on stream in Autumn 2018
to reduce the suicide rate by 10% by 2022 in line with providing a step up step down alternative to hospital. This will
the draft “
Protect Life 2 Strategy”.
support individuals in social and emotional crisis, building on
previous investments in Community Mental Health Crisis Services.
WHSCT TRUST DELIVERY PLAN 2018/19 26
1.12 By September 2018, to have advanced the
Within the Western Trust caseload sizes and waiting times remain
R
implementation of revised substitute prescribing
an issue for the substitute prescribing service.
services in Northern Ireland, including further
exploration of models which are not based in
Additional prescribing and therapist resource is required to address
secondary care, to reduce waiting times and improve
the substitute prescribing demand in the Western Trust. The Trust
access. This is an important element in the delivery of has explored the potential for a shared care model with GP’s,
the strategy to reduce alcohol and drug related harm
however this does not appear to be a workable solution. In many
and to reduce drug related deaths.
practices there are very low numbers (if any) of substitute
prescribing patients registered which presents challenges around
maintaining the required skill levels. In addition, in order to ensure
appropriate cover arrangements, at least two GPs in each practice
would need to be able to support the model which presents a
further challenge. The option of an increase in medical and
substitute prescribing nurse time (particularly the option of nurse
prescribing) needs to be explored if this target is to be achieved.
1.13 By July 2018, to provide detailed plans (to include Work has been undertaken to redesign podiatry services to include
financial profiling) for the regional implementation of risk stratified, including high risk and active clinics and improved
G
the diabetes feet care pathway. Consolidation of MDT links in diabetes team. Regional links within podiatry services
preparations for regional deployment of the care have been clarified for appropriate onward referrals and follow up
pathway will be an important milestone in the delivery of high risk patients. Recent clarification of low risk foot screening
of the “
Diabetes Strategic Framework”.
plans have been agreed regionally and review of practice lists is
ongoing.
Recurrent funding has been confirmed in relation to the ICP
Diabetes Foot project and non-recurrent transformation funding
has been identified to support implementation of the foot protection
aspects of the integrated pathway.
WHSCT TRUST DELIVERY PLAN 2018/19 27
Aim: To improve the quality and experience of health and social care
Outcome 2: People using health and social care services are safe from avoidable harm
COMMISSIONING PLAN DIRECTION OUTCOME
PROVIDER RESPONSE
RAG
2.1 By March 2019 all HSC Trusts should have fully While this target relates to Phases 2, 3 and 4, the Trust notes that
implemented phases 2, 3 and 4 of
Delivering Care, to full implementation of Phase 1 – Medical and Surgical Wards
A
ensure safe and sustainable nurse staffing levels continues to be challenging due to the supply of registered nurses.
across all emergency departments, health visiting and However, the Trust is continuing to take forward its action plan to
district nursing services.
address this.
Phase 2 – Emergency Departments
The planned staffing level for the Altnagelvin Emergency
Department (ED) agreed through Phase 2 of Delivering Care is
76.00wte, which was calculated using 2016 ED attendance figures.
The Trust’s Corporate Management Team has agreed to increase
the nurse staffing level from the original funded level of 56.70wte to
63.91wte in line with the Phase 2 model to provide clinical
leadership and contribute to the stabilisation of the Department
The staffing level within the SWAH is in keeping with the nurse
staffing model agreed under Phase 2 Delivering Care. The
unregistered component of the team, recruitment of Band 3 Health
Care Assistants has commenced, additional staff have been
recruited and are currently completing their training.
WHSCT TRUST DELIVERY PLAN 2018/19 28
Phase 3 – Community Nursing
The nursing workforce to implement Phase 3 has been calculated
as 270.00wte – a deficit of 71.31wte staff. The Trust is developing
an implementation plan to help prioritise where to target any
investment. The most significant challenges to achieving this
objective will be the availability of funding and the supply of
registered nurses. A proposal for transformation funding has been
developed. In addition five district nurse training places were
commissioned in September 2017and four were commissioned for
September 2018.
Phase 4 –Health Visiting
The Trust has received the Delivering Care Phase 4 Model,
approved by the Chief Nursing Officer and an implementation plan
is being developed. The most significant challenges to achieving
this objective will be the availability of funding to educate additional
Health Visitors and the supply of registered nurses to provide the
backfill. A proposal for transformation funding has been
developed.
The final calculation of the gap in health visiting staffing is not yet
available. The Trust commissioned 7 Health Visitor training places
in September 2017 and proposes to commission 11 in September
2018.
2.2 By 31 March 2019:
The first element of this target is not applicable to the Trust.
Ensure that total antibiotic prescribing in primary
A
care, measured in items per STAR-PU, is reduced
Reduction in total antibiotic use in secondary care:
WHSCT TRUST DELIVERY PLAN 2018/19 29
by 2% from the 2017/18 level of prescribing and:
1% reduction – achievable
Taking 2017/18 as the baseline figures, secure in
3% carbapenems – achievable
secondary care:
3% piperacillin- tazobactam – achievable if ARK study is
o a reduction in total antibiotic use of 1%,
implemented and rolled out
measured in DDD per 1000 admissions;
o a reduction in carbapenem use of 3%,
Either 55% of antibiotic consumption should be from the
measured in DDD per 1000 admissions;
WHO Access AWaRe category or an increase of 3% in use
o a reduction in piperacillin-tazobactam use of
of antiobiotics from the WHO Access AWaRe category –
3%, measured in DDD per 1000 admissions,
the PHA are helping Trusts regionally to determine which
and
target to aim for. At this point, achievability is uncertain as
o EITHER
baseline measures are not available.
that at least 55% of antibiotic consumption
(as measured in DDD per 1000 admissions)
The Trust notes that the measures are DDD per 1000 admissions –
should be antibiotics from the WHO Access
a rate not fully under Trust control with respect to volume of
AWaRe* category,
OR
admissions.
an increase of 3% in use of antibiotics from
the WHO Access AWaRe* category, as a
Reduction in total antibiotic prescribing by 10% by 31 March
proportion of all antibiotic use.
2021 - most of antibiotic prescribing (85%) is in primary care.
Therefore a specific focus is needed there.
With the aim of reducing total antibiotic prescribing
(DDD per 1000 population) by 10% by 31 March
2021.
*For the purposes of the WHO Access AWaRe targets, TB
drugs are excluded.
Reducing Gram-negative bloodstream infections
The regional aggregate reduction of 11% has been set and the
Trust’s reduction target is still awaited. A meeting has been
G
2.3 By 31 March 2019, secure an aggregate reduction of arranged with the PHA for 27th September 2018 to discuss the
11% of
Escherichia coli,
Klebsiella spp. and reduction target setting. The Trust is unable to provide an
WHSCT TRUST DELIVERY PLAN 2018/19 30
Pseudomonas aeruginosa bloodstream infections assessment of achievability until individual Trust targets are set.
acquired after two days of hospital admission, Enhanced surveillance has commenced for 25% of identified gram
compared to 2017/18.
negative surveillance and further analysis is required to identify
additional risk factors for those acquired two days after admission.
MRSA
2.4 In the year to March 2019 the Public Health Agency The Trust achieved the 2017/18 target with a 20% reduction in the
and the Trusts should secure a reduction of 7.5% in
G
number of episodes compared to 2016/17, which equated to four
the total number of in-patient episodes of
Clostridium episodes, all of which are categorised as community acquired
difficile infection in patients aged 2 years and over, which the Trust has limited scope to reduce. The regional
and in-patient episodes of Methicillin-resistant aggregate reduction has been set and the Trust awaits the
Staphylococcus
aureus
(MRSA)
bloodstream individual Trust reduction target. However, it is noted that it will be
infection compared to 2017/18.
difficult to achieve any further reduction in relation to MRSA given
the low numbers and limit scope the Trust has to reduce
community acquired infections.
Clostridium difficile
The challenging target reduction was not met for 2017-2018.
The Trust identified 64 cases of Clostridium difficile, 20 more than
the target of 44. This was an increase of 14% compared to the
previous year’s performance (56 cases). 28 of the 64 cases were
community-associated. The Trust has a number of initiatives in
place to try to reduce the incidence of Clostridium difficile infection
but the Trust’s ability to affect change regarding community
associated is limited and requires a regional approach.
The current numbers of episodes for 18/19 has reduced by 40%
WHSCT TRUST DELIVERY PLAN 2018/19 31
compared to same time period 17/18.
While the aggregate target has been identified, the Trust is unable
to assess achievability of this target until individual Trust reduction
targets have been agreed.
2.5 Throughout 2018/19 the clinical condition of all The Trust can confirm that clinical condition of all patients is
G
patients must be regularly and appropriately regularly and appropriately monitored against the NEWS KPI audit
monitored in line with the NEWS KPI audit guidance, guidance. If any area reports a low score from an audit, an
and timely action taken to respond to any signs of improvement plan is implemented to address and a validation audit
deterioration.
is completed to confirm improvement.
2.6 By March 2019, review and regionally agree The Trust is participating in regional work with the Public Health
G
standardised operational definitions and reporting Agency and the other Trusts to agree the revised definitions and
schedules for falls and pressure ulcers
reporting schedule.
2.7 By March 2019, all Trusts must demonstrate 70% Achievable if the measures become more objective and with some
A
compliance with the regional Medicines Optimisation more regional targeted work e.g. on patient-centred decision
Model against the baseline established at March 2016 making. This is a new document and the measures are a work in
and the HSC Board must have established baseline progress. The Trust has self-assessed to be 53% compliant at 70%
compliance for community pharmacy and general (substantive level) and 88% at moderate to substantive level in
practice. Reports to be provided every six months 2017/18. Challenging to improve further without specific projects
through the Medicines Optimisation Steering Group.
including 7 day working in pharmacy to improve medicines
reconciliation on admission, through the stay and on discharge.
2.8 During 2018/19 the HSC, through the application of In 2017/18, four failure to comply notices were issued. During
care
standards,
should
continue
to
seek 2018/19, the Trust The Trust will continue to work in partnership
G
improvements in the delivery of residential and with the registered providers to make every effort to reduce the
WHSCT TRUST DELIVERY PLAN 2018/19 32
nursing care and ensure a reduction in the number of number of failure to comply notices and ensure that a notice of
(i) residential homes, (ii) nursing homes, inspected decision is not taken. Actions that will be taken forward include:
that (a) receive a failure to comply, and (b) Continue to hold regular contract review meetings with providers
subsequently attract a notice of decision, as
and proactively engage with them to address any issues that
published by RQIA.
may arise to ensure the best outcomes for Trust clients.
Engage in shared learning events with providers subsequent to
safeguarding findings to improve practices across the area.
Undertake client review meetings on a regular basis.
Continue to review Trust services from a maintenance and
improvement perspective.
Monthly regulation visits are carried out by the registered
provider. During these visits, the registered provider must be
satisfied that the standards are being met.
Regular monitoring by Trust managers for regulated facilities in
residential provision. Where there are concerns, Trust staff
increase monitoring of Trust services and/or enhance
monitoring within external provision to assess and identify risk
and assist with areas for improvement.
WHSCT TRUST DELIVERY PLAN 2018/19 33
Outcome 3: Improve the quality of the healthcare experience
COMMISSIONING PLAN DIRECTION OUTCOME
PROVIDER RESPONSE
RAG
3.1 By March 2019, all patients in adult inpatient areas There are no issues with meeting this target in the South West
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should be cared for in same gender accommodation, Acute Hospital which has 100% single rooms. The Trust strives to
except in cases when that would not be appropriate ensure same gender accommodation at Altnagelvin Hospital where
for reasons of clinical need including timely access to there is a mix of single rooms and multiple bedded bays, however
treatment.
exceptions to this would be very rare occurrence. The level of
single room provision will increase on completion of the north wing
extension currently under construction which is anticipated to be
complete in January /February 2019.
Quarterly returns are completed
only on an exception basis and
exceptions are reported through the Trust’s Nursing & Midwifery
Governance Meeting at this is a standing item.
3.2 During 2018/19 the HSC should ensure that care, Social workers are aware that for their individual cases they must
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permanence and pathway plans for children and take account the views of children/young people in care or leaving
young people in or leaving care (where appropriate) care to ascertain their feelings in relation to the development of the
take account of the views, wishes and feelings of care plan
children and young people.
3.3 By March 2019, patients in all Trusts should have The Trust continues to engage with the HSCB in the development
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access to the Dementia portal.
of the HSC patient portal for dementia patients. The Trust is
piloting the portal with dementia patients starting in September
2018.
WHSCT TRUST DELIVERY PLAN 2018/19 34
3.4 By March 2019, to have arrangements in place to During 2018/19, the Trust will continue to progress a range of core
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identify individuals with palliative and end of life care and transformational work plans to improve the earlier identification
needs, both in acute and primary settings, which will of those in the palliative phase of their illness to ensure timely
then support people to be cared for in their preferred intervention and support through the use of advance care plans by
place of care and in the manner best suited to meet staff trained as key workers with advanced communication skills
their needs.
supported by enhanced specialist palliative care teams.
3.5 By March 2019 the HSC should ensure that the Co- The WHSCT Patient and Public Involvement (PPI) Strategy 2018-
production model is adopted when designing and 2021 has identified the need to ensure effective communication
delivering transformational change. This will include and closer strategic working between the PPI and Patient/client
A
integrating PPI, co-production, patient experience into experience and states its commitment to the principles of co-design
a single organisational plan.
and co-production.
The Trust will take cognisance of the DoH Guidance on co-
production which is due to be launched at the end of August.
The PPI action plan 2018-2019 will set out the Trust’s
arrangements to provide advice and guidance to staff on
involvement of users, carers and patients in all proposals involving
change or withdrawal of service including transformational change.
The Trust continues to enage with users and carer through the
Western Trust Adult Learning Disability services. As part of this
work, a website has been developed to support service users and
carers access information in a timely and informative manner.
There are also plans to undertake a pathfinder project in the South
West Acute Hospital using a co-production approach.
WHSCT TRUST DELIVERY PLAN 2018/19 35
Outcome 4: Health and social care services are centred on helping to maintain or improve the quality of life of people who
use them
COMMISSIONING PLAN DIRECTION OUTCOME
PROVIDER RESPONSE
RAG
4.1 By March 2019, to increase the number of available
Not applicable to the Western Health and Social Care Trust.
N/A
appointments in GP practices compared to 2017/18
4.2 By March 2019, to have 95% of acute/ urgent calls to
Not applicable to the Western Health and Social Care Trust.
N/A
GP OOH triaged within 20 minutes.
4.3 From April 2018, 72.5% of Category A (life
Not applicable to the Western Health and Social Care Trust.
N/A
threatening) calls responded to within 8 minutes,
67.5% in each LCG area.
4.4 By March 2019, 95% of patients attending any type 1, While the Trust did not achieve this target in 2017/18, the agreed
2 or 3 emergency department are either treated and performance improvement trajectory in relation to the 4-hour target
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discharged home, or admitted, within four hours of was met despite an increase in attendances. A new performance
their arrival in the department; and no patient improvement trajectory for 2018/19 has been developed which
attending any emergency department should wait seeks further incremental improvement from 76% in 2017/18 to
longer than 12 hours.
78% in 2018/19.
The Emergency Department at Altnagelvin continues to experience
an increase in demand and a number of changes were introduced
to support the management of this. The focus for 2018/19 will be
WHSCT TRUST DELIVERY PLAN 2018/19 36
on consolidating these as follows:
1. Conversion of CDU to Ambulatory Care
Consolidating and growing this service is a Trust priority. This
service has a discharge rate in excess of 80% and also has
direct access to imaging and labs. A surgical assessment area
has also been re-established and posts to support the
cardiology pathway have been permanently recruited. These
services now co-exist as one “Front of House” assessment
service.
2. Stabilisation of nursing and medical workforce remains key to
the delivery of safe and effective care.
The South West Acute Hospital has also continued to experience a
continuing rise in presentations to its Emergency Department.
This, coupled with a reduction in nursing home availability in the
area, is compounding flow issues within the site and will impact on
the ability to achieve this target.
4.5 By March 2019, at least 80% of patients to have The Trust exceeded this target across all sites in 2017/18 and
commenced treatment, following triage, within 2
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expects to continue to meet this target in 2018/19.
hours.
4.6 By March 2019, 95% of patients, where clinically In 2017/18, 90% of all fractures and 91% of hip fractures were
appropriate, wait no longer than 48 hours for inpatient treated within 48 hours which was a very strong performance.
A
treatment for hip fractures.
The key issues impacting on the ability to achieve the target are:
WHSCT TRUST DELIVERY PLAN 2018/19 37
Overall demand and peaks in demand, eg paediatric patients in
summer;
The requirement for side-rooms;
The overall complexity of patients and procedures is a
challenge;
The current funded baseline is based on 2005/6 demand.
Actions that will be taken forward in 2018/19 include:
A Trauma Access Patient Pathway Group is in place which
reviews issues in relation to patient flow and ensures effective
multi-disciplinary team communication and utilisation of
resources;
Continued flexible working by orthopaedic surgeons to ensure
theatre capacity and throughput is maximised;
Clinical prioritisation of trauma – this has an impact on elective
and has meant extensive cancellation of elective inpatient and
day case sessions in order to meet the target and enable
access to trauma if there are peaks in demand. This will
become more likely without an increase in trauma capacity.
An IPT for two additional consultants for orthopaedic services
is currently being developed. As well as addressing surgical
capacity for elective orthopaedics the Trust proposes that 3
additional theatre sessions and 10 additional ward beds with
associated resources will be developed to meet demand.
Recruitment of nursing staff is a major risk for this
development. Analysis of a further rise in trauma demand is
being carried out as there are concerns that even when this is
put in place demand will still not be met.
WHSCT TRUST DELIVERY PLAN 2018/19 38
Requirements to maintain or improve on performance are:
Funding allocation as per IPT.
Increased rehabilitation bed numbers / throughput, particularly
in the SWAH and NHSCT; same being developed with PCOP
teams.
Increase in the number of single rooms planned for move into
north wing development.
More trainees/staff grades – same included in consultant IPT
re staff grades.
Recurrent funding for the consultant physician cover and AHP
leave cover as these roles make a significant impact on
throughput and clinical standards of care.
4.7 By March 2019, ensure that at least 15% of patients In 2017/18, the Trust again exceeded the target with 18.4% of
with confirmed ischaemic stroke receive thrombolysis patients with confirmed ischaemic stroke receiving thrombolysis
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treatment, where clinically appropriate.
treatment. This was also an improvement on 2016/17 when a
performance of 17.8% was achieved. The Trust will continue to
strive to meet and exceed this target. However, it is noted that the
ability to achieve the target is dependent on a number of factors:
A high percentage of patients admitted with ischaemic stroke
cannot provide accurate time of onset. Without the early
recognition of symptoms, these patients cannot be considered
for thrombolysis. In addition, if they do not recognise their
symptoms within the 4.5 hours window, they will also fall
outside the threshold to receive thrombolysis.
The recruitment of suitably qualified staff continues to be a
challenge and the Trust continues to strive to secure
WHSCT TRUST DELIVERY PLAN 2018/19 39
permanent recruitment through all possible available options.
The Trust has a 1:4 lysis rota in place in Altnagelvin Hospital
and a 1:3 rota in the South West Acute Hospital (SWAH) and
is working towards the establishment of a Trust-wide lysis
rota. However, competing pressures within the general
medical rota, particularly in the SWAH, are delaying the
process.
4.8 By March 2019, all urgent diagnostic tests should be Trust performance against this target in 2017/18 was 93.3%, a high
reported on within two days.
level of compliance that was achieved despite a 48% vacancy rate.
A
The Trust expects to maintain this performance in 2018/19. In
relation to radiology, there remain ongoing issues with meeting a
48 hour target which include weekend reporting.
The radiology management team are actively involved with MRCN
to ensure that recognised regional issues in relation to 7 day
reporting are being addressed as part of the Imaging Review”
The Trust will also continue to:
Pursue recruitment of radiologists through local, national
and international recruitment;
extend radiographer reporting roles e.g. Plain Film, ultra-
sound and Nuclear Medicine;
The Trust acknowledges that formal arrangements for network and
Outsourced reporting will remain an essential part of the radiology
service for the foreseeable future.
WHSCT TRUST DELIVERY PLAN 2018/19 40
4.9 During 2018/19, all urgent suspected breast cancer
14 Day Breast Cancer
referrals should be seen within 14 days; at least 98% An excellent level of compliance with the 14 day breast target was
of patients diagnosed with cancer should receive their achieved in 2016/17 (99.9%) and this has been maintained into
A
first definitive treatment within 31 days of a decision 2017/18 with 100% performance achieved. The Trust has
to treat; and at least 95% of patients urgently referred developed a performance improvement trajectory for 2018/19
with a suspected cancer should begin their first which projects that this performance should be maintained.
definitive treatment within 62 days.
However a number of risks to maintained performance exist:
Retirement of the Clinical lead for breast services will reduce
the breast team to 1 WTE radiologist with an interest in breast,
in Mar 2019
Continued availability of WLI funding – the ability to provide a
triple assessment is impacted by workforce challenges in both
surgery and radiology specialties. The Trust has used waiting
list initiative (WLI) funding to fund additional clinics. The Trust
would wish to continue to deliver these additional sessions.
The availability of breast radiologists from March 2019 is likely
to impact on the number of clinics available in WHSCT. There
may be a requirement for regional support to the service at this
time and there is a clear need for the appointment of more
breast radiologists.
Due to the local issues with continued service provision, the
Trust’s ability to engage in regional work to address waiting
times on a Northern Ireland basis will be impacted and may
result in some deterioration for the Trust in the DoH published
performance statistics.
WHSCT TRUST DELIVERY PLAN 2018/19 41
31 Day Target
The Trust achieved 99.7% compliance against this standard in
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2017/18 compared to 100% in 2016/2017. As above the delivery
of 31 Day target remains at risk in the absence of a regional
solution to the radiology recruitment issue in WHSCT. However,
The Trust expects to maintain performance 2018/2019.
62 Day Target
Access to endoscopy for red flag referrals is a challenge for the
A
Trust as a result of vacancies in a number of key gastroenterology
and surgery posts. A Gastroenterologist is due to commence in
September 2018. The demand for red flag slots is outstripping
capacity particularly in the Southern Sector of the Trust. This is
resulting in a number of patients breaching the 62 day target
particularly in the lower GI pathway. Funding has been secured
for an additional nurse endoscopist who has recently been
recruited and this will enable endoscopy capacity to be increased,
particularly in the southern sector. This post will be filled in
September 2018. The Trust has identified a plan to release
capacity for appropriate skilled staff to undertake additional
sessions to meet the demand
There can also be challenges in relation to the timeliness of inter-
Trust transfers which impact on the ability of the Trust to achieve
this target.
WHSCT TRUST DELIVERY PLAN 2018/19 42
Increasing demand for cancer surgery in both the WHSCT and the
BHSCT cancer centre is impacting on the Trust’s ability to fully
achieve the 62 day standard of 95%. The prioritisation of patients
classified as “red flags” can impact on elective capacity,
particularly in theatres, which can lead to issues regarding access
to treatment. Again the Western Trust is challenged with
vacancies in surgery. The Trust will continue to work with primary
care colleagues to ensure appropriate classification of referrals.
During 2018/19 the Trust will continue to:
Engage internally and with the Regional Cancer Performance
and Service Improvement Forum in order to improve patient
pathways and access to services;
Focus on inter-Trust transfers in an effort to assess gaps in
capacity and improve performance;
Work to achieve access to first diagnostics (particularly
endoscopy) within 21 days;
Learn from analysis of breach reports through multi-
disciplinary meetings and service engagement;
Monitor the demand for cancer related surgeries;
Actively pursue recruitment to vacancies in Gastroenterology
and Surgery.
4.10 By March 2019, 50% of patients should be waiting no The Trust did not achieve this target in 2017/18 when 29.8% of
longer than 9 weeks for an outpatient appointment patients waited no longer than 9 weeks for their first outpatient
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and no patient waits longer than 52 weeks.
appointment compared to 37.5% in the previous year. There was
also an increase in the numbers waiting greater than 9 weeks from
19,730 in 2016/17 to 24,128 in 2017/18 and greater than 52 weeks
WHSCT TRUST DELIVERY PLAN 2018/19 43
from 6404 in 2016/17 to 11,039 in 2017/18.
The growth in red flag and urgent referrals impacted on the
capacity to see routine referrals which resulted in routine waiting
times in some specialties significantly exceeding 52 weeks. This is
unlikely to change during 2018/19. In addition, the Trust continues
to experience medical workforce pressures in a number of
specialties such as neurology, respiratory medicine and
gastroenterology (two additional consultants were recruited but
start dates are to be confirmed) which will impact on the ability to
achieve these waiting times. There are also nursing workforce
pressures which are impacting on outpatient clinic capacity.
Funding has been secured from the HSCB to deliver additional
waiting list initiative activity. However funding approval is only
currently available to address red flag and urgent referrals and
while this should contribute to a reduction in the number of patients
waiting, it will not address the routine longest waits.
During 2018/19 the Trust will:
Through our dedicated resource for patient access carry out
focused work on outpatient waiting times.
Continue to work with HSCB in relation to the increasing
numbers of red flag referrals which impact on the Trust’s ability
to see urgent and routine referrals within the waiting time
standard.
Ensure implementation of good waiting list management
practice, including the chronological management of patients of
the same clinical priority.
WHSCT TRUST DELIVERY PLAN 2018/19 44
Ensure appropriate triage and categorisation of all patient
referrals, including the roll out of the regional CCG system
(eTriage).
Ensure that clinics are booked in accordance with agreed clinic
templates to ensure capacity is fully utilised.
Develop improvement plans for specialities identified by the
HSCB that are underperforming in their SBA.
Ensure implementation of agreed investments to increase
capacity and reduce waiting times within current financial
constraints.
Engage with the HSCB and other Trusts for the implementation
of the regionally agreed Outpatient Reforms.
The Trust is also planning to pilot an admin validation of longest
waiters with three specialties identified in the first instance.
4.11 By March 2019, 75% of patients should wait no longer While the Trust will continue to strive to meet this target, there are
than 9 weeks for a diagnostic test and no patient
a number of challenges which are impacting on the ability to deliver
A
waits longer than 26 weeks.
the expected target waiting times.
Radiology
Radiology performance continues to excel with 100% of patients
(20 at end of Mar 18) waiting less than 9 weeks for imaging.
Diagnostic waiting times are being maintained but the WHSCT has
a fragile radiology service due to the level of consultant vacancies.
However the Trust has had some success with international
recruitment for NHS locums in 2018 and despite further loss of
WHSCT TRUST DELIVERY PLAN 2018/19 45
radiologists expects to maintain this level of performance
Imaging – The Trust will strive to maintain the high level of
performance against this target, however there is a risk to
continued achievability due to the current 54% vacancy rate within
radiology staffing.
Physiological Measurement – this is also a risk for the Trust in
particular to due to the number of people on the waiting list for
echoes. The Trust recognises the additional capacity funded in
2017/18 and will endeavour to maximise this to reduce the length
of time patients are waiting, however additional funding to
undertake waiting list initiative activity would also be required.
Endoscopy - the ability to meet this target has been impacted by
medical and surgical staffing shortages, particularly in the South
West Acute Hospital. An additional nurse endoscopist has been
secured which will contribute to improved performance. The two
vacant gastroenterologist posts have also been successfully
recruited, however the Trust is still awaiting final confirmation of
start dates.
4.12 By March 2019, 55% of patients should wait no longer The Trust did not achieve this target in 2017/18 when 35% of
than 13 weeks for inpatient/ daycase treatment and
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patients were waiting no longer than 13 weeks for inpatient/day
no patient waits longer than 52 weeks.
case treatment compared to 38.1%in 2016/17. There was also an
increase in the numbers waiting greater than 13 weeks from 9385
in 2016/17 to 10,810 in 2017/18 and greater than 52 weeks from
3013 in 2016/17 to 4548 in 2017/18.
WHSCT TRUST DELIVERY PLAN 2018/19 46
Performance is impacted by a number of issues:
Increased demand for red flag procedures and the requirement
for these to be prioritised will increasingly result in routine
patients waiting longer in those specialties where waiting list
initiative provides insufficient additional capacity.
Consultant vacancies, particularly in general surgery.
Impact of increase in ED attendances and bed pressures on
access to elective beds, particularly during the winter period.
Impact of staffing shortages, ie ward nursing shortages affecting
elective bed capacity and theatre nursing and anaesthetic
staffing shortages affecting theatre capacity.
Planned essential upgrade works in DESU in the final quarter of
2018/19 will impact on theatre capacity. While the Trust has
developed contingency plans to mitigate the impact, theatre
capacity will be reduced. There is also a risk that the works will
continue into the first quarter of 2019/20.
Actions 2018/19:
Additional funding for in-house waiting list initiative sessions has
been allocated for red flag and clinically urgent patients in
2018/19. While this may help to address the numbers of
patients waiting, it does not address the long waiters. The Trust
will endeavour to ensure is utilised to achieve optimum benefit,
however this may be restricted due to staffing issues within
theatres and nursing provision at ward level.
Ensure implementation of good waiting list management
practice, including the chronological management of patients of
WHSCT TRUST DELIVERY PLAN 2018/19 47
the same clinical priority.
Through the Trust’s dedicated patient access resource, seek
improvements through a focus on theatre scheduling and
theatre utilisation.
No funding in 2018/19 has been allocated for the Independent
Sector to date.
Within the current financial constraints, ensure implementation of
agreed investments to increase capacity, reduce waiting times and
implement alternative working practices, where applicable.
4.13 By March 2019, no patient waits longer than: nine
CAMHS
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weeks to access child and adolescent mental health The WHSCT CAMHS Crisis Team became operational on the 12
services; nine weeks to access adult mental health March 2018. The team is comprised of a Band 7 lead and 5 Band
services; nine weeks to access dementia services; 6 clinicians, providing a CAMHS Crisis response service across the
and 13 weeks to access psychological therapies (any Trust area from 9am to 5pm.
age).
A reduction trajectory for the CAMHS Waiting List has been
completed for 2018/19 to assist in the management of breaching to
a zero position by year end.
Adult Mental Health – 9 Week Target
In 2018/19 referrals and demand for service is expected to
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continue to increase whilst challenges in relation to recruitment and
availability of staff continue.
The breach position within adult mental health has been increasing
and work has commenced internally to understand the issues
WHSCT TRUST DELIVERY PLAN 2018/19 48
impacting on performance and identify actions to address.
The Trust has developed a performance improvement trajectory
which sets out the level of performance that it expects to be able to
achieve based on projected demand and existing capacity. Due to
challenges with recruitment and availability of appropriately trained
staff, the Trust is predicting a substantial number of breaches at
the end of March 2019.
The Adult Mental Health Service have also initiated a system wide
service improvement process whereby the flow, function and
efficiency of all the teams which have an impact on these figures
are being reviewed. A series of workshops have taken place from
January 2018 to June 2018 and there has been significant learning
in relation to improved systems. The Trust plan to report on the
way forward which will bring the Trust into line with other areas in
the region.
In parallel with this project Mental Health Services have had a
series of meetings with GPs in relation to referral pathways and
prioritisation and communication. It is anticipated that this will have
a positive impact as the mental health services progress to a
potential new model of assessment and intervention.
Dementia – 9 Week Target
The requirement for 1 wte Consultant Psychiatrist for memory has
A
been identified in order to meet demand. This has been highlighted
WHSCT TRUST DELIVERY PLAN 2018/19 49
regionally through the work that is ongoing in relation to the
development of the regional dementia pathway. However, even if
investment is secured, the Trust will still continue to have difficulty
in recruiting and retaining medical staff here in the Western Trust.
The Trust has submitted a performance trajectory to the HSCB
which sets the level of performance expected to be achieved in
2018/19 and in order to try to manage the waiting list, the older
people’s mental health service has put in place additional nursing
(0.6 WTE) and medical (4 consultant PAs) resources. Whilst the
service may meet the target to see new patients, it is noted that
some patients are waiting beyond their clinical time for reviews.
There are also increased waiting times from assessment to
diagnosis
Psychological Therapies – 13 Week Target
This target is expected to be achieved in children’s LD and LAC.
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However, the Trust does not expect to be able to meet this target
across a number of service areas as follows:
Older People’s Service - there are capacity gaps to meet
projected demand due to limited funded establishment and
therefore limited capacity to deliver services to inpatient wards,
outpatient services, Trust-wide memory clinics and direct and
indirect interventions to patients and family caregivers. Currently
all funded establishment posts are filled.
Adult Learning Disability Service - Recruitment challenges
WHSCT TRUST DELIVERY PLAN 2018/19 50
continue to be experienced in relation to qualified psychology staff
which is significantly impacting on the ability to meet the 13 week
target. Posts are being re-advertised in 2018/19 and the Trust is
looking at innovative ways to attract qualified staff, e.g.
Preceptorship posts. Other possible options being considered to
increase capacity include:-
Employing Assistant Psychologists on a temporary basis in lieu
to vacant posts;
Considering redirecting money from clinical psychology to
behaviour support service to increase chance of recruiting;
Alternative training routes within the professions.
Adult Mental Health Service – Vacancies and availability of
qualified staff are impacting on the ability to deliver the 13 week
target. The Trust has submitted a bid for waiting list initiative
funding for psychological therapies within adult mental health which
if funded will contribute to a reduction in the number of patients
breaching the target.
Clinical Psychology - Capacity has been impacted by unfilled
maternity leave vacancies and an increase in demand impacting on
performance. The service continues to prioritise clinical
need/urgent referrals. Recruitment for maternity leave backfill has
been unsuccessful via the traditional route or agency and in the
interim a sessional contract is in place. A bid for waiting list
initiative funding has been submitted to HSCB for approval which if
funded will contribute to a reduction in the number of patients
WHSCT TRUST DELIVERY PLAN 2018/19 51
breaching the target.
Children's Psychology – vacant posts have impacted on
capacity. While some of these have now been filled, an unfilled
maternity leave vacancy will continue to impact until approximately
October 2018. The service has been considering the potential for
innovative ways of working i.e. group work and also submitted a
waiting list initiative bid to the HSCB which if funded will contribute
to a reduction in the number of patients breaching this target.
Outcome 5: People, including those with disabilities, long term conditions, or who are frail, receive the care that matters to
them
COMMISSIONING PLAN DIRECTION OUTCOME
PROVIDER RESPONSE
RAG
5.1 By March 2019, secure a 10% increase in the number In 2017/18, the Trust exceeded this target with 804 recipients of
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of direct payments to all service users.
direct payments at the end of March 2017 compared to 624 at the
end of March 2017. The Trust will continue to ensure that service
users are given the option of direct payments and that direct
payments continue to be promoted. The Trust expects to
continue to meet and exceed this target in 2018/19.
5.2 By March 2019, all service users and carers will be In 2017/18, 2808 users were assessed under the Self Directed
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assessed or reassessed at review under the Self- Support (SDS) approach. At April 2018, there were 2978 Service
Directed Support approach, and will be offered the Users and 163 Carers in receipt of an ongoing SDS package
choice to access direct payments, a managed with:
WHSCT TRUST DELIVERY PLAN 2018/19 52
budget, Trust arranged services, or a mix of those 2397 (76.3%) in receipt of a Trust arranged service;
options, to meet any eligible needs identified.
722 (23%) in receipt of a direct payment;
22 (0.7%) in receipt of a managed budget.
At 31 March 2018, 572 Individuals in receipt of services received
Direct Payments broken down as follows:
99 (17%) Adult Learning Disability
77 (13%) Physical &Sensory Disability
21 (4%) Children’s Mental Health
221 (39%) Primary Care & Older People
154 (27%) CWD (including ASD)
In addition there were 577 One-Off Direct Payments and 129
individuals in a caring role received direct payments in 2017/18.
Since the implementation of SDS in Western Trust, and in
addition to the 3141 active clients:
139 Service Users have ceased an SDS service
391 Service Users have received a one-off SDS service
1 Carer has ceased an SDS service
388 Carers have received a one-off SDS service
5.3 By March 2019, no patient should wait longer than 13 At 31st March 2018, a total of 4758 people were waiting longer
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weeks from referral to commencement of treatment than 13 weeks to commence treatment by an allied health
by an allied health professional.
professional compared to 2176 in 2016/17. The Trust has
received waiting list initiative funding following the submission of
its plan. This funding will be targeted to deliver the shortest
waiting times achievable by professional grouping. The only risk
WHSCT TRUST DELIVERY PLAN 2018/19 53
associated with the delivery of the planned improvement will be
the availability of workforce. The Trust expects to meet the 13
week target for all areas with the exception of occupational
therapy where a substantial reduction in the number of patients
breaching is expected to be achieved but the breach position will
not be fully cleared in 2018/19.
5.4 By March 2019, have developed baseline definition The Trust has already increased its baseline adult speech and
data to ensure patients have timely access to a full language therapy staffing complement through a mixture of
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swallow assessment.
investment and workforce re-design. The Trust continues to have
a staffing capacity deficit in this area linked to the growth in
demand associated with demographic change and the increasing
prevalence of swallowing difficulties within an ageing frailer case
mix. The Trust will deploy transformation resources associated
with dysphagia to enhance knowledge and skills across all HSC
settings and ensure timely access to assessment
5.5 By March 2019, Direct Access Physiotherapy service The Trust has successfully trialled and extended a ‘First Contact
A
will be rolled out across all Health and Social Care Physiotherapy’ service within a GP practice in Strabane. The
Trusts.
Trust in partnership with the Derry GP Federation has been
awarded transformation funding for the development of Primary
Care Multi-disciplinary Teams. The joint submission will deliver
the establishment of First Contact Physiotherapy Services across
GP practices servicing two thirds of the Trust’s resident
population. The staffing of this model will require the re-
alignment of existing Physiotherapy resource from within the
Trust’s core MSK service to ensure the appropriate knowledge
WHSCT TRUST DELIVERY PLAN 2018/19 54
and skills are available within a first contact model. This core
capacity will then be backfilled. In light of this the Trust will not be
in a position during 2018/19 to develop a self-referral model
across the Trust but those living in the Derry GP Federation
catchment area will be able to access Physiotherapy first contact
assessment via their GP practices. Where assessed as
appropriate onward referral and appointment allocation will be
processed providing directly accessed via this route. Ultimately
the Trust envisages Direct Access and First Contact
Physiotherapy as being component elements of its future
Physiotherapy Delivery model. However, the Trust will need to
evaluate the impact of the First Contact Physiotherapy Service
within Primary Care to re-model its overall service delivery
configuration
5.6 By May 2018, to have delivered the Children & Young The task and finish group responsible for this framework met in
People's Developmental & Emotional Wellbeing August 2018 for the first time since January 2018 and a series of
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Framework along with a costed implementation plan
meetings are scheduled for the next 12months on which the
WHSCT is represented. The final document is not yet finalised
the Trust has provided comments back in respect of the
document as requested due by 18th September 2018. The
framework will be subject to the usual consultation process once
completed.
5.7 During 2018/19, ensure that 99% of all learning Adult Learning Disability
disability and mental health discharges take place During 2017/18, patients not dependent on new community
A
within seven days of the patient being assessed as arrangements were all discharged within the 7 day timeframe.
medically fit for discharge, with no discharge taking However, significant pressures were experienced in discharging a
WHSCT TRUST DELIVERY PLAN 2018/19 55
more than 28 days.
small percentage of patients who required new community
placements to be developed resulting in the 7 and 28 day
timeframes being missed, ie 91% of discharges took place within
7 days and 4 discharges took more than 28 days.
These challenges will continue into 2018/19 as community
housing options remain limited and most admissions as a result
of community / family breakdowns require new arrangements to
be made. Provider organisations are also experiencing difficulty
in recruiting staff.
Adult Mental Health
While a strong performance against the 7-day target was
achieved in 2017/18 for mental health discharges (98%),
availability of low secure accommodation across the region is
impacting on the ability to fully achieve this target. In addition, the
availability of suitable community placements for people with
complex needs is also a challenge which is resulting in delayed
discharges. A regional group has presented a paper in relation to
rehabilitation services to the Regional Bamford Monitoring Group.
WHSCT TRUST DELIVERY PLAN 2018/19 56
Outcome 6: Supporting those who care for others
COMMISSIONING PLAN DIRECTION OUTCOME
PROVIDER RESPONSE
RAG
6.1 By March 2019, secure a 10% increase (based on In 2017/18 the Trust increased the number of carers assessments
G
2017/18
figures) in the number of carers’ offered to 628 compared to 407 in the previous year and will
assessments offered to carers for all service users.
continue to ensure that, where possible, carers are identified and
offered a carer assessment. Significant improvements were
made in adult learning disability services which reported a 14.5%
increase in the number of carers assessments offered and adult
physical disability services which reported a 6.25% increase.
The Truts will continue to strive in 2018/19 to meet the target set.
Carers continue to be offered an assessment and this is reviewed
regularly.
6.2 By March 2019, secure a 5% increase (based on In 2017/18, 29,702 short break hours were delivered (
based on
2017/18 figures) in the number of community based
final quarter 2017/18), which fell substantially short of the 5%
A
short break hours (i.e. non-residential respite) target increase.
received by adults across all programmes of care.
During 2018/19, the Trust will continue to endeavour to achieve
this target. Within some service areas significant increases were
achieved, such as adult learning disability and adult physical
disability, where the increase was above the target 5%. The
Trust will build on this and will promote the use of alternative non-
residential short break provision in line with assessed need. The
use of self-directed support and direct payments will also continue
to be supported and there will be a focus on discussion with
clients regarding choice and the options available.
WHSCT TRUST DELIVERY PLAN 2018/19 57
6.3 By March 2019, to create a baseline for the number of The Trust will work to create a baseline for the number of young
G
young carers receiving short breaks (ie non- carers receiving short breaks in line with technical guidance which
residential respite).
is still awaited.
Aim: Ensure the sustainability of health and social care services provided
Outcome 7: Ensure the sustainability of health and social care services
COMMISSIONING PLAN DIRECTION OUTCOME
PROVIDER RESPONSE
RAG
7.1 By March 2019, to have commenced implementation Not applicable to WHSCT.
N/A
of new contractual arrangements for community
pharmacy services.
7.2 By March 2019 to establish an outcomes reporting Work has commenced with the HSCB and the Directors of Social
framework for Delegated Statutory Functions (DSF) Work to agree an outcomes reporting framework. It is anticipated
G
that will demonstrate the impact and outcome of that some pilot areas will be developed and tested in 2018/19 with
services on the social wellbeing of service users and further rollout thereafter. A significant amount of preparation work
the baseline activity to measure this.
has already been undertaken and a revised circular agreed to
underpin the relevant statutory functions and accountability
arrangements.
7.3 By March 2019, to establish a baseline of the number The Trust will establish a baseline as required by March 2019.
G
of hospital cancelled, consultant led, outpatient Based on this, an assessment will be made on the achievability of
appointments in the acute programme of care which a 5% reduction by March 2020.
resulted in the patient waiting longer for their
appointment and by March 2020 seek a reduction of
5%.
WHSCT TRUST DELIVERY PLAN 2018/19 58
7.4 By March 2019, to reduce the percentage of funded
The Trust’s delivery of funded elective activity reduced in 2017/18
activity associated with elective care service that
compared to 2016/17. The ability to deliver core activity was
R
remains undelivered.
impacted by a number of issues but key factors were:
Medical vacancies and sickness absence in some
specialties, e.g gastroenterology, ophthalmology, general
surgery, pain, orthopaedics and rheumatology;
Impact of unscheduled demand on elective capacity and
regional decision to cancel routine elective in the latter part
of 2017/18.
For 2018/19, the Trust has developed performance improvement
trajectories for elective inpatients/day cases and new outpatients
which aim to achieve substantial improvements, reducing under-
delivery in inpatient/day case from -11.1% to -8% and in new
outpatients from -15.7% to -11%. Work is also ongoing to
improve delivery of review outpatient core activity.
The Trust’s ability to deliver core activity will continue to be
impacted by a range of issues as follows:
Ability to recruit and establish stable clinical teams in
vulnerable specialties, eg respiratory, general surgery,
gynaecology.
Impact of increases in unscheduled care demand on elective
inpatient capacity
Continuing impact of Band 5 nursing shortages on elective
inpatient bed capacity.
The need for workforce controls as part of the Trust’s financial
plan to manage expenditure, has constrained the steps which
WHSCT TRUST DELIVERY PLAN 2018/19 59
would normally be taken to support core elective delivery, in
particular backfill of vacancies, sick leave and maternity leave.
In-house capacity to run additional sessions due to staff
availability.
Two key risk areas to delivery of core in 2018/19 are planned
works in the DESU theatres during the final quarter of the year
and the current level of theatre nursing vacancies. As a result of
the vacancies, the Trust is currently unable to schedule sessions
in two theatres per week. While the Trust has developed plans to
minimise the impact on core activity and has put in place
arrangements to manage this, some impact on the core
inpatient/day case delivery will be unavoidable.
The Trust also notes that substantial reform and modernisation is
being taken forward which has resulted in changes in how
services are delivered, for example virtual activity, multi-
disciplinary teams, nurse-led activity. As this progresses, it is
essential that the current core activity as set out in the Service
and Budget Agreement with the Trust is reviewed to ensure that it
reflects these changes. The Trust acknowledges that some work
has commenced on this locally in relation to diabetes and
respiratory services.
7.5 By March 2019, ensure that 90% of complex There was an improvement in performance against this target in
discharges from an acute hospital take place within 2017/18 with 82% of complex discharges taking place within 48
R
48 hours, with no complex discharge taking more hours compared to 76% in 2016/17 and 91% taking place within 7
than seven days; and all non-complex discharges days compared to 87% in 2016/17. The number waiting greater
from an acute hospital take place within six hours.
than 7 days also reduced from 479 in 2016/17 to 410 in 2017/18.
A performance improvement trajectory has been developed for
WHSCT TRUST DELIVERY PLAN 2018/19 60
the 48 hour target for 2018/19 which aims to improve
performance to 85%.
The Trust has put in place residential support beds at one of its
statutory residential homes in the northern sector, initially starting
with 6 beds and now increased to 17 beds as demand increased.
The Trust continues to have this flexible bed capacity available
during 2018/19. The Trust would like to replicate this type of bed
provision in the southern sector of the Trust and is currently in
negotiations with an independent provider to take this forward.
The Trust is also developing its winter resilience plan for 2018/19
to put in place arrangements to manage patient flow during peaks
in unscheduled demand. Initiatives being taken forward during
2018/19 such as further development of ambulatory care
pathways on both the Altnagelvin and South West Acute hospital
sites should also support improvements in unscheduled flow.
7.6 By March 2019, to have obtained savings of at least This is a combined primary and secondary care target and the
R
£90m through the 2016-19 Regional Medicines work is being managed through the Medicines Optimisation
Optimisation Efficiency Programme, separate from Regional Efficiency Programme. The Trust expects to be able to
PPRS receipts.
achieve its target share although this will not be until 2020.
However, the combined target will be challenging to achieve and
will require clinician engagement from both sectors.
WHSCT TRUST DELIVERY PLAN 2018/19 61
Aim: Support and empower staff delivering health and social care services
Outcome 8: Supporting and transforming the HSC workforce
COMMISSIONING PLAN DIRECTION OUTCOME
PROVIDER RESPONSE
RAG
8.1 By June 2018, to provide appropriate representation The Trust will provide representation to the Programme Board
on
the
programme
board
overseeing
the and associated workstreams.
G
implementation of the health and social care
Workforce Strategy.
8.2 By June 2018, to provide appropriate representation The Trust will provide representation to the Project Board as
on the project board to establish a health and social required.
G
care careers service.
8.3 By March 2019, to have completed the first phase of The Trust will work in partnership with the HSCB and regional
the implementation of the domiciliary care workforce colleagues to design and roll out a new model of domiciliary care
G
review.
provision
8.4 By June 2018, to provide appropriate representation The Trust will participate fully in the project as required.
G
to the project to produce a health and social care
workforce model.
8.5 By March 2019, to provide appropriate representation The Trust participates in a range of internal audits and follow up
and input to audits of existing provision across the actions are prioritised.
G
HSC, in line with actions 10 – 14 of the Workforce A full census HSC Staff Survey is being planned for 2019 which
Strategy.
will form the basis for further actions to achieve workforce
strategy aims.
The Trust will comply with any other audit requirements.
WHSCT TRUST DELIVERY PLAN 2018/19 62
8.6 By December 2018, to provide the information In order to achieve this target, the Trust has identified the
A
required to facilitate the proactive use of business requirement for an informatics system that will provide a platform
intelligence information and provide appropriate that will facilitate proactive use of business intelligence
personnel to assist with the analysis.
information. A business case is currently being prepared to
secure funding to enable a proof of concept to be undertaken.
This will include recruitment of additional resources with the
required software development skills to ensure the system is
optimised. While the Trust is working towards this, it is doubtful
that this target can be achieved within the identified timescale.
8.7 By December 2018, to ensure at least 40% of Trust Whilst the Trust acknowledges that the target was not achieved in
A
staff (healthcare and social care staff) have received 2017/2018 there has been an improvement from 25.74% in
the seasonal flu vaccine.
2016/2017 to 27.4% of frontline staff vaccinated.
The following actions contributed to this improvement:
Widespread Flu Fighters campaign across the three hospital
sites, non-acute hospitals and health centres including drop-in
vaccination clinics. Clinic times were also scheduled to
accommodate night staff.
Education and communication – campaign widely and
repeatedly promoted through Trust Communication and
newsletters plus daily reminders of clinic venue and times.
Occupational Health staff visited wards at the three hospital
sites and offered the vaccine to staff while at their work.
Training venues were also attended to promote vaccine
uptake.
Incentives were offered.
WHSCT TRUST DELIVERY PLAN 2018/19 63
Flu vaccination available to the end of season
Local Flu Champions encouraged and promoted uptake
amongst staff.
Weekly update figures were reported to the Medical Director.
Flu fighters provided promotional posters and stickers and
supported Trust staff in the delivery of the programme.
In 2018/19, the Trust will undertake another extensive flu
campaign and ensure that the vaccine is widely accessible to all
staff. Plans also include:
Working closely with the PHA to ensure effective education
and communication, including roll out of the flu campaign,
particularly to hard-to-reach staff groups.
Designated “champions” identified and trained to encourage
front line staff to avail of the vaccination.
Gathering statistical data to measure the uptake and this will
be analysed to target areas where uptake is low.
PHA has also decided to procure “Flu Fighters” for the up
and coming season to provide additional support to our local
campaign.
Personal invite to all staff has been proposed
Peer vaccination proposal has been tabled.
Enhanced communication strategy
8.8 By March 2019, to reduce Trust staff sick absence The Trust was required to achieve a 5% reduction on 7.51%
levels by a regional average of 5% compared to (position at 31 March 2017) which was a target of 7.13% The
A
2017/18 figure.
Trust achieved the 5% reduction target and as at 31 March 2018
the cumulative absence rate was 7.02% which means that the
WHSCT TRUST DELIVERY PLAN 2018/19 64
tarrget for 2018/19 is 6.67%.
During 2017/18 work was ongoing in relation to the Quality
Improvement Cost Reduction (QICR) Plan 2017-2020:
A new Managing Attendance Policy was launched in
September 2017.
Absence Management Training to support implementation of
the new Trust policy was developed and commenced in
October 2017. To date 446 managers have been trained.
This training which is jointly delivered by HR Directorate
Support Teams (DST) and Occupational Health focuses on
early intervention, escalation and communication to support
employees to return to work. The training involves practical
exercises and group discussion to enhance learning. To date
evaluations from participants show that the majority have
rated this training as excellent. This training will continue
throughout 2018/19.
HR DSTs are continuing to develop a schedule of targeted
absence workshops to focus on Departments who are
identified as Absence Hot Spots within the absence
reports. These targeted workshops will provide a more in
depth review of absence patterns within these departments
and will produce a more focused and individualised plan for
these specific areas.
The Trust will continue to provide local leadership
development initiatives and participate in the regional
WHSCT TRUST DELIVERY PLAN 2018/19 65
leadership development programmes.
The Trust recognises the importance that staff health and
wellbeing makes to creating and maintaining a motivated,
engaged and productive workforce and acknowledges how
important it is to the successful delivery of quality health and
social care services for our population. We are committed to
developing a detailed programme of activities aimed at
promoting the wellbeing of staff, led from Chief Executive level
downwards throughout the organisation to include:
- A 3-year Strategy and Action Plan
- The TWIST West Wellbeing hub which can be accessed by
all staff
- A Health Champion network throughout the organisation
- New wellbeing programmes and grow existing programmes
8.9 By March 2019, to have an agreed and systematic The Trust recognises the importance that staff health and
action plan to create a healthier workplace across
wellbeing makes to creating and maintaining a motivated,
G
HSC and to have contributed to the Regional
engaged and productive workforce and acknowledges how
Healthier Workplace Network as part of commitments
important it is to the successful delivery of quality health and
under PfG.
social care services for our population.
We are committed to working together will all HSC
organisations through the Regional Healthier Workplace
Network and actively participate at each of the workshops.
The WHSCT also has representation on the four work streams
of this group to include Measures and indicators, Online
toolkit/apps, Healthier Workplaces Charter, Ageing Workforce.
The Trust is actively participating in the development of a
WHSCT TRUST DELIVERY PLAN 2018/19 66
Regional HSC Staff Wellbeing Charter. Locally our plan is to
develop:
A 3-year Strategy and Action Plan
The TWIST West Wellbeing hub which can be accessed
by all staff
A Health Champion network throughout the organisation
New wellbeing programmes and grow existing
programmes
8.10 By March 2019 to pilot an OBA approach to The Trust has already provided a range of OBA training for Social
strengthen supports for the social work workforce
Work staff and have established pilots within Women and
G
Children's Directorate with all our reform plans using an OBA
approach.
8.11 By March 2019, 50% of the HSC workforce should The Trust is committed to ensuring that staff are trained in the
A
have achieved training at level 1 in the Q2020 Q2020 Attributes Framework.
Attributes Framework and 5% to have achieved Level 1 Training: As part of the regional Quality 2020 Strategy,
training at level 2 by March 2020.
an eLearning programme was made available in 2016/17 which
covers the attributes described in Level 1 of the Framework. The
Trust has worked with its Management Development Team to
ensure that the content of the training is included within their
relevant existing programmes. This target should be achievable
but it is dependent on staff completing the e-learning module.
This has now been added to the mandatory training list and face
to face sessions have also been provided. A further Trust
Communication and information in the staff newsletter will be
provided during 2018/19 in order to encourage uptake.
WHSCT TRUST DELIVERY PLAN 2018/19 67
Level 2 Training –The Trust does not believe that it will be able to
train the target number of staff by March 2020. It is only this year
that the Trust has in place a faculty of staff trained at level 3 who
can deliver the level 2 training which is an 8-month programme.
The Trust’s first training programme will commence in October
2018 and based on experience from other Trusts, capacity on the
training programme has been set at 60 although there may be an
opportunity to slightly increase this in future years when the
training becomes embedded. This will mean by 2020
approximately 120 staff will be trained vs a target figure of 525.
An additional small number of staff are also trained regionally
each year, however this would not be sufficient to enable the
target to be achieved.
8.12 By March 2019, to have developed and commenced The Trust recognises the importance of staff health and wellbeing
implementation of a training plan on suicide and creating an awareness of suicide intervention for all HSC
G
awareness and suicide intervention for all HSC staff staff. The Trust is committed to working with all HSC
with a view to achieving 50% staff trained organisations through the Regional Protect Life 2 Strategy to
(concentrating initially on frontline staff) by 2022 in promote awareness around suicide and develop skills to ensure
line with the draft Protect Life 2 strategy.
staff can intervene in an effective and appropiate way.
From 10th September to 10th October there will be a ongoing
campaign to support and promote World Suicide Prevention Day
and World Mental Health Day. A campaign pack will be available
to all staff as well as the Voluntary / Community sector. The
theme is the "Elephant in the room".
WHSCT TRUST DELIVERY PLAN 2018/19 68
Via the Trust’s Health Improvement Department, a selection of
training courses targeting suicide awareness and emotional
health and well-being awareness will be available to staff These
include Mental Health First Aid, Safe Talk and Connections.
In partnership with the Mental Health Services, five ASIST
training courses have been arranged for 2018/19 (121 places in
total). This training will target Mental Health frontline staff and
any additional places will be allocated to the Voluntary/
Community sector staff.
Also in partnership with Mental Health Services a suicide
awareness conference targeting 100 frontline staff is planned for
September 2018 in the North West Regional College. This event
will take place during World Sucide Prevention week. The theme
for the conference is to ensure staff are equipped to work
effectively with patients and clients who are expressing suicidual
idealisation. This will include a showcasing of best practice in this
area of work.
8.13 By March 2019, Dysphagia awareness training The Trust will develop a project implementation plan in line with
designed by speech and language therapy to be the commissioner’s transformation IPT to ensure the recruitment
G
available to Trust staff in all Trusts.
and delivery of this training across the Trust
WHSCT TRUST DELIVERY PLAN 2018/19 69
Section 3.2 TRUST RESPONSE TO REGIONAL COMMISSIONING PLAN PRIORITIES
UNSCHEDULED CARE (9)
R
A
G
2
7
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1. Effective arrangements should Trust
responses
should The Trust has developed a draft IPT response
be in place to enhance a demonstrate plans to deliver rapid which sets out how it will use proposed
G
therapeutic frontline home based response with professional review at transformation funding to implement a model of
intermediate
care
team, home by a member of the team home based rehabilitation that will enhance the
responding rapidly and with a within 4 hours, bed days saved, re- Trust’s range of intermediate care pathways.
focus
on
recovery, admission avoidance & admission These pathways will support timely Transfers of
independence
and
patient avoidance.
Care and also respond rapidly to provide an
experience.
alternative pathway to avoid hospital admission
where appropriate. This development is
dependent on the allocation of transformation
funding.
2. Effective arrangements should Trust
responses
should The Trust is completing the IPT for phase 1 of this
G
be in place to ensure availability demonstrate how the service will service which involves recruitment of pharmacy
of
a
regional
Outpatient enhance
the
governance
and staff
and
additional
microbiologist
time.
Parenteral Antibiotic Therapy stewardship of intravenous antibiotic OPAT/Stewardship pharmacists will be recruited
project
prescriptions
and
reduce
the to work in Altnagelvin and South West Acute
WHSCT TRUST DELIVERY PLAN 2018/19 70
number prescribed, as well as Hospitals to focus on the regular review of OPAT
reduce the number of patients patients, increasing the number of hospital
waiting in hospital be discharged on patients referred to the service, reviewing patients
appropriate IV antibiotics.
and their antibiotics, prescribing new antibiotics
and making IV to oral switches as clinically
appropriate. This work will be carried out in
collaboration with an OPAT multidisciplinary team
which will meet weekly in line with national
guidelines. The pharmacists will lead on the
development of operational and clinical policies
and guidelines as well as audit and will work
closely with microbiology and rapid response
nursing. A medical resource will be needed to
develop this service fully.
3. Effective arrangements should Trust
responses
should Altnagelvin Hospital now has 7 day working
be in place to build on the 7 day demonstrate a reduction in time across
all
areas
of
Unscheduled
Care.
G
working
for
Physiotherapists, from referral to / request for AHP Physiotherapy, Occupational Therapy, Pharmacy
Occupational
Therapists, support to first contact; a reduction and Social work services input directly to the
Pharmacists and Social Workers in patients declared as a complex Emergency Department, Ambulatory Care Unit
in base wards building on the delay over 48 hours; increased AHP and the Acute Medical Unit at the weekend. A
2014 paper “Improving Patient contacts at weekends and over central base of the Emergency Department has
Flow in HSC Services”.
holiday periods.
been created for co-ordination and provision of
central communication channels is presently
being created.
The Trust will prioritise the availability of 7 day
AHP access in the South West Acute Hospital to
WHSCT TRUST DELIVERY PLAN 2018/19 71
ensure timely assessment and targeted therapy
across a 7 day model.
Transformation funding has been identified to
support enhancement of AHP, social work and
pharmacy input to base wards and this will be
targeted based upon clinical need and the
potential to deliver reduced length of stay.
4. Effective arrangements should
Trust responses should
At Altnagelvin Hospital, a Hub has been in place
G
be in place to ensure Trusts
demonstrate a sustainable robust
now for 15 months and is chaired on a daily basis
have in place local arrangements rota over 7 days, 365 days of the
(Mon-Fri) by an Assistant Director. The chair is
for site co-ordination / control
year that provides a single point of
supported a medical and surgical single point of
room to manage patient flow.
contact for system control.
contact (SPOC). SPOC’s are Band 8a Lead
Nurses and 8b Service Managers. Transformation
funding has now been secured to extend this
provision to 365 days per year and a consultation
to review senior management working practices is
being developed. Weekends are presently
supported by voluntary presence on site,
alongside normal on-call arrangements, on-call
Director
support
and
Patient
Throughput
Managers. The funding secured for 2018/19 will
provide a consistent presence in the Hub at
senior manager level and will support delivery of
service improvement. In the Southern Sector the
funding will provide administrative/data collection
support to the bed management team who
WHSCT TRUST DELIVERY PLAN 2018/19 72
manage flow on the South West Acute Hospital
site.
5. Effective arrangements should
Trust responses should
The Trust continues to provide Acute Care at
G
be in place to provide Acute /
demonstrate how, working with
Home (AC@H) to patients in the Northern Sector
Enhanced Care at Home that
appropriate partners Acute /
of the Trust following a multi-disciplinary
provides active treatment by
Enhanced Care at Home services
approach and avoiding an acute admission to
health care professionals in the
will be made available 24/7 and
hospital. The AC@H team has established links
persons own home for a
linkages to core primary /
with colleagues in community teams and the
condition that would otherwise
community care teams and NIAS.
acute hospital setting in order to provide a
require acute hospital in-patient
seamless service for our over 75 year old clients.
care.
The Trust has submitted an IPT for extension of
AC@H to a Trust-wide service.
6. Effective arrangements should
Trust responses should
There is no current date for activation of the
be in place to provide care to
demonstrate how arrangements will
trauma ward in the RVH which will accept all
A
seriously injured patients at a
be put into place to provide a
patients with significant trauma after initial
regional Major Trauma Centre
consultant-led service for the care
treatment in a trauma unit. This is outside of the
with the aim of increasing
and coordination of patients
control of the Western Trust and trauma patients
survival following major trauma
including rapid access to specialist
will continue to be treated locally and transferred
and reducing the incidence of
services related to trauma.
as required for regional specialist management.
long-term disability from injuries.
This is kept under review by the Trust Trauma
Committee.
SWAH is to host the European Trauma course
this year to equip candidates with skills to
respond to a major trauma call.
WHSCT TRUST DELIVERY PLAN 2018/19 73
7. Effective arrangements should Trust
responses
should The Trust will continue to provide rehabilitation to
A
be in place to ensure patients demonstrate how patient care will patients following major trauma from its existing
receive access to rehabilitation be enhanced by arrangements for baseline AHP resources. The Trust resources for
services
to
maximise
their AHP resources to support timely rehabilitation post trauma are under review by the
recovery following major trauma. access to rehabilitation services in Acute and PCOPS directorate staff as a
acute and general care settings.
programme of transformation of services.
At present significant delays in access to non-
acute
rehabilitation
services
can
restrict
repatriation and rehabilitation of major trauma
patients. Despite efforts of service staff, there
remain
occasions
where
repatriation
and
rehabilitation may be delayed. The goal of the
transformation work is to improve flow in these
pathways.
The Trust continues to engage with regional
groups regarding this pathway.
8. Effective arrangements should
Trust responses should
Altnagelvin Emergency Department has a trauma
G
be in place to ensure Trusts are
demonstrate how processes will be
team
pathway
which
ensures
appropriate
able to respond to major trauma
implemented to alert local Trust
response to all patients who attend with major
in their local Emergency
trauma teams to respond to major
trauma. This consists of senior doctors from ED,
Department as part of a regional
trauma calls and ensure teams have anaesthetics, general surgery, T&O, radiology
Major Trauma Network.
adequate and up to date training.
and paediatrics when required. The Trust has
Process should also include ‘call
processes and dedicated equipment in place for
and send’ for patient requiring
the safe and timely transfer of Time Critical cases
onward transfer to the Major Trauma to the regional centre.
Centre.
WHSCT TRUST DELIVERY PLAN 2018/19 74
9. Effective arrangements should
Trust responses should
Altnagelvin’s Ambulatory Care Unit has been fully
G
be in place to increase the
demonstrate the ambulatory care
functional since May 2018. It accepts Medical,
number of unscheduled care
pathways prioritised for
Cardiology, Surgical and ENT GP Referrals and
patients managed on ambulatory implementation / enhancement in
Emergency Department referrals. It sees on
pathways avoiding the need to
2018/19 plans for same day / next
average 30 patients per day with a discharge rate
be admitted to hospital
day referrals to services as well as
of 90%. In September 2018 it will accept ED
direct GP access for patient
Surgical Referrals also.
management advice.
Following the successful establishment of the
Ambulatory Care Unit (ACU) for GP access for
medical conditions, the Trust has extended ACU
to include surgical GP referrals as of May 2018.
Limited transformation funding has been identified
for 2018/19 which will be directed towards the
development of ambulatory pathways in the
South West Acute Hospital. Pathways are
currently being developed.
WHSCT TRUST DELIVERY PLAN 2018/19 75
ELECTIVE CARE (7)
R
A
G
4
3
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1. Effective arrangements should
Trust responses should
The WHSCT has representatives on the
be in place to establish a
demonstrate how they are
Pathology network board, which is taking the lead
G
regional programme of pathology supporting delivery of regional
on managerial reform. Following PAR review the
transformation.
pathology transformation
Department of Health has setup a small subgroup
programme objectives, which are
to bring forward proposals on managerial reform
broadly as follows:
to network.
• To enable managerial reform,
Regional
standardisation
projects
are
including necessary regional
ongoing in all disciplines and WHSCT staff
standardisation;
supporting this programme.
• To ensure future workforce &
The WHSCT has serious issues recruiting
service sustainability;
qualified Biomedical Scientist staff as there is
• To further develop the quality,
a very limited number of staff available and
performance & regulatory
reduced output from the University of Ulster
framework for pathology;
due to reduction in bursary support by DOH
• To develop a strategy for
to BMS placement students. Consideration
Pathology to support delivery
needs to be given to offering more attractive
of effective clinical services;
recruitment packages attract staff to the
• To procure & implement
Western Area. The WHSCT has one of the
WHSCT TRUST DELIVERY PLAN 2018/19 76
replacement regional LIMS,
lowest staffing levels in the province in most
blood production and tracking
disciplines
and
have
had
to employ
systems, and an interim digital
locums. This has been communicated via
pathology solution.
the pathology network, however the current
priority for funding is LIMS projects. In
order to mitigate this, the WHSCT are
keeping on some staff in the South West
Acute Hospital who had been employed to
cover maternity, however a more sustainable
solution is required. A position paper will be
developed for presentation to the network.
The
WHSCT
has
achieved
UKAS
accreditation for all disciplines, however the
excessive additional workload has been
flagged up to the Trust and Network. It is now
accepted that a 10% increase in workload
and costs per discipline is required to
maintain UKAS accreditation. The WHSCT
is the only Trust without a dedicated fulltime
quality officer. At the last Network Board it
was agreed that additional support is
required if the Network requirement is for all
laboratories to be accredited.
WHSCT has a number of consultant
vacancies within its pathology services with 3
vacant posts out of 8 within cellular pathology
and one vacant haematology consultant
WHSCT TRUST DELIVERY PLAN 2018/19 77
post. A locum cellular pathologist was
recruited via the international recruitment
programme, however this contract is now due
to end. Both microbiology and clinical
chemistry have two consultant staff and
additional resources would be required for
these areas. The service is considering
advanced roles for biomedical scientists to
take on some of consultant workload.
The WHSCT is working at all levels on LIMS
IT replacement. The Network accepts the
need to recruit staff now in order to backfill
experienced staff when they are working on
the LIMS project. Blood tracking and digital
pathology projects representatives working
on projects.
In summary WHSCT Pathology service is at the
most risk within Northern Ireland due to staffing
levels.
2. Effective arrangements should
Trusts should demonstrate plans to
The existing guidance has been shared with
be in place to make the best use
ensure that existing effective use of
surgical consultants to make them aware of the
A
of resources in surgical and
resources guidance is being
procedures included within the criteria. The
related specialties.
adhered to.
Trust will consider the proposed expansion of this
guidance when it is available.
Trust should also provide plans,
subject to consultation, on the
T&O-New
day
case
theatre
for
elective
WHSCT TRUST DELIVERY PLAN 2018/19 78
proposed expansion of this
orthopaedics will be maximised. The enhanced
guidance in 2018/19.
recovery model for arthroplasty has been
implemented. Initial impact on LOS reduced due
to time patients waiting for surgery, but this will be
monitored going forward.
3. Effective arrangements should
Trust responses should confirm that
The Trust will continue to engage with and
A
be in place in primary and
they will continue to engage with
support the regional scheduled care reform
community care settings to
and support the regional scheduled
process. The outpatient reform programme
minimise the need for patients to care reform process, working with
continues in all the named specialities, for
be referred by GPs to hospital
appropriate partners, to support the
example:
consultants for specialist
development of new enhanced
assessment.
services in primary and community
Respiratory Nurse Led Clinics and GP
care settings in a range of
referrals
specialities including:
GP Direct referrals to the new nurse led
cardiology nurse specialists and Cardiology
• Minor Surgery
Consultants
• Gastroenterology
Dermatology are progressing the regional
• ENT
plans for photo triage and equipment to be
• Gynaecology
installed at GP hubs where referrals will be
• Dermatology
sent via link.
• Dermatology Photo Triage
• Rheumatology
• MSK/Pain Management
• Trauma & Orthopaedics
• Cardiology
• Neurology
• Urology
WHSCT TRUST DELIVERY PLAN 2018/19 79
• Ophthalmology
• Vascular surgery
• Vasectomy
4. Effective arrangements should
Trust responses should confirm that
Regional work has already taken place with
G
be in place at the interface
they will continue to engage with
regards to developing Guidance Banners on CCG
between primary and secondary
and support the regional scheduled
between Primary and Secondary Care Service
care, organised around the
care reform process, working with
and this work will continue to develop.
needs of patients with effective
appropriate partners, to include
CCG has now been integrated with ECR and
communication between GPs
further roll out of e-referral and e-
eTriage has been implemented across a majority
and hospital consultants.
triage arrangements.
of Specialities across the Trust and full
Actions should improve the
implementation is expected by December 2018.
efficiency and effectiveness of
95% of Referrals are being received electronically
outpatients, diagnostics and
with a view to receipt referrals at 100%. The
treatment services in line with the
referral now becomes part of the patient’s record,
Transformation, Reform and
prompt receipt with traceability and quick turn
Modernisation agenda, which
around with triage outcome. This has, and will
includes partnership working with
continue, to create better communication between
ICPs.
Secondary Care back to Primary Care. Referrals
are being triaged to the correct pathway efficiently
and the Trust will be in a position to extract this
data to improve on Service Development,
Delivery and Quality.
Further developments are expected in 2018 with
the introduction of Advice Requests also via CCG
from Primary to Secondary Care and return.
WHSCT TRUST DELIVERY PLAN 2018/19 80
There are also well established and successful
communication arrangements across a range of
areas including Outpatient Reform Programme
Board, Delivering Together Programme Board
and the Unscheduled Network all of which
engage with the LCG and primary care/GPs. The
Trust and the Derry GP Federation were also
successful in a bid to pilot the introduction of
multi-disciplinary teams in primary care and
robust communication arrangements will be put in
place to take this forward.
5. Effective arrangements should
Trust response should detail plans
Vaginal mesh services are currently suspended
be in place to ensure the
that complement the regional
as per CMO letter 3/8/18, HSS(MD) 13/2018 -
G
regional priorities for
strategic direction for both
Pause in Vaginal Mesh Surgery - Restriction of
Endometriosis and vaginal mesh endometriosis and vaginal mesh
Use and High Vigilance Scrutiny Requirements
services are implemented by
services.
Endometriosis
the
British
Society
of
Trusts.
Gynaecological Endoscopy (BSGE) and the
Royal
College
of
Obstetricians
and
Gynaecologists (RCOG) recommend that a
dedicated endometriosis specialist nurse is
required as part of the multi-disciplinary team for
an accredited endometriosis centre in order to
provide a safe and high quality service. The Trust
has submitted an IPT to secure investment to
ensure that this standard is met.
WHSCT TRUST DELIVERY PLAN 2018/19 81
T&O:Pilot of one stop / multi-professional
(surgeons/AHP/Nursing) clinic in shoulder and
foot and ankle pathways planned.
Breast Clinic - The Trust has recently trained and
competency assessed a specialist nurse who
attends the Triple Assessment Breast Clinics and
is involved in the assessment of red flag breast
patients. This has allowed additional patients to
be appointed to these clinics which assist with the
attainment of the 14-day breast target.
Day case Laparoscopic Cholecystectomy in
OHPCC pilot commenced on 02.10.17 with 20
cases successfully completed by June 2018. The
pilot is ongoing.
A new vascular nurse for the Southern Sector has
been appointed to commence on 20.08.18. The
role will be an integral part of the service
modernisation for the Vascular service to ensure
the patient’s quality of life is enhanced. The
nurse
will
work
closely
with
the
wider
multidisciplinary team and other teams such as
ward and community teams. The nurse is
expected to deliver service improvement within
the wider context of the regional vascular service
improvement agenda and priorities for change.
WHSCT TRUST DELIVERY PLAN 2018/19 82
6. Effective arrangements should Trust
responses
should
See and Treat
be in place to improve further the demonstrate the specific actions A
pilot
of
multi-professional
A
efficiency and effectiveness of being taken in 2018/19, working with
(surgeon/AHP/Nursing) one stop clinics in
elective
care
services appropriate partners, to improve
shoulder and foot and ankle pathways is
planned.
(outpatients,
diagnostics
and elective
care
efficiency
and The Trust has recently trained and
inpatients/day case treatment) effectiveness including:
competency assessed a specialist nurse who
delivered by Trusts.
• Development of one stop ‘see
attends the Triple Assessment Breast Clinics
and treat’ services, linked to
and is involved in the assessment of red flag
unscheduled care services as
breast patients. This has allowed additional
appropriate
patients to be appointed to these clinics which
assist with the attainment of the 14-day breast
• The rollout and uptake of e
target.
triage to help streamline the Work is currently ongoing in relation to see
patient pathway
and treat for cardiology and gastroenterology.
•
Application
of
Transforming
E-Triage
Cancer Follow Up principles to CCG has now been integrated with ECR and
transform review pathways
eTriage has been implemented across a majority
• Maximisation
of
skill
mix of Specialities across the Trust and full
opportunities in the delivery of implementation is expected by December 2018.
assessment,
diagnostic
and 95% of Referrals are being received electronically
treatment services
with a view to receipt referrals at 100%. The
• Direct
access
diagnostic referral now becomes part of the patient’s record,
pathways to improve patient prompt receipt with traceability and quick turn
access to appropriate tests.
around with triage outcome. This has, and will
continue, to create better communication between
WHSCT TRUST DELIVERY PLAN 2018/19 83
Secondary Care back to Primary Care. Referrals
are being triaged to the correct pathway efficiently
and the Trust will be in a position to extract this
data to improve on Service Development,
Delivery and Quality.
Transforming Cancer Follow Up
The Trust will take the principles of TCFU into
account when reviewing pathways.
Skill Mix
The Trust will continue promote this in areas such
as endoscopy, radiography, advanced pharmacy
roles and nurse specialists/practitioners for
example, a breast consultant radiographer has
been funded which will help to address issues
around support of breast services, transformation
investment will support the training of additional
nurse endoscopists and pharmacy technicians, a
specialist dietitian to undertake reviews of coeliac
patients has been funded, physician assistants
are in place in the South West Acute Hospital to
support medical staff and further training of ANPs
in ED is also underway.
7. Effective arrangements should Trust
responses
should The Trust has been actively pursuing recruitment
A
be in place to ensure the demonstrate that all reasonable to fill vacant posts across a range of professions
WHSCT TRUST DELIVERY PLAN 2018/19 84
appropriate volume and case steps have been taken to fill all where shortages and recruitment challenges are
mix of staff are in place to deliver vacant posts and where clinically being experienced. This has included the use of
the agreed strategic priorities
appropriate maximise the use of international recruitment and participation in a
available skill mix
regional
international
nurse
recruitment
programme as well as an active recruitment
programme for pre-registration nurses in their
final year of training
The Trust is also pursuing alternative options to
maximise use of available skill mix. Funding has
been secured for an additional nurse endoscopist
post and through transformation funding a further
two nurse endoscopists will be trained. Funding
was also secured for a consultant breast
radiographer. Following a successful pilot, the
Trust has secured recurrent funding for a
specialist dietician to undertake reviews of
patients with coeliac disease which will free up
consultant gastroenterologist capacity. Within
trauma and orthopaedics there have been
challenges recruiting at upper limb sub-speciality
level which are likely to be ongoing for the Trust
as well as regionally. Engagement with
international recruitment for middle tier/ non
consultant grade doctors in T&O have been
unsuccessful to date but will continue. A review
of physician cover in T&O is ongoing as well as
WHSCT TRUST DELIVERY PLAN 2018/19 85
development of new roles in nursing for nurse
practitioners and theatre aides to assist in
throughput but also to address deficits due to
inability to recruit doctors. In the South West
Acute Hospital, physician assistants are in post to
support medical staff and further training of ANPs
in ED is taking place.
WHSCT TRUST DELIVERY PLAN 2018/19 86
MATERNITY & CHILD HEALTH (14)
R
A
G
2
12
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1.
Effective arrangements should
Trusts should work with the HSCB,
The Trust can confirm that it is working with the
be in place to ensure that
PHA and other partners through the
HSCB, PHA and other partners but notes that the
A
appropriate pre-conceptual
maternity strategy implementation
regional maternity strategy Implementation group
advice and care is available to
group to develop population based
(MSIG) have not identified this as a priority
women at low and higher risk to approaches and pre-conceptual
currently as other initiatives are being worked
ensure women are supported
pathways for women who may
through. There is a pre-conceptual care sub-
to be as healthy as possible at
become pregnant.
group on which the Trust is represented by the
the time of conception to
lead midwife.
improve outcomes for mother
and baby.
2.
Effective arrangements should
Trust responses should describe
The Trust operates a paediatric assessment unit
be in place to ensure that care
arrangements for primary care to
which provides access to rapid assessment of
G
is provided as close to home as access senior decision makers
patients and facilitates treatment and discharge
possible with children only
and how same day and next day
of patients in the unit where appropriate rather
being transferred to the
assessment is facilitated. Trusts
than admitting to an acute ward. A consultant of
regional children’s hospital for a should continue to work with the
the week model is also in place in both
tertiary service which is not
HSCB/PHA to develop and test
Altnagelvin and South West Acute Hospital which
provided locally.
models of care which reduce the
enables the consultant of the week to concentrate
reliance on in-patient and
on acute admissions and respond to queries from
WHSCT TRUST DELIVERY PLAN 2018/19 87
secondary care paediatric
GPs who are concerned and considering
services.
referring a child to hospital paediatric services.
Trust responses should
The Trust will work with the HSCB/PHA, through
demonstrate how they will work
the establishment of the paediatric network to
through the developing Child Health ensure that regional pathways are developed and
Partnership and the existing Critical
adhered to.
Care Network to develop pathways
of care and ensure they can safely
provide a range of interventions
including high flow oxygen for
children in line with the regional
pathway being developed.
3.
Effective arrangements should
Trust responses should
The Trust can confirm that Badgernet and
be in place to ensure that
demonstrate commitment to
NIMATS are fully implemented and being utilised.
G
required data is captured to
collecting data to evidence best
The KPIs that are being monitored in this year
monitor service activity,
practice and identify opportunities
which will provide an indication of quality and
compliance with standards and
for further service improvement.
safety have been revised. The NNNI KPI
to underpin quality
Plans should include evidence of full dashboard includes:
improvement work.
utilisation of NIMATS and
Birth location of Preterm infant deliveries < 27
Badgernet.Assurance should be
weeks’ gestation
provided on the collection of data to
Admission temperature of babies delivered
facilitate the regional outcome
under 32 weeks’ gestation
focused dashboards developed for
Breast milk at discharge.
maternity and neonatal care under
Sepsis Screening Completed
the Maternity Collaborative and
% of parents who were seen by a Senior
Neonatal network.
Member of Staff within 24 hours after
admission.
WHSCT TRUST DELIVERY PLAN 2018/19 88
4.
Effective arrangements are in
Trust responses should evidence
The Trust can confirm that regular multi-
place to support
how they are taking forward
disciplinary morbidity and mortality reviews take
G
multidisciplinary learning and
Departmental direction to implement place across each of its service areas as follows:
service improvement through
a child death process which is
Neonatal: Altnagelvin has monthly morbidity
regular multi-disciplinary
based on multi-disciplinary mortality
meetings and mortality meetings when required.
morbidity and mortality review.
review. Trust responses should
South West Acute Hospital has quarterly joint
detail how the multi-disciplinary
morbidity/mortality meetings.
aspect of this is being developed.
Paediatrics: monthly Trust-wide paediatric
morbidity meetings are held when required (ie
following a child death). Trust-wide paediatric
mortality meetings take place twice yearly.
Learning is shared with staff.
Obstetrics
: regular Trust-wide meetings are held
with obstetric, paediatric and where relevant
anaesthetic staff.
Gynaecology: meetings are less frequent due to
lesser frequency of morbidity and mortality in this
area.
All child death reviews are also brought for
discussion to these meetings. The Trust aim to
improve the attendance at these meetings so that
they are more multi-disciplinary focused and that
there is evidence of the shared learning being
cascaded throughout the departments
WHSCT TRUST DELIVERY PLAN 2018/19 89
5.
Effective arrangements should
Trust responses should
The regional Antenatal care pathway is actioned
be in place to ensure that the
demonstrate how they will
and is ongoing. One of the EITP work streams
G
agreed regional antenatal care
implement the agreed regional care
‘Getting ready for baby’ is now being rolled out
pathway is delivered. This
pathway for antenatal care for
Trust-wide and is to become part of normal
pathway, developed by the
women with low risk pregnancies.
business. This project offers all first time mothers
Maternity Strategy
the opportunity to come together with other ladies
Responses should evidence how
Implementation Group, is
at the same stage of pregnancy for group based
they are taking forward antenatal
designed to promote a healthy
education. Although this has been advocated for
group-based care and education.
pregnancy and improve
low risk pregnancies the group education
outcomes for mothers and
Responses should also evidence
sessions are being offered to all first time
babies – including a reduction
that Trusts are implementing
mothers in the Trust.
in low birth weight – through a
UNICEF Baby Friendly Initiative
range of actions including
Standards.
In January 2017 the ‘Saving Babies Lives’ care
reducing smoking and high
bundle was introduced Trust-wide. This allows
quality antenatal care.
women to be identified at their booking if they
should be on a consultant led or midwife led
pathway.
6.
Effective arrangements should
Trusts should also demonstrate how
A joint diabetic clinic for women with
be in place to ensure that
they will deliver services to meet the
gestational and insulin dependent diabetes is
G
women with more complex
needs of more complex
in place in Altnagelvin Hospital. SWAH has
pregnancies are offered the
pregnancies.
a joint clinic for women with gestational
best possible care in line with
diabetes while women who are insulin
Responses should evidence:
national evidence based
dependent are referred to the Altnagelvin
guidelines.
• Recent investment in ante-natal
Hospital clinic. A quality Improvement
diabetic services.
project is taking place in Altnagelvin this year
to improve the pathway for women with
• Plans to implement the ‘Weigh to
WHSCT TRUST DELIVERY PLAN 2018/19 90
a Healthy Pregnancy’ programme
gestational
diabetes.
This
is
a
targeting women with a BMI of
multidisciplinary project.
>40.
The ‘Weigh to a Healthy Pregnancy’
programme continues across the Trust and is
• Progress in implementing the
now accepting referrals of women with a BMI
NICE guidelines on multiple
of 38 or above.
pregnancies, including the
Dedicated ‘twin clinics’ are in place across
delivery of dedicated ‘twin clinics’.
the
Trust.
Women
pregnant
with
• Plans to implement the regional
monochorionic twins are cared for at
care pathway for women with
Altnagelvin Hospital only.
epilepsy.
The Trust will continue to work with
Commissioners on the development and
implementation of pathways for and epilepsy
care.
7.
Effective arrangements should
Trusts should continue to work with
In South West Acute Hospital, an early
G
be in place to offer early
the HSCB/ PHA on the development pregnancy pathway has been introduced and
pregnancy assessment
and implementation of early
agreed between GPs, Emergency Department
pathways for women.
pregnancy assessment pathways
and Obstetrics and Gynaecology staff to ensure
based on NICE guidelines.
compliance with the recommendation. A nurse
led early pregnancy clinic, (EPC) is in place
Monday-Friday 9-5.
In Altnagelvin, an EPC is held Monday-Friday
every afternoon, although it is medical led. There
are plans to review and extend the hours of the
EPC in Altnagelvin.
WHSCT TRUST DELIVERY PLAN 2018/19 91
8.
Effective arrangements should
Trusts should provide direct access
Paediatric assessment units are in operation
G
be in place to offer short stay
to senior decision makers to support adjacent to the children’s wards on both acute
assessment and ambulatory
primary care in the management of
hospital sites. The Altnagelvin unit operates an
models of care in all paediatric
acutely unwell children. Trusts
extended day during periods of peak escalation
units. These should be
should have arrangements for same and recruitment to all vacant posts is being
available during times of peak
day and next day assessment of
actively pursued to enable these hours to be
demand.
children where this is deemed
honoured every day. The South West Acute
appropriate.
Hospital unit operates 4 days a week and it is
planned to increase to 5 days up to 8pm in the
first instance as a result of transformation funding
to finance nursing hours.
9.
Effective arrangements should
Trust should put in place effective
A regional ‘in-utero transfer form’ has been
G
be in place to ensure that there
processes to monitor the number
implemented and is available. It is to be
is appropriate monitoring of
and care pathway for in-utero and
completed when there are transfers between
transfers to the RoI that take
ex-utero transfers from NI to the RoI trusts and ROI hospitals. A copy of this form is
place because of capacity
that take place due to lack of local
sent to the CCaNNI Office for monitoring
constraints.
neonatal capacity.
purposes. These figures are discussed and
reviewed at the maternity collaborative and the
Data collected should be collated
neonatal network meetings.
regionally and reviewed jointly by
the Maternity Collaborative and the
Neonatal Network.
10.
Effective arrangements should
Trust responses should evidence
The Trust can confirm that the additional AHP input
G
be in place to ensure that
how recent investment in AHP
has
been
deployed
within
NNICU
and
opportunities to offer early
services for neonatal units is being
complements
the
nursing
and
medical
intervention and prevention of
deployed and how they will ensure
developmental care already established within
WHSCT TRUST DELIVERY PLAN 2018/19 92
long term disability by
that the input will focus on
the NICU. The introduction of a dietician is
enhanced therapy services in
neurodevelopment and nutritional
beneficial in terms of monitoring growth and
neonatal units are realised.
support.
meeting the nutritional needs of the neonate.
11.
Effective arrangements should
Trusts should continue to work with
An identified consultant within the WHSCT has
G
be in place to care for women
the PHA and HSCB to standardise
slots available at his Gynaecology clinics to see
who have recurrent
and implement an agreed clinical
women who have recurrent miscarriage (ie
miscarriages
pathway for women who have
women who have 3 or more consecutive
recurrent miscarriage.
miscarriages. The Trust will continue to work
with the PHA and HSCB to standardise and
implement an agreed clinical pathway.
12.
Effective arrangements should
Trust responses should
The Trust can confirm that both its children’s
A
be in place to ensure children
demonstrate that their paediatric
wards now admit children up to their 16th
and young people receive age
services can accommodate children birthday. Altnagelvin moved to this position from
appropriate care up to their
up to their 16th birthday.
February 2018. Age appropriate care is one of
16th birthday.
the recommendations of the Inquiry into
Trust responses should also
Hyponatraemia Related Deaths (IHRD) report
demonstrate how they ensure that
and a protocol is being developed for the Trust.
children’s care is supported by all
A sub- group of Nursing Assistant Directors are
specialties and support services
tasked with identifying the areas within the Trust
required to provide high quality and
that need to do further work to ensure that this is
safe care only transferring to the
totally
achieved.
There
are
other
regional centre to access a tertiary
recommendations within the IHRD report (10-30)
service.
relating to clinical care of children, and there is a
Trusts should also describe how
regional working group (with medical and nursing
they will ensure that children aged
representatives from paediatrics) reporting to the
DoH on these recommendations.
WHSCT TRUST DELIVERY PLAN 2018/19 93
up to their 16th birthday, who are
admitted to hospital, are cared for in
an age appropriate environment by
staff with paediatric expertise with
input from paediatricians where
necessary.
13.
Effective arrangements should
Trusts should demonstrate how
The Trust have an information system (Alamac)
be in place to ensure that
antenatal, postnatal and neonatal
that allows staff in postnatal wards to record the
G
mothers and babies are not
services aim to prevent avoidable
number of babies that are receiving IV ab’s or
separated unless there is a
admissions to neonatal units and
other indicators that may be classified as
clinical reason to do so.
paediatric services.
transitional
care.
These
are
babies
that
previously may have required an admission to
Whilst funding has not been
Neonatal. Regional audits are being repeated on
identified, Trusts should continue to
all postnatal wards, to capture the information on
work with PHA and HSCB to scope
babies receiving care on the postnatal wards that
out the requirement for transitional
fits with transitional care.
care and outreach services.
14.
There would be an opportunity
Trusts should demonstrate plans to
The Trust continue to support staff undertaking
to enhance skill mix further with work with PHA and HSCB to scope
their maternity support worker training and will
G
the appointment of additional
out the requirement for additional
need to recruit 3-4 staff per year over the next 2-3
maternity support workers to
maternity support workers and how
years to achieve the skill mix required. This
work alongside midwives to
they could be best utilised to
however will require some further funding. The
support mothers
support services.
Trust will work with PHA and HSCB to scope out
this requirement.
WHSCT TRUST DELIVERY PLAN 2018/19 94
FAMILY AND CHILDCARE (13)
R
A
G
2
11
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1.
Effective arrangements should
Trust responses should
Regional Managed Care Network meetings are
be in place to implement the
demonstrate plans to contribute to
now
held
regularly
and
attended
by
G
Managed Care Network for
the development and establishment
representatives from WHSCT CAMHS. HSCB
Children and Young People
of a Managed Care Network for
funding (temporary) has been approved and IPTs
with Acute and High Intensity
Acute CAMHS which includes
are being finalised. Recruitment to Clinical
Care Needs as recommended
Secure Care, Youth Justice and
Director and Coordinator is to commence.
by the independent review into
Forensic CAMHS to deliver a more
CAMHS Inpatient Services
consistent service across the region
and equitable access to acute
services.
2.
Effective arrangements should
Trust responses should detail their
The Marshall regional action plan has been fully
G
be in place to prevent the
reporting arrangements to the
implemented
within
the
Trust.
Monthly
increasing threat of Child
HSCB in relation to the regional
operational meetings take place between the
Sexual Exploitation (CSE) as
action plan.
PSNI,
Residential
Care
Managers
and
identified by the Marshall
Community Fieldwork Managers. Information is
Inquiry.
shared at these meetings to ensure all
appropriate actions are taken to safeguard
children and young people identified as being at
WHSCT TRUST DELIVERY PLAN 2018/19 95
risk of CSE. The Trust also holds quarterly
operational meetings to review the practice in
regards to CSE and attend strategic planning
meetings with senior personnel from the PSNI
and Juvenile Justice every six months.
CSE
continues to be a priority for the Trust.
3.
Effective arrangements should
Trusts responses should
Within the last year the SBNI have revised and
G
be in place to safeguard
demonstrate plans to
launched new child protection policy and
children and promote their
procedures for Northern Ireland which have been
• provide effective safeguarding
welfare in line with Co-
implemented throughout the Trust. Through the
services
operating to Safeguard
monitoring of child protection case conferences,
Children (2017).
• ensure robust HSC child
team health checks, case file audits and line
protection processes are in place management supervision the effectiveness of
• ensure safeguarding policy and
practice is continually monitored.
procedures are in place relating
to referrals, assessment, service
planning, case management and
record keeping
• monitor and audit effectiveness of
policy, practice and service
provision in achieving specified
outcomes for children and young
people.
• to ensure access to an effective
range of therapeutic supports
based on assessed needs.
WHSCT TRUST DELIVERY PLAN 2018/19 96
4.
Effective arrangements should
Trust responses should
Within the Western Trust, CAMHS are currently
be in place to improve data
demonstrate how they will use
developing a strategy for Clinical Outcome
G
collection in CAMHS services
information to assess the
Measurements which when implemented will be
to capture need, demand
effectiveness of CAMHS and
collated through a revised regional data template.
activity, outcomes and service
evaluate outcomes, fully implement
The Trust is also in the process of implementing
user experience.
CAPA and ensure effective case
CAPA. Job plans are now complete, electronic
management in line with NICE
diaries have been set up and a skills matrix has
guidance.
been completed which will inform future
Trusts responses should
training/development across the service.
demonstrate plans to strengthen
CAMHS staff have availed of HSCB funded
NICE approved Psychological
Psychological Therapy Training since 2015 and
Therapies to include a skills
now have staff training in CBT, Family Therapy
analysis and workforce plan to
and Psychotherapy.
identify gaps in the delivery of
evidenced based therapies and skill
Some of the actions which WHSCT CAMHS have
mix requirements to deliver a range
taken forward as a result of the Sensemaker
of therapeutic interventions.
Audit include:
-
Single Point of Entry had now been
developed across CAMHS, ASD, Children’s
Trusts should demonstrate how the
ID/LD and Community Paediatrics.
findings from the Sensemaker Audit
-
CAMHS in collaboration with VOYPIC and
on service user experience of
young people have developed an information
CAMHS will drive any required
leaflet and DVD for WHSCT CAMHS.
service improvements.
-
CAMHS have also developed an information
booklet titled ‘Think About These’ which will
provide information on supports available to
WHSCT TRUST DELIVERY PLAN 2018/19 97
families whilst they prepare for their
appointment with CAMHS.
5.
Effective arrangements should
Trust responses should
The demand and complexity of children and
be in place to appropriately
demonstrate how service provision
young people presenting with complex healthcare
A
manage the increasing number
will meet the needs of children with
needs and challenging behaviour continues to
of children with complex health
complex health care needs and
increase. The needs of each case are individually
care needs and challenging
challenging behaviour.
assessed, however the carer support required is
behaviour.
increasing and the current level of demand has
resulted in the Trust incurring an unfunded
pressure in this area.
A review is currently ongoing within Children’s
Disability Services to ensure current service
provision is meeting the needs of the children and
young people presenting to access services.
The number of children with complex health care
needs who have transitioned has demonstrated
that there is a need for good governance and
robust arrangements to be in place in respect of
‘delegation of tasks’ to those caring for these
children. Women and Children’s services are
working closely with District Nursing/Adult
Learning Disability and Physical Disability to seek
alternative solutions so that there are no gaps in
care as children reach the age of transition.
WHSCT TRUST DELIVERY PLAN 2018/19 98
6.
Effective arrangements should
Trusts responses should
The Trust has introduced a Corporate Childrens
be in place to appropriately
demonstrate how:
Panel which is chaired by an Assistant Director
G
manage the increasing number
and all Heads of Service attend. The Trust has
• criteria will be set to ensure
of Looked After Children (LAC)
recently reviewed all places in fostercare to
children become looked after
entering the system.
ensure that all places are being effectively
where there is a clear indication
utilised. The Trust hopes to begin work with
that their long term outcomes
Kinship Care NI through the innovation fund to
will be improved or removal is
look at all kinship placements over 2 years with a
required in order to safeguard
view to assessing for the possibility of granting
the child/young person;
Residence Orders. The Trust has recently
• initiatives will be put in place to
revamped its residential childcare provision which
increase the number of
has meant that one children’s home is adopting a
placements and specify how
‘no wrong door’ approach, this will also assist
these will be provided;
with intensive support packages for children
• support will be provided to
deemed to be on the edge of care. However due
young (16/17 year olds),
to demand, the looked after service continues to
homeless individuals who are
be under great pressure and the Trust continues
seeking to achieve a safe,
to have difficulty in meeting the differing needs of
stable return to a family;
children entering the fostercare arena.
• Specialist Therapeutic Foster
Carer placements in keeping
with the needs of children and in
line with regional criteria will be
provided which will be monitored
as part of the DSF process;
• appropriate safeguarding
measures will be put in place for
WHSCT TRUST DELIVERY PLAN 2018/19 99
extra-ordinary placements;
• intensive edge of care
interventions and family support
will be provided to enable
children to remain within their
families where this is in the
child’s best interest.
• required volumes of service
activity for 2018/19 will be
delivered.
7.
Effective arrangements should
Trust responses should
The Trust has a Placement under Pressure Panel
be in place to ensure the
demonstrate a reduction in
to ensure that effective and timely supports are
G
stability of mainstream care
unplanned care placement moves
provided to ensure permanency within our foster
placement arrangements for
for children in care and use of
care arena, we utilise our relationship with Extern
children in care
effective interventions to deescalate to support placements in line with their assessed
crisis and prevent moves for
needs. The Trust has managed to decrease the
children in care, particularly into
number of fostering breakdowns over the last few
high end regional facilities
years.
8.
Effective arrangements should
Trust responses should
The Trust has established a Corporate Children’s
G
be in place to appropriately
demonstrate plans to ensure that
Panel to replace the Children’s Resource Panel;
manage the increasing number
admissions to care are planned and
this panel approves all children’s placements. A
of unplanned/emergency
children are provided with
practice note was issued in May 2018 in relation
placements where children are
placements matched to their
to the kinship process which it is hoped will
known to a Trust.
assessed need to provide stability
reduce unplanned emergency placements. The
and continuity.
Family Group Conference Service continues to
play a key role in respect of these placements.
WHSCT TRUST DELIVERY PLAN 2018/19 100
9.
Effective arrangements should
Trust responses should
The Trust achieved 86% of children within the
be in place to ensure a
demonstrate how effective
Looked After Service with no placement move
G
seamless care pathway for LAC arrangements are in place to ensure within the year 2017/18. The Trust continues to
which promotes stability and
a stable care pathway for LAC
review the stability and permanency of Looked
permanency for children.
(where placement moves are kept
After children as a priority, the Corporate
to an absolute minimum) and to
Childrens
Panel,
the
Permanency
Panel,
deliver permanency for them within
Placements under Pressure Panel and the Team
the quickest possible timeframe.
Around the Family Model of Practice all
contribute to ensuring a stable and permanent
Trusts should have effective
environment for children.
arrangements and monitoring
should be put in place to ensure
LAC have plans for and can achieve
permanence in line with the agreed
policy. Trusts should also report on
challenges to achieve these and
plans to address these.
10.
Effective arrangements should
Trust responses should
The Trust has reviewed the Permanency Panel
be in place to ensure that
demonstrate how robust
with emphasis on reviewing care plans to ensure
G
children’s care plans explicitly
assessments (in keeping with policy that there is no drift in care planning. We adhere
state what is to be achieved by
and procedures) will be undertaken
to the Regional Permanency Policy.
the admission to care, the child
for all children who are to return
and young person’s views
home, enabling the Trust to
about their care plan, what is
determine the feasibility of such a
expected from parents in order
move and to identify any support
for the child to return home and required to maintain the placement
the anticipated duration of the
and discharge any existing Care
WHSCT TRUST DELIVERY PLAN 2018/19 101
placement.
Order. This assessment should
outline how the child/young person’s
views have been taken into account
in agreeing the care plan.
11.
Effective arrangements should
Trust responses should
The Trust continues to perform well in relation to
G
be in place to manage an
demonstrate how recent
GEM and will ensure that any additional funding
increasing number of children
investments will ensure equitable
is utilised to ensure that appropriate young
who are looked after, those
access by all young people in foster
people have access to GEM in line with eligibility
who are placed in kinship and
care to avail of GEM.
and assessed need. As of 25.7.18 the Trust has
non-kinship foster care, in
64 care leavers in the GEM Scheme.
keeping with the provisions and
entitlements of GEM
12.
Effective arrangements should
Trust responses should
Within the WHSCT Children’s ASD services,
be in place to meet the
demonstrate plans to address
existing provision has been reviewed and aligned
A
increasing demand for Autism
autism waiting lists in line with the
to ensure the most effective use of the resources
Services to include the creation Autism Access Standard and
available. The demand for autism assessment,
of an integrated care system for support the development of an
support and intervention for children has
Children, Young People with
integrated service model to include
increased significantly in recent years and this
Developmental, Emotional and
assessment, early intervention,
trend continues. During 2017/18 there was a
Mental Health services.
diagnostic and transitional services.
22% increase in referrals for Children’s ASD
Services and during the same period there was a
78% increase in the number of completed
assessments for diagnosis. There was also a
77% increase in referrals for intervention
reflecting a considerable growth in demand on
the service overall.
WHSCT TRUST DELIVERY PLAN 2018/19 102
The Children’s diagnostic assessment process is
multi-disciplinary and in line with National Institute
for
Health
and
Care
Excellence
(NICE)
guidelines. The time taken to complete the
assessment process is variable and a diagnostic
decision can be made when it is clinically
appropriate to do so. Within Children’s services
the Trust recently embarked upon a service
improvement
initiative
with
Community
Paediatrics
in
relation
to
the
diagnostic
assessment process through sharing of the
neurodevelopmental history for those children
referred from this referral source.
The Autism service is currently revising the
Transitions protocol for children transitioning to
adult autism services, in conjunction with the
Trust's Transitions Protocol.
13.
Effective arrangements should
Trusts should demonstrate plans to: The WHSCT CAMHS Crisis Team became
be in place to manage the
operational on the 12 March 2018 which
G
• Demonstrate the management
increasing demand in CAMHS
promotes effective interfaces between acute
of service demand
and the continued
services and CAMHS. The team is comprised of
implementation of the stepped
• Improve interface arrangements a Band 7 lead and 5 Band 6 clinicians, providing
care model focusing on:
between CAMHS acute and
a CAMHS Crisis response service across the
improvement of the interfaces
community care, secure care
Trust area from 9am to 5pm. This development
between acute and CAMHS
and with Youth Justice
has been a key restructuring of the service in
community care including
• Integrate CAMHS, Autism and
keeping with the stepped care model and the
WHSCT TRUST DELIVERY PLAN 2018/19 103
secure care and Youth Justice;
ADHD services to ensure
objective to provide a specialist tiered service to
integration of CAMHS and
effective access based on
families based on their level of need.
children’s neurodevelopmental
assessed needs to children,
CAMHS have established a Single Point of Entry
(autism and ADHD) provision.
young people and their families
supported through the development of an ECR
• Ensure implementation of the
referral form for GP’s to refer electronically.
CAMHS Integrated Care
Pathway (March 2018)
Single Point of Entry had now been developed
across CAMHS, ASD, Children’s ID/LD, Rise and
Community
Paediatrics
which
support
multidisciplinary
discussion
and
integrated
decision making regarding children known to 2 or
more services with more appropriate and timely
referral on to the next appropriate service
needed.
The CAMHS Integrated Care Pathway Booklets
and leaflets have now been developed and have
become operational and WHSCT CAMHS have
distributed these across their teams.
The Childrens Disability review is ongoing
WHSCT TRUST DELIVERY PLAN 2018/19 104
CARE OF THE ELDERLY (13)
R
A
G
6
7
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1.
Effective arrangements should
Trust responses should
The WHSCT are on a journey to ensure an
be in place to ensure the
demonstrate plans to promote the
integrated approach to ASG practice which is
G
implementation of requirements development of the Adult Protection
underpinned by the principles of the Regional ASG
contained in Adult
Gateway model.
policy.
This
is
being
achieved
through
Safeguarding and Protection in
development of the LASP and Trust ASG forum,
Partnership (2015).
training and development opportunities based on
the Regional framework (core IO/DAPO training,
multi-disciplinary practitioner forums, targeted
training e.g. Safeguarding Service User finances
with providers and staff) and development of an
Adult Safeguarding Champions Peer Support
Network. This highlights a whole systems
approach with all key stakeholders to ensure
consistent
messages
are
shared
around
integration of the policy. There are also Quality
improvement Initiatives ongoing such as use of
Advice and resolution and a more personalised
response to ASG concerns through Signs of
Safety. The Adult Protection Gateway Model
WHSCT TRUST DELIVERY PLAN 2018/19 105
remains in place and continues to grow with
recruitment
in
progress
for
Quality
and
Governance
Support
Officers
to
enhance
monitoring, quality and safety with contracted
providers (Care Homes) in line with the Policy.
Whilst these measures are in place it needs to be
highlighted that this is a journey for the Trust and
work will continue to ensure the requirements of
the policy are met and core principles embedded.
2.
Effective arrangements should
Trust responses should
There are a number of initiatives in place and
G
be in place to further develop
demonstrate plans that engage with
being developed including:
ICP initiatives targeted at frail
the range of integrated care
older people.
initiatives/projects designed to
Extension of acute care at home
maintain older people in the
Development of falls service, with falls co-
community.
ordinator in post
Frailty pilot in Primary Care
Review of dementia pathway
NIAS falls pathway has been successful with
OPALS
Extension of ESD Stroke service
3.
Effective arrangements should
Trust responses should outline
The Trust is implementing the Stepped Care
G
be in place to provide a
plans to work with ICPs to
service model. Training on dementia continues to
standardised model for the
implement the New Stepped Care
be provided to a wide range of primary care staff,
delivery of services to older
Model for Older People and for
voluntary and community groups. A number of GP
people and individuals with
people with dementia.
practices and community groups are being
dementia.
supported to become dementia friendly. The Trust
WHSCT TRUST DELIVERY PLAN 2018/19 106
has also supported a number of community groups
to establish EDEN clubs for people with
mild/moderate dementia.
The Trust was involved in the development of the
regional dementia care pathway. A business case
is now being submitted to the DOH for the
implementation of the pathway. The Trust is
currently developing a costed proposal for the
business case.
Dementia and Memory Services are also a key
theme within the Integrated Care Pathway for Frail
Older
People.
In
the
context
of
this
primary/secondary care local collaboration, links
between Dementia and Frailty interventions will
continue to be developed within a wider reform
system of Effective Integrated Care.
4.
Effective arrangements should
Trust responses should
The Trust was involved in the development of the
be in place to optimise capacity demonstrate plans to work within
regional dementia care pathway. The pathway
A
to meet the number of people
the regional strategic
aims to optimise capacity to meet the projected
with dementia which is
implementation arrangements to
increase of numbers of people requiring memory
projected to increase by 35%
develop early intervention models
assessment. A business case is now being
by 2025.
and timely access to memory
submitted to the DOH for the implementation of the
services.
pathway. This will include a 3 to 5 year
implementation plan.
WHSCT TRUST DELIVERY PLAN 2018/19 107
The Trust is currently developing a costed
proposal for the business case. This will take into
account the projected increase in people with
dementia.
The dementia navigator service has been in place
for some time and provides a highly responsive,
individualised information and signposting service
to people with a diagnosis of dementia. Recurrent
funding has been secured in 2018 for the dementia
navigator service, two service improvement leads,
and a number of dementia companions for the
acute hospitals
5.
Effective arrangements should
Trust responses should
The Trust has developed an IPT response which if
A
be in place to address the issue demonstrate plans to ensure
supported will utilise the Trust’s homecare
of delayed discharges from the
capacity within the community
reablement team rotas to support all hospital
acute sector and other
/domiciliary sector to accommodate
discharge pathways requiring care up to 6 weeks.
institutional settings due to the
timely hospital discharge.
This will provide a timely discharge pathway and a
non-availability of independent
period of time during which long term care can
sector community based
either be brokered or arranged through which ever
services especially domiciliary
SDS option the service user wishes to avail of.
care.
The Trust has now completed the recruitment to all
its reablement teams and will operationally deploy
a mixed rota of core homecare and reablement to
provide a locality sensitive model in more remote
rural areas.
WHSCT TRUST DELIVERY PLAN 2018/19 108
6.
Effective arrangements should
Trust responses should
The Trust has developed its IPT response for the
be in place to support services
demonstrate plans to expand and
enhancement of intermediate care and will ensure
A
for carers that can be
promote the assessment of needs
the carer support funding made available through
developed to maintain
and the availability and uptake of
this initiative is targeted effectively to support
individuals to live as
short breaks.
carers during any initial crisis period utilising social
independently as possible in
work staff to ensure a full carers assessment is
their own home.
offered and a support plan established to ensure
the carer is supported in their caring role as it
continues.
7.
Effective arrangements should
Trust responses should
The Trust is currently reviewing its current
A
be in place to review existing
demonstrate plans to review existing configuration of day care services to consider how
day opportunities for older
day care provision to make best use to make best use of resources which may involve
people to ensure that they meet of resources.
the amalgamation of facilities where there are low
current needs and
levels of attendance.
expectations.
The facilities are also being assessed to ensure
RQIA standards are being met. This is dependent
on capital funding being available.
8.
Effective arrangements should
Trust responses should
Reablement rotas in Lisnaskea, Belleek, Belcoo
be in place to support the full
demonstrate a review of local
and Garrison have now all been recruited to and
G
implementation of the regional
progress with reablement, in line
these will be operational by the end of Q2. The
model of reablement.
with the regional model and targets.
Trust’s reablement model is delivering well against
regional and national KPI’s as evidenced in the
National Audit of Intermediate Care 2017
9.
Effective arrangements should
Trust responses should
The Trust is actively reviewing block rota utilisation
G
be in place to optimise recent
demonstrate plans to deliver the
across its In-House and Contracted service
WHSCT TRUST DELIVERY PLAN 2018/19 109
demography funding to meet
recent investment in demography to
provision. Improved utilisation will improve the
domiciliary care demand and
meet the needs of the aging
timeliness of response to address assessed need.
wider demographic demand.
population.
The Trust will also be reviewing the number of
cases where 2 carers are currently allocated to
provide care to ensure this is in keeping with the
service users risk assessment. It is anticipated
that this review will also yield additional capacity to
be re-deployed against new or unmet need.
10.
Effective arrangements should
Trust responses should
A Falls co-ordinator has been appointed who is
be in place to optimise capacity demonstrate plans to actively
working across primary and secondary care
A
to support the numbers of
promote a range of healthy ageing
towards establishment of a falls service. The PHA
people aged over 65 and over
initiatives in areas such as
also provide funding to enable the development of
85 which are projected to
promoting good nutrition, social
health and wellbeing plans for older people aimed
increase by 12% and 22% by
inclusion and falls prevention.
at reducing social isolation and in 2018/19 will also
2022 respectively, to maintain
fund a programme aimed at re-connecting older
healthy lifestyles.
people which will include programmes to promote
physical activity and nutrition.
11.
Effective arrangements should
Trust responses should
The Directorate is undertaking a review of its
be in place to support an
demonstrate a commitment to
statutory residential care services to ensure the
A
appropriate balance of services remain engaged with both the
current facilities meet RQIA standards, but this will
between the statutory and
current reform of statutory
require extensive capital funding.
independent sectors in relation
residential care, domiciliary care
The Excellence in Community Care project
to domiciliary and residential
and the Reform of Adult Social
continues to move forward with the reform of adult
care.
Care. These projects are seeking
social care.
the most appropriate balance and
focus of statutory/independent
WHSCT TRUST DELIVERY PLAN 2018/19 110
sector domiciliary and social care
provision.
12.
Effective arrangements should
Trust responses should
The Trust’s 6 residential support beds in one of its
be in place to support the
demonstrate review options for
statutory residential homes were extended during
G
development of
remodelling existing provision or
2017/18 as demand required and at one stage, 17
intermediate/step down care to
developing new services to increase beds were being utilised to support hospital flows.
relieve pressures on acute care availability of these services.
The Trust will continue to provide this service
and promote rehabilitation.
during 2018/19. Negotiations are also on-going
with an independent provider to replicate the
service model in the southern sector of the Trust.
13.
Effective arrangements should
Trust responses should
As detailed in the response to CPD at 5.2.
be in place to ensure the
demonstrate plans to deliver
G
promotion of personalisation
progress with the regional project
through Self Directed Support
implementation targets to optimise
to increase individual choice
opportunities for services tailored to
and facilitate responsive
user needs and include the training
remodelling of service models.
and development needs of staff.
WHSCT TRUST DELIVERY PLAN 2018/19 111
MENTAL HEALTH (10)
R
A
G
1
9
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1.
Effective arrangements should
Trust responses should
Funding has been made available to enable the
A
be in place to improve the
demonstrate how they will develop
Trust to progress medical monitoring when patients
physical health care of people
medical monitoring and physical
are undergoing refeeding programmes, including:
with serious mental illness
health care support for people
undergoing treatment for an eating
Undertaking tests (blood, BP, ECGs, other);
disorder. The Trust should also
Reviewing results (basic results review -
demonstrate how they are
identification of abnormal results; maintain all
supporting people with long term
results
in
appropriate
database;
mental health conditions to support
communicating results to psychiatric, medical
their physical health outcomes.
and primary care as appropriate;
Managing abnormal results. (Non-complex
case management - undertaken in partnership
with primary care and secondary care
colleagues as appropriate).
This will also support the implementation of
Management of Really Sick Patients with Anorexia
Nervosa (MARSIPAN) and Junior MARSIPAN
guidelines in medical wards.
WHSCT TRUST DELIVERY PLAN 2018/19 112
The Trust is in discussions regionally to ascertain
best practice model to roll out. When in place this
will enhance the existing community Eating
Disorders Team.
2.
Effective arrangements should
Trust responses should
When the new Mental Health Services Framework
G
be in place to provide evidence
demonstrate what measures are in
is issued, the service will work closely with the
of the impact on all mental
place to ensure that an annual
Trust’s performance management team to ensure
health services.
comprehensive analysis will be
that effective processes are in place to monitor and
provided in line with the indicators
analyse the indicators included in the Framework.
set out in the new Mental Health
The ‘You In Mind’ (YIM) mental health care
Services Framework and that this
pathway was launched in October 2014. The
will include an overview of
document has been piloted and the Home
presenting need, the volume of
Treatment Teams in the Trust were involved in this
interventions provided, the
pilot. The responses have been returned to the
outcomes achieved and the quality
of people’s experience of using the
PHA and the HSCB. A working group has been
developed to progress the Personal Well Being
services.
Plan. Regional Informatics is revising the Service
Framework II standards to support implementation
and monitoring including regional coding. The
Trust’s Service Improvement Manager for adult
mental health is involved in this work. The Trust
has, in line with other Trusts, set up a local Trust
YIM oversight group which will mirror the Regional
Oversight Group.
WHSCT TRUST DELIVERY PLAN 2018/19 113
3.
Effective arrangements should
Trust responses should
Funding has been confirmed to enable delivery of
G
be in place to ensure that
demonstrate what specific
10 day workshops to continue the work of
people with mental health
measures will be taken in 2018/19
embedding the Regional Health Care Pathway
needs and their families receive to further embed the Regional
within the role and functions of Community Mental
the right services, at the right
Mental Health Care Pathway and to
Health Teams. The Adult Mental Health Service
time by the right combination of strengthen the provision of
alongside the CEC and service users has delivered
professionals.
psychological care within the role
training to 100 staff across trust.
and function of Community Mental
The trust Service improvement Manager along with
Health Services.
the CIS Team, ICT Services, WHSCT is in the
process of having the YIM “getting the most of your
appointment” document onto all appointment
letters sent out to Service Users of the Adult
Mental health Service.
4.
Effective arrangements should
Trusts should participate proactively The Trust has developed a plan to increase access
G
be in place to improve the
in the review of acute mental health
to psychological approaches for service users and
effectiveness of Acute Inpatient care pathway to ensure regional
psychological formulation, training and reflective
Services through the provision
consistency with best practice
supervision for staff by proposing to recruit two
of modern therapeutically
benchmarks and standards.
psychologists for adult mental health acute
focused inpatient care to
inpatient/crisis services across the Trust.
safeguard those people who
The Trust has representatives who attend regional
are experiencing acute mental
meetings
on
MHACP
and
regional
bed
health needs.
management. This is fed back through SPNG for
team managers to disseminate information via a
structured monthly timetable which includes crisis
service development meetings, crisis service
managers meeting, weekly staff meetings, clinical
WHSCT TRUST DELIVERY PLAN 2018/19 114
microsystems which is our main driver, quality
improvement
which
includes
service
user
participation,
reflective
practice
groups
and
mandatory training/journal clubs.
5.
Effective arrangements should
Trusts should support the
Recovery Colleges continue to be available
G
be in place to strengthen
development of peer led self-
widely within the Western Trust with increasing
approaches to support people
sustaining relapse prevention
numbers. A variety of co-produced educational
on their recovery journey in line groups and family carer support
courses promoting well-being and recovery are
with the principles and
groups
offered to everyone and are delivered in a range
objectives of the Regional
of easily accessible facilities, i.e. libraries,
ImROC Programme.
community centres and art centres.
New courses are co-produced every term, the
most recent being coaching skills for Health &
Wellbeing, Asserting Yourself and Exploring
your Options.
Recovery College provided training on the
Recovery ethos to Mental Health Day Centres
as part of the recommendations from the Day
Care Review.
Another Recovery College Peer Trainer has
recently graduated with an Advanced Diploma
in Mental Health & Wellbeing Coaching
provided by Mindwise & Kingston College.
The Recovery College took part in the “What
Matters to You” day with a co-produced tree
collecting feedback from students who attend
WHSCT TRUST DELIVERY PLAN 2018/19 115
the college. This proved invaluable and shaped
the forthcoming term’s curriculum in giving staff
an insight into how important the Recovery
College is and how we can continue to improve
student experience.
Another student from the Aspire Programme is
now on placement with the Recovery College.
This employability programme is a joint initiative
with the Trust, Omagh Council and the
Education Authority.
Following
successful
Recovery
College
Roadshows, this is now becoming an annual
event with the Recovery College delivering a
taster session of courses within the inpatient
units both in the Northern and Southern Sectors
of the Trust.
Since October 2017, the Ulster American Folk
Park
(UAFP)
Wellness
Camp
bespoke
programme has been delivered one day a
month in partnership by multidisciplinary trust
staff, service users and staff at the UAFP;
supported by an “Awards for all Northern
Ireland” Big Lottery £10K Grant. A core
working
group
involving
multidisciplinary
members of the recovery mental health team,
Trust recovery college staff, service users and
the community partners of the Ulster American
WHSCT TRUST DELIVERY PLAN 2018/19 116
Folk Park (part of the National Museums of NI)
was formed to design the project. It consisted of
an informal, fun programme of activities based
on the NEF Five Ways to Wellbeing, Connect,
Be Active, Take Notice, Keep Learning and
Give within a valued community location. The
project has seen consistent engagement of
service users throughout who have fed back
regarding the valued opportunity to engage in
new learning experiences and build healthy
relationships within a peer support model.
WRAP courses continue to be offered and co-
delivered with Peer Trainers through the
Recovery College.
Core Groups of “experts by experience”
continue to co-produce and co-deliver courses
and offer input to services at a wider level by
presenting at both Trust and Regional meetings.
The Recovery College is a regular feature in the
curriculum for second year Mental Health
Nursing students at Magee Campus University
of Ulster. A co-produced Resource Book for
the Recovery College and Adult Mental Health
facilities which is being funded by the PHA is
currently in production
Adult Mental Health is currently recruiting a
service user Consultant and two Peer Support
WHSCT TRUST DELIVERY PLAN 2018/19 117
Workers.
“CAWT Project I Recovery Co-ordinators
covering the Derry/Donegal area and the
Fermanagh/Cavan/Leitrim areas continue to
work in close partnership with the Western Trust
Recovery College. The Peer Educator posts
have been recruited and are all awaiting pre-
employment checks with the first due to start on
1st August 2018. Some initial workshops have
run and focused on co-production in this early
stage of the project with co-ordinators visiting
Mental Health Teams in the cross borders areas
to raise the profile of the project and engage
staff.
6.
Ensure the effective provision
Trusts should participate in the
Trusts in NI are continuing to experience pressures
G
of community based Addiction
planned review of community based within Addictions Services. Non-recurrent funding
services to address growing
Addiction services, the outcome of
for 2018/19 has been identified by the HSCB which
demand, including opiate
which should be to ensure that a
will be used in-year to address addiction service
substitute prescribing (Tier 3).
more effective service provision
pressures for core and sub specialisms i.e,
Likewise, in-patient and
model is in place given increasing
recruitment additional staff for both OST services
residential rehabilitation
demand (this will include exploring
and the main Addiction Tier 3 services. The Tier 3
services (Tier 4A & 4B) must be the potential for service coordination services are also working to a regionally agreed
provided within a regional
regionally).
Care Pathway regarding interfaces with Tier 2 and
Network arrangement
Tier 4A and 4B.
A key focus will be the future design
accessible by all Trusts.
of opiate substitute prescribing
The Trust continues to engage in the Regional
services (encompassing appropriate Review of Tier 3 service provision and will continue
WHSCT TRUST DELIVERY PLAN 2018/19 118
harm reduction measures).
working within the regional network to provide safe
Additional investment, being
and effective timely addiction services.
deployed promptly, should be
evidenced through increased
service activity and reduced waiting
times.
7.
Effective arrangements should
Trust responses should
The Assistant Director for adult mental health and
G
be in place to support the new
demonstrate plans to support and
the clinical lead for adult psychological therapies
Regional Mental Health Trauma participate in the development and
have supported the development of the Regional
Network.
implementation of the Network.
Trauma Network (RTN) via membership of the
RTN Implementation group and Care Pathway
workshops. The Trust continues to support the
training of staff on the MSc in CBT Trauma Care
with an additional three members of staff being
released to apply for 2018/2019. A Trust RTN
implementation
group
is
currently
being
coordinated with its initial meeting planned for
September 2018. We are also currently finalising
the Job Descriptions for 3 Trauma Therapist posts
(1 B8A, 2 B7s) within the Trust.
8.
Effective arrangements should
Trust responses should
This is a new development within Forensic
be in place to support the new
demonstrate plans to support the
G
Services. The Trust is represented within the
Forensic Managed Care
development and implementation of
Network. The Trust will identify the training
Network.
the Network including:
needs of the local Forensic Team and consider
the recommended training that will be identified
• advancing training and
by the Forensic Network.
WHSCT TRUST DELIVERY PLAN 2018/19 119
education of the forensic
The CFMHT will continue adhere to the
workforce
Regional Forensic Care pathway.
The CFMHT will be encouraged to participate in
• research and quality
any Regional Audits and will develop services
improvement,
following the outcome and recommendations of
• improving interagency
the Audit.
collaboration and learning from
clinical practice
The Network will serve as an opportunity for
Regional
Forensic
Services
to
develop
relationships and share experiences regionally.
9.
Effective arrangements should
Trust responses should
The Multi-disciplinary forum continues to develop
G
be in place to ensure that the
demonstrate the actions to be taken
and implement its strategy as outlined for
workforce delivering mental
to implement the Mental Health
2017/2018. The strategy remains closely aligned to
health care is appropriately
Learning Together Framework.
the
Learning
Together
Working
Together
skilled
Details of Trusts’ mental health
framework
workforce plans should also be
provided.
10. Effective arrangements should
Trust responses should
Actions to increase access to evidence based
G
be in place to enhance clinical
demonstrate how the range and
psychological therapies are ongoing and in line
and personal outcomes by
scope of psychological therapies will with those outlined for 2017/2018. In addition we
improving access to evidence
be strengthened, including releasing have endeavoured to increase access through
based NICE approved
core mental health staff to avail of
waiting list management strategies. Also we are
psychological therapies
training opportunities to develop
currently exploring possible recruitment and
including increasing the range
skills in various modalities of
retention strategies to increase numbers of
and scope of Talking Therapies psychological therapies and improve qualified psychologists to deliver therapies and
in primary care.
psychological approaches
increase access. Furthermore additional funding is
WHSCT TRUST DELIVERY PLAN 2018/19 120
underpinning mental health
being utilised to endeavour to employ CBT and
treatment.
Psychology agency staff to meet increased
demand for psychological therapies and increase
access in a timely manner.
WHSCT TRUST DELIVERY PLAN 2018/19 121
LEARNING DISABILITY (6)
R
A
G
N/A
1
4
1
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1.
Effective arrangements should
Trust responses should
The Trust is continuing to identify and invest in the
be in place to increase the
demonstrate what specific actions
development and provision of day opportunities
G
number of individuals availing of will be taken to increase the number and remains committed to ensuring individuals
community based Day
of Day Opportunity placements in
have access to mixed packages of care. The five
Opportunities.
partnership with community /
year action plan completed as part of the review of
voluntary / independent sector
day care and day opportunities will shape the
organisations to meet the needs of
necessary workings to facilitate the drive to create
individuals already in services or
increased opportunities and the change of working
coming through transition.
practices in statutory, community and voluntary
sectors.
SDS has been a significant driver in bringing about
an increase in the number of day opportunities,
Trust staff will continue to support individuals who
chose this model.
Trust Community Access Workers are also
providing an essential service to individuals
choosing day opportunities, in many cases they
are
supporting
individuals
to
access
day
WHSCT TRUST DELIVERY PLAN 2018/19 122
opportunities personal to their needs which bring
them into the heart of their communities.
The Trust continues to recognise the need to work
in partnership with other providers i.e. Community
Planning,
Voluntary
and
Public
sector
organisations to explore ways of jointly creating
and offering new day opportunities for individuals.
The workings of the Regional Day Opportunities
Group ensures and facilitates the opportunity for all
Trusts to discuss with other government bodies the
needs of individuals with a learning disability and
provides a vital forum for the development of new
opportunities to be discussed and taken forward.
The Western Trust is an active participant in these
meetings and will continue to work with all involved
to bring about an increase in the number of
individuals availing of community based Day
Opportunities.
2.
Effective arrangements should
BHSCT, NHSCT and SEHSCT Trust The WHSCT has completed resettlement of N/A
be in place to complete the
responses should demonstrate what hospital patients.
resettlement of people from
processes are in place to complete
.
learning disability hospitals to
the person centred resettlement of
appropriate places in the
individuals from learning disability
community.
hospitals into the community, with
appropriate long term support, in
line with recent investments.
WHSCT TRUST DELIVERY PLAN 2018/19 123
3.
Effective arrangements should
Trusts should continue to ensure
Community Learning Disability Nursing Services
G
be place to improve physical
key information gathered through
have been remodelled in line with Strengthening
health care for people with a
the annual health check initiative is
the Commitment and the WHSCT Learning
learning disability.
collated, analysed and shared.
Disability Community Nursing Strategy 2016.
Community nurses focus on health inequalities,
Trusts should participate in the
working closely with primary care to promote
evaluation of the “health passport”
annual screening and appropriate referrals for
for people with a learning disability.
required investigations etc.
There has been a reported increase in the number
Trusts should continue to support
of annual health screenings completed in 2017/18
people with a learning disability to
and systems are in place to identify those who
access mainstream health
have not attended for adults known to Adult
screening initiatives
Learning Disability Services. These individuals will
be targeted for attendance in 2018/19.
The roll out of the regional hospital passport has
been progressed and there has been a reported
increase in the number of adults availing of this in
2017/18.
A range of easy read literature has been
developed to support adults with learning
disabilities access appropriate health services.
4.
Effective arrangements should
Trust responses should
The Trust continues to assess the needs of people
be in place to appropriately
demonstrate how short
for short break provision. However there is a
A
manage people with a learning
breaks/respite will be extended
demand for continued investment across the
disability developing dementia
outside of the traditional model in
programme and this includes short breaks for
WHSCT TRUST DELIVERY PLAN 2018/19 124
and other conditions associated
order to meet the needs of
people with dementia.
with old age including short
families/carers including Dementia
The Trust will engage with the Regional Project to
breaks/respite which are varied
Memory Services and other
develop the model for learning disability services
and flexible in nature.
appropriate services.
where this issue can be the subject of further
discussions and training. Staff will continue to be
encouraged to avail of dementia training and
dementia champions will ensure the issue is
considered proactively at service level.
Information has been shared with HSCB regarding
additionality required to provide more effective
learning disability dementia services.
The Regional Project is slow to make progress and
is inhibiting progress at Trust level. The Trust
promotes dementia training but needs further input
from the region to fully implement the Regional
Learning Disability Dementia Care Pathway.
5.
Effective arrangements should
Trust responses should outline clear This will be achieved for those who can return to
G
be in place for discharge once
protocols, processes and
their community placement. For other more
the patient has been declared
procedures to ensure timely
complex cases, this may prove more difficult and
medically fit for discharge.
discharge from hospital with
therefore will require additional time resulting in a
appropriate support, where required. small percentage of patients missing the 7 and 28
day timeframes. Arrangements for these patients,
who require new community placements to be
developed, are also impacted by the limited
number of community housing options available
WHSCT TRUST DELIVERY PLAN 2018/19 125
and
difficulties
provider
organisations
are
experiencing with recruitment.
6.
HSCB & PHA will work with
Trust responses should
The Trust is working with HSCB and DOH to
people who use services, their
demonstrate plans to work
progress this transformational project in 2018/19.
G
families, Trusts and other
collaboratively with service users
stakeholders to develop a
and to develop a new NI service
regionally consistent service
model for learning disability
model for people with a learning services.
disability.
WHSCT TRUST DELIVERY PLAN 2018/19 126
PHYSICAL DISABILITY (3)
R
A
G
2
1
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1.
Effective arrangements should
Trust responses should
Following significant work undertaken, a Trust
be in place to ensure the
demonstrate plans that ensure
Transitions Protocol (June 2017) has been
A
seamless transition of people
seamless transition for people with
approved. In 2018/19, one child transitioned to
with Physical and/ or Sensory
Physical and Sensory Disability who adult services with a substantial care package
Disability from children’s
are approaching age thresholds for
£120k+. At present there are no other children
services to adult services and
Adult services and Older People’s
identified to transition. Given that within
from adult services to Older
services.
children’s services these children have a
People’s services.
wraparound service for which an equivalent
service is not available within adult services, it is
anticipated that there will be significant pressures
with children transitioning to adult services.
There is therefore a need to ensure earlier
intervention and joint working. Within Physical
Disability, additional funding of £60k was applied
in 2017/18. However, this is not sufficient to meet
the financial requirements and additional funding
has been identified as being required in 2018/19
which it is proposed to allocate via demographic
monies.
WHSCT TRUST DELIVERY PLAN 2018/19 127
2.
Effective arrangements should
Trust responses should
Access
be in place to develop a
demonstrate equitable access to
The Trust is part of the Regional Sensory Support
A
Physical and Sensory Disability
Health and Social Care for people
Network through which standardised approaches
structure/ network which
with Physical and Sensory Disability are being put in place to ensure that those people
facilitates regional, multi-agency including:
with Physical and/ or Sensory Disability are
strategic planning for the needs
empowered to access HSC services. There is a
Access
of people with Physical and/ or
Regional Physical and Sensory Group for
Sensory Disability.
• Trusts to ensure people with
statutory, community, voluntary and independent
Sensory loss/ Disability are
sector providers, as well as service users/
empowered to access HSC
families/ carers in place which is represented
services (i.e. statutory HSC
from the Trust area. As part of the Regional
services and services provided
Physical and Sensory Disability Strategy a
by Community &Voluntary /
regional action plan is being delivered by the
Independent sectors).
Trust and the Trust is represented on Regional
work-streams to complete this work. In addition,
people are supported through Trust service user
• Trusts should ensure
groups and engagement forums.
communication with people with
sensory loss is in an accessible
The Trust has pathways and guidelines in place
format to include appointments,
(i.e. Hearing Loss Pathway, Sight Loss Pathway,
access to interpreting, signage
etc.) which are adhered to in order to ensure
and access to healthcare
communication with people with sensory loss is in
information
an accessible format to include appointments,
access to interpreting, signage and access to
healthcare information.
Buildings
Equipment
• Trusts should ensure all HSC
In relation to equipment there is professional
WHSCT TRUST DELIVERY PLAN 2018/19 128
facilities have visual display units assessments completed to identify the needs of
and hearing loops which are
people with Physical and/or Sensory Disability.
working and ensure HSC staff
Regional procurement arrangements are being
are fully trained in use.
put in place for tendering of the following
equipment, in the interim current arrangements
• Signage in HSC facilities should
are being adhered to in order to ensure timely
meet HSC accessibility minimum
and equitable access of equipment.
standards.
Low vision
Equipment
Lighting
•
Assistive alerting devices
Trusts should ensure equitable
Assistive listening devices
access to equipment (including
Daily living aids
adaptive/ assistive technologies)
Mobility aids
and accessible, age appropriate
accommodation/ care facilities for In relation to appropriate accommodation/ care
people with Physical and/or
facilities, people are currently in nursing home
Sensory Disability.
settings which meet their needs. The Trust
continues to explore alternative appropriate
accommodation/ care facilities which includes
considering adaptive/ assistive technological
solutions through the Regional Sensory Support
Network and Trust service user forum, to enable
people to be supported in their own communities.
Buildings - The WHSCT is committed to
ensuring equitable access to Health and Social
Care for people with Physical and Sensory
WHSCT TRUST DELIVERY PLAN 2018/19 129
Disability.
All new healthcare buildings have hearing loops /
VDU’s installed and have signage which meets
HSC accessibility minimum standards.
The WHSCT has a large and varied estate, and
buildings are selected for refurbishment and
upgrade through a need for service development
or condition, all refurbishment works are
completed
to
best
practice
accessibility
standards.
3.
Trusts and Arm’s Length Bodies Trust responses should
The Trust has mandatory disability training in
should have effective
demonstrate plans to ensure all
place which all staff must complete. The Trust
G
arrangements in place to ensure HSC staff including HSC provider
has contractual arrangements with community,
staff are trained to understand
staff in Community & Voluntary /
voluntary and independent sector providers which
the disparate needs of people
Independent sectors receive
includes that staff must receive mandatory
with Physical and/or Sensory
mandatory disability training.
disability training, this is monitored through Trust
Disability.
contractual arrangements with the providers.
In addition, the Trust has the following training in
place for staff:
Visual Awareness Training: continues to be
offered Trust-wide in association with RNIB. This
training provides staff with skills and knowledge to
ensure that service users with a visual impairment
receive a high level service.
WHSCT TRUST DELIVERY PLAN 2018/19 130
Deaf Awareness Training: delivered by the
British Deaf Association (BDA) throughout the
Trust, the training includes an Introduction to
deafness/Hearing loss and provides information
on Communication Methods used by Deaf/Hard
of Hearing people and how to communicate
clearly.
Disability Awareness Training: delivered by
Employers for Disability NI. The training covers
Disability Discrimination Act (DDA) overview and
case law with a brief overview of legislation
followed by case study exercise using DDA
cases. A variety of learning methods are used
including an exercise on Language etiquette and
Disability awareness training video clips. There is
also an overview of five key disability areas;
hearing loss, visual disability, learning difficulty
and disability, physical disability and hidden
disability, including mental health. Information is
provided on the nature and extent of disability, as
well as good practice in interacting with people
with disabilities.
Working
with
Interpreters
(Foreign
Language/Sign Language) Training: this training
is offered Trust-wide on an on-going basis. The
WHSCT TRUST DELIVERY PLAN 2018/19 131
training aims to improve the experience of
patients/clients who do not have English as a first
language or who have a hearing impairment. The
Equality & Involvement Team also offers the
training to specific teams/units, as per requests.
The Working with Interpreters Training is
supported by Trust Communication Support
Guidelines, which contain information for staff on
accessing Foreign Language and Sign Language
Interpreters, and Written Translation.
Sensory
Awareness
e-learning
module:
Available to all Trust staff, this training was
developed in collaboration with Royal National
Institute of Blind People (RNIB) and Action on
Hearing Loss (AoHL) was available for all HSC
staff
‘Making a Difference E-learning programme -
This E-learning programme was launched in the
Western Health and Social Care Trust (WHSCT)
in March 2018 as mandatory Equality, Good
Relations and Human Rights Training for all
WHSCT staff and managers. The programme
was developed regionally by HSC Equality Leads
and a number of Western Trust staff participated
in the pilot of the programme in early 2017.
‘Making a Difference’ is an interactive programme
WHSCT TRUST DELIVERY PLAN 2018/19 132
tailored specifically to the healthcare setting and
aims to ensure that all staff realise the importance
of their part in creating an inclusive and
welcoming environment for all colleagues and
service users.
‘Making a Difference’ is supported by a regional
Equality
Training
manual for
staff which
complements the programme. The programme is
also complemented by a suite of HSC
Discovering Diversity awareness modules, which
all staff are also encouraged to complete.
The aim of the ‘Making a Difference’ training is to
show staff how they can make a difference by:
Promoting positive attitudes to diversity
Ensuring they treat everyone with respect
and dignity
Behaving in a way that is in keeping with
HSC values and equality and human rights
law.
The aim of this module is to support staff to make
a difference in work through:
Recognising,
Respecting and
Responding to the different needs of people
WHSCT TRUST DELIVERY PLAN 2018/19 133
they come into contact with in work
The programme can be accessed via the HSC
Learning Portal and should be renewed by staff
every 3 years.
Disability Equality Training - Trust Disability
Action plans include an undertaking
to
co-design
and deliver bespoke disability equality training for
frontline staff in partnership with disabled people.
The training will include specific guidance on
communication disability and autism. This will
lead to increased staff awareness on disability
equality and how to promote positive attitudes
and participation in public life. The training that
will reflect all disabilities (including hidden,
autism, sensory) and will challenge negative
stereotypes / attitudes about disabled people
WHSCT TRUST DELIVERY PLAN 2018/19 134
SPECIALIST SERVICES (14)
R
A
G
N/A
2
2
10
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1. Effective arrangements should
Trust responses should
Rheumatology has had investment from the
be in place to ensure:
demonstrate how they will engage
local commissioner to recruit a Rheumatology
A
with the HSCB to inform the
Consultant to meet the demand of referrals. A
• New patients continue to
projected requirements associated
locum consultant commenced early June 2018
access previously approved
with the increase in the number of
and is located in SWAH with 5 clinics per week.
specialist drug therapies
patients on existing treatment
The Trust is working to complete an IPT to
• Access to new NICE TAs
regimes across a range of
enable
recruitment
of
occupational
and other NICE
conditions. Responses should also
therapist/physiotherapist and nurse specialist
recommended therapies
demonstrate how Trusts will deliver
support.
approved during 2018/19
on the requirements of new NICE
There has been investment in the biologics and
TAs in line with planned
specialist medicine infusion unit. The unit has
investments.
moved to Level 9 Tower Block, Altnagelvin
increasing chair capacity to enable patients
prescribed specialist drugs therapies to receive
their treatments locally. Due to regional nursing
shortfalls we are currently unable to fill all
vacancies which will delay the transfer of
Western Trust patients from the BHSCT to the
WHSCT TRUST DELIVERY PLAN 2018/19 135
WHSCT. The Trust will continue to work closely
with the Commissioner in relation to this. Once
nursing recruitment has been achieved patients
will be repatriated to this hospital for ongoing
treatment
and
extension
of
neurological
therapies and IBD treatments commenced with
appropriate governance arrangements in place.
The rheumatology nurse specialists continue to
commence or switch patients onto biologic
therapies with rheumatology conditions in a
timely manner
2. Effective arrangements should
Belfast Trust should outline, by the
N/A to WHSCT
N/A
be in place to continue to
end of September 2018, the key
progress the implementation of
priorities for development to further
the Northern Ireland Rare
support the delivery of the Northern
Disease Plan working in
Ireland Rare Disease
partnership with the NI Rare
Implementation Plan.
Disease Partnership
HSCB/PHA membership of the
This may cross reference to
national Rare Disease Advisory
developments in progress in other
Group ensuring that Northern
specialist services areas as support
Ireland is fully engaged in the
of rare disease commissioning is
planning and evaluation of
common to other areas of work.
highly specialist services
The Belfast Trust is asked to bring
forward options and proposals to
WHSCT TRUST DELIVERY PLAN 2018/19 136
identify a clinical lead/leads for adult
specialist services for consideration
and agreement in 2018/19.
The Belfast Trust is asked to bring
forward options and proposals for
interface with the Northern Ireland
Rare Disease Partnership for
consideration and discussion in
2018/19.
3. Effective arrangements should
Belfast and South Eastern Trusts
N/A to WHSCT
N/A
be in place to provide a
are requested to agree and bring
specialist adult pulmonary
forward detailed proposals for a
hypertension service for
specialist adult pulmonary
Northern Ireland
hypertension service for the
population of Northern Ireland.
This will take into account the
recommendations of the National
Peer Review of Pulmonary
Hypertension Services, 2016/17.
4. Effective arrangements should
Belfast Trust should demonstrate
N/A to WHSCT
N/A
be in place for the provision of
how it will work with the HSCB/PHA
Paediatric Cardiac Services in
through the specialist paediatrics
line with the Ministerial decision
group and all-island structures to
on the establishment of an All-
take forward the implementation of
Island Network.
the service model for congenital
cardiac services set out in the full
A range of elective cardiac
WHSCT TRUST DELIVERY PLAN 2018/19 137
procedures, as well as
business case for the All-Island
emergency and urgent cases
CHD Network. This should include
are now being accommodated in local developments as well as
the ROI.
developments planned on an all-
island basis.
5. Effective arrangements should
Belfast Trust should demonstrate
N/A to WHSCT
N/A
be in place to improve the
arrangements which improve
resilience, sustainability and
resilience, sustainability and access
access to specialist paediatric
to specialist paediatric services
services
including:
• Planned arrangements for the
paediatric lead for rare disease
by 30 September 2018.
• Plans for a Paediatric Waiting
List Office. This will ensure
equity of access for patients
waiting for tertiary services.
• New arrangements for the
management of children with
hepatitis B in conjunction with
Birmingham Children’s Hospital.
• A framework to support leads in
paediatric cardiology, specialist
paediatrics, paediatric network,
NISTAR and the critical care
and trauma networks in
WHSCT TRUST DELIVERY PLAN 2018/19 138
improving communication and
ensuring complementary service
planning and delivery for the
paediatric population.
6. Effective arrangements should
Belfast Trust should work with
N/A to WHSCT
N/A
be in place to deliver an Adult
HSCB/PHA and DoH in developing
Infectious Diseases (ID) service
a plan to improve the resilience and
specification and phased
sustainability of the Adult Infectious
investment within available
Disease Service. By Autumn 2018,
resources.
the Trust will have agreed with
HSCB/PHA a service specification
for Northern Ireland including both
specialist care and the role and
function of local DGH acute
medicine in the management of ID
conditions with a view to
establishing the new model from
April 2019.
7. Effective arrangements should
Belfast Trust’s response should
N/A to WHSCT
N/A
be in place to appropriately
demonstrate how the Trust will
manage the service need of
deliver the required volumes of
patients requiring specialist
service activity in light of the
services.
changing population need and
demand for specialist services in
2018/19.
Belfast Trust should also advise of
WHSCT TRUST DELIVERY PLAN 2018/19 139
any emerging vulnerabilities in
specialist services including
proposed contingency
arrangements.
8. Effective arrangements should
Belfast and South Eastern Trusts
N/A to WHSCT
N/A
be in place to progress the work
should continue to take forward
of the Plastics & Burns Project
actions in the RQIA review,
Board which will provide
reporting progress to the Plastics
strategic direction for the service and Burns Project Board. The
and respond to the RQIA
Trusts should input to project
recommendations (2017)
products, including:
In particular, the project board
• Needs assessment
will agree a service specification
• Service profile
and develop options for the
• Service specification
future configuration of plastics
• Gap analysis
and burns services, including
consideration of a single
service/site model.
9. Effective arrangements should
Belfast Trust should demonstrate
N/A to WHSCT
N/A
be in place to deliver a
plans to:
sustainable scoliosis service.
• deliver a timely, accurate and
effective monitoring of
programme of activity and
waiting lists consistent and
WHSCT TRUST DELIVERY PLAN 2018/19 140
compliant with extant DoH
guidance
• ensure commissioned capacity is
fully utilised (RVH, MPH and
RBHSC) and is accessible, for
appropriate cases, within the
clinically recommended
timescale.
• deliver scoliosis surgery within
ministerial targets detailing any
short to medium term subvention
required to fully deliver these.
• submit a formal escalation plan
for any projected breach outwith
the specified clinically determined
window for treatment detailing
the process by which this will be
addressed to secure treatment
within the planned timescale.
• detail proposed service models,
level of investment to meet any
gap in service, both in RVH and
RBHSC, expected volumes to be
delivered in 2018/19 from new
investment by September 2018.
WHSCT TRUST DELIVERY PLAN 2018/19 141
10. Effective arrangements should
Trust responses should identify how Negotiations have been ongoing with the
be in place to ensure the
the Trust will implement the key
neurologist
in
Belfast
to
enable
the
A
continued progress with
priorities from the specification
establishment of MS specific clinics. The impact
implementing the service
namely; the provision of dedicated
of MS specific clinics would be to increase the
specification for patients with
multidisciplinary clinics for patients
waiting times for general neurology referrals. It
Multiple Sclerosis (MS)
with MS, the local presence of
is deemed the right thing to do however with
specialist MS nursing staff and the
current service gaps and extremely long waiting
local provision of infusion delivered
lists, a decision has yet to be reached. HSCB
disease modifying therapies.
plan to visit the WHSCT with the aim of
progressing to MS specific clinics.
11. Effective arrangements should
Trust responses should identify how The Trust’s Head of Pharmacy has met with
be in place to ensure the
Trusts will ensure that arrangements RBTS, BHSCT & the HSCB to discuss this
G
transfer of the management of
are in place to manage the transfer
transfer which will take place on 1 October.
immunoglobulin therapies to
of the management of these
Current immunoglobulin usage data has been
Trust pharmacies from the
therapies by October 2018 to
provided to the Trust and a scoping exercise is
Northern Ireland Blood and
improve the governance
being carried out in collaboration with clinicians
Transfusion service
arrangements in line with medicines
who use the product. Pharmacy staff attended a
management principles.
regional training session at the end of August.
Funding requirements for additional staffing
resource have been calculated and shared with
the HSCB and negotiations in relation to this are
continuing.
12. Effective arrangements should
Belfast Trust’s response should
N/A to WHSCT
N/A
be in place to improve the
demonstrate plans to:
pathway for patients accessing
consider issues arising from the
WHSCT TRUST DELIVERY PLAN 2018/19 142
Gender Reassignment Services
HSCB’s Gender Reassignment
including:
Surgery consultation with a view
to outlining how the Trust will
Setting out the
address and implement these in
arrangements for specialist
the future, as appropriate.
surgery as part of the
develop options to ensure the
continued delivery of the
pathway
Regional Gender Identity Service
Improving referral and
including recruitment to fill key
assessment of patients to
staff vacancies.
improve the pathway and
ensuring workforce issues
are addressed.
13. Effective arrangements should
Belfast Trust should demonstrate,
NA to WHSCT
be in place to ensure the
via a project plan, how it will secure
opening of the Phase 2B Critical the balance of the Phase 2B staffing
Care Unit to accommodate the
to deliver a full bed complement of 8
transfer of ICU/HDU capacity
HDU and 17 ICU beds as well as
with the service to be fully
the 2 ICU beds associated with
operational in 2018/19.
trauma which will also transfer into
Phase 2B.
Work will continue to progress
The Trust has representation at all committees
during 2018/9 on the current
All Trusts should demonstrate full
A
within CCaNNI, including the CCaNNI Board
role, scope of responsibility and
commitment to collaborate in the
where progress on Phase 2b is discussed. Both
accountability arrangements
provision of safe, effective, clinically
Critical Care cares units at Altnagelvin and
offered by the Northern Ireland
equitable access to ICU. The
South West Acute Hospitals receive non-clinical
Critical Care Network and how it Northern Ireland Critical Care
transfers and repatriation to support the
might best develop consistent
Network will support this with
networks timely and effective access to critical
with the vision set out in
improvements in timely monitoring
WHSCT TRUST DELIVERY PLAN 2018/19 143
Delivering Together.
of bed availability, clear escalation
care services.
protocols, timely discharge and
staffing levels.
14. Effective arrangements should
Belfast Trust’s response should
N/A to WHSCT
N/A
be in place to deliver a
detail proposals for a sustainable
sustainable neuromuscular
service model by December 2018
service for Northern Ireland.
including a phased implementation
approach.
WHSCT TRUST DELIVERY PLAN 2018/19 144
CANCER SERVICES (13)
R
A
G
N/A
3
6
4
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1.
Effective arrangements should
Trust responses should
All patients on a ‘Red Flag’ suspect cancer
G
be in place to deliver cancer
demonstrate plans to improve
pathway are tracked through the 31 and 62 day
access targets
compliance against cancer access
pathway by the dedicated MDT tracker. The
standards across all relevant
Administration Manager, Cancer Services meets
services.
on a monthly basis with the Cancer General
Manager and reviews individual breach reports
for that month. The purpose of this is to identify
any bottlenecks in the pathway to include
process or service issues. Any identified issues
are then addressed by the relevant manager or
assistance is sought from the Macmillan Service
Improvement Lead to address any bottlenecks
in pathway etc. A Service Manager Forum has
been set up in early 2018 to investigate any
breaches and identify key learning. This group
meet on a monthly basis.
2.
Effective arrangements should
Trust responses should
The Trust will respond as required when the N/A
be in place to take forward
demonstrate how they will support
review is available. It is noted that the WHSCT
WHSCT TRUST DELIVERY PLAN 2018/19 145
recommendations from the
the implementation of
continues to have extreme difficulties in
Review of Breast Assessment
recommendations arising from the
recruiting to breast posts and whilst meeting the
Service
Review of Breast Assessment
current cancer targets, this remains a significant
Services.
and worsening risk.
3.
Effective arrangements should
Trust responses should
The Trust is participating in the Regional
G
be in place to support the
demonstrate how they will support
Transformation of Cancer Services to implement
transformation of non-surgical
the review of non-surgical oncology
service improvement initiatives or prototypes to
oncology services, to include
to include the development and
improve the patient journey and ensure
the development and delivery
delivery of local quality improvement processes and procedures are as efficient as
of local quality improvement
projects.
possible. At a local level the Trust have
projects.
established a SACT Weekly Capacity Group to
maximise clinics and streamline processes.
4.
Effective arrangements should
Trust responses should
Training has been delivered with the secretarial
A
be in place to ensure
demonstrate how they will fully
teams. Issues around Haematology letters are
implementation of the Regional
implement the electronic patient
being worked through at regional level. An
Information System for
record and electronic prescribing
alternative solution such as scanning letters into
Oncology & Haematology
modules of RISOH within
RISOH has been submitted to Project Board
(RISOH) within haematology
haematology services in line with
awaiting decision. The Trust is working with the
services.
the agreed regional project plan.
HSCB in relation to this. As project nears
completion the first go live date is January 2019.
Training
to
commence
late
August/early
September 2018 with the Consultant team in
preparation for ‘go live’. Chemo regimes are
being finalised by the regional pharmacist.
WHSCT TRUST DELIVERY PLAN 2018/19 146
5.
Effective arrangements should
Belfast Trust should demonstrate a
N/A to WHSCT
N/A
be in place to establish a
commitment, working in partnership
regional coordination service
with all Trusts, to taking forward this
for Metastatic Spinal Cord
service development on behalf of
Compression.
the region.
6.
Effective arrangements should
Belfast Trust should demonstrate
As part of the radiotherapy development within
A
be in place for the treatment of
plans to take forward an expansion
the North West Cancer Centre (NWCC), capital
basal cell carcinoma to include
of Mohs provision.
funding was provided for the purchase of a
Mohs surgery and the provision
superficial x-ray machine which is now housed
NWCC to develop a regional
of radiation therapy.
in a dedicated suite within the NWCC.
radiation therapy service for Basal
Cell Carcinoma (Superficial X-Ray).
The Trust will work with the commissioners and
CRG to bring forward a funding proposal which
would allow for a dedicated resource to develop
the policies and protocols to have the service
operational to include referral criteria, pathways
and associated clinical guidelines. It is also
hoped that there will be opportunities for this
service to be a regional one to ensure equity of
access for patients across NI.
7.
Effective arrangements should
Northern Ireland Cancer Centre
A True Beam software upgrade is planned to
A
be in place for the
(NICC) and NWCC to roll out
take place in October which is required to be in
developments within
delivery of DIBH across Northern
place before DIBH can be delivered. Work has
radiotherapy services.
Ireland to people with breast cancer
been established and will continue to develop in
who would benefit from this
terms of planning and treatment protocols.
Radiotherapy technique.
Training is currently underway to deliver this
safely.
WHSCT TRUST DELIVERY PLAN 2018/19 147
Belfast Trust response should
confirm the establishment of a
regional service to deliver SABR for
Oligometastatic disease and people
with lung cancer at NICC during
2018/19.
8.
Effective arrangements should
Trust responses should
The Trust received a positive response from the
G
be in place to improve the
demonstrate plans to take forward
Cancer Patient Experience Survey in 2015 and
patient experience of cancer
any actions arising from the findings also from local patient surveys completed at an
services. Commissioners will
of the 2018 survey, which will report
MDT level. The Trust has recently participated
take forward a further regional
in the Autumn 2018.
in the 2018 CPES Survey with findings due back
Cancer patient Experience
September 2018.
Survey in June 2018.
The Trust will continue to liaise with primary
care to improve early referral and access to
services and will work closely with the
Macmillan GP facilitators who are now in post.
9.
Effective arrangements should
Belfast Trust response should
N/A to WHSCT
N/A
be in place to establish a
demonstrate a willingness to take
testing service for Lynch
forward the establishment of a
Syndrome in line with NICE
regional testing service during
Diagnostic guideline DG27.
2018/19.
10.
Effective arrangements should
Belfast Trust response should
N/A to WHSCT
N/A
be in place for the centralisation demonstrate a commitment to taking
of partial nephrectomy, hemi
forward the centralisation of this
WHSCT TRUST DELIVERY PLAN 2018/19 148
nephrectomy and pyeloplasty to surgery within the specialist team.
the specialist urological centre
in Belfast Trust.
11.
Effective arrangements should
Trust responses should
The Trust continues to work with the
G
be in place to expand the
demonstrate the particular actions to Commissioners and PHA to deliver the Regional
clinical nurse specialist (CNS)
be taken in 2018/19 to expand the
CNS Workforce Plan.
workforce in Northern Ireland in CNS workforce, and in doing so,
line with national benchmarks
how this will increase opportunities
and the agreed regional CNS
to modernize care pathways and
development plan.
improve the patient experience of
care.
12.
Effective arrangements should
Trust responses should
The Trust has an established systemic anti-
G
be in place to take forward the
demonstrate how they will take
cancer therapy (SACT) Group and meets on
expansion of non-medical
forward plans for the expansion of
monthly basis. Membership of this group
prescribing of Systemic Anti-
non-medical prescribing of SACT.
includes
Oncologists,
Haematologist,
Cancer Therapy (SACT).
Management, Pharmacy and Nursing.
This group continues to ensure the development
and implementation of robust processes in
regards to the introduction of new cancer drugs.
The group also oversees service delivery and
development within the chemotherapy unit e.g.
nurse led initiatives, non-medical prescribing
etc.
Members of this group have been nominated to
sit on the HSCB non-medical prescribing
working group.
WHSCT TRUST DELIVERY PLAN 2018/19 149
13.
Effective arrangements should
Trust responses should
Radiographer breast consultant is appointed
be in place to bring forward
demonstrate commitment to the
and training continues. All formal qualifications
G
radiographer skills mix within
development of advanced
have been attained and she is undergoing a
breast assessment services.
practitioner and consultant
period of mentorship. The progress is within the
radiographer roles within breast
timeframes agreed in the IPT.
assessment services.
WHSCT TRUST DELIVERY PLAN 2018/19 150
LONG TERM CONDITIONS
Stroke (7)
R
A
G
N/A
1
4
1
1
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1.
Effective arrangements should
Trust responses should
The Moving On service, which employs a neuro
be in place to provide
demonstrate plans to improve stroke occupational therapist in the northern sector of
A
appropriate stroke services for
services for younger stroke patients
the Trust, remains part of the longer term
younger people as 20% of all
in line with the recommendations of
pathway for stroke in the northern sector. There
stroke occurs in people aged
the RQIA inspection report (2014) to is a limited neuro OT service in the southern
under 65
include vocational rehabilitation.
sector for vocational rehabilitation. There are
numerous voluntary and independent sector
services identified to support the younger
person across the WHSCT, with onward
referrals being made by any member of the
community stroke rehabilitation team or the
stroke specialist nurse for any patient with
identified long term needs. Further investment
from the IPT for ESD services may support the
occupational therapists to extend their role in
providing
specialist
neuro
interventional
supporting vocational rehabilitation in the
southern sector of the Trust.
WHSCT TRUST DELIVERY PLAN 2018/19 151
2.
Effective arrangements should
Trust responses should outline
The key issue is that when there are bed
R
be in place to ensure that all
plans to review their operational
pressures, any empty stroke beds will be filled
stroke patients are admitted
protocols for admission and develop with a non-stroke patient. The outflow from the
directly to a stroke unit within 4
processes that ensure that more
wards is restricted due to poorly resourced
hours in line with NICE guidance than 90% of acute stroke patients
community stroke services. An IPT has been
are admitted to a stroke unit as the
submitted to increase staffing levels in the
ward of first admission.
community to establish an ESD service to
support reducing length of stay with the aim of
supporting direct admissions to Stroke unit.
Monthly service improvement work is also being
undertaken
in
both
acute
sites
across
departments involved in the acute stroke
pathway to support improvement in direct
admission to the stroke unit.
3.
Effective arrangements should
Trust responses should outline
There has been no regional progress in relation
A
be in place to provide
plans to work with the regional
to the spasticity service and the current service
appropriate specialist spasticity
stroke network to develop a regional remains unchanged, with no specialist spasticity
services for stroke survivors.
pathway for the management of
service for stroke survivors.
spasticity after stroke.
4.
Effective arrangements should
Trust responses should
There is an effective thrombolysis service in
G
be in place to provide
demonstrate initiatives to ensure at
both acute sites. The WHSCT lysed 21% of all
thrombolysis as a treatment for
least 15% of acute ischemic stroke
ischaemic stroke patients admitted in 2017/18.
acute ischaemic stroke.
patients, attending each of its
Quarterly lysis review meetings remain on both
hospitals, receive thrombolysis and
acute sites 93% of those patients lysed received
that those patients who receive
it within the 60min target
thrombolysis do so within 60
minutes of arrival.
WHSCT TRUST DELIVERY PLAN 2018/19 152
5.
Effective arrangements should
The Belfast Trust response should
This target is not applicable to the WHSCT.
N/A
be in place to provide
demonstrate plans for the continued The WHSCT contact the RVH and transfer all
mechanical thrombectomy for
development of regional stroke
appropriate patients who would have the
large vessel stroke as an
mechanical thrombectomy services
potential
of
meeting
the
criteria
for
effective intervention for
as per the NICE guidance.
thrombectomy. In 2017 the WHSCT transferred
selected stroke patients
a total of 16 patients with 10 patients receiving
thrombectomy intervention. This service is only
available Monday to Friday 8am to 5pm and
therefore there will be occasions when patients
who are suitable for thrombectomy are unable to
access this service. The ‘Reshaping of Stroke
Services’ consultation document proposes the
extension of this service to a 24hour/ 7 day
week service.
6.
Effective arrangements should
Trust responses should
A low percentage of TIAs are referred at the
be in place to provide weekend
demonstrate plans to provide
weekend and the current Trust protocol is to
A
outpatient assessment for TIA
ambulatory services for suspected
admit
for
necessary
investigation
and
patients with high risk TIA
high risk TIA patients seven days a
assessment. All high risk patients continue to
patients assessed within 24
week, in line with NICE guidance.
be admitted at the weekend across all Trusts.
hours of an event and
There is a proposed regional development
commence appropriate
through the Reshaping of Stroke Services to
treatments to prevent stroke.
provide a regional centre for weekend high risk
TIA assessment/investigation.
7.
Effective arrangements should
Trust responses should detail how
The WHSCT has submitted an IPT to enhance
A
be in place to facilitate, where
ESD services for stroke patients will
the current Mon- Fri stroke CST to a 6 day
WHSCT TRUST DELIVERY PLAN 2018/19 153
appropriate, early supported
be made available seven days a
stroke ESD service. The 7th day support will be
discharge (ESD) of acute stroke week, able to respond within 24
integrated through the proposed enhancement
patients from hospital.
hours of discharge and providing the of the intermediate care and reablement
required levels of therapy.
services across the Trust,
The ongoing delays in nursing home placements
and care packages being available continues to
have a direct impact on the more elderly
patients with life changing effects from stroke.
Regional work is ongoing in respect of this.
WHSCT TRUST DELIVERY PLAN 2018/19 154
Diabetes (11)
R
A
G
2
9
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1.
Effective arrangements should
Trusts responses should
The Trust received additional funding to enable
be put in place to develop
demonstrate plans to build capacity
additional resources to be recruited to assist with
G
services for women with
in clinical delivery through additional meeting the increasing number of women
diabetes in pregnancy in
commitment of consultants,
diagnosed with gestational diabetes. A QI
Northern Ireland
midwifery, nursing etc. (or
project is taking place within the Trust involving
combination of all).
all members of the MDT and service users to
improve and find alternative and innovative ways
to deal with this increase in demand.
2.
Effective arrangements should
Trusts responses should
Trust representatives are included in the inpatient
G
be put in place to implement
demonstrate action plans to address work stream of the regional diabetes strategy.
the recommendations arising
the recommendations of the
Standardised protocols have been agreed and
from the Northern Ireland
Inpatient Audit 2016.
will be implemented in Western Trust as per
Inpatient Audit 2016.
regional guidance. Criteria for inpatient referral to
diabetes team will be standardised.
Working groups have been established in liaison
with PHA and Trust representatives to secure
opportunity for ward staff to be released into the
Diabetic inpatient team to improve quality of
WHSCT TRUST DELIVERY PLAN 2018/19 155
inpatient care and education of core staff at ward
level to meet the requirements of acutely ill
diabetic patients in hospital. Funding is to be
released to trusts week of 30th July 2018.
3.
Effective arrangements should
Trust responses should
Transformation funding has been secured to
G
be put in place to develop a
demonstrate plans to implement
support diabetes prevention programmes. Work
regional Diabetes Prevention
NICE PH38 with a particular focus
is ongoing to aim to secure regional programme
Programme (DPP)
on supporting behaviour change in
and standardisation in each Trust area. Existing
high risk groups within community
diabetes prevention sessions will be replaced by
settings.
the regional programme once this is clarified.
The diabetes team are maintaining links with
health improvement department to ensure that
the central referral point is maintained and that
current service is not lessened but that it will be
enhanced eg links to social prescribing.
4.
Effective arrangements should
Trust responses should
Structured Diabetes Education remains a key
G
be put in place to provide
demonstrate plans to expand
element offered by the diabetes specialist team
education and support for
access to Structured Diabetes
and staff have been directly involved in the
people recently diagnosed with
Education (SDE) and the associated subgroup undertaking the review of structured
diabetes.
catch up programme for those
education for the regional board. There are
requiring it.
various programmes offered to patients with
diabetes in the Western Trust including CHOICE
(for adults and children with Type 1 diabetes) and
DESMOND (for type 2 diabetes). Diabetes CHAT
sessions are also offered to patients, focussing
on updates in treatment and refreshers in self-
WHSCT TRUST DELIVERY PLAN 2018/19 156
management. The standardised approach to
education is supported by the diabetes team and
we
look
forward
to
implementing
the
recommendations from the regional board.
5.
Effective arrangements should
Trust responses should
Trust representatives are included in regional
G
be put in place to develop
demonstrate plans to expand
subgroup for insulin pump and CGM service.
patient pathways for insulin
access to insulin pumps and CGM
Funding is secured for replacement pumps and
pumps and Continuous
in-year.
patients are updated when warranty period
Glucose Monitoring (CGM).
expires (4 years) The replacement numbers
increase in March 2019 when warranty period
expires and this will affect the number of new
starts that can be offered. Although funding has
been clarified for insulin pumps there has been
no funding for additional staff resource. The staff
resource is a significant limiting factor for this
specialised part of the diabetes service.
Paediatric teams have identified that the capacity
for 2018/19 is 8 new starts. New starts for adult
service will not be possible due to limited staff
resource, and the existing pressures of young
adults on pumps transferring from paediatrics to
adult’s team. Regional guidance is awaited on the
role of pharmaceutical company support for
insulin pump and CGM service.
WHSCT TRUST DELIVERY PLAN 2018/19 157
6.
Effective arrangements should
Trust responses should
Data collection for the LIBRE audit is included at
G
be put in place to ensure
demonstrate plans to complete the
time of Libre start. The detail on the ABCD audit
appropriate usage of Freestyle
ABCD audit of Freestyle Libre in
is time consuming and clerical and professional
Libre.
2018/19.
teams of DSN and dietitians are all collating the
data. Education on patterns, insulin adjustment
and carbohydrates is key to ensure appropriate
usage of the device and the Trust offer joint DSN
+ dietetic clinics to support this.
7.
Effective arrangements should
Trust responses should
One of the WHSCT diabetes consultants is co-
be put in place to improve
demonstrate plans to use ‘Ready
chair of the regional transition work stream. Close
G
transition arrangements for
Steady Go Hello’ materials in
links are maintained in the Western Trust with
transfer of care from paediatric
transition planning.
adult and paediatric teams and ‘Ready Steady
to adult diabetes services.
Go Hello’ materials have already been secured
and plans in place to start implementation.
8.
Effective arrangements should
Trust responses should
Paediatric diabetic nurse specialists continue to
G
be put in place to provide
demonstrate plans to ensure all
deliver
education
in
schools
and
to
education and support for
children have updated “annual
provide/annually review care plans. The inclusion
children with diabetes.
health plans” and promote the use
of the regional communication booklet to enable
of the communication booklets
education, staff and parents to share information
among parents for insulin injections
has been effective.
and insulin pumps.
9.
Effective arrangements should
Trust responses should
As of February 2017, all children up to their 16th
be put in place to ensure
demonstrate plans to accommodate birthday are admitted to the children’s wards on
G
children with diabetes are
children with diabetes up to their
both hospital sites when they require an inpatient
treated in age appropriate
16th birthday for in-patients and out
stay. They are all seen within the paediatric
WHSCT TRUST DELIVERY PLAN 2018/19 158
settings
services and confirm arrangements
outpatient settings in both hospitals.
are in place for monitoring blood
glucose and blood ketones.
10.
Effective arrangements should
Trust responses should
Funding has been received to support the
G
be put in place to implement
demonstrate plans to develop all
implementation of the regional diabetes foot
relevant areas of the Northern
areas of the agreed pathway
pathway (July 2018). The podiatry service has
Ireland Diabetes Foot Care
including the vascular surgery
been redesigned and clinics are structured to
Pathway.
interface.
support the risk categories within the pathway.
The additional funding will support the ongoing
development of the service, including diabetes
foot clinic and to improve the low risk service in
primary care.
There are twice weekly arterial vascular outreach
clinics on the Altnagelvin site (Monday &
Thursday) where the Diabetic Foot Podiatrist has
access to the arterial Vascular Consultant for
advice or onward referral of the patient.
11.
Effective arrangements should
Trusts responses should
Western Trust diabetes team has introduced new
be put in place to develop new
demonstrate plans to develop
models of care since 2014 and continues to
G
models of care for people with
community diabetes capacity and
develop the MDT service with joint consultations,
diabetes.
address the needs of vulnerable
increased group education and virtual review
groups.
options for patients eg DIASEND, email BG
downloads. The network office continues the links
This will be supported through the
with practices and reports from GP practices are
‘New Models of Care’ work stream
used to identify at risk groups eg elderly, -
WHSCT TRUST DELIVERY PLAN 2018/19 159
which will be launched in 2018/19.
medication review to avoid hypoglycaemia and
ensure individualised targets, , improving links
with practice based pharmacists, promoting
service to at risk non-attenders etc. The role of
diabetes assistants/ diabetes support workers will
be promoted.
WHSCT TRUST DELIVERY PLAN 2018/19 160
Respiratory (4)
R
A
G
1
3
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1.
Effective arrangements should
Trust responses should
The Respiratory Forum continues to meet
G
be in place to deliver findings
demonstrate that plans are in place
quarterly. Maintenance of service standards
from the annual respiratory
to contribute to:
continues
in
completing
KPI’s
through
baseline assessment (subject to
Respiratory Service Framework. The PHA/HSCB
• Maintenance of current service
some alterations to targets
Respiratory Forum meet twice yearly to review
standards and, where applicable,
agreed with DoH and limitations
the KPI’s and plan future audits.
meeting minimum standards as
of recording mechanisms).
outlined in the baseline review
undertaken in years 1 and 2 of
the revised Respiratory Service
Framework.
Development of services in line
with Year 3 requirement arising
from the baseline assessment
(where not otherwise explicitly
mentioned in this summary)
2.
Effective arrangements should
Trust responses should
The paediatric respiratory nurses and
G
be in place to ensure local
demonstrate that plans are in place
consultants with a specialist interest in
health economies deliver
to contribute to:
respiratory continue to work at delivering
appropriate integrated pathways
against the standards of the respiratory
WHSCT TRUST DELIVERY PLAN 2018/19 161
for adults and children across
• Ongoing implementation of the
framework. The demand for paediatric allergy
community, primary, secondary
paediatric asthma pathway in
services has grown and allergy services are
and tertiary care.
remaining Trusts, including
now provided at Altnagelvin, Omagh and
primary care elements
South
West
Acute
Hospitals.
This
is
predominantly an outpatient service.
• Working with colleagues in HSCB The Trust is engaging with the HSCB to
to develop effective counting and
develop
effective
counting
and
coding
coding methodologies to record
methodologies in respect of consultant and
relevant service and patient level
nurse-led activity within the respiratory service.
data
There has been no change with OT and
• Completion of the implementation
Dietetics remaining within core services and
of recommendations from the
standard referral process is accessible.
RQIA Review of Community
Although there remains a long waiting time for
Services
OT assessments. Psychology is offered as an
integral
part
of
the
pulmonary
rehab
• Effective arrangements for
programmes and referrals can also be
managing the ‘local network’ for
processed on an individual basis.
respiratory care through
There is no further development in the
Integrated Care Partnerships
provision of a dedicated physiotherapy within
amongst others, including senior
the team. A Bid was submitted to the
level clinical and managerial
Transformation funding stream in 2017 to
leadership
achieve a more integrated multidisciplinary
skill mix but this has been unsuccessful to
date. However, the Trust is proceeding to
work
within
the
development
of
a
transformational proposal as part of the
intermediate care model which is aiming to
WHSCT TRUST DELIVERY PLAN 2018/19 162
increase the availability of AHP services of
which CRT are to be included in this service
enhancement.
Local Respiratory Forum meetings take place
co-chaired by the Trust’s Assistant Director of
Nursing and the Respiratory Service Manage.
A respiratory consultant is also a member of
this meeting.
WHSCT
ICP
multidisciplinary
group
developed. Regular meetings take place
chaired
by
a
respiratory
consultant.
Representation on the group includes the
LCG, ICP, patient representatives and cross
directorate attendees (Acute and PCOP).
3.
Effective arrangements should
Trust responses should
Community Respiratory Team continues to take
G
be in place to:
demonstrate plans to deliver referral direct referrals from G.P and respiratory
pathways to appropriate self-
consultants which results in earlier discharges
• promote self-management,
management programmes.
from Acute Hospitals and less admissions.
self-directed care and other
suitable training
Pulmonary Rehabilitation programmes continue
programmes for patients.
Trust Wide delivered by Respiratory Nurse
• reflect the concepts of co-
Specialists and the Community Respiratory
design and co- production in
Team.
improving and developing
services in line with the
Delivering Together agenda
WHSCT TRUST DELIVERY PLAN 2018/19 163
4.
Effective arrangements should
Trust responses should
The temporary Interstitial Lung Disease (ILD)
be in place to support the
demonstrate plans to:
Nurse role continues with up to 4 clinics per
A
development of networked
week. This nurse also runs clinics for reviewing
• Develop a network approach for
services across Northern Ireland
Non Invasive Ventilation patients.
ILD as a conduit for referral,
for the following:
treatment and advice across
A Clinical Physiologist has been employed for
• Interstitial Lung Disease
HSCTs and via standardised
one year to assist with changeover of new
(ILD)
pathways
machines and help review patients on the waiting
• Neuromuscular related
• Progress one stop shop clinics
list.
respiratory disease (NMD)
between neurology and
The Trust is making arrangements to have an
respiratory services to manage
• Non-Invasive Ventilation
ambulatory area as part of the respiratory ward
patients with specialist needs due
(NIV)
when it is relocated as part of the Altnagelvin
to neuromuscular diseases
North Wing Development.
• Obstructive Sleep Apnoea
across Northern Ireland including
(OSA)
diagnostics in BHSCT and
There is also a project manager in post which has
WHSCT.
been extended for a year to ensure that the
• Ambulatory Care Pathways
respiratory reform programme is progressed.
in the Unscheduled Care
• Facilitate progress of the ongoing
Reform Programme
regional procurement exercise for
Non Invasive Ventilation (NIV)
• Home IV antibiotics service
methods
• Difficult asthma guidelines
• Continue to reduce waiting lists
for sleep studies in BHSCT.
• Implementation of COPD,
bronchiectasis and
• Facilitate respiratory teams to
paediatric asthma audit
develop ambulatory care
recommendations
pathways for patients requiring
WHSCT TRUST DELIVERY PLAN 2018/19 164
same day respiratory care, where
appropriate
• Participate in a regional task and
finish group to standardise the
Home Intravenous Anti biotic and
Anti-Viral service for respiratory
patients (OPAT) as required.
• Deliver difficult asthma services
for children, young people and
adults to ensure the
implementation of NICE TAs.
WHSCT TRUST DELIVERY PLAN 2018/19 165
Pain Management (7)
R
A
G
1
5
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1.
Effective arrangements should
Trust responses should
The Trust has continued to contribute to the
G
be in place to enhance the skills
demonstrate plans to:
Queen’s University FO junior doctor training in
and capacity of secondary care
relation to pain management.
• Support staff education and
pain management teams and
training for improved and
The Trust will continue to participate in the
their scope for integrated
integrated bio psychosocial
Regional Pain Forum.
working in line with Core
management patients with
Standards for Pain Management
The Trust contributes to the delivery of public
persistent pain.
Services in the UK published by
awareness programmes and discussions will be
the Faculty of Pain Medicine at
• Contribute to the development
undertaken with Health Improvement to identify
the Royal College of
and delivery of pain related
opportunities to extend awareness further.
Anaesthetists in 2015.
public awareness, information
and education projects through
This needs to include capacity
the Northern Ireland Pain
for a leadership role in educating
Forum.
and training practitioner
colleagues in other secondary,
• Transform services to ensure
primary and community care
more patients with complex
services.
needs can be seen earlier to
prevent or halt irreversible
deterioration.
WHSCT TRUST DELIVERY PLAN 2018/19 166
2.
Effective arrangements should
Trust responses should
The Trust is working with clinicians to ensure
A
be in place to ensure regional
demonstrate plans to optimise
that regional local prescribing guidelines are
and local prescribing guidelines
prescribing practice, reduce the risk
followed. Plans include:
are followed and supported
of side effects, misuse and
through regular medication
addiction, as well as reducing
Ensuring cost effective choices continue
reviews in line with NICE
prescribing costs by supporting
to be used
recommendations.
services in secondary, primary and
Carrying out OP prescribing audits
community care.
A new Trust pharmacist with responsibility for
controlled drugs has just been appointed and his
will be included in her work plan. She will link
with chronic and acute pain services to take this
work forward.
3.
Effective arrangements should
Trust responses should
Patients in the Western area have access to the
be in place to ensure patients
demonstrate plans for a range of
following programmes:
G
have timely access to supported supported self-management options
self-management options as
in line with a stepped care model.
Multi-disciplinary
-
Pain
Management
part of a stepped care model,
Depending on local service
Programme
including those provided with the configuration and priorities, this may
Physiotherapy led – Moving with Pain
help of expert patients, peer and include:
Programme
lay trainers.
Community based – Manage the Challenge
• reworking of existing contracts
Programme
with voluntary providers of self-
The Trust is participating in the PHA led
management programmes and
regional scoping exercise regarding low staffing
local support groups,
in relation to pain management. Initial
•
indications are that the WHSCT has insufficient
reconfiguration of community
consultant input to deliver the pain management
and primary care services ,
WHSCT TRUST DELIVERY PLAN 2018/19 167
• collaboration with other
service. The Trust will continue to engage with
government agencies to booster the HSCB in terms of further developments.
condition management
programmes (CMPs), and
• increasing capacity of pain
management programmes
(PMP) provided by specialist
pain management teams.
4.
Effective arrangements should
Trust responses should
The Trust has to date established a Care
be in place to ensure patients
demonstrate plans to support ICPs
Pathways Reform Programme focused on the
G
are managed along regionally
in developing integrated patient
six ICP Priority areas of Frail Elderly,
agreed integrated pathways to
pathways including initial
Respiratory, End of Life, Diabetes, Stroke and
improve outcomes and patient
assessment for painful conditions of
Cardiology.
Service
delivery
across
experience.
MSK conditions, fibromyalgia,
programmes of care in each of these areas is
endometriosis and other long term
complemented by strategic multidisciplinary
surgical and medical conditions.
integrated care groups chaired by clinicians and
incorporating all service provision stakeholders
relevant to the patient group. Trust continues to
deepen and develop further collaborative
approaches to care within and between these
pathways,
in
full
partnership
with
ICP
stakeholders. The Trust will continue to use this
proven methodology to engage with ICPs in the
development of additional integrated pathways.
Locally work is commencing on the chronic pain
referral pathway for the painful conditions,
WHSCT TRUST DELIVERY PLAN 2018/19 168
including MSK, fibromyalgia, chronic fatigue
syndrome, endometriosis. Patients with these
conditions already avail of the existing pain
management programme but they are not
condition
specific.
Further
work
will
be
progressed
to
identify
patient-centred
approaches to providing integrated care for
these clinical priority areas and Trust will work
closely with GPs in taking a connected view of
how existing clinical services and knowledge
can be mobilised to support patients with MSK
conditions, fibromyalgia, endometriosis and
other long term surgical and medical conditions.
5.
Effective arrangements should
Trust responses should
The Trust has established a multi-disciplinary
G
be in place to ensure patients
demonstrate plans to optimise
Pain Management Group which meets to
with persistent pain have
patient flows by improving referral
discuss appropriate pathways for patients
equitable access to evidence
pathways for patients with painful
referred across various specialties.
based services, including
conditions.
interventional techniques like
This should include consideration of:
neuromodulation and
radiofrequency ablation.
• cross speciality triage criteria
between primary care, core
physiotherapy, ICATS,
rheumatology, orthopaedics and
pain management
• the use of the Clinical
WHSCT TRUST DELIVERY PLAN 2018/19 169
Communication Gateway
(CCG) and e triage
• improved access to evidence
base interventional pain
management treatments as well
as discontinuing treatment
modalities that are no longer
considered effective
6.
Effective arrangements need to
Trust responses should
The WHSCT will continue to participate in the
G
be put in place to develop a
demonstrate a commitment to
development of a sustainable and effective
medically led regional diagnostic participate in the development of a
regional service model for diagnosis in
service for patients with ME and
sustainable and effective regional
partnership with service users and carers as
related conditions supported by
service model for diagnosis in
required.
locally available management
partnership with service users and
support services.
carers.
7.
Effective arrangements need to
Belfast Trust response should
N/A to WHSCT.
N/A
be put in place to deliver a
demonstrate plans to reconfigure
sustainable regional
existing resources, seek additional
multidisciplinary persistent pain
ones and support delivery of this
management service for children service on a sustainable basis in
and young people with complex
line with multidisciplinary models of
needs.
good practice.
WHSCT TRUST DELIVERY PLAN 2018/19 170
Cardiovascular (5)
R
A
G
5
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1. Effective arrangements should
Belfast Trust should ensure a
N/A to WHSCT
be in place to further develop
regular submission of monitoring
services for patients awaiting
data on regional patient numbers
Transcatheter Aortic Valve
and waiting times for TAVI. They
Implantation (TAVI) in Northern
should also aim for inpatients
Ireland.
waiting on TAVI to have their
procedure completed within 7
working days of being deemed fit for
the procedure.
Belfast Trust carry out Transcatheter Aortic Valve
All Trusts should demonstrate plans
G
Implantation (TAVI) procedure for patients
to streamline investigations for
referred. Depending on waiting lists patients are
patients awaiting TAVI within 28
generally taken within 7 working days.
working days.
2. Effective arrangements should
Trust responses should
The Western Trust is moving away from exercise
G
be in place to scope plans for a
demonstrate plans that secure a
stress testing to CT angiography on a phased
phased implementation of NICE
phased implementation of NICE CG
basis.
CG95 (Chest pain of recent
95 (Chest Pain of recent onset) in NI
onset) through a regional
which will see a move away from
WHSCT TRUST DELIVERY PLAN 2018/19 171
approach in partnership with
exercise stress testing to CT
cardiology and radiology regional angiography.
leads.
3. Effective arrangements should
Trust responses should
Trust-wide there is rapid access chest pain
be in place to support the recent
demonstrate plans to support direct
clinics. All patients who are referred are phoned
G
implementation of the Clinical
referrals from GPs for these cardiac
by a nurse triaged and generally given an
Communication Gateways
investigations and support the timely appointment within 2 weeks.
(CCGs) for direct access to
analysis and follow up of results.
A new clinical lead has been appointed and will
Echo, Rapid Access Chest Pain
take up post in the Autumn and this will be a
Clinics, holter monitoring and
priority work area.
blood pressure monitoring.
4. Effective arrangements should
The Western Trust response should
This is a new model of service delivery.
be put in place to develop and
demonstrate plans to pilot a new
Recurrent funding has been secured and the
G
test a new model of care within
model of care within cardiac
Trust is progressing recruitment. Learning will be
cardiac rehabilitation and heart
rehabilitation and heart failure in the
reported in 2019/20 when the new model is fully
failure in the Western Trust.
first instance with the potential over
operational. It is hoped to have the service
time to implement with other patient
operational in September 2018. Priorities for this
groups such as people at high risk
service will include direct access for GPs.
of heart disease, patients with
A transformation proposal will also be taken
diabetes and patients with
forward in 2018/19 to deliver a preventive
peripheral vascular disease, etc.
cardiology programme to individuals across the
All Trusts will share in the learning
cardiovascular disease spectrum from those at
from the pilot outcomes.
risk of developing the disease to those with
established disease.
WHSCT TRUST DELIVERY PLAN 2018/19 172
5. Effective arrangements should
All Trusts should demonstrate plans
The Trust can confirm that the process has begun
be put in place to develop new
to actively participate in a task and
but staff are not in place as yet. The Trust will
G
models of care for patients with
finish group to consider the
participate as required.
heart failure in light of the
management of heart failure.
NCEPOD report – Acute Heart
Failure and the NICE CG 187.
SEXUAL HEALTH (11)
R
A
G
2
9
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1.
Effective arrangements should
Trust responses should
A Sexual Health Service is provided in the South
A
be in place to ensure provision
demonstrate actions that continue to West Regional College but due to GU staffing
of clinical sexual health
refine and develop the Further
levels it has been difficult to provide a
services in higher education
Education model for delivering
comprehensive GU service. Ongoing attempts to
settings, including services
sexual health and wellbeing
develop a more robust and integrated service
such as condom distribution,
services/initiatives to youths under
with adequately trained staff is continuing.
pregnancy testing,
25 years of age.
contraception advice and STI
testing.
WHSCT TRUST DELIVERY PLAN 2018/19 173
2.
Effective arrangements should
Trust responses should
The WHSCT has re-instated a walk-in and wait
G
be in place for safe and
demonstrate plans to improve
service for three mornings a week. The number
clinically governable SRH and
patient access times and clinical
of patients turned away from services is being
GUM services to respond to
governance arrangements by
monitored to assess unmet need/demand. A
patient need within 48 hours
appointing the required clinical
triage system is in place so certain patients will
support staff particularly in the
be seen regardless of capacity (e.g. those
NHSCT and SHSCT areas.
presenting for PEP/Sexual Assault/U16).
The majority of clinics now have doctor led cover
to aid governance and offer more flexibility for
Trust responses should
complex patients on when they can be seen.
demonstrate actions to strengthen
sexual health service provision for
A new express testing initiative has been set up
uncomplicated patients closer to
during an evening clinic to provide testing for
home in collaboration with Primary
asymptomatic U25. It will provide rapid access
Care Providers through partnership
and GC/CT results will be available by lunch time
and collaborative working.
the following day
A sexual health integrated workshop identified as
a priority the need to appoint a sexual health
advisor to follow up STI diagnosis and ongoing
HIV management. This action will be taken
forward by a project management team. A factor
affecting the governance and follow up of patients
within the WHSCT is the lack of a designated
sexual health advisor in addition to current staff
shortages. Despite rising testing numbers, STI
diagnosis (some requiring TOC) and ongoing HIV
WHSCT TRUST DELIVERY PLAN 2018/19 174
management, there is no designated role to
complete these tasks. An interim solution is
being explored through the procurement of the
Sxt.software system.
Recruitment is underway for two Band 5 PHSN
training posts which will ensure sustainability for
the nursing workforce.
Consultant staff within the clinic provide support
for local GP services when required and teaching
at local GP partnerships has been provided to
update local practice for up to date sexual health
testing and treatment policies.
3.
Effective arrangements should
Trust responses should
The WHSCT website has been updated to
be in place for patients to
demonstrate plans to:
provide information on sexual health matters with
G
access telephone and online
links to evidence based information sites.
• Prioritise responses to patients
advice for clinical sexual health
WHSCT are in the process of updating their Web
seeking sexual health services
matters including family
based software and this will allow the GU
and triage these according to
planning and sexually
services to make changes to their web based
need; this requires enough
transmitted infections.
design.
administrative support staff to
respond to all telephone calls
Administrative support has been increased in the
by patients within a clinically
CASH dept. on a temporary basis to support the
justifiable time frame
current work load and the implementation of Lillie
• Support consolidation of
Blythe. This has improved patient flow, access
electronic patient management for clients and job satisfaction.
systems across Northern
WHSCT TRUST DELIVERY PLAN 2018/19 175
Ireland and exploration of
The Lillie Blythe Business Case for the Family
online and postal testing
Planning Module in CASH has been approved.
services for uncomplicated
WHSCT have now configured the standalone
sexual health, contraceptive
server to enable Lillie Blythe GUM module
and STI related needs of
update.
patients.
Whilst telephone access remains good a recent
patient survey confirmed the significant demand
for online booking and access to services. The
WHSCT are now exploring the possibility of
procuring the online booking and prescribing
modules for Lillie Blythe.
WHSCT fully supports the bid for SH24 and is
hopeful for a positive outcome. Online and
remote testing would be extremely beneficial for
the rural geographical location of many residents
of the WHSCT.
4.
Effective arrangements should
Trust responses should
The Western Trust is working in partnership with
G
be in place for evidence-based
demonstrate plans to provide
the PHA to co-coordinate and deliver a range of
promotion of sexual health and
targeted sexual health promotion
training, campaigns and awareness targeting
wellbeing for young people and messages, focusing on those most
sexual health messages including general sexual
adults, including HIV
at risk and explore the potential of
health training and World Aids Day and STI
awareness, STI prevention,
social media and other technologies awareness campaigns targeting those most at
with a particular focus on those
in collaboration with PHA.
risk.
most at risk.
As mentioned in point 3, the service’s website
WHSCT TRUST DELIVERY PLAN 2018/19 176
has also been updated to provide links to relevant
evidence based websites and include a section
on “Frequently asked Questions”. This will again
improve with the update of the Web software for
WHSCT
New
health
promotion
literature
promoting both sexual and reproductive health
has been designed in collaboration with the
Health Improvement Department.
Within the clinic there is continued work towards
health promotion and strategies to convey
specific targeted messages. This could be greatly
enhanced by the appointment of a Sexual Health
Advisor as mentioned in Point 1.
5.
Effective arrangements should
Trust responses should
The Western Trust is supporting the ongoing
G
be in place for Trust Health
demonstrate plans to continue to
delivery of the Regional Relationship and
promotion staff to support the
provide support through their staff to Sexuality (RSE) Programme, providing support to
whole schools model of
those schools who receive whole
participating schools and working in partnership
Relationships & Sex Education
school RSE training in their area as
with the BHSCT Sexual Health Team.
(RSE) provided by the BHSCT
required.
Sexual Health team.
6.
Effective arrangements should
Trust responses should
All Family Planning and GUM staff received joint
be in place to support the
demonstrate plans to ensure uptake training from the Family Planning Association on
G
sexual health needs of
of learning disability sexual health
how to address the sexual health needs of people
individuals with learning
training for all relevant staff.
with learning disabilities.
disabilities.
WHSCT TRUST DELIVERY PLAN 2018/19 177
7.
Effective arrangements should
Trust responses should
A workshop took place in September 2018 to plan
be in place to provide
demonstrate plans to develop the
the ongoing work required towards the goal of
G
integrated sexual health
co-location of GUM and SRH
integration of the services.
services to vulnerable parts of
service delivery in geographical
The co-location of GUM and CASH services in
the population
areas of need, and to vulnerable
Derry/Londonderry will be progressed this year.
populations e.g. in prisons and
children’s homes.
A business case has been completed to support
the capital investment for building redesign.
The workshop project team will take forward the
necessary actions required for colocation and
integration of in Fermanagh and West Tyrone.
GUM services now provide a full range of
contraceptive services, including LARC, for hard
to reach vulnerable groups. Two medical staff
are able to provide LARC and one member of
nursing staff is currently being trained towards
this goal.
8.
Effective arrangements should
Belfast Trust response should
Currently all patients requesting/requiring PrEP
be in place to ensure that HIV
confirm the timescales for
are referred to Belfast as part of the risk reduction
G
prevention clinics are
implementing the HIV prevention
clinics. An ongoing referral strategy has been
established for high risk groups. clinics. The Trust response should
developed within the clinic to allowgreater
also confirm that the patient
capacity for information giving / and referral to
pathway and eligibility criteria for
these services. Demand appears high for referral
accessing these clinics have been
to Belfast but also for monitoring of those
shared with relevant colleagues in
accessing and purchasing PrEP online. This is
other Trusts.
being reviewed and may result in a requirement
WHSCT TRUST DELIVERY PLAN 2018/19 178
The HSCB/PHA will work with the
for additional investment to provide PrEP to
Trust to put in place formal
patients attending services.
arrangements to monitor and
evaluate these clinics.
9.
Effective arrangements should
Trust responses should
An SOP has been created for referral to the risk
A
be in place between local and
demonstrate how they would
reduction clinics in Belfast. SHAAPT coding is
regional GUM services to
support and monitor the
used to monitor those both accessing via Belfast
support a two year prototype
effectiveness of the two weekly
and online.
HIV high risk reduction clinic
clinics which all Trusts will refer into
For those known to access PrEP online standard
within the defined agreed
for those identified as high risk and
monitoring is offered to provide the ongoing
eligibility criteria for the
meeting agreed eligibility criteria
standard of care required.
administration of PrEP as part
including changes in testing
of a clinically agreed risk
behaviours; changes in STI and HIV Current monitoring of requests for access to PrEP
reduction package for the
diagnoses; assessing improved
within the WHSCT is ongoing, as those unable to
assessed patient
equality/equity of service with other
access set clinical times in Belfast or who can`t
parts of the UK; seeking
afford to purchase PrEP, receive a reduced
improvement in the quality and
equality of access to care due to geographical
experience of care; building capacity location.
in prevention of HIV and other STIs;
supporting and empowering GUM
clinic staff.
10.
Effective arrangements need to Trust responses should
Staff within the clinic have good training
G
be put in place to ensure
demonstrate actions to identify staff
opportunities
supported
by
WHSCT
and
sustainability of clinical sexual
training and replacement needs and significant advances in staff attaining BASHH and
health services
communicate these to appropriate
FSRH accredited training standards has been
regional workforce planning
successfully progressing.
colleagues.
WHSCT TRUST DELIVERY PLAN 2018/19 179
Workforce planning is one of the top priorities
identified from the sexual health workshop and
this includes the appointment of a Health Advisor.
11.
Effective arrangements should
Trust responses should
In 2017/18 the Trust’s Health Improvement
be in place to ensure all
demonstrate actions to ensure the
Department worked in partnership with the Trust’s
G
relevant staff are trained in
identification of staff who require
GUM, CASH and LAC services to deliver two
sexual health issues, including
training in sexual health promotion
awareness sessions to promote the services and
core skills such as awareness,
and deliver of training as required.
links.
attitudes, information,
communication skills, sexuality
In 2018/19, this work will be continued with the
and relationships.
support of PHA funding to enable the following:
Development of leaflets to promote CASH and
GUM services;
Development of a Pull Out Pen Service
Directory;
Facilitation of a Traffic Light Sexual
Behaviours Training Session for staff who
work with young people.
Facilitation of a Consent Awareness Raising
Session for professionals who work with young
people.
Coordination and co-delivery general sexual
health
awareness
training
sessions
in
partnership with GUM colleagues.
Awareness raising of HIV for community
voluntary and statutory partners.
WHSCT TRUST DELIVERY PLAN 2018/19 180
PALLIATIVE CARE SERVICES (7)
R
A
G
7
ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
1.
Effective arrangements should
Trust responses should
The Trust has introduced guidance for the role
be in place to ensure the full
demonstrate plans to implement the of the key worker in palliative and end of life
G
implementation of the key
regionally agreed key worker
community settings. This guidance sets out very
worker function.
function in line with the roll-out of
clearly the aim of the key worker role, which is to
Delivering Care.
ensure optimum quality of life in the last year of
life and should support the person to remain in
their preferred place of care. Access to
guidance is available to all staff via the Trust’s
palliative and end of life SharePoint site hosted
on the Trust’s intranet.
Targeted training has been developed and
delivered to staff undertaking the role of key
worker during 17/18 with ongoing evaluation.
This is also being incorporated into existing
education programmes - CEC, WHSCT, other
providers
The Trust is awaiting the Regional KPI’s for
keyworker implementation and will develop an
action plan to deliver these.
WHSCT TRUST DELIVERY PLAN 2018/19 181
2.
Effective arrangements should
Trust responses should
The Trust has developed targeted training on
be in place to embed Advance
demonstrate plans to ensure that
advance care planning (ACP)using regionally
G
Care Planning within operational those with progressive conditions
agreed ACP educational resources through a
systems.
should be offered the opportunity to
rolling programme of delivery during 2017/18
access and to record their individual which will continue to be delivered during
wishes.
2018/19
During 2017/18 the Trust has hosted a number
of Masterclasses for GP and Primary care
regarding ACP and other targeted raising
awareness to different groups. This programme
of education will continue during 2018/19.
Supporting regional and local guidance and
documentation available in palliative care
information and resource SharePoint site. Made
available to all care sectors.
Introduction of Key information summary (KIS) to
targeted
GP
practices
with
supporting
information systems E.g. vision which includes
advance care planning.
Your life your choices – plan ahead NI –
advance care planning awareness public and
professional events held 2017 /2018
3.
Effective arrangements should
Trust responses should
Trust-wide
raising
awareness
and
G
be in place to improve the
demonstrate plans to ensure that
implementation of tools to support identification
WHSCT TRUST DELIVERY PLAN 2018/19 182
identification of palliative care
practices taking part in the prototype e.g. ELCOS across core teams and all care
patients in primary care –
are supported to hold regular MDT
settings
through
education
and
raising
identification prototype.
meetings [details of practices taking
awareness sessions
part in the prototype will be shared
ELCOS is embedded on key documentation
with Trusts].
referral forms/ RMA referrals system / End of life
care folders / share point site for palliative and
end of life care/ KIS.
9 GP practices signed up to regional
identification pilot to take part in the prototype to
hold regular MDT meetings/ primary care
register etc.
Rathmore, Belleek
Park Medical, Great James Street
Oakleaf, Gt James Street
Dunnamanagh Surgery
Dr Doherty, Clarendon Street
Foyle Family Practice, Bridge Street
Glendermott Medical, Waterside Health
Centre
Eglinton Health Centre
Three Spires Surgery, Omagh
Funding will be used to backfill District nursing to
facilitate Sister/Charge Nurse to regularly attend
the Multi-disciplinary Meetings in GP Practices
and also plan the work care that is required.
WHSCT TRUST DELIVERY PLAN 2018/19 183
Money will be put into bank cost centre and
used for this purpose.
4.
Effective arrangements should
Trust responses should
The Trust has a range of education and training
be in place to improve the
demonstrate plans to ensure to
opportunities available to the MDT professional /
G
education and training of the
support staff to attend relevant
carer workforce. Based on KSF and core
professional workforce in
courses to strengthen palliative care competency framework for palliative and end of
palliative care.
capacity.
life care and through training need assessment
Trust delivered courses (rolling programmes)
Final Journeys
Advance care planning
Link nurse programme
Trust carers programme
Advanced Communication skills training
Ward based education programmes
Altnagelvin and SWAH
Ad hoc
RCN Band 5 nurses end of life care
GP / primary care Masterclasses
Palliative and end of life Masterclasses /
events
Foyle Hospice
European Certificate for Essential
Palliative Care Course
WHSCT TRUST DELIVERY PLAN 2018/19 184
Clinical education centre
1,3 and 6 day principles palliative care
Breaking bad news
Universities (UU and QUB)
Specialist practice palliative care (post
grad)
Non-medical prescribing
This money will fund a band 6 0.5wte
Palliative care Nurse Facilitator to work
alongside the GP Facilitators and Nurse
band 7. Targeting all Trust staff and areas
but also a focus on Nursing Homes within
the area.
5.
Effective arrangements should
Trust responses should
The Trust commissions and provides a range of
be in place to increase the
demonstrate plans to ensure that
services which currently work in partnership with
G
capacity of the out of hours
current gaps in the service are
General
Practice
and
OOH
to
provide
rapid response nursing service
addressed and that specific
appropriate generalist support to patients in
across the region to provide full
proposals are brought forward by
primary care settings during the OOH Period.
regional coverage of the Marie
the Belfast and South Eastern
The Trust will continue to engage with the
Curie led service.
Trusts/Localities to describe how the commissioner to progress the provision of 24/7
service integrates with the generic
community access to further enhance the overall
out of hours district nursing
model of service delivery. During 18/19 the Trust
services.
will progress the extension of the Marie Curie
rapid response nursing service to ensure Trust-
wide coverage.
WHSCT TRUST DELIVERY PLAN 2018/19 185
6.
Effective arrangements should
Trust responses should
2018 / 2019 Trust engaging in planning for a
G
be in place to implement a
demonstrate plans to ensure
model of in house specialist palliative care out of
regional specialist palliative care commitment to working collectively
hours advisory rota between palliative care
out of hours advisory rota.
and with voluntary partners to
consultants – rota of 5 Consultants (Trust / Foyle
develop a sustainable regional rota
Hospice) pilot for 6 months starting with inpatient
for access to specialist palliative
facilities to extend to WUC.
care advice out of hours.
Funding secured from transformation monies.
7.
Effective arrangements should
Trust responses should
Funding has now been secured to fund the GP
G
be in place to enhance the
demonstrate plans to implement the Facilitators permanently. Recruitment will be
Specialist palliative care
recommendations of the review of
undertaken with immediate effect.
workforce.
the specialist palliative care
Transformation Funding allocated to the Trust
workforce and work through their
will be used to recruit 1 WTE Band 7 Social
locality board to progress
Worker. The Trust would propose to appoint 0.5
implementation.
wte of each of the following AHP’s to meet
service
need-
Occupational
Therapist/Physiotherapist/Speech
and
Language Therapist/Dietitian. Discussion and
approval from PHA is required.
WHSCT TRUST DELIVERY PLAN 2018/19 186
Section 3.3 WESTERN TRUST RESPONSE TO LOCAL COMMISSIONING PLAN PRIORITIES (15)
R
A
G
2
3
10
LOCAL ISSUE/OPPORTUNITY
PROVIDER REQUIREMENT
PROVIDER RESPONSE
RAG
W1
Effective arrangements
Western Trust should state the
The Trust will endeavour to maximise existing
G
should be in place to
volumes by service which it will
capacity to ensure that funded volumes of activity,
ensure that the volumes of
deliver in addition to the 2017/18
including additional activity identified as part of
activity to be delivered
Service and Budget Agreement
2017/18 investments, are delivered, however it is
reflect commissioned
which reflect the Full Year Effect
noted that in some areas workforce challenges and
services and investment.
of investments in 2017/18 and
constraints in providing backfill for sick and maternity
additional funding provided within leave will impact on the ability of some service areas
this Commissioning Plan.
to deliver funded activity in full.
The Trust will identify additional volumes associated
with 2018/19 funding as part of the IPT process.
POC Currency
SBA
Proposed
17/18
Delivery 18/19
1
Non-elective
36,747
36,747
admissions
1
ED
118,478
120,798
attendances
WHSCT TRUST DELIVERY PLAN 2018/19 187
1
Inpatients
10,956
10,956
1
Day Cases
36,411
36,866
1
New
109,550
110,050
Outpatients
1
Review
140,986
142,036
Outpatients
2
Obstetrics
4,009
4,009
(births)
2
Health Visiting
119,948
119,948
(contacts)
3
Interim SBA agreed following SAFRA
exercise in 2015/16. Final SBA not yet
agreed
4
Domiciliary
1,520,059 1,676,160
Care Hours
4
Residential
517,115
517,115
and Home
WHSCT TRUST DELIVERY PLAN 2018/19 188
Care Occupied
Bed Days
4
Community
192,188
192,188
Nursing
Contacts
5
Hospital
30,082
30,082
Occupied Bed
Days
5
Residential
30,296
30,296
and Nursing
Home
Occupied Bed
Days
5
Domiciliary
29,544
29,544
Care Hours
Delivered
6
Domiciliary
99,473
99,473
Care Hours
6
Residential
109,069
109,069
and Nursing
Home Care
Occupied Bed
WHSCT TRUST DELIVERY PLAN 2018/19 189
Days
7
Domiciliary
310,489
310,489
Care Hours
7
Residential
22,982
23,368
and Nursing
Home Care
Occupied Bed
Days
W2
Effective arrangements
Western Trust should provide an
As part of the transformation programme, the Trust is
should be in place to
overview of plans to develop
developing plans to further develop ambulatory and
G
ensure unscheduled care
unscheduled care, including
acute care at home services in the Omagh and
services in the Western
ambulatory and acute care at
Fermanagh areas of the Trust.
area are safe, sustainable
home.
The Trust continues to provide Acute Care at Home
and accessible.
The Trust should contribute to the (AC@H) to patients in the Northern Sector of the
production and implementation of Trust following a multi-disciplinary approach and
a Winter Resilience Plan.
avoiding an acute admission to hospital. The AC@H
team has established links with colleagues in
community teams and the acute hospital setting in
order to provide a seamless service for our over 75
year old clients. The Trust has submitted an IPT for
extension of AC@H to a Trust-wide service
Altnagelvin’s Ambulatory Care Unit has been fully
functional since May 2018. It accepts Medical,
WHSCT TRUST DELIVERY PLAN 2018/19 190
Cardiology, Surgical and ENT GP Referrals and
Emergency Department referrals. It sees on average
30 patients per day with a discharge rate of 90%. In
September 2018 it will accept ED Surgical Referrals
also. The Trust has extended ACU to include surgical
GP referrals as of May 2018.
Limited transformation funding has been identified for
2018/19 which will be directed towards the
development of ambulatory pathways in the South
West Acute Hospital. The Trust will prepare a Winter
Resilience Plan as required.
W3
Effective arrangements
Western Trust’s response should The Trust can confirm that work is ongoing to take
G
should be in place to
outline progress in relation to the
forward completion of the business case for the
support the need to develop business case for Altnagelvin
Phase 5.2 development at Altnagelvin which is due for
modern, appropriate
Phase 5.2 which the LCG
submission by the end of December 2018.
accommodation for
anticipates will be completed
emergency department,
during 2018.
theatres and related
services on the Altnagelvin
site.
W4
Effective arrangements
Western Trust’s response should The Trust can confirm that the new theatres were
should be in place to
provide an update on the
handed over at the end of June 2018 and the first
R
ensure appropriate daycase progress of commissioning the
operating session is planned for 16th August 2018.
operating capacity.
two new Daycase Theatres at
Revenue funding for one of the new theatres is
Altnagelvin which are due to open
WHSCT TRUST DELIVERY PLAN 2018/19 191
in August 2018 and give an
dependent on funding through the orthopaedics
indication of daycase capacity
consultants IPT and the Trust will continue to work
which will be realised through the
with the Commissioner in relation to the revenue
investment.
requirements associated with this. Six sessions in the
second theatre are intended to enable extended days
It is anticipated that the new
in main theatres to be ceased and are therefore
theatres will deliver much-needed funded from existing resources. The HSCB has
daycase operating capacity.
indicated that the remaining four sessions could be
funded to facilitate non-recurring initiatives. The new
theatres will therefore provide 14 additional day case
sessions per week (based on 42 weeks).
The Trust notes that full implementation is very
challenged due to recruitment difficulties and staff
shortages which have resulted in substantial
vacancies within existing theatre nursing and
anaesthetic staffing complements and will make
recruitment of the new posts very difficult. The
service has been dependent on overtime to fill gaps
and is now exploring the potential to recruit agency
staff.
W5
The LCG recognises
Western Trust’s response should Recurring funding has been secured for a specialist
G
considerable pressure
outline progress in relation to
dietitian to undertake reviews of patients with coeliac
experienced in
introducing a specialist dietician
disease. This post had previously been in place non-
gastroenterology services
to undertake reviews of patients
recurringly and substantial progress has been made
in recent years due to
with Coeliac Disease, including
in establishing the service. The service will be
medical vacancies. The
plans to extend the service to the
delivered via outreach clinics at a number of locations
WHSCT TRUST DELIVERY PLAN 2018/19 192
LCG has invested in
Southern Sector in due course.
in the Trust area to maximise attendance at clinics.
specialist nurse training
The majority of these clinics have now been set up.
which has gone someway
to shoring up capacity
shortfall. The LCG is
further committed to invest
in specialist dietetics to
undertake review of
patients with Coeliac
Disease, thereby allowing
consultant
gastroenterologists to focus
on more chronic
gastroenterology
conditions.
W6
The LCG has identified a
Western Trust’s response should IPTs have been submitted to the HSCB in respect of
considerable shortfall in
outline progress in relation to
fracture triage clinics and AHP support for
A
capacity in Trauma and
putting these investments on the
orthopaedics and formal confirmation of funding is
Orthopaedics services in
ground and an indication of the
awaited. In the meantime the Trust has progressed
the West. The LCG and
additional capacity which will be
implementation of the fracture triage clinics which
HSCB plan three
realised.
have been operational since 21 May 2018 and has
investments in 2018/19:
also had to proceed to recruit some of the hand
establishment of fracture
therapy resource associated with the AHP IPT in
triage clinics; investment in
advance of confirmed funding. The additional
allied health professionals
capacity associated with these investments has been
to support consultants; and
identified in the IPTs.
WHSCT TRUST DELIVERY PLAN 2018/19 193
funding for two additional
The Trust is finalising the business case for two
orthopaedic consultants
additional orthopaedic consultants and notes that the
leading to considerable
costings are significantly higher than the indicated IPT
additional capacity in
funding of £2.2m. Discussion is ongoing internally in
orthopaedics and trauma
relation to this and further discussion is required with
care.
the HSCB in relation to the shortfall.
W7
The LCG notes plans to
Western Trust’s response should
Echoes – funding was allocated in 2017/18 for 0.5
G
invest in diagnostics for
indicate progress in relation to
Band 7 clinical physiologist to address an agreed
cardiology ECHO and for
putting this additional capacity in
reduction in the activity a clinical physiologist can
audiology which will
place and anticipated additional
deliver and an increase in demand. This investment
increase capacity within
capacity which will be realised.
permits an overall increase in capacity of 217
these services.
transthoracic echoes giving a new SBA of 8316. The
Trust can confirm that this additional capacity is in
place.
Audiology – in line with the Adult Audiology
Workforce Plan (June 2017) funding has been
identified for an additional Band 4 associate
audiologist post. This will ultimately enable capacity
to be increased by 2100 tests per year once the
postholder has completed the 2-year foundation
degree programme. This post will be recruited once
funding has been confirmed.
WHSCT TRUST DELIVERY PLAN 2018/19 194
W8
Effective arrangements
Western Trust’s response should The Trust continues to progress with the reform of
should be in place to
outline plans to complete the
community nursing as part of the Transforming Your
G
appropriately manage the
establishment of 24-hour
Care Acute Care in the Community project.
increasing number of older
community nursing across the
Work is nearing completion in partnership with Marie
people over 75 years which Western area, building on
Curie for the provision of an out of hours service to
is impacting on hospital
investment to date in district
finalise a 24/7 community nursing service before the
demand, length of stay and
nursing, Rapid Response nursing end of the year.
delayed discharge.
and treatment rooms, and
including the establishment of
Recurring funding has been secured for a Clinical
Clinical Intervention Centres in
Intervention Centre in Enniskillen, which is due to
Enniskillen, Strabane and
become operational before the end of 2017.
Limavady within the next two
years.
The Trust will consider the establishment of clinical
intervention centres in Strabane and Limavady over
the next 2 years subject to availability of funding.
W9
The LCG introduced out-of-
Western Trust’s response should The Trust commissions and provides a range of
G
hours palliative care
consider how the service
services which currently work in partnership with
nursing support in the
provided, with the support of
General Practice and OOH to provide appropriate
Northern Sector two years
Marie Curie and Western Urgent
generalist support to patients in primary care settings
ago and there is evidence
Care, can be rolled-out in the
during the OOH Period. The Trust will continue to
of its benefit to patients and Southern Sector in line with plans engage with the commissioner to progress the
other HSC services. The
to reorganise community nursing
provision of 24/7 community access to further
LCG, with Transformation
services.
enhance the overall model of service delivery. During
Funds, is in the position to
18/19 the Trust will progress the extension of the
roll-out the service in the
Marie Curie rapid response nursing service to ensure
Southern Sector.
Trust-wide coverage.
WHSCT TRUST DELIVERY PLAN 2018/19 195
W 10 Primary care talking
Western Trust’s response should The Primary Care Talking Therapies Hub is fully
A
therapies has proven a
provide an update on plans to
functional in the Northern Sector of the Trust. There
popular service among GPs introduce talking therapies in the
continues to be an ever increasing demand from GPs
and patients. Its successful Southern Sector and an
for the Hub services in the Northern Sector over the
roll out in the Northern
indication of shortfall in capacity
past quarter. Referrals to the service have been in
Sector has exceeded initial
in terms of triage and counselling
excess of 3000 in the last year and plans to roll out
expectations of patient
which will be addressed with
this service to the Southern Sector of the Trust are
numbers. Its delayed
resources available within
well advanced. Recruitment of a Hub Co-ordinator
introduction in the Southern Transformation Funds.
(Band 7) and Band 3 Admin support is underway.
Sector has led to an
However further investment will be required to
inequity of service.
develop the same model in the Southern Sector. The
patient experience and feedback has been excellent
and the timeliness of the interventions have proved
very positive in preventing the progression to steps
3,4 & 5 statutory services in many instances. This
service is an effective front line approach in terms of
professional advice, guidance and signposting for the
Step 2 mental health presentations. However, there
continues to be significant and growing pressures on
the current budget allocation. Data would suggest
that the Western Trust Hub is dealing with more
referrals than any of its counterparts in any of the
other Trusts in Northern Ireland. The Assistant
Director of Mental Health Services is currently in
discussions with the HSCB in relation to the current
demand for service and funding deficit.
WHSCT TRUST DELIVERY PLAN 2018/19 196
W 11 Monitoring of patients
Western Trust’s response should The Trust has established a specific group for
R
prescribed anti-psychotic
consider how it will collaborate
‘Physical Health Monitoring in Mental Health Patients’
drugs is undertaken
with General Practice in ensuring
The group has met on two occasions to review current
inconsistently in the West.
blood monitoring required in line
practice. The group has representatives from
While initial monitoring is
with guidance is undertaken.
Psychiatry (DCD), G.P. Lead, Commissioner, ICP
undertaken by the
Lead and Pharmacy. The Trust also have regular
prescriber, ongoing
interface meetings between DCD, GP practices and
monitoring is not rigorously
senior services managers locally to monitor issues
undertaken either in
that arise regarding service users. The Trust has
primary or secondary care.
currently a 0.5 WTE Pharmacist to assist with a-
psychotic monitoring in the Grangewood Mental
Health Inpatient Unit including high dose and
combination antipsychotic monitoring.
Inpatients to Trust acute mental health facilities
receive baseline investigations consistent with the
initial monitoring requirements. This was initiated as a
response to the need for monitoring. Patients
commenced on
anti-psychotics
in
the
Home
Treatment
Teams
have
blood
and
physical
measurements completed at initiation of anti-
psychotic medication. There continues to be an unmet
need in relation to the ability of the community mental
health teams to complete the initial and ongoing
monitoring requirements. GPs have indicated that
there are not funded to provide this service and have
declined to carry out this work.
WHSCT TRUST DELIVERY PLAN 2018/19 197
W 12 The introduction of Primary
Western Trust’s response should The Western Trust worked collaboratively with both
Care multi-disciplinary
demonstrate how it works closely
GP Federations in its area to develop bids for the
G
teams offers a significant
with GP Federations in the
introduction of primary care multi-disciplinary teams.
opportunity to extend
Western area to ensure the
The bid for the northern GP Federation was one of
capacity within General
successful implementation of
two successful bids. The Trust will continue to work
Practice through access to
teams.
collaboratively with the GP Federation to take forward
AHP, mental health and
implementation and working arrangements will be
social work resources in
reflected in an agreed governance and accountability
General Practice and to
structure. Central to this will be the Delivering
address patient issues
Together Project Board.
earlier than at present.
W 13 The LCG notes ICPs’ plans Western Trust’s response should
The ICP is an active participant in the Trust’s
to continue work on
confirm its continued support for
Outpatient Reform Programme Board which is jointly
G
outpatient reform with a
ICP plans and outline how the
chaired by the GP Associate Medical Director and the
focus on: fatty liver
Trust will contribute to the work
Acute Services Assistant Director which is the forum
pathway,
planned in 2018/19.
to ensure alignment between both outpatient reform
Haemochromatosis
programmes. The Trust continues to support ICP
Venesection, DMARD
plans and work for 2018/19 includes:
monitoring, and NI roll out
of primary care Joint
injections service. ICPs are
also planning a pilot of
remote control of Atrial
Fibrillation and focused
work on development of
portfolio opportunities for
GPs in the West.
WHSCT TRUST DELIVERY PLAN 2018/19 198
W 14 Effective arrangements
Western Trust’s response should The Paying Patients Officer (PPO) staff visit patients
G
should be in place to
demonstrate plans to keep under
on wards and obtain information from them to verify
appropriately manage the
review requests for healthcare
their entitlement to free healthcare. This can involve
number of patients
from residents of the Republic of
requesting them to complete questionnaire and
registered to Western GP
Ireland and ensure these are
provide relevant evidence and liaising with GP
practice as there are
from cross-border workers
Practices. Procedures are in place to verify that
approximately 25,000 more
entitled to receive NI HSC
patients claiming to be cross border workers are
patients registered with
services.
entitled to free healthcare. In addition the PPO
Western GP practices than
generates regular inpatient BOXI reports from the
live in the Western LCG
Access to Healthcare tool which after various filters
area, some of whom may
are applied identifies inpatients who require some
live in ROI.
level of further investigation to establish whether or
not they are entitled to free healthcare including
having them complete a questionnaire, seeking
evidence of free entitlement and follow-up processes.
*Note for information Access to Healthcare Pilot used
an electronic solution to identify patients. This is a
matching tool that enables the cross-references of
information for patients held between the Trust PAS
and the National Health Applications and
Infrastructure System (NHAIS) which is the
centralised GP Patient Register for Northern Ireland.
W 15 The LCG remains
Western Trust’s response should The Trust can provide the following update on
committed to promoting the
provide an update on progress on progress:
A
development of Primary
each of the hubs, including
Care Hubs in the Western
Enniskillen, Derry Cityside,
Enniskillen – refurbishment of the Erne Health
WHSCT TRUST DELIVERY PLAN 2018/19 199
area. The Enniskillen hub
Lisnaskea and Strabane. Notably
Centre is completed and Trust staff are now
will open during 2018 with
the Trust is asked to confirm its
located on the top floor and the GP practice on the
additional Trust services
continued support for the council-
ground floor.
being provided adjacent to
led masterplan for Strabane
Lisnaskea – the business case is complete and
GP services. Efforts to
Canal Basin which may include
queries raised by the Department of Health have
progress the business case the Primary Care hub for the
been responded to. Discussions are currently
for Lisnaskea hub continue
town.
ongoing with between the Trust, Department of
and the LCG is also
Health and Department of Education with regard to
working closely with Derry
the preferred site.
City and Strabane District
Derry Cityside – the business case is in the
Council to realise a hub in
development
stage.
A
schedule
of
Strabane as part of the
accommodation
has
been
completed
and
Council masterplan project.
responses to further requests for information to
inform the business case are being developed. A
working group has been established to project
manage this through the Trust’s Strategic Capital
Development Directorate.
Strabane – currently in early stages of discussion.
Trust is working closely with the Board.
The Trust will continue to work towards the
enhancement of primary care infrastructure in line
with the allocation of capital funding.
WHSCT TRUST DELIVERY PLAN 2018/19 200
Section 4. Resource Utilisation
Section 4.1 Financial Strategy / Measures to Break Even
Introduction
This section provides details of the financial plan for the Western Trust for 2018/19. It
sets out the strategic context and financial parameters within which the Trust will
operate for 2018/19. The income and expenditure position is summarised and key
areas of risk are highlighted.
Background
The Trust submitted an initial Financial Assessment for 2018/19 to the DoH which
documented a forecast deficit of £58.8m. The Trust further submitted to the HSCB/DoH
as part of the month five financial monitoring returns, a revised forecast deficit for
2018/19 of £24.4m after receiving an indicative allocation budget from HSCB on 29
June 2018 and in year non recurrent easement funding. It has been agreed with the
HSCB/DOH that the Trust will report a forecast deficit of £24.4m in the Trust Delivery
Plan.
The indicative allocation has confirmed three savings plan targets for 2018/19 as
outlined below:
General savings target of £11.7m;
MORE pharmacy savings target of £1.863m;
Community & Voluntary Sector target of £0.297m.
The HSCB has provided £6m easement funding against the above savings targets in
year.
Following the Confidence and Supply Agreement, £100m has been made available
to the Department of Health in 2018/19 to support the Transformation agenda
launched by “Delivering Together: Health and Wellbeing 2026”. All Trusts are
WHSCT TRUST DELIVERY PLAN 2018/19 201
required to work with local commissioners (HSCB and PHA) to ensure that normal
business processes in relation to IPTs/Business cases are completed by 31 March
2019. In common with other Trusts, WHSCT has carried out a “sequencing”
exercise to ensure a phased and managed implementation.
In addition to implementing Transformation projects in accordance with regional
priorities being addressed by all Trusts, the WHSCT in partnership with the
Londonderry/Derry GP Federation has been selected as one of two pilot sites for roll
out of a Primary Care Multi-Disciplinary Team (PC MDT). The staffing implications
of this are significant and being managed by close cross directorate working both
within the Trust and across Trusts.
Deficit Position as at 1 April 2018
Appendix 1 documents the Trust’s opening deficit position at £58.8 and the
following should be noted:
Since 2014/15 the Trust has been experiencing additional costs primarily in
relation to medical locums and Looked After Children which have impacted on
the Trust’s ability to breakeven. In the 2015/16 financial year, the Trust worked
with the HSCB through a support and accountability process called ‘SRaFA’
which reviewed these increasing costs in detail. Within this context the Trust has
received in-year financial support for the past three years to enable it to reach a
breakeven position or report an approved deficit. It should be noted that during
2018/19 these ongoing cost pressures have continued and have been factored
into the forecast year-end deficit for 2018/19. The Trust has received
confirmation that it would be allocated £52.9m recurrent / non recurrent funding to
support the opening budget deficit of £58.8m.
The Trust reported a number of cost pressures in the opening deficit to the HSCB
on 5 March 2018 in relation emerging service cost pressures for medical and
nursing agency costs, Looked After Children and medical and surgical
consumable costs and the rental of equipment totalling £5.8m. There is still no
WHSCT TRUST DELIVERY PLAN 2018/19 202
agreed budget solution for these pressures as part of the opening indicative
allocation.
The North West Cancer Centre opened in November 2016 and the indicative
allocation confirmed recurrent funding of £6.6m for this service.
The opening forecast deficit of £58.8m takes account of the FYE of a range of
expenditure areas such as the North West Cancer Centre, Demographics,
Emergency Departments in Altnagelvin & SWAH, Learning Disability placements,
Looked After Children and domiciliary care packages/nursing home placements
commissioned during the winter period. The indicative allocation has confirmed
recurrent funding for a number of these service pressures.
During 2015/16 safety concerns were raised about staffing levels in the
Emergency Departments in Altnagelvin and SWAH hospitals. The Trust engaged
with the HSCB/PHA regarding these concerns and there was agreement to
enhance the nursing and medical complement within both hospitals. During
2016/17 the Trust progressed with the permanent recruitment of staff. The
indicative allocation has funded this pressure non recurrently for 2018/19 (£4.8m)
and the Acute Directorate has funded £1.4m from the 2017/18 demographics
allocation recurrently. The Trust will continue to use the Demographics allocation
annually to support a budget solution for this service pressure.
Financial Plan 2018/19
Indicative Revenue Resource Allocation
The Trust received an opening Revenue Resource Allocation letter on 29 June 2018
which along with an indicative allocation lists the areas of investment in 2018/19 as
noted in Table 1 below:
WHSCT TRUST DELIVERY PLAN 2018/19 203
Table 1
£’000
Indicative Allocations
Opening Recurrent Baseline
532,697
Cost Pressures 2017/18
31,886
Inescapable Pressures 2018/19 – Non Pay
7,378
Inescapable Pressures 18/19 - Demographics
2,539
RCCE
10,990
TYC – prior years projects
1,363
Childrens Services
365
Learning Disability
630
Mental Health
285
Drugs
2,432
Other
1,537
Savings Target
(13,879)
Total
578,223
The HSCB advised at that time that a number of the income figures notified to the
Trust would be indicative and they have made some assumptions to support
financial reporting.
Based on the recent opening allocation and the indicative allocation assumptions
confirmed by the HSCB and after reviewing our cost pressures the Trust has revised
its forecast deficit to £24.4m, which is primarily made up of £13.5m of emerging cost
pressures, £7.2m from the under-delivery of prior year’s recurrent savings target and
a savings gap in the 2018/19 plan of £3.7m.
WHSCT TRUST DELIVERY PLAN 2018/19 204
The Trust received a further update confirming that the Trust would receive Winter
Resilience FYE funding of £1.8m.
As part of the regional financial plan for 2018/19, the Trust has been issued with a
total recurring savings plan target of £13.9m as outlined at Table 5.
Other Income
The Trust receives income from a range of other sources such as other Trusts,
residential and nursing home client contributions, NIMDTA, SUMDE and the Republic
of Ireland.
Financial Assumptions 2018/19
The financial assumptions used to inform the Trust’s financial plan 2018/19 are outlined
below:-
Pay & Non Pay Pressures
The Trust has identified the following Pay/Non Pay pressures for 2018/19:
Table 2
£’000
Pay/Non Pay Pressures
TYE
Pay Award (To be confirmed by DoH)
tbc
Non Pay
4,437
National Living Wage (NLW)
2,921
Apprenticeship Levy
19
The forecast pay and non-pay pressures for 2018/19 are based on the following
assumptions:-
- Pay Award – to be confirmed by DoH;
- Pay costs arising for AFC staff who will be due an increase up to the NLW rate of
£7.83;
WHSCT TRUST DELIVERY PLAN 2018/19 205
- Non pay inflation has been assumed at 3% across the relevant non-pay
expenditure lines except for independent sector homes, domiciliary care and
voluntary and independent healthcare providers;
Service Developments
The Trust has identified the following service developments for 2018/19:
Table 3
£’000
Service Developments
TYE
RCCE – North West Cancer Centre
6,600
RCCE – Other
4,390
Demographics
2,737
Inescapable Pressures
2,634
ICP/Transformational Funding
1,363
Children’s Services
365
Mental Health
285
Learning Disability
630
Drugs
2,432
Winter Resilience for 2017/18
1,426
Other
1,537
Funding has been confirmed for all of the Service Developments outlined above as part
of the Indicative Allocation received on 29 June 2018.
New & Emerging Cost Pressures
The Financial Plan has taken into consideration the following unavoidable cost
pressures which will emerge in 2018/19 to address risk, governance and safety issues:
WHSCT TRUST DELIVERY PLAN 2018/19 206
Table 4
£’000
Cost Pressures
TYE
Looked After Children
3,000
Medical Agency Staffing
3,300
Medical/Surgical consumables and rental of equipment
1,500
Nursing Agency premium
1,020
Auto enrolment
3,300
Energy
200
Supporting People (Trust Contracts)
70
Nursing Graduates
770
Physical Disability / SDS / Direct Payments
1,288
Pay Award 2018/19
tbc
TOTAL
14,448
The rationale for the estimates is as follows:-
-
Looked After Children – There has been a significant year on year increase in
the number of Looked After Children within the Western Trust since
2015/16. This increase has been mainly driven by the introduction of Kinship
Care standards, depravation and the support provided to children when they
leave the foster care system. The past three years have demonstrated an in-year
cost increase in the region of £3m per annum. In March 2016 the number of
Looked After Children was 555, in March 2017 it was 588, in March 2018 it was
627 and the forecast number for March 2019 is 687. This represents an increase
of 132 children 23.8% from the baseline year of March 2015/16. The demand for
social services contacts has a direct impact across both FIS and LAC. The
growth in the numbers and the complexity of cases is continuing to present a
challenge in finding suitable placements for Looked After Children resulting in
frequent requests for private and expensive out of trust placements. This
process is tightly managed by the Trust. The child protection register has
increased from March 2016 from 290 children to 408 children as at March 2018,
representing a 41% increase.
WHSCT TRUST DELIVERY PLAN 2018/19 207
Indications are that this cost will continue to increase at this rate in 2018/19 and
therefore the Trust would estimate a growth in the children’s numbers of 60 with
an in-year cost pressure of £3m. This is in line with the growth in 2017/18 being
39 at an in year cost of £2.0m tye and £2.9m fye. The Trust has received non-
recurrent support of £6.4m in 2018/19 to address the base line service cost
pressure.
-
Medical Agency – The Trust has had an increasing reliance on Medical Agency
staffing for many years. Up to 2017/18 there has been a significant year on year
increase in the expenditure on Medical Locums. Despite the cost of medical
locums in 2017/18 being maintained at the same level as 2016/17 (£17m), the
latter months of 2017/18 have seen a significant increase due to a number of
factors:
Impact of increased vacancies in a number of specialities. The Trust was
allocated 4 additional F2 NIMDTA Junior Doctors in August 2017, however,
NIMDTA where not able to supply the Trust with these doctors. The Trust
filled these vacancies using medical agency at a premium cost.
Impact of increased vacancies of GP trainee posts from the NIMDTA. The
Trust was allocated a budget of 4 GP training posts, 3 of these where filled
using medical agency at a premium.
Junior Doctor banding pressures specifically in relation to Surgery within
Altnagelvin Hospital. The Trust has experienced compliance issues in relation
to the Junior Doctors rotas primarily within Altnagelvin Hospital in relation to
the August 2017 intake. The Trust has explored all possible options and had
no alternative but to increase the Junior Doctor banding to band 3 which is
100 % above the basic. If the supply of doctors reduces further in the August
2018 intake from NIMDTA this will have a further impact on the medical
budget in year. We have not factored any further financial impact in at this
stage.
Medical vacancies – the month 7 financial performance is reporting an
increase in medical staffing vacancies which has resulted in the Trust having
to appoint two additional agency doctors. The Trust has received a serious
WHSCT TRUST DELIVERY PLAN 2018/19 208
adverse incident report which will require additional resources in Endoscopy.
This will require additional medical staffing.
Medical Job Planning – completion of the Trust’s Job Planning process is
required by the Audit Committee during 2018/19 and this has and will
continue to increase costs in medical expenditure.
Medical Staffing Obs & Gynae SWAH – For several years there has been a
challenge in filling posts in the SWAH. About 4-5 years ago, following a safety
alert letter regarding hospitals that provide maternity services, the Trust then
allocated funding to increase the middle tier to 8 doctors, in addition to having
6 doctors on the lower tier. The Trust has for a number of years had the
opportunity of doctors appointed from the International Recruitment of Medical
Staff Project. Unfortunately a number of doctors have left which were
recruited through this project to take up training posts in Northern Ireland or
employment in other Trusts. The consequence of this is to leave substantial
vacancies in the middle and junior tiers. The DoH has agreed with the Trust
that we would commence a Pathfinder and the medical staffing issue will form
part of this project. The Trust is currently using medical agency staffing at a
premium cost above the contracted rates to fill all gaps in the tiers to maintain
safe services.
In addition, the Trust has made cost avoidance and cash savings in relation to
international medical recruitment and this cost benefit has been offset against
increasing costs above.
-
Medical/Surgical consumables and rental of equipment - The Trust has
experienced an increase in expenditure during 2017/18 for medical and surgical
consumables. This pressure is primarily due to price and volume issues within
the Theatres, Emergency Departments and other service areas to maintain
patient flow. The Trust also has increased expenditure on rental of respiratory
equipment and mattresses, dressings and medical gases which are also linked to
patient flow and safe and effective services being maintained. This pressure
reflects the number of complex patients and comorbidity of the patients that is
being treated in the Acute Hospitals and ageing population. There is also an
increased use of single use equipment in line with patient’s safety guidelines.
WHSCT TRUST DELIVERY PLAN 2018/19 209
-
Nursing Agency premium - The Trust during 2017/18 has experienced an
increasing reliance on expensive nursing agency providers to ensure the delivery
of safe and effective care in line with normative staffing. The Trust has increased
expenditure with off contract nursing agencies during 2017/18 and has recorded
on average 2,300 hours monthly with off-contract agencies. The forecast
premium expenditure is in the circa of £1m for 2018/19. This forecast is based
on advice from professional nursing colleagues, the actual contract as at July
2018 and it is recognised that the workforce supply will take a minimum of three
years to reach sustainable levels of qualified nurses. Despite the ongoing work
to recruit staff internationally it would be prudent to estimate this pressure for next
year based on all information available at this time on the supply issue in relation
to the nursing profession.
-
Energy – The WHSCT annual budget for 2018/19 heat light and power, water
and sewage is in the circa of £8.1m. The utility services are currently subject to
the Northern Ireland regional framework contracts, procured via BSO/PALs, the
main exception being oil which is procured under the UK National Fuels
framework agreement. Water and sewage are provided via Northern Ireland
Water (NIW, directly). The projected price increase is exceptionally high for
2018/19 in the circa of 4.5%. The Trust is forecasting a budget deficit net of
inflation of £200k.
-
International Nurse Recruitment – The Trust is working collectively with other
Trusts and the BSO in relation to the recruitment of nurses from oversees with a
forecast cost in year of £215k for 2018/19 and confirmation of funding has been
received.
-
Winter Resilience – The Trust experienced a very difficult winter in 2017/18 and
received £1.4m of recurrent funding to support the services put in place during
this period. Unfortunately, due to the recruitment difficulties a number of the
services that where put in place have not been able to secure professional staff
due to staff shortages. If these staff shortages where resolved the fye cost of the
services would be in the circa of £2.2m.
WHSCT TRUST DELIVERY PLAN 2018/19 210
It is anticipated that the same difficulties will emerge in the winter of 2018/19
despite the additional resources to meet the additional demand of the winter
periods in 2017/18. The Trust has developed a Winter Resilience Plan and the
only funding confirmed is the funding available from 2017/18 totalling £1.8m.
-
European General Data Protection - This change in policy will reduce the
Trust’s income in the circa of £40k and has the potential to increase costs as the
Trust will be required to employ additional medical records staff (2.00wte - £44k)
to address the potential increase in the requests received by the Trust.
-
Auto Enrolment - There has been in the circa of
950 staff that has been auto
enrolled to the 2015 pension scheme with a full year effect cost in the circa of
£3.3m. This cost pressure has not been included in the regional financial plan
and is affecting all Trusts.
Savings Targets 2018/19
As part of the regional financial plan for 2018/19, the Trust has been issued with a
savings plan target of £13.9m as outlined at Table 5 below:
Table 5 – Savings Targets 2018/19
Table 5
£,000
General
11,719
Pharmacy (MORE)
1,863
Community & Voluntary Sector
297
Total Savings Target
13,879
WHSCT TRUST DELIVERY PLAN 2018/19 211
The Trust has been advised that its share of the regional general savings target,
originally £43.5m, has been allocated to the Trust on the basis of contract share,
adjusted for equity and efficiency. The Western Trust share is 27% compared to the
LCG capitation share of 16.8% and the Trust business share of 15.8%.
The Trust has been allocated £1.863m (12%) of the regional £15m MORE savings
target allocated to secondary care. We fully recognise the difficult financial climate
for Health and Social Care and the continued need to focus on pharmacy and
medicines optimisation efficiencies. However, the current regional plans assume full
delivery against a challenging procurement work-plan, and a switching programme of
high-cost medicine regimes across many specialties. High levels of commitment,
clinical leadership and collaborative multidisciplinary working across medical,
nursing, pharmacy and management is required to successfully deliver a detailed
switching implementation change plan.
The Trust believes it can achieve its FYE target from 2019/20 and current
expectations are that we would not be able to deliver the target of £1.863m in-year.
The Trust is forecasting savings of £678k and has been given in year non recurrent
support of £1.2m.
The Trust has been issued with a further recurrent savings target for 2018/19 in
relation to the Community & Voluntary Sector of £297k which represents a business
share (15.8%) of the total target of £1.9m. The Western Trust has already completed
an efficiency programme in the Community and Voluntary Sector, therefore we
would believe that this target is not achievable against this sector of our business.
The forecast gap in the Community and Voluntary sector target is £297k.
The Trust has agreed with the HSCB/DoH to the development of a Savings Plan
totalling £3.5m. The Trust has identified in year natural slippage on service
development and demographics funding to support meeting this target in year.
WHSCT TRUST DELIVERY PLAN 2018/19 212
In recent years, it has proven exceptionally difficult to generate new recurrent
savings particularly in the context of demographic growth, increased complexity and
acuity and a growing reliance on high cost medical and nursing cover.
DoH has advised that the Trust should not implement high impact measures at this
stage.
The financial monitoring of the Trust 2017/18 general savings target of £3.9m
reported actual delivered savings from low impact measures of £2.3m,
demographics slippage 2017/18 £0.8m and further general in-year slippage from
allocations of £0.8m.
Some of the areas listed in the circular such as controls over vacancies and reducing
avoidable expenditure on non-pay are already being utilised to contribute to the
Trust’s internal financial plan. It should also be noted that discretionary spend was
yielded up in 2016/17 as a savings measure and therefore this area has no more
scope to deliver further savings. In addition, it would be extremely difficult to reduce
management costs further as the Trust has continuously reported the second lowest
management costs percentage to income in the region.
The approach taken to developing these proposals is consistent with Circular
HSS(F) 34/2001 – Contingency Planning to Achieve Financial Balance, which
documents the process to be undertaken by the Trust when a forecast deficit
position is predicted.
The forecast gap in the in year general savings target is £3.7m after receiving
£6m easement funding and the development of low impact savings of £3.5m
primarily made up of natural slippage in service development and
demographics funding.
WHSCT TRUST DELIVERY PLAN 2018/19 213
Financial Objectives
The Trust has a statutory obligation to financially breakeven in 2018/19 with the
resources provided to the Trust primarily through the HSCB and other income sources.
In line with Circulars HSS(F) 26/2001 and 34/2001 ‘Contingency Planning to achieve
Financial Balance’, the Trust must ensure that deficits are not allowed to develop and
that where they do arise, contingency arrangements should be put in place to address
the deficit.
The Trust has had ongoing discussions with the HSCB on the ability of the Trust to
breakeven in 2018/19. The Trust is reporting a forecast deficit for 2018/19 of
£24.4m
details of which were discussed with the HSCB. The projected deficit can be
summarised as follows:-
Table 6 – Forecast Deficit
Table 6
£’000
Residual Deficit – prior years c/f savings targets
7,200
Cost Pressures 2017/18 & 2018/19
13,500
Savings Plan Gap 2018/19
3,700
Total Forecast Deficit
24,400
It has been agreed with the DoH/HSCB that the Trust will report a £24.4m deficit in
their Trust Delivery Plan and will embark on a 3 year financial recovery process.
The Trust has an underlying recurrent deficit in the circa of £67m and has been
managing internal cost pressures and vacancy controls in the circa of £18m for a
number of years. It was agreed that the Trust needs to quantify the financial gap that
will be included within the financial recovery process. The underlying deficit has grown
significantly over the last two years mainly due to the share of the regional savings
targets and new emerging service cost pressures. The Trust has no authority to
WHSCT TRUST DELIVERY PLAN 2018/19 214
implement high impact measures to address the recurrent service cost pressures or
address the savings target gaps.
The DOH has agreed to the Trust developing a Financial Recovery Plan over a three
year timescale commencing on 1 April 2019 with the objective of achieving financial
breakeven in the 2021/22 Annual Accounts.
In addition, the Trust will ensure that the necessary financial management
arrangements are in place to meet the other key financial objectives, these being:
Delivery of the internal and external cash savings plans against the agreed
plans;
Progress the Trust’s capital plans while remaining within the Capital Resource
Limit set by the DoH;
Achieve value for money in its use of resources employed by the Trust;
Delivery against the prompt payment target.
Financial Assessment 2018/19
This revised position as outlined in Table 6 above is based on the recent opening
allocation, further indicative allocation assumptions and further cost pressure support
in year. The revised forecast of £24.4m and has been included in the Trust Delivery
Plan.
The forecast deficit based on the assumptions used within this financial strategy is
£24.4m.
Financial Planning Proformas
The DoH has prescribed the financial planning/monitoring proformas to be completed
by the Trust to support its Financial Strategy.
WHSCT TRUST DELIVERY PLAN 2018/19 215
CAPITAL INCOME ANALYSIS
The Trust has received an indicative opening Capital Resource Limit (CRL) letter from
the DHSSPS on 30 March 2018, confirming both specific and general capital
allocations for 2018/19, updated by a revised letter on 22 October 2018.
Table 7 – Capital Resource Allocation
Table 7
£’000
Altnagelvin Tower Block (Phase 5.1)
14,660
Theatres Altnagelvin
345
Cranny, Omagh
250
Combined Heat and Power Plants Altnagelvin & Omagh
1,617
R&D Commercial Income
(400)
R&D Commercial Income Spend
400
ICT
2,553
General Capital
8,909
Imaging Diagnostics
1,625
Total
29,959
It is anticipated that the Trust will contain capital expenditure within the CRL allocation
of £29.959m, whilst bidding for additional CRL to cover emerging pressures.
WHSCT TRUST DELIVERY PLAN 2018/19 216
Financial Risks
The Trust has identified a number of financial risks which are to be highlighted within
the context of this Financial Strategy and these have been summarised in Table 8
below:
Table 8 – Financial Risks
Risks
Comments
1.
QICR
One of the key components to enable the Trust to meet its
financial plan is the ability to deliver against the 2018/19
QICR target of £2.5m to address the Trust’s operational
inefficiencies. All Directorates will be required to deliver
against the QICR plan.
2.
New & Emerging
This Trust is experience new and emerging cost pressures as
Cost Pressures
a result of safety issues facing the Trust. Funding needs to
2018/19
be secured to address these pressures or this will have an
impact to the Trust ability to breakeven in 2018/19.
Discussions are continuing with the DoH and HSCB to
address this issue.
3.
Elective Care
The Trust is normally allocated non-recurring funding from
HSCB to reduce or at least maintain waiting times for access
to acute assessment and treatment. This plan has assumed
that any waiting list activity will be fully funded.
4.
Recruitment &
The Trust has experienced a shortfall in the number of junior
Retention Issues
doctors being allocated to the Trust which has resulted in
locum doctors being recruited to sustain services. The Trust
has also experienced recruitment and retention issues in
relation to Specialty Doctors which requires the Trust to use
expensive medical agencies. An estimate has been provided
in the Trust’s overall financial plan for the costs anticipated
however the risk is that if the shortfall is greater than
anticipated, additional costs will be incurred which may further
impact the financial plan.
WHSCT TRUST DELIVERY PLAN 2018/19 217
The Trust is also experiencing a workforce shortage
regionally and locally in relation to a number of professions
including nurses and AHPs. The Trust is working collectively
with other Trusts and BSO to recruit nurses from international
countries to address the shortfall. This shortage is a risk to
the Trust going forward in the delivery of core services and
the transformation projects. The risk is currently being
managed and monitored by service leads. This shortage is
also affecting the budget position as the Trust is employing
staff at a premium from agencies to maintain emergency
services.
5.
Absence Rate
The baseline absence rate for 2017/18 is reporting 7.02% in
the Trust’s accounts as at 31 March 2018. The Trust has
developed a plan under the QICR programme to address the
Trust’s operational inefficiencies as a result of sickness
absence. If the Trust was able to reduce our absence rate
this would support the workforce shortage issue as more
contract hours would be available. Delivery of this target is
required in-year to support the projected year end deficit.
6.
Revenue
Discussions will continue during 2018/19 with the HSCB/
Consequences of
DHSSPS in relation to the recurrent revenue funding for the
Capital Schemes
RCCE projects current in our plan.
7.
Transformation
The DOH has received £100m Confidence and Supply
Projects
funding to support the implementation of a range of
Recurrent Funding
transformation projects. The HSCB has confirmed on 17
Risk 2019/20 and
August 2018 that funding will be available for approved IPTs
beyond
for 2018/19. However at this time no transformation funding
can be confirmed for 2019/20 and hence commitment for
2019/20. The HSCB have confirmed that any recurrent tails
in relation to transformation fund projects beyond 2019/20
must be met from reductions in, and re-prioritisation off,
expenditure in other areas. The funding for all projects in
WHSCT TRUST DELIVERY PLAN 2018/19 218
2018/19 is non-recurrent. The Trust has made a decision that
all entry level posts will be made permanent. There should
be limited risk to the Trust recurrent budget as the workforce
assessment which has been completed both regionally and
locally has given an assurance that the Trust should be able
to absorb entry level post with normal turnover of staff.
WHSCT TRUST DELIVERY PLAN 2018/19 219
APPENDIX 1
OPENING RECURRENT DEFICIT POSITION – 1 APRIL 2018
£’000
£’000
Opening Deficit FYE 1 April 2018
Cost Pressures c/f (SRaFA)
4,795
Cost Pressures 2016/17
21,040
Cost Pressures 2017/18
30,013
Reported to Trust Board/HSCB
55,848
Adjustments/Opportunities
Recurrent Savings Delivered 2017/18
(1,008)
Demographics – Acute ED pressure
(1,400)
Four Seasons
(373)
Little Hands Surestart
(217)
Infusion Unit – Altnagelvin
75
LD Crisis / Out of Hours
63
(2,860)
New Pressures 2018/19 – Advised to HSCB 5 March 2018
Medical
1,700
Medical & Surgical/Rental of Equipment
1,500
WHSCT TRUST DELIVERY PLAN 2018/19 220
Scottish Guilds Nursing
520
European General Data Protection Regulations
84
3,804
LAC 2018/19
2,000
TOTAL
58,792
WHSCT TRUST DELIVERY PLAN 2018/19 221
4.2
Workforce Strategy
The Trust Delivery Plan 2018/19 continues to be delivered in a time of severe
financial pressures with increasing demands placed on all services. Pressures
continue in addressing sickness absence, reducing agency and locum spend and
addressing recruitment challenges. We recognise the need to develop job plans and
roles and explore flexible working arrangements to respond to an ageing workforce
and to also have clearly defined career pathways for all employees.
The HR Directorate will continue to provide advice and support to enable
Directorates to achieve their strategic objectives and will dedicate resources to the
implementation of service changes, transformation and reform initiatives, savings
plans and to the work of QICR.
The Trust is fully committed to working in partnership across the HSC to shape the
future of health and social care provision and to address the workforce issues that
need to be fixed. We will therefore review our current workforce strategy to ensure
that our action plans are aligned to the themes identified within the HSC Workforce
Strategy. These 10 themes are:
1. Attracting, recruiting and retaining staff
2. Sufficient availability of high-quality training and development
3. Effective workforce planning
4. Multidisciplinary and inter-personal working and training
5. Building on, consolidating and promoting health and wellbeing
6. Improved workforce communication and engagement
7. Recognising the contribution of workforce
8. Work-life balance
9. Making it easier for the workforce to do their jobs
10. Improving workforce business intelligence
WHSCT TRUST DELIVERY PLAN 2018/19 222
Maximising Attendance
Supporting a reduction in the Trust’s absence levels across all Directorates remains
a priority for 2018/19, with particular emphasis on achieving the target set by the
Department of Health of reducing absence due to sickness by 5%.
The Trust was required to achieve a 5% reduction on 7.51% (position at 31 March
2017) which was a target of 7.13% The Trust achieved the 5% reduction target and
as at 31 March 2018 the cumulative absence rate was 7.02%.
The QICR team has worked together with HR Directorate Support teams to deliver
on the Maximising Attendance project plan which includes development of a range of
tools to facilitate effective management of absence across the Trust. This includes
engagement with managers to develop the new Attendance at Work policy and
associated Toolkit which was launched in October 2017. Attendance at Work training
has been developed and is delivered jointly by Occupational Health and HR
Directorate Support Teams. *501 Managers have been trained to date and 4
sessions per month are planned across both sectors of the Trust. A suite of reports
has been further developed for the areas rolled out on e-Roster which enables
managers to easily identify absence hotpots and absence trends over the past 2
years. A Maximising Attendance Best Practice Workshop was held in January 2018
and a further workshop is scheduled for October 2018. A series of engagement
events are also being planned to support managers with maximising attendance in
their areas. The project plan for 18/19 has been updated to reflect the shift in
emphasis of the project.
Occupational Health continues to experience increases in the number of referrals as
the emphasis on reducing absence is sustained. The Occupational Health team have
developed new ways of working to ensure that patients are reviewed as quickly as
possible by the most appropriate clinicians. There is planned quality improvement
work within occupational health and work towards restructure of the occupational
health service is on-going and will be completed in 2018/19.
The Trust’s Absence Recording team continues to improve the recording and
reporting of sickness absence.
WHSCT TRUST DELIVERY PLAN 2018/19 223
All Managers within WHSCT now have access to record sickness absence on either
E-Roster or HRPTS.
The Absence Team have now created reporting templates to send to managers on a
monthly basis identifying staff on long-term sickness including half-pay/no pay
absence. This new process has been developed following the noted increase in
overpayments caused by delayed reporting of absence by managers.
The reporting template identifies to managers, staff who are recorded on the system
as being absent from work in order to prompt managers to either extend sickness,
where applicable or enter a Return to Work Interview date to close the absence.
This falls in line with the new Attendance at Work Policy and Procedures.
A quarterly sickness absence report will also be sent to each Head of Service
detailing sick leave of staff within their structure.
Sickness information will continue to be reported corporately through the monthly
Yellow Pages report.
Work is also on-going across a range of work streams throughout the Trust including
the development of Health Improvement and HR Hubs, Policy Design has been
focusing on reviewing flexible working policies and will be developing a step down
policy to support staff wishing to ease themselves into retirement. The Trust has
established a Culture Group and Working Longer Group to support all staff in the
workplace.
Appraisal and Development Review (ADR)
A total of 53% of non-medical Trust staff received an appraisal in 2016/17,
representing an 18% improvement on the 2015/16 figures. We also exceeded the
5% improvement target by 13%. Training on the appraisal and development review
process was provided either face-to-face or via webinar to support managers and
clinicians in achieving the target. We continue to work toward achieving the target for
annual appraisal of 80% for non-medical staff and 95% of medical staff.
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A review of the Trust’s Appraisal and Development Review process will take place
during 2018/19 to incorporate up-to-date thinking and research, with a view to
introducing a new process later in the year.
Seasonal Flu Campaign
The Trust has continued to promote the Seasonal Flu campaign and will do so again
in 2018/19. Whilst the Trust acknowledges that the target was not achieved in
2017/2018 there has been an improvement from 25.74% in 2016/2017 to 27.4% of
frontline staff vaccinated. In order to improve the uptake of staff being vaccinated
the Trust has focused on widespread communication campaigns across the three
hospital sites and held drop-in clinics with the support of ‘Flu Fighters’.
In 2018/19, the Trust will undertake another extensive flu campaign and ensure that
the vaccine is widely accessible to all staff. Plans will include working closely with
the PHA to ensure effective education and communication, including roll out of the
flu campaign, particularly to hard-to-reach staff groups. Designated “champions” will
be identified and trained to encourage front line staff to avail of the vaccination.
Staff Survey
During 2017/18 individual Directorates have continued to work on the
implementation of their Staff Survey Action Plan. Some of the actions taken to date
include:
GROW leadership development programme for new managers
Development and implementation of e- learning Corporate Induction for all
staff including junior Doctors
Working Longer Group established
Development of Human Resources and Health & Wellbeing Hubs
Guidance for staff when dealing with abusive phone calls
Automated Incident Feedback
Dragon’s Den Quality Improvement events
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Work has commenced on the design and development of the next HSC Staff Survey
which will be issued to all staff in early 2019.
Workforce Plans
The Trust has developed a Workforce Strategy 2016-2021 which has detailed
workforce information and identified workforce issues and plans within job families.
An Action Plan has been developed and key actions. Leads have been identified for
these various projects and these continue to be monitored on a quarterly basis
through HR SMT. However in light of the HSC Workforce Strategy 2026 Delivering
for our People the Trust will review the strategy to ensure that it is aligned to all the
themes and actions identified within the strategy.
The Trust will continue to support any regional or internal workforce planning
initiatives by providing high quality workforce business intelligence information and
will engage together in the development and delivery of these plans.
International Medical Recruitment Project
The Trust’s International Medical Recruitment project has recruited 60 doctors to
date across a range of specialties (35 are currently still in post). A further 35 doctors
are progressing in the recruitment process. In addition 5 doctors have converted
from locum rates to NHS contracts. A majority of doctors have taken extensions to
their initial 1 year contracts and 5 have taken permanent contracts. Work on the
project will continue during 2018/19 targeting areas of need and where locum spend
is highest.
International Nurse Recruitment
International Nurse Recruitment is continuing and regionally 689 offers have been
made across 5 separate campaigns, 134 of these are for the Western Trust. It is
anticipated that the majority of nurses will commence their employment as Band 3
Nursing Auxiliary’s and will progress to Band 5 when fully registered with the NMC.
Delays are experienced for the nurses completing our sections of the process, but
particularly with the immigration legislation/procedures in the own countries.
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TTM and HSC reviewed the recruitment practice and increased the shortlisting
criteria to include nurses who have scored 6 – 6.5 in their International English
Language Testing System (IELTS) before interview. This has increased the success
rate at interview. Skype interviews are now being held at the TTM Offices in Belfast
and these are a good success.
Section 4.3 Capital Investment Plan
In addressing the Estate Strategy for the Western Health and Social Care Trust, the
Trust will initiate capital developments which derive from the current DOH Regional
Strategy and service developments initiated by the Trust’s main commissioners.
At the core of the management of its estates infrastructure over the next five years, the
Trust will maintain a strategy which will ensure its estate remains safe, in compliance
with existing and developing statutory standards, is relevant in terms of service delivery
and is of a satisfactory maintenance standard. In this respect, the Trust will endeavour
to secure, where available, additional backlog maintenance money specifically ring-
fenced for fabric upgrade and for health and safety improvement.
The Trust will in the current financial year complete the implementation of a number of
major construction projects and, subject to business case approvals and securing the
necessary capital and revenue funding streams, continue to develop and implement
over the next five years a series of estate developments in terms of the major strategic
projects within the Trust geographical area particularly in relation to the Altnagelvin
Hospital site together with a number of PCID, Social Care and Mental Health
developments. In addition, the Trust will also undertake a number of minor capital
developments, remedial work improvements and statutory standard measures to its
existing infrastructure. It will also direct capital resources to the maintenance of
essential medical and other equipment needs.
The Trust will engage with DOH in order to ensure the effective management of capital
budgets within agreed timescales, post-approval monitoring and post-project
evaluations in line with current departmental direction.
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The Trust will also work in close collaboration with respect to the implementation of the
Department’s Asset Management Strategy and in particular identified surplus land
disposals to agree timescales as identified within the Trust Property Asset Management
Plan.
4.3.1 Priorities
The Trust will ensure infrastructural investment remains relevant to public service
transformation and service requirements necessary as part of the response to the
Bengoa Report and in line with departmental policies such as “Transforming Your
Care”, the Bamford Review and “Caring for People Beyond Tomorrow”.
In particular, the Trust’s Estate Strategy will take into account the capital implications of
a number of proposed service changes within the Trust which include development
priorities in relation to:
2018/19 Financial Year Completion
Interim Theatre Capacity, Altnagelvin
Cranny (Rathview) Facility within the Tyrone & Fermanagh site
Altnagelvin Health and Wellbeing Campus incorporating the Macmillan Cancer
Information Centre
2018/19 Financial Year Completion (defects & retentions only)
•
North West Cancer Unit
•
Omagh Hospital and Primary Care Complex
Next 5 Years
Altnagelvin Tower Redevelopment Phase 5.1 (ongoing)
Altnagelvin Tower Redevelopment Phase 5.2
A&E Service Expansion
Enhanced Theatre Capacity, Trust-wide
Renal Service Expansion
Critical Care Service Expansion
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PCID Developments including Lisnaskea, Derry/Londonderry City Side and
Strabane (incl GP Out of Hours Services where appropriate).
Acute Mental Health Facility, Southern Sector
Upgrading/refurbishment of Trust-wide community health and social facilities
Upgrading of medical / nursing residential accommodation
In working to achieve these objectives the Trust will also target available investment to
improve the Trust’s core estate in terms of statutory standards, fire-code compliance,
physical condition together with energy and environmental standards. This is in order
to progressively meet the Estate shortfall identified in central KE84 returns.
Through a periodic review and update of Trust Estate Control Plans, the Trust will, in
accordance with DOH Policy, ensure that its buildings and land are developed to
ensure both optimum and cost effective use in terms of the existing and developing
services provided by the Trust. In this respect the Trust is currently reviewing and
updating the Trust proposed Asset Management Plan and in this respect, the Trust will
also work closely with DOH/CPD Health Projects with respect to reviewing its estates
utilisation and developing plans for the disposal of redundant estate.
With respect to the Trust obligations in achieving DOH Fire-code Compliance targets,
the Trust will continue to invest in upgrading its Estate to Fire-code or equivalent
standards. In this regard the Trust will also endeavour to undertake the investment in
areas, which reduce the degree of nugatory expenditure.
The Trust will continue to undertake consultations with the Northern Ireland Fire and
Rescue Service in order to ensure that the Trust’s investment programme minimises
the Fire Safety Risks including those within the Altnagelvin Tower Block whilst directing
the investment in a realistic way which takes into account the five year Capital
Investment Programme.
All schemes will be subject to the requirements of the DOH Business Case approvals
process as outlined within the Capital Investment Manual. The Trust will work closely
with DOH and CPD Health Projects to secure early approval and development of
Strategic Outline Cases for future phases of the Altnagelvin Strategic Redevelopment
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and other priority schemes and take forward the necessary Business Cases in line with
agreed profiling in consultation with DOH, HSCB, PHA and other key stakeholders.
Where relevant Business Cases for developments previously approved but not
commenced on site after a prolonged period of time will be reviewed and in
consultation with DOH, updated with respect to service need and capital cost
adjustments.
Section 4.4 Plans for Shift Left of Resources and Other Transformation
Initiatives
In line with Health and Wellbeing: Delivering Together (2026) and following release
of funding through the Confidence and Supply agreement, the Trust has received
non-recurrent funding for a number of work streams to support Transformation and
shift left.
The Trust has been selected as one of two pilot sites in the region to roll out a multi-
disciplinary team across the Derry Federation of Family Practices representing an
exciting opportunity to deliver a radically different approach to primary care – one
based on multi-disciplinary teams embedded around general practice. This will
support the move to more population based health management and individuals
proactively managing their health, prevention and early intervention. The MDT model
will be rolled out across 28 GP Practices serving a population of 203,267.
We will be taking forward a further range of projects under these 4 themes:
1. Build capacity in communities and in prevention
Children’s Services
A range of proposals, largely in relation to “Looked After Children” (LAC), have been
developed by Directors of Social Work, working together to ensure a regional
approach to transformed LAC provision. Proposals include:
Post-Permanence placement support team for LAC
Increased capacity to recruit specialist foster parents
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Mother and baby Foster Placement Scheme for vulnerable mothers
Work with women re: repeat removals of children from their care
Regional clinical psychology support for LAC
Healthier Places
The regional priorities include development of demonstration projects for the
Healthier Places Programme and also to implement more effective models of
community development.
MyAction
This WHSCT led initiative has been identified as a regional priority.
MyAction is a transformative programme designed to prevent Cardio Vascular
Disease (CVD) and other chronic diseases. This programme
flips care - from
reactive, acute hospital based care, which treats the disease post-event, and
has short term follow up with patients, to a personalised preventive service
which aligns with the aims of “Delivering Together”. Its focus is on prevention
and community support for those at higher/highest risk. A presentation on
MyAction was delivered to Delivering Together Programme Board during
2017.
2. Provide more support in primary care
Primary Care Multi-Disciplinary Teams
The Department of Health invited all Trusts, in partnership with General Practice
(GP) Federations, to apply to become a
“Primary Care Multi-Disciplinary Team
(MDT) initial roll out site”. In collaboration with the 2 GP Federations in the West, the
Trust developed and submitted bids by the closing date of 29th June. The Trust were
successful in one of these bids and have been selected to roll out a Primary Care
MDT with the Derry Federation of Family Practices and will receive investment of up
to £2.7m in 2018/19 and up to £5m in 19/20 to implement the new model.
The funding will support the establishment of a new model including enhanced
resources such as:
• Practice Based Social Worker
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• Increased Nursing & Health Visitor Capacity
• Practice based first contact Physiotherapist
• Practice based mental health support
It will also model new ways of addressing population needs through Healthcare
analytics, specialist support, Training & Skills, and community seed funding. An initial
implementation meeting was held between the Trust and the Derry Federation on 7th
August to discuss plans for implementation.
GMS Reform
Significant components of this are being led by GP Federations with the Derry
Federation of GP Practices receiving funding for 9 Advanced Nurse Practitioners.
3. Reform our community and hospital services
Integrated Care Partnerships
This programme is being led by the Integrated Care Teams in Health and Social
Care Board and will build on work in recent years relating to Care Pathways for
people living with long term conditions.
Service Reconfiguration
The components of this priority area include paediatric, stroke and cancer services.
Trust staff have contributed to local priorities through existing regional fora.
Developments in relation to stroke services will have to align with proposals
emanating from the regional consultation on stroke services. The priority for the
Trust is to increase our capacity for Early Supported Discharge.
“Service reconfiguration” also includes proposals relating to the development of
Elective Care Centres and Elective pathway development, and work has
commenced on the 2 prototype Elective care centre models, for Cataracts and Veins
treatments.
Unscheduled Care
Priority areas include:
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In-hospital Flow – in particular establishing Control rooms; extension of 7 day
working and roll out of OPATs within acute hospitals
Acute Care at Home (ACAH) - Within the Western Trust our priority, is to
establish a model in the Tyrone/Fermanagh area. The provision of ACAH is
increasingly being seen as a component of an Integrated Intermediate Care
provision referred to below.
Ambulatory Care Services - the Western Trust proposal is to establish an
ambulatory unit in South West Acute Hospital (SWAH) and to enhance
provision in Altnagelvin particularly in relation to patients living with respiratory
illness.
RAID (Rapid Assessment Interface Discharge) is a mental health service
based in acute hospital setting. The team specialises in understanding the link
between people’s physical and mental health. It will support the assessment,
diagnosis and management of people in hospital who might be suffering with
mental health issues. The Western Trust proposal is to develop a team in
both Altnagelvin and SWAH to ensure that people are linked to appropriate
child, adult or older people’s mental health services.
Adult Social Care
The single biggest proposal for the Trust in this area relates to Domiciliary
Care. There are three work streams (workforce stabilisation, developing new
models and developing a monitoring system). Trust staff are linking closely
with regional colleagues on this programme. Our own reform proposals differ
in parts from those of other Trusts to accommodate our Independent sector
contracts and also our commitment to providing training apprenticeships and
linking the domiciliary care service with carers support. The Trust has been
allocated 1wte Band 8A post to work with regional counterparts to develop the
model for Domiciliary Care.
Mental Health
All Trusts have been advised that the regional priority within this theme is
“Zero Suicide”. The other Mental Health priorities include: Primary Care
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Talking Therapies Hubs as well as Drug, Alcohol and Substance Misuse and
Prevention Programmes.
Dentistry and Oral Health
The priorities within this area include hospital orthodontic services, provision
of special care dentistry, and also dental health nurses working in nursing
homes.
Medicines Optimisation
The Western Trust priorities include Prescribing Pharmacists to support Junior
Doctors, Paediatric Pharmacist and Cardiology Pharmacist for discharge
prescriptions. In addition the Trust will support regional priorities including
medicines safety and co-production and health literacy training.
Nursing
Some of the components originally within this area have been defined within
the framework of the Integrated Intermediate Care proposal. Integrated
Intermediate Care provision describes provision in relation to: crisis response;
bed based rehabilitation; home based rehabilitation and reablement. It will
include and integrate a range of previously separate services with strong
nursing input including: Acute Care at Home, Community Respiratory Team,
Rapid Response Nursing, Palliative Nursing, Discharge to Assess. The
community based components of dementia care provision will be integrated
into the framework as will initiatives relating to “frailty”.
4. Elective Care Waiting Lists
DoH have allocated £30m in 18/19 to this area and all Trust have submitted bids.
Trust have been asked to focus on In-house Waiting List Initiatives only at this point,
prioritising Red Flag and Urgent patients, particularly those waiting longest. The bid
also includes some work on reducing AHP waiting lists, although that has been
limited at this point.
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5. Organise ourselves to deliver
Workforce
Professional leads from across the Trust have fed into components of this work
stream. It includes developments relating to nursing, midwifery, Allied Health
Professionals (AHP), medical staff, pharmacists as well as staff health and well-
being and leadership strategy implementation.
Technology and Innovation
Trusts will be resourced to develop models of eHealth, telecare and innovation in
relation to the use of technology to improve access, support shared care and secure
transformation.
Quality Improvement
This area includes reference to the Western Trust Flow Coaching Academy
programme.
The Flow Coaching Academy programme aims to develop a learning network of
Flow Coaching Academies (FCAs) across the UK. The Academies provide training to
build team coaching skills and improvement science at care pathway level in order to
improve patient flow through the health and care system.
The programme is supported by the Health Foundation and intends to be sustainable
through a social franchise model. The Western Trust was successful in its
application to join the academy in 2018, which consists of an initial 3 year
programme. This will involve running a FCA for Northern Ireland in Year 2 and 3.
Throughout 18/19, the Outpatient Reform will continue across 11 specialities; the
focus of this reforms programme will be on reducing review appointments where it is
appropriate to do so and continuing with the GP led elective care reform in 4 clinical
areas of dermatology, gastroenterology, general surgery and rheumatology and this
work will continue throughout the western trust area.
Work to develop long term condition pathways for the ICP clinical priority areas (Frail
Elderly; Cardiology, Diabetes etc) will continue in 18/19 and indications are that the
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Trust will receive permanent funding to support work in the following areas;
community respiratory team, stroke (orthopist access and vascular visual
assessment) GP training sessions for palliative and end of life care, frail elderly
hospital pharmacist; diabetes strategy implementation. We are awaiting clarification
on a resource to support the chest pain assessment clinic.
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Section 5. Governance
In order to reflect national guidance, Trust Board decided to adopt an integrated
approach to governance and risk management, thus providing a co-ordinated source
of information and assurance to Board members on all aspects of governance
including financial, organisational and clinical and social care. Committee structures
have been developed to reflect this approach. The terms of reference of the
Committee were last reviewed in June 2017 and were approved without amendment.
The Board applies the principles of good practice in corporate governance and
continues to further strengthen its governance arrangements by undertaking
continuous assessment of its compliance with corporate governance best practice.
A Trust Board workshop was held on 29th March 2018 to review the reporting
arrangements, membership and papers which come to Governance Committee work
and a briefing paper has been developed for consideration by the Board. Internal
Audit undertook an audit of Board Effectiveness as part of the 2016/17 audit
programme and this concluded that overall there is an adequate and effective
system of governance, risk management and control.
Managing Risk
The Trust Risk Management Strategy was reviewed in March 2014 and was
approved as a Trust policy by Trust Board. The Trust’s Risk Management Strategy
was reviewed in March 2014 and was approved as a policy by Trust Board. The
Policy was due for review in March 2017 however due to the advice from the
Corporate Management Directorate; Department of Health regarding the expiry of
the Licence for the AS/NZ standard the existing Trust Policy has remained in place
and will be reviewed in 2018 in line with the regional approach to Risk Management.
The Policy clarifies the leadership and accountability arrangements for ensuring that
appropriate systems are in place throughout the organisation to manage and control
risks to the achievement of Trust objectives. It clarifies individual staff
responsibilities on reporting and managing risks. Paragraph 9 of the document has
a statement on Risk Appetite and guidance for managers when considering action
plans for new and emerging risk. Appendix 4 of the Policy is the Risk Register
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flowchart, which provides guidance on how and when risks should be escalated to
senior managers for their attention.
Following workshops with the Corporate Management Team and Governance
Committee a revised Corporate Risk Register process was approved by Governance
Committee in December 2016 which gives more clarity and provides for further de-
escalation mechanisms where the risk can be more appropriately managed if
necessary. Each risk was reviewed in detail and the register reduced to 26 risks
presently from 37 in November 2016. In October 2017 Trust Board held a workshop
to review all risks on the Corporate Risk Register and to review progress on de-
escalated risks which had been delegated to sub-committees/working groups for
monitoring. At the workshop there were further amendments proposed to how
information is displayed on the Corporate Risk Register and Assurance Framework.
The Corporate Risk Register (CRR) is tabled along with the Assurance Framework
(AF) at every Operational CMT, Trust Board and Governance Committee. Any
proposed new Corporate Risk or material amendment to the register is tabled at
Operational CMT for approval in principle and then tabled for final approval at the
following month’s Trust Board if that Trust Board is a least one month before the next
Corporate Governance Committee. Otherwise it will be tabled at Governance
Committee for approval and the updated CRR & AF tabled at the next Trust Board
(and Risk Management Sub Committee) for noting. A summary table showing how
the Corporate Risks are managed over time is also tabled at every Governance
Committee (and preceding CMT). This has proved very effective in assisting in
identifying those risks in most need of review and update.
Directorate Risk Registers are a standing item on all Directorate Governance
meetings. Current risks are reviewed and new risks for inclusion on the Directorate
Risk Register are considered at these meetings. Directors are required to report on
a quarterly basis to Governance Committee on significant risks within their area of
responsibility. Directorate Risk Register process is supported by the Directorate
Risk Register Working Group which has been established to support the Risk
Management Sub- Committee to ensure effective risk register management at
Directorate level.
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The Trust actively encourages the reporting of incidents and risks and staff have
embraced the learning culture by participating in incident reviews which focus on the
lessons for improvement for the organisation as a whole. To support this process
the incident reporting system has been upgraded to ensure it is more user-friendly
for staff to encourage reporting and effective review. Datix now includes an
automatic feedback to reporters when an incident review is complete with learning
and actions identified. An Incident Form specifically for Medics has been developed
to encourage and increase participation in Incident reporting and review. The
‘MediForm’ is a shorter version of the on line reporting form to be completed by
medical staff. The form is currently being piloted in a number of areas. Learning
from Serious Adverse Incidents (SAIs) and Litigation cases are now being added to
Datix and are reportable across directorate and service areas as required.
Following the ‘limited assurance’ audit report of the Management of Acute Falls an
action plan is in place and actions identified for Risk Management have been
completed. The work is being monitored by the ‘Slips Trips and Falls’ Working
Group. This Trust developed a system to facilitate completion of a Post Falls Review
on Datix to ensure an efficient and fully reportable process which allows learning to
be shared regionally through the PHA and locally through the Datix system. A Falls
Learning Review group has been established to ensure learning from serious falls
are appropriately captured and shared.
Incidents and Claims Dashboards highlighting trends are considered by the
Governance Committee quarterly. At the Trust Board Workshop in March 2018
members considered possible amendments to the information that is provided and
this will be trialled at the June 18 meeting. The Quality and Safety quarterly report for
Directorate Governance Groups provides detail of learning on SAIs and litigation for
discussion, action and further sharing by the groups. Regional learning from Serious
Adverse Incidents, including Safety Quality Alerts issued from the HSCB and PHA, is
disseminated and monitored by the Quality and Safety Team. The Trust continues to
publish a Quality and Safety Newsletter to highlight Trust wide learning.
Recognising that there is a limit to the immediacy of written communication and to
the volume of content, the Trust also publishes a ‘Lesson of the Week’. This sits on
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the Trust Intranet server and opens as a default on all desktop computers within the
Trust.
To support Directorates in managing risk, Quality and Safety staff provide on-going
training on all aspects of risk management. Training is being revised and updated
on root cause analysis (RCA) methodology for senior clinicians and managers
undertaking serious adverse incident (SAI) investigations. In March 2018 the Trust
secured funding from the PHA and held a 2 day training session by an external
provider for Senior Clinical Staff (possible SAI chairs), on RCA SAI investigation.
Work is ongoing in ensuring Trust Mortality & Morbidity (M&M) meetings have
access to the relevant Risk Management information including incidents reports and
associated learning. M&M chairs are being trained on how to retrieve relevant
reports directly from Datix for review at M&M Meetings. The Child death notification
process is managed through Risk Management working with M&M leads to ensure
both Datix and the M&M system support timely review and notification.
Assurance
The Board Assurance Framework which was developed in accordance with the
Department of Health (DOH) guidance ‘An Assurance Framework: a Practical Guide
for Boards of DOH Arm’s Length Bodies’, is updated on an annual basis and
submitted to Governance Committee for approval.
Internal Audit undertook an audit of Board Effectiveness as part of the 2016/17 audit
programme and this concluded that overall there is an adequate and effective
system of governance, risk management and control. The Trust Board members
concur with the findings of the Internal Auditors that the Trust Board is effective and
is conducting its business in accordance with best practice.
The Risk Register / Assurance Framework provide the Governance Committee with
evidence based assurances on the way in which it manages risk in the Organisation
at a strategic level. Directorates are required to identify and document gaps in
controls and assurances for all risks on the Corporate Risk Register.
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The Assurance Framework and Mid-Year Assurance and Governance Statement
provide the DOH with assurance on governance and risk management related
issues.
Directorates also provide quarterly Governance Reports, under the themes of the
regional Quality 20/20 strategy, to provide assurance to Governance Committee
members.
Quality Improvement Plans / Strategy
Improving the quality of clinical and social care is a key component of clinical and
social care governance. The Trust will continue to ensure good progress on Quality
Improvement Plans, which focus on key priority areas that will lead to improved
quality services and better outcomes for patients and clients.
The main aim of the Trust Quality & Safety Programme has been to implement a
range of evidence-based improvement plans agreed as regional priorities. The
Medical Directorate Quality & Safety Team continues to focus on the reduction of the
risk of thrombosis for patients admitted to hospital (Venous Thrombus Embolism
prevention), as well as safety and improvement work in relation to stroke, World
Health Organisation (WHO) surgical checklist, National Early Warning Scores
(NEWs), falls, malnutrition universal screening tool, absent without leave in mental
health hospitals, reducing admitted and delayed medication doses and pressure
ulcer prevention. The Trust will continue to work with the Northern Ireland Safety
Forum on new and on-going Collaborative Groups for example normalising
childbirth, safety initiatives in mental health and paediatrics and a regional approach
to identifying and managing sepsis.
The Quality Improvement Plan for 2018/19 will include the core commissioning
quality improvement plan priorities and other areas of quality improvement identified
by the Trust.
In order to progress with building staff quality improvement knowledge and
capability, the Trust has been encouraging and facilitating a range of training
opportunities. This supports the Regional Quality 2020 Strategy Attributes
Framework for ‘Supporting Leadership for Quality Improvement and Safety’. The
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Trust worked towards training 30% of staff during 2017/18 in level one of the
framework. The focus during 2018/19 will be the development and provision of a
level 2 programme. The Quality Improvement Steering Group oversees training and
Trust events to promote and enable a culture within the Trust which reflects the
desire and need to continuously improve the quality of services we provide.
The sixth Trust Annual Quality Report will be produced for 2017/18 based on the
regionally agreed minimum dataset.
Robust Standards
Trusts are required to have appropriate clinical and social care governance
arrangements in place to ensure satisfactory progress is made towards full
implementation of best practice guidance and alerts. A Standards Triage Group,
Chaired by the Associate Medical Director, reviews all quality and safety related
guidance and ensure that appropriate leads are nominated to take forward
associated action. The Governance Team has developed a data base for recording
the dissemination of these standards and providing an alert to the nominated lead if
a response deadline has passed. The Quality and Standards Sub Committee
monitors progress against the specific standards which require a Trust response and
action and provides exception reports to the Trust’s Governance Committee.
Leads have also been identified for Service Frameworks, who link with professionals
or commissioning leads within the HSCB/PHA.
Medical Revalidation
During 2017/2018 the Trust continued to support doctors through Appraisal and
Revalidation developing and delivering on Colleague & Patient Feedback, Appraisal
Training, Essential Training Days, Policies & Guidance documentation and local
support, all essential for the continued engagement of doctors as required under
legislation and by the GMC. During the year:
The Trust Responsible Officer made 33 revalidation recommendations and all
recommendations were upheld by the GMC;
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100 doctors attended in-house appraisal training with further sessions already
planned for April and November 2018;
More than 96 doctors attended mandatory training sessions facilitated by the
Essential Training days held in May 2017.
During 2017/2018 the Trust, engaging with all other relevant organisations,
continued to lead on the development of a Regional Medical Appraisal System for
doctors. The proposed system will be based on the existing Western Trust Medical
Appraisal System and has the support of the Medical Leaders Forum (NI). To
support this development the Regional Appraisal System User Group and the
Regional Appraisal System Administrative User Group were set up. Test versions of
the system have been made available to all relevant organisations for feedback and
first implementation is planned for autumn 2018. Post implementation, the user
groups will continue to meet facilitating the development of regional standards, the
sharing of experience and good practice and the continued development of the
regional system to meet user and legislative requirements.
The Trust continues to meet regularly with the GMC Employer Liaison Adviser for
Northern Ireland regarding a range of topics, including Appraisal & Revalidation.
These meetings provide the opportunity to discuss general and individual appraisal
and revalidation matters on how best to manage and support our doctors.
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Section 6. Promoting Well-being, PPI and Patient Experience
6.1
Promoting Well-being
In general, the health of the public has been improving over time. Social, economic,
environmental and service improvements have meant that people are living longer
than before. However the poorer health status of disadvantaged communities
illustrates the health inequalities associated with poverty and social exclusion. There
is a widening gap in health status between the least deprived and most deprived
communities.
The Trust continues to be committed to the promotion of health and wellbeing
through working collaboratively across sectors and communities to inform and
deliver programmes of care. Its work is informed by the six key themes of the Making
Life Better Public Health Framework and the Delivering Together Health Strategy
prioritising work to reduce the health inequalities in the Western Trust area, working
to ensure early interventions and service user involvement in the improvement of
Health and wellbeing services.
WHSCT maintains its commitment to targeting the health inequalities experienced by
disadvantaged communities through poverty and social exclusion. To alleviate our
health and equalities by our most deprived communities we will work in partnership
with our service users and clients and carers and coproduce effective outcomes
focused solutions. It will seek to actively engage with people and disadvantaged
communities through its work in support of the Community Planning agenda; its
continued support for the Neighbourhood Renewal Communities; and the
development of networks and actions targeting the Travelling Communities. This
year we will have a renewed emphasis on coproducing with our local BME
communities projects to ensure health and well-being for these communities The
Trust will continue its work in prevention of ill health to support the healthy population
remain healthy and well.
In support of the reform agenda the Trust will continue to engage all sectors,
including communities, developing and strengthening important partnerships across
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the West which are providing essential infrastructure to assist in reducing health
inequalities and improve health and social wellbeing. The WHSCT will continue to
leverage additional resources for example, Department for Communities (DfC),
Department of Environment, and Rural Affairs (DAERA) INTERREG V, Big Lottery
and others. These will facilitate a shift in new ways of working, seeking opportunities
for co-operation leading to coproduction in planning and delivery of services based
on local needs. Furthermore, the ongoing work with existing key community
networks is vital in terms of ensuring inclusion in consultations and decision making,
building social capital and securing positive outcomes for patients and clients.
The Trust will strengthen its community support. It will work with local providers to
support the work of volunteers and actively engage at the local level with our
vulnerable service users, older people, those with a learning disability, and our
carers. We will work in partnership with other sectors and communities to increase
the ability and opportunity of our communities and service users to obtain,
understand and use healthcare information to take control of their own health and
make better use of our health and social care services.
The Trust is committed in working in partnership with local community/ voluntary,
funders and other statutory agencies to develop and deliver evidenced based
interventions to mitigate the impact of attempted and completed on the individual,
family and community.
Within the Context of Delivering Together , and with the child and young person in
focus the Trust will work in partnership across all sectors to deliver evidence based
early interventions targeting early years and families endeavouring to give every
child the best start in life.
The Trust will continue to promote the health and wellbeing of its staff through its
Investing In Your Health Programmes.
Further information is available in the WHSCT’s Directorate Delivery Plans which
have been written in consultation with our key partners in line with current health and
wellbeing strategies. As in previous years a number of specific strategies and
frameworks will be addressed including, Smoking, Obesity, Sexual Health and
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Teenage Pregnancy, Suicide Prevention, and Mental Health and Wellbeing. These
aim to maximise and make the best use of available resources in making a real
difference to people’s health and wellbeing. Performance management will be
provided through Health Improvement monitoring returns evidencing impact and
delivery against outcomes.
6.2
PPI
The Western Trust remains committed to service user, carer and public involvement
and ensuring that there are no circumstances under which proposals for material
change or withdrawal of service can proceed without effective involvement. The
Personal and Public Involvement (PPI) Plan 2018-2021 is under development with
the driving emphasis of embedding PPI and co-production ethos in the development
of services and quality improvement projects through all directorates. PPI is the
active and effective involvement of service users, carers and the public in Health and
Social Care (HSC) services. PPI operates on a number of levels within the Trust,
ranging from one-to-one discussions about care and treatment with service users,
carers and their advocates through to involvement in policy development, service
design, redesign and elevation. In line with the new Ministerial target that:
‘By March 2019 the HSC should ensure that the Co-production model is adopted
when designing and delivering transformational change. This will include integrating
PPI, co-production, patient experience into a single organisational plan.’
The Trust will ensure that PPI and Patient and Client Experience are integrated to
support the development of the co-production ethos throughout the Trust’s service
delivery.
The Trust will co-produce with the Adult Learning Disability Advisory Group an
effective model of engagement for Adults living with a learning Disability and their
carers.
The Trust will increase its resources for PPI/ Co-production by the appointment of
two posts: a band 6 User Involvement Advisor and a Senior PPI Officer .
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The Trust continues to be represented on Regional PPI Forum, established by the
Public Health Agency (PHA), by both service users and staff. The Trust is
supported by the Trust PPI Steering Group which is co-chaired by a service user and
a member of the Trust Board. The Equality and Involvement Team have increased
representation on the Trust PPI Forum by service users during the reporting period.
All PPI Forum members receive an induction from Equality and Involvement staff
and are reimbursed for out of pocket expenses in accordance with the
Reimbursement Guidelines.
In line with its commitment to embedding PPI and the co-production model, the Trust
will continue to provide opportunities to highlight Personal and Public Involvement
(PPI/co-production) work, share learning and celebrate and showcase good practice
in relation to PPI within the Trust. The Trust demonstrates good practice via our
Annual PPI Report, Monitoring and Verification Visit from the PHA and Annual PPI
Engagement Event. Trust staff can access the Regional HSC Engage and Involve
E-learning Programme and can access information on PPI via the staff intranet.
Support is also offered by the Equality and Involvement Team.
Engagement and Consultation is an intrinsic element within the Trust’s approach to
Personal and Public Involvement and the Trust’s Equality Scheme. The Trust’s
Equality Scheme and Consultation Scheme sets out arrangements for consulting in
accordance with the principles contained in the Equality Commission Northern
Ireland (ECNI) Guidance “Section 75 of the NI Act 1998”. In taking forward
engagement and consultation, the Trust shall continue to further embed community
development approaches to support local involvement and innovation in the future
delivery of services including working in partnership with other key stakeholders to
encourage and support the development of social enterprise models.
During 2018-2019 the Trust will also:
Develop a new PPI Strategy and Action Plan for 2018 – 2021
Implement the ALD hub and spoke model of engagement.
Continue to involve and engage patients, service users, carers and
representative groups in establishing priorities and plans and supporting the
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evaluation of health and social care delivery to provide learning and
continuous improvement.
Support the ethos of coproduction.
Support the Reform agenda and ensure Users and Public are supported and
involved in having a voice as part of changing and improving services.
Support enhanced recording and reporting of involvement activities which will
focus on improvements made as a result of user involvement.
Continue to support user involvement through reimbursement of out of pocket
expenses for service users, carers and stakeholders involved in service
improvement.
Develop a new TOR for the Trust’s PPI Steering Group which will strengthen
the role of the Group and increase the numbers of Service users and carers
with developed decision making processes and involvement at levels 4 and 5
assured.
Produce a Trust PPI Annual Report and host PPI ‘Engagement’ events for
staff, users and public.
Seek to support improvements in PPI practice in line with recommendations
from Annual PHA Monitoring and Verification visit.
Encourage sharing of good practice, increasing links with other HSC
organisations and implement both Regional and National PPI models of good
practice.
Support the recommendations from PPI research: PPI and its impact:
Monitoring, measuring and evaluating the impact of PPI in Health and Social
Care in Northern Ireland.
Equality & Human Rights Considerations - The Trust is committed to the
discharge of its Section 75 obligations in all parts of our organisation and to ensuring
the effective implementation of our Equality Scheme. In carrying out our functions
relating to Northern Ireland we are required to have due regard to the need to
promote equality of opportunity between:
Persons of different religious belief, political opinion, racial group, age, marital
status or sexual orientation
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Men and women generally
Persons with a disability and persons without
Persons with dependents and persons without
The Trust is also mindful of the Human Rights Act, which was enacted in October
2000, and we also consider our duties under Section 49a of the Disability
Discrimination Act 1995 (DDA 1995) (as amended by Article 5 of the Disability
Discrimination (NI) Order 2006) to have due regard to:
The need to promote positive attitudes towards disabled people; and
Encourage participation of disabled people in public life.
Through the applications of our Equality Scheme, specifically through the
methodologies of Equality Screening, Equality Impact Assessment (EQIA) the Trust
will seek to promote and further its equality duties.
6.3
Patient Experience
Patient experience and service user voices are acknowledged as having a “key role
to play” in tracking quality of care and shaping service improvements (The Kings
Fund 2016). Improving the quality of the healthcare experience is included as an
outcome indicator in Programme for Government (PfG) (2016-2021
) which
recognises that a good healthcare experience lies at the heart of a high quality
service.
As part of the 10,000 Voices initiatives, over 13,000 stories have been collected
regionally to date. Therefore 10,000 Voices
has been re-launched as
10,000 More
Voices. The work is commissioned and funded by the Health and Social Care
Board and the Public Health Agency to provide a more person centred approach to
improving health and social care experience and to shape how services are planned
for the future. 10,000 More Voices is based on a partnership and co- production
approach. People who use and deliver services are the key people who can provide
feedback about their health and social care experiences received within the Trust
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and this information can be used to inform future planning and service
improvements.
The key themes of treatment and care which contribute to a positive experience for
patients and carers on their experiences of a range of services are as follows:
Receiving care and treatment in a timely manner
Being treated and looked after by caring and compassionate staff
Having confidence and feeling safe with staff
Having access to timely, accurate information
Advice on follow up treatment and aftercare
Key areas include:
1. Unscheduled Care -Local Actions:
Review of pathways for treatment
Additional staffing levels, and staff support
Meals and drinks provision continue to be monitored by departmental staff
Sharing of stories for staff induction/education and training
Provision of adequate and timely pain relief.
Additional triage room
All staff to keep patients/ carers/ family informed of progress
Staff introductions / embedding of # hello my name is
2. Experience of care in relation to Discharge from hospital - Emerging Themes:
Having a good plan in place for discharge, this includes the following:
Care package in place prior to discharge if required
Explanations about medications
Advice on discharge
Discharge arrangements for day of discharge
Advice on after care and who to contact for follow up
Regional report and Trust report to follow
3. Experience of Care in Relation to Bereavement - Emerging Themes:
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Communication with patient and family- listening: consistency; breaking bad
news; managing expectations
Communication between professionals- need to work in a collaborative
manner with primary care
Information- distribution of printed information/ sign posting in a timely
manner when needed
Environment – stories highlight dying inappropriately in ward bays due to lack
of side rooms; facilities for relatives; transferring of dying patients; place of
death
Support for those bereaved
Safe and effective care; advanced care planning; coordinated care; symptom
management; value of good care/ clinical skills; person centred care.
Creating a supportive experience; 5 Patient and Client Standards
Staff support following personal bereavement
Regional report and Trust report to follow
4. Experience of Care in Relation to Delirium - Emerging themes:
Providing information and explanation
Importance of family presence
Appreciating the effects that an episode of delirium can have on the patient/
family and carers
5. Adult Safeguarding - Emerging Themes:
Communicate the purpose of adult safeguarding to Service User / carers.
Provide written information for reflection
Consider alternative approaches to investigation that result in Service User
desired change / action.
Building resilience of Service User in protection plans
Opportunity for post investigation support / therapeutic intervention for Service
User / families in closure stage of safeguarding process.
Regional Report and Trust report to follow.
6. Hospital Eye Care Services Experiences - Local actions:
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Reception desk re-opened.
A review of current patient information leaflets sent out from eye department
with input from RNIB.
Hello my name is. Badges ordered for all staff.
Developing WHSCT webpage for Ophthalmology services to include
educational and information materials for patients and relatives
Name boards for Clinic 6 Altnagelvin in yellow background, with black to
identify clinician in each room
A cataract pathway being devised
Expansion of accommodation in Clinic 6 Altnagelvin – patient feedback in
design process to be included.
Availability of Volunteers to assist those who wish to use the self-check in.
RNIB engaged with signage team and giving feedback to Estates design
team.
WHSCT promotional video as part of regional launch in September - 6 top tips
for health care staff when communicating with blind/ partially sighted people.
2 Staff and a service user from WHSCT will feature on the regional
communication card.
7. Reduce noise at night.
Noise management can be difficult to manage on the Altnagelvin site given the 24
hour admission process and multiple bedded bays in the tower block.
Lights are to be dimmed by 11pm following the medication round
Internal transfers of patients between wards to occur up to 10pm – other moves
are when the patient is a direct admission.
In the areas where there is 100% single rooms such as SWAH and parts of the
new build in Altnagelvin noise is not as challenging.
Patients who tend to be disruptive or requiring one to one care are, as far as
possible, cared for in a single room or appropriate area where they can be
closely observed in order to minimise disturbance to other patients.
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8. Mixed Gender Accommodation
A policy on Mixed Gender Accommodation is available on the Western Trust
Intranet. Breaches are reported through Western Trust Nursing & Midwifery
Governance Meeting. A regional priority for 2018/19 will be to undertake an
improvement project in relation to Mixed Gender Accommodation. Part of this project
will involve a thematic review which has been approved by the Quality, Safety and
Experience team (QSE). It is anticipated that the review will be completed by end
March 2019.
9. Family Presence Visiting Policy
This reinforces the Trusts commitment of participation, engagement and working in
partnership with relatives and carers. The policy highlights the principles of how
relatives and friends can support relatives while they are in hospital, this will also be
displayed on banners at hospital entrances and individual ward posters.
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