Agenda item

            The Committee considered the undernoted report:

 

“Relevant Background Information

 

Purpose

 

      To bring to the attention of the Strategic Policy & Resources Committee details of a consultation by Belfast Health and Social Care Trust – New Directions: A conversation on the future delivery of health and social care services in Belfast.  The Belfast Trust has started a process to examine how it will deliver services in the future and this consultation details the initial overview of the strategic direction for services.  The consultation runs from 29th August 2008 to 7th November 2008.

 

Background

 

      On the 22nd November 2005, the previous Minister for Health, Shaun Woodward announced the largest reform to health and social services in Northern Ireland.  The plans included:

 

·         A considerably smaller Government Department;

 

·         A Strategic Health and Social Services Authority to replace the four boards and take on some functions currently with the Department;

 

·         Eighteen Trusts reduced to five by April 2007 (the Ambulance Service remains as a separate Trust);

 

·         Seven local commissioning bodies, demand led by patients and driven by GPs and primary care professionals, taking on some roles from the four boards and some roles from the 15 Local Health and Social Care Groups, which will be abolished;

 

·         One Patient and Client Council replacing the existing four Health and Social Services Councils.

 

      Belfast Health and Social Care Trust was formed in April 2007 from the merging of six Trusts, four of which were acute, as part of the Review of Public Administration reforms.  The new Trust is responsible for a full range of services, removing the distinction between acute, community and mixed Trusts.  It was intended that the new Trusts would promote integration between health and social services, across professional groupings and across geographical areas; the networking of services would be at the core of this.

 

Summary of the Consultation

 

      The consultation document outlines the guiding principles that will steer the Trust’s approach to reviewing and reorganising services.  The Trust is generally seeking feedback around the guiding principles and the proposed models of care that might be implemented.

 

      The key principles outlined in the consultation documentation for comment under the following headings:-

 

1.   Guiding Principles

 

·         Improve health and wellbeing and reduce health inequalities

 

·         Focus on prevention of illness, early assessment and intervention

 

·         Focus on individual needs and choices

 

·         Provide safe, high quality, effective care

 

·         Improve accessibility to services – promote equity and welcome diversity

 

·         Localise where possible, centralise where necessary

 

·         Integrate services (through partnerships working)

 

·         Provide clear directions to services, reducing fragmented and frustrating services

 

·         Maximise utilisation of assets

 

2.     Proposals for modernisation and reform of services

 

·         Following discussions within the Trust, proposed models of care have been outlined and set within DHSS policy decisions and PfG

 

3.    How do I get access to community health and social care services?

 

·         A network of seven wellbeing and treatment centres, intended to be single access points for information, advice and services

 

4.     Where do I go if I am having a baby?

 

·         Central to the delivery of the Trust’s Maternity Services are Choice, Continuity and Control.  The Belfast Trust’s model of care favours a holistic, community based model of maternity care which incorporates a wide range of services in a variety of settings including the women’s own home (community midwifery teams), Wellbeing and Treatment Centres, a midwife led unit (at the Mater Hospital) and a single inpatient obstetrics unit (On the Royal Hospitals site).

 

5.     Where do I go if I need to access services for children?

 

·         The Trust favours a model of care which incorporates a wide range of services to children in a variety of child focused settings.  The Trust is committed to providing high quality assessment and treatment and intervention across the continuum of care.

 

6.    Where do I go if I need support or care because of my physical or sensory disability?

 

The Trust favours a model of care that continues to provide a range of specialist rehabilitation services on a single site, Musgrave Park Hospital.  The Trust’s services plan is that people with physical or sensory disability should be supported to live as independently as possible in the community.

 

7.    Where do I go if I need support because I have a learning disability?

 

·         The Trust will continue to provide inpatient assessment and treatment services (however after 2016 Muckamore AbbeyHospital will not be a home for life for people with a learning disability).  The Trust will develop, in partnership with other agencies, homes for life in the community and to expand the availability of small respite units and develop a small number of community treatment beds for people in Belfast.  The Trust also plans to develop new day service accommodation for people with complex needs and challenging behaviour.

 

8.    Where do I go if I am an adult and need mental health services or I have an acute mental illness?

 

·         The Trust’s strategy is to provide a modern, responsive mental health service in a range of settings with the aim of moving away from hospital-based models of services to early intervention and community support.  While the Trust currently provides acute inpatient mental health services at Belfast City Hospital, the Mater Hospital and Knockbracken Healthcare Park, the preference for the future is to develop a single acute inpatient mental health facility for patients that cannot be treated within the home setting.

 

9.     Where do I go if I need acute hospital services?

 

·         Emergency Services would be retained at the Mater Hospital, BelfastCity Hospital and Royal Hospitals. However, there would be differentiation of services to improve patient care, based on the type of patient’s condition and needs:

 

·         Cardiology services would be provided at the Mater Hospital, BelfastCity Hospital and Royal Hospitals.

 

·         The provision of a major acute hospital; encompassing trauma services, emergency services and a heart centre on the Royal Hospitals site.

 

·         The provision of a range of acute hospital services and a Regional Ophthalmic Centre (including a unit for planned eye surgery and treatment) on the Mater Hospital site, as part of a larger ambulatory care centre.

 

·         The provision of a range of acute hospital services, encompassing cancer and renal services, the chronic admissions centre as well as the major elective centre for Belfast (including an elective orthopaedics unit) on the Belfast City Hospital site.

 

·         The provision of specialist rehabilitation services on Musgrave Park Hospital site.

 

10.  Where do I go if I need support because I am an older person?

 

·         The Trust’s aim is that older people should e maintained in their own homes, supported by a network of care services that enable them to maintain their quality of life.

 

Key Issues

 

Implications for Belfast City Council

 

Guiding Principles

 

      The Trust has set out a draft document for 2008-2013, entitled ‘The Belfast Way’ which describes the values and objectives for service delivery.  Many of the guiding principles, as set out above, reflect the values and direction of Belfast City Council.  There is scope, therefore, for the Council to work in partnership with the Trust to improve the health and quality of life for all people living in, or indeed visiting Belfast.  The Council is already actively working with the Health Trust and other health organisations to improve well-being and to reduce health inequalities; the vision document therefore recognises and provides an opportunity to build upon this work.  In addition, the principles of maximising assets and integrating services through partnership working provides scope for the Council and others throughout the city to contribute to efficient and more customer focussed service delivery.  The focus on prevention; promoting equality and diversity; service improvement and local access are all reflected in the strategic work of the Council.

 

Wellbeing Centres

 

      The Trust is proposing to establish a network of seven wellbeing centres, strategically located within the main community sectors across Belfast which are expected to be single points of access for information, advice and services i.e. Four of these centres are open including the Grove Centre and three more are set to open over the next two years.  The Knockbreda Centre will open early in 2009, followed by the Shankill Centre and the West Belfast Centre which are set to open in 2010.  Each centre will have dentistry, occupational health, physiotherapy, speech and language therapy and may in the future offer outpatient clinics relocated from hospital settings.  There is scope for Belfast City Council to work in partnership with the Trust and others to maximise the utilisation of assets, not just within the Trust, but across the city thereby creating economies and more effective and accessible services.

 

Modernisation and Reform

 

      The Belfast Trust is planning to centralise mental health services through the provision of a single acute health care facility at Knockbracken HealthcarePark, which will be part of a network of residential, day care and treatment centres provided locally throughout Belfast.  The potential closure of acute inpatient mental health facilities at both Belfast City Hospital and the Mater Hospital will have various implications and may potentially mean increased waiting times to be seen by a professional mental health care worker, and the subsequent impact this may have on vulnerable patients.  There is no information provided on the level or pattern of usage of services within the two hospitals that are proposed for closure, the current waiting times or of the ability of a single health care facility to absorb the volume of displaced patients.

 

      Acute emergency care will continue in the three hospitals and in future will specialise and differentiate service depending on the patient’s needs and condition.  Cardiology services will be provided at the MaterHospital, BelfastCity Hospital and the Royal Hospital.  The Royal Hospital site will be a major acute hospital encompassing trauma services, emergency services and a heart centre.  Belfast City Hospital will provide a range of acute services encompassing cancer and renal services, the chronic admissions centre and the major elective centre for Belfast.  The MaterHospital will provide a range of acute services and a Regional Ophthalmic Centre as part of a larger ambulatory care centre.

 

      Inpatient obstetric services including neonatal services will be on a single site at the Royal Hospital and this will be supported by a midwifery led unit at the Mater Hospital.  With the closure of the Jubilee Maternity Unit at BelfastCity Hospital and the subsequent merger with the Royal Hospital in January 2001, Belfast has already experienced serious upheaval in maternity care in recent years.

 

      Considering the major changes to service provision for the Belfast area that the Trust have outlined as above, and in order to fully understand the impact that this may have on the city as a whole, much more detailed information would be required.  Perhaps even including a detailed impact assessment and further consultation on specific changes.

 

Partnership Working and Integrated Services

 

      The guiding principles that are outlined within the consultation are generally aligned with the principles of the Council, particularly in the current corporate plan, to deliver high quality, customer focused services that meet the needs of local people and work towards improving quality of life and well being.  In order to be successful in these aims, effective partnership working is crucial.  The Council has already proved its willingness to work with the Trust in the successful development of the Grove Wellbeing Centre.  In addition, the Council is currently working with the Trust and other partner agencies to ensure that services for older people are appropriate to need and accessible.  Furthermore the Trust is keen to work with the Council and other agencies in the care of Children and Young People.  The Council has indicated its desire to work with the Trust in the consultation response and the potential role of the Council has been highlighted.

 

      As a result of the Review of Public Administration, Councils have a new wellbeing power.  Four Councillors from Belfast City Council will be represented on the Local Commissioning Group and there are plans for local collaborative working arrangements between Councils and the new public health agency

 

Ongoing Engagement

 

      The Strategic Policy and Resource Committee were advised of a correspondence received from William McKee, Chief Executive of the Belfast Trust, seeking permission to address the Committee on health issues.  As yet, no date has been set for this meeting.

 

Further Details

 

      Belfast Health and Social Care Trust welcome all views & comments regarding future access to services.

 

      The consultation document is available at the following website:

 

http://www.belfasttrust.hscni.net/lnews/New_Directions.html#TopOfPage

 

      All responses should be forwarded to Belfast Health and Social Care Trust by 7th November 2008.

 

Recommendations

 

      Members are asked to approve the attached draft response from Belfast City Council and agree its submission to Belfast Health and Social Care Trust.”

 

            The Committee approved the draft response for submission to the Belfast Health and Social Care Trust.