We held our third national conference of the National Audit of Intermediate Care 2018 on Friday 1st March, bringing together the NAIC findings, transformation plans and an update from Wales, to Northern Ireland.
Shane Breen, Allied Health Professional Consultant for Northern Ireland’s Public Health Agency, opened the conference, welcoming Marie Roulston, Director of Social Care and Children for the Health & Social Care Board, who provided the Opening Remarks. Her points focused on the strategic direction of intermediate care, identifying areas such as effective multi-disciplinary team working and shared learning, topics which would be returned to throughout the conference.
Delegates were then shown an insightful and inspiring video of intermediate care from a service users’ perspective. The video, from Belfast Health & Social Care Trust, highlighted each area of intermediate care and how the appropriate care provided has enabled service users to continue their journey to improved health and independence.
We then moved onto the NAIC Northern Ireland findings, which were delivered in two parts by Claire Holditch, Director of the Network, and Lucy Trubacik, Project Manager. There were high levels of participation for NAIC 2018, with five Local Commissioning Groups and five Health & Social Care Trusts participating in the audit, and over 2,000 contributions to the service user audit - the highest response rate UK wide.
Three aims of the NAIC was avoidance of unnecessary hospital admission, independence following a stay in hospital, and prevention of residential care. Findings from the NAIC demonstrate the adverse effects of hospital based deconditioning, with data showing patients with frailty related conditions admitted to the emergency department having 2-5% reduction in muscle power in the first 24 hours of admission. There is also evidence to suggest that therapy input within intermediate care has a direct and positive impact on a service users dependency levels on discharge.
The findings from the audit showing that care at home services are effective were reinforced by Anne O’Reilly, our second service user presentation of the day, who confirmed that patients want care at home. There was also emphasis on the benefits introduced by Marie earlier in the day of shared learning; Anne identified that shared decision making supports improving outcomes and quality of life, as well as communication and a culture of transparency and confidence.
Next to the lectern, we welcomed Tracey Williams, Head of New Models of Care, Transformation Programme in Wales, Welsh Government, who shared an update on how NAIC has been used in Wales, following a three-year cycle of the audit. Tracey recognised the system challenges, before focusing on the transformation work being implemented, especially at a regional level. Their vision includes a focus on prevention and early intervention, as well as delivering care locally through new models of care, that can be scaled up to a national level.
Following a networking break, delegates were welcomed back by Paul Cavanagh, Assistant Director of Commissioning for the Health & Social Care Board, who introduced Mary Hinds, Director of Nursing & Allied Health Professionals at the Public Health Agency. Mary presented intermediate care in the context of transformation in Northern Ireland, sharing high level messages from NAIC 2017. These included findings such as a high use of spot-purchased beds, limited use of home based intermediate care, and limited step-up capacity within Northern Ireland. The audit gave opportunity for a non-recurrent Transformation Fund to drive new ways of working in intermediate care. This was a 3-year proposed programme committed to multi-disciplinary working and home-based rehabilitation, the aim of which was to reduce unnecessary stays in acute beds, as well as increasing community capacity. The work is ongoing and Health & Social Care Trusts were welcomed to review their transformation plans and service improvement opportunities in round table discussions.
Delegates heard the final section of NAIC findings from Josh Davies, NAIC Project Coordinator, who presented ‘the patient experience: how effective are intermediate care services in Northern Ireland’. This was based on the Patient Reported Experience Measure (PREM), containing 15 questions covering various domains of patient experience, as well as an open narrative question. Summary scores and analysis from the PREM can be located in the report on the members’ area.
We closed the conference after Trusts had an opportunity to share their improvement plans and progress since Year 1 of the audit. One example includes Southern HSCT who are working to improve Step Up access by working across boundaries and breaking down silos to improve outcomes. Paul Cavanagh concluded the conference alongside Mary Hinds, detailing the next steps in intermediate care for Northern Ireland.
Thank you to all who attended in both a speaker and delegate capacity. If you have any queries about the NAIC, please contact Josh Davies, Project Coordinator.