Briefing on Winter Health and Social Care Challenges

Health and Social Care Trusts across Northern Ireland are preparing for another difficult winter period for both patients and staff.

The winter pressures reflect the fact that demand for urgent and emergency hospital care is growing - and the capacity of the system to cope is being increasingly stretched.

Looking to the longer-term, a review of urgent and emergency care across Northern Ireland’s hospitals has recently been announced by the Department of Health.

The review will aim to establish a new regional care model for the province, with particular focus on meeting the needs of the rising proportion of older people in the population.

In the meantime, the Health and Social care system have put in place detailed plans to alleviate some of the pressures this year. The winter resilience plans focus on: providing alternatives to hospital admissions in appropriate settings; ensuring patients can leave hospital quickly when they are clinically fit; and in improving ambulance turnaround times at emergency departments.

Winter Pressures Initiatives

Examples of winter pressures initiatives include:

• Extra investment in GP services

 An extra winter payment of £2.27m has been invested in GP services here to enable GPs to offer additional consultations with patients during the winter period. This will include the days immediately following the Christmas and New Year holidays, which have traditionally been busier times. This investment will see GP practices offering same day urgent appointments, remaining open at lunch time and no half day closure following the Christmas and New Year holidays.

• Community pharmacists to offer consultations on minor winter ailments

 A new Pharmacy First service has been launched in Northern Ireland this winter, which will enable patients to have a consultation in a private area with their community pharmacist for advice and treatment for sore throats, colds and flu-like illness. The service will be available from participating community pharmacies from 1st December 2018 until 31st March 2019 and represents a £2.1m investment in pharmacy services from the Department of Health as part of the transformation of health services.

• Emergency Care Village (Belfast Trust)

 Belfast Trust is creating temporary additional accommodation in the Royal Victoria Hospital to support the winter resilience plan. The emergency care village has been created to enhance the capacity of the Emergency Department (ED) service and is co-located on the same level as the current Emergency Department, the Diagnostic Radiology Imaging Centre and Fracture Clinic on the Royal Site. The new area, which is due to open on 20 December, includes the following enhanced services: ED Ambulatory Stream, Clinical Assessment Unit, Minor Injuries Unit, Short Stay Unit and a Surgical Ambulatory/Assessment stream.

• Direct Assessment Unit, Antrim (Northern Trust)

The Direct Assessment Unit (DAU) provides an alternative to the Emergency Department (ED). Recent £1.5m investment has increased the number of bed spaces from 13 to 24. Patients can be referred to the Unit directly from GPs (they can speak directly to medical staff), via the ED or from the Northern Ireland Ambulance Service. The DAU provides full medical and nursing assessments / treatments with access to diagnostic services and other professionals and sees on average 500 patients a month, with 80% discharged home or to another appropriate care setting. Patients that do not need to be seen urgently on that day, can also be referred to a Rapid Access Medical Clinic where they are given an appointment to attend the next day at a specific time.

• Ambulatory Care Unit (Western Trust)

To help provide an alternative to Emergency Departments (EDs) and to help avoid hospital admissions GPs can refer patients directly to the Ambulatory Care Unit at Altnagelvin Hospital between 9am and 5pm Monday to Sunday. It also has direct access from the ED and triage. Patients who previously would have been admitted for diagnostic tests can now be managed as an outpatient. The unit has recently been expanded to include surgical care models and a cardiology pathway.Between April and October 2018 there has been a seven percent increase in attendances at Altnagelvin’s ED. For the same period hospital admissions were down by 800 people. There are plans to replicate this model at the South West Acute Hospital in the New Year.

• Ambulance Turnaround Times (Northern Ireland Ambulance Service)

The Northern Ireland Ambulance Service (NIAS) are working in collaboration with the South Eastern Trust and voluntary and private Ambulance services providers to pilot the use of ambulance receivers in the Ulster Hospital. This initiative will see appropriately trained personnel from voluntary and private Ambulance services accepting patients from NIAS crews. This will help with the timely and safe transfer of patients into hospital care and also frees up ambulance crews, who would have waited with patients, to respond to urgent calls. Plans are being developed to roll this out to a number of Emergency Departments during the winter as appropriate.

• Hospital Ambulance Liaison Officers (HALOs) in Emergency Departments (Northern Ireland Ambulance Service)

The Northern Ireland Ambulance Service (NIAS) are increasing the hours of cover for Hospital Ambulance Liaison Officers (HALOs) in the Royal, Ulster, Craigavon and Antrim Emergency Departments (EDs) over the peak winter period. The function of HALOs in hospital sites is to liaise with ambulance crews and clinical staff to ensure that NIAS hand over patients into the care of hospital staff as safely and quickly as possible and to work with Trust ED teams to optimise patient flow within the ED departments.

• Enhanced Care at Home  (South Eastern Trust)

Enhanced Care at Home (ECAH) is an innovative service providing older, frail people with expert care in their own home, including nursing and residential homes. This enables older people to avoid attending an Emergency Department (ED) or being admitted to Hospital. Additionally, older patients can be discharged from hospital earlier in order for treatments to be continued, monitored and managed at home. ECAH has been operating within the Ards and North Down sectors from January 2016. The service has now rolled out to both the Down and Lisburn sectors from January 2018 and June 2018 respectively.

• Hospital at Home for Older people in Newry and Mourne (Southern Trust) 

The Southern Trust’s ‘Acute Care at Home’ service has now been rolled out to the Newry and Mourne area. As the first Consultant Geriatrician led service of its kind in Northern Ireland, the team aims to respond to referrals from GPs, Northern Ireland Ambulance service and local hospitals within just a few hours. The team can treat patients over the age of 65 with a wide range of acute illnesses in residential, nursing or own homes.
Since it was originally set up as a pilot in Craigavon and Banbridge in 2014 the service has prevented around 4050 hospital admissions and supported earlier discharge for over 1400 people. The service is operational in Craigavon, Banbridge, Armagh, Dungannon and available to suitable patients in Newry City, Mayobridge, Hilltown, Rathfriland and Bessbrook. The next phase will see the service extended to South Armagh and Kilkeel. 

For more information visit the HSC website.