Parallel Sessions – Changing Culture

Wednesday 22 April, 2pm-3:15pm

1) End of Life Care – Are we getting it Right? (Glen Suite) “What do we need to do as a society to promote caring and compassionate communities which support people to live and die in their place of choice?”The session will be chaired by Heather Weir, CEO NI Hospice and have input from patients, carers, Mary Hinds Director of Nursing and AHPs at the PHA, Brendan O’Hara Transforming Your Palliative and End of Life Care Programme, Marie Curie and Professor Colm Cunningham, Director of Hammond Care's Dementia Centre (Australia).

2) Delivering clinical research through collaboration (Glen1 & 2) A number of organisations including ABPI and HSC R&D were involved in the Innovation workshop at NICON 14. Over the year the Clinical Research collaborative group has made great strides in progressing this agenda culminating in a high level conference at the end of 2014 involving over 19 pharmaceutical companies with our local organisations. This workshop led by Stephen Kennedy, GSK, the chair of the Group, will showcase progress over the past year and discuss with delegates how this work can be developed further to transform care and build the profile of N Ireland on the cutting edge of global innovation.

3) Cafe Conversations (Milford Suite)20 Tables, 3 Conversations X 20 minutes each

Organisation Title

Members

NIAS

The future of the NI Ambulance Service: to 'treat and leave'? NIAS is almost a year into a comprehensive programme of modernisation to enhance our services for patients and to improve how we link with wider health and social care services in a climate of ever-increasing demand. Come and hear about our new Appropriate Care Pathways, our ideas regarding how we might increase our Hear and Treat rates with the pilot of a new Clinical Support Desk and share your ideas and feedback to help shape the programme....

An evaluation of Social Work Practice in NIGALA with Children and Families from Black and Minority Ethnic Communities.

1. To consider the volume of cases referred to NIGALA from BME populations in 2013/2014.2. To identify case characteristics including child’s ethnicity, first language, number of court hearings.3. To generate knowledge about cultural competence and difficulties faced by Guardians.

Research in the area of working with Ethnic minorities and Foreign Nationals in the care system is limited, particularly in Northern Ireland. Previous research identified a number of challenges when working with BME families, including language barriers, issues surrounding the use of interpreters and lack of cultural competency amongst social workers.

The key objectives of this study were to consider the cases referred to NIGALA from ethnic minority and foreign national populations in 2013/14; consider the location of cases by Health and Social Care Trust; to identify case characteristics including the children’s ethnicity, first language and proficiency in English, the number and types of experts used, the number of court hearings and reasons for any delay; to consider case duration and case outcomes, to generate knowledge about cultural competence and its development in Guardian ad Litem practice. The findings of the study will be disseminated to the wider justice system to inform learning for social work practitioners, solicitors and the judiciary.

A mixed methods approach was used to collect data. This involved the collection and analysis of both quantitative and qualitative data. The sample included all Public Law and Adoption Proceedings referred to NIGALA between 1st April 2013 and 31st March 2014, which involved children and families from ethnic minorities and foreign national populations. A file audit was used to identify cases, a questionnaire was administered to all Guardians and semi-structured interviews lasting between 30-45 minutes were conducted with ten Guardians.

The findings are analysed and a series of recommendations for practice delineated.

PHA

10,000 Voices, Listening to and Learning from patient experience

1.Development of a regional structure to capture, understand and improve patient experience using a blended approach of qualitative and quantitative information2. Development of a partnership model to lead quality improvements in patient and client experience IN Northern Ireland , which is based on the Experience Based Design principles3. Implementation of a number of regional and local actions to improve and influence patient experience

The 10,000 Voices has been commissioned and funded by the HSCB and PHA to provide a more patient focused approach to the delivery of health and social care in Northern Ireland.10,000 Voices is a metaphor for collecting patient experiences on a large scale and has provided a unique and innovative opportunity to provide assurance to members of the public that their voice is being heard by those who commission and deliver health and social care services.10,000 Voices uses a narrative methodology, asking patients to describe their experience of health and social care services by “telling their story”. Sense Maker methodology is used to record and analyse the information, to date 6400 stories have been collected across the six HSC Trusts.

To support the implementation of 10,000 Voices, a Trust Project Facilitator was appointed in each Trust. The role of the Trust Facilitator is to develop the processes for story collection, analysis and interpretation of the data, reporting to Trust Boards and leading quality improvement plans. In order to ensure widespread representation from all service users in Northern Ireland, comprehensive regional and local engagement and communication plans were developed and have adapted throughout the duration of the initiative.

The work of 10,000 Voices is making significant contributions in meeting the objectives of key strategic drivers by raising the profile of patient experience in Northern Ireland. Patient experience information from 10,000 Voices has been used in the Human rights Inquiry into EDs and was cited as an area of good practice in the recent Donaldson review. Some improvements that have taken place in the Trusts, to date include the following: Review of cleaning schedules in Emergency Departments, improved communication for patients while waiting in unscheduled care areas, increased training for staff in the care of patients with dementia and the provision of food and fluids on 24 hour basis in Emergency Departments

NIMDTA

A common patient safety curriculum for HSC NI – Why is it important?1. Complete agreement to work together on a common Patient Safety Curriculum2. Identification of the need for a NI Patient Safety Faculty3. Identification of the need for relevant local anonymised clinical case studies

Increased knowledge of diseases and new technological innovations have contributed substantially to improving life expectancy during the 20th Century. However the greatest challenge today is not necessarily keeping up with the latest procedures or the latest high-tech equipment but more about delivering safe care in complex, pressurised and rapidly evolving situations. In such complex environments, things can unfortunately go wrong. Unintentional but serious harm can happen to patients during routine clinical practice or as a result of clinical decisions.

The systems that healthcare professionals work in need to be re-designed to make patient care safer - minimising variation between medical devices, simplifying processes, reducing clutter, better labelling – to make it easier to do the right thing.

However, the role of education and training of healthcare professionals in addressing the challenges of improving patient safety has been underutilised and undervalued.

NIMDTA is working with the QUB, UU, CEC, Pharm Society of NI, Patient Safety Forum, HSC Medicines Governance and RQIA as part of Quality 2020 on the introduction of a common curriculum for patient safety in healthcare education programmes in NI. This curriculum highlights the key risks of healthcare and how to manage them, teaches how to recognise adverse events and hazards, report analyse and learn from them. It teaches about the importance of clear communication, team-work and engagement with patients and carers. It explains how awareness of the importance of human factors and use of quality improvement methods can improve patient care.

NHSCT Locality Community Navigator – bridging the gap between the community and voluntary sector and health and social care

1. Increased knowledge, confidence and utilization of Northern Trust staff in relation to the support available from the Community and Voluntary sector including maintenance and development of Locality Directories2. Further strengthening of the connections between the Community and Voluntary sector, the Northern Trust and other stakeholders, using these connections to identify gaps/duplication in support available and to develop common goals3. The support of community and voluntary groups with the development of policies and procedures and

sourcing of potential funding to contribute to future sustainability.

Promoting health and wellbeing and maintaining the independence of older people within their own homes and communities is a key tenet within the current proposals to reform health and social care services as outlined in “Transforming Your Care” (DHSSPS, 2011) and in the proposals to welfare reform, “Who cares?” The Future of Adult Care and Support in N. Ireland. (DHSSPS, 2012). In 2013 the NHSCT undertook a mapping of the community and voluntary groups within the Trust identifying the support available as well as the challenges and issues that existed. This scope highlighted the need for a ‘bridging’ post between the sector, the Trust and other stakeholders, a post that would offer support to community and voluntary organisations as well as providing the Trust with knowledge of schemes and the ability to influence the development of services to meet the holistic needs of older people in their own communities. A series of stakeholder engagement workshops confirmed that this post would be essential in taking forward this objective. The Locality Community Navigator post is currently being piloted in the Causeway locality of the Northern Trust, funded by PHA and HSCB. The café conversation will discuss the implementation and benefits of the post to date.

WHSCT

Smoke- Free Western Trust

On the 12th March 2014 (No Smoking Day) the Western Trust introduced a complete Smoke-Free Campus Policy. This Policy designated all Trust workplace buildings, trust-owned vehicles and grounds as smoke-free. The Smoke-Free Policy seeks to guarantee Western Health and Social Care Trust employees and those who access the Trust facilities and services the right to air free of tobacco smoke, and is in keeping with the Western Trust ethos as a Health Promoting Organisation.The policy will help change social norms around tobacco use. Together in partnership, we are working towards achieving a cultural shift, so it becomes unthinkable that anyone - staff, patients, service users or visitors would smoke on a Western Trust site. The smokefree policy also supports people trying to give up smoking so that they can succeed in an environment where social pressures to smoke are reduced. The WHSCT Stop Smoking team assists both patients and staff who wish to stop smoking by ensuring smoking cessation support is widely available.

One Year on the Western Trust is extremely proud to have reached the key milestone of being one year Smokefree. As the first Trust in Northern Ireland to become smokefree across all facilities our patients, visitors and staff are reaping the benefits of having a healthier, cleaner and more pleasant environment. When we embarked on this Smokefree journey, we knew it would be challenging. Although some challenges remain, overall the journey has been very positive, with a high rate of compliance. We remain committed to encouraging a cultural shift to enable people to live healthier more fulfilled lives - Smokefree. The café conversation will discuss the implementation, challenges and share learning to aid planning and implementation of smoke-free.

HYGIEIA

Taming Diabetes Using the d-NavTM Insulin Guidance Service

1. Dramatically improved diabetes management (glycaemic control) compared with standard care2. Significant cost savings for the HSC3. Excellent patient satisfactionThe d-Nav Insulin Guidance Service is a technology-enabled managed service currently provided to patients at South Eastern HSC Trust and was the Winner of the inaugural HSC ‘eHealth Award for Best Use of Technology to Improve Health and Care’.

Patients using the d-Nav Service have experienced a significant reduction in average HbA1c from 9.2% to 7.5% after as little as 6 months of d-Nav use.

Only 13% of patients were achieving target HbA1c at baseline compared with 60% of users achieving target HbA1c after at least 6 months of d-Nav use.

The benefits or using d-Nav have been sustained over 2 years with over 80% of d-Nav users achieving glycaemic control targets.

The d-Nav service saves the HSC money by reducing the cost of consumables; reducing the use of adjuvant antidiabetic medication; reducing medication waste and improving the effectiveness of insulin therapy; reducing the incidence of foot ulcers and promoting faster healing of foot ulcers; and reducing the need for multiple Physician and Specialist Nurse clinic visits in secondary care.

A survey carried out by the Safe and Effective Care Department and South Eastern HSC Trust shows that overall patient satisfaction with the d-Nav service is 99% with patients reporting that they find the device easy to use, 96.4% were happy with the support and advice received from their diabetes care team, and 91.9% feel d-Nav helped them improve the management of their diabetes.

BHSCT

Accelerating improvement in healthcare: from 0 - 100 (in a year!)-unlocking clinical creativity in BHSCT

Engaging doctors in training with quality improvement effort results in a volunteer army for QI

Developing QI and leadership skills in doctors results in engagement of the wider clinical team in improvement work

Shared learning with doctors in training and managers will deliver lasting cultural change for our organisation

In 2013/4, Dr Claire Lundy, Paediatric Consultant in Neuro-disability and Kris McKeever, Children's Management colleague established a QI Programme for Specialist Medical Trainees across Paediatric services in Belfast. The voluntary programme supported the doctors to develop their Quality improvement and Leadership skills whilst undertaking specific improvement projects in their services and, so successful was the initiative, that application for the second year was extended across the Trust and was heavily oversubscribed. Over 100 doctors are now trained across emergency ophthalmology services, mental health, children's services, dermatology, neurosurgery, anaesthetics and laboratory services and are enthusiastic advocates for shared QI learning.

This volunteer team of QI recruits has developed and delivered improvements for patients across BHSCT. They have engaged with their clinical and managerial colleagues taking them on their improvement journey resulting in an even greater number of individuals being involved in QI work in a short space of time. They have shared their experiences with colleagues in primary care and hope to expand the programme next year. The programme and delivery style is easily replicated. If you want to find out more about how we successfully developed 100 improvement leaders come to our stand for a conversation....

SHSCT Title TBC

Associates

KINNEAR CONSULTING

Professional Tweeting For Beginners

1. Build your network by connecting with others in your field and beyond2. Keep right up to date with the latest policies, opinions and developments in your field3. Engage with and influence others

Dr Steven Kinnear, once sceptic, now advocate, will discuss the rise of the ‘clever economy’ and how rapidly changing socio-cultural trends reveal a world which is much less impressed by professional and managerial hierarchies. Today’s society wants – and expects – to be engaged. Steven will explain how Twitter and social media in general is being used in health care innovation and transformation. He will take you through a good practice guide for using Twitter as a professional tool, show you those in the NI Healthcare Community already Tweeting, and if you bring your own device he will show you how to set up and use your own account.

NICAN Transforming Cancer Follow-up (TCFU) Programme NICaN / Macmillan

The Transforming Cancer Follow-Up (TCFU) initiative was launched November 2010. This was a partnership between Macmillan, HSCB, PHA and facilitated by NICaN. The project team had regional and local project managers working closely with clinical teams to progress the programme.Using a risk stratified approach we moved from a one size fits all model, to tailored follow-up for individuals. We developed and agreed regional risk stratified pathways for breast and prostate cancer follow-up. We undertook process redesign to negate the necessity of a surgical appointment to trigger the review mammograms. We developed a regional cancer survivorship website searchable by postcode. We introduced the recovery package which allows patients to avail of a holistic needs assessment, a treatment summary record, and health and wellbeing events. Outcomes:Improved patients’ experience and enhanced coordination of care:

90% reported their mammogram appointments took place on time Regionally prostate patients are moving onto new pathways aided by Clinical Nurse

Specialists

Health and wellbeing events have shown 33% point increase in patients being made aware of the importance of lifestyle changes and 26% point increase in support to manage physical impacts of cancer

Significant improvements in resource utilisation: 58% of new breast cancer patients are allocated to a self–directed aftercare pathway 2,952 appointments reduced in waiting lists across breast services. 39% reduction in dual specialty follow-up No additional oncology review waiting lists clinics required

(63 required in 2010/2011)Significant learning has been harnessed with extensive pathway redesign taking place in some other regional tumour groups. The learning from this project is easily transferable to other non-cancer areas, and interest in the approach adopted is increasing.

AHP Federations NI

Reducing the Burden on A and E AHPs and Emergencies

Key Outcomes:1. Independent prescribing2. Workforce planning and meeting the needs of A&E demand3. AHPs as part of an integrated care service in A&E

Over view

How the AHP team can assist in reducing A&E waiting times and improving outcomes.Using the skills of the work force better to enhance service.

Patients

Patient Client Council

Painful Truth

Chronic or long term pain is a feature of many people’s lives in Northern Ireland. The Patient and Client Council undertook a study of pain and spoke to 2500 people. ‘The Painful Truth’ makes a number of strategic recommendations. Chronic pain is now recognised as a long-term condition. The Health and Social Care Board are taking forward a plan to respond to 7 of the 10 recommendations made. The Patient and Client Council will continue to talk and listen to people who were involved with the project to ensure that changes are made to improve the lives of those who experience chronic pain.

AHP Federation NI

Afternoon tea with AHPs

A silver service for people with a Dementia

Outcomes1. Eating and drinking well and safely2. Enjoying small talk3. Living life to the full

OverviewJoin us for afternoon tea and hear about the work of Dieticians, Occupational Therapists and Speech and Language Therapists in enabling people with a Dementia to enjoy life to the full.

Third Sector and Representative bodiesThe College of Podiatry

“We need to talk”.

Podiatry and the Diabetic Foot Care Pathway

Podiatry Key outcomes:1.Raise awareness of Podiatry’s role in Diabetes and the Diabetic Foot Care Pathway2.Share information on how podiatry is doing this in Northern Ireland3.Listening to views from NICON members on how to promote podiatry’s role in diabetic foot care (protection and prevention of amputations)

Short Overview:Diabetes is on the increase, driven by increased levels of obesity and other factors – for example the proportion of older people in our population. The Diabetes UK ‘State of the

Nation’ report showed a 33% increase in the past five years. Over 80,000 people live with diabetes across Northern Ireland, with 20,000 of those in the Northern Board area. Shockingly the number of people with diabetes has doubled since the publication of the 2003 Joint Taskforce Report. Health and Social Care expenditure on diabetes is estimated at 10% of the total HSC budget, projected to rise to 17% in the next two decades. Our primary mission is to draw attention the value of podiatry in terms of health economics, focusing on how podiatry can save money in terms of prevention, early intervention, preventing and enabling avoidance of high cost surgery such as diabetes related amputations. The reason we are putting the emphasis on cost savings and podiatry is because podiatry appreciates the absolute need for stringent cost saving measures (as the Northern Ireland budget is under pressure across all departments). The College of Podiatry would wish to stress that podiatry is not only cost-efficient and highly effective – it transforms people’s lives, wellbeing, mobility, and keeps people living at home, especially our older population. Podiatrists are pivotal to the prevention of lower limb amputation, for the specialist treatment of people with diabetes, renal complications, musculoskeletal and long term conditions. Podiatry contributes across the entire spectrum of Transforming Your Care – in particular that veer from hospital to community based care – and in particular for people with diabetes, renal complications and various long term conditions. Podiatrists provide foot health education to newly diagnosed diabetics in NI, through the Trusts’ diabetes structured education programmes. Empowering patients to look after their feet and preventing problems arising later.

British Lung Foundation

IPF – Idiopathic Pulmonary Fibrosis

Hear Velcro©? Think danger!

1 To raise awareness of the prevalence of IPF. BLF is calling for more to be done to help fight IPF and the devastating impact it has on the lives of patients and their families.

2 To raise awareness of the BLF’s IPF Patient Charter and ongoing commitment to improving IPF care across the Nations.

2 People with IPF and their families have the right to timely and accurate diagnosis and care, involving an appropriately skilled, specialist multidisciplinary team.

The Velcro© Test is a key element in early detection. All HCPs need to know about it

Idiopathic Pulmonary Fibrosis is a little-known but deadly condition that causes scarring in

the interstitial lining of the lung. At present, there is no cure. Those who have the disease

have an average life expectancy of two to five years, though significantly longer survival is

possible.

The BLF has made raising awareness of IPF one of our key strategic aims for the next decade.

Our IPF project runs across the whole of Great Britain and Northern Ireland, setting up

support groups, running patient information events, and talking to healthcare practitioners

and policymakers about the importance of this deadly condition.

A key part of the project has been the development of our IPF Charter. This document was written in consultation with patients, carers, and clinicians to sum up the standard of care someone with IPF should expect to receive.

Together for You

NICON 2015 - Together For You

Together For You is a Partnership project involving 9 leading mental health charities to provide a co-ordinated approach to the planning and delivery of a range of activities aimed at:

Educating people and their communities;

Raising awareness of mental health and encouraging help seeking;

Promoting good mental health; preventing mental illness and early intervention; and

Providing intensive support for those already experiencing mental ill health.

The project has two primary functions namely:

To provide a range of mental health and well-being interventions across Northern Ireland, through a co-ordinated approach; and

To evaluate the delivery mechanisms, quality assuring them and providing recommendations for the delivery of future mental health and well-being projects in Northern Ireland.

The Together For You Project is based on a stepped Care Model, as recommended by the National Institute of Clinical Excellence (NICE) 2. A stepped-care model is used to organise the provision of services and to help people with common mental health disorders, their families, carers and healthcare professionals to choose the most effective interventions. The project received £2.93 million, from the Big Lottery Fund and is due to run until July 2016; Action Mental Health is the lead partner.

To date 8,605 people have directly benefited from the services being delivered;

Qualitative feedback from service users to date suggests high levels of satisfaction with the services provided; and

Social Returns on Investment are starting to emerge, for example to date at least 223 volunteer hours have been provided, with an approximate value of £1,4073.

The Together For You Partnership involves: Action Mental Health, Aware Defeat Depression, CAUSE, Cruse Bereavement Care, MindWise, Nexus, PraxisCare, The Rainbow Project and Relate NI.

Arthritis Care

Arthritis CareArthritis Care NI has been working in collaboration with SEH&SCT Local Commissioning Group to provide self-management for people living with long-term pain within the Trust area since early 2013. The self-management courses run by Arthritis Care are designed to help patients understand more about persistent pain, provide options to self-manage using coping strategies as well as signposting them to useful resources. There is a two-week programme called ‘Challenging Pain’ which encourages participants to consider strategies to cope specifically with the symptom of pain while the six-week course ‘Challenging Your Condition’ looks at coping with pain, as well as other symptoms such as fatigue, emotional distress, poor sleep and shortness of breath.The partnership is driven by the Medicines Management Group looking at the pain medication usage and patterns of participants who attend the self-management programmes run by Arthritis Care. It is championed by Dr Michael Steele, GP at Ballywalter Health Practice and Greg Miller, Medicines Medicine Adviser, HSCB who have been very proactive in encouraging GPs, Community Pharmacists and other HCPs to consider referring patients onto the self-management programmes in their locality.

Each person who is referred by their GP or other HCP or, indeed, who self-refers on to a course, is asked to list the pain medications that they are taking at the time of registration and this is then measured at post-course stage (between 3/5 months after completion of the programme). This is to determine whether medication usage has increased, decreased or remained the same following attendance on a course.Between June 2013 and December 2014, 163 people completed the two-week CP course and 104 people completed the six-week CYC course across the SEH&SCT area. Currently, there are 8 courses (4 of each) running which are due to be completed before end March 2015.

Tricia Bowers, Training Manager, Arthritis Care

Business

Ehealth Transforming Care

SEHSCTHealth Care 21

“Changing the game” using FeNO to transform the lives of patients living with Asthma

1. NICE draft guidance recommends FeNO testing for assisting diagnosis and management of asthma2. Aids how you can improve treatment and care of patients using FeNO testing 3. Detect patient non-adherence to Inhaled corticosteroids (ICS) while improving asthma outcomes and reducing costs

NIOX VERO is a point-of-care device for assessing airway inflammation in patients with respiratory problems such as asthma. FeNO (Fractional exhaled Nitric Oxide) testing with NIOX VERO offers individualised asthma management that can improve the treatment and care of patients.Regular FeNO testing of asthma patients with NIOX, measures allergic airway inflammation and helps to:Reveal if the patient will benefit from Inhaled corticosteroids (ICS) treatmentOptimise ICS dose and reduce exacerbations up to 50%Detect patient non-adherence to ICSNICE draft guidance recommends FeNO testing for assisting diagnosis and management of asthma

ChambrePublic Affairs

How to engage with the NI Assembly Health Committee – do’s and don’ts

Key Outcomes:1. Understand the role of the Health Committee2. Do’s and Don’ts - How to successfully provide written and/or oral evidence to the Committee3. How to effectively expand upon engagement with the Committee

Overview:The Committee for Health, Social Services and Public Safety undertakes a scrutiny, policy development and consultation role with respect to the Department of Health, Social Services and Public Safety and plays a key role in the consideration and development of legislation.Health Committee members are therefore key stakeholders for all individuals and

organisations wishing to inform and influence health policy in Northern Ireland. Understanding how to effectively engage with the Committee can be critical to successfully carrying out change or maintain the status quo.