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Minister Rubberstamps South Eastern Trust's Reform Proposals
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Modernisation Proposals: Safety, Quality and Sustainability – Modernising Health and Social Care Services in the South Eastern HSC Trust.

The South Eastern Health and Social Care Trust’s recent proposals to reform mental health, physical disability and emergency care services have been approved by the Department of Health, Social Services and Public Safety. The plans had been consulted upon from June until September 2010, and were accepted by the Trust Board and supported by the HSC Board in November before being submitted to the Department.

The proposals relating to Emergency Care in the Downe are, the South Eastern HSC Trust argues,  the most urgent due to the ongoing shortage of middle grade doctors. The Trust now plans to implement these proposals from April this year. The Trust maintains the new arrangements will see no change for patients using the Emergency Dept between 8am and 10pm, while between 10pm and 8am there will be a new urgent care model in place run by GP Out of Hours and accessed in the normal way.

Director of Hospital Services Seamus McGoran said, “We welcome the Minister’s support for this new model of care.  The Emergency Department at the Downe was becoming unsustainable due to the local and national shortage of middle grade doctors. These new night time arrangements will mean 97% of patients will get their care as usual, and the front door of the hospital remains open.  We see this as a model for the future for local hospitals.”

The mental health changes will mean the creation of a single centre of excellence for acute psychiatric inpatients at Lagan Valley Hospital, Lisburn replacing three units on the Ulster, Downe and Lisburn sites. The service is also seeing an increase in mental health services in the community.

In disability services, three day centres in the Ards and Bangor areas, all of which are in accommodation which needs updating, will be replaced by one brand new and one refurbished centre.  Both the mental health and physical disability reforms require capital investment and the timescale is likely to be 18 months to two years.

Business cases will now be developed for mental health and disability proposals and further details with regards to their implementation will be issued in due course.

Director of Adult Services, Desi Bannon said, “I am pleased that the proposals have been approved. This model of service delivery promotes recovery and independence and I look forward to working with users, carers and professionals in their implementation”.

A Trust spokesperson said the three reform and modernisation proposals of the Trust  are:

1.    Urgent Care

Proposals for a Safe and Sustainable Urgent Care Network in the South Eastern Trust (Including a proposal to change the Emergency Department at the Downe Hospital)

Safety, Quality and Sustainability – Modernising Health and Social Care Services in the South Eastern Trust, June 2010, highlighted the difficulty with regards to sustaining the existing service at the Downe Hospital, particularly with regards to the recruitment and retention of middle grade   Doctors. The Trust considered the challenges facing the organisation in continuing to provide emergency care services and commenced a review of the provision across all its hospitals including the Ulster, Ards, Bangor, Downe and Lagan Valley Hospitals.  However, the Trust believes that there is a real opportunity to develop a safe, sustainable and effective model of care within a relatively short timescale in the Downe Hospital, building on the developments that have already taken place with the opening of the new hospital.

In respect of the Downe Hospital the Trust will:

*  Continue to provide an urgent care response at the Downe Hospital 24 hrs/day, 7 days/week, through the creation of an Urgent Care Co-operative between the Emergency Department (ED) and the GP Out of Hours service (GPOOH) so that local residents will continue to have access to emergency facilities that are both safe and sustainable. Although this would result in a reduction in the opening hours of the ED, it would be linked to the GPOOH that already exists within the Downe ED. It would also be linked to the clinical network ED in the Ulster Hospital.  The ED would continue to function as it currently does between the hours of 8am and 10pm.  From 10pm to 8am, the GPOOH would provide the urgent care response supported by the appropriate services within the hospital. In this option, the emergency department doctors would continue to be on the premises until 12 midnight for purposes of handover.

*  Ensure that under the new arrangements, the vast majority of people will notice no significant difference in their treatment in the Downe. The Out of Hours General Practitioners will be able to admit medical patients to the hospital at night

*  Facilitate the new model by the enhanced use of clinical protocols and increased use of technology such as the Northern Ireland Picture Archiving and Communications System (NIPACS).   This allows x-ray

*  images to be sent between hospitals via computer links and facilitates quick reporting and diagnosis.

*  Finally, the Trust will continue to work with General Practitioners and the Northern Ireland Ambulance Service to manage the service change.

2.    Mental Health Services

The Future of Hospital In-patient Care in the South Eastern HSC Trust

This proposal recommended the relocation of acute inpatient care from the three current locations (Downe Hospital, Lagan Valley Hospital, Ulster Hospital) to a single facility on the Lagan Valley Hospital site.  As a result of this, acute in-patient services will no longer be provided at the Ulster Hospital or Downshire Hospital.

It also recommended that the Southern Eastern Trust continues to provide Psychiatric Intensive Care (PICU) Services and Low Secure Services and the services are relocated to more appropriate environments.  Specifically, it recommended that PICU moves from the Downshire Hospital and is relocated adjacent to Acute Psychiatry on the Lagan Valley Hospital site and that Low Secure Services move from the Downshire Hospital to a single site at the Downe Hospital.

The Trust is confident that with continuing investment in community services, there will be a diminishing requirement for acute inpatient provision and that the quality of the in-patient provision would be increased where resources were concentrated at one location. This includes the development of 18 additional community places in the Ardcora provision thus ensuring that people can experience living in a community setting in Downpatrick.

3.    Disability Services

The Proposed Reform and Modernisation of Learning and Physical Disability Services in the South Eastern Health and Social Care Trust – “Not for you but with you”

In Safety, Quality and Sustainability – Modernising Health and Social Care Services in the South Eastern Trust in June 2010, the Trust indicated that it was in the process of reviewing whether specific statutory day care services and residential services were fit for purpose and could be delivered in alternative ways.

The Trust proposed to modernise existing facilities in North Down and Ards and reduce from the current three facilities to two.

The Trust will now, in collaboration with service users, carers, relatives, stakeholders and staff, pursue the implementation of the proposals in respect of:

*  The reconfiguration of statutory day care services to meet the needs of clients with a physical disability from all age groups and those with more complex needs.

*  Extending the range of independent living options for people with a learning disability across the Trust area to ensure services are focus on those in most need and review the one remaining statutory learning disability residential home offering permanent residential placements.

*  The reconfiguration of statutory day care services for clients with a learning disability in the North Down and Ards sector.

*  Details of all proposals are available at the South Eastern Health and Social Care Trust website at :

www.setrust.hscni.net