TRANSFORMING YOUR CARE


ThE norThErn IrElAnD AUDIT offICE hAS PUBlIShED ITS rEPorT on ThE MAnAgEMEnT of ThE TrAnSforMIng yoUr CArE (TyC) ProgAMME. PIf ConSIDErS ITS ConClUSIonS.


‘huge opportunity for improvement’ says TyC report


T


he report, which was compiled by the Comptroller and Auditor general, Kieran Donnelly,


concludes that ‘in the absence of a precise action plan, backed by the necessary finance, the impact of TyC has been much more limited than expected and the hoped-for shift of services from hospitals into people’s own homes has not happened as rapidly as had been intended’.


The report’s conclusion will not come as a surprise to nI’s healthcare professionals, many of whom had recognised from the outset that, while TyC was optimistic in its aims, it was very much lacking in the detail as to how these aims would be achieved.


When it was first published in December 2011, TyC certainly provided a very ambitious vision of how health and social care services would respond to the many challenges it faced in meeting the future needs of the local population. Based around the central idea of the home as the ‘hub’ of service provision, a key facet of the five-year TyC programme was the reallocation of £83 million of resources from the hospital sector to primary and community care.


In his report, Kieran Donnelly is quick to point out that the task faced by TyC was a daunting one.


‘given the time to identify and consult on the range of service


10 - PhArMACy In foCUS


changes required,’ he says, ‘full implementation of the transformation programme did not commence until March 2013. Indeed, the scale and complexity of the task TyC set itself is not to be underestimated.’


he is also quick to give praise for initiatives that have produced positive results, such as the Portadown health and Care Centre.


opened in March 2010 at a cost of £16.5 million, the Portadown ‘hub’ provided patients with the ability to access a wide range of primary and community care services, such as gP services, orthopedics, and X-ray and ultrasound investigations all under one roof. The hub took significant pressure off outpatient referrals to the local acute hospital because people were getting the service closer to home. The X-ray facility accommodated 80 per cent of referrals from gPs based within the hub and 20 per cent from gPs based in spoke practices surrounding the hub. As a result, a total of 6553 X-ray attendances were undertaken in 2012-13, which would otherwise have required referral to an acute hospital.


‘The evidence brought together in this report,’ Mr Donnelly continues, ‘identifies a range of ways in which health and social care bodies have sought to improve outcomes and deliver better value services for patients under TyC. Making better


use of available data on local health and social care needs, these initiatives have involved changes in clinical practice so that care is provided more appropriately and in more co- ordinated ways. for example, the use of reablement services has allowed £7 million to be redirected to support the management of demand for domiciliary care services; fewer hospital beds have been required as a result of changes in the rehabilitation of those suffering from strokes, and further inroads have been made in developing community-based mental health services.’


But, he points out: ‘Despite the progress made in developing locally-based services and revising how core elements of health and social care services are delivered, the impact of TyC overall has been more limited and the pace of change not as swift as originally envisaged. In January 2016, commenting on our general report on the health and Social Care Sector 2012-13 and 2013-4, the Public Accounts Committee said: ‘Transforming your Care is heralded as the great transformational saviour for health and social care, but the pace of change has been at best mediocre.’


‘realisation of the benefits which TyC was designed to deliver - and when they would be delivered - has also posed a difficult challenge for the Department. While we found that the Department and its partners have


demonstrated a clear commitment to managing the realisation of the benefits of TyC in terms of improved patient outcomes, a precise action plan had not been established at the outset of the programme setting out clear, measurable aims and objectives together with an appropriate set of performance indicators for assessing its performance.’


The report makes it clear that the implementation of TyC was particularly hampered by the financial challenges encountered, which resulted in a lack of stable funding and having to rely on monies becoming available through the in- year monitoring process.


To compound matters, many of the Department’s bids for such resources were unsuccessful. As a result, by March 2016, the programme had only realised £28 million of the £130 million savings anticipated in the original business case.


Despite TyC’s shortcomings, Mr Donnelly ends his report on an optimistic note, pointing out that TyC provided a ‘shared vision for the reform of health and social care services which patients, carers and health professionals can unite behind’, but insists that ‘while progress has been made under TyC, in our view there is huge opportunity for further improvement’.


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