Clare Lewis Deputy Chief Nursing Officer Community

1. Clare Lewis Deputy Chief Nursing Officer Community • Sláintecare • Implications for Advancing Community Nursing Services Twitter: @chiefnurseIRE

2. INTEGRATING CARE SOLUTION PROBLEM Hospital Centric Approach to Care Services operating at 100% capacity. Connected Community Care were care follows the individual providing care close to or in the home.

3. Health Care Reform: A Case For Change Focus on prevention, self-management and proactive co-ordinated care • Provide appropriate and financially sustainable care to manage care needs in the community • Robust Primary and Community Care Services

4. KEY ACTIONS SLÁINTECARE TO ADVANCE COMMUNITY NURSING OPPORTUNITIES TO FACILITATE CHANGE COMMUNITY BASED CARE EXPANSION Services at home and in the community (e.g. Diagnostics, workforce, collective resource to enable to deliver on expanded vision) NEW MODELS OF CARE Based on population need with a focus on prevention and promotion (e.g. Healthy adults, children, older persons, people with disabilities, people with mental health needs) • COMMUNITY NURSING SERVICES • To introduce a unit of service delivery on a phased basis. • (e.g. Demonstrator sites aligned with innovations identified within the Sláintecare Integration Fund)

5. Align Actions to Develop Community Nursing Services

6. Nursing Services Re-design 7 Steps to Developing and Implementing models of nursing care (Sláintecare) To Inform Service Expansion Role(s) development

7. Supporting Shift Left: A Case Management Approach in Community

8. Enablers to Deliver on Integrated Care Safe Staffing Framework to determine level of staffing for population needs. Capability Framework for the Enhanced Practice Role Connected Community Care “Care Follows the Child/ Person” Flexible mobility of nurse resources based on level of care needs “Right people, Right Place, Right time” ANP Framework Specialist generalist with credentialing pathways to create a critical mass

9. TO DETERMINE COMMUNITY NURSING RESPONSE Define the unit of service delivery to mobilise nursing services across acute and community sectors. (Define the central hub of care) OUTCOMES • Patient sensitive • (Self-management, service user empowerment, choice and access, first point of contact) • Service Provider • (Delivering on patient- centred care) • Health System • (Effectiveness of programmes of care ) Define roles and responsibilities of nursing services in response to unit of service delivery • Clarify structures and nursing services required to re-orientate care in the community with geo alignment. • (Acute and community services collaboration) • Structures for clinical governance and processes of care. • (Standardized assessment, measurement and programmes of care provided)

10. GOAL OF FIRST 5 TO SUPPORT PHN ROLE DEVELOPMENT

11. Delivering on an Environment for Integration Describe service model approach The Where & the What Replicate an integrated workforce: “Care Follows the Individual” Case Management Standardize screening & criteria to access services that reflect a changing demographic Formalise pathways between the acute & community services Providing joint programmes of care preventing further disability Service Access: Increase availability of ambulatory care services (e.g. COPD, HF, Frail older persons) in primary care centres Improve Access to intermediary care services (e.g. short-term beds, rehabilitation) Result: Reduction in Demand for acute hospital services Increase the number of citizens cared for in the community

12. DEVELOPING A QUALITY, POPULATION NEED BASED SERVICE Predicting Population Need and Responding Understanding Current Demands and Trends • Trends in demand for service • What Data is feasible to collect • What is relevant to your service • Economic considerations • Collaboration 4

13. Understanding and Measuring Quality Measuring Quality • Development of metrics that provide us with information of what we are trying to measure • Show trends to demonstrate improvements that are made over time • Alert to where improvements can be made in a service • Meeting and exceeding an acceptable level of performance through the provision of a safe and effective service • Broad and Complex concept • Only through measurement that quality can be ensured and improved on if necessary (HIQA,2013) Quantifying Quality

14. LEVEL OF RESULTS A strategy focussed on performance and achievement of outputs, outcomes and impacts (OECD 2010) Impact Changes in the lives of people Outcome Institutional Change: values, laws – associated with institutional performance, new institutions Behavioural change: new attitudes, practices Output Operational Change: products and services – knowledge, skills

15. The Nursing Response It’s no longer enough to perform – Nursing must thrive and flourish……….

16. THANK YOU Follow us on: @chiefnurseIRE