Introduction
This information is to help us share with the public, our plans for health and social care services over the winter months. In order to protect our services, we prepare an annual winter plan setting out arrangements to manage the predicted increase in demand for our services, particularly within our Emergency Departments. The information has been agreed with our partners including Primary Care, service users, NIAS, other Trusts, our Trades Unions and across unscheduled, elective, community and independent organisations.
Delivering care to you, which is of high quality, and is safe and compassionate, is essential. Regardless of the pressures on the Health and Social Care system, we will continue to do our very best to deliver the right care in the right place for you and your loved ones. We hope you find this information useful and reassuring.
Context
The next few months will be a demanding time across primary care, hospital services and community services. As always, health and social care relies on the dedication and resilience of all our staff, who continue to support new initiatives, while delivering existing services with compassion and care.
All Trusts have been asked to develop a local Winter Plan, read the plan here, which is based around three regionally agreed high impact areas to support people to live well at home and avoid unnecessary attendance at ED or admission.
- Maximising ambulance capacity
- Reducing time spent by patients in emergency departments awaiting clinical decision and next stage of care
- Timely hospital discharge for patients who are medically fit for discharge.
Key enablers to support our ability to meet these plans include our staff health and well-being, leadership, preparation for industrial action and comprehensive oversight arrangements.
It is important to highlight the ongoing pressures, in which the Belfast Trust, and our partners, are already operating, as we now prepare for a period of additional challenges.
Delivery of Services
During the coming months, we may find it difficult to provide all of our planned services whilst also managing the expected increase in demand for unscheduled or critical care. Patient safety will always be our priority, whilst we balance these risks.
To address the continuing pressures on the Belfast Trust Emergency Departments, we are working on a number of fronts, including the expansion of our Hospital at Home service across 7 days, working with primary care partners to support patients in the community, and working with services to develop alternative pathways.
Timely Patient Discharge
Across our hospital sites, we anticipate an increase in demand for inpatient beds. Therefore, timely discharge of patients once medically fit, remains key to ensuring all patients can be accommodated when admission is required.
Despite the best efforts outlined above, there will be times that patients have to stay in the ED whilst waiting for a bed to become available in a ward. Further surges of Covid-19, Flu or other respiratory illnesses will impact on service delivery and bed availability.
General Practice teams
The Winter Plan highlights the reliance of the health and social care system on the availability and sustainability of patient care outside of hospital. Close working between General Practice and the Trust is in place to ensure the smooth transition of patients between services and we are committed to ongoing collaboration on services for patient benefit.
Communications
Belfast Trust will continue to build on the engagement work already in place with partners. We recognise there is further work to do to build awareness and confidence with our public in understanding the alternatives to Emergency Departments.
A Phone First service for adults with minor injuries is planned.
Financial Constraints
The enormous financial pressures facing the Health Service across Northern Ireland are already well documented, and are not expected to change this winter.
If you become ill or injured and need medical help or advice, choose well by using the right health service for your needs.
Selfcare: To treat an ache, pain, upset stomach, cough or cold and get plenty of rest, take simple pain killers if needed and use over the counter medicines.
Children’s symptom checker: If your child is feeling unwell, you can use our symptom checker below to gain a better understanding of what might be happening and where to get treatment. Visit the Children’s Symptom Checker here.
Your local pharmacist: They are there to give confidential, expert advice and can treat a number of minor ailments such as aches and pains, skin conditions, allergies, eye conditions, upset stomach and emergency contraception
Your GP: They will give expert medical advice and diagnosis, referring you for further care or consultation as needed.
Primary Eyecare Assessment & Referral Service: Treats sudden eye conditions such as red eyes, sudden reduction in vision, eye pain or a foreign body in the eye. Find out more on the HSC website
Mental healthcare: If you are experiencing mental health difficulties there are a range of services available to help you. More information is available on the NI Direct website.
Emergency Dental Treatment: If patients have an urgent dental need they can follow advice on the HSC website.
Minor Injuries Unit: Treats injuries that are not life threatening such as broken bones, sprains, bits and burns.
Urgent Care Centre: Treats injuries that are not life threatening such as broken bones, sprains, minor scalp wounds and suturing of minor wounds.
Emergency Department: Provides the highest level of emergency ease for patients, especially those with acute illnesses or trauma, such as heart attacks, stroke, serious accidents or head injuries.
How you can help
Maximising Ambulance Capacity
Working together with Northern Ireland Ambulance Service to support ambulance handover, enhanced co-ordination and smoother transfer of patients e.g. Nurse navigator, Hospital Ambulance Liaison Officers.
Extended Hospital at Home service 7 days a week to include weekend provision.
Belfast Trust, Primary Care and Care Homes working in partnership to keep people well at home and to reduce unnecessary ED attendance.
Maximise pathways to support admission avoidance (adults and children).
Maintain Mental Health Liaison contingency arrangements to support ED e.g. Mental Health community. navigators
Community Falls teams provides direct access service for GPs and Northern Ireland Ambulance Service to avoid unnecessary ED attendance .
Integrated approach to care of patients with respiratory (and other) conditions across hospital and community.
Reducing Time in Emergency Departments
Maximise Emergency Department arrangements including Urgent Care Centre, Acute Medical Assessment unit (and Acute Frailty Assessment Unit).
Maximising existing pathways – virtual clinics, rapid access arrangements, and service helplines.
Improving patient flow through co-ordinated approach to admissions and service in-reach to ED.
Mental Health presence in ED to allow joint assessment by medic and mental health teams .
Co-ordinated approach to management of bed pressures across acute, children’s and mental health hospitals, including RSV (Respiratory Synctial Virus) hub.
Communication to raise awareness of other pathways and to reduce time spent in ED.
Timely Hospital Discharge
Improved engagement with and support for patient, carers and family to promote safe and timely discharge.
Co-ordinated approach to safe and appropriate patient discharge arrangements including Early Review Team, and extended use of discharge lounge (adult’s and children’s).
Ensure timely repatriation for all transfers of patients to their home Trusts (adults and children).
Maximise domiciliary care provision and mitigate deficit in provision.
Enhanced community stepdown facilities e.g. Discharge to recover initiative and intermediate care services.
Enhanced Independent Care Home oversight arrangements.
- Ensure elective inpatient & day case theatre capacity is maximised for patients including promotion of Day of Surgery Unit, MPH Daycase Centre.
- Build on new elective service via the Mater elective overnight stay centre (EOSC).
- Through the Elective Care Steering Group, continue to work on reducing length of stay and addressing waiting lists.
- Continued partnership working with Independent Sector to address waiting lists.
Protecting Elective Care