What is No More Silos?
No More Silos is a plan, published by Health Minister Robin Swann in October 2020, to maintain and improve urgent and emergency care services across Northern Ireland.
Prior to Covid-19 there was clear evidence that our urgent and emergency care services were under increasing pressure. Growing numbers of people were experiencing long waits to be seen in overcrowded Emergency Departments (EDs).
The impact of Covid-19, and the need to focus on preventing the spread of infection has driven home the pressing need for change.
The pandemic has helped to strengthen relationships between health and social care professionals. There is continued involvement from service users and partnerships with local communities all of which are supporting the changes needed to access to the right care, first time.
The project is testing new services and better ways of working together to ensure that urgent and emergency care services across primary care and secondary care can be maintained and improved for patients, service users and staff.
The ‘No More Silos’ plan sets out ten key actions, which build on learning from the pandemic and the strong relationships that have been developed during this time. It also includes the evidence, and the experiences of patients, service users, carers and staff.
Any proposed permanent changes to services is subject to public consultation in keeping with the requirements of equality legislation as part of the Urgent and Emergency Care Review. You can read the Urgent and Emergency Care Review consultation here.
The 10 key actions within ‘No More Silos’ can be read in full on the link below:
The actions relate to two main areas:
- How the general public access care when they need urgent or emergency care or treatment.
- How older people and others who need support will be offered treatment and care in the community to avoid admission to, or long delays in hospital.
1 Public access to emergency or urgent care
Many of those who attend Emergency Departments may have urgent conditions which, while serious, are not life-threatening and could be managed better by another service elsewhere. Until recently it has been difficult for patients to access these different services/pathways of support.
The changes outlined highlight ‘No More Silos’ plans to protect access to emergency care whilst providing alternative services/pathways of support for urgent but not life threatening conditions.
The overarching goal is to achieve the ‘right care first time’.
Phone First is a telephone service available for members of the public who are unwell and considering travelling to an ED to ring. When you make a call you will be medically assessed on the phone by a health professional and will then be given advice and, if needed, directed to the most appropriate urgent or community service to meet your treatment or care needs. This could include an appointment to attend an Emergency Department, an Urgent Care Centre, a Minor Injuries Unit or being redirected to a GP, pharmacist or other service. The service is now available in the following Health and Social Care Trusts:
For more information visit – Urgent and Emergency Care – HSCB (hscni.net)
Phone First does not replace 999.
For all emergencies that are life threatening always call 999 immediately. This can include: stroke, heart attack, loss of consciousness, breathing difficulties, severe bleeding or major trauma.
In addition, Phone First does not replace the advice or direction from your own GP practice or GP out of Hours if they advise you to go directly to an Emergency Department.
Urgent Care Centres
Urgent Care Centres are one of the new ways that hospital and GP/primary care staff teams are working together to assess and treat patients, adults and children who present with illnesses and injuries which require urgent attention but are not life threatening.
Urgent Care Centres provide same day / next day access through Phone First appointment, seven days a week.
Care and support is provided by a range of health and social care professionals across medical, nursing and allied health professionals.
Rapid Access Assessment and Treatment Services
When fully operational this service will enable your GP to make direct appointments for you to be seen rapidly by the right specialist (nurse, consultant, allied health professional) for assessments, tests, diagnosis and, if required, ongoing support at hospital or community clinics. Examples include; rapid assessment services for lung, heart and stomach problems.
2 Enhancing support for older people in their homes
The second part of the overall plan is developing a range of services to better support older people at home and in the community. This includes:-
- Support to care homes;
- Hospital at home;
- Arrangements for admission and discharge from hospital.
Improving the care experience of older people is a key priority which must include individuals, carers and family members being actively involved in all key decisions regarding changes to care needs.
The Covid-19 pandemic has demonstrated the importance of increasing and improving support for care homes and their residents, and the need also for Health and Social Care organisations and GP practices to improve their level of ongoing professional support for care homes.
All Health and Social Care Trusts and GP practices are working together to ensure that individuals with complex needs have an appropriate assessment from a multidisciplinary team featuring a range of healthcare professionals including; medical, specialist nursing, physiotherapists and occupational therapists.
This includes ensuring that every individual will have a future care plan (anticipatory care plan) that:
- supports physical and emotional health and well-being;
- provides acute care and treatment as needed;
- ensures the individual’s wishes for continuing care are known and respected.
Hospital at Home
Hospital at Home is a service that is being developed across Northern Ireland enabling people with more medical care needs to be treated and cared for in their own home. The service is focused on preventing individuals from being admitted to hospital inappropriately, and also to avoid unnecessary trips to Emergency Departments.
If the person and their family agree with the care recommendation, the Hospital at Home team will provide hospital type interventions in the person’s own home. The service will be able to treat a wide range of medical conditions.
Should the person’s health deteriorate arrangements will be in place for transfer to hospital when appropriate.
Discharge / Transfer arrangements from Hospital
There is clear evidence that people who are deemed medically fit suffer emotionally and physically from prolonged stays in hospital.
It is therefore critically important that discussions take place early with the person, carer or family to agree what the arrangements will be, when the time is right, to be discharged or transferred to an environment which can provide safer and more appropriate continuing care to meet the individual’s need.
Discharge arrangements can mean a return to the individual’s home or temporary admission to a care home.
Where possible, no decisions about long term care should be made in an acute hospital setting.