Corporate Plan 2024-25 – 2027-28

Foreword from the Chair and Chief Executive

After a number of single-year corporate plans produced during and following the COVID pandemic, we are delighted to provide you with a longer term view of our vision and objectives for the services, staff and population of the Northern Trust.

The issues facing our health and social care system are well known: an ageing population, increasing demand, long waiting lists, workforce shortages and financial pressures.

In a context as difficult as this, it is important for us to remind ourselves of our vision: We provide compassionate care with our community, in our community.

In this Corporate Plan you will see this vision in action, as we set out some of the main areas we will be focusing on over the next three years.

We have worked with our staff, service users and local community to identify and refine these priorities.

We hope they will resonate with you and whether you are a member of Team North or a resident of the Northern Trust, you will support us on this journey.

Anne O’Reilly Chair	Jennifer Welsh Chief Executive

About the trust

Population profile

The population served by the Northern Trust is around 479,000. The population pyramid illustrates that our Trust area has a large proportion of older people, with women living longer than men.

Over the last 10 years our population profile has changed. Our birth rate has decreased, and life expectancy has increased. On average women live until the age of 82.7 and men live to the age of 78.4. This is slightly higher than the NI average. The number of people aged 65 and over is projected to grow by 49.2% by mid-2046. The number of children is projected to fall by 14.6%. The population aged 16-64 is projected to fall slightly by 0.6% (NISRA, 2023).

There is a low level of migration into Northern Ireland, which has changed the proportion of different ethnicities in our area.

Births

In 2022 5,166 babies were born in the Trust. 2.4% of babies were born to teenage mothers, and 3.9% were born to women over 40 years of age.

Deaths

In 2022, 4,364 residents of the Trust died. 85% were over the age of 65.

Migration

Since 2011, the total number of people of non white ethnic origin has increased from 1.3% to 2.3% of the population.

Looked after children

There are 779 children in care, in the Trust. 87% of these children live with foster carers.

Carers

12% of the population are unpaid carers. 22% of adults between 44 and 75 spend up to 50 hours a week care-giving.

Disabilities

11% of the Trust population has a disability that significantly impacts on their daily activities.

Common risk factors

Risk factors are attributes which individuals may have as the result of a personal habit, or of exposure to a hazard in the environment which increases their risk of developing certain diseases. In the Trust, the key risk factors that the Making Life Better Strategy use as indicators of future disease are smoking, obesity and alcohol intake. The number of people who smoke has decreased, but the number of people classified as obese, and the number of people who drink too much alcohol is rising.

Smoking

The number of adults who smoke has reduced since 2013, from 22% to 15%. The number of deaths attributed to smoking has also reduced within the Trust.

Obesity

In the Trust area the number of obese adults has increased from 24% in 2013 to 28% in 2022.

Alcohol

17% of adults in the Trust area drink above recommended weekly limits.

Most prevalent diseases amongst adults in the NHSCT

Disease prevalence means the total proportion of a population who are diagnosed with the disease. Diseases with the highest prevalence amongst the Trust population in 2023:

• Hypertension
• Asthma
• Diabetes
• Chronic Kidney Disease
• Coronary Heart Disease

Rural and urban

People living in urban areas are more likely to be a victim of crime, to take illegal drugs, to drink too much alcohol and are much more likely to smoke than their rural counterparts.

Life expectancy is slightly higher in our rural areas. However, people in rural areas are more likely to become obese as adults, experience social isolation, have to travel further to access health services, and are more likely to have poorer internet access.

A recent survey conducted by Samaritans (2022) discovered that people living in rural areas in Northern Ireland are less likely than those in urban areas to reach out for support to talk to someone if they are struggling with their mental health.

Our services

The Trust provides a range of health and social care services to a population of approximately 479,000 across a geographical area of 1,733 square miles making it the largest geographical Trust in Northern Ireland.

The Trust has an expenditure of circa £1 billion and employs approximately 15,000 people across a range of medical, health and social care disciplines. We deliver services from over 150 facilities including 2 acute hospitals, a mental health hospital, local community hospitals, health centres, social services, and a significant network of community services as well as provision of care in the home. An average week in the NHSCT would be the following:

• 21,370 service users on open social care caseloads
• 4,978 children receiving care, support and protection from social workers
• 2,357 review appointments
• 779 looked after children
• 105 elective admissions
• 2,020 community mental health contacts
• 482 children on the Child Protection Register
• 70 average births per week
• 902 non elective admissions
• 52,830 domiciliary care hours delivered
• 2,864 Emergency Department/Minor Injuries Unit attendances
• 774 day case admissions
• 3,624 total outpatient admissions
• 6,704 district nurse contacts
• 1,267 new outpatient admissions
• 17 admissions to mental health hospitals (including transfers)
• 7,801 contacts with Allied Health Professionals

Build Northern partnerships and integrate care

The Trust is committed to strengthening and expanding our partnerships, taking a whole systems approach to population health, including through the Northern Outcomes Group, our Community Planning Partnerships and the Northern Area Integrated Partnership Board.

• Informed by experience: We will continue to engage and work collaboratively with service users and carers to ensure we take into account the needs of all those who require our services including rural communities and those living in economically deprived areas.
• Informed by partners: We will continue to engage and build on existing partnerships with primary care, local councils, schools and college, the community and voluntary sector and others to create a strong, forward looking local partnership. This will be supported through the work of the new Integrated Care System (ICS) which signifies a new way of planning, managing and delivering our health and social care services based on the specific needs of the population.
• Informed by data: We will use data to understand our population’s health needs, to design services which meet the needs of our community and to identify areas of inequity and exclusion.

Focus on: Unpaid or family carers

A carer is someone who provides a regular, substantial care on an informal or unpaid basis.

The Trust is committed to supporting carers. Carer involvement is important in all we do and we will ensure that the carers’ voices are heard when developing specific support and resources. Our Carer Hub provides information, signposting and peer support to unpaid, family carers.

The Trust will continue to work with Carers UK to make support accessible via digital resources. We offer a designated carer platform to carers living in the Trust area via www.carersdigital.org which brings together online resources such as a website with links to local supports, downloadable resources and guides, topical e-learning programmes and free access to “Jointly” a care co-ordination app to support carers.

Carers have told us that they live under increasing pressure and they need support with their psychological wellbeing. We will establish a dedicated and qualified emotional and wellbeing support resource for carers through one to one and group sessions.

We also want to recognise and support carers within Team North, acknowledging their significant contribution and recognising the potential impact on their work life balance. We recognise the challenges for our staff when they are managing work and caring responsibilities, and will highlight policies and procedures designed to help support carers in the workplace.

Our Chair and Chief Executive have committed to meeting regularly with unpaid, family carers including young carers, to better understand how we can meet their needs.

Continue to improve outcomes and experience

Quality Strategy

We are developing a new three year strategy for the organisation to support continuous improvement in outcomes and experience for service users. This is being co-designed by staff, service users and carers and will help us identify main objectives for the organisation to work on collectively in order to deliver on those improvements.

Quality Improvement (QI)

Our ambition through our Quality Improvement programmes is to drive continued improvement in services and outcomes, listening to both staff and service users and encouraging ideas for improvement. This ambition will be realised through the Trust-wide Quality Improvement Network.

The network is an important step in having a systematic approach and infrastructure for the Trust to support staff trained in QI skills to use these skills in the workplace.

A QI capability and training framework has been developed to ensure staff have the confidence, skills and knowledge to lead improvements with tailored programmes for staff across a wide range of roles.

Focus on: encompass

The encompass programme is being rolled out across all HSC Trusts in Northern Ireland and represents a once-in-a-generation moment for digital transformation in healthcare. It will streamline services and patient journeys and link information across primary, secondary, community and social care.

encompass will give everyone in the region a digital integrated care record which is powered by Epic, a proven global technology. The Northern Trust will go live with encompass on 7 November 2024.

Benefits for staff

• More time spent on what’s important
  • Less time chasing paper records and trying to read illegible handwriting.
• More capacity to care
  • Easier access to the record means more time with patients or service user.
• Improved access
  • Faster and easier access to more information to support decision-making.
• Safer, better care
  • Higher quality of care through standardised workflows and implementation of best practice.

Benefits for patients and service users

• Less repetition
  • Less time repeating information to multiple health care professionals
• Improved quality and consistency of care
  • Evidence-based standards and practices for all Northern Ireland
• Increased ownership of the health journey
  • A patient portal to empower patients and service users to own their personal health journey
• Improved safety
  • Built in digital safety checks for allergies, infection risks and medication dosing

Focus on: Causeway Hospital

Causeway is an important part of our acute hospital network.

In March 2024 we published our Strategic Vision for Causeway Hospital which restates our commitment to a 24/7 Emergency Department and acute inpatient services.

There are many ways in which Causeway can develop to serve its community and beyond. Our ambition for the site includes:

• Further development of Same Day Emergency Care to provide a wider range of specialist services
• Leading the way in providing integrated, joined up care for an older population
• Becoming an elective and diagnostic hub for the North-West
• Rethinking and reshaping how we provide mental health services for the local population.

As we work together to focus on the right things, attract investment and build our workforce, we are confident that Causeway Hospital has a very bright future and can continue to serve its population for many years to come.

Focus on: Older people

On average women live until the age of 82.7 and men live to the age of 78.4. This is slightly higher than average in Northern Ireland. The number of people aged 65 and over is projected to increase by 49.2% by mid-2046.

While living longer is something to be celebrated and many older people are able to live independent lives, these graphs present data which indicates how much our older population relies on the services of health and social services in Northern Ireland.

In the context of an increasingly older population, we have developed a programme of reform to enhance and refocus our services for older people.

This includes measures to strengthen home care provision, particularly in rural areas, where it can be difficult to recruit carers.

It will also look at how we use our community beds to meet our population’s need for bed-based care.

Focus on: Learning Disability

With the launch of the new Learning Disability Service Model by the Department of Health anticipated in 2024, the Trust will ensure we continue to put service users and carers at the centre of our developments. To help us to do this, we will establish a new Service User and Carer Advisor role to support the Trust in designing how we deliver our services.

Carers have a vital role in supporting adults with a learning disability, and to support this we have developed a Carer Lead post. We aim to support carers through short breaks services in Ellis Court and Hollybank, as well as continuing to offer nursing short breaks in specialist nursing homes. Our ambition is to support short breaks for individuals with complex needs through the design of a new bespoke service.

The Trust is remodelling learning disability day services to develop new capacity and offer flexible services to create better choice and user experience through opening evenings and on Saturdays. The Trust is continuing to enhance day opportunities services through investments in new social farming and performing arts services.

Following the announcement of the planned closure of Muckamore Abbey Hospital, the Northern Trust is working with patients, families and colleagues across the region to create homes for life for those patients remaining in the hospital. We are working with commissioners to ensure there are appropriate community and hospital based assessment and treatment services for people with a learning disability in the Northern Trust who need this support.

Focus on: Waiting lists

Our waiting lists are longer than we would like them to be. After significant growth during the COVID pandemic we have seen reductions in most waiting lists over the past two years, and we are committed to keeping waiting times as short as possible.

Patients waiting more than 52 weeks for a first outpatient appointment

Patients waiting more than 52 weeks for inpatient or daycase treatment

To do this we will work with the Department of Health to ensure we are providing the maximum activity and efficiency we can with the resources that we have, including the use of Independent Sector partners where this is appropriate.

We will also take forward a significant programme of reform and modernisation of our elective (planned) activity, including:

• Developing Advanced Clinical Triage pathways, where patients who have been referred by their GP can be sent on for diagnostic tests or given advice where this is appropriate, without needing an outpatient appointment.
• Carrying out Waiting List Validation, to ensure that the patients who are on our waiting lists still need to be seen, and that they know we have not forgotten about them.
• Extending our use of Patient Initiated Follow Up, so that patients are only seen for review appointments when they need to be.

Focus on: Reform North

ReformNORTH is the Trust’s programme of reform and transformation, an ambitious plan across seven areas of work underpinned and influenced by regional strategies and reviews to deliver improved outcomes and deliver best care for our patients.

Acute Services

We are strengthening and remodelling the use of our hospital sites to deliver the best care.

Elective

We are modernising and transforming elective services to address growing demand and long backlogs, for outpatient services and inpatient and day case surgeries using alternative and innovative approaches.

Cancer Services

We are working to implement the actions set out in the regional cancer strategy with our local improvement plans ensuring that our cancer services are top quality for the population we serve.

Children’s Services

We are continuing to develop capacity, sustainability and resilience in our children’s services in line with regional structures.

Intermediate Care and Community Services

We are redesigning our local intermediate and anticipatory care delivery across all of our care provision in our community hospitals, residential homes, nursing homes and homecare.

Unscheduled Care

We are providing alternatives to the Emergency Department and greater levels of ambulatory care whilst strengthening our partnerships with Primary Care

Mental Health and Learning Disability

We are developing plans and modernising Mental Health and Learning Disability services across the Trust in line with the Mental Health Strategy 2021-31 and the Learning Disability Service Model.

Deliver value by optimising resources

In a period of unprecedented financial pressures, the Trust has established a Delivering Value Programme Board. This Programme Board will contribute to the Regional Delivering Value Work and ensure focus on our own Delivering Value Programme.

The Programme Board will focus on 3 main areas:

• Productivity: redesigning and improving services to do more with what we have, such as increasing day case rates or reducing the number of people not attending appointments.
• Cost control: bringing down spend that doesn’t add value to our services, such as reducing our use of high cost agency and locum staff.
• Sustainability: controlling our energy costs by investing in renewable energy and energy efficiency improvements.

The Delivering Value Programme Board will consider both internal and external evidence, identify areas of potential cash-releasing and productivity gain for the Trust and ensure all areas are captured and have clearly defined and achievable action plans.

Regular project highlight reports will be used to monitor progress against agreed timescales and improvements and the Board will oversee regular communication and promote financial stewardship at all levels.

The Board will engage regionally with regard to regional projects or enablers to Delivering Value.

Focus on: Birch Hill Centre for Mental Health

Birch Hill is the new inpatient mental health facility for the Northern Trust.

It will provide 134 inpatient mental health beds in a modern, purpose-built facility, providing a vastly improved therapeutic experience for patients and a much better working environment for staff.

The Trust’s Vision

Birch Hill is designed around a ‘village’ concept where a series of buildings are incorporated into the existing rural landscape.

The site will encourage the use of outdoor space with internal ward gardens, The Square, The Park and The Wildflower Way nature trail along eastern boundary of site.

The internal spaces are designed with an emphasis on the use of natural daylight, integration with nature and views to the surrounding countryside.

Paired wards will support the delivery of modern mental health care in a patient centred therapeutic setting.

Birch Hill will offer a provision of individual patient bedrooms which have been designed through co-production with service users at the heart of the process.

The centre is due to become operational in early 2027.

Focus on: Sustainability

The Trust recognises the enormous challenge that the issues of climate change, air pollution and waste present and the impact that these issues will have on our service users and future generations. Climate change represents a significant health challenge for the 21st century.

Northern Ireland now has its own Climate Change Act which supports the transition to net zero and places a legal duty on the NI Executive to reduce our contribution to climate change. In January 2024, the Trust Sustainability Group was established to further drive sustainability practices and initiatives across the organisation. Its aim is to embed environmental responsibility, promote sustainable practices, and address climate change challenges to create a more resilient healthcare system.

There are many different sectors responsible for the emissions and those related to actual energy usage, water and waste, within the estates remit, are small. We will continue to focus on key areas such as; Improving energy and water efficiency in buildings, Switching to low-carbon forms of heat, replacing fossil fuel fleet vehicles with low or zero emission alternatives and encouraging sustainable development through our supply chain.

• Medicines, medical equipment and other supply chain
  • Medicines and chemicals – 20%
  • Medical equipment – 10%
  • Non-medical equipment – 8%
  • Other supply chain – 24%
• NHS carbon footprint
  • Building energy – 10%
  • Water and waster – 5%
  • Anaesthetic gases and metered dose inhalers – 5%
  • Business travel and NHS fleet – 5%
• Personal travel
  • Patient travel – 5%
  • Staff commute – 4%
  • Visitor travel – 1%
• Commissioned health services out – 4%

Nurture our people, enable our talent and build our teams

Our ambition is to become the employer of choice in Health and Social Care, committed to nurturing our people, enabling our talent and building our teams.

In pursuit of this the Trust launched a People & Culture Plan in May 2023, that seeks to create a positive and sustainable future for all our staff. The healthcare needs of the future will be different from today, and our workforce and the way we work with our partners need to reflect this.

This plan reflects our present and future Team NORTH as we continue on our mission to truly become Team North: More than a Workplace.

Nurture our people

Our commitment is to build on our open, just and learning #teamNORTH culture, and nurture an environment where staff health and wellbeing is protected and diversity and inclusion is embraced.

We want all our staff to be recognised and valued for their contribution to serving our population and experience #teamNORTH as more than a workplace.

Our commitments are focused on:

• Health, Wellbeing and Inclusion
• Recognition and retention

What success will look like

• Increased participation across all of our health, wellbeing and inclusion initiatives
• Increased retention rates across all staff groupings
• Our people experience effective and inclusive team work
• Improved recognition scores across internal and external staff surveys and assessments
• Reduced absence rates across all staff groupings

Enable our talent

Our commitment is to further enhance leadership capability at all levels, develop stronger teams and the next generation of #teamNORTH leaders.

We want our staff to feel supported to develop the skills and confidence to ensure we have a digitally literate team for today and the future. Our commitments focus on:

• Leadership, Management and Professional Development
• Digital Literacy

What success will look like

• Increased participation across divisions / directorates in leadership and management development programmes
• Improved survey data and feedback in relation to leadership and management capability
• A digitally literate workforce, confident and motivated to use digital technology in their roles
• People will be given the opportunity and time to access digital learning opportunities

Building our teams

Our commitment is to ensure that our staff understand our #teamNORTH vision that they feel informed, engaged and listened to. We want staff in work to feel safe and flexible in a team that meets the needs of our population both now and in the future.

We will put in place plans to attract the best talent to join #teamNORTH and our commitments are focused on:

• Communication and Engagement
• Workforce planning and Resourcing

What success will look like

• Our programme of improvement and change is managed in a way that our people feel involved and engaged with
• Improved candidate and hiring manager feedback
• Improved attraction rates, leading to reduced vacancy rates
• Positive evaluation of the impact of new roles and ways of working on staff and patient experience

Improve population health and address Health and Social Care inequalities

The aim of the Trust’s Health and Wellbeing (HWB) Service is to work with individuals, communities, statutory, community and voluntary partners, to coproduce interventions which address the social determinants of health, and the health inequalities experienced by our population. The health and wellbeing team provides support to people at every stage of life to help prevent physical and mental ill-health and to provide early intervention to reduce the likelihood of escalation of issues when possible. Partnership is key to the delivery of sustainable and successful HWB initiatives. By working with Public Health Nursing, Dietetics, Midwifery, and Palliative Care services, the Education Authority, our four councils, and grassroots community groups we can harness expert and local knowledge to ensure that interventions are designed for the context in which they are delivered.

• Children and families: We will continue to support children, young people and their families through the delivery of parenting programmes, positive mental health promotion, tackling childhood poverty and reducing childhood obesity.
• Adults: We will continue to address the social determinants that impact the health and wellbeing of our adult population through health coaching, positive mental health promotion, physical health promotion and signposting through the Connect North service and social prescribing.
• Older people: The HWB team is committed to helping people age well through frailty prevention interventions and empowering older people to continue their own contribution to our society. The HWB team will continue to improve death literacy, and death preparedness through the co-production of resources and interventions. This will ensure that as many people as possible can live well until the very end of life.

Focus on: Rural communities

The Northern Trust is the largest geographical Trust in Northern Ireland spanning over 1,733 square miles, with nearly 204,000 people (42.5%) living in rural areas. The Trust aims to raise awareness and form a better understanding of the key issues rural dwellers face.

Both Trust staff and rural dwellers stated that social isolation is very common in rural areas that people are less likely to attend medical appointments because of distance and lack of regular public transport that carers who live in rural areas do not have enough support, and may not know about support they could receive and that there are very few social/leisure activities in rural areas which can have a negative impact on physical and mental health.

Rural survey

Key to this process has been involving rural dwellers in the conversation about the things that matter to them and working alongside them to help address the challenges. Trust staff and citizens of the Northern Trust area were encouraged to take part in surveys to collect their views on the needs of rural communities. There was agreement on most of the issues cited including the overall lack of services and amenities and the distance to travel for health services as well as poor transport and poverty. This fits in with the evidence we already know about rural areas.

Northern Trust Rural Framework

Living rurally has many benefits including lots of green space, less noise and wonderful views. However, there is also a range of challenges in rural areas. The Northern Trust Rural Framework has been developed to identify and raise awareness of key rural issues some of which are shared with urban areas. There are also notable inequalities compared to our urban counterparts. The Framework seeks to map local strengths including mainstreamed and successful pilot projects whilst encouraging, supporting and strengthening relationships with the rural community and engaging stakeholders to maximise rural wellbeing. The Framework will also help strengthen the Trust’s focus to achieve better outcomes for those who live in the countryside and will drive the work
of the Rural Health Forum.

Focus on: Domestic and Sexual Abuse

On average an incident of domestic abuse is reported to the PSNI every 16 minutes. To support staff experiencing domestic abuse the Trust has developed a Workplace Support Strategy aimed at Making Work a Safe Space. The strategy was launched in April 2024 and includes:

• Development of a Support Pack for staff and managers
• New support measures in place including ‘safe leave’
• Creation of a network of Designated Advisors
• Series of awareness sessions and clinics for managers

The Rowan

The Rowan is the regional Sexual Assault Referral Centre (SARC) for Northern Ireland. The service is jointly funded by the Department of Health and the Police Service for Northern Ireland (PSNI) and operated by the Northern Trust.

Our professional and highly trained team delivers a range of support and services 24 hours a day, 365 days a year to children, young people, women and men who have been sexually abused, assaulted or raped, whether this happened in the past or more recently.

The Rowan in numbers, from April to December 2023:

• 258 referrals to the service
• 78 victims referred were under the age of 18
• 26 victims referred were under the age of 13
• 74% of victims were referred by the PSNI

The Rowan is developing a new communications strategy which will include a website redesign. This will enable the service to provide digital materials for adults, children and young people to help them to understand and access the Rowan’s services when they need them.

Focus on: Children’s Health and Wellbeing

Take 5 steps to wellbeing

The Trust partners with the Education Authority to help schools with the mental wellbeing of pupils and staff through the Take 5 Steps to Wellbeing Framework.

The Trust supports the schools to build their capacity through virtual and physical resources which include lessons plans, materials for activities and promotion, peer testimony videos and online and in person training. To date there are 39 primary and 25 post primary schools accredited as a Take 5 school under our joint Framework, which is 17% and 44% respectively of the total number of schools in the Northern Area. Moving forward we are working to increase the level of accreditation for each school, to add new Take 5 schools, to extend the programme to nursery schools and to continue to hold a recognition and award event each June.

Causeway Health Kids

The Causeway Healthy Kids programme is an award winning 11-week programme operated through the Northern Healthy Lifestyles Partnership, initially developed within Causeway Coast and Glen Council.

It brings together nutrition and mental and physical heath for children of Key Stage 2 age and was co-designed with schoolchildren and teachers. Initially targeting schools in areas of deprivation, the programme has now been delivered to over 1,000 children from 36 primary schools.

During the programme children experience interactive physical activity sessions as well as learning about nutrition and emotional wellbeing through innovative animated videos, worksheets and lesson plans. Healthy Kids demonstrates the effectiveness of partnerships to build healthier lifestyles for children through a mix of knowledge and practical delivery that has been thoroughly enjoyed by the children, embraced by schools, is receiving recognition within the wider health care and education community.

Northern Healthy Lifestyles Partnership

The Healthy Lifestyle Partnership is engaged in extending the Healthy Kids Programme across the other boroughs within the Northern Area.

Get involved

If you have any questions or comments please email: equality.unit@northerntrust.hscni.net

Or you can write to us at:

Equality Unit
Route Complex
8e Coleraine Road
Ballymoney
Co Antrim
BT53 6BP

Tel: 028 2766 1377
Fax: 028 2766 1209
Textphone: 028 2766 1377

This document is available, on request, in accessible formats, including Braille, CD, audio cassette and minority languages. If you need any help in accessing any of the information, please contact the Equality Unit.

Message, post and comment; there are loads of ways you can connect with us online. Just visit our website and the link on our home page will provide you with access to a number of ways you can get involved.