Involvement Annual Report 2024/25

Foreword

Welcome to our Involvement Annual Report. I am delighted to share this report with you which details how we have worked in partnership with service user, carers, communities and staff to develop and improve services.

Our aim is to ensure that the voice of patients, carers, families, and communities are embedded at every level of the organisation, shaping how we design, deliver, and improve services.

Throughout the year, we have worked in partnership with service users, carers and our community to promote inclusive engagement, build trust, and ensure that lived experience informs decision making. This has been especially important as we respond to ongoing system pressures, rising demands, and a renewed focus on reducing health inequalities.

Our approach is guided by key strategic frameworks including Making Life Better which reflect the Trust’s commitment to our HSC Values. Throughout this incoming year we will engage with our key stakeholders to co-design our new 3 year strategy, as we continue to build a culture of shared ownership and continuous improvement.

Finally, I would like to thank everyone who has worked with us over the year: the service users, carers, communities and staff, your support has been invaluable.

Jennifer Welsh
Chief Executive

A message from our Chair

As Chair of the Northern HSC Trust I am delighted also to be the board director lead for PPI and carers. I believe that for effective involvement, people need to feel supported and for their contribution to be valued, respected and have an impact. Understanding what matters most to local communities is really important, particularly given the diverse rural and urban differences in the Trust area.

Partnership working with the voluntary and community, helps provide vital insight into groups across our communities, so that our services are accessible and responsive to all.

Understanding what our service users want and expect, allows health and social care to design services that are efficient, effective, sustainable and responsive to needs. Bringing people on the journey, ensures that the best models of care are provided and I believe that service users and carers have unique expertise which should be used to influence and redesign services.

Anne O’Reilly
Northern Trust Chair & Non-Executive Personal and Public Involvement (PPI) Lead

Background

Effective involvement is a priority outlined in the Department of Health’s (DOH) Health and Wellbeing 2026 – Delivering Together Strategy. Personal and Public Involvement (PPI) has been a statutory requirement since 2009 and has been further enhanced by the DOH Co-Production Guidelines which were published in 2018.

PPI is the term used to describe the concept of involving people and local communities in the planning, commissioning, delivery and evaluation of health and social care services.

Patient and Client Experience (PCE) standards have been in place since 2009. Overall, the outcome of PCE is to ensure that the voices of the service user and carers, and their experience, result in change and improvement.

Understanding patient experience is a key step in moving toward patient-centred care.

Our Integrated Involvement Plan sets out our vision, commitment and integrated approach to PCE, PPI and Co- production activities. Within the Northern Trust, this includes Patient Experience Standards, Real Time Feedback and 10,000 More Voices, Personal and Public Involvement and Co-Production.

The creation of a central Involvement Team supports a consistent, co-ordinated approach to involvement.

Involvement Team

Our Involvement Team provides support, advice and guidance to staff, along with training and support for service users, carers and the public as required. Our three year Integrated Plan , which sets out our vision, commitment and integrated approach to PCE, PPI and Co-production activities within the Northern Trust, is due to end in 2025. Work has commenced on our new Integrated Plan which will be co-produced with services users, carers and staff.

Our vision is for a Health Service shaped by the voices of patients, carers and, communities, where involvement is meaningful, inclusive, and central to how we improve care and outcomes.

We believe that involving patients, carers, and communities in shaping healthcare services will lead to better, safer, and more equitable care. Their lived experience brings a unique insight that improves decision-making, strengthens trust, and ensures services meet real- world needs. When involvement is meaningful and inclusive, it drives innovation, enhances outcomes, and supports more responsive, person-centred health system.

Going forward this year our priority is to foster deeper alignment between quality improvement, personal and public involvement, reform initiatives and governance, ensuring a more cohesive approach to service transformation, creating a unified system that learns, listens, and leads together.

Veronica Meenan
Involvement Manager

Lynda Elliott
Service User Involvement Co-Ordinator

Sarah Arthur
Patient Client Experience Facilitator

Jan Taylor
Involvement Admin Support Officer

Governance and Assurance

Neil Martin
Divisional Director of Strategic Planning, Performance and ICT the lead Director for PPI ensuring that PPI is a priority within all aspects of our business and planning agenda including transformation projects.

Anne O’Reilly
Northern Trust Chair, has been identified as the Non-Executive PPI Lead and plays a key role in embedding PPI into the culture and practice of Trust Board and the organisation.

Jayne McReynolds
Interim Assistant Director of Corporate Planning.

Kelly McBride
This year we welcomed our new Head of Equality and Trust Lead for service user and carer involvement including Patient Client Experience, Personal and Public Involvement and Co-Production.

We have a range of governance, management and reporting mechanisms in place to support our involvement work.

Our Northern Partnership & Population Health Committee provides assurance that the Trust is compliant with its statutory requirements. The Committee is Chaired by Anne O’Reilly, Trust Chair and Co-Chaired by Neil Martin, Director of Strategic Planning, Performance and ICT. The Northern Partnership and Population Health Committee is a standing committee of the Trust Board and oversees the Trust’s strategy for personal and public involvement and patient experience. The Committee meets quarterly and is provided with an update on involvement work across the Trust.

Trust Divisional Directors are responsible for ensuring appropriate PPI within the work of their Divisions. Trust Board has responsibility for ensuring that the organisation is compliant with PPI Legislation and PCE standards and that it promotes good practice. The Non-Executive Directors ensure that the Board acts in the best interests of service users, carers and the public and hold the Board to account, by challenging its decisions and outcomes and ensuring due process is followed. This includes compliance with PPI legislative requirements.

The Engagement Advisory Board continues to ensure that the Trust is approaching engagement in a way that meets the needs and interests of all communities, with a focus on targeting the most hard to reach groups. We have recently recruited four new members, selected following an expression of interest exercise, to represent the communities we serve. This year members have helped us shape the Trust Corporate Plan, Quality Strategy and engagement regarding the Vision for Causeway. They have also provided pre-engagement advice on the General Surgery Consultation and the Piloting the use of Body-worn Camera Devices within the Emergency Department Consultation.

Monitoring

PPI Monitoring

We continue to ensure that monitoring of involvement is embedded across all Divisions with support available from the Involvement Team. This year we have had some great involvement activities happening throughout our Divisions and we submitted a total of 101 involvement projects in our monitoring submission to the Public Health Agency (PHA).

This monitoring data gives assurance that we are meeting our statutory obligation to involve service users and carers. Using data-driven insights, we are shaping an action plan that targets our most pressing priorities for this year ahead.

This year we piloted an Involvement Human Library assurance process. This process identified four projects submitted through the monitoring submission to attend a human library style event with the PHA to talk further about their project. The process has been developed to capture learning and celebrate involvement and the positive contributions it makes. This monitoring process was completed with service user involvement which enhanced it. A task and finish group was established with service users, to reflect and review the process and to make improvements to it going forward into this year. Projects were featured on the regional Engage website to highlight positive examples of service user involvement and share best practice across the region.

Patient Client Experience is collected through Care Opinion, which is a safe and simple online user feedback platform where patients, service users, families and carers can share their experience of Health and Social Care.

Since the launch of Care Opinion in August 2020, we have received 2659 stories. To date, these stories have been viewed on Care Opinion 135,495 times.

Over the past year, Care Opinion has published 1102 stories of experience of healthcare shared by patients, service users, their families and carers.

The Trust’s commitment to Care Opinion is monitored by the PHA with the submission of an accountability framework report every three months.

These reports highlight the criticality of the stories, response timeframes, themes of what is good and what can be improved, as well as any planned changes resulting from stories.

Patient Client Experience

Patient Client Experience is collected through two main feedback platforms:

• Care Opinion, and
• 10,000 More Voices

Care Opinion

Care Opinion was launched in Northern Ireland in August 2020 providing a platform where service users, families and carers can share their experiences of health and social care services. The Involvement Team continues to embed Care Opinion into Trust culture as the online, real-time, service user feedback platform. This two-way feedback mechanism, promotes the opportunity for open, honest conversations and is the foundation to build and develop trusting relationships between the service user and provider.

The Involvement Team provides support, advice and guidance to staff, working in collaboration with all services, across all Divisions within the Trust. The service user ‘lived experience’ is recognised and valued as a driver to encourage and inspire staff to reflect on their personal practice, to identify learning, to develop and participate in quality improvement initiatives at local ward/ department level and at wider Trust level.

Care Opinion Priority Developments for 2025/26:

• To highlight the value of the patient experience in Quality Improvement Initiatives.
• To develop a Governance Escalation Framework to be shared across all Divisions for shared learning.
• To further develop Care Opinion Champion Support Groups across the Trust.

In the last 12 months the Trust received 1102 stories from service users sharing their experience.

• 33% increase in the number of stories shared in 2023/2024
• 82% were positive
• 18% were less positive

Across the Trust, Care Opinion has become more widely recognised as a service user performance indicator, supporting evidence for quality improvement initiatives, and in ward or department story reports, used to inform leadership walkabouts.

Every story was read, shared with the appropriate manager and staff, responded to, listened to and learnt from. The themes and trends that reflect positive experience and also those identified in the less positive experiences, are shown in the following word clouds.

What has been working well

Links to positive stories:

• “Made me feel really safe and comfortable“
• “Treated very quickly and very kindly“
• “The nurses were friendly and informative“
• “My son went in frightened and came out smiling”
• “The entire team were excellent”
• “Doctor and staff were amazing”

Stories of experience which highlight what is working well, provide staff with the opportunity;

• To reflect on their personal practice and learn what they are doing well
• To replicate and improve good practice
• To resource information for professional revalidation across disciplines.

It also helps to increase staff morale and team working.

What could be improved

Less positive stories provide opportunities to learn and improve, to make change/ to have an impact on the service reflecting ‘what matters’ to the people who matter.

Regional Care Opinion campaigns continue to be supported by the Involvement Team. The following figures illustrate the number of stories collected to date:

• District Nursing – 97
• Health Visiting – 79
• Continuity of Midwifery Care – 33
• School Nursing – 32
• Maternity Service – 194
• Smoking Cessation – 0

“Staff being able to read personal stories from women is integral to understanding what we are doing well as a team and also improvements that could be made to the service. When feedback is shared through the platform it contributes to staff well-being through understanding the positive impact to women when facilitating their care through pregnancy, birth and the early parenting period”.

Rachel Chakravarti
Lead Midwife for Continuity of Midwifery Carer (CoMC)

“We are delighted that PHN receive a high number of care opinion stories , all stories are shared with staff and discussed at team meetings. Positive stories are uplifting and staff are so pleased to receive this feedback. Staff feel valued when there is recognition of good practice and it boosts morale. When gratitude is shared on care opinion it affirms that staff are making a difference for clients and families. Negative stories sometimes can be difficult for staff to read but we use the opportunity for reflection and learning regarding the client’s experience.”

Elizabeth Whyte
Lead Nurse, Public Health Nursing

Changes made as a result of sharing a story

Over the past 12 months changes have been made in response to Care Opinion stories. A few examples of the changes made are detailed below.

Hard to understand the letter from the heart failure team

“I took my aunt to an early morning appointment with the Heart Failure nurse. After driving for an hour we went to Outpatient to be advise this was a telephone call and they weren’t able to see her…But I feel it is important I share this as the letter received clearly stated that the following outpatient appointment has been made for you at the Mid Ulster Hospital..”

Response – from Clinical Services Manager:

‘Letters have been updated to include virtual or telephone appointments. Thank you again for your feedback.’

Read the full story.

The podiatry treatment I received was excellent

“The corridor, which leads to the podiatry waiting area ends with a pair of heavy double doors which are extremely difficult for a wheelchair user such as myself to open, and which are even more difficult to manage when leaving as they are on an incline…it would be helpful if these doors could be attended to as soon as possible.”

Response from Services Manager:

“Thank you again for alerting us to the challenge you have experienced when accessing Podiatry Clinics. I have linked with estates services and they have now repaired the doors. If you have any further difficulty please do not hesitate to contact Head of Service for Podiatry.”

Read the full story.

Patient Experience Network National Awards

Congratulations to the Connect North Team who were finalists in the Patient Experience Network National Awards (PENNA) 2024. The awards recognise best practice in patient experience across all aspects of health and social care in the UK.

The Team were runners up in two categories: Partnership Working to Improve the Experience and Commissioning for Patient Experience.

Update on 10,000 More Voices Projects

The 10,000 More Voices survey is a patient and client experience initiative led by the PHA. Its primary goal is to gather in- depth feedback from individuals who have used health and social care services, including patients, families, carers, and staff. By collecting personal stories, the programme aims to understand the impact of healthcare experiences and identify areas for improvement. Unlike traditional surveys, the 10,000 More Voices programme employs Sensemaker, a narrative- based software that captures and analyses personal accounts to uncover themes and insights within complex healthcare contexts. This approach allows for a deeper exploration of individual experiences, moving beyond quantitative data to understand the nuances of patients and client perspectives.

Position of current 10,000 More Voices projects

The PHA has a number of projects on-going across the private sector and health and social care sector. Trust involvement varies from staff training, to support with data collection, involvement in data collection and access to Sensemaker data, to facilitate sharing of information within the Trust. The Involvement Team will share the campaign outcomes with relevant staff across the Trust to support shared learning and strengthen work with similar issues or service user groups.

My experience of Multidisciplinary Services in Primary Care

This campaign explores the experience of service users attending the Primary Care Multidisciplinary services. Data collection has closed with a return total of 721. The PHA will share report findings with services for learning and development early this year.

My experience of the nurse at the GP surgery

This campaign explores the experience of 18 surgeries registered to date. Dates for story generation will be confirmed on receipt of printed resources.

My experience of decisions about my care in HSCNI

This campaign aims to explore the experience of service users being involved in shared decision making during their healthcare journey. This campaign seeks to implement the NICE Guidelines (NG197). This is a regional campaign and each Trust has been asked to identify up to five services to run the project, over a sustained period of time throughout 2025. The Northern Trust has gone live with a pilot in its General Surgery Pre-assessment Clinic and will commence pilots in the other four areas soon.

My experience of a Care Home – a resident’s perspective

Service users will be invited to share their story as a resident of a Care Home, regarding what it is like to live within a Care Home and the ways in which their health and wellbeing needs are supported. Seven Care Homes took part in this campaign and the Feedback Report of Phase 1 will be presented to the Care Home Advisory Board.

My experience of waiting for a package of care

Project proposed through SPPG exploring delays in domiciliary care – Impact on service users and carers; this work links to Social Care Collaborative Reform of Social Services.

Due to the time limitations and parameters of the project, it was not possible to take it forward as a full 10,000 MORE Voices project. However the programme is supporting a scoping exercise, which will inform a larger 10,000 MORE Voices project into Domiciliary Care in 2025/26 as a strategic priority.

Shared Decision Making

Shared Decision-Making (SDM) is a collaborative process where healthcare professionals and patients work together to make decisions about treatment options. It involves discussing the available choices, considering the patient’s preferences, values, and circumstances, and reaching a decision that aligns with the patient’s needs and desires. Shared Decision Making empowers patients to be active participants in their healthcare, promoting better outcomes and satisfaction.

As part of the Trust’s on-going work on the Shared Decision Making Project, members of the Involvement Team sit on the Trust Steering Group, to oversee its development and implementation.

We have successfully recruited and are supporting three service users to participate in the group, ensuring that their perspectives are central to the project’s progress and decision-making process.

Pilot Projects

The Involvement Team is supporting the implementation of five pilot projects to conduct 10,000 More Voices Surveys within the Trust.

Our first pilot has gone live. Patients attending Causeway Hospital’s pre-operative assessment clinic are being invited to take part in a survey, giving them the opportunity to describe their healthcare experience and how involved they have felt in decisions about their care and treatment options.

The patient-centred approach, also referred to as Shared Decision Making (SDM), aims to give patients more autonomy over their care, encouraging a discussion between them and their clinicians when it comes to their personal healthcare journey.

The Trust’s survey is part of the Public Health Agency’s 10,000 Voices initiative, a survey that invites patients and service users to share their healthcare

experience, to help inform quality improvements in all aspects of care.

Service User Feedback

The Trust encourages complaints, enquiries, comments/suggestions, and compliments and views them as a positive opportunity for learning and improving services. The total number of formal complaints received this year was 979 (including 120 follow on complaints). Services across the Trust receive many compliments; these can range from written letters and thank you cards, verbal feedback and donations to our Charitable Trust Funds, in recognition of the service provided. This year the Chief Executive received a total of 7067 compliments.

Feedback from our service users, carers and members of the public/visitors using our services or facilities, helps us to identify areas where high quality care is being provided and where this is not the case we will make changes to improve service quality and safety.

Feedback can be given directly to the service involved, either verbally or in writing, or by sending your feedback directly to the Chief Executive.

Complaints, enquiries, comments/suggestions and compliments can be sent to:

Complaints/Service User Experience Office
Northern Health and Social Care Trust
Bush House
45 Bush Road
Antrim, BT41 2QB

Further contact details:

Tel: (028) 94424655
Email: user.feedback@northerntrust.hscni.net

Opportunities and Support for Involvement

Service User Panels

The Trust has established and supported a number of Service User Panels in partnership with service users, carers and the community and voluntary sector. These partnerships ensure an effective network for on-going stakeholder involvement and co-production in our work. Our Carer Pathway Steering Group and Disability Consultation Panel are both user-led, chaired by a carer and service user.

The Involvement Team is currently completing a scoping exercise to identify existing service user groups within the Trust. The aim of this exercise is to ensure that we have a clear and comprehensive overview of current engagement, to avoid duplication of efforts, and to identify any gaps in representation. By understanding where groups already exist and where they are needed, we can ensure more effective co-ordination, inclusive participation and better support for service users across the Trust.

Get Involved

The Involvement Team regularly raises awareness about Care Opinion and Personal and Public Involvement with staff and service users. This year we have attended Ballymena Health and Care Centre, Causeway Hospital, and Antrim Hospital.

Involvement offers our community the opportunity to share their experience, opinions and what matters most to them.

The Involvement Network is made up of over 300 service users, carers and representative organisations who work in partnership with the Trust to develop health and social care services. The Network is a key resource to help shape and design services, and contribute to the development of service information. Members have received 63 involvement opportunities and 375 members have taken part in more than 35 engagement events.

Over the year our service users and carers have helped to shape and develop a number of service improvements. We continue to advertise membership of our Involvement Network through our website and regularly on social media. In addition the Involvement Team regularly attends networking events to promote the Network.

In November we carried out a survey with service users to hear about their experience of being involved, helping us to identify any barriers that our service users/carers are experiencing and to better understand any training needs that may be required for our service users/carers to gain confidence to work with the Trust in improving services.

We have identified key themes to improve how service users and carers are involved. This will be shared with staff and relevant groups. The outcome of this work will be fed back to participants and we will review progress against our action plan at a later stage.

If you would like more information or to become a member of our Involvement Network, please contact InvolvingYou@northerntrust.hscni.net or 028 2766 1377.

Support and Resources

Having the best health and wellbeing for everyone in our communities can only be achieved by putting people at the heart of the Trust’s work. For effective involvement, people need to feel supported, and for their contribution to be valued, respected and have an impact. We are committed to ensuring that our staff have the skills and expertise to involve service users and carers effectively by providing specialist training and ongoing support.

Service users and carers are given the opportunity to receive induction training which provides information around the statutory duty of Personal and Public Involvement (PPI) and the support they can receive when becoming involved with the Trust.

We have a range of resources available to raise awareness of service user involvement on our staffnet site and our website. This includes information for service users and carers on how to share their experiences and get involved. Engage is a regional website, which provides those with an interest in involvement, including health and social care staff, service users, carers and the public, with information, opportunities and resources in PPI, Co-Production and Partnership Working.

Tweet, message, post and comment; there are loads of ways you can connect with us. We continue to use our Facebook page and Twitter account to circulate any opportunities for involvement to over 61,000 people. We use YouTube as a platform to provide service users, carers and the public with a variety of information including informative videos and audio interviews.

Knowledge and Skills

Care Opinion Responder Training

Each story on Care Opinion is shared with the appropriate staff to listen, reflect and learn. Each story then receives a response from a trained responder. Responder training provides staff with the knowledge and skill to provide a timely, meaningful response. This year 36 members of staff completed responder training. All responses to feedback, whether positive or less positive, should be personal, empathetic and understanding. Dialogue between the service user and provider helps to build confidence and trusting relationships, with the recognition that patient experience is a valued contributor to service improvement and change. This year we plan to develop the number of responders, and to improve targets set by the PHA around responding. (Response time scale, more active responders).

Care Opinion Awareness Training

Care Opinion Awareness training and Framing the Ask training, is shared with all staff across the Trust. The aim of the training is to raise awareness, knowledge and understanding of Care Opinion and to provide staff with the confidence to ask for feedback and to value the learning received through the lived experience. This year 764 members of staff completed this training.

Citizen Space

Citizen Space is an online tool which we use to design questionnaires and surveys. It continues to be very popular as a method for gathering service user and carer feedback. 314 staff accounts have been set up and staff have received the relevant training and support. Citizen Space was designed in collaboration with government, specifically for public sector use.

Service User Involvement Training

The Trust is committed to providing training to make sure staff have the skills and expertise to involve service users and carers effectively. This year a total of 924 members of staff have taken part in our involvement training programme. To build capacity we also provide advice clinics, to support staff in involving service users and carers. This year we provided 30 advice clinics. Moving forward, we plan to use webinars to expand training opportunities and promote service user co-delivery training.

Facilitation Training

To ensure our staff have the skills to facilitate and plan service user involvement, we delivered a session of our specialist facilitation training. 20 members of staff completed this training. The session was designed to create a safe and interactive space, to provide guidance on facilitation tools and the meeting designs which would work best in different situations. The session also looked at the use of technology to support the facilitation of discussions as we are still in a hybrid working situation with in person and online events.

Engage

There are a number of levels of involvement and many different ways to involve people. A range of approaches can be used to reach out and involve service users and carers. For example, a change in a service may be co-produced with service users and carer, but engagement with wider groups will take place to help to develop information or communication about the change to the service. Engage is a regional website which we use to ensure there is a wide range of tools available to effectively involve service users and carers.

What has been happening across the Trust

Connect North

The Connect North service was co-designed with service users and carers to support those experiencing a range of social, practical and emotional needs. Clients and carers continue to be regularly involved in resource and service developments.

We designed and piloted a “Community Appointment Day” (CAD) to assess, engage and connect clients (and their carers) to helpful community based services and supports within one single appointment and without impacting waiting times.

Client and carer feedback from the event highlighted a need to continue to invest in the many, often under-rated aspects of care which matter most to our clients and their carers; timely access to appropriate help and support, easy to understand information, client/carer led care, personalised care, relaxed atmosphere, professional personnel and a warm and friendly approach to care provision.

Our CAD was a huge success with clients and their carers reporting that they felt comfortable, listened to, involved and better informed following their connection with our service. All participants reported that they would recommend the service and event to others.

This feedback identifies a need for our service to continue and expand the CAD initiative for our clients and their carers. We are currently gathering feedback from clients on our usual care pathways to further inform service improvement:

“So well organised. From receiving the invitation everyone has been so welcoming and friendly, we have felt really comfortable.”

“I would recommend this to anyone.”

“Perfect service, delivered professionally by friendly people.”

Quality Strategy moves to next phase of ‘turning ambition into action’

A Quality Strategy event at The Tullyglass Hotel on Thursday 20 March 2025 heard how the next phase of the initiative will see the implementation of a delivery plan.

Owen Harkin, Deputy Chief Executive, said “Ambition alone is not enough. It must be paired with action and that is why achieving our ambition requires collective action from each and every one of us.”

He continued: “We also made a promise in this strategy. A promise to our service users and staff. A promise that the status quo is not an option anymore. A promise to do things differently, to listen and learn from those who use our services, working in true partnership”.

The event also heard from staff and service users who were instrumental in shaping the strategy. Thelma Dillon, Chair of the Engagement Advisory Board, spoke of how the strategy represents ‘a shift from passive recipients to active partners for all those who use our services’.

Guest speaker Hugh McCaughey, Chief Executive of Ulster Rugby, whose career has spanned Health and Social Care, NHS England and professional sport, shared parallels between healthcare and sport. His insights also helped to illustrate how excellence and quality is not about reaching an end point, but about a journey of on-going learning, innovation, adaptation and an unwavering commitment.

The event was closed by Carol Diffin, Trust Board Vice-Chair, who declared: “The real work begins now, for us all! In the conversations you continue after today, in the ideas we take away and put into practice and in the bold steps we take from this day forward to make our plans a reality.”

Carers Week

Carers Week was held in June and ran from 10 – 14 June with the theme of, “Putting Carers on the Map.”

Our first event was our Carer Information Fair in the Adair Arms, Ballymena. We worked with our colleagues across the public and community and voluntary sectors to showcase as much support as possible. On the day we had over 60 exhibitors with a world of information for unpaid, family carers.

“Thank you for arranging an information fair for carers in the town. It was great to be able to walk in off the street and see so much that is available that I didn’t know about.”

We finished Carers Week in Antrim at Country Cakes. We would like to thank the carers who co-deliver at these events, as that is what makes our programme extra special. We had one of our carers demonstrating how to make a lemon curd from scratch and how to use it to decorate and fill various puddings or cakes.

Carers Listening Forum

The Northern Trust Carer Listening Forum is a designated time for the carer voice to be heard. The Chief Executive, Jennifer Welsh and Trust Chair Anne O’Reilly meet with carers twice a year. Now in its second year, the Listening Forum has discussed issues such as transitions between services, identifying and recognising carers, including young carers and has a project underway to review equipment available in the Trust.

Carers also meet quarterly in the Trust’s Carer Pathway Steering Group, which is Chaired and Co-Chaired by carers. Two carers are also involved with the new Northern Partnership Population Health Committee.

It is important that the Trust includes the voices of informal, unpaid family carers at every level because of the significant contribution carers make every day.

Ballywillan Wellness Hub

Ballywillan Hub was developed in May 2023 by working collaboratively, educating, teaching and gaining the trust of the community, partners and stakeholders. The aim was to have a one-stop shop available to support the health and wellbeing needs of People Seeking International Protection residing in the locality. A population health approach was used, giving volunteers a purpose and a role in supporting others.

Service user feedback – we listened to our clients who wanted support with their emotional health and wellbeing and we developed a support structure through arts, crafts, music and dance.

Outcomes – reduced need for ED attendances, reduced referrals to Social Services, a reduction in reports of mental health problems, a reduction in referrals relating to parenting/behaviour concerns, an increase in the morale and self-esteem of clients.

Endoscopy Unit

The Trust’s Linked Endoscopy Units participate in the Global Rating Scale (GRS, which is designed to obtain accreditation for the endoscopy service. GRS is set by the Joint Advisory Group (JAG). Accreditation gained from JAG will show that the service demonstrates a high level of quality of care, which means that service users can feel confident in the service when attending for their endoscopy procedure.

We regularly engage with our service users to get feedback on the pre-procedure information we provide, how well we communicate, and whether our service users feel they are treated with dignity and respect. We also want to hear if the information provided post-procedure meets the needs of the service users.

We also carry out an annual survey to gauge and update the information we give verbally and in our patient information leaflets / appointment letters. This helps us to measure our current practice against a defined standard. Furthermore, it allows our service to build meaningful user/provider relationships, by establishing effective and constructive communication.

Lessons from an Elephant

An interactive workshop for Year 8 pupils, developed by Tracey Stewart, Specialist Palliative Care Dietitian was held in collaboration with Dunclug College, Ballymena. The workshop used the theme of elephants and focused on food and memories to raise awareness of palliative care, grief, loss and bereavement and to help pupils begin to develop coping skills, should anyone close to them die now or in later life. The pupils also completed art work to form a memory mural for display within the college. Feedback from staff, parents and pupils described the workshop as a very worthwhile and valuable experience. The Community Palliative Care Service Improvement Team has recently set up a Compassionate Schools Working Group to develop this work with other schools.

Psychological Services

Michele Kavanagh, Consultant Clinical Psychologist, works collaboratively with all the psychologists, service users and carers across psychological services. The group met five times in 2024/25 to support the various involvement activities across the Trust.

“In 2024/25, we ran a poetry project with people who have lived experience of traumatic brain injury and teenagers with chronic physical health conditions.

We also launched two different photography projects with adults who use psychological therapy services.

Our Personality Disorder Service has been working at a regional level to challenge stigma surrounding this condition and has run various creative events. This work has gathered momentum to the degree that regionally a charity has been set up to support future sustainability.

We supported the Mental Health, Learning Disability and Community Wellbeing Division to develop a process for recruiting service users and carers into advisory roles.

We have been reviewing how we promote involvement and communication with service users and carers and are looking forward to future exciting projects that can be co-produced with involvement collaborators and partners.”

Hearing Support Lanyards

To celebrate Sign Language Week 2025, the Equality Team launched hearing support lanyards, which are now available for patients and service users. The lanyards can be used as a discreet signal to staff that the wearer is deaf, hard of hearing or a lip reader, and that they may need additional support.

The lanyards were introduced after a service user contacted the Equality Unit about his experiences using our services as a deaf person and the challenges he faced.

The service user told us “During hospital stays, being profoundly deaf makes me feel very isolated and I experience great difficulty understanding staff conversations with me, especially if they are not always aware of my situation, many assume I am hard of hearing and raise their voices, which only creates more difficulty. I am delighted with the introduction of hearing link lanyards, which will immediately identify my deafness and hopefully prompt staff to establish my preferred method of communication. I hope they will be of benefit to others.”

The lanyards will help the wearer inform staff of their deafness or hearing loss, and help to let staff know about the person’s preferred method of communication, for example, lip reading.

Cultural Competency Framework

Health and social care colleagues worked collaboratively to develop a Cultural Competency Framework to help reduce inequalities in health experienced by ethnic

minority populations and patient groups across the region. The framework is underpinned by staff training and resources, including the, “Little Book of Cultural Competence,” which has been designed to promote equity and enhance patient care.

Co-Design Macmillan Information and Support Centre (Antrim site)

This project has been ongoing since 2023 and we have conducted stakeholder engagement events at each stage of the project development;

feasibility stage, business case stage and now pre- construction. The fourth engagement event held on 10th April 2025, included four service users, who alongside staff, reviewed and commented on the interior finishes. Their comments have been taken on board by the architects and this will ensure that the building décor will meet the needs of service users.

Service user evaluation of the 2 stop model of chemotherapy delivery in Laurel House

In 2024, staff in Laurel House Chemotherapy Unit recognised that the current model of chemotherapy assessment and delivery, using a same day, one-stop design, was becoming much more difficult to manage and was causing long waits for patients in the unit. We conducted a survey with patients (165 responses) and staff (35 responses) to understand the underlying problems from both perspectives.

Utilising this feedback we changed our model of care to a 2 stop model, whereby patients were assessed on one day, with treatment at an allocated time on a separate day. This was implemented at the end of October 2024. In February 2025, we completed a follow up survey with patients, receiving 92 responses. This indicated that 92% of patients reported their experience in Laurel House to be very good or excellent and that waiting times for treatment were greatly reduced.

Collaborative working with Breast Cancer Now

The Trust has been working with Breast Cancer Now to conduct a patient feedback survey. Patient participation was very positive with a 45% response rate, 77/172 from primary breast cancer patients and 34% response rate, 44/136 from secondary breast cancer patients. Five survey participants also participated in an online focus group. A staff survey, 31 responses and focus group, 12 participants, was also conducted.

The collective results were discussed at a feedback session with staff and service users in September 2024 and a Trust Action Plan developed. Additional support for patients with secondary breast cancer was identified as a key area for improvement. We are currently working with Breast Cancer Now to establish a local support group for those with secondary breast cancer.

The initial step has been to go back to those patients surveyed in 2024, to gain an understanding of how this group should be developed to meet their needs. Again we had an excellent response rate, 28% and with Breast Cancer Now we will be utilising this information to establish the support group later this year and ensure the time, location and content of the group is based on the views of service users.

Birch Hill Centre for Mental Health

Construction of a new Mental Health Inpatient Service

Birch Hill Centre for Mental Health is a new mental health hospital being constructed on the grounds of Antrim Hospital Estate. Throughout the development process the Trust has adopted a collaborative approach and co-production has been integral to how the plans for Birch Hill have been developed.

Staff have worked very closely with service users throughout the entire design process. Listening to service users and carers has been vital as they are best placed to advise on what support and services will make a positive difference to their lives.

Improving the experience and outcomes for patients and service users is at the heart of the centre’s design, and this will be a fantastic new facility, allowing the Trust to provide the highest standards of compassionate care with our community, in our community.

MEM Service User Engagement Panel

The Division of Medicine & Emergency Medicine (MEM) engages with service users on an on-going basis in relation to various services and topics. The MEM Service User Engagement Panel is a key part of the process of designing, reviewing & improving services. The overall aim of the Panel is to ensure personal and public involvement on the development, design and improvement of Medicine and Emergency Medicine services within the Trust.

The purpose of service user and carer involvement in the Panel is to;

• provide input into plans and decisions
• utilise the expertise, knowledge, and skills of service users and carers
• inform, shape, and influence plans and decisions
• discuss projects within the Division of Medicine & Emergency Medicine.

Engagement with our panel has led to improved service quality, better outcomes for our service users and has provided opportunities to reflect on Trust practice and learn directly from our service users. Through the Service User Engagement Panel the MEM Division has embedded service user involvement, fostering a culture of continuous improvement, working in partnership to better meet the evolving needs of our community.

Recently we have worked with our MEM Service User Engagement Panel to co-produce a patient information and communication leaflet for the Discharge Lounge. Panel members’ expert advice was integral when developing this leaflet, to ensure the information is accessible, relevant and truly meets the needs of those it is designed to support.

RISE NI (NHSCT) KS 2 Service

The Regional Integrated Support for Education (RISE) NI service offers universal, targeted and specialist supports within mainstrea preschools and primary schools up to the end of Key Stage 1 (KS1), with a focus on four main areas of development; social, emotional and/or behaviour, speech, language and communication, gross motor skills and sensory processing, fine motor and visual perceptual skills.

The service received additional temporary funding until March 2025 from the Department of Education, as part of the Emotional Health and Wellbeing Framework in Education. This provided the opportunity for RISE NI to embark on a multifaceted expansion into Key Stage 2 (KS2) to promote children’s emotional health and wellbeing (EHWB).

Service user involvement was central to the development of this new service. From the outset, an initial scoping exercise was conducted with KS 2 school staff to gauge the EHWB needs of this KS 2 population, what supports may be required and what could feasibly be delivered within the confines of the curriculum and the school setting. This informed how the service was to evolve. Staff training, alongside whole class and small group programmes, were highlighted as being the most beneficial supports. Many of these were of a bespoke design for this population, with service user involvement again being at the centre. Some of the methods used were; the involvement of a small group of KS 2 teachers in the design and evaluation of the training material, ensuring that the needs of the children and service were met.

We asked for feedback from the children involved at the end of each group session to ascertain the acceptability of the session for KS 2 children. Pre and post-programme evaluations were completed from the perspectives of the teachers, children and parents (programme dependent), to evidence the acceptability, feasibility and effectiveness of each programme. This let us know about any improvements which were required before the programmes were delivered again.

We received an overall evaluation from KS 2 school staff on the RISE NI service, following an Outcomes Based Accountability Framework, to gauge whether their expectations from the initial scoping exercise had been met. We shared the findings of this evaluation with school staff, outlining any key learning for the RISE NI service to take forward, should funding be made available to continue this aspect of the service.

RISE NI acknowledges the immense benefit that the service user perspective brings to informing service design and delivery. This has been extremely important in the evolution of the RISE NI KS 2 service to support children’s SEWB in KS 2 classrooms and has no doubt been instrumental in making the RISE NI KS 2 service such a success. 100% of schools who responded to the service evaluation would recommend the RISE NI KS 2 service to other schools and requested that the funding be made available on a permanent basis.

Echocardiography Patient Satisfaction Survey

This Trust Echocardiography Patient Satisfaction Survey was carried out as part of the Echocardiography Quality Framework (EQF) audit tool, recommended by the professional body, the British Society of Echocardiography, which is used in the Echo Department. The EQF is a unique, comprehensive, holistic approach to improving all aspects of an echocardiography service. It is a patient-centred programme, combining Quality Assurance and Continuous Service Improvement. This part of the EQF approach views our service from the patient perspective – how would we wish to be treated in our own department? This is articulated by the question: Are we kind to our patients?

The audit was undertaken retrospectively and sent to patients who had an echo carried out in the Trust. There was a 37% response rate, with overall favourable responses. The audit told us that we can improve our service by including directions to our echo rooms in our patient information leaflets and by improving our communication with our service users.

Drumalis ‘Care4Me’

This year, as part of our Carers Week celebrations, we held a special event for informal, unpaid family carers in the beautiful Drumalis Centre in Larne. Drumalis is a peaceful retreat along the Antrim Coast

and we always find it a calm and refreshing venue. Carers enjoyed a hand reflexology session learning of the benefits of hand reflexology and tips on how to use it to relax.

This was followed by a specially designed ‘Care4Me’ workshop by The Sunshine Project, on how to look after ourselves while we care for someone else. Many carers find that, while looking after someone can be rewarding, they often give up their own interests, social activities and hobbies because they think they have no time or they are too busy attending to the cared for person. We discussed how we can feel when faced with tough times or periods where it is, “one thing after another.”

We learned about our physical reactions to stress and anxiety, how there can be, “knock on,” effects from our thoughts, to our feelings, to our physical symptoms. We briefly tried some, “tapping therapy,” to energise us, while also discussing what brings each person happiness and what that feels like. The morning finished up with a lunch for everyone and carers could take a walk and enjoy the beautiful gardens and peaceful surroundings of Drumalis.

Mental Health Length of Stay “Right Care, Right Time, Right Place”

HSCQI Delivering Value Programme project

This project was one of two Trust projects, identified as examples of best practice in the region, as part of the HSCQI Delivering Value programme and as a result, has been selected for regional scale and spread, by demonstrating significant improvements in patient care, staff experience, financial sustainability and operational efficiency. Our project team, with representatives across Mental Health Acute and Community teams, as well as service user representation from our Service User Consultant and a service user with lived experience, was established with the aim of reducing overall bed occupancy across all acute admissions and PICU inpatient MH beds by at least 10% by end August 2024.

Our vision was to ensure all admissions are purposeful and outcome-based for individuals receiving care, culminating in timely discharges. As a result, services would provide “Right Care, at Right Time, in Right Place” with a focus on reducing length of stay, optimising patient independence and promoting staff wellbeing.

As well as attending project team meetings and workshops, our Service User Consultant and service user representative collaborated on the design of our patient engagement survey, in order to obtain feedback from our service users on their journey through our service.

From our data it was noted that as well as an, on average, 2% reduction in bed occupancy, 12.7% of referrals for voluntary admission between October 23 and July 24 did not progress to an admission. This equates to one in eight avoided admissions.

This means that one in eight of our service users were supported at home, in a collaboration among the Crisis Resolution Home Treatment Team, Mental Health Liaison Service and Community Mental Health Teams. This has significant benefits to service users and their families, enabling greater choice and control over their care in the least restrictive setting. Their care was shifted from the acute setting and people were enabled to be supported to live well in their communities.

Enhanced Patient Care and Observation

MHLD Inpatient Services

The Enhanced Patient Care and Observation (EPCO) approach is currently being piloted within Mental Health and Learning Disability Inpatient services, as part of a scale and spread approach, following successful implementation in the Trust’s general acute services. The MHLDCW Division aims to adapt and implement, spread and scale the use of EPCO toolkit across all inpatient wards in Holywell Hospital and Ross Thompson Unit, with the view to providing a standardised and consistent approach to assessment, treatment and monitoring, with daily evaluation of patient care. This will in turn enable our patients to get the appropriate level of care, support and observation they need, whilst supporting optimisation of resources.

The approach has been built on strong collaboration with staff, service users and families, establishing a deep understanding of needs and identifying opportunities to improve person centred care.

As part of the spread into MHLD inpatient services an, “easy read,” information leaflet for patients, relatives and carers on what EPCO means, was produced in collaboration with Speech and Language Therapy in Learning Disability services and in consultation with a service user. Feedback on the leaflet by staff and service users has been really positive, with the suggestion that the leaflet also be displayed as a poster, to promote the culture of care across the wards.

Crisis Resolution Home Treatment Team

Carer information sessions have been organised by the Home Treatment Team; these run monthly with information provided in relation to service user and carer resources. This forum also enables feedback to be received from carers to help shape and inform service development and improvements.

Mental Health Inpatient Wards Service User/Staff meetings

Our Mental Health inpatient wards in Holywell Hospital and Ross Thompson Unit hold regular service user/staff meetings. This is an opportunity for service users to make suggestions, raise concerns as well as a forum for staff to advise of any current developments or improvements in relation to the ward. Our wards have also implemented, “you said we did,” boards to illustrate how suggestions from our service users have been considered and put into practice.

A Partnership Approach to Care Home Resident Falls Prevention

The REACH team (Responsive Support, Education & Anticipatory Care with Care Homes) identified, through data intelligence, a number of residents who were experiencing falls in the care home, which result in an attendance at the Emergency Department. A communication letter was issued to the Care Home managers to encourage participation with the new falls and frailty prevention model and a poster was supplied to offer relatives / nominated persons, the opportunity to be part of the REACH face to face clinical assessment of the resident.

A key feature of the REACH Falls and Frailty Prevention model was the holistic assessment co-design approach. REACH completed the falls and frailty assessments in synergy with the Care Home staff, the resident, their relatives and the multi- disciplinary team.

The REACH team used its knowledge and skills to support Care Home colleagues in the development of resident-centred care plans, contributing to a positive resident outcome.

REACH then communicated with the resident’s Named Workers advising of any recommendations for the resident care plans. The purpose of the assessment is to improve resident outcomes in relation to repeated falls, to reduce attendances to Emergency Departments and raise awareness of tools to assist improved management of residents who fall.

REACH discussed with the families and Care Home staff the use of the PHA Post Falls Guidance for Care Homes, to ensure a consistent application of clinical and regional falls guidance in practice. A marked reduction in resident falls has been noted.

The ‘My Journey’ Project

The, “My Journey,” Project was developed just over three years ago to support services to find a different way to provide information and education to patients via their care pathway in the Trust, in the form of videos, podcasts & webinars. The project enables service users to have access to help and guidance in digital form, when they are on the waiting list or in between appointments and to self-manage their condition when at home, on public transport or even on holiday.

This year service users have contributed by telling their stories in the Continence Services Podcast, “The Continence Challenge – Helping You Regain Control,” to help service users and the general public manage their continence issues. “My Journey,” benefits service users and their families in a way that services are not always able to deliver.

The below quote epitomises how the, “My Journey,” project provides an alternative care opportunity. This recent feedback from a parent, relates to another podcast series called, “Let’s Talk,” which was created by the Paediatric and Neonatal Clinical Psychology Service and includes a service user’s story called, “Living with Type 1 Diabetes – Aoife’s Story.”

“I have never taken time to access support myself since my child’s diagnosis as all the focus has been on appointments for her.

It is so helpful to be able to listen as I go about my daily routine. Thank you so much! You’ve no idea how much it means.

It has verbalised so many of the emotions and validated what for us has been a hugely traumatising experience.

I love how it is patient and parent focused. So much of our experience doesn’t acknowledge the parent at all.”

Acknowledgement

We would like to extend our sincere appreciation to everyone who continues to be a champion of Involvement. Your commitment will help shape our future services.

Get in touch

Please contact the Involvement Team for further information on our work or if you wish to join our Involvement Network.

Tel: (028) 2766 1453
Email: InvolvingYou@northerntrust.hscni.net

Involvement Annual Report 2024/25 (PDF)