Conclusions and recommendations

Transformation work across health and social care is being supported in Northern Ireland despite the lack of a local Assembly in recent years. This is being led by the Department of Health in conjunction with the Health and Social Care Board, GPs, health trusts and other health agencies. Broad objectives for health transformation were laid out in health strategies published towards the end of 2016 and early 2017. In addition, the publication of the Power to People report in late 2017 recognised the importance of reforming an adult social care system that cannot meet growing demand in its current form, especially with a growing ageing population.

Many innovative models of care and support exist already in Northern Ireland. Some of these are already delivered by health trusts or community and voluntary providers. The challenge is scaling up proven models of person-centred care beyond specific geographical areas or specialisms of care and embedding co-production at all stages.
Key recommendations include:

• Develop key broad shared objectives and targets across government departments and public bodies in relation to supporting innovation around care and support models. This will mean greater collaboration and shared resources between bodies responsible for health education, housing, council services and tackling poverty and income issues.
• Develop Northern Irelandwide evaluation tools for wellbeing and social connection. This will create opportunities for gathering evidence and data across different providers which can be used by commissioners to support further investment in innovation and prevention services.
• Establish an innovation scaling fund in Northern Ireland to test new approaches and evaluate if they can deliver better outcomes and more person-centred care especially for older people. A clear mechanism for scaling up innovation will be critical to develop the capacity in the system to transition away from less person-centred models of care.
• Bring together the evidence base on innovative models of health, care and support into a single ‘what works’ information source, perhaps building on the SCIE Northern Ireland social work and social care hub. This can be shared with all stakeholders interested in transformation and innovation across Northern Ireland.
• Discussions around investment in innovation often focus on ‘new money’ but commissioners also need to tackle the issue of transferring resources away from existing low-quality outcome approaches to more person-centred sustainable care and support services. This can be difficult for existing commissioners especially when they have funded services for many years. Existing care providers also need to be supported to innovate and transform services where possible.
• Commissioners need to embed co-production in all new services to ensure buy-in and support from service users and their families. It will also allay fears about moving away from more traditional care services to new models which can deliver better outcomes. Service users become partners in this process co-producing solutions and actively managing their own health.
• Commissioners should pay care and support providers on the basis that they improve resilience, independence, self-care and social connections. These outcomes will be critical in meeting the demands of an ageing population and delivering more sustainable services in the medium to longer term. There will need to be a transition away from paying providers to provide set tasks and only supporting those who have reached a critical threshold in relation to care needs.