1. Clare Lewis Deputy Chief Nursing Officer Community
Sláintecare
Implications for Advancing Community Nursing Services
Clare Lewis
Deputy Chief Nursing Officer Community

2. Hospital Centric Approach to Care Services operating at 100% capacity.
INTEGRATING CARE
SOLUTION
PROBLEM
Hospital Centric Approach to Care Services operating at 100% capacity.
Connected Community Care were care follows the individual providing care close to or in the home.

3. Health Care Reform: A Case For Change
Provide appropriate and financially sustainable care to manage care needs in the community
Focus on prevention, self-management and proactive co-ordinated care
Robust Primary and Community Care Services

4. KEY ACTIONS SLÁINTECARE TO ADVANCE COMMUNITY NURSING
OPPORTUNITIES TO FACILITATE CHANGE
COMMUNITY BASED CARE EXPANSION
Services at home and in the community
(e.g. Diagnostics, workforce, collective resource to enable to deliver on expanded vision)
NEW MODELS OF CARE
Based on population need with a focus on prevention and promotion
(e.g. Healthy adults, children, older persons, people with disabilities, people with mental health needs)
COMMUNITY NURSING SERVICES
To introduce a unit of service delivery on a phased basis.
(e.g. Demonstrator sites aligned with innovations identified within the Sláintecare Integration Fund)

5. Align Actions to Develop Community Nursing Services
Scaling of C.I.T & Implementation of First 5 Policy
C.I.T consider how aligns with community nursing teams to increase response and supportive care at home
First 5 policy in line with Sláintecare principles, develop a dedicated childhood workforce (PHNs, CNS, ANP, HSCP, Paediatric Units)
Scaling of Integrated Clinical Care and Older Persons Programmes
Development of Pathways for Role Expansion in Community Nursing to align with programmes
Developing unit of service delivery to support programmes
Expansion of General Practice Chronic Disease Management
Opportunities to examine PHN role in population health planning aligning with GP chronic disease management programmes
Opportunities for community RGN roles in clinical case management and enhanced practice and longer term programmes of care.

6. Define a set of principles
Nursing Services Re-design 7 Steps to Developing and Implementing models of nursing care (Sláintecare)
Population health needs assessment Risk stratification
Objectives
Improving morbidity
Mortality
QOL
QOC
Define a set of principles
Whole system
Individual Groups
Cohorts
Standards of care
Decision Making
Risk Assessment
Prioritisation
Impact on health & society
Standards
Clear
Implementation standards (expected for population group)
Evaluation
Data collection
Analysis
Interpretation
Linked to objectives
Improve Mortality
Morbidity
To Inform
Service Expansion
Role(s) development

7. Supporting Shift Left: A Case Management Approach in Community
Define and Implement Effective Case Management Processes
Determine Levels Of Need
High, Moderate, Low risk supporting timely service mobilisation and direct the pathways for clinical care programmes, integrated care programmes.
Support Population Healthcare Planning
Define pathways of care to support a connected community approach (shift left)
Support Case Load Management
Skill Mix (Safe Staffing Framework, ANP Framework), 4 Quadrants of care (Community Nursing Policy)
“Care Following the Person”

8. Enablers to Deliver on Integrated Care
Safe Staffing Framework to determine level of staffing for population needs.
Capability Framework for the Enhanced Practice Role
Connected Community Care “Care Follows the Child/ Person”
Flexible mobility of nurse resources based on level of care needs
“Right people, Right Place, Right time”
ANP Framework
Specialist generalist with credentialing pathways to create a critical mass

9. TO DETERMINE COMMUNITY NURSING RESPONSE
Define the unit of service delivery to mobilise nursing services across acute and community sectors.
(Define the central hub of care)
OUTCOMES
Patient sensitive
(Self-management, service user empowerment, choice and access, first point of contact)
Service Provider
(Delivering on patient- centred care)
Health System
(Effectiveness of programmes of care )
Define roles and responsibilities of nursing services in response to unit of service delivery
Clarify structures and nursing services required to re-orientate care in the community with geo alignment.
(Acute and community services collaboration)
Structures for clinical governance and processes of care.
(Standardized assessment, measurement and programmes of care provided)

10. GOAL OF FIRST 5 TO SUPPORT PHN ROLE DEVELOPMENT
All babies and young children early years will be valued as critical
Strong and supportive families and communities
Optimum physical and mental health.
An effective early childhood system
Positive play-based early learning
GOAL OF FIRST 5 TO SUPPORT
PHN ROLE DEVELOPMENT

11. Delivering on an Environment for Integration
Describe service
model approach
The Where & the What
Replicate an integrated workforce:
“Care Follows the Individual”
Case Management
Standardize screening & criteria to access services that reflect a changing demographic
Formalise pathways between the acute & community services Providing joint programmes of care preventing further disability
Service Access: Increase availability of ambulatory care services (e.g. COPD, HF, Frail older persons) in primary care centres
Improve Access to intermediary care services (e.g. short-term beds, rehabilitation)
Result: Reduction in Demand for acute hospital services
Increase the number of citizens cared for in the community

12. DEVELOPING A QUALITY, POPULATION NEED BASED SERVICE
Predicting Population Need and Responding
Understanding Current Demands and Trends
Trends in demand for service
What Data is feasible to collect
What is relevant to your service
Economic considerations
Collaboration 4

13. Understanding and Measuring Quality
Meeting and exceeding an acceptable level of performance through the provision of a safe and effective service
Broad and Complex concept
Only through measurement that quality can be ensured and improved on if necessary (HIQA,2013)
Quantifying Quality
Measuring Quality
Development of metrics that provide us with information of what we are trying to measure
Show trends to demonstrate improvements that are made over time
Alert to where improvements can be made in a service

14. LEVEL OF RESULTS Impact Outcome Output
A strategy focussed on performance and achievement of outputs, outcomes and impacts (OECD 2010)
Impact
Changes in the lives of people
Outcome
Institutional Change: values, laws – associated with institutional performance, new institutions
Behavioural change: new attitudes, practices
Output
Operational Change: products and services – knowledge, skills

15. The Nursing Response Performing Thriving Flourishing
It’s no longer enough to perform – Nursing must thrive and flourish……….
Focus on compliance
Performing
Focus on service improvement
Thriving
Focus on innovation
Flourishing

16. THANK YOU
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