Frequently Asked Questions

The purpose of this page is to give you some background on Transforming Your Care (TYC) and answer some of the questions we are most frequently asked.


What is Transforming Your Care?

Transforming Your Care – A Review of Health and Social Care in Northern Ireland was published in December 2011.

The report confirms that people are living longer and that demand for health and social care services will only increase in the future. It highlights the need for change so that we can meet everyone’s needs in the future.

It also recommends how services can be delivered differently in the future to improve the health and well-being of people in Northern Ireland while making the best use of available resources to ensure we can deliver safe, high quality and sustainable services.

After the report was published the Health and Social Care (HSC) organisations in Northern Ireland developed draft proposals and plans for how TYC would happen in terms of service changes.

These were set out in the Vision to Action consultation document.

A public consultation on these draft plans was undertaken over a 14 week period from 9 October 2012 to 15 January 2013. All of the consultation documents are available to view or download from the Health and Social Care Board (HSCB) website.

Since the end of the consultation process, HSC organisations have been making changes in how much they commission and provide services, and have begun to implement the model set out in TYC.

It is expected that this journey of reform will take a number of years.


What has Transforming Your Care achieved to date?

Since the former Minister for Health, Edwin Poots, endorsed the Transforming Your Care proposals in March 2013, we have started to see real, meaningful and positive change through the implementation of reforms.

You can read more by visiting our TYC in Action pages which set out how work is progressing across Northern Ireland.

You can also view or listen to our videos featuring people whose lives have been transformed by TYC projects.

Alternatively, you can view our latest news on our website.


Why is Transforming Your Care important?

Transforming Your Care describes how and where you will receive health and social care services today and in the future.

The report sets out how doctors, nurses, social workers and all those providing care for people in Northern Ireland will work together to offer high quality care for everyone.

If we do not reform our health and social services now, increasing pressures will mean that it will become very difficult to provide high quality services in the future.


What will Transforming Your Care achieve?

The Transforming Your Care Review Report (December 2011) says:

  • People will get support to stay healthy, make good health decisions and manage their own conditions.
  • More services will be provided locally with opportunities to access specialist hospitals where needed.
  • Where it is safe and appropriate to do so, more people will be cared for at home.
  • People will have more choice and greater control over the types of services they are able to access.
  • Investment in new technology will help people stay at home or receive care locally rather than in hospitals.
  • Doctors, nurses, social workers and everyone providing care will work together in partnerships to help keep people healthy and prevent them going to hospital when that’s not necessary.
  • Everyone working in health and social care services will be supported in helping to make the changes set out in Transforming Your Care.


Isn’t this just all about cuts in our health and social care service?

No, TYC is about carefully managing a change in our health and social care service which although it has served us well in the past, is under increasing pressure due to an ageing population, and advances in technology and treatments.

We know that the present model won’t work in future.

So it isn’t about cutting the level of spending or investment in our health and social care services.

We spend £10m per day – it is not about how we can spend £9m or £8m but how we can spend £10m to have the greatest impact on all our patients and users. We want to ensure we are using our resources in the best way possible so that we can cope with future increased demand.


How long with it take? How much will it cost?

In 2013 we estimated that the implementation would take three to five years but this will be influenced by our financial circumstances.

We will be supported by transitional funding to support the implementation – this means that service changes can be put in place and our staff are supported to make the changes happen. There will inevitably be some dual running as services change, and there needs to be investment to ensure there is no adverse impact on existing services.

In the TYC report it was estimated that this would be £70 million over the transition period.  The NI Executive has supported this with funding in 2012/13 and 2013/14.

In the present climate this investment has slowed but the Health and Social Care Board has continued to invest in a wide range of projects to move forward with TYC and good progress is being made.



What does a ‘hospital network’ mean?

This is a term used to refer to a number of hospitals working together as one system. As treatments and technology become more advanced and specialised, not every hospital can deliver every service. Unless demand is at a certain level it is very hard for hospitals to attract and retain staff for these specialist services, and this can lead to a fragile service. But if the hospitals work together and share resources this reduces this risk significantly, and means we can deliver significantly better outcomes for patients.

In essence, the doctors and nurses work together as if they work in one hospital which is located in two or three sites. For patients, this means that sometimes you will travel to a hospital which is slightly further away so that you can access the specialist service, at other times you will be able to get specialist services at your local hospital because the staff from the bigger hospital can be used by other hospitals in the network.

We propose there would be five acute hospital networks – one each in the Belfast, Northern, Southern, South Eastern and Western areas.


What does Integrated Care Partnership mean?

The establishment of 17 Integrated Care Partnerships (ICPs) across Northern Ireland was one of the key Transforming Your Care proposals.

Integrated Care Partnerships include doctors, nurses, pharmacists, social workers, hospital specialists, other healthcare professionals and the voluntary and community sectors, as well as service users and carers.

ICPs enable those involved in providing care to work more closely together on a collaborative basis to improve efficient and effective service delivery and deliver better outcomes for patients.

To view news and information about out how ICPs are delivering real change visit http://www.transformingyourcare.hscni.net/integrated-care-partnerships/


Will my GP have to change?

No, the relationship you have with your GP will be unchanged by Transforming Your Care.

The Integrated Care Partnerships will support GPs and make it easier for you to access the rest of the health and social care services as everyone providing care will be more ‘joined up’ and working together.

This might mean that you can receive specialist nursing care arranged through your GP, or some diagnostic tests will be done at a GP surgery rather than at hospital.


Does this mean fewer nurses and doctors?

The implementation of Transforming Your Care will have an impact on our workforce, as you would expect with any major change. During the Review there was clearly a strong willingness to make change happen across our workforce, and we are committed to supporting our workforce. The detailed plans are yet to be worked out but we expect that due to the new way we provide services, some staff who currently work in hospitals would work in the community settings instead, and overall there will be a modest reduction (around 3%) in our workforce over the next three to five years.


What are you doing to support carers?

There is a strong recognition in Transforming Your Care of the need to support carers in Northern Ireland.

During the consultation process consultees told us that we need to provide more information, provide more support and ensure the needs of the carers are considered fully when designing services.

The Health and Social Care Board is committed to ensuring that this happens.

The former Minister for Health, Social Services and Public Safety, Edwin Poots,  said in his statement to the NI Assembly (19 March 2013) that targets have been developed and set for 2013-14 to monitor the number of carers identified; the number of assessments offered; and the number accepted.

In addition to this £500,000 has been invested to encourage innovation in the area of respite and short breaks for carers.

The Health and Social Care Board believes this is critical for the health and wellbeing of all patients, clients and carers and continues to support the development and roll out of important pieces of work, like Self Directed Support.


What does “reablement” mean?

Reablement is a person-centred approach which is about promoting and maximising independence, to allow people to remain in their own home as long as possible. It is designed to enable people to gain or regain their confidence, ability, and necessary skills to live independently, especially after having experienced a health or social care crisis, such as illness, a deterioration in health or injury.

The aim of Reablement is to help people perform their necessary daily living skills such as personal care, walking, and preparing meals, so that they can remain independent within their own home.


Proposals on statutory residential care homes for older people


What are the Trusts’ proposals about the future of Statutory Residential Care Homes?

The Health and Social Care Board (HSCB) confirmed on 19 May 2015, that the review of Statutory Residential Care Homes is still an ongoing process and no final decisions have yet been made about any Home.

The Trusts’ proposals, approved by the HSCB on 19 May 2015, now mean appropriate local consultation will be progressed by Trusts. The proposals outline that some Trust Statutory Residential Care Homes will be retained, some will be considered for alternative use and others are proposed for future closure.


Will permanent residents be allowed to remain in their home?  Will this be the case even if a home is proposed to close?

Yes. The Health and Social Care Board remains committed to the assurance given to current permanent residents by the former Minister, Edwin Poots that they can remain in their existing home for as long as they wish and their care needs can be met. No resident will be forced to move against their will whilst the home continues to be able to meet their health and social care needs.


What is the background to the review of Statutory Residential Care?

On 3 May 2013, the Health and Social Care Board (HSCB) was asked by the Minister for Health, Social Services and Public Safety (DHSSPS), Edwin Poots to develop a regional process, working closely with Trusts, for consulting, engaging and implementing Transforming Your Care in relation to statutory residential care homes.

A Regional Group was set up, made up of people from the Health and Social Care Board, Health and Social Care Trusts and the DHSSPS to take this work forward. The Group submitted its plan for a new process to the Minister which he approved on 16 August 2013.

The plan for the new process related specifically to the future of statutory residential care homes for frail elderly people. The intention was to help deliver better care for closer to home and to meet the needs of older people into the future, enabling them to remain as independent as possible. This goal is in keeping with the Transforming Your Care (TYC) policy and programme of change for older peoples’ services.

The revised plan from August 2013 proposed a two stage of consultation:

Stage 1: In the first stage of consultation, views on the proposed evaluation criteria were sought. This stage of consultation began on 29 November and ran for 14 weeks until 7 March 2014. It is now complete.

  • Using the agreed evaluation criteria, the Health and Social Care Board asked Trusts to develop proposals about future changes to their homes. Each Trust subsequently submitted their proposals for each home for consideration to their Local Commissioning Groups (LCGs).
  • The Trust proposals were considered by the Health and Social Care Board at a public Board Meeting on 19 May 2015.

Stage 2: The Trust proposals will still be subject to further local public consultation processes, and the recommendations made post-consultation will be reviewed by the Minister. This will be the second stage of consultation.


How were proposals quality assured and examined? What did the Board and LCGs contribute?

The Health and Social Care Board and the Local Commissioning Groups have examined the Trusts’ proposals regarding how the Trusts have applied the criteria and how decisions have been reached. This was to ensure regional consistency. The Local Commissioning Groups (LCGs) carried out their own local assessment of need and used this information to inform their consideration of the Trust proposals.

(LCGs are committees of the Health and Social Care Board and commission services to meet the needs of their local population.  Members include GPs, political representatives, voluntary sector representatives and health and social care professionals).


What statistical and other information was used to inform the local needs assessment and application of the criteria?

In the first stage of consultation, views on the proposed evaluation criteria were sought. This stage of consultation began on 29 November and ran for 14 weeks until 7 March 2014. The final evaluation criteria produced took account of feedback during the consultation process, and these were subsequently applied by Health and Social Care Trusts to inform proposals about future changes to their homes. These proposals were also informed by the needs assessment of older people’s services undertaken by each LCG. Three of the evaluation criteria were weighted and scored:

  • Quality of Care;
  • Care Trends; and
  • Best use of public money.

The criterion ‘Availability and Accessibility of Resources’ was evaluated through the application of the local needs assessments undertaken by LCGs.

The information examined under each of the above criteria and the detailed application of the evaluation process for each Trust can be viewed by accessing the relevant Trust’s document setting out their proposals for change to statutory residential homes for older people.  These are accessible on the Health and Social Care Board website at http://www.hscboard.hscni.net/board/meetings/May%202015/


Will the Health and Social Care Board and Local Commissioning Groups now simply approve the Trusts’ proposals?

The LCGs provided the Board with a view on Trusts’ proposals. The Health and Social Services Board reviewed the proposals to ensure that the agreed criteria were used appropriately and consistently, homes scored correctly, decisions fully tested and any eventual changes proposed were robust.

Proposals for changes to a Trust Statutory Residential Care Home were only permitted to progress to further consultation if the proposals met the agreed criteria and if Trusts are able to demonstrate that alternative services are in place, or if there are concrete plans about how alternative services will be put in place.


What is the Minister’s role? When will he approve the final proposals?

  • Trusts’ proposals have not been approved at this stage.
  • The Health and Social Care Board has approved (on 9 May 2015) the proposals for local consultation.
  • Trusts must now proceed with local consultation on their proposals.
  • Only following the outcome of a further local consultation process will the final proposals be submitted to the Health and Social Care Board and Minister for consideration.


What’s happening next?

  • The Health and Social Care Board (HSCB) approved Trusts’ proposals for consultation on 19 May 2015.
  • Trust consultation to commence on proposals (subject to internal Trust approval of consultation document and sharing of same with HSCB and Department of Health, Social Services and Public Safety.
  • Trusts will consult locally on their proposals in summer 2015. This consultation process will take a period of approximately 3 months
  • Trusts will analyse results of consultation and develop their recommendations in the form of a post-consultation report.
  • Trust post-consultation report to be submitted to the Health and Social Care Board and Department of Health, Social Services and Public Safety for consideration. Implementation will be subject to approval and resolution of any HSCB/DHSSPS issues.
  • Subject to consultation commencing in the summer of 2015, Trusts’ post- consultation reports will be published by the end of 2015.
  • Trusts will begin to transition to the changes in their published plans from 2016 onwards.


How many statutory residential care homes are closing? No approval for any home closure has been approved.

Trusts’ proposals for their homes were approved by the Health and Social Board on

19 May 2015 for further public consultation. A post consultation report on final proposals will be submitted to the Health and Social Care Board later and the Minister for consideration.


Are all homes included in this process?

There are currently 19 statutory residential care homes across Northern Ireland which provide care for the frail elderly which are involved in this process.

Homes where previous consultation was completed, prior to the Minister’s statement on 3 May 2013, were not included in this process. Nevertheless, the Health and Social Care Board have already reviewed these processes to provide assurance to the Minister prior to any changes taking place.


Will residents and their families be consulted about future changes?

Yes. Residents and their families have been an integral part of the Stage One consultation process and will continue to be involved throughout the Stage Two of the Trusts’ local consultation process and in any final decisions.

The Health and Social Care Board and Trusts are committed to ensuring that all residents and families are treated sensitively and with respect and that any transition is managed carefully with their full involvement.


Will you consult and engage with staff?

Yes, staff are valued and respected and will be kept informed at every stage of the process including the local consultation outcomes that could affect their position.


What about the non-admission positions imposed by some Trusts?

Trust proposals also include changes associated with the admissions positions. Any change to admissions positions will be subject to further local consultation, along with all the other proposals for change.  Until the recommendations arising from the local consultation being undertaken by Trusts on the proposals for change are approved, the current admissions positions will remain.


In what circumstances would a home close?

Closure could only take place if there were no permanent residents in the home and the Trust does not identify any potential alternative use for it.


What if I get regular respite in a home that the Trust decides to close?

There will be no immediate change to this because homes will not close immediately and any change would happen in a planned manner. Where, following local consultation, a home is identified for closure, alternative sources of respite, including access to flexible ‘short breaks’, would be discussed with you well in advance of any change being made.


Will the remaining homes have a long term future? What if I want to move to another home now?

By applying the criteria and developing their proposals, Trusts have now identified the homes that are needed to meet the needs of older people in the immediate future. However, needs will continue to change and the health and social care system has a responsibility to plan for and respond to changing needs and demands.

If you wish to move to another home, the Trust will discuss this option with you and help you consider alternative homes. The Trust will also support you in the process of moving if that is what you decide to do.


If I decide to move to a private home, will I have to pay more?

Trusts have guaranteed that if you move from one residential placement to another you will not be required to make any additional payment. However, if you choose to pay for additional services in the new home you can make your own arrangements to do so.


Are the changes simply about saving money?

No. Although making best use of public funds is an important consideration, changes to statutory residential care are not about saving money; rather they are about making sure that services for older people are fit for the future and that older people have access to a range of services that support their independence and offer a better quality of life.


Why was change needed at all?

We must ensure that services are available that can support the growing numbers of older people, both now and in the future, within their own home as far as possible as set out in Transforming Your Care.

Alternative services already in place (as listed below) and have had a positive impact in improving independence, leading to a better quality of life for older people.


What is a Statutory Residential Care Home?

Residential care homes provide a service for those who need help with personal care due to old age, illness and/or infirmity, or disablement.  A person may be in residential care if they can no longer manage in their own home. Services provided in residential care include meals and accommodation, help with personal care tasks such as bathing and dressing, physical and emotional care, and care through a short illness with staff available 24 hours.

Statutory residential care homes are owned by Health and Social Care Trusts, however, the majority of residential beds are provided by homes in the Private Sector – which are not affected by these proposals.


Residential care homes are different from nursing homes.


What is a Nursing Home? Are they included?

Nursing homes are homes where residents require full time nursing care or support, or have a specific disability or medical need, for example those with complex medical needs e.g. stroke. An individual will be in a nursing home if they need nursing care on a frequent basis.  Nursing homes will have qualified nursing staff available 24 hours a day.

There are no proposals regarding any nursing homes.


In future, what range of services will be available for older people?

There are a range of services available now for older people and we are investing to improve the range and choice in the future;

  • Residential Care – will continue to be available for those who wish to avail of it after a needs assessment is carried out by health and social care professionals and it is agreed that it is the best option for the individual. The majority of residential care in Northern Ireland is currently provided by the private sector across the region.
  • Supported Living accommodation or ‘housing with care’ – people who live in supported living schemes have their own self-contained homes with a lounge, kitchen, bedroom(s) and bathroom and care staff are available on the majority of sites 24 hours a day, 7 days a week. There are also communal facilities and activities available for those residents who like to socialise. The accommodation allows couples to remain together and allows families to visit and stay. Substantial progress has been made in recent years in developing supported living facilities for older people in conjunction with the Social Housing Development Programme led by the Department for Social Development. Further projects are at an advanced stage of planning which represent a substantial increase in accommodation options.
  • Re-ablement services – provide a short period of intense help and support to help people build up the confidence and skills to do things for themselves after a period of ill health in their own home.
  • Self-directed support – gives people greater control over the services they receive by use of personalised budgets and increased use of cash direct payments, changing the way care is delivered.
  • Assistive technology – increased access to assistive technology and widening the access of this technology to older people to support them living at home. Many people are now familiar with ‘care alarms’, either worn by the individual or activated by a button somewhere in the person’s home. They are used by people who are living alone. Other devices include: falls detectors, low and high temperature sensors, movement sensors and carer pager alerts.
  • Domiciliary care packages – people will receive the care and support they need in their own homes to live independently in the community for as long as possible.
  • Promoting health and wellbeing of older people and prevention of ill-health – the ‘shift left’ agenda is about promoting good health and healthy ageing and preventing some of the conditions people experience in later life.
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