Dáil Éireann Debate, Tuesday - 23 January 2024
583. Deputy Fergus O'Dowd asked the Minister for Health to provide on update on the Programme for Government commitment on the target of community services assigning a case manager for older people with chronic conditions to assist them with accessing the care they need, since the establishment of the Government; and if he will make a statement on the matter. [2474/24]
View answerIn line with Sláintecare priorities, the Enhanced Community Care Programme (ECC) objective is to deliver increased levels of health care with service delivery reoriented towards general practice, primary care, and community-based services. The focus is on implementing end-to-end care pathways that will care for people at home and over time prevent referrals and admissions to acute hospitals where it is safe and appropriate to do so.
ECC funding will support the ambitious, programmatic, and integrated approach to the development of the primary and community care sector which, amongst other initiatives, includes the development of primary care teams within 96 Community Healthcare Networks across the country, alongside 30 Community Specialist Teams for Older People, 30 Community Specialist Teams for Chronic Disease, and national coverage for community intervention teams.
To date, 96 Community Health Networks have been established, 24 Community Specialist Teams for older people, and 24 Community Specialist Teams for chronic disease.
Further ECC teams will be implemented in early 2024, with the focus for the Programme this year being on consolidating the progress made to date, increasing productivity and outputs to maximise impact from the existing level of resources.
Community Healthcare Networks
Through the implementation of the ECC Programme, 96 Community Healthcare Networks (CHNs) have been established, with each serving a population of on average 50,000. Each CHN is comprised of a multi-disciplinary team and provides the foundation and organisation structure through which integrated care is delivered locally at the appropriate level of complexity. This new approach will improve integrated team working between GPs, Health and Social Care Professionals, and nursing and other staff working in primary care services, moving towards more integrated end-to-end care pathways for individuals, especially older persons and those with complex and chronic conditions. Multidisciplinary Clinical Team Meetings now take place on a scheduled basis to support this approach.
Community Specialist Teams (Hubs)
The work that has been undertaken by the Integrated Care Programme for Older People (ICPOP) and Chronic Disease over recent years has shown that improved outcomes can be achieved particularly for older people who are frail, and those with chronic disease, through a model of care that allows the specialist multidisciplinary team engage and interact with services at CHN level, in their diagnosis and on-going care.
With the support of the Department of Health and Sláintecare, these models are now being implemented at scale by the HSE, with the establishment and full rollout of Community Specialist Teams for Older People and Community Specialist Teams for Chronic Disease to support CHNs and GPs to respond to the specialist needs of these cohorts of the population, bridging and linking the care pathways between acute and community services with a view to improving access to and egress from acute hospital services.
These Community Specialist Teams will service a population on average of 150,000, equating on average to 3 CHNs. Ideally, the teams will be co-located together in ‘hubs’ located in or adjacent to Primary Care Centres, reflecting a shift in focus away from the acute hospital towards general practice, and a primary care and community-based service model.
With regard to case managers for older people with chronic conditions to assist them with accessing the care they need, the HSE recognises the importance of embedding the multi-disciplinary Clinical Team Meetings as previously referenced. To ensure that these meetings are optimised and deliver a coordinated approach to individual clients, the roles of Clinical Coordinator and Key Workers have been created within the CHNs.
The Clinical Coordinator is a member of the multidisciplinary team, at senior therapy or nursing grade, and is central to the organisation and coordination of Clinical Team Meetings. A Key Worker may be identified for service users with complex needs and is also a member of the multidisciplinary team. The role of Key Worker is to assist in coordinating the delivery of services to the individual, while acting as a single point of contact and enhancing the experiences and outcomes for individuals.
The importance of the Clinical Coordinator and Key Worker roles are recognised within the ECC resource allocation, and a total of 3 WTE resources have been allocated to each CHN to allow protected time to carry out these essential functions.
Older adults with complex care needs who require the input of the Community Specialist Teams for Older People also require a proactive care coordination approach for their episodes of specialist care. As well as undertaking comprehensive assessment, MDT members will act as key workers until outcomes are optimised. This includes working collaboratively with other care providers across primary and secondary care to agree on how the older person’s care needs are to be met, in line with their will and preference, and ensuring seamless transitions back to the CHN team at the completion of the episode of specialist input.
584. Deputy Fergus O'Dowd asked the Minister for Health to provide on update on the Programme for Government commitment on the development of the role of advanced nurse practitioners in older person services and chronic disease management, since the establishment of the Government; and if he will make a statement on the matter. [2475/24]
View answerI am pleased to provide the Deputy with an update on the Programme for Government commitment to develop the role of advanced nurse practitioners in older person services and chronic disease management. In November 2021, I increased the target of the number of nurses and midwives practicing at an advanced level across the health service from 2% of the total nursing and midwifery workforce to 3%. I am pleased to note that , as of November 2023, the total number of nurses and midwives at advanced practice level was 1,087 WTE, which is just over 2.3% of the nursing and midwifery workforce.
Advanced Nurse / Midwife Practitioners (ANMPs) provide complete episodes of care and timely access to healthcare and earlier interventions. Creating a critical mass of ANMPs will contribute effectively and efficiently to addressing population health needs and has demonstrated improved patient experience, reduced waiting times and reduced admissions to hospitals. ANMPs contribute to service reform by providing the right care, at the right time, and in the right place.
This Government has invested heavily in Advanced Practice for Nurses and Midwives, particularly since the publication of the Policy on the Development of Graduate to Advanced Nursing and Midwifery Practice for Nurses and Midwives (Department of Health, 2019). The role of ANMPs and the allocation of ANMPs across the various service areas is aligned with policy priorities. This includes older persons services and chronic disease management.
In 2020, 52 new ANMP posts were created. Of these, 12 were allocated to older persons services and a further 16 to chronic disease management.
In 2022, I allocated €11m to the HSE to recruit 149 ANMPs, 15 of which were allocated to Integrated Care Programme for Older Persons and 12 were allocated to chronic disease management.
In 2023, I announced the creation of a further 80 ANMP posts. 10 of these posts were allocated to older persons and 27 were allocated to chronic disease management. The table below sets out the total number of new ANP posts allocated to Older Persons Services and Chronic Disease Management since 2020.
New ANP posts since 2020 for Older Persons Services and Chronic Disease Management
|
Older Persons Services |
Chronic Disease Management |
|
|
2020 |
12 |
16 |
|
2022 |
15 + 1 post ED post in CUH Trauma Older Persons |
12 |
|
2023 |
10 |
27 |
|
Total |
38 |
55 |
The HSE have advised that within the older persons service, there are currently 148 ANP posts; and in chronic disease management there are currently 78 ANP posts. These numbers will be added to when the 37 allocated posts for 2023 have all been filled.
