The Modernisation of Domiciliary Care in SEHSCT by Ecosystem Mapping

In the South East Health & Social Care Trust (SEHSCT), like other healthcare regions across the UK, Domiciliary Care services are under acute pressure with high demand and limited capacity. This has an impact on both service-users and staff working within Domiciliary Care, but also has significant consequences for other healthcare pathways, which rely on Domiciliary Care capacity to help individuals in their own homes, ensure time-efficient discharge from hospital etc. Looking to the future, the challenges facing SEHSCT’s Domiciliary Care services will continue to grow. Northern Ireland Statistics and Research Agency (NISRA) projections estimate that between mid-2018 and mid-2043, the population aged 65 and over will increase by over 50% and the population aged 85 and over will increase by over 100%. Various reviews have made strategic recommendations that will shape future Domiciliary Care Services. The Department of Health’s 2022 Consultation on The Reform Of Adult Social Care sets out a vision for the future of adult social care services, at the centre of this is: ‘an evidence based, whole systems approach to the design and delivery of adult social care in co-production with service users and carers’. Against the back-drop of these pressures, the shifting policy landscape and the anticipated growing demand for Domiciliary Care, the project aimed to bring the many stakeholders involved in supporting, co-ordinating and delivering Domiciliary Care in the SEHSCT together to map the Trust’s current ecosystem of Domiciliary Care. For the purposes of this project, ecosystem mapping can be considered to be the development of a high-level visual representation of the key pathways that make up Domiciliary Care in the SEHSCT, the stages in these pathways, connections with other services and a representation of the journey of service-users through the system. The project has developed this shared visual representation through a series of 4 online workshops involving over 75 participants from across the Domiciliary Care Service in the SEHSCT. Stakeholders represented service users and carers, community and voluntary organisations, acute and community services, primary care teams, NIAS, health service planning, finance, HR, governance and quality teams and commissioners. The evolving ecosystem map has then be used as a catalyst for reviewing the current Domiciliary Care provision in SEHSCT from a number of perspectives, co-producing suggestions for improvement with stakeholders. This report provides summaries of these discussions. These have been mapped onto the Domiciliary Care Ecosystem visualisation and describe: • What should SEHSCT’s definition and aims be for Domiciliary Care? • What the are current Domiciliary Care challenges? • What Domiciliary Care data might be useful? • What are the opportunities for Domiciliary Care improvement? • What might a 2030 Domiciliary Care ecosystem look like for SEHSCT. This work has provided shared understanding of Domiciliary Care in SEHSCT that has informed and prioritised the strategic improvements work ongoing across the Trust with a vision for a modernised service for 2030.