What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Domiciliary care is under pressure with high demand and limited capacity.  Future projections considering the ageing demographic and workforce crisis highlight the importance of evidenced based commissioning. The delay due to lack of domiciliary care availability has been identified as a contributing factor to poor hospital flow and ED pressure.

By conducting an Eco System Mapping exercise we have visualised and articulated the complexity of delivering care with multiple internal and external stakeholders in community and acute settings.

A strategic plan has been devised with opportunity for improvement initiatives and is part of SEHSCT corporate improvement priorities. The map highlights the suite of change initiatives including longer-term service redesign.

This project will focus on a number of changes including QI leadership embedded within the team to action the initial change projects such as developing a service user panel, a dom. care system professional guide and expansion of technology enabled services.

What does your project aim to achieve?

SEHSCT have developed a Quality Management Approach to care as part of their Quality 4 All Strategy. This approach has been taken in the Dom. Care modernisation and has involved a multidisciplinary team from planning, performance, governance, medicine, service delivery teams and service users to apply QMS to the improvement plan.

The primary aim of this project is to deliver maximum for available resources ensuring the right high quality support is provided for those with care needs to enable independent living.

Secondary aims include:

• Valuing and supporting the workforce
• Reducing Variation across geographical locations
• Enhancing digitalisation
• Creating a Transparent and accessible service.

The improvement impact will be evaluated using the SEHSCT Q4ALL framework including focus on health inequalities and service user outcomes.

How will the project be delivered?

Dom Care Evaluation Matrix

As a SEHSCT Strategic Improvement Priority this exploration of Domiciliary Care has been extensive. Working with a system designer and focusing on service user and stakeholder experiences there has been a systematic understanding of the current process and future opportunity. An evaluation matrix was developed to weight the feasibility and impact of each improvement idea.

This project is supported by the SEHSCT Quality Improvement team and has senior sponsorship at Trust Board Level. The governance and impact evaluation of this initiative is embedded in this work with a clear aim and measurement plan for each of the QI initiatives.

The work will be conducted by a Dom. Care steering group with a project lead embedded in the team with protected time to bring the energy and focus to the various initiatives within the strategic plan. Service users and carers will be foundational to this group.

How is your project going to share learning?

As a SEHSCT corporate priority this work is reported monthly to the Trust Board and is being used a live test example of a QMS approach to organisational wide quality improvement.

The Domiciliary Care project is part of the Regional HSCQI Timely Access Collaborative and the learning from this work is being shared across the region, for service learning and also learning across settings.

A review of Adult Social Care is currently being undertaken in Northern Ireland and this Quality Approach is being used to shape the review.

This work will be shared through SEHSCT organisational links with Health Improvement Alliance Europe Network and it is hoped to share across Q Community as the work progresses.