This paper outlines the need for developing a new training model for Integrated Care Medical Consultants in rural Northern Ireland, how the model was developed in collaboration with key stakeholders in the community using ECHO methodology, the implementation of the Integrated Care Fellowship scheme and the potential that this model offers for other rural areas where there are medical workforce challenges.

Across the world sustaining a medical workforce in rural areas is a challenge. Existing training schemes tend to be based around major population areas and it is often hard to attract consultants to rural areas. In addition, existing training schemes may not be geared to the particular needs of a rural population, and recent changes in the training programmes of both Care of the Elderly and Palliative Care Doctors in the UK has been implicated for a fall off in numbers seeking such training.

Through the Pathfinder project key stakeholders across the Western Trust used the ECHO methodology to identify the key priorities that the community living in rural Tyrone and Fermanagh wanted from a health service in relation to the elderly, frail and those needing palliative care services. The findings can be summarised as wanting more integrated and locally connected services.

To respond to this and the demographic need of rapidly increasing numbers of elderly and frail people in the population we created an Integrated Care Fellowship training scheme combining the Care of the Elderly Curriculum with that of the Palliative Care Curriculum. The four year fellowship seeks to create a robust consultant workforce equipped with the skills and knowledge to lead the development of a more integrated way of working across the geography and in collaboration with existing assets and supports from both the statutory and voluntary sector to better deliver the care of the future that people in rural areas want.

Support for the programme has been demonstrated by the Western Trust, the numbers of applicants for the programme, the quality of those candidates and by existing traditional training scheme leaders.

Norfolk Initiative for Coastal and Rural Health Equalities (NICHE) is an ‘Anchor Institute’, at the University of East Anglia, which aims to co-create a healthy place to live and work, underpinned by collaborative and innovative approach to research, education, and evaluation, maximising sustainable initiatives for Integrated Care System (ICS) workforce and system level transformation. National strategic direction for health and social care aims to develop an integrated whole systems approach to position people and communities and what matters to them at the heart of care providing services that are person and people centred, compassionate, safe, and effective using targeted resources (including the workforce) effectively across place-based systems (NHS 2016,2019a/b, 2020). There is an urgent need to draw on the strengths of the whole workforce and the full potential of our communities to contribute to people working together effectively to achieve a common purpose, as well as focussing on what matters to people and communities and how it is evaluated through co-production and leadership (Best et al; 2012; Stromgren et al; 2017).
NICHE works across a geography of coastal, rural and isolated communities, seeking to engage and co-create embedded activity for those who live and work across our locality, coproducing outcomes relevant to local, national and international communities.
Central to our shared governance approach is effectively engaging with patients, people and partners across health and social care.
NICHE is a co-ordinated approach to embedded programmes of activity working in collaboration with system partners across the Norfolk and Waveney ICS aimed at delivering maximum, sustainable impact for workforce and system transformation focused around four core work streams of activity. Evaluation is integral to all our work, capturing what works, for whom and how through mixed and creative methodologies.
NICHE draws upon key principles of Collaboration, Inclusion and Participation. Through working alongside and with communities, government, and industry partners, our programmes and funded research and evaluation activity offers improvements to the economic, health and social sustainability agendas, all of which form part of our Anchor Institute status. Our programmes are in their early phases of development, the following aspects are emerging:
a) Caring for the workforce, through addressing their wellbeing is a central aspect of health and social care workforce sustainability
b) Health and care system requires new and flexible roles, and the importance of 'live' effective supervision plays a significant role in retaining staff across the ICS.
c) Creative arts engagement, heritage sites and inclusion of historical aspects of the locality context are important and often overlooked assets when working in rural, coastal and isolated communities.
d) Coproduced, embedded packages as bespoke programmes of work, facilitated effectively to enhance and release talent and promote local expertise are highly effective strategies for cultural transformation across coastal and rural communities.
e) Cultural transformation cannot be rushed as new language, partnerships and interactions are formed.
When working with coastal, rural and isolated communities it is imperative to engage local partners, to ascertain cultural contextual wisdom to initiate and sustain change for good.

Short Summary:

Ireland, like other prosperous nations, has an ageing population who predominantly want to age well at home. However, home support services are struggling to recruit and retain home support workers. This scoping review of the international research literature drew together evidence and best practice to develop proposals for a comprehensive career pathway encompassing career structures, training and workforce development.

The Issue/Challenge:

Globally, healthcare systems are undergoing transformation, with a notable transition away from traditional institutions towards provision of integrated care and support in home settings. The challenges of delivering safe and sustainable models of home-based care and support are an international concern, particularly in relation to building workforce capacity and capabilities. In many nations, home support workers have historically lacked entitlements, access to training, and opportunities for career progression, resulting in high turnover, recruitment and retention challenges. In Ireland, these challenges have led to a mounting 'waiting list lottery' affecting over 6,000 vulnerable and elderly individuals.

Aims and objectives:

The aim was to produce recommendations for a career pathway for support workers in home care in Ireland based on the international research evidence. The research question was:

“What is the evidence to inform the development of a career pathway for home support workers in Ireland?”

Target Audience:

This research is likely to be of interest to an international audience of health policymakers, commissioners of home support services, home support service providers, educators and training providers, as well as home support workers, clients and family caregivers.

Stakeholders and their Contribution to this Research:

National stakeholder consultations on the Green Paper include policymakers, service organisations, researchers, digital health/AI specialists, and voluntary organisations.

Initiative/Intervention:

A scoping review following Joanna Briggs Institute methodology was performed using structured searches of electronic databases (Web of Science, PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, Social Care Online, and Social Sciences Citation Index) and grey literature (Sept-Nov 2023). Inclusion criteria and methods/relevance grading were applied. Data were analysed thematically and interpreted using a “what, works for whom, when and why” framing.

Results and Impact:

The 261 included articles highlight the global significance of the issues. Four overarching themes were identified: 1. Attract and develop a competent and motivated workforce, 2. Enhance working lives and retention, 3. Utilise career pathways for quality and impact, 4. Invest in data and digital for integrated home care and support. Drawing from the evidence, a Green Paper was developed outlining proposals and actions for change. The impact so far is to raise awareness of the challenges and create a shared vision for collaborative action.

Learning for an International Audience:

A career pathway for home support workers is essential for growing workforce capacity and skills, improving working lives and retention, and achieving the policy goal of providing home support for aging populations.

Next steps:

Advancing the Irish home support sector based on the proposals, necessitates collaborative action by policymakers, commissioners, employers, regulators, education and training organisations as well as the involvement of home support workers in plans for change.

Funder:

Leading Healthcare Providers Skillnet

Background: In Canada, most paid home care is provided by an unregulated workforce of personal support (PS) providers. Given their frequent and consistent interactions with clients, PS providers are well-positioned to identify unaddressed client needs; however little infrastructure exists to communicate these observations with the broader home care team. To support deeper integration of PS providers and their contributions into home care teams, the Observe, Coach, Assist and Report (OCAR) Framework was collaboratively developed in 2015 with point-of care clinicians and practice leaders. Following development, the OCAR Framework was adopted to guide PS practice at a large Canadian homecare agency, but little is known about how OCAR is used in care planning and decision-making at micro, meso, and macro levels.

Aims: Since development of the OCAR Framework, the Canadian home care landscape has changed substantially, with the COVID-19 pandemic impacting service volumes, the types of services required; and health human resources, making workforce optimization using OCAR a high priority. The aim of this project was to assess the ongoing relevance and current use of the OCAR framework and identify opportunities for enhanced use both within and outside early adopter organizations.

Methods: A cross-sectional approach was taken, using a web-based self-report survey of point-of-care leadership, clinical management, and practice and operations support (education, training, advance practice leaders) staff at SE Health. A proportional quota sampling strategy was employed, recruiting ~30% of eligible staff from each perspective. Participants were asked about the relevance of the OCAR Framework for daily practice; how frequently they used it for various care tasks (e.g., communicating client care needs); and to identify and rate importance of potential opportunities to improve its use (e.g., knowledge about PS provider roles) and helpful integration resources.

Results: Survey respondents (n=99) overwhelmingly (81-95%) felt the OCAR Framework was often or almost always relevant to daily practice in the PS provider program. Notable findings include 81% of point-of-care staff report using OCAR regularly with client care documentation; 67% of clinical management often or almost always use OCAR when developing care plans; and 47% of practice and operation support staff often or almost always use OCAR when orienting new hires. Participants felt opportunities to improve SE Health’s use of OCAR were important to support consistency in client care across providers, improve role clarity (i.e., with both clients and staff), and ensure relevant, actionable information is available for providers.

Learnings: Without regulation guiding practice standards, organizations are left to set education, training, and documentation requirements, in addition to outlining role and task descriptions. Variability in these professional practice requirements can create role confusion and barriers to integrated care. The OCAR Framework is a practical, relevant, and frequently used integration resource for home care providers, managers, and support staff within this homecare organization. Future planned work aims to expand the use of the OCAR Framework in Canada and beyond by co-designing an implementation toolkit to support delivery of integrated care by leveraging clinical contributions, improving communication, and integrating this important workforce into the home care team.

Introduction:
Older adults living with stroke and other comorbidities often experience care transitions across multiple health sectors. Multiple transitions jeopardize safe patient care. Managing stroke in addition to other comorbidities requires the expertise of multiple health and social care providers. Implementing best practices for integrated stroke care is critical to ensuring patients receive quality care to support full community reintegration. Interprofessional stroke-specific teams are required to deliver the specialized care required. Our team has developed a unique simulation that focuses on enhancing competencies for interprofessional integrated stroke care to support care quality and patient safety.
Description:
Guided by the INACSL Standards of Best Practice for simulation development,researchers and expert stroke clinicians co-designed the simulation scenario. Learning
objectives were informed by experiential and reflective learning theories, and theCanadian Patient Safety Institute (CPSI) Safety Competencies. Multiple types of
fidelity (e.g., physical environment, conceptual, psychological) were incorporated tocreate a realistic case scenario representing current best practices for stroke and care
transitions. The simulation is intentionally focused on managing an older stroke survivor’s complex trajectory through two formal integrated care transitions from hospital to home in the community.
The simulation incorporates concepts related to current system-level changes andexisting integrated models of stroke care in Ontario, Canada. Integrated care models are
people-centered approaches to address fragmented care systems to improve quality of care, through the coordination of people’s care needs across services, providers, and
settings. The simulation promotes active learning, problem-solving, and critical thinking skills. The content incorporates Canadian Best Practices for Stroke Care, CPSI Safety Competencies for Health Professionals, the International Foundation of Integrated Care Pillars, and the Model for Improvement quality framework.
Discussion:
This novel open-access simulation consists of two video-recorded scenes featuring an interprofessional integrated approach to stroke care across two care transitions from 1)
acute care to a rehabilitation hospital, and 2) a rehabilitation hospital back to the patient’s home in the community. The simulation profiles the specific knowledge and skills of the interprofessional team members’ roles for stroke care. Further, the simulation intentionally highlights how the patient is actively engaged as a member of the interprofessional integrated stroke team. The video simulation provides an opportunity for use in the context of undergraduate/graduate courses with further uptake that can be considered in practice contexts such as stroke rehabilitation programs to enhance safe, quality integrated care transitions. Results from the in-class evaluation of the video simulation focusing on the student experiences of the debrief discussion will be presented.
Next steps: We aim to engage clinicians in additional practice partner agencies from the hospital and community sector to support workforce capacity for integrated stroke care.

Given the ongoing workforce constraints across health and social care, this session will outline how one area in Wales developed an approach to ‘integration’ that allowed a ‘shared goal’ which contributed to optimising the capacity and capability of the community-based workforce. It will also describe how this learning contributes to development and delivery of an Integrated Community Care System for Wales.