No More Silos

No More Silos is the Department of Health’s action plan to support and maintain urgent and emergency care services, making changes to existing services and introducing new ones to ensure that patients can access the right care, in the right place, and at the right time.

In October 2020, the Minister of Health published an urgent and emergency care action plan called ‘No More Silos’. This sought to maintain and improve urgent and emergency care services through the COVID-19 pandemic and beyond.

Even before the pandemic, there was clear evidence that our urgent and emergency care services were under increasing pressure. Growing numbers of people were experiencing long waits in overcrowded Emergency Departments (EDs), while other urgent care services were also experiencing significant pressure.

The impact of COVID-19 and the accompanying focus on infection prevention and social distancing demanded that immediate steps should be taken to ensure that services could respond to the many challenges presented by COVID-19 as well as address the issues faced by emergency and urgent care generally.

The No More Silos Network brings together clinicians from primary and secondary care, service users, policy makers and commissioners, and has created 10 key actions;

1. Introduce Urgent Care Centres
2. Keep Emergency Departments for Emergencies
3. Rapid Access Assessment and Treatment Services
4. 24/7 Telephone Clinical Assessment Service – ‘Phone First’
5. Scheduling Unscheduled Care
6. Regional Anticipatory Care Model
7. Acute Care at Home
8. Ambulance Arrival and Handover Zones
9. Enhanced Framework for Clinical and Medical Input to Care Homes
10. Timely Discharge from Hospital

It also established Local Implementation Groups that have played a key role in developing the roadmap for the implementation of the 10 key actions in our Western Trust area. A combination of regional planning and locally led implementation has been a key factor in the progress that has been made since Health Minister Robin Swann announced No More Silos in October 2020.

A range of services such as the development of Hospital at Home and enhanced support in care homes will help to ensure that patients can be treated in the community wherever possible, creating extra capacity in Emergency Departments.

Direct access pathways and Rapid Access Services are also being developed to enable patients to be referred directly into key specialties, bypassing the traditional route through ED.

No More Silos is also seeking to identify a range of measures which improve capacity and flow through hospitals. This includes measures to reduce ambulance turnaround times, and facilitate timely discharge from hospital through measures such as enhanced community rehab, domiciliary care and support for patients in care homes.

‘Phone First’ is a regional clinical triage service for patients who are unwell but not suffering from life-threatening illness, and are considering travelling to ED. This has been operational across the Western Trust since January 2021, and will soon be available across the region using the same regional three-digit number.

Early indications suggest that the Phone First service has been welcomed by service users and enables many patients to be directed more effectively to the care they require. This helps to avoid lengthy waits at ED and reduces the risk of transmission of Covid-19 infection.

No More Silos is also seeking introduce measures to reduce ambulance turnaround times, and facilitate timely discharge from hospital through measures such as enhanced community rehab, domiciliary care and support for patients in care homes.

‘No More Silos’ is about everyone working together, breaking down traditional barriers and ways of working for the benefit of the patient and service user. ‘No More Silos’ is implementing changes to ensure that urgent and emergency care services across primary (GPs) and secondary care (hospitals) can be maintained and improved in an environment that is safe for patients and staff into the future.