At least half of state-run residential care homes in Northern Ireland are to close under a proposed £70 million overhaul of the health service.
The move would see around 28 of the current 56 facilities shut their doors within five years, with at least 750 places being lost as a consequence.
Health Minister Edwin Poots insisted the proposal was not motivated by cost but instead part of his wider Transforming Your Care (TYC) reform agenda aimed at changing how care is delivered, with more emphasis on enabling older people to remain at home in their later years.
State-run residential homes account for around a quarter of the sector and privately-owned facilities would not be directly impacted by the proposal. Nor will homes that provide nursing care.
Outlining further details of the streamlining TYC blueprint, the minister also confirmed there would be job losses in the NHS.
Around 1,600 healthcare jobs (3% of the workforce) are set to go in the next five years.
Mr Poots said he expected these to be managed without the need for compulsory redundancies.
The proposals were among a series outlined by Mr Poots to the Assembly as he provided more details on what TYC will potentially entail.
Another proposal was the creation of six mental health in-patient units at hospitals across Northern Ireland, with existing dedicated facilities closing.
Part of the rationale behind the plan is to eliminate the stigma patients may encounter by attending a site exclusively associated with psychiatric care.
The TYC plan envisages a reconfiguration of acute service provision in Northern Ireland with hospitals working together in five regional networks, each serving a population of around 400,000.
Mr Poots told MLAs this would have consequences for the Causeway hospital in Coleraine.
The proposals will explore whether the Causeway’s network links should be strengthened with the Antrim hospital in the east or with Altnagelvin to the west. One proposal would see management shift from the Northern Trust to the Western Trust.
The minister, who first announced the major NHS shake-up last year, has now asked the public to give their feedback on a range of proposals put forward.
“The proposals in Transforming Your Care present a vision of a new model of care which is focused on ensuring that more services are provided in the community, closer to people’s homes where possible,” he said.
“It is about prevention, earlier interventions, promoting health and wellbeing and having more personalised care that is planned and delivered around the needs of the individual, and tailored as far as possible to suit them.
“We have a growing and ageing population. The treatment and care of citizens is also changing. We have increasingly specialised services with technology driving many improvements in the design and delivery of care.
“Changing how our services are provided is inevitable. I want to ensure that change is planned and managed.”
He added: “It is incumbent on all of us to ensure that the resources allocated to health and social care services are used in the best way for the benefit of all citizens.”
The TYC proposals also include:
::The creation of 17 Integrated Care Partnerships, incorporating the region’s 355 GP practices along with primary care professionals from hospitals and other health trust workers;
:: This added focus on care away from a hospital setting is anticipated to see the number of beds provided across the region’s hospitals reduced by 180;
:: The resettlement of long-term residents living in learning disability hospitals at Muckamore, Co Antrim and Longstone, Co Armagh;
:: The provision of specialist cardiac services at two centres in Belfast and Londonderry;
:: The adoption of a full seven-day week working rota within hospitals, ensuring there is no reduction in service at weekends;
:: A formalised relationship with health authorities in the Republic of Ireland to ensure a joined up approach to the care of particularly border residents;
:: Improving access to respite services for carers.
The public consultation exercise will run until January, and Mr Poots said it was vital that as many people as possible take the opportunity to have their views heard.
“This consultation exercise seeks your views - as patients, clients, service users, service providers and citizens,” he said.
“We will aim to ensure that everyone is informed and involved in this process.
“There will be a series of public engagement events and I have agreed that an information leaflet should be provided for every household to advise on how to get involved in the consultation process.
“I would therefore encourage you to engage with this important consultation, let us know your views and be part of the delivery of change. We have a real opportunity now, one that doesn’t come along too often, to reshape our system.”