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Case Study – Northern Ireland Southern Health and Social Care Trust

New Community Navigator role aims to help older people in Northern Ireland to improve health and wellbeing due to the increased ageing population

Northern Ireland’s Southern Health and Social Care Trust (SHSCT) has created a Community Navigator role which aims to support older people in maintaining and improving
their health and wellbeing. After a successful pilot, the Trust worked with Skills for Health’s role development specialists to further develop the Level 3 role, which is now ready to implement when funding becomes available.

In common with the whole of Northern Ireland, the population of older people in the Southern Health and Social Care Trust (SHSCT) area is increasing. Over-65s are projected to increase by more than 15% by 2021, placing more strain on services which are already under pressure.

Early intervention and the promotion of health and wellbeing are vital in supporting older people and enabling them to live independently at home and in the community. The Trust planned to develop a Community Navigator Service which will work in partnership with the community and voluntary organisations to support older people in accessing the services that they need.

“The Community Navigator role should support other services in the community and improve communication between different areas. Sometimes we work in isolation so we hope this initiative will bring different services together to deliver improved integrated care solutions.”

Heather Clyde, Vocational Workforce Assessment Centre Manager

The aim of the new Level 3 Community Navigator role is to understand the needs of their patients and to assist them in accessing help. It can also involve supporting them as they make their first visit to a community centre, for example. This approach is widely recognised to reduce the number of readmissions to the hospital and to enhance the care that older people receive on discharge.


  • the role was successfully piloted in 2012, receiving 52 referrals and providing support to 28 individuals
  • support interventions included befriending, household maintenance, transport, state benefits, district nursing, and community-based activities
  • the Level 3 role is now further developed and supported by a job description and template which is transferable across health and social care sectors
  • the role is ready to roll out when funding becomes available
  • IT systems are being developed which will eventually draw together all relevant information to support the role


  • cost savings through the prevention of unnecessary readmissions to hospital, a reduction in inappropriate referrals to clinical services, and the ability to discharge patients from these services sooner due to support being in place
  • vulnerable older people are given the help and support they need, enabling them to remain independent in the community
  • carers and families better able to focus on their caring tasks
  • better communication between clinical teams and other services: the Community Navigator can inform health and social care providers about other local services, and refer clients to them
  • better use of Trust funding for community projects: the Community Navigator could help ensure that money goes to the right places by advising on the type of initiatives that are most needed by their patients

The new role was based on the pilot role and service, and so it was important to build on this role and previous experience. Our workforce experts created an outline project plan with SCHCT, which included reviewing and agreeing the essential functions, tasks and activities required to be delivered by this new role, identifying where the role could be implemented, and assessing the learning and development required.

By using the Skills for Health recognised role redesign methodologies, the Career Framework for Health, competence application tools, national occupational standards and the evaluation impact map to offer guidance on the expectations of the role and governance issues associated with it. A one-day workshop was attended by staff from the different clinical areas which could benefit from the role development, along with staff from the learning and development team at SCHCT. A role profile and Transferable Role Template were then developed, based on the list of tasks identified by participants.

“We were pleased to work with healthcare workforce experts Skills for Health, and the team of consultants were always at the end of an email or phone call, or able to meet us, and were willing to help at any stage of the project to make it a success. It was useful to have the support of specialists to give us advice and support as we developed the Community Navigator role.”

Tara Davison, Allied Health Profession Peripatetic Assessor and Quality Assurer, Northern Ireland Southern Health and Social Care Trust

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