Health Social Care Reform in Northern Ireland HMIIHM

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Health & Social Care Reform in Northern Ireland HMI/IHM Joint Leadership Event 15 May

Health & Social Care Reform in Northern Ireland HMI/IHM Joint Leadership Event 15 May 2009 Dean Sullivan Director of Planning and Performance, DHSSPS

Overview Organisational context n Structural reform n Performance improvement n Challenges n

Overview Organisational context n Structural reform n Performance improvement n Challenges n

Organisational context n n Steady state system at macro level since 1973 – creation

Organisational context n n Steady state system at macro level since 1973 – creation of integrated Health and Social Care system Conservative reforms of early 1990 s n n n Commissioner/ provider split GP fundholding ‘Self-governing’ Trusts Labour Government elected in 1997 – GP fundholding abolished, new primary care engagement process, new organisational forms No equivalent push in NI

Structural reform n Restoration of NI Assembly 1999 – Review of Public Administration (Health,

Structural reform n Restoration of NI Assembly 1999 – Review of Public Administration (Health, Education, Local Government, etc. ) an immediate priority n Suspension of Assembly 2002 – hold on RPA continued until 2005 n Shaun Woodward pushes forward on HSC reform – proposals developed for six Trusts and a Regional Health Authority n Assembly restored May 2007 – RHA plans scrapped; alternative arrangements introduced April 2009 – increased focus on public health agenda

New organisational arrangements April 2007: n 18 Trusts reduced to six (12, 000 to

New organisational arrangements April 2007: n 18 Trusts reduced to six (12, 000 to 22, 000 employees) April 2009: n Four area-based commissioning Boards replaced by two new regional organisations: n HSC Board (with five local commissioning groups) n Public Health Agency n Business Services Organisation – non-clinical support n Patient and Client Council

Performance – context Longest waiting times in UK n Appleby Review 2005 – poor

Performance – context Longest waiting times in UK n Appleby Review 2005 – poor performance relative to England n NIAO/ PAC reports n Damaged public confidence n

Performance – 2005 n n 180, 000 patients waiting for initial outpatient assessment (74,

Performance – 2005 n n 180, 000 patients waiting for initial outpatient assessment (74, 000 6+ months) 48, 000 patients waiting for surgery (14, 000 6+ months) Hundreds of patients waiting over 12 hours for admission to hospital each week Absence of robust performance information for many other hospital and community services

Focus on Performance n n Strategic Alliance between DHSSPS and GMSHA from April 2005

Focus on Performance n n Strategic Alliance between DHSSPS and GMSHA from April 2005 Initial focus (2005 -06 and 2006 -07) on elective care Focus substantially broadened in 2007 -08 to include A&E, cancer, fractures, etc. and a range of community services Dedicated Service Delivery Unit established as part of DHSSPS in 2006 – now a core element of the new HSC Board

Key elements of reform Clear, unambiguous targets n Comprehensive, accurate and timely management information

Key elements of reform Clear, unambiguous targets n Comprehensive, accurate and timely management information n System and process change n High quality, professional support n Clinical engagement n Holding leaders accountable for delivery n

Impact: OP 2002 – 2007

Impact: OP 2002 – 2007

Impact: IP/DC 2002 – 2007

Impact: IP/DC 2002 – 2007

Impact: Patients waiting over 12 hours each week in A&E

Impact: Patients waiting over 12 hours each week in A&E

Impact: Patients waiting over 12 hours each month in A&E

Impact: Patients waiting over 12 hours each month in A&E

Impact: Patients waiting over 12 hours each month in A&E

Impact: Patients waiting over 12 hours each month in A&E

Challenges n n n Alignment of focus and key priorities across the HSC –

Challenges n n n Alignment of focus and key priorities across the HSC – Minister/Department/Commissioners and Providers Sustaining hard-won performance improvements Increasing focus on quality and public health agendas Roles and responsibilities, accountability and assurance – ‘eye watering’ clarity Challenging financial context Core competence – access, safety, finance. No false trade-offs

“Thank goodness it’s not healthcare. ” Rocket Scientists across the world

“Thank goodness it’s not healthcare. ” Rocket Scientists across the world