HSE Social Inclusion and Marginalised Groups: Priorities, Perspectives, Plans

1. HSE Social Inclusion and Marginalised Groups: Priorities, Perspectives, Plans Nursing in a context of marginalised health DCU, September 2015 Diane Nurse: National Lead: Social Inclusion

2. Health Service Executive (HSE) • Provides public health and social care services to everyone living in Ireland. • Net revenue budget of €12.131b (2015) • Approx. 67,000 direct employees and 40,000 in funded health care organisations. • HSE Divisions: Primary Care, Health and Wellbeing, Social Care, Mental Health, Acute sector…. Also….Clinical Programmes, Quality Improvement Division, Cancer Control Programme etc

3. HSE Primary Care Division • A range of services designed to keep people well: health promotion, screening for disease, assessment, diagnosis, treatment, rehabilitation and personal social services. • First-level contact that is accessible by self-referral. • Working with communities and individuals to improve their health and social wellbeing. • Primary Care Teams (PCTs) help to meet the needs of people living in a community and provide a single point of contact to the health system. PCT Professionals  GP and Practice Nurse  Community Nursing Service  Occupational Therapist  Physiotherapist  Home Help/support staff Links with other community-based disciplines  Speech and Language Therapy  Dieticians  Mental Health Services  Counsellor/Psychologist  Podiatry  Social work  Dental  Ophthalmic Services

4. HSE Social Inclusion • Located within the Primary Care Division. • Remit for Substance Misuse, Homelessness, Intercultural Health, Travellers, Roma, Domestic, Sexual and GBV, LGBT, HIV/AIDS, Community Development etc. • Works across Divisions of HSE as well as across statutory and voluntary sectors. • Key aim is to enhance access of vulnerable groups to health services…equality of access, participation and outcomes. • Targeted Interventions versus Mainstreaming.

5. Social Inclusion Approach • Change of emphasis from “groups” to “issues” • Small national office • Few Social Inclusion staff across CHOs (approx 550) • Need to be strategic, work smart etc • Use levers to influence change • Work across divisions towards synergies • SLAs with Voluntary sector • Partnership project • Evidenced approach • Commission research • Service user involvement • Community development • Rethinking, evaluating, redoing….

6. Challenges for Social Inclusion • Marginalised groups not often a priority in broader schemes….”one size fits all approach” • “Inverse care law”, accessibility of services, equity of access etc • Outcomes are hard to measure • Questions around “value for investment” • Commissioning must be evidenced and needs based. • Fragmentation, inconsistencies, replication of good practice etc…

7. Key documents, strategies etc • Healthy Ireland… “a whole-of-Government and whole-of-society approach to improving health and wellbeing and the quality of people’s lives”… “reducing health inequalities….” • HSE Corporate plan….2015-2017… “core values of care, compassion, trust and learning.” • HSE Reform process • Commitments in HSE National Service and Operational plans

8. National Strategy for Service UserInvolvement in the Irish Health Service2008-2013 http://www.hse.ie/eng/services/publications/corporate/Your_Service,_Your_Say_Consumer_Affairs/Strategy/Service_User_Involvement.pdf

9. Your Service, Your Say Guiding Principles for Service User Involvement… • Service users, especially those whose voices are seldom heard, have a right to be involved in the development of the health and social services that they use and this is a key element in the delivery of patient-centred care. • Service user involvement initiatives must be systematically evaluated and learning from service user involvement initiatives must be disseminated across the health and social services.

10. National Strategy for Service UserInvolvement in the Irish Health Service2008-2013

11. National Service Plan 2015 • Achieve improved health outcomes for persons with addiction issues. • Support the Implementation Plan to reduce Homelessness (approved May 2014) with particular attention to health related recommendations. • Improve health outcomes for vulnerable groups with particular emphasis on Travellers, Roma, asylum seekers, refugees, homeless service users and women and children experiencing violence. • Implement the prioritised recommendations of the National Hepatitis C Strategy 2011-14. http://www.hse.ie/eng/services/publications/corporate/sp2015.pdf

12. Some examples of Social Inclusion roles, inputs across sectors • National Drugs Strategy 2009-2016 (Dept of Health) • National Substance Misuse Strategy report 2012 (Dept of Health) • Cross Departmental Team on Homelessness and associated fora • National Strategy Domestic, Sexual and Gender based Violence (COSC Office) • National Action plan on Women, Peace and Security) (Dept Foreign Affairs) • Working Group on Direct Provision dept of Justice) • National Traveller and Roma Inclusion Steering Group (Dept of Justice) • National Sexual Health Implementation Strategy • National Integration Strategy • etc

13. Examples of specific projects, services, resources etc. • Tallaght Roma Integration project • Specialist FGM Clinic • Pharmacy Needle Exchange • Naloxone project • Hidden Harm • Traveller Asthma Education project • Partnership for Health Equity project • Ethnic Equality monitoring • Emergency Multilingual Aid (EMA) • Intercultural Guide • Lost in Translation resource • Guidelines for communication in cross cultural General Practice

14. Tallaght Roma Integration Project (TRIP) • A model of engagement between the Roma community and the wider society, particularly the public systems of health and welfare services. • Works from a participatory perspective, which focuses not only on the problems of access to healthcare but on the processes used to tackle the identified problems. • Multi agency partnership approach including Roma Cultural Mediators. • Series of Consultation meetings facilitated by Roma Cultural Mediators. • Agreement to follow Primary Healthcare and Community Development principles. • Funded via Social Inclusion • Once a week service now expanded to twice weekly. • Signposting to other services and associated support in accessing these. • Location of service changed...progress towards integration.

15. Tallaght Roma Integration Project (TRIP) Attendance at the Roma GPService Attendance at the Roma GP Service by children under 5 years.

16. FGM Clinic • Estimated 3,800 women/ girls in Ireland… • Part of a package of actions in relation to FGM. • Actions include the development of a resource for health professionals, training and awareness raising and the development of a Second National Action Plan to address FGM. • Sessional clinic funded by HSE Social Inclusion operated by IFPA • Akidwa funded to carry out community related actions around FGM.

17. Partnership for Health Equity Project • Collaboration of HSE Social Inclusion/ Primary Care, University of Limerick (UL) and North Dublin City GP Training Programme (NDCGP). • Aim is to improve access to primary healthcare for marginalised groups, including homeless persons, drug users, travellers, migrants and others….. through… • Educational initiatives for medical students and GP trainees on how to care for these marginalised groups • Conducting research about access to healthcare for these groups • Delivery of a low-threshold GP service in Limerick city • Raising awareness about health equity and encouraging networking between interested health professionals, community organisations and academics.

18. Partnership for Health Equity Project cont. • “Homelessness: An Unhealthy State” to be launched by Minister Varadkar on 23 September. • Health Equity website www.healthequity.ie

19. Ethnic Equality Monitoring Service users will be asked about their • Ethnic group/cultural background • Religion • Language spoken at home • Country of birth Benefits: • Shows if unintentional discrimination is occurring • Helps in the design of more targeted services. • Supports more accurate diagnoses. • Helps health services to meet legal requirements and implement National and HSE Strategies and Plans. • Collection of data will begin in Connolly Hospital in Qtr 4 and HSE PC in CHO 9 over the coming months.

20. Emergency Multilingual Aid • A resource to assist staff in communicating more effectively with patients who present in acute or emergency situations, prior to requesting the services of an Interpreter • Comprises Language ID Card, 20 Multilingual phrasebooks, User Manual, CD • Allows staff to form a preliminary assessment while awaiting arrival of Interpreter • Currently being converted into an APP that can be downloaded free of charge on a mobile phone, tablet etc.

21. HSE Intercultural Guide Support for staff in delivering responsive, culturally sensitive services: Responding to the needs of diverse religious communities and cultures in healthcare settings Available as APP “understandme” free of charge from Apple store

22. Guidelines for Communication in Cross Cultural General Practice http://lenus.ie/hse/bitstream/10147/212769/1/Guidelinecrossculturalgp.pdf • Developed by the Department of General Practice, NUI, Galway, the Centre for Participatory Strategies, Co. Galway and the HSE National Social Inclusion Office. • Extensive participatory research approach used to involve service users from migrant communities and other key stakeholders in the generation of guidance for best practice. The results are based on a consensus view across stakeholder groups. • Guidelines disseminated widely….need to look back, evaluate uptake, impact?

23. Thank you Contact details: Diane Nurse National Lead: Social Inclusion National Social Inclusion Office Primary Care Division Health Service Executive Mill Lane Palmerstown Dublin 20 Tel. (01)6201666 Email: diane.nurse@hse.ie