The Service Vision in Northern Ireland

1. The Service Vision in Northern Ireland

2. The Northern Ireland Model • Overview of Model - John Cole • Connected Health - Andrew Hamilton Chief Executive European Centre for Connected Health • The Belfast Model - William Mckee Chief Executive Belfast Trust • Design Approach - John Cole • Afternoon Visits

3. Health and Social Services in Northern Ireland • Population of Northern Ireland approx 1.7 million . Almost 50% live within 30 minutes of the capital Belfast • Integrated organisation and delivery of health services and social services under the control of the Northern Ireland Government Department of Health, Social Services and Public Safety • Approx. 98% of health services and facilities are directly funded and owned by the public sector

4. Historic Situation • Ever-increasing demand for services • Surge in the number of emergency medical admissions delaying elective work • Bed-blocking in acute hospitals by elderly patients waiting for care packages • Large number of beds occupied by patients with chronic diseases • Long waiting lists for GP referrals for OPD appointments, diagnostics and elective surgery • Difficulty in staff recruitment • High quality complex care increasingly unsustainable in smaller units • Overcrowded Accident and Emergency Departments • Limited integration between primary and acute sectors and services

5. Extracts from Departmental Review of the Service Model • ‘Patient care is best seen as a system in which the acute episode is an event in an unfolding and ideally seamless pattern of care’ • ‘We were attracted by the concept of a virtual hospital, or a hospital without walls’ • ‘Part of the objective is to keep people out of acute hospitals who should not or need not be there’ • ‘The day of the stand-alone institution attempting to do everything from its own resources, acting in isolation from the wider system is already gone’

6. Current Departmental Strategy • 1 Commissioning Body will shortly replace 4 Commissioning Bodies • 5 Health and Social Services Provider Organisations (Trusts) have just replaced 19 (April 2007) • All 5 are responsible for providing both acute services and primary and community services (previously separate organisational responsibilities) • Specialist and Complex Services (Cancer Services,, Cardiac Surgery, Neuro-Surgery, Regional Paediatrics, Elective Orthopaedics etc.) have been centralised at Regional Centresof Excellence • 18Acute Centres to be reduced to 9 (facilitated by the development of managed clinical networks) • 7 of the remaining 9 hospitals to be redevelopedasLocal / Community Hospitals • A number of hospitals designated as Protected Elective Centres (high volume) • 48 new one-stop community / primary care centres (also providing a range of services previously only available in hospital settings)

7. Total System Design Regional Strategy and Key Service Objectives facilitated by: • New Service Model • Re-engineering of the work-force • Optimising Information Technology • Redesigning the facilities

8. 5 Types / Levels of Facility 1 - Local Health Centres 2 - Community Health Centres 3 - Local Hospitals 4 - Acute Hospitals 5 -Regional Centres • All linked by clinical and information technology networks and protocols • General principles but no rigidly fixed definition of which services are delivered at each level • Best fit model will vary from location to location reflecting local needs • Individual projects include various combinations of services

9. Key Trends in Location of Services 1 - Local Health Centres 2 - Community Health Centres 3 - Local Hospitals 4 - Acute Hospitals 5 - Regional Centres Movement of out-patients diagnostics and treatments from acute towards community Key issue is the movement of chronic disease management to the community preventing unnecessary hospitalisation Movement of complex specialties or specialties benefiting from higher critical mass to Centres of Excellence

10. Local Hosp. 4 Local Hosp. Acute Hospital 150-300 Thousand Acute Hospital CHC 3 Local Hosp. Non-health agencies Regional Hospital 1.7 Million 100 Thousand+ 2 CHC CHC HC Acute Hospital 1 20 – 70 Thousand Individual homes HC 2-10 Thousand Other Community Facilities. An Integrated Services Model

11. Potential Co-locations – Health Village 1 HC

12. 2 CHC Potential Co-locations – Health Village 1 HC

13. 2 CHC 3 Local Hospital Potential Co-locations – Health Village 1 HC

14. 2 CHC Mental Health Facility 3 Local Hospital Potential Co-locations – Health Village 1 HC

15. 2 CHC Mental Health Facility 3 Local Hospital Renal Dialysis Unit Potential Co-locations – Health Village 1 HC

16. Level 2 (Approx 48 across Northern Ireland) H o r i z o n t a l I n t e g r a t i o n Regional Hospitals Acute Hospitals Local Hospitals Complementary Therapies Community and Voluntary Sector V e r t i c a l I n t e g r a t i o n Healthcare and Social Services Private Sector Related Public Sector Community Health Centres Primary Care: Local Health Centres

17. Cross - Sector Integration Comm Fac. Leisure/Fitness Centre 1 HC Rec/ Café/ Atrium 2 CTCC Day Centre Pharm. Library/ Resource Centre

18. Level 4 - Acute Hospitals MATER 180 km

19. Level 3 - Local Hospitals WHITEABBEY NEWTOWNARDS 180 km

20. Level 2 – Community Treatment and Care Centres SEVEN CENTRES in BELFAST 180 km

21. “ Are you sure this is what they mean by moving care into the community ”