Next Generation Measurement

1. Next Generation Measurement Barry McGinn 11th June 2014 Health Promotion Research Centre 18th Annual Health Promotion Conference Galway

2. Introduction • Overview of Health and Wellbeing Division • Development of target based performance management in Irish health services context • Change in focus and emphasis – Future Health & Healthy Ireland • Implications

3. Health and Wellbeing Division • Established in July 2013, the work of the Health and Wellbeing Division is focused on helping people to stay healthy and well, reducing health inequalities and protecting people from threats to their health and wellbeing. • Budget approx €223m in 2014 (including additional investment of €6.75m) • Workforce of approx. 1,200 WTE • Public Health and Health Protection • Child Health • Environmental Health • Health Promotion and Improvement (approx. 180 WTE / €18m) • National Screening Services • Emergency Management • Knowledge Management (Health Intelligence).

4. Delivery System 4 other Service Divisions: • Acute Hospitals - 7 Groups • Social Care • Mental Health ISAs • Primary Care

5. Planning, Performance & Programme Management • Lead and support strategic and operational planning • Provide integrated view of performance • Design and implement systems and governance processes to support the effective delivery of the Divisions objectives

6. Environment • Quest for greater accountability a feature of Irish public life • Customer Focus • Performance • Sustainability • Productivity (Haddington Road)

7. Origins of current performance framework The Health (Amendment) (No.3) Act, (1996) • introduced service planning, monitoring of performance, service reviews and the use of performance indicators to the Irish Health Service. • established a legislative requirement for each health board to produce a yearly service plan, annual report and annual financialstatement.

8. Origins of current performance framework • Brennan Report (2003) noted that current Service Plans: • Have very weak or no links between activity and funding. • Prospectus Report (2003) – ‘develop supporting processes to strengthen the consolidated structure • National Performance Indicator Project

9. Origins of current performance framework • Health (Act), 2004 – creates Health Service Executive • Specify the ‘type and volume’ of health and personal social services for the year will be delivered and is the benchmark against which performance is measured throughout and at the end of the year

10. Origins of current performance framework • Since 2005: • Greater focus on measurement & reporting • Shift to target-driven performance management • Improved granularity & data quality • Balanced Scorecard Significant data challenges persist

11. Health & Wellbeing Scorecard • No. and % of Primary Care Centres/Health Centres with Tobacco Free campus policy implemented • % of PCTs in School Growth Monitoring Sites trained in Health Service –ICGP Weight Management Treatment Algorithm for Children • No. of smokers who received intensive cessation support from a cessation counsellor • No. of frontline healthcare staff trained in brief intervention smoking cessation

12. Changing environment • Implementing Reform Programme in the context of • Budget reduction • Staffing reduction • Changing structures • Greater Clinical Leadership

13. Change in approach • Changing emphasis • Is the conversation too narrow? • What interests are being served? • How do we broaden the lens? • What does that look like? • Re-balancing the scorecard? • Quality Indicators

14. Population • Demographic Changes • Ageing Population • Chronic Illness • Health Inequalities

15. Healthy Ireland Framework 2013 - 2025 • Whole of Government, whole of society approach to health improvement. • 64 actions shared across a wide range of partners from public, private and civil society.

16. Healthy Ireland Framework 2013 - 2025 • Goal 1: Increase the proportion of people who are healthy at all stages of life   • Goal 2: Reduce health inequalities  • Goal 3: Protect the public from threats to health and wellbeing  • Goal 4: Create an environment where every individual and sector of society can play their part in achieving a healthy Ireland

17. Healthy Ireland Framework 2013 - 2025 • Governance and Policy • Partnerships and Cross-Sectoral Working • Empowering People and Communities • Health and Health Reform • Research and Evidence • Monitoring, Reporting and Evaluation

18. Role of Health Services • 3 year Health Services implementation plan for Healthy Ireland • Prioritise actions for implementation • Translate through NSP / Operational Plans • Better measurement aligned to outcomes • Implementation is critical issue • Cross Divisional • NSP 2015 & associated measures

19. Health & Wellbeing Opportunities • ISA review: increase the H&WB footprint & capacity • Hospital Groups: standards • Clinical Care Programmes • External Partnerships • Wider Reform Programme

20. Challenges • New Division – capacity • How to show impact within the health services – data • How to sustain focus • Need for greater co-ordination & collaboration • Change Management

21. What we need to do • Aligning • Healthy Ireland implementation actions / plans • Service / business planning process • Service Arrangements & Standards • Supported by • Sequenced reporting on implementation • Better Measurement • More systematic use of evaluation/s • National outcomes framework for Healthy Ireland Change the conversation – Leadership

22. Summary • Governance & leadership • Use of people & resources • Partnerships • Systems for healthcare • Use of evidence • Measurement & evaluation • Programme Management

23. “Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.” Winnie the Pooh A.A. Milne.