‘Integrated teams in an integrated system’ The Northern Ireland Perspective Mr John McGarvey Assistant Director for Intermediate Care, Rehabilitation & AHP’s

Derry D.C. Limavady D.C. Strabane D.C. Omagh District Council Fermanagh D.C. Coleraine D.C. Moyle D.C. Ballymoney D.C. Ballymena D.C. Magherafelt D.C. Cookstown D.C. Antrim D.C. Dungannon D.C. Armagh D.C. Newry & Mourne D.C. Banbridge D.C. Craigavon D.C. Down D.C. Lisburn D.C. Ards D.C. Castlereagh D.C. Belfast D.C. North Down D.C. Newtownabbey D.C. Carrickfergus D.C. Larne D.C. MAP OF NORTHERN IRELAND Western Area Population 295,192 Area (Hectares) 484,080 Population Density 0.58 Northern Area Population 449,623 Area (Hectares) 435,567 Population Density 0.98 Eastern Area Population 671,579 Area (Hectares) 175,124 Population Density 3.80 Southern Area Population 342,754 Area (Hectares) 318,768 Population Density 0.98

Derry D.C. Population 108,535 Area Sq. Km Density / sq.km 280 Strabane D.C. Population 39,430 Area Sq. Km Density / sq.km 46 Limavady D.C. Population 34,428 Area Sq. Km Density / sq.km 59 Omagh D.C. Population 51,508 Area Sq. Km Density / sq.km 46 Fermanagh D.C. Population 61,291 Area Sq. Km Density / sq.km 33 Western HSCT Area Population 295,192 Area Sq. Km 4,842 Density / sq.km 61 Northern Ireland Population 1,759,148 Area Sq. Km 14,160.5 Density / sq.km 124 Source: NISRA 2007 Mid Year Estimates. Omagh D.C. Area Fermanagh D.C. Area Strabane D.C. Area Derry D.C. Area Limavady D.C. Area

The Western H&SC Trust

Health & Social Care in N. Ireland Historical Context 1948 – 1972 Tripartite System – Hospitals, GP’s & Public Health HPSS [NI] Order 1972 Establishment of 4 H&SSB’s HPSS [NI] Order Commissioning Boards and 19 Trusts (Hospital / Community) HPSS [NI] Order 1994 Shift in some delegated functions from Boards to Trusts, decentralisation & devolved budgets RPA 2005 – Streamlining of H&SS Structures

Review of Public Administration 2005 Streamlining the Structures Launched June Outcomes announces November 2005 All of N. Ireland’s Public Services affected with H&SC at the fore-front. Modernised, Accountable & Efficient Services

New Structures From 19 to 6 Health & Social Care Trusts From 4 Health & Social Care Boards to 1 5 Local Commissioning Groups 1 Patient & Client Council 1 Business Services Organisation

RPA - Benefits Services centred on patients, service users and carers Improved service efficiency Clear priorities, targets and performance Improved governance and quality Regional standardisation

Northern Ireland Assembly Minister for Health Social Services & Public Safety Health & Social Care Board LocalCommissioning Groups X 5 HSC Trusts X 5 Ambulance Trust GP’s Public Health Agency Patient and Client Council Business Services Organisation Department of Health & Social Services RQIA

Strategic Drivers / Themes Priority Area 1 Improve the health status of the population and reduce health inequalities Priority Area 2 Ensure services are safe & sustainable, accessible & patient-centred Priority Area 3 Integrate primary, community and secondary care services Priority Area 4 Help older people to live independently Priority Area 5 Improve children’s health and well-being Priority Area 6 Improve mental health services and services for people with disabilities Priority Area 7 Ensure financial stability and the effective use of resources

Responsive & Integrated Teams Priority For Action Target PRIORITY AREA 3: INTEGRATE PRIMARY, COMMUNITY AND SECONDARY CARE SERVICES – Aim: to ensure greater engagement between secondary and primary care clinicians and practitioners to agree clinical pathways which reduce the use of hospital services and increase the capability of primary care to manage patients more locally.

Trust Structures Director of CapitalDevelopment

Where we were in 2007 Professional Service Delivery Structures – District Nursing / Treatment Rooms – Social Work – Allied Health Professions – LTC Management Professional Boundaries – Physical – Operational – Cultural Multi-disciplinary working – Enabled through Care Management Process –

Where we were in 2007 – Director of Primary Care & Older Peoples Services Community Services Manager Older People’s Social Services Social Work Team Team Manager Social Workers X 3 SW Assistants X 2 Social Work Team Team Manager Social Workers X 3 SW Assistants X 2 Social Work Team Team Manager Social Workers X 3 SW Assistants X 2 Community Services Manager Health & Disability Services Head of District Nursing Services GP Cluster Model DN Teams Head of Health Visiting & Health Promotion Head of AHP Services HOS X 6

New Directorate Structure  Human Resources  Information  Planning & Performance  Finance

Integrated Service Delivery Fully integrated multi-disciplinary working across hospital and primary community settings. Fundamental re-design of team structures and methods of working. Locality sensitive response. More effective person-led service coordination Reduced reliance on hospital and residential care settings Key focus on Long Terms Conditions Management

Where Are We Now – Assistant Director for Primary & Community Care Services Locality Services Manager (X4) PCC Team Team Mgr (Nurse) District Nursing Social Work Occupational Therapy Case Managers PCC Team Team Mgr (SW) District Nursing Social Work Occupational Therapy Case Managers PCC Team Team Mgr (SW) District Nursing Social Work Occupational Therapy Case Managers

What Are The Challenges Managerial Resistance – RPA Enabler Professional Governance – Supervision / CPD / Capacity & Cover Custom & Practice – Geography (SW) – GP Linkage to D/N’s – Professional Separation Infrastructure – Accommodation – ICT

What Have Been The Benefits Improved Communication “Patient / Client needs are addressed quicker” “Reduced bureaucracy, no need for formal referrals” Improved Team Work “Appreciation of other professional roles and skills” “Increased monitoring” “Understanding of resource challenges” Reduced Duplication “Shared Records” “Single Assessment”

Key Enablers Accommodation Professional Governance Leads NISAT Administrative Support A Balanced Strategic Investment Plan – HEALTH & social care

Any Questions