Reforming the State System for the provision of social services, setting the vision, aims and objectives: The United Kingdom Experience Mr Sean Holland Chief Social Services Officer Department of Health Social Services and Public Safety Northern Ireland United Kingdom

The Northern Ireland Context Population 1.6 million Lowest GDP in UK Largely rural population outside Belfast and Derry Economy – agriculture and public sector

The Northern Ireland Context -DEMOGRAPHICS Ageing population (fastest growing in UK) Growing birth rate Increasing diversity -GLOBAL FINANCIAL CHALLENGE Rising demand Falling tax take

Society emerging from conflict 1969 – ,585 dead 91% male; 74% under 39 Equivalent of 130,000 UK wide Individual and community trauma A changing relationship with the State

Westminster UK and England WalesScotland Northern Ireland

Government of Northern Ireland OFMDFM Executive DSDDSD 15 Ministers 108 MLAs 26 Local Councils * One of the most governed regions in the world! DHSSPSDHSSPS DARDDARD DFPDFP DRDDRD OFMDFMOFMDFM DEDE DCALDCAL DETIDETI DOJDOJ DOEDOE

The Programme for Government The Executive’s over-arching aim is to build a peaceful, fair and prosperous society. To ensure that Government is clearly focused on achieving that aim, the Executive has set out in the Programme for Government five key strategic and interdependent priorities as follows: Growing a dynamic, innovative economy Promote tolerance, inclusion and health and well-being Protect and enhance our environment and natural resources Invest to build our infrastructure Deliver modern high quality and efficient public services

Minister Headcount:707.0 FTE:1.000 Special Advisor Headcount:1.0 FTE:1.000 Assembly Private Secretary Headcount:1.0 FTE:1.000 Permanent Secretary Headcount:705.0 FTE:1.000 Chief Medical Officer Headcount:113.0 FTE:1.000 Under Secretary Headcount:133.0 FTE:1.000 Under Secretary (Vacant) Headcount:1.0 FTE:1.000 Under Secretary Headcount:222.0 FTE:1.000 Under Secretary Headcount:88.0 FTE:1.000 Assistant Secretary Headcount:47.0 FTE:1.000 Chief Officer OSS Headcount:56.0 FTE:1.000 Assistant Secretary Headcount:34.0 FTE:1.000 Chief Nursing Officer Headcount:13.0 FTE:1.000 DHSSPS ORGANISATION CHART

DHSSPS: KEY FACTS 709 staff 30.3m running costs 4.3 billion expenditure

13 Roles and Responsibilities The Department Sets the strategic context in policies and legislation and determines the standards and targets by which outcomes in terms of access, quality and value for money are measured. Establishes annual ministerial priorities for action, which set standards and targets for the HSC as a whole, and reflects these in a Commissioning Direction, which provides the framework within which the HSCB (including its LCGs) and the PHA will commission health and social care.

14 BSO RQIA PCC Agencies Minister/ Department 5 Trusts Key Stakeholders including: Service Users and the Public Voluntary and community sector providers Private sector providers Health and Social Care System HSCB

15 Roles and Responsibilities HSCB – Commissioning (development of a commissioning plan in consultation and agreement with PHA); HSC performance management & service improvement; HSC financial management; relevant statutory functions. Health improvement; health protection; partnerships with local government and other stakeholders; input to commissioning plan. BSO – Business support to the HSC sector – HR, finance, legal services, procurement, ICT and other services. PCC – Providing a strong and independent voice to represent the views of patients, clients & carers. HSC Trusts - Plan and deliver services in response to the commissioning plan, ensuring quality, value for money and financial stability.

16 Challenging the system In addition to the usual internal and external audit arrangements and the performance management and service improvement role of the HSCB and the PHA, the HSC has two other source of independent challenge. The Regulation and Quality Improvement Authority is charged with monitoring and reporting on the quality of health and social care in Northern Ireland. The Patient and Client Council is charged with representing the interests of users, carers and communities in health and social care and promoting their direct involvement in the planning, delivery and evaluation of services.

Policy to Practice Government policy (based on political ideology) Legislative Framework Policy Guidance Commissioning statements Service provision

18 What is commissioning? Commissioning to improve health and well-being, reduce inequalities and respond to health and social care needs by: – Assessing the health and well-being needs of groups, populations and communities of interest; – Prioritising needs within available resources; – Building the capacity of the population to improve their own health by partnership working on the determinants of health in local areas; – Engaging with patients/clients/carers and other key stakeholders at local level in planning health and care services to meet current and emerging needs; – Securing, through service and budget agreements, the delivery of value for money services that meet standards and service frameworks for safe, quality care; – Safeguarding the vulnerable; – Using investment, performance management and other improvement initiatives to develop and reform services, change culture and build capacity The main focus for these actions is at local level, though some aspects of service are commissioned regionally. There is a continuous evaluation of the extent to which the services have the desired effect.

Continuous Process Government policy Legislation Policy guidance Commissioning intentions Service provision User feedback Community involvement

Key Features of Success Integrated system Partnership working Mixed Economy of Care Service user and public participation Strong communities Skilled and trained workforce Strong Governance Clear Standards