1. Integrated Services Programme – Integrating Hospital and Community Services Overview Irish Pharmaceutical Healthcare Association September 2010

2. CASE FOR CHANGE HSE Corporate Plan 2008-2011 sets out a clear vision for implementing an Integrated health and social model for Ireland. Why are we making these changes?  To drive and support safe, quality care for patients and clients.  To bring decision making close to where services are delivered.  To allow clinicians to shape and assure the services they work in.  To get the best health outcomes for the money spent.  To plan and organise around what we know people need and what we know works to give the best results.  To organise to meet increasingly complex patient and client needs  To remove barriers to integrated care.

3. CHANGING DEMANDS ON OUR HEALTH AND SOCIAL CARE SYSTEM……. Source: CSO, National Cancer Registry Ireland; CSO; Interviews; team analysis  Population is aging  000’s, persons over 60  The average number of cancer cases is predicted to increase  000’s, predicted no. of cases, 95% CI  1996  2002  2006  Increase in demand from higher- dependency segment of population  Increased requirement for prevention and specialist treatment  2005  2010  20152015  2020  CAGR +3%  Increasing prevalence of conditions such as diabetes, obesity, heart disease and asthma puts an increasing burden on the health service

4. WHAT SHOULD THIS MEAN FOR PATIENTS & CLIENTS  Services will be more accessible locally, centred around the patient, rather than centred around an institution  Shift towards prevention and better self care rather than a focus on acute care and treatment  Improved patient outcomes  Right balance between inpatient, day case and community based care  More efficient use of resources and more transparent accountability * As per the HSE Corporate Plan 2008

5. PROGRAMME STAGES  Stage I (completed June 2008)  Design optimal organisation structure and supporting management process building on Mc Kinsey review and agreed Integrated Model of Care  Stage II (continuing June 2008 – Dec 2009)  Establishment of the new Quality and Clinical Care Directorate  Putting new top team in place  Establishment of Integrated Services Directorate  RDOs appointed & Interim Regional Management Teams in place  Stage III (continuing August 2009 - 2010)  Determining how front line services should be organised  Management arrangements to support above  Drafting of catchment areas for hospitals and primary care Bottom Up Top Down

6.  Organisation structure  Reporting  Roles  Accountabilities  Measures & Objectives  Goals & Objectives  Budget allocation  Performance management  Metrics and good information  Monitoring  Care Pathways  Clearly defined interfaces  Transparent, easy-to-follow care pathways  Shared values  Common vision  Mutual respect  Right People  Committed, competent individuals  Development of teams RECOGNITION THAT SHAPING AN EFFECTIVE ORGANISATION GOES FAR BEYOND ‘BOXES ON A PAGE’

7. LEVERS FOR INTEGRATION  Service Delivery Models and Strategies  Organisation  Organisation structure  Budgetary and planning processes  Patient and Client Pathways

8. Service Delivery Model

10. Patient Home Level I Primary Care Teams Level II Community Health & Social Care Networks Level III Integrated Service Areas (Including Secondary Care Hospitals) Patient 7,000-10,000 Home Level IV Tertiary Acute Services 30,000-50,000 100,000-350,000 500,000 + National Programmes of Care SERVICE DELIVERY MODEL

11.  531 Primary Care Teams mapped for the entire country  Health and Social Care Networks to be established  Hospital reconfiguration programmes underway  Programmes of Care established, e.g. Acute Medicine Programme  Structures and processes in place to ensure care groups are managed cohesively

12. INTEGRATED SERVICE AREAS (ISA)  PCT’s are building blocks for an Integrated Service Area  Policy objective is to transfer non-complex acute service to local hospitals and/or PCTs  PCTs and related secondary care Acute hospitals should have co-terminous populations  Will contain hospital or no. of hospitals that provide for the secondary care needs for that population  Clear criteria set for identification of ISAs that include wider public service integration  Design methodology involved detailed analysis of current patient flows coupled with local intelligence  Eight in place on an interim basis and design process established in other areas – process will take time

13. PROGRAMMES OF CARE  20 Programmes established with Clinical Leads appointed  Joint initiatives with the academic colleges  Focused on implementation of solutions in 2011  Separate project underway in Childcare; some gaps in other Personal and Social Services  Programmes established in: Primary CareCare of the elderlyPalliative CareRadiology Obstetrics and Gynaecology Obstetrics and Gynaecology (Deputy) Joint Stroke (Geriatrician) Joint Stroke (Neurology) Acute Coronary Syndrome Heart FailureDiabetesCOPD AsthmaMental HealthEpilepsyDermatology Neurology out patientsRheumatologyJoint Acute Medicine Emergency MedicineCritical CareSurgery

14. REGIONAL OPERATING UNITS  Four regions in place  HSE West  HSE South  HSE Dublin/Mid-Leinster  HSE Dublin/North East  Headed by a Regional Directors of Operations – roles replaced twelve senior managers covering hospitals and community  Focus is on performance managing the local operating units

15. INTEGRATED SERVICE AREAS  Purpose of the ISA is to align services around a population  Eight ISA’s agreed and being rolled out  Local unit for service delivery  Design based on catchments, road network, primary care team design, spatial planning, local authority boundaries etc  Further design work ongoing in:  HSE South (East)  HSE DML  HSE DNE /Leitrim

16. PROGRESS MADE  Stage I – Corporate restructuring complete  Stage II – Regions established  Stage III  Eight ISAs defined and interim management arrangements in place  ISA catchments being scoped  Service Delivery Model defined  Programmes of Care defined and teams working  Performance Management process being developed

17. SUMMARY  Range of levers to integrate services across all settings  Priority is to develop programmes of care for priority areas to make patients and clients pathways clear  Organisation structure and processes must support this direction of travel – will take time as some legacy structures are more complex