1. Strictly Private & Confidential – Not for Circulation
DRAFT for Discussion
Strictly Private & Confidential – Not for Circulation
CHO Implementation Programme
CHO Operating / Substructure Workstream
Presentation to PMO Forum 31 Jan 2018

2. Presentation to PMO Forum 31 January 2018
DRAFT for Discussion
Strictly Private & Confidential – Not for Circulation
Presentation to PMO Forum 31 January 2018
Community Healthcare Organisations (x9)
Community Health Organisations
Area 1
Area 6
Area 2
Area 7
Area 3
Area 8
Area 4
Area 9
Area 5
TYRONE
DERRY
ANTRIM
DOWN
ARMAGH
FERMANAGH
BELFAST
Castlebar
Cork
NORTH
TIPPERARY
WESTMEATH
WATERFORD
KERRY
LIMERICK
SOUTH
KILKENNY
WEXFORD
CARLOW
LAOIS
KILDARE
MEATH
OFFALY
GALWAY
MAYO
ROSCOMMON
LONGFORD
CAVAN
SLIGO
LEITRIM
DONEGAL
MONAGHAN
LOUTH
CLARE
WICKLOW
DUBLIN 6 1 8 7 9 5 3 4 2
Ballyshannon 1
Donegal, Sligo/Leitrim/West Cavan, Cavan/Monaghan 2
Galway, Roscommon, Mayo 3
Clare, Limerick, North Tipperary/East Limerick 4
Kerry, North Cork, North Lee, South Lee, West Cork 5
South Tipperary, Carlow/Kilkenny, Waterford, Wexford 6
Wicklow, Dun Laoghaire, Dublin South East 7
Kildare/West Wicklow, Dublin West, Dublin South City, Dublin South West 8
Laois/Offaly, Longford/Westmeath, Louth/Meath 9
Dublin North, Dublin North Central, Dublin North West
CAVAN
Swords (9)
Clonskeagh (6)
Tullamore
Merlin Park
Naas
Limerick
Lacken
Cork

3. CHO Operating Model / Substructure Workstream
DRAFT for Discussion
Strictly Private & Confidential – Not for Circulation
Presentation to PMO Forum 31 January 2018
CHO Operating Model / Substructure Workstream
Workstream purpose:
determine a common way of organising CHO services
to develop what was not articulated in the CHO report
clean up historical configurations (as the workstream aims to configure community healthcare services per CHO); and
to align with the CHO Operating Model Change Objectives and Design Principles.
Workstream activity:
Kicked off in May 2016, (sponsored by Aileen Colley, Chief Officer CHO 5) with As-Is Operating Model analysis of all functions in a CHO (CHOs 1, 5 & 7) and As-Is Substructure Analysis for SC and PC Structures (CHOs 5, 6, 7 & 8).
Across 2017 change objectives and design principles for the CHO Operating Model were developed and baselined against the National Centre operating model’s change objectives and design principles. Both of which were then approved by programme governance as the rules and requirements for both models’ designs
Design work commenced October 2016, firstly with SC, then in 2017 with PC, followed by MH, Q&S, HR, and H&WB. All designs developed with Care Divisions SMT and other senior stakeholders as appropriate.
Approach and timing for implementation or operating models across 2018 developing now.

4. Presentation to PMO Forum 31 January 2018
DRAFT for Discussion
Strictly Private & Confidential – Not for Circulation
Presentation to PMO Forum 31 January 2018
CHO Services and Management historical configured on the boundaries of our former community organisations
Health Boards
HSE Regions
TYRONE
DERRY
ANTRIM
DOWN
ARMAGH
FERMANAGH
Monaghan
Castlebar
Cork
WATERFORD
CORK
KERRY
LIMERICK
TIPPERARY
SOUTH
KILKENNY
WEXFORD
CARLOW
LAOIS
KILDARE
DUBLIN
MEATH
OFFALY
WESTMEATH
GALWAY
MAYO
ROSCOMMON
LONGFORD
CAVAN
SLIGO
LEITRIM
DONEGAL
MONAGHAN
LOUTH
CLARE
WICKLOW
NORTH 6 1 8 7 9 5 3 4 2 1 8 7 9 5 3 4 2
TYRONE
DERRY
ANTRIM
DOWN
ARMAGH
FERMANAGH
WATERFORD
KERRY
LIMERICK
SOUTH
TIPPERARY
KILKENNY
WEXFORD
CARLOW
LAOIS
KILDARE
DUBLIN
MEATH
OFFALY
WESTMEATH
GALWAY
MAYO
ROSCOMMON
LONGFORD
CAVAN
SLIGO
LEITRIM
DONEGAL
MONAGHAN
LOUTH
CLARE
WICKLOW
Cork
Ballyshannon
Ballyshannon
TYRONE
DERRY
ANTRIM
DOWN
ARMAGH
FERMANAGH
Castlebar
Cork
NORTH
TIPPERARY
WESTMEATH
WATERFORD
KERRY
LIMERICK
SOUTH
KILKENNY
WEXFORD
CARLOW
LAOIS
KILDARE
MEATH
OFFALY
GALWAY
MAYO
ROSCOMMON
LONGFORD
CAVAN
SLIGO
LEITRIM
DONEGAL
MONAGHAN
LOUTH
CLARE
WICKLOW
DUBLIN
CHO
Castlebar
Shannon
Cork
CAVAN
CAVAN
Ballyshannon
Swords (9)
Clonskeagh (6)
Swords (9)
Clonskeagh (6)
Merlin Park
Tullamore 6
Merlin Park
Tullamore
Naas
Naas
NORTH
TIPPERARY
CAVAN
Limerick
Limerick
Lacken
Lacken
Cork
Swords (9)
Clonskeagh (6) 4
Cork
Merlin Park
Tullamore
Naas
Limerick
Lacken
Cork
TYRONE
DERRY
ANTRIM
DOWN
ARMAGH
FERMANAGH
Castlebar
Cork
WATERFORD
KERRY
LIMERICK
TIPPERARY
SOUTH
KILKENNY
WEXFORD
CARLOW
LAOIS
KILDARE
DUBLIN
MEATH
OFFALY
WESTMEATH
GALWAY
MAYO
ROSCOMMON
LONGFORD
CAVAN
SLIGO
LEITRIM
DONEGAL
MONAGHAN
LOUTH
CLARE
WICKLOW
NORTH 6 1 8 7 9 5 3 4 2
WEST
TYRONE
DERRY
ANTRIM
DOWN
ARMAGH
FERMANAGH
Castlebar
Cork
WATERFORD
KERRY
LIMERICK
TIPPERARY
SOUTH
KILKENNY
WEXFORD
CARLOW
LAOIS
KILDARE
DUBLIN
MEATH
OFFALY
WESTMEATH
GALWAY
MAYO
ROSCOMMON
LONGFORD
CAVAN
SLIGO
LEITRIM
DONEGAL
MONAGHAN
LOUTH
CLARE
WICKLOW
NORTH 6 1 8 7 9 5 3 4 2
WEST
ISAs
LHOs
Ballyshannon
Ballyshannon
Dublin North
Dublin North Central
Dublin North West
Dublin South City
Dublin South East
Dublin South West
Dublin West
Dun Laoghaire
CAVAN
CAVAN
Dublin North
Dublin City North
Dublin City South
Dublin South West
Dublin South East
Swords (9)
Clonskeagh (6) *
Swords (9)
Clonskeagh (6)
Merlin Park
Tullamore
Merlin Park
Tullamore
Naas *
Naas
Limerick
Limerick
Lacken
Cork - West
Cork - South Lee
Cork - North Lee
Cork - North 4
Lacken
North Cork
Cork
Cork
Cork
North Lee
West Cork
South Lee

5. CHO Operating Model Framework – Framework used to develop out models
Strategy
Governance
Organisation
Geography
Process
Channel
Service Recipient
Measurement
Stakeholders
Information/Systems
Definitions
1) Service / Activity Group - Summary
Factors influencing the strategy and direction of the service
3) Operating Model Lenses
High level governance model
High level structure and roles
Where the service is being provided
High level steps in the provision of the service
2) Service / Activity Group - Considerations
Who provides the service
Who the service is aimed towards
Key service performance indicators
External and internal stakeholders
Enabling technology and information management

6. Presentation to PMO Forum 31 January 2018
DRAFT for Discussion
Strictly Private & Confidential – Not for Circulation
CHO Design Approach –
Process used to develop the operating model
Presentation to PMO Forum 31 January 2018 G
Stage Gate x
Feedback Loop
Recruitment
Governance
Formal Engagement
Consultation
Design
Legend
High Level Process
Layer 3
Layers 6 <
Layers 4 - 6
High Level Design
( e.g. Layers and Roles) 1
Detailed Design
(e.g. Detailed Job Descriptions, T&Cs, Contracts etc.) 2
Consultation & Recruitment 3
Detailed Process
G. Formal Employee Engagement
JICF
Representative Bodies
F. Engagement with DPER and DoH
Thanks for coming along
High level recap on key messages from previous meeting
High level overview of next steps
A. Design
B. Governance
C. Detailed Design
D. Governance
E. Consultation Process G1 G2 G3 G4
H. Recruitment / Imlementation G5 G6 x x x
Stakeholder Groups
CHO staff as nominated to design project teams
CHO Steering Group
CHO staff as nominated to design project teams
CHO Steering Group
Representative Bodies
NRS
National Divisional representatives
Service Delivery Programme Board
National Divisional representatives
Service Delivery Programme Board
Consultative Forum
HR National Division
CHO Chief Officers and Heads of Service
CHO Chief Officers and Heads of Service
WRC
National Director
National Director

7. CHO Operating Model / Substructure Workstream
DRAFT for Discussion
Strictly Private & Confidential – Not for Circulation
Presentation to PMO Forum 31 January 2018
CHO Operating Model / Substructure Workstream
As at end of 2017
As end of 2017 operating model options designed for CHO level:
Social Care
Primary Care
Quality & Safety
Mental Health (complete, approval to follow)
Human Resources (CHO view drafted, National HR / HBS input next)
As end of 2017 designed governance and management structures for CHO level:
Social Care to layer 5
Primary Care to layer 4, including for Network and non Network services
Mental Health to layer 4 (complete, approval to follow)
2018 Workplan
A detailed work plan has been developed and approved by the CHO Steering Group, that details the approach to further develop out the next level of structures and detailed processes to operationalise CHOs
Quarter , Networks will be piloted through a ‘learning site process’ that is forecast to span 6 months
Other CHO structures and roles have now been designed and can be considered for implementation

8. NOV 2017 – JUNE 2018 CHO OP MODEL ROADMAP:
DRAFT for Discussion
Strictly Private & Confidential – Not for Circulation
NOV 2017 – JUNE 2018 CHO OP MODEL ROADMAP:
Overall Summary of Design, and Implementation Work breakdown
Presentation to PMO Forum 31 January 2018
CHO Operating Model and Substructure Implementation
This document contains the Community Healthcare Organisations Operating Model and Substructure Workstream Roadmap across all component parts from November 2017 to end June 2018 – outlining key design next steps, identifying cross-CHO function design component dependencies and identifying interaction with the Hospital Groups.
A. Design Next Steps
B. Recruitment / Appointment
C. Network Learning Sites Integration Opportunities (TBC)
Cross-CHO
Clinical Gov. Process/Service User Scenarios
Heads of Discipline
Professional Development
Mainstreaming of Safeguarding
Monitoring and Service Improvement
Office of/Clerical Administration/Processing Hub
Primary Care
Layer 3 – ways of working & processes
Layer 4 – roles, structures & processes e.g. ‘Ologies’ Leads
Design of other services and functions e.g. Social Inclusion
GP Lead Role - to be completed in line with ongoing GP Contract negotiations
Social Care
Home Support – Layer 3-4 ways of working & processes. Layer 5-7 SC integration opportunities to learning sites.
Disability Services – Layer 3-4 ways of working & processes. Layer 5+ Design of Design of roles, structures & processes.
Residential Services – Layer 3-4 ways of working & processes. Layer 6 Design of Design of roles, structures & processes.
Mental Health
Lead roles for ECDs
Lead roles for ADONs
Roles for Heads of Disciplines
CAMHS, GA and BM Roles
Health and Wellbeing
Health Promotion and Improvement
HP&I
Other Design Elements (Environmental Health, Public Health and Population Needs Assessment) HR
Layers 3 & 4/Process Improvement
Additional Support
Quality and Safety
Wider Quality & Professional Development
Core Q&S Structure
CHO and Hospital Group Interaction Model
Interaction Model
THE TIMING AND APPROACH FOR ANY RECRUITMENT AND APPOINTMENT ARISING FROM ALL CHO OPERATING MODEL / SUBSTRUCTURE DESIGN WORK IS TBC, BELOW IS INCLUDED FOR INDICATIVE PURPOSES ONLY
Primary Care
Grading, Loading, Volume and Resourcing
Job description completion
Union negotiation
Recruitment / Appointment campaign
Social Care - All Roles
Mental Health
HR Function
Quality and Safety
IT IS YET TO BE DETERMINED IF ANY DESIGNS ARISING FROM THE CHO OPERATING MODEL / SUBSTRUCTURE WILL BE INCORPORATED INTO A LEARNING SITE PROCESS AS A POSSIBLE PHASE TWO OR OTHERWISE

9. NOV 2017 – JUNE 2018 CHO OP MODEL ROADMAP:
DRAFT for Discussion
Strictly Private & Confidential – Not for Circulation
NOV 2017 – JUNE 2018 CHO OP MODEL ROADMAP:
Illustrative View: Cross-Care Group / Divisional Functions – Detailed Design activity only
Presentation to PMO Forum 31 January 2018
Roadmap View
2017
2018
Nov
Dec
Jan
Feb
Mar
Apr
May
June 1
Clinical Gov. Process/Service User Scenarios
Redefinition and validation of all clinical governance accountabilities using service user scenarios and process mapping against designed structures and roles 2
Design of Heads of Discipline Structure
Heads of Discipline 3
Design required operating model / structure / interaction model to support Professional Development remit
Professional Development
Cross-CHO Design 4
Mainstreaming of Safeguarding
Design required operating model / structure to support mainstreaming scope of Safeguarding function. 5
Monitoring and Service Improvement
Design CHO Monitoring and Service Improvement op model / structure / interaction model 6
Office of/Clerical Administration/Processing Hub
Identify areas for shared services, deign model for administrative & data support for Offices Of Service/Function
Change Management, Stakeholder Management, Communications, Engagement, Culture Change, Programme and Benefits Management
Legend
Design
Detailed Design
Change Management

10. NOV 2017 – JUNE 2018 CHO OP MODEL ROADMAP:
DRAFT for Discussion
Strictly Private & Confidential – Not for Circulation
NOV 2017 – JUNE 2018 CHO OP MODEL ROADMAP:
Illustrative View: Social Care Group Functions – Detailed Design activity only
Presentation to PMO Forum 31 January 2018
Roadmap View
2017
2018
Nov
Dec
Jan
Feb
Mar
Apr
May
June 11 1
Home Support Services
Design required governance / processes to give effect to new joint operating model for Home Support and HS L3&4 Substructure, i.e. Clinical Supervision, Clinical Governance, Management of Procurement Processes
Implement required Governance / Process Changes / Roles and Responsibilities / Standard Operating Procedures as required
CHO SC Op Model / Substructure Design Completed, Endorsed and Approved 12
Scope and Design L5+ Disability Residential and Day Services
Disability Residential and Day Services
Design and implement required process changes to give effect to new operating model for Disability Residential and Day Services L3&4 Substructure 13
Residential Services for Older Persons
Scope and Design L6+ Residential Services
CHO Steering Group,
Centre Steering Group, and
HG Steering Groups in parallel then onto
ervice Delivery Programme Board for final approval.
Design and implement required process changes to give effect to new operating model for Residential Services for Older Persons L3&4 Substructure
Change Management, Stakeholder Management, Communications, Engagement, Culture Change, Programme and Benefits Management
CHO SC Design
Legend
Design
Detailed Design
Change Management

11. Presentation to PMO Forum 31 January 2018
DRAFT for Discussion
Strictly Private & Confidential – Not for Circulation
Presentation to PMO Forum 31 January 2018
Why Design Principles and Change Objectives?
The Design Principles and Change Objectives are there to help us navigate the design process from end to end and ensure that all aspects of the design adhere to same underlying principles.
They will be used at every stage of the design process as outlined previously to test the options developed by the project teams and the decisions made by key stakeholders.
D. Governance
E. Consultation Process
H. Recruitment
C. Detailed Design
G. Formal Employee Engagement
B. Governance
A. Design
Representative Bodies
F. Engagement with DPER and DoH
JICF G1 G2 G5 G6 G3 x G4
“Does the high level operating model and structure adhere to principles and objectives? If not can we proceed?”
- Design Team
“Does the preferred option adhere to the principles and objectives?” If not can we sign off?
- CHO Steering Group
“Does the job description adhere to the principles and objectives? If not can we proceed?”
- Design Team
“Does the detailed design adhere to the principles and objectives?” If not can we sign off?
- CHO Steering Group
“Do the changes required based on the consultation process adhere to the principles and objectives? If not how do we proceed. What changes can be made?”
- Design Team

12. Presentation to PMO Forum 31 January 2018
DRAFT for Discussion
Strictly Private & Confidential – Not for Circulation
Presentation to PMO Forum 31 January 2018
CHO Operating Model – Change Objectives
Change Objective
Detail
1. To provide a standard suite of services and a common organisation, delivery, service and resource model for CHOs across the country
To provide clarity to the community, service users and families about the services delivered so that communities can expect consistent and sustainable service delivery across all local communities
To facilitate active and meaningful engagement with these stakeholder groups as part of the design and delivery of services
To establish clear and consistent care pathways in all CHOs
To enable the equitable delivery of accessible and high quality services across the country in accordance with the determined population need and manage expectations in an open and transparent manner
To support and enable the standardisation of models of care across care settings in the community
2. To provide CHOs with the management information required to support decision making and effective management of their organisations
To provide a platform for the use of standard systems and practices supported by embedded cultures and behaviours
To enable CHO Management to have easy access to reliable information about key components of their business
To enable the development of a capability and culture of continuous improvement in CHOs managed and supported by appropriate frameworks
3. To provide CHOs with the autonomy to deliver / operationally manage services within nationally set frameworks
To provide clarity to CHOs around nationally agreed frameworks and policies
To provide clear mechanisms to support CHOs to feedback to National Centre as appropriate
4. To provide the basis for a productive, engaging work environment where employees are proud to work
To ensure that the all activities carried out in the CHOs align to the vision for CHOs
To clearly define the roles, responsibilities and accountabilities (including corporate and clinical governance) of CHOs and for all staff that work in CHOs
To clearly define the link between work carried out in CHOs and its impact on patients
To enable effective communication and engagement both within CHOs and with the rest of the system
5. To clearly define roles, responsibilities, accountabilities in the relationship between the CHOs and key stakeholders
To clarify and establish effective roles, responsibilities, accountabilities and relationships between and within CHOs from the Chief Officer to front line staff across corporate and clinical structures
To clarify and establish effective roles, responsibilities, accountabilities and relationships between the CHOs and partners (e.g. third parties / Section 38s and 39s), including commissioning and contracting relationships
To clarify and establish effective roles, responsibilities, accountabilities and relationships between the CHOs and HGs
To clarify and establish effective roles, responsibilities, accountabilities and relationships between the CHOs and the National Centre
To clarify and establish effective roles, responsibilities, accountabilities and relationships between the CHOs and the Department of Health and other government departments, agencies and regulators
6. To embed nationally agreed performance, patient safety and patient outcome measures
To ensure that decisions around service planning, design and delivery are adequately supported by agreed metrics and information
To develop a performance management framework that supports better outcomes for people accessing services
7. To enable and support integration in the delivery of services
To enable and support the delivery of effective integrated care and services, in line with the ‘Triple Aim’ goals of quality, access and cost, across the entirety of the Irish Health System including;
Within and across CHOs
Between CHOs and HGs
With partner providers (voluntary and private)
To support staff and workforce development as part of the ‘Triple Aim’ and recognise the importance of an engaged workforce to provide integrated care and improve outcomes for people

13. Presentation to PMO Forum 31 January 2018
DRAFT for Discussion
Strictly Private & Confidential – Not for Circulation
Presentation to PMO Forum 31 January 2018
CHO Operating Model – Design Principles
Design Principle
Detail
1. The CHO Operating Model will place person centred outcomes at the heart of its design and take account of and incorporate the level of variation across CHOs
The Operating Model will:
ensure that all CHOs employ a common organisation, delivery, service and resource model
ensure that all the planning, design and delivery of all CHO services is aligned to CHNs
ensure that clinical leadership, risk management and governance is embedded throughout the CHOs, across all care areas and levels, and that it is adequately fostered and supported
ensure that the approach to service delivery and management accounts for levels of variation within and across CHOs (e.g. depravation, eligibility, geography)
make services as easy as possible for people to navigate, minimising the number of contact points required to access what they require within a CHO
ensure that services are managed and delivered at the most appropriate level according to need and in the right setting
ensure that services are managed and delivered in the safest manner, and delivered as close to people’s homes and local communities as appropriate
ensure that care is delivered in partnership with service users and external providers/agencies and is respectful and responsive to individuals’ needs and values
ensure a clear definition and suite of services in CHOs and CHNs
ensure that all CHOs have the appropriate structures, ways of working, capability and capacity to complete the activities required of them as part of the ‘Evidence Informed Commissioning Cycle’ in partnership with the Centre operating model
ensure that the appropriate focus is placed on the integration of services, at all levels, and that the appropriate ways of working are put in place to support this
2. The role of the CHOs will be to deliver ‘fit for purpose’ person centred healthcare services within nationally agreed frameworks
The role of the CHOs will be to:
deliver person centred services in the safest and most efficient manner that fully utilises a co-ordinated approach across multiple agencies within local community settings
ensure services are available within the community that will support the most appropriate flow of people to acute healthcare settings as agreed through integrated clinical pathways
proactively manage and report on risk and quality within the community
continuously improve service delivery in the community
CHO performance management will be based on outcomes not levels of activity
3. All National Functions and Enablers will need to align to the National Centre / CHO / HG/ NAS as appropriate
Nationally delivered enabling services (e.g. Finance, HR, K&I, Comms, Health Business Services) will continue to be used to capitalise on economies of scale, scope and learning
The relationship between national enabling services and CHOs will be based upon a ‘provider - customer’ relationship
There will be clear definition around the requirements of CHOs with regard to enabling services, the expected levels of service and the metrics and approach through which the delivery of enabling services will be managed
4. The National Centre and the CHOs will have ownership and accountability for National and Local matters respectively
The role of CHOs will be to deliver / operationally manage services within nationally set frameworks
The ownership and accountability for CHO service delivery will rest at local level within the CHOs
The ownership and accountability for overall system design and performance, and National and/or systemic issues will rest at the Centre
The responsibility for dealing with the Department, Oireachtas or media interactions relating to service delivery matters will rest with the Delivery System
The responsibility for dealing with the Department, Oireachtas or media interactions relating to National and/or systemic matters will rest with the Centre
5. The National Centre and Delivery System Operating Models will be aligned with each other
The CHO Operating Model will be aligned with the HG, National Centre and NAS Operating Models
The CHO Operating Model will not include activities which are included in the National Centre Operating Model
Decision making and resource management should be decentralised as appropriate to and within CHOs, consistent with the corporate need for coherence, comparability and economies of scale
6. The activities in the CHOs will be structured so that they operate in the most efficient and effective manner possible
There will be no unnecessary duplication of activities between CHOs and the National Centre
Common activities, within and across CHOs (where appropriate), will be standardised and aggregated to avoid duplication of effort and leverage efficiencies within and across CHOs, at network and CHO level as appropriate
Services will be managed at the optimal organisational level within the CHO with clearly defined criteria for management of services at CHO, multiple CHN or CHN level