2. Co-operation and Working Together (CAWT) European Co-operation in the Health Sector – “Added Value for people, economy and regions” 27 September 2005 University Hospital, Basel By Mr Tom Daly Regional Development/European Officer Health Service Executive - North Western Area, Republic of Ireland 2

3.  Background to cross-border cooperation in the border region of Northern Ireland and the Republic of Ireland  Funding  Some Projects  Positive aspects and challenges  The Future Presentation Objectives

4. CAWT REGION 2 HSE North Eastern Area HSE North Western Area Southern Health and Social Services Board Western Health and Social Services Board 4 Health Authorities – 2 in Northern Ireland (NI)and 2 in the Republic of Ireland (RoI)

5. Health System – Northern Ireland  Health and social services free of charge  Planning / purchasing is separate from the provision of health services  Dept of Health, Social Services and Public Safety (DHSSPS) - policy, regional planning and resource allocation  4 Health and Social Services Boards (Eastern, Northern, Southern and Western) - agents of the DHSSPS / local needs  19 Health and Social Services Trusts – service provision  Review of Public Administration – consolidation

6. Health Systems – Republic of Ireland  Mixed public/private health care system  Department of Health and Children (DoHC) – policy, planning and resource allocation  Health Service Reforms  11 Health Boards 1 Health Service Executive (HSE) with 11 HSE areas  purchaser/provider functions

7. Border Region – A Common Bond “Borders, by their very nature, create obstacles and barriers to effective economic and social development. The reality of life in a border region is such that, to address these problems effectively, requires practical day-to-day working together and co-operation on both sides of the border.”

8. CAWT border region – some facts  25% of the total land area of the island of Ireland  Population of 1 mln people – 21% of the total population of the Island  Similar challenges with common demographic features  Region has experienced peripherality from political and economic decision making

10. Rationale for CAWT Border region has experienced associated problems of rurality such as:  Deprivation / poor infrastructure  30 years of violence ‘The Troubles’ Consequently Made sense for health service providers North and South to:  Share ideas and experiences  To pool expertise  In essence, to exploit all opportunities for joint working

11. CAWT – A Framework for Agreement  Spontaneous local cross-border work during the 1980s  Recognition of the need to formalise relationships  Ballyconnell Agreement – 10 th July 1992  Partners - North Eastern Health Board /North Western Health Board in the Republic of Ireland. Southern Health & Social Services Board / Western Health & Social Services Board in Northern Ireland

12. Political Context  Belfast Agreement signed on 10 th April 1998 - North South co-operation placed on a new basis  North-South Ministerial Council (NSMC) established  Identified 6 new cross-border implementation bodies including Special EU Programmes Body (SEUPB)  In addition, 6 areas agreed for co-operation through existing bodies in each jurisdiction – including health  Endorsement of CAWT as a framework to progress cross-border co-operation within health

13. Acute Services Physical & Sensory Disability Family and Childcare Comms Health Promotion ICT Mental Health Primary Care Finance Human Resources Director General & Management Board CAWT Development Centre Secretariat Public Health CAWT Organisational Structure Older People Learning Disability Other interest areas: -Traveller Health -- N/S Emergency Planning Steering to Safety Project Board Project Boards

14. Chief Officer CAWT Development Centre Executive Officer NEHB / SHSSB Executive Officer NWHB / WHSSB Office Manager Communications Coordinator Clerical Officer ICT Officer Finance Manager Finance Officer

15.  Department of Health in both jurisdictions(DHSSPS and DoHC)  HSE / Health Board’s own resources  Interreg IIIA  Measure 3.2 Health and Social Well Being  Peace II  Measure 5.2 Public Sector Co-operation SOURCES OF FUNDING

16.  Steering to Safety  Care of Type II Diabetes in Primary Care  Support for Learning Disability  Planning Services for Children and Young People  Health Protection A New Challenge  Epidemiological Study of Oral Health  CAWT Development Centre  Good Morning North West  Health Impact Assessment – Cross Border Approach  Improving Cross Border Mobility  GP Out of Hours  New Chance – Foster Care  Continence Support  Therapeutic Interventions for Sex Offenders INTERREG IIIA PROJECTS – Business Plan

17. Steering to Safety Rationale 2  High number of collisions/deaths from Road Traffic Accidents (RTAs)  33% higher in the CAWT region * compared to non-CAWT areas * CAWT Population Health Profile 2002  Highest Morbidity for Road Traffic collisions (RTCs) in Ireland  A major preventable area.  Above circumstances compounded by increased use of roads due to commercial, tourist and social pursuits.

18. Steering to Safety - Project Advisory Committee  National Safety Council  Dept of Public Health, HSE North Eastern Area  Health Promotion Dept. HSE North Eastern Area  National Roads Authority  An Garda Siochana  Police Service for Northern Ireland (PSNI)  Dept of Environment, Belfast  CAWT Health Promotion Sub Group  Altnagelvin Hospital – Accident & Emergency Depart.  Roads Service (NI)  Dept of Psychology Trinity College, Dublin Project Manager: Maggie Martin Reports to: CAWT Health Promotion Sub Group (Project Board) The Project Advisory Committee comprises representation from:-

19. Health Protection – ‘a new challenge’ 2  Different legislative requirements  Different roles and responsibilities  Different reporting mechanisms  Same disease  Same problems  Combined solution  Strong permanent links formed Cross border Legionella Conference - February 2005

20. GP Out - of - Hours pilot project 2  Cross border feasibility study  70, 000 people closer to a GP out-of-hours service in the opposite jurisdiction  70% of these living in socially deprived areas  Project Manager recently appointed  Two pilot areas in the border region

21. INTERREG IIIA PROJECTS - N+2  An Outcome Framework for Cross Border Children’s Services  Training the Trainers – Cognitive Therapy  Workplace Health and Wellbeing Project  Improving Cross Border Care for Those with Diabetes  Cross Border Carers of the Disabled – A Journey of Sharing and Caring  Improving Cross Border Communications for the Border Region  Promoting Mental Health Awareness Training  Sharing Cross Border Cardio Cath. Services  Recompression for Deep Sea Divers – A Cross Border Approach  It’s Good To Talk – Parents as Sex Educators  Oral Health – A Cross Border Outreach Skills Centre  EMART – A CAWT Response to CBRN  Computerised Cross Border Renal Services  Cross Border Oral Maxillo Facial Services  North South Emergency Planning  Operational Training for Ambulance Staff 8

22. Termonmaguirc – ‘a journey of sharing and caring’ Official opening of cross border holiday and respite home in Bundoran, Co. Donegal Republic of Ireland– December 2004

23. Improving Mental Health - Cognitive Therapy Participants – Celebration Event July 2004  Cross border training  NI centre for Trauma and Transformation  Response to ‘Omagh Bombing’ of 1998  Treatment for post traumatic stress disorder (PTSD)  200 trained in CT Awareness / Train the Trainers programme

24. 2 Dental Outreach skills centre – opened 22 April 05 3 cross border projects:  Fluoridation research study  Oral maxillo facial surgery project  Dental Outreach skills centre Oral Health

25. What Have Been the Challenges?  European Bureaucracy / Deadlines – N+2 and other  Currency fluctuations  Different standards, protocols and auditing  Emphasis on Spend vs Quality  Steering Group rigour v self interest  Recruiting and retaining the right staff  Local Government assembly  Health Reforms North/South

26. What Has Worked Well  Strategic Direction  Establishment of cross border health services  Delivery Agent for INTERREG IIIA Measure 3.2  Relationships with Depts. of Health, SEUPB/INTERREG IIIA  Prince II project management methodology  CAWT Development Centre  Energy /commitment of sub group and project board members  Creative Cross Border projects – very motivating and rewarding  Links with other parts of Europe

27. The Benefits  Track record - cross border health and social care works  Model of best practice  Shared sense of identity and increased understanding  Legacy of capital equipment  Pilot projects large scale projects or mainstreaming  Economies of scale – sharing of resources  Benefits to local border populations

28. The Future  Current tranche of projects – completed 2006 /07  Cross border mobility of staff and resources  Mainstream  INTERREG 4 and Peace II extension?  Expertise in place  EU legislation  Local and national political developments

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