1. Nigel Carson Director of Equality and Public Safety Strategic Context 16 th March 2007

2. Background to Reform Programme 1998/99 – Fit for the Future 1998/99 – Fit for the Future 2001 – Acute Hospital Review 2001 – Acute Hospital Review 2002 – Developing Better Services 2002 – Developing Better Services 2005 – Appleby Review 2005 – Appleby Review 2005 – 20 Year Strategy for Health and Wellbeing – A Healthier Future 2005 – 20 Year Strategy for Health and Wellbeing – A Healthier Future 2005 – The Review of Public Administration 2005 – The Review of Public Administration

3. Vision for Change Health and well being, not just health services Health and well being, not just health services Making the system respond to the patient and client, rather than the person to the system Making the system respond to the patient and client, rather than the person to the system A self-organising system, benefiting from strong internal motivation and performance management A self-organising system, benefiting from strong internal motivation and performance management

4. Vision for Change Integrated acute, primary and community care services supporting people to live independently Integrated acute, primary and community care services supporting people to live independently Structures and control procedures that will delivery against key policies Structures and control procedures that will delivery against key policies Quality and safety Quality and safety Patient/Client experience and involvement Patient/Client experience and involvement

5. No 10 Principles of Reform National standards to ensure that people have the right to high quality services wherever they live National standards to ensure that people have the right to high quality services wherever they live Devolution to give local leaders the means to deliver these standards to local people Devolution to give local leaders the means to deliver these standards to local people More flexibility in service provision in light of people's rising expectations More flexibility in service provision in light of people's rising expectations Greater customer choice. Greater customer choice.

6. Key Policy Goals Separation of commissioning and providing Separation of commissioning and providing Delegation of a strong commissioning role to local level Delegation of a strong commissioning role to local level Strong performance management Strong performance management Strong incentives and sanctions Strong incentives and sanctions Much clearer accountability- All this should ensure improvement for patients, clients and carers. Much clearer accountability- All this should ensure improvement for patients, clients and carers.

7. Real Reform: How to Recognise it Effect is to make public services more responsive and effective Effect is to make public services more responsive and effective Requires expertise – because the world and the tasks are difficult Requires expertise – because the world and the tasks are difficult Challenges complacency and inertia Challenges complacency and inertia Recognises that the citizen is in charge, not the provider Recognises that the citizen is in charge, not the provider

8. The Model 5 Trusts plus Ambulance Service Primary Care/GPs/other Independent Primary Care Providers 7 Local Commissioning Groups HEALTH AND SOCIAL CARE AUTHORITY Patients & Clients Minister DHSSPS Patient Client Council RQIA

9. Rationale Strong patient voice –new Patient and Client Council Strong patient voice –new Patient and Client Council Regulator - RQIA to test quality against recognised standards and promote improvement Regulator - RQIA to test quality against recognised standards and promote improvement HSCA – regional service planned by health and social services specialists HSCA – regional service planned by health and social services specialists DHSSPS – smaller Department focussed on strategic policy and supporting Minister DHSSPS – smaller Department focussed on strategic policy and supporting Minister

10. Health and Social Care Authority Four main areas of responsibility:- Implementing government policy Implementing government policy Performance management Performance management Workforce planning and development Workforce planning and development Commissioning Commissioning

11. A Local Commissioning Group is: Committee of the Health and Social Care Authority (HSCA) with delegated power to commission services Committee of the Health and Social Care Authority (HSCA) with delegated power to commission services Primary care led with 15 members, two of which are lay people from the local community Primary care led with 15 members, two of which are lay people from the local community Lead and decision maker for commissioning health and social care services Lead and decision maker for commissioning health and social care services Accountable to the HSCA Board Accountable to the HSCA Board

12. LCG Configuration

13. Where are we now? Joint committee established Joint committee established Appointments – HSCA Directors Appointments – HSCA Directors LCGs – appointments next week LCGs – appointments next week New Trusts operational from April 2007 New Trusts operational from April 2007 Trust non- executives; announcement next week Trust non- executives; announcement next week

14. South Eastern HSS Trust (includes) Ulster Community & Hospitals Down & Lisburn Western HSS Trust (includes) Sperrin Lakeland Altnagelvin Hospital Foyle Northern HSS Trust (includes) Causeway United Hospitals Group Homefirst Belfast HSS Trust (includes) Belfast City Hospital Greenpark North & West Belfast Mater Infirmorum Royal Group of Hospitals South & East Belfast Southern HSS Trust (includes) Craigavon Area Hospitals Group Craigavon & Banbridge Community Newry & Mourne Armagh & Dungannon

15. Looking Ahead Accommodation - locations initially on a temporary basis Accommodation - locations initially on a temporary basis Trust legislation in place Trust legislation in place Draft reform bill for consultation, closing date 11th April 2007 Draft reform bill for consultation, closing date 11th April 2007 HSCA operational by April 2008 HSCA operational by April 2008

16. But more than structure… New structures do not of themselves create new behaviours New structures do not of themselves create new behaviours Success will be better services for the public through Success will be better services for the public through Strong leadership Strong leadership A spirit of cooperation A spirit of cooperation Relentless focus on improvement Relentless focus on improvement A culture of learning and innovation A culture of learning and innovation