Health & Social Care Reform in Northern Ireland

1. Health & Social CareReform in Northern Ireland HMI/IHM Joint Leadership Event 15 May 2009 Dean Sullivan Director of Planning and Performance, DHSSPS

2. Overview • Organisational context • Structural reform • Performance improvement • Challenges

3. Organisational context • Steady state system at macro level since 1973 – creation of integrated Health and Social Care system • Conservative reforms of early 1990s • Commissioner/ provider split • GP fundholding • ‘Self-governing’ Trusts • Labour Government elected in 1997 – GP fundholding abolished, new primary care engagement process, new organisational forms • No equivalent push in NI

4. Structural reform • Restoration of NI Assembly 1999 – Review of Public Administration (Health, Education, Local Government, etc.) an immediate priority • Suspension of Assembly 2002 – hold on RPA continued until 2005 • Shaun Woodward pushes forward on HSC reform – proposals developed for six Trusts and a Regional Health Authority • Assembly restored May 2007 – RHA plans scrapped; alternative arrangements introduced April 2009 – increased focus on public health agenda

5. New organisational arrangements April 2007: • 18 Trusts reduced to six (12,000 to 22,000 employees) April 2009: • Four area-based commissioning Boards replaced by two new regional organisations: • HSC Board (with five local commissioning groups) • Public Health Agency • Business Services Organisation – non-clinical support • Patient and Client Council

6. Performance – context • Longest waiting times in UK • Appleby Review 2005 – poor performance relative to England • NIAO/ PAC reports • Damaged public confidence

7. Performance – 2005 • 180,000 patients waiting for initial outpatient assessment (74,000 6+ months) • 48,000 patients waiting for surgery (14,000 6+ months) • Hundreds of patients waiting over 12 hours for admission to hospital each week • Absence of robust performance information for many other hospital and community services

8. Focus on Performance • Strategic Alliance between DHSSPS and GMSHA from April 2005 • Initial focus (2005-06 and 2006-07) on elective care • Focus substantially broadened in 2007-08 to include A&E, cancer, fractures, etc. and a range of community services • Dedicated Service Delivery Unit established as part of DHSSPS in 2006 – now a core element of the new HSC Board

9. Key elements of reform • Clear, unambiguous targets • Comprehensive, accurate and timely management information • System and process change • High quality, professional support • Clinical engagement • Holding leaders accountable for delivery

10. Impact: OP 2002 – 2007

11. Impact: IP/DC 2002 – 2007

12. Impact: Patients waiting over 12 hours each week in A&E

13. Impact: Patients waiting over 12 hours each month in A&E

14. Impact: Patients waiting over 12 hours each month in A&E

15. Challenges • Alignment of focus and key priorities across the HSC – Minister/Department/Commissioners and Providers • Sustaining hard-won performance improvements • Increasing focus on quality and public health agendas • Roles and responsibilities, accountability and assurance – ‘eye watering’ clarity • Challenging financial context • Core competence – access, safety, finance. No false trade-offs

16. “Thank goodness it’s not healthcare.” Rocket Scientists across the world