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 DalyRegional Development/European Officer

Health Service Executive - North Western Area, Republic of Ireland

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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

CAWT REGION

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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)

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

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

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.”

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

Rationale for CAWT

Border region has experienced associated problems of rurality such as: Deprivation / poor infrastructure 30 years of violence ‘The Troubles’

ConsequentlyMade 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

CAWT – A Framework for Agreement Spontaneous local cross-border

work during the 1980s Recognition of the need to formalise

relationships Ballyconnell Agreement – 10th 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

Political Context

Belfast Agreement signed on 10th 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

AcuteServices

Physical & SensoryDisability

Family andChildcare

CommsHealth

PromotionICT

MentalHealth

PrimaryCare

Finance

HumanResources

Director General&

Management Board

CAWT Development

Centre

SecretariatPublic Health

CAWT Organisational Structure

Older People

LearningDisability

Other interest areas:-Traveller Health

-- N/S Emergency Planning

Steering to Safety

Project Board

Project Boards

Chief Officer

CAWT Development Centre

Executive Officer

NEHB / SHSSB

Executive Officer

NWHB / WHSSB

Office Manager Communications Coordinator

Clerical Officer

ICT OfficerFinance

Manager

Finance Officer

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

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

Steering to Safety Rationale

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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.

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:-

Health Protection – ‘a new challenge’

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Different legislative requirementsDifferent roles and responsibilitiesDifferent reporting mechanismsSame disease Same problemsCombined solutionStrong permanent links formed

Cross border Legionella Conference - February 2005

GP Out - of - Hours pilot project

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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

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

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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

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

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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

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

What Has Worked WellStrategic 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

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

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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