1

The Service Vision in Northern Ireland

2

The Northern Ireland Model

• Overview of Model - John Cole

• Connected Health - Andrew Hamilton Chief Executive European Centre for Connected Health

• The Belfast Model - William Mckee Chief Executive Belfast Trust

• Design Approach - John Cole

• Afternoon Visits

3

Health and Social Services in Northern Ireland

• Population of Northern Ireland approx 1.7 million .

Almost 50% live within 30 minutes of the capital Belfast

• Integrated organisation and delivery of health services and social services under the control of the Northern Ireland Government Department of Health, Social Services and Public Safety

• Approx. 98% of health services and facilities are directly funded and owned by the public sector

4

Historic Situation

• Ever-increasing demand for services

• Surge in the number of emergency medical admissions delaying elective work

• Bed-blocking in acute hospitals by elderly patients waiting for care packages

• Large number of beds occupied by patients with chronic diseases

• Long waiting lists for GP referrals for OPD appointments, diagnostics and elective surgery

• Difficulty in staff recruitment

• High quality complex care increasingly unsustainable in smaller units

• Overcrowded Accident and Emergency Departments

• Limited integration between primary and acute sectors and services

5

Extracts from Departmental Review of the Service Model

• ‘Patient care is best seen as a system in which the acute episode is an event in an unfolding and ideally seamless pattern of care’

• ‘We were attracted by the concept of a virtual hospital, or a hospital without walls’

• ‘Part of the objective is to keep people out of acute hospitals who should not or need not be there’

• ‘The day of the stand-alone institution attempting to do everything from its own resources, acting in isolation from the wider system is already gone’

6

Current Departmental Strategy

• 1 Commissioning Body will shortly replace 4 Commissioning Bodies

• 5 Health and Social Services Provider Organisations (Trusts) have just

replaced 19 (April 2007)

• All 5 are responsible for providing both acute services and primary and

community services (previously separate organisational responsibilities)

• Specialist and Complex Services (Cancer Services,, Cardiac Surgery, Neuro-

Surgery, Regional Paediatrics, Elective Orthopaedics etc.) have been centralised at

Regional Centres of Excellence

• 18 Acute Centres to be reduced to 9 (facilitated by the development of managed

clinical networks)

• 7 of the remaining 9 hospitals to be redeveloped as Local / Community

Hospitals

• A number of hospitals designated as Protected Elective Centres (high volume)

• 48 new one-stop community / primary care centres (also providing a range of

services previously only available in hospital settings)

7

Total System Design

Regional Strategy and Key Service Objectives

facilitated by:

• New Service Model• Re-engineering of the work-force• Optimising Information Technology• Redesigning the facilities

8

5 Types / Levels of Facility

1 - Local Health Centres

2 - Community Health Centres

3 - Local Hospitals

4 - Acute Hospitals

5 - Regional Centres

• All linked by clinical and information technology networks and protocols • General principles but no rigidly fixed definition of which services are

delivered at each level• Best fit model will vary from location to location reflecting local needs• Individual projects include various combinations of services

9

Key Trends in Location of Services

1 - Local Health Centres

2 - Community Health Centres

3 - Local Hospitals

4 - Acute Hospitals

5 - Regional Centres

Movement of out-patients diagnostics and treatments fromacute towards community Key issue is the movement of chronic disease management to the community preventing unnecessary hospitalisation

Movement of complex specialties or specialties benefiting from higher critical mass to Centres of Excellence

10

An Integrated Services Model

1.7 Million RegionalHospital

Acute Hospital

Acute Hospital

Other CommunityFacilities.

Non-healthagencies

Individualhomes

HC

1

2-10 Thousand

150-300 Thousand

Acute Hospital

LocalHosp.

LocalHosp.

4

HCCHC

2

20 – 70 Thousand

100 Thousand+

CHC

LocalHosp.

CHC3

11

Potential Co-locations – Health Village

1HC

12

Potential Co-locations – Health Village

1HC

2 CHC

13

Potential Co-locations – Health Village

1HC

2 CHC

3Local

Hospital

14

Potential Co-locations – Health Village

1HC

2 CHC

3Local

Hospital

Mental Health Facility

15

Potential Co-locations – Health Village

1HC

2 CHC

3Local

Hospital

Mental Health Facility

Renal Dialysis Unit

16

H o r i z o n t a l I n t e g r a t i o n

Regional HospitalsAcute Hospitals Local Hospitals

Primary Care: Local Health Centres

Complementary Therapies

Private Sector

Community and Voluntary Sector

Healthcare and Social Services

Related Public Sector

V e

r t

i c

a l

I

n t

e g

r a

t i

o n

Community Health Centres

Level 2 (Approx 48 across Northern Ireland)

17

Cross - Sector Integration

1HC

2 CTCC

Library/ResourceCentre

CommFac.

Pharm.

Leisure/Fitness Centre

Rec/Café/Atrium

Day Centre

18

ALTN AG ELVIN

C AUSEWAY

AN TRIM

ENN ISKILLEN

C RA IG AVO N

M USG RAVE

BC H

D A ISY H ILL

ULSTER

Level 4 - Acute Hospitals

180 km

MATER

19

OMAGH

M IDULSTER WHITEABBEY

MATER

SOUTH TYRONE

LURGAN

LAGANVALLEY

DOWN

Level 3 - Local Hospitals

180 km

NEWTOWNARDS

WHITEABBEY

20

BELLEEK

ENNISKILLEN

IRVINESTOWN

FINTONA

OMAGH

CASTLEDERG

CARRICKMORE

STRABANE

COOKSTOWN

MAGHERAFELT

LIMAVADY

CITY CENTRE

SHANTALLOW

WATERSIDE

COLERAINE

ROBINSON

DALRIADA

BRAID

ANTRIM

NEWRY

S ARMAGH

ARMAGH BANBRIDGE

HILLSBOUROUGHPORTADOWN

DUNGANNONBROWNLOW

KILKEEL

NEWCASTLE

BALLYNAHINCH

LISBURN

DUNMURRAY

LARNE

WHITEABBEYCARRICKFERGUS

DOWNPATRICK

PORTAFERRY

COMBER

HOLYWOODDONAGHADEEBANGOR

ARDS

Level 2 – Community Treatment and Care Centres

180 km

SEVEN CENTRES in BELFAST

21

“ Are you sure this is what they mean

by moving care into the community ”