The Experience on Health and Social Care Services Integration in

N h I l dNorthern Ireland

Dr Andrew McCormick

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

“We need a comprehensive, integratedapproach to service deliveryapproach to service delivery.

We need to fight fragmentation.”

WHO Director-General, 2007WHO Director General, 2007

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Current challenges

• Growing and gageing population

• Increase in number of people with Longof people with Long Term Conditions

• Over reliance and demand on Acutedemand on Acute Hospital beds

• Workforce Population 1.8M

• FinancePopulation 1.8M

Health and Social Care annual budget £4.3Bn 

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Integrated care?

• Integrated structure in Northern Ireland since 1973• Reform of Health and Social Care in 2009 to maximise

economies of scale and improve outcomes• More streamlined structures:

– One Ministerial Department for Health and Social Care

– One Regional Commissioning Board working inOne Regional Commissioning Board working in tandem with One Regional Public Health Agency

– Five Local Commissioning GroupsSix Health and Social Care Trusts including the NI– Six Health and Social Care Trusts including the NI Ambulance Service Trust.

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Integration is a Statutory Duty

Health and Social Care (Reform) Act (Northern Ireland) 2009Department’s general duty2. (1) The Department shall promote in Northern Ireland an

i t t d t fintegrated system of(a) health care designed to secure improvement

(i) in the physical and mental health of people in Northern(i) in the physical and mental health of people in Northern Ireland, and(ii) in the prevention, diagnosis and treatment of illness; and( ) p , g ;

(b) social care designed to secure improvement in the social well-being of people in Northern Ireland.

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Barriers to Integration

• Traditional focus on acute care and the medical d lmodel

• Under-developed community infrastructure• Different information systems• Professional and financial silosProfessional and financial silos• Business Models and payment mechanisms that

are not alignedare not aligned.

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Integration Maturity Pathg yAccountable Carele Care

Integrated carecare

Coordinated Care

Connected care

Independent careIndependent care

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Enablers for Integrationg• Policy and Legislative Reform

• Integrated Care Partnerships

• Family Support Hubs and Early Intervention• Family Support Hubs and Early Intervention

• Infrastructure Reform

• Innovative technology

• Personalisation of Care

• Mixed Economy / Integrated Ecosystem• Mixed Economy / Integrated Ecosystem

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Enabler for Integration:Policy & Legislative Reform

Th N th I l d E tiThe Northern Ireland Executive• Programme for Government : Priority 5 –“Reconfigure, reform and modernise the delivery of Health and Social Care

services to improve the quality of patient care”services to improve the quality of patient care•Regional Economic Strategy includes key focus on healthcare innovation

•Cross Government Departments•Cross Government Departments• Delivering Social Change (2012)• Public Health Strategic Framework (due Autumn 2013)

•Department for Health, Social Services & Public Safety• Health and Social Care Act (2009)• Transforming Your Care (2011)Transforming Your Care (2011)

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Enabler for Integration:I t t d C P t hiIntegrated Care Partnerships

•Multi-sector collaborative networks of health and social care providersMulti sector collaborative networks of health and social care providers

•1 ICP per 100,000 of the population; implemented across Northern Irelandbringing together statutory and non-statutory sectorsg g g y y

•Respond innovatively to the assessed care needs of local communities

•Co-ordinate the local application of fully integrated care pathways

•Initial priority areas: frail older people and those – regardless of age – withcertain long term conditions

•Aim is to ensure that service users receive more effective and efficient, joinedd t id i it t h it lup care and to avoid unnecessary visits to hospital.

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Enabler for Integration:Family Support Hubs & Early InterventionFamily Support Hubs & Early Intervention• Multi-agency network - statutory, community and voluntary - providing

di t d f l i f f ili di l i t ti icoordinated referral services for families needing early intervention services

• Hubs facilitate access to services in a particular locality; they do not provide services directlyservices directly

• Hubs accept referrals from a range of agencies on behalf of families in need of early intervention support services

• They use their knowledge of local service providers and the regional Family Support Database to signpost families to appropriate services

• The Delivering Social Change Hub Signature Project will support the existing network of Hubs and develop 10 new ones.

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Enabler for Integration:Infrastructure Reform

I t t i i d it i f t t t t th d li•Investment in primary and community care infrastructure to support the deliveryof integrated care locally

Provision of a wide range of services under one roof For example: GP• Provision of a wide range of services under one roof. For example: GP services, physiotherapy, podiatry, social care, and diagnostic investigations

•‘Hubs’ are centres which provide services for both the local population and for• Hubs are centres which provide services for both the local population and forits range of ‘spokes’ which are its GP surgeries

•The aim is to make it easier to access the health and social care system and toThe aim is to make it easier to access the health and social care system and toreduce the need to visit hospital for services which could more easily bedelivered locally.

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Enabler for Integration:gInnovative Technology

• Electronic Care Record is a ‘joined up network of patient information’ which provides a single view of key patient/service user data

• E-health:•Telehealth monitoring• Telecare Services•ICT and Communication between health professionals and with patients/clients•Social media to support public health messaging•Use of eHealth technologies in delivering services and supporting care provision such as Telepresence Robot

• Smart Residential Communities provide opportunities to harness technology to bl l t li i d d tlenable people to live independently.

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Enabler for Integration:Personalisation of Care

Di t P t (DP) h b il bl i N th I l d f 10•Direct Payments (DP) have been available in Northern Ireland for over 10 years. Any adult who has been assessed as in need of community care services is eligible to receive a Direct Payment, together with the parents of disabled children and carerscarers

•Self Directed Support empowers people to use an individual budget to obtain the support they want by giving them more choice and control over their supportsupport they want by giving them more choice and control over their support arrangements

•The aims of self directed support include promoting greater choice supportedThe aims of self directed support include promoting greater choice, supported participation, mutuality and equality and human rights.

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Enabler for Integration:Mixed Economy

I N h I l d h l h i d i l id d b h•In Northern Ireland healthcare is predominantly provided by the state on the NHS model

• Many aspects of adult social care are provided by the private and voluntary sector

• Securing effective integration requires mature management of the work between all sectors and recognition of the potential g pdifferences of interest.

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Enabler for Integration:Mixed Economy

J 25 ld S i l W k

Nurse Psychiatrist

Supported Joe – 25 year oldRecently diagnosed with

Severe Mental Illness

Social WorkerSupported Housing

Support GroupAdvocate

Support Worker Employment

Support GroupAdvocate

Support Worker Advisor Statutory Sector

Community & Voluntary SectorCommunity & Voluntary Sector

Independent Sector

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Enabler for Integration:gIntegrated Ecosystem

Like Catalunya, we have an ECH Alliance Ecosystem which:

• supports collaboration and innovation within Northern Ireland• supports collaboration and innovation within Northern Ireland and with partner regions; and

•brings together all the necessary parties in a region to facilitate dissemination of best practice, ideas and solutions to support more effective service user caremore effective service user care.

Commissioners of HealthcareCommissioners of Social Care

CONSUMERS

PATIENTS

PEOPLE

Primary, Secondary and Community Care

Domiciliary services

Assisted Living

Care Homes

US

Community Care services services services

IndustryPublic Providers University & Research Organisations

Technology devices, equipment and services

y

PharmaceuticalICT / telecoms

y g

servicesConsumer healthcare products and

services

The Experience on Health and Social Care Services Integration in Northern IrelandDr Andrew McCormick

Integration: The Way Ahead

“My vision is to drive up the quality ofMy vision is to drive up the quality of care for patients, clients and service

users, improve outcomes, and enhance the patient experience so that peoplethe patient experience so that people

are treated in the right place at the i ht ti d b th i ht l ”right time and by the right people”.

Minister for Health, Social Services and Public Safety