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The Service Vision in Northern Ireland
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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
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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
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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
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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’
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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)
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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
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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
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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
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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
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Potential Co-locations – Health Village
1HC
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Potential Co-locations – Health Village
1HC
2 CHC
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Potential Co-locations – Health Village
1HC
2 CHC
3Local
Hospital
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Potential Co-locations – Health Village
1HC
2 CHC
3Local
Hospital
Mental Health Facility
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Potential Co-locations – Health Village
1HC
2 CHC
3Local
Hospital
Mental Health Facility
Renal Dialysis Unit
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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)
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Cross - Sector Integration
1HC
2 CTCC
Library/ResourceCentre
CommFac.
Pharm.
Leisure/Fitness Centre
Rec/Café/Atrium
Day Centre
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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
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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
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“ Are you sure this is what they mean
by moving care into the community ”