Leadership and investment key to success

Leadership and investment were the keys to success if the Irish health services were to move from structural change to implementing integrated care, Mr. Joe Ryan, Interim Head of the Programme for Health Service Improvement (PHSI) in the HSE told a meeting of HMI South in the Erinville Hospital, Cork.

Joe Ryan
Joe Ryan

He said it was critical that all health leaders, at all levels in the organisation, showed unity of purpose and determination to implement the changes envisaged in the programme.
Lack of resources could not be the narrative on this. “We must prioritise improvement and do the maximum with what we have. We must direct the funding that is there for improvement to where it will benefit the patient. “
Mr. Ryan said the HSE PHSI had been established to drive the implementation of the priority transformation programmes at a time when a significant scope of work was being initiated across the health system to transform service delivery.  In addition, each of the Care Divisions had established service improvement programmes.

All of these programmes were competing for the same resources and management input. Projects and programmes were being initiated on an individual divisional basis, with dedicated governance structures, while criteria for evaluation of initiatives and outcomes were inconsistent. The PHSI has put a singular governance structure and processes in place to address this.

The Service Delivery elements of the Programme covered the establishment and delivery of services across the CHOs, the National Centre, Hospital Groups, the National Children’s Hospital, the National Ambulance Service and the Primary Care Reimbursement Service.

Areas it covered included network operating  and operating models for the CHOs the National Centre and Hospital Groups, network spatial mapping, an evidence based commissioning model, centre ‘Ways of Working,’ and a governance and service reconfiguration model for the Hospital Groups.

Mr. Ryan said the Service Design elements of the programme covered development of Integrated Care Programmes, the National Clinical Programmes, the implementation of service development initiatives arising from care division strategies (eg: Healthy Ireland, Vision for Change) and service improvement initiatives, that were not considered part of operational activities.

The Enabling Services elements of the programme covered projects relating to the development of the corporate functions to support the delivery system in implementing the revised service, designs, including human resource, knowledge and information, finance, communications and HBS.

He said achievements to date of the Programme included:
CHO Establishment Programme

  • Social Care operating model and organisation structures ready for implementation.
  • Primary Care operating model and organisation structures ready for implementation..
  • Mental Health operating model and organisation structures ready for implementation
  • HR, Quality Health & Wellbeing operating models.

National Centre Programme

  • Components of future commissioning framework defined. To be further developed.
  • Centre operating model to support commissioning developed.
  • Organisation arrangements to support current national centre in progress.
  • Increased clarity on future role of centre to enable delivery of delivery system changes.

Hospital Group Programme

  • Saolta clinical business unit model defined.
  • Establishment of the Women and Children’s Directorate for SSW hospital group in progress.
  • Emergency department for UL hospital group complete.

Programme Management

  • Improved integration of programme governance through establishment of revised programme structures. Further development required.
  • National and local capacity implemented for management of projects and programmes.
    Improved oversight of resourcing and funding decisions across programme
  • Consistency in approach to management of project activities, through implementation of project management systems and processes.

Service Design

  • Older Persons Model of Care 10 Step Process and implementation in Pioneer Sites
  • National Clinical Programmes and Integrated Care Programmes
  • Service improvement project on decongregation.

Service Delivery

  • Implementation of the Portlaoise HIQA Report, ED Taskforce, Out Patients Programme.
    Supporting the SDU in the planning and reporting of its work.
  • National Ambulance Service development and implementation of the Vision 2020 strategy, initial implementation of EPCR, design and initial development of the Clinical Hub.
  • PCRS –  the implementation of the Medical Card Service improvement, reimbursement service improvement and the development of the High Tech Hub.
  • National Drugs Management Programme –  the design and development of a National Pharmaceutical Unit, procurement compliance and optimisation, NCPE development and op model, development of reimbursement model for high tech drugs and development of a National Medicines Catalogue.

Enabling Services

  • Implementation of the Human Resources People Strategy, and the HR operating model.
  • The development and communication of the eHealth strategy and business case.
  • The development and implementation of the Individual Health Identifier.

Mr. Ryan said that in service design, the implementation of the Clinical and Integrated Care Programmes across the delivery system must make a more perceptible impact on the patient. This will be the focus in 2018 and beyond.

“In service delivery we must ensure that expected benefits are achieved through implementing new models of care, we must clearly communicate the changes we are making and describe the improvements being achieved and we must focus all of our efforts not on ensuring the organisation structures and processes are satisfactory to us, but that the structures and processes meet the needs of the patient and service user.

“There is a need for greater alignment of purpose across the health system to enable the programme make a real difference in the outcomes for patients and service users.

“The programme has significant complexity, which is a reflection of the scale of the health system and the nature of the changes required to move towards a more integrated delivery model that emphasises delivery of service in the most appropriate care setting.

“While there were certain commonalities in the objectives set out in the  strategy and policy documents that initiated many of the projects in the programme, there is a need for a clearer set of objectives, based on the emerging vision for health services from the Joint Oireachtas Committee Report “Sláintecare,”  that the programme should achieve, in order to ensure appropriate prioritisation of activities, resources and funding.

He said the priorities and future focus were on the delivery of integrated care and Slainte Care.“The Programme for Health Service improvement will be aligned around the delivery of the Sláintecare implementation plan being developed by Government, the integrated care programmes, chronic disease children, older persons, the Value Improvement Programme and the Urgent and Emergency Care Programme.

He said “We are doing great things across the service every day. We should unashamedly tell these stories. We must engage our staff and leaders across the system in this movement for improvement. We must engage the public in working with us to improve and change our services. We must engage our politicians in building on the start that is Sláintecare toward realising the need to invest in health and social care on a multi-year and non politicised way.”