Nigel CarsonDirector of Equality and

Public Safety

Strategic Context

16th March 2007

Background to Reform Background to Reform ProgrammeProgramme

1998/99 – Fit for the Future1998/99 – Fit for the Future 2001 – Acute Hospital Review2001 – Acute Hospital Review 2002 – Developing Better Services2002 – Developing Better Services 2005 – Appleby Review2005 – Appleby Review 2005 – 20 Year Strategy for Health 2005 – 20 Year Strategy for Health

and Wellbeing – and Wellbeing – A Healthier FutureA Healthier Future 20052005 – – The Review of Public The Review of Public

AdministrationAdministration

Vision for ChangeVision for Change

Health and well being, not just Health and well being, not just health serviceshealth services

Making the system respond to the Making the system respond to the patient and client, rather than the patient and client, rather than the person to the system person to the system

A self-organising system, A self-organising system, benefiting from strong internal benefiting from strong internal motivation and performance motivation and performance managementmanagement

Vision for ChangeVision for Change Integrated acute, primary and Integrated acute, primary and

community care services supporting community care services supporting people to live independentlypeople to live independently

Structures and control procedures Structures and control procedures that will delivery against key policiesthat will delivery against key policies

Quality and safety Quality and safety Patient/Client experience and Patient/Client experience and

involvementinvolvement

No 10 Principles of No 10 Principles of ReformReform

National standards to ensure that National standards to ensure that people have the right to high quality people have the right to high quality services wherever they liveservices wherever they live

Devolution to give local leaders the Devolution to give local leaders the means to deliver these standards to means to deliver these standards to local people local people

More flexibility in service provision in More flexibility in service provision in light of people's rising expectationslight of people's rising expectations

Greater customer choice. Greater customer choice.

Key Policy GoalsKey Policy Goals

Separation of commissioning and providingSeparation of commissioning and providing

Delegation of a strong commissioning role to Delegation of a strong commissioning role to

local level local level

Strong performance managementStrong performance management

Strong incentives and sanctions Strong incentives and sanctions

Much clearer accountability- Much clearer accountability- All this should All this should

ensure improvement for patients, clients and ensure improvement for patients, clients and

carers.carers.

Real Reform:Real Reform: How to Recognise it How to Recognise it

Effect is to make public services Effect is to make public services more responsive and effectivemore responsive and effective

Requires expertise – because the Requires expertise – because the world and the tasks are difficultworld and the tasks are difficult

Challenges complacency and inertiaChallenges complacency and inertia Recognises that the citizen is in Recognises that the citizen is in

charge, not the provider charge, not the provider

The ModelThe Model

5 Trusts plus Ambulance Service

Primary Care/GPs/other

Independent Primary Care Providers

7 Local Commissioning Groups

HEALTH AND SOCIAL CARE AUTHORITY

Patients & Clients

Minister DHSSPS

Patient Client Council RQIA

RationaleRationale Strong patient voice –new Patient and Strong patient voice –new Patient and

Client CouncilClient Council Regulator - RQIA to test quality Regulator - RQIA to test quality

against recognised standards and against recognised standards and promote improvementpromote improvement

HSCA – regional service planned by HSCA – regional service planned by health and social services specialistshealth and social services specialists

DHSSPS – smaller Department DHSSPS – smaller Department focussed on strategic policy and focussed on strategic policy and supporting Ministersupporting Minister

Health and Social Care Authority

Four main areas of responsibility:-Four main areas of responsibility:-

Implementing government policyImplementing government policy

Performance managementPerformance management

Workforce planning and developmentWorkforce planning and development

CommissioningCommissioning

A Local Commissioning A Local Commissioning Group is:Group is:

Committee of the Health and Social Care Committee of the Health and Social Care

Authority (HSCA) with delegated power to Authority (HSCA) with delegated power to

commission services commission services

Primary care led with 15 members, two of which Primary care led with 15 members, two of which

are lay people from the local communityare lay people from the local community

Lead and decision maker for commissioning Lead and decision maker for commissioning

health and social care serviceshealth and social care services

Accountable to the HSCA BoardAccountable to the HSCA Board

LCG ConfigurationLCG Configuration

Where are we now?Where are we now?

Joint committee established Joint committee established

Appointments – HSCA DirectorsAppointments – HSCA Directors

LCGs – appointments next weekLCGs – appointments next week

New Trusts operational from April New Trusts operational from April

20072007

Trust non- executives; announcement Trust non- executives; announcement

next weeknext week

South Eastern HSS Trust (includes)Ulster Community & HospitalsDown & Lisburn

Western HSS Trust (includes)Sperrin LakelandAltnagelvin HospitalFoyle

Northern HSS Trust (includes)CausewayUnited Hospitals GroupHomefirst

Belfast HSS Trust (includes)Belfast City HospitalGreenparkNorth & West BelfastMater InfirmorumRoyal Group of Hospitals

South & East Belfast

Southern HSS Trust (includes)Craigavon Area Hospitals GroupCraigavon & Banbridge CommunityNewry & MourneArmagh & Dungannon

Looking AheadLooking Ahead

Accommodation - locations initially on a Accommodation - locations initially on a

temporary basistemporary basis

Trust legislation in placeTrust legislation in place

Draft reform bill for consultation, closing date 11th Draft reform bill for consultation, closing date 11th

April 2007April 2007

HSCA operational by April 2008HSCA operational by April 2008

But more than But more than structure…structure…

New structures do not of themselves New structures do not of themselves create new behaviourscreate new behaviours

Success will be better services for Success will be better services for the public throughthe public through• Strong leadershipStrong leadership• A spirit of cooperationA spirit of cooperation• Relentless focus on improvementRelentless focus on improvement• A culture of learning and innovationA culture of learning and innovation