A number of areas have been selected to be pioneer areas to test new models of care for older persons and chronic diseases. These areas will align with existing improvement initiatives, writes Dr. Aine Carroll, National Director of the Clinical Strategy and Programmes Division (CSPD) of the HSE.
I took over from Dr. Barry White as Director of Clinical Strategy and Programmes Division of the HSE in late 2012. The division is focused on bringing clinical leadership to the heart of the decision-making process with the ultimate aim of improving quality, access and value of healthcare in the country. With some 33 National Clinical Programmes (NCPs) and nine supporting initiatives they have been one of the most significant, positive developments in the Irish Health Service. They have changed, and continue to change, how care is delivered using evidence-based approaches to system reform.
All health services are facing the enormous challenge of delivering better care whilst controlling costs. Where and how care is delivered is fundamental to addressing these challenges. The National Clinical Programmes have contributed significantly to tackling these challenges. With a changing demographic pressures, comes the need to change our approach to meeting those challenges and developing person-centred, co-ordinated models of care for everyone, thereby improving patient experiences, outcomes and efficiency of care.
Integrated Care Programmes (ICPs)
The NCPs have provided a foundation of valuable learning of the need to maintain and enhance clinical leadership and develop clinical pathways that are truly patient-centred. To this end, the NCPs are being restructured into integrated care programmes.
Four of the five Integrated Care Programmes have commenced their programmes of work and key positions to enable the development of the programmes are either filled or being finalised.
The key features are that they are designed by clinicians, with formal structures agreed with the Medical Colleges for input and sign-off. Along with similar structures being developed with Nursing and Midwifery and with Health and Social Care Professionals, the programmes take a cross-organisational view – basing the emerging models of integrated care and pathways around patients’ needs rather than organisational structures.
The Clinical Strategy & Programmes Division is working with the HSE’s Systems Reform Group to implement this reorganisation of the National Clinical Programmes and their restructuring into Integrated Care Programmes.
The five Integrated Care Programmes are focused on older persons, prevention and management of chronic disease, patient flow, children’s health and maternity. Their goal is to ensure that the health service is able to provide person-centred, coordinated care.
Four of the five Integrated Care Programmes have commenced their programmes of work and key positions to enable the development of the programmes are either filled or being finalised. The Integrated Care Programme for maternity is not yet in full development pending the release of the Department of Health’s National Maternity Strategy and its recommendations to ensure complete alignment with the strategy.
I believe the change of environment for clinical staff will present the biggest challenge, moving from a hospital-centric model to a community-based model of care.
Patient outcomes
I recognise that some areas of the health service already provide fantastic levels of person-centred, co-ordinated care. However, the challenge is ensuring that this level of co-ordinated care is maintained consistently at scale. Ultimately, my focus is on ensuring that every patient can answer confidently these three simple questions:
- Do you know who your care co-ordinator is?
- Do you know your self-management programme?
- Do you know what your care plan is?
It is the patient’s ability to answer these simple questions that will truly provide the important measure of patient outcomes and experiences to ensure the health service is as efficient and effective as it can be. It is for this reason that we fully intend on having patients and service users at the table working collaboratively with us on developing integrated care and building the structures in public.
Despite the questions appearing simple, getting to that stage will require a major change in Ireland’s health service. I am not expecting miracles and I have set realistic targets for the years ahead. I know we can’t ‘boil the ocean’. We need to identify priority pieces of work we are going to absolutely commit to over the next couple of years and make sure we successfully implement them right across the country.
Pioneer areas
Over the next year, establishing the operating model for the ICPs will be my primary focus. Ensuring the plans have the appropriate support and sign-off, appropriate monitoring and actually achieve their targets will prove challenging but I recognise their importance.
The Prevention and Management of Chronic Disease ICP will be tested in pioneer areas to test the proof of concept. If successful, it will be scaled up and brought to other areas in an attempt to learn as much as possible about the programme’s successful implementation prior to a nationwide rollout.
In 2016, the ICP for Older Persons intends to select and work with at least one integrated care pioneer area to test and deploy a model of integrated care for older persons that aligns with existing improvement initiatives. Further pioneer areas will be developed and will ultimately form an improvement network, linked with international integrated care improvement best practice.
The proof of concept workstream of the Patient Flow Integrated Care Programme is underway with a tender competition to identify a technical partner who will work to develop operational management and improvement capabilities within hospitals initially while HSE staff build up their own expertise and become self-sufficient in using these scientific approaches to health improvement.
I believe the change of environment for clinical staff will present the biggest challenge, moving from a hospital-centric model to a community-based model of care. Are we going to be asking specialists to think about specialism in ‘out of hospital’ settings? Yes we are. Are we seeking to have a look at the role of technology in supporting people to remain well at home? Yes we are. We need to look at ways to do that. We don’t know yet how we’ll be challenged. Those are the things we’ll really only be able to work through by experiencing it and dealing with the issues as they crop up. It will be an iterative continuous improvement process.
I believe Ireland can become a world leader in integrated care. There’s a global movement towards integrated care at present and I believe that despite the headlines, the fantastic, caring and compassionate staff in Ireland’s hospitals and communities are the best I have come across. It’s this high quality that fills me full of hope that the target of a person-centred, co-ordinated approach can become a reality. I have no doubt we have got the experience, expertise, drive and passion as well as numerous examples across the country of where we have managed to do it, so I absolutely believe we will be able to meet our ultimate target.”
