The new Health Regions would stand up from February 2024, as the REOs were appointed, and would continue to progress throughout 2024, in accordance with an agreed design/blueprint, Damien McCallion, HSE Chief Operations Officer, told the Conference.
In the first instance, CHOs and Hospital Groups would report directly to the REOs, but a Health Region Leadership Team would be appointed during the year, with a view to standing down the CHOs and HGs by the end of 2024.
Implementation of the new structures would continue through 2024 and managers would have to maintain focus on service delivery and improving our services while going through this process, difficult as that could be, Mr. McCallion said.
But revised structures were only part of the programme:- ways of working/processes were more important to deliver Integrated Care.
Health Regions would provide autonomy to plan and deliver services to meet the needs of the local population. National consistency would be achieved via pathways and national frameworks/national programmes. Managers/staff should expect in the future to work across the pathways of care. The focus from HSE Centre would be on Planning, Enabling, Performance and Assurance (PEPA).
Mr. McCallion said that integrating services to improve outcomes and experiences for people went beyond structures. There were nine pillars of integration:
- Shared values and vision.
- Population health and local context.
- People as partners in care.
- Resilient communities and new alliances.
- Workforce capacity and capability.
- System wide governance and leadership.
- Digital solutions.
- Aligned payment systems.
- Transparency of progress, results and impact.
The Chief Operations Officer stressed the importance of culture and continuous improvement –empowering front-line teams in the delivery of integrated patient-centred care that included full engagement of patients/service users. There were existing programmes and initiatives such as Clinical Programmes, Integrated Care Programme for Older People (ICPOP) and Modernised Care Pathways trying to integrate care.
“We must continue to implement key programmes that organise and deliver our services in a more integrated manner, where needed, so that people’s access to and experience of our system is positive with good outcomes,” he said.
The challenges of the current model were lack of integrated care for patients, fragmented care or patients unable to access the care they needed in a timely manner, misaligned geographies, which increased pressure on urgent and unscheduled care, decisions being made too far from the patient, too far from HSCPs, and which required navigating significant bureaucracy and less efficient allocation of resources between hospital and community care.
The strategic objectives of the health regions were to:
- Align hospital-based and community-based services to deliver joined-up, integrated care closer to home.
- Clarify and strengthen corporate and clinical governance and accountability at all levels.
- Support a population-based approach to service planning and delivery.
- Balance national consistency with local autonomy to maintain consistent quality of care across the country.
“We will still be a single HSE organisation, with six health regions. Services will be integrated across hospitals and community in these health regions. The six geographical boundaries have been agreed within the HSE – Health Regions will not be separate statutory bodies. They will use the HSE logo and be under the governance of the HSE Board.
“Following a transition period, the Health Region management structure will replace existing CHO and HG management structures. The Regional Health Forum structure will remain but will reflect Health Regions structure. Operational focus will move from HSE national to Health Region. HSE national will develop and oversee standards and guidelines for implementation at regional level.”
Mr. McCallion said work completed or currently underway by the Health Regions Programme Team in collaboration with a wide range of stakeholders included:
- Stakeholder Engagement: Ongoing stakeholder engagement would continue to inform further design of the Health Regions programme across multiple fora.
- HSE Centre: A CEO review of the HSE Centre was currently underway. High level design to be finalised by end of November 2024.
- Integrated Service Delivery: An ISD Workstream had been established to consider the preferred set of organisational arrangements to support integrated care.
- Geographic Impact Assessment: An analysis of the outputs of the impact assessment was under consideration by Operational Leads.
- Recruitment of the six Health Region Regional Executive Officers (REOs): The recruitment process was underway with the Public Appointments Service.
- Workforce Transition: A programme of work was underway with National HR in relation to workforce considerations and the potential impact on staff/roles.
- Change Management: A proposal to establish Change and Innovation Hubs within the Health Regions was being developed.
We had to consider how we integrated services for people on a range of levels – Population, Age cohort, e.g. Children, Care Needs, Service, Facility and Team.
An Integrated Service Delivery (ISD) Workstream Group had been established to inform the design of the ISD model. The group was comprised of multi-disciplinary representatives from across health and social care services including patients/service users, academics, healthcare staff and managers, and policymakers. The purpose of the Integrated Service Delivery Workstream Group was to progress the detailed design for ISD and to propose a preferred set of organisational arrangements to underpin, enable and support the provision of integrated care.
The workstream members had also considered how clinical networks, care pathways and service planning and delivery processes would underpin integrated care. The scope of the ISD Workstream Group was to make recommendations for the end state organisational arrangements and structures to enable integrated care.
“It is recognised that there are many factors that contribute to enabling integrated care, e.g., workforce, digital solutions, aligned payment systems etc., as set out in the IFIC 9 Pillars of Integrated Care. The primary focus of the ISD Workstream Group is the structures needed to facilitate integrated service delivery.
“Key Recommendations that emerged from Integrated Services Model Process were:
- HCHNs as building blocks for structure and key access point for patients.
- Hospital and Community services under common governance arrangement.
- A structure that took account of voluntary organisations based on partnership principles.
- Strong regional leadership and governance including QPS, performance and strategy with IHAs having an operational focus.
- Hospital networks and support functions to be maintained.
- Patient partnership function as part of regional and local structure.
- Clinical leadership role of GPs to be addressed in structure.
- Supra-regional and national specialist services needed to be accounted for/protected in structure.
- A structure that allowed for crossing of boundaries where there were gaps – enabling access to all levels of hospitals within a region/between regions.
- A population health lens to be applied to detailed design of IHA/region.
- Built in capacity to enable self-assessment against standards of integrated care.
- Academic/research component embedded to create continuous learning environment.
- Leaner, more agile management teams & structure.
- Clinical Director covering hospital and community services within a geographical area, e.g., mental health palliative care.
- Management structures that created one team across IHA rather than separate teams in hospital and community, e.g., HSCPs.”
Mr. McCallion then discussed how integration impacted on some key priorities such as hospital and community waiting lists. He said the challenge was that despite increased activity, lists were standing still or growing as demand increased. We needed to consider potential across services such as the pathway for Ophthalmology which worked across community and hospital settings.
In the area of Urgent and Emergency Care where patients moved across pre-hospital emergency care, community and hospital settings, care pathways for some critical care conditions across the pathways, e.g. stroke and cardiology had already been implemented.
We needed to consider if our service was best organised to support urgent and emergency care and older people within our hospitals and across our care continuum, e.g., diagnostics, therapy assessments, discharge planning.
We were challenged to support children and families with basic needs and more complex needs such as in mental health and disabilities. Staff were working hard but families were unhappy and regulators and the Ombudsman were critical of our integrated response. “We need to put needs of the child up front in a holistic sense and also look at need within the community network and we need to ensure we integrate our response to children and their families and improve ‘hand offs.’”