Transcript Organising to deliver integrated care

Integrated Services Programme –
Integrating Hospital and
Community Services
Overview
Irish Pharmaceutical Healthcare
Association
September 2010
CASE FOR CHANGE
HSE Corporate Plan 2008-2011 sets out a clear vision for implementing an
Integrated health and social model for Ireland.
Why are we making these changes?
 To drive and support safe, quality care for patients and clients.
 To bring decision making close to where services are delivered.
 To allow clinicians to shape and assure the services they work in.
 To get the best health outcomes for the money spent.
 To plan and organise around what we know people need and what we
know works to give the best results.
 To organise to meet increasingly complex patient and client needs
 To remove barriers to integrated care.
CHANGING DEMANDS ON OUR HEALTH AND
SOCIAL CARE SYSTEM…….


Population is aging
000’s, persons over 60

The average number of cancer
cases is predicted to increase
000’s, predicted no. of cases, 95%
CI

552
590
650

25

1996 
2002 

Increase in demand
from higherdependency segment
of population
2006


2005
CAGR +3%
30
2010 
35
201 
5
42
2020
Increased requirement for
prevention and specialist
treatment
Source: CSO, National Cancer Registry Ireland; CSO; Interviews; team analysis

Increasing
prevalence of
conditions such
as diabetes,
obesity, heart
disease and
asthma puts an
increasing
burden on the
health service
WHAT SHOULD THIS MEAN FOR PATIENTS & CLIENTS
 Services will be more accessible locally, centred around
the patient, rather than centred around an institution
 Shift towards prevention and better self care rather
than a focus on acute care and treatment
 Improved patient outcomes
 Right balance between inpatient, day case and
community based care
 More efficient use of resources and more transparent
accountability
* As per the HSE Corporate Plan 2008
PROGRAMME STAGES
Top
Down
Bottom
Up

Stage I (completed June 2008)

Design optimal organisation structure and supporting
management process building on Mc Kinsey review and agreed
Integrated Model of Care

Stage II (continuing June 2008 – Dec 2009)

Establishment of the new Quality and Clinical Care Directorate

Putting new top team in place

Establishment of Integrated Services Directorate

RDOs appointed & Interim Regional Management Teams in place

Stage III (continuing August 2009 - 2010)

Determining how front line services should be organised

Management arrangements to support above

Drafting of catchment areas for hospitals and primary care
RECOGNITION THAT SHAPING AN EFFECTIVE
ORGANISATION GOES FAR BEYOND ‘BOXES ON A PAGE’
 Organisation structure
 Reporting
 Roles
 Accountabilities
Measures & Objectives
 Goals & Objectives
 Budget allocation
 Care Pathways
 Performance management
 Metrics and good information
 Monitoring
 Clearly defined interfaces
 Transparent, easy-to-follow care pathways
 Shared values
 Common vision
 Mutual respect
 Right People
 Committed, competent individuals
 Development of teams
LEVERS FOR INTEGRATION
 Service Delivery Models and Strategies
 Organisation
 Organisation structure
 Budgetary and planning processes
 Patient and Client Pathways
Service Delivery Model
SERVICE DELIVERY MODEL
Level IV
Tertiary Acute Services
Level III
Integrated Service Areas
(Including Secondary Care Hospitals)
Level II
Community Health &
Social Care Networks
Level I
Primary Care Teams
Home
Home
100,000-350,000
30,000-50,000
7,000-10,000
Patient
SERVICE DELIVERY MODEL
 531 Primary Care Teams mapped
for the entire country
 Health and Social Care Networks to
be established
 Hospital reconfiguration
programmes underway
 Programmes of Care established,
e.g. Acute Medicine Programme
 Structures and processes in place to
ensure care groups are managed
cohesively
Primary Care Teams
Donabate
Rathoath
Ashbourne Oldtown
Swords
Mulhuddart/Corduff Finglas
Ballymun
Kinsaley
Dunboyne
Coolock/Darndale
Blakestown
Edenmore
Coolmine
Killester
Roselawn Phibsborough MillmountMarino
Leixlip Lucan Heights Castleknock
Cabra West Clontarf East
Ashtown
East Wall
Lucan Esker
Chapelizod/Palmerstown irishtown
Lucan St Helens
Drumfinn Rialto Pearse st
Celbridge 2
Sandymount
Curlew Road
Donnybrook
Clondalkin
Walkinstown Rathmines/Terenure
Dundrum
Kilnamanagh/Tymon
Blackrock
Brookfield Limekiln
Stillorgan
Balally
Rathcool/Saggart Millbrook Ballyboden
Ballinteer
Killinardan/Oldbawn
Jobstown
Carndonagh/Clonmany
Moville
FanadBuncrana
Dunfanaghy/Falcarragh Rosquill
Derrybeg
Dungloe
Letterkenny Raphoe/Manor
Stranorlar/Cloghan Lifford/Castlefin
Ardara/Glenties
Ballyogan/Ballinteer
Firhouse
Ballyogan
Kill
Killibegs/Rossan
Donegal
Shankill
Blessington
Bray
Ballyshannon/Bundoran
North Sligo
Erris
Monaghan
Sligo Town North Leitrim & West Cavan
West Sligo
Central Sligo
Crossmolina
Clones
BallybayCastleblaney
Central Leitrim
Ballina
West Cavan
South Sligo East Sligo
Cootehill
Cooley
Dundalk
Cavan
Carrickmacross
Boyle
South Leitrim
Swinford
Bailieborough/Kingscourt
Carrick on Shannon
Arvagh/Ballinagh
Charlestown
Mid Louth
Ballaghadereen
Ardee
Ballyjamesduff Virginia
WestportCastlebar
Nobber Clogher Head/Dunleer
Ballyhaunis
Strokestown
Granard
Drogheda
Castlerea
Oldcastle Kells
Longford
Slane
Drogheda/Meath
Claremorris
Edgeworthstown Nth Westmeath
Louisburgh
Duleek Laytown/Bettystown
Athboy Navan
Glenamaddy
Delvin
Roscommon
Ballinrobe
Balbriggan
Ballymahon
Trim AshbourneOldtown Skerries
Tuam
Mullingar
Lusk Rush
Clifden
Dunshaughlin
Kinnegad
Innfield Summerhill RathoathSwords Donabate
Mountbellew
Oughterard
Athlone LW
Headford
Dunboyne FinglasHowth/Sutton
KilbegganRochfortbridge
Abbey
Kilcock
Moate
Athlone R
Mulhuddart/Corduff
South Connemara
Derrinturn
Claregalway
Celbridge 2
Clara
irishtown
Moycullen
Clondalkin
Edenderry
Clane
Spiddal
Ferbane
Castlegar
Ballinasloe
Rathcool/SaggartBlackrock
Athenry
Daingean
Kilmeague
City East
Oranmore
Kill FirhouseBallyogan
Tullamore
Rathangan
Naas
Banagher
Jobstown Shankill
Loughrea
Newbridge
Portarlington
Bray
Greystones
Blessington
Kildare
Aran Islands
Mountmellick
Monasterevin Kilcullen
Newtownmountkennedy
Portumna
Gort
Birr
Dunlavin
Portlaoise
Lisdoonvarna
Borrisokane
Athy
Wicklow
Mountrath
Stradbally
Baltinglass
Shinrone
Rathdrum
Borris
in
Ossary
Castledermot
Scarriff
Roscrea Abbeyleix/Durrow
Ennistimon
Ballickmoyler Hacketstown
Arklow
Nenagh
Ennis
Carlow
Ballina/Killaloe
Castlecomer
TullowSouth Wicklow
Templemore
Sixmilebridge
Freshford/Johnstown
Shannon
Westbury Newport
Bagnelstown/Leighlinbridge
Kilrush
Thurles
CastleCastletroy
Bunclody Gorey
Kilkenny
Kilkee
Ballycummin
Cappamore
Rathkeale
Goran/Graiguenama
Slieve Ardagh
Patrickswell
Glin
Callan
Cashel
Thomastown / Ballyhale
Ballybunion Listowel
Enniscorty
Hospital
Clonroache
Newcastle West Croom
Tipperary
New Ross
Kilmallock
Kerry Head
Wexford
Ballylanders
AbbeyfealeDromcolliher
ClonmelCarrick on Suir
Charleville
Mullinavat
Cahir
Ballyculliane Taghmon
Tralee
Mitchelstown
Bridgetown Rosslare
Buttevant
Newmarket
Kilmacthomas Waterford
West Kerry
Castleisland
Fermoy
Tramore
Kanturk
West Waterford
Mallow
Rathmore
Dungarvan
Kilorglin
Millstreet
Castlelyons
Carrignavar
Killarney
Clashmore
Blarney
Middleton Youghal
Coachford Riverstown Castlemartyr
Kenmare/Sneem
Macroom
Iveragh
Carrigtohill
Ballincollig Douglas Cobh
Cloyne
Bishopstown
Carrigaline
Bantry Dunmanaway
Bandon
Ballineen
Kinsale
2 Teams
Beara
Achill
Mizen
Drimoleague
Clonakilty
RossCarbery
Skibbereen
3 Teams
4 Teams
5 Teams
6 Teams
1 Team
Data Sources
Health Service Executive
Ordnance Survey Ireland
Central Statistics Office
Map Produced By:
Projects Office, PCCC
Health Service Executive
Holland Rd
Plassey
Limerick
INTEGRATED SERVICE AREAS (ISA)
 PCT’s are building blocks for an Integrated Service Area
 Policy objective is to transfer non-complex acute service
to local hospitals and/or PCTs
 PCTs and related secondary care Acute hospitals should have
co-terminous populations
 Will contain hospital or no. of hospitals that provide for the
secondary care needs for that population
 Clear criteria set for identification of ISAs that include wider
public service integration
 Design methodology involved detailed analysis of current
patient flows coupled with local intelligence
 Eight in place on an interim basis and design process
established in other areas – process will take time
PROGRAMMES OF CARE




20 Programmes established with Clinical Leads appointed
Joint initiatives with the academic colleges
Focused on implementation of solutions in 2011
Separate project underway in Childcare; some gaps in other Personal and
Social Services
 Programmes established in:
Primary Care
Care of the elderly
Palliative Care
Radiology
Obstetrics and
Gynaecology
Obstetrics and
Gynaecology (Deputy)
Joint Stroke
(Geriatrician)
Joint Stroke (Neurology)
Acute Coronary
Syndrome
Heart Failure
Diabetes
COPD
Asthma
Mental Health
Epilepsy
Dermatology
Neurology out patients
Rheumatology
Joint Acute Medicine
Joint Acute Medicine
Emergency Medicine
Critical Care
Surgery
REGIONAL OPERATING UNITS
 Four regions in place




HSE West
HSE South
HSE Dublin/Mid-Leinster
HSE Dublin/North East
 Headed by a Regional
Directors of Operations –
roles replaced twelve senior
managers covering hospitals
and community
 Focus is on performance
managing the local operating
units
INTEGRATED SERVICE AREAS
/Leitrim
 Purpose of the ISA is to
align services around a
population
 Eight ISA’s agreed and being
rolled out
 Local unit for service delivery
 Design based on catchments,
road network, primary care
team design, spatial planning,
local authority boundaries etc
 Further design work ongoing
in:
 HSE South (East)
 HSE DML
 HSE DNE
PROGRESS MADE
 Stage I – Corporate restructuring complete
 Stage II – Regions established
 Stage III
 Eight ISAs defined and interim management
arrangements in place
 ISA catchments being scoped
 Service Delivery Model defined
 Programmes of Care defined and teams working
 Performance Management process being developed
SUMMARY
 Range of levers to integrate services across all
settings
 Priority is to develop programmes of care for
priority areas to make patients and clients
pathways clear
 Organisation structure and processes must
support this direction of travel – will take time
as some legacy structures are more complex