Health reform quietly gathers pace

The successful implementation of Transforming Your Care is critical to the future health of all citizens in Northern Ireland. At its heart is the very simple proposition that the health system as presently structured is not fit for purpose as the population ages and is desperately in need of reform.

This will involve a shifting of emphasis away from acute hospital provision to ensure that people have access to services centred around their own home, with a greater focus on promoting good health and preventing illness.

To date there has been much cynicism in the press and elsewhere as to whether the programme will be successfully implemented. The much publicised Donaldson report highlighted a lack of leadership within the health system, ill-informed political intervention and media coverage all combining to stall progress, not least on the vexed and politically sensitive issue of reducing the number of acute hospitals in Northern Ireland.

Donaldson ultimately came to the view that the only way that progress could ultimately be made would be to appoint an independent body to recommend the necessary changes and for politicians to sign up in advance to implementing them.

It was suggested that that might be the only way to get around the fact that whilst politicians of all parties have embraced TyC they will fight tooth and nail to prevent hospital closures in their own constituencies, and to be fair, the nature of the media coverage around such closures means that it would be political suicide for them to do otherwise.

In addition budgetary pressures are leading to Trusts shoring up acute services because of the immense pressures they are under, without having the funds to invest sufficiently in social care and preventative interventions that would enable more care to be carried out at home, therefore relieving the pressures on hospitals.

This has led many observers to conclude that TyC will not happen, and the more cynical to imply that the entire programme is an elaborate cloak to justify cuts.

Despite all this there are signs of quiet progress. One of them has been the appointment of Claire Lavery as the Integrated Care Partnership Co-ordinator for the Third Sector.

Lavery is on secondment from her role at Action on Hearing Loss until March with a brief to act as a conduit between the Health and Social Services Board and the Third Sector. It is significant that the board has chosen to appoint someone from the sector, rather than a civil servant to the role.

The Integrated Care Partnerships are a vital element in the overall TyC programme.

They are local networks of health and social care providers joining together the full range of health and social care services in each area, and they include GPs, health and social care providers, hospital specialists and representatives from the independent, voluntary and community sectors and service users.

The idea is that they help ensure that services are delivered as close to peoples’ homes as possible, reducing the demands on hospitals and that they also help to promote good health and prevent illness. The TyC programme describes this as ensuring that everyone gets the right care in the right place at the right time. This process is therefore central to the success of the programme.

TyC author John Compton said: “: “If you really are serious about wanting to enable people to be cared for and treated at or close to home, then the professionals who work in the community are going to be central to that.”

The ICPs’ initial brief is to concentrate on services for the Frail Elderly, Respiratory services, Diabetes services and Stroke services. All are areas in which the voluntary sector has considerable expertise.

Critical to Claire Lavery’s role is to plug that sectoral knowledge and insight into the partnerships and the Board.

She said: “Across the sector there is a huge range of expertise on so many relevant issues and there is a commitment that the Third Sector is treated as an equal partner in helping to make the system work. We want voices to be heard, and it’s my role to ensure that they are. “

Next month she is hosting a conference for the Third Sector on Integrated Care Partnerships which will feature a discussion on forming a strategic approach to Third Sector involvement in the partnerships. There will also be workshops on the key areas the ICPs are initially concentrating on.

Her appointment and her work is evidence that the Board is being inclusive: it wants to involve relevant experts from the community and voluntary sectors in helping to ensure that the new structures work and to date participants report a positive atmosphere and mutual goodwill.

There is much work to be done in implementing TyC and the challenges are formidable and not to be under-estimated. However it is pleasing to note that in one key area work is progressing and that the Third Sector is at the heart of it.