Long term conditions in Northern Ireland
Northern Ireland's system is characterised by greater intergration of health and social care than occurs in other UK countries
Health and Social Services are of key importance for the devolved government in part because they make up such a large proportion of its overall budget. The recent restructuring of health and social care has resulted in a more centralised system.
Eighteen Trusts have been reconfigured into five new Trusts which are responsible for all areas of health provision, including primary care, secondary care, community health care and mental health services. Additionally, a new Public Health Agency has been introduced.
Northern Ireland’s system is characterised by greater integration of health and social care than occurs in other UK countries and the aim is for this to increase.
The aim of policy is to design services which are more responsive, effective and efficient. There is also a desire to see personalised care plans for people with long term conditions.
A Healthier Future
Published for consultation in 2004, a 20-year regional strategy for health and well-being, A Healthier Future presented a vision for health and personal social service development in Northern Ireland from 2005-2025. It is intended to give the direction of travel for health and social services and places a strong emphasis on:
- promoting public health
- engagement with people and communities to improve health and well-being
- the development of responsive and integrated services which will aim to treat people in communities rather than in hospital
- new, more effective and efficient ways of working through multi-disciplinary teams
measures to improve the quality of services - flexible plans, appropriate organisational structures and effective, efficient processes to support implementation of the strategy
According to 'A Healthier Future: A twenty year vision for health and well-being in Northern Ireland 2005-2025' (Department of Health, Social Services and Public Safety 2004) the population twenty years from now will:
- have grown in number
- live longer and be older
- contain more people of working age
- experience much higher levels of chronic disease, particularly those conditions
- associated with old age such as some cancers
- die in greater numbers ( due to the greater proportion of older people)
- be more ethnically diverse
- have greater expectations of the type of services they wish to receive
Priorities for Action 2010-11
This document sets out the ministerial targets and standards for Health and Personal Social Services (HPSS) until 2011.
All the priorities identified will be important for occupational therapists, and include:
- improving the health status of the population and reducing health inequalities
- ensuring services are safe & sustainable, accessible & patient-centred
- integrating primary, community and secondary care services
- helping older people to live independently
- improving children’s health and well-being
- improving mental health services and services for people with disabilities
- ensuring financial stability and the effective use of resources
Source: Department of Health, Social Services and Public Safety (2010): priorities for action 2010/2011
Public Health Strategy: Investing for Health
The public health strategy, Investing for Health, launched in March 2002 sets out how the health and well-being of all the people of Northern Ireland can be improved.
It argues that health and well-being is largely determined by the social, economic, physical and cultural environment and that health policy has so far tended to concentrate on the treatment of ill health rather than on its prevention.
This strategy seeks to shift that emphasis by taking action to tackle the factors which adversely affect health and perpetuate health inequalities.
It contains a framework for action which is based on partnership working amongst Departments, public bodies, local communities, voluntary bodies, District Councils and the social partners. For example, decisions to tackle damp and heating problems in housing will have a positive health impact for residents.
The key aims of the strategy are to improve life expectancy across the population and to reduce health inequalities. The Strategy has a particular focus on the most disadvantaged in Northern Ireland. A review of 'Investing for Health' was due to take place in 2009.
Primary Care Strategy: Caring for People Beyond Tomorrow
This strategy sets out the Department's policy position through a Vision Statement for a future Primary Care Service, and a policy framework designed to steer the future development of policies and services in primary care.
Key aspects of the Framework are:
- a service focused on providing comprehensive person-centred care
- a first point of contact that is readily accessible and responsive to meet people's needs day or night
- a co-ordinated, integrated service employing a team approach with multi-agency linkages
- an emphasis on engagement with people and communities about their care and the way services are designed and delivered
- a focus on prevention, health education and effective self-care
Outcomes envisaged will include:
- making primary care services more responsive by encompassing a wider range of services in the community
- making primary care services more accessible, by way of time to see practitioners, greater number of locations, enabling people to see appropriate practitioners and greater provision of information
- developing more effective partnerships and team working across organisational and professional boundaries, as a means of increasing the effectiveness of the services
more proactive engagement with service users about service planning, design and delivery - improved premises and infrastructure, harnessing new technologies and clinical advancements
Source: Department of Health, Social Services and Public Safety website.
The Primary Care Strategy is available at www.dhsspsni.gov.uk/primarycare05.pdf
The Department of Health, Social Services and Public Safety (DHSSPS) has been working jointly with the LTCANI in order to develop services and to facilitate user involvement in service design
A key milestone in this work was a joint conference held in October 2008. This identified three main priorities for action:
- joint working with voluntary sector
- patient and user involvement in services
- self management and self management network
Service Frameworks
Much of the work in Northern Ireland is focusing on specific long term conditions, with the development of Service Frameworks. These 'set out clear standards of health and social care that are evidence based and are capable of being measured'. Source: Department of Health Social Services and Public Safety 2009 'Draft Service Framework for Cancer Prevention, Treatment and Care' p40. Key service frameworks include:
- cardiovascular health and wellbeing
- respiratory health and wellbeing
- cancer prevention treatment and care
The Service Frameworks contain certain quality standards. In Northern Ireland these are:
- safe - health and social care which minimises risk and harm to the public and staff
- effective - health and social care that has been shown to improve health and wellbeing for individuals, communities and populations
- efficient - health and social care that is planned and delivered in a way that gives value for money and avoids waste
- accessible - health and social care that is timely, within a reasonable travel distance / travel time, and provided in a setting that is appropriate to the needs of the person in terms of skills and resources
- patient/client centred - health and social care that takes into account the needs and wishes of service users and carers, and the culture of their communities
- equitable - every person gets the same quality of care regardless of age, sex, ethnicity, race, class or where they live
Source: Department of Health Social Services and Public Safety 2009 ‘Draft Service
Framework for Cancer Prevention, Treatment and Care’ pp41-2.
Long Term Conditions Alliance N Ireland (LTCANI)
LTCANI was established in 2005 and unites many voluntary and not-for profit organisations working with people with long term conditions. LTCANI priorities include:
- a strategy for long term conditions in Northern Ireland
- a commitment to taking forward genuine Patient and Public Involvement within the Northern Ireland Health & Social Care system
- aupport for self management training and other forms of structured, condition specific, patient education
- prevention and early diagnosis
- exemption from prescription charges for all patients with long term conditions
- integration and smooth transitions between services
- support for ending inequalities in health
Source: Response to Proposals for Health & Social Care Reform in Northern Ireland 2008, p4
