A new report, ‘Community Healthcare Organisations – Report and Recommendations of the Integrated Service Area Review Group’, setting out how health services, outside of acute hospitals, will be organised and managed is published today, Wednesday 8th October 2014. Known as community healthcare services, these services include primary care, social care (involving services for older persons and for persons with a disability), mental health and health & wellbeing.
‘Community Healthcare Organisations – Report and Recommendations of the Integrated Service Area Review Group’ provides a framework for new governance and organisational structures in order to improve service delivery and ensure the public receive “the right service, at the right time, in the right place, by the right team”.
Launching the report, Tony O’Brien Director General, HSE said “In 2014, more than half of our total health spend on operational services is in the community healthcare sector. This sector is significant and the reform of these structures will facilitate a move towards a more integrated health care system, improving services for the public by providing better and easier access to services, services that are close to where people live, more local decision making and services in which people can have confidence.”
The team that carried out the review, led by Pat Healy, National Director Social Care, consulted widely with more than 600 multi-disciplinary health service staff and 40 representative groups. They found that many people experience a very good service but have difficulty with the complexity and scale of the current arrangements. The new structures will make things simpler by delivering more integrated care closer to where people live.
Pat Healy highlighted that “The delivery of integrated care is very important for those who use our services and for staff. These new structures will enable more ‘joined up’ working arrangements that will see all community and acute services working together in a co-ordinated way to meet people’s assessed needs. This will be achieved in terms of ease of access for patients/service users through the different community and acute healthcare services as well as the quality of service they receive.”
The new governance and organisation structures being put in place to enable this type of integrated care, are the:
· Establishment of nine Community Healthcare Organisations (CHOs), which are the best fit to deliver an integrated model of care.
· Development of 90 Primary Care Networks, averaging 50,000 population with each CHO having an average of 10 networks to:
- support groups of Primary Care Teams; and
- enable integration of all services for a local population.
- support prevention and management of chronic disease at community level.
· Reform of Social Care, Mental Health and Health & Wellbeing services to better serve local communities through:
- standardising models and pathways of care while delivering equitable, high quality services; and
- supporting primary care through the delivery of rapid access to secondary care in acute hospital and specialised services in the community.
Welcoming the publication of the report, Kathleen Lynch TD, Minister of State for Primary and Social Care added, “The changes that will now be put into effect will allow health services to work in a coordinated way to meet people’s needs, with the majority of care being provided in the community. I particularly welcome the clear focus being brought to improving the interface between community services and acute hospitals, so that people can receive structured, high-quality care in the most appropriate setting. I look forward to early progress with these improvements.”
The benefits to patients and service users that will emanate from the new CHOs and primary care networks are as follows:
CHO Level
· The CHOs will focus on delivering standard models and pathways of care developed nationally by service divisions and National Clinical Programmes, bringing consistency to how services are delivered across the country.
· Clinical staff and GPs will be appointed to CHO management teams bringing professional staff closer to patient decision-making.
· The CHOs will enable and support integrated care within community healthcare services, between community healthcare and acute hospital services, and better coordination with other bodies, such as the local authorities, the Gardaí, Child and Family Agency, Education, community organisations, etc.
Network Level
· For the first time ever, an identified accountable person, a primary care network manager, working with a GP lead and a network team, will be responsible for driving integrated care in each primary care network.
· The current ‘Heads of Discipline’ role e.g. Director of Public Health Nursing, Physiotherapy Manager, etc. will be redesigned to provide clinical governance and clinical supervision for primary care network staff.
· Focus on prevention and management of chronic disease at community level.
Primary Care Team Level
· A team lead will be appointed to each primary care team, with protected time from the day job, to co-ordinate the daily working arrangements.
· Staff at local level will have more autonomy and decision-making ability to respond quicker, better and safer to patient and service user needs.
· A named key worker will be assigned to support people with complex needs so that all staff working with this patient will have a contact person to work through and the patient and carer will also know this key worker.
The following illustrates how this integrated care approach can benefit people at local level.
Mrs O’ Neill is a 79 year old widow with diabetes, heart failure and arthritis. She wants quick responsive services from skilled health and care providers that talk to one another and that have a good understanding of all her care needs. This framework will help us to provide what Mrs O’Neill wants.
Following the publication of the report, an intensive communication and engagement process will be undertaken, including feedback to all those involved in the original consultation, together with other staff and partners in the wider health service.
A national steering group will oversee the implementation of the report’s recommendations and the first step towards implementation will be the appointment of Chief Officers, with a view to their taking up responsibility in January 2015.
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