Part 3 Implementing change

Chapter 7 Action Plan
Chapter 8 Making change happen

Introduction

Government non-capital funding of health services has doubled since 1996, and has meant greatly enhanced services throughout the health sector. However, this investment was made against a background of historically low levels of funding by international comparisons. Also, some two-thirds of the new investment over recent years have been committed to pay and technical costs, with just one-third available for new developments.

The costings of the Strategy are estimated at just over £10 billion (€ 12.7 billion) as expressed in 2001 prices. The breakdown of the figures are £6.1 billion (€ 7.7 billion) capital and £4 billion (€ 5 billion) non-capital.

The capital figure provides for all costs in regard to projects from planning, through construction and equipping. It is additional to the £2 billion (€ 2.54 billion) already committed by the Government to the health services as part of the National Development Plan (NDP) 2000-2006. The inclusion of the health services in the NDP was the first time that this sector had been funded by the NDP and it represented a significant increase over previous funding levels. However, this must be measured against historically low investment in the Health Capital Programme, leading to a situation where many of the buildings in use are now old, poorly maintained and overall in bad repair. The provision currently made for ongoing maintenance and replacement of major items of equipment also needs to be increased.

The capital cost of £6.1 billion (€ 7.7 billion) is the estimate for putting in place across all service programmes a modern and quality infrastructure which meets the needs of providers and users of services. This investment will benefit acute hospitals, the development of a range of facilities in the community and the provision of much-needed facilities for client groups such as older people, children and people with an intellectual, physical or sensory disability. The investment will also support necessary improvements in research and information systems.

The non-capital estimated cost of £4 billion (€ 5 billion) will fund major initiatives such as extensions of eligibility for medical cards, additional bed capacity in acute hospitals, significant enhancement of services for older people, together with resourcing ongoing developments such as services for people with a disability and child care.

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The Action Plan

National Goal No. 1: Better health for everyone
Objective 1: The health of the population is at the centre of public policy

Action
Deliverable
Target date
Responsibility
1 Health impact assessment will be introduced as part of the public policy development process.
• Health impact assessment
to be carried out on all new
Government policies
June 2002
Relevant Government departments
2 Statements of strategy and business
plans of all relevant Government
departments will incorporate an explicit commitment to sustaining and improving health status.
• Departmental statements
of strategy to include commitments
to sustaining and improving
health status
With
immediate
effect
Relevant Government departments
3 The National Environment and Health Action Plan will be prepared.
• Plan submitted to Government
June 2002
Relevant Government departments and agencies
4 A population health division will be established in the Department of Health
and Children.

A population health function will be established in each health board.
• New division to be established
and begin

• Reorganisation and expansion
of existing
function
March 2002

June 2002

Department of Health
and Children (DoHC)

Health boards
 
 
 
 

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Objective 2: The promotion of health and well-being is intensified

 

Action
Deliverable
Target date
Responsibility
5 Actions on major lifestyle factors
targeted in the National Cancer, Cardiovascular and Health Promotion Strategies will be enhanced.

• To achieve targets set out in the
National Health Promotion Strategy
(2000-2005) through:

Smoking
• Enhanced health promotion
initiatives aimed at addressing the
risk factors associated with cancers
such as smoking

• Targeting a reduction in smoking
for young women

Alcohol
• Introducing further actions to
promote sensible alcohol consumption
on the basis of a review of the National Alcohol Policy

• Examining possible further
restrictions on the advertising
of alcohol

Diet and exercise
• Continuing action to improve Irish
diet so that essential nutrients and energy levels are maintained and fat
consumption is controlled

• Continuing measures to promote
physical exercise

Ongoing



Ongoing





Ongoing


Mid 2003









Ongoing





Ongoing

DoHC and health boards
6 The Public Health (Tobacco) Bill
will be enacted and implemented as
a matter of urgency.
• Enactment of Bill
• Implementation of Act
– Policing of bans on advertising
and sponsorship
– Establishment of register of
retailers
Passed by Easter 2002
Ongoing

End 2002
DoHC

Tobacco Control Agency

Tobacco Control Agency
7 A reduction in smoking will
continue to be targeted through
Government fiscal policies.

8 Initiatives to promote healthy
lifestyles in children will be
extended.







9 Measures to promote and support breastfeeding will be
strengthened.






10 A National Injury Prevention
Strategy to co-ordinate action on
injury prevention will be
prepared.






11 The programmes of screening for
breast and cervical cancer will be
extended nationally.







12 A revised implementation plan for
the National Cancer Strategy will be published.






13 The Heart Health Task Force will
monitor and evaluate the
implementation of the prioritised cardiovascular health action plan.






14 Initiatives will be taken to
improve children’s health.


















15 A policy for men’s health and
health promotion will be
developed.





16 Measures will be taken to promote
sexual health and safer sexual
practices.





17 Legislation in the area of food
safety will be prepared to take
account of developments in food
safety regulation at national and
EU level.

 

Decisions on tax and excise duties on tobacco products


Extension of substance abuse
prevention programme and social,
personal and health education
programmes






• Appoint national breastfeeding
committee
• Review the national breastfeeding policy and make recommendations
to the Minister




• Action plan drawn up









• Full extension of breast
screening programme
• Full extension of cervical
screening programme






• Revised implementation plan
published







• Monitoring and implementation
processes agreed and in place








• Integrated programme for child
health developed
• National minimum standards
and targets for surveillance and
screening drawn up
• Mental health services for children
& adolescents will be expanded:
– Implementation of the
recommendations of the First
Report of the Working Group on
Child & Adolescent Psychiatry
– development of mental health
services to meet the needs of children
aged between 16 and 18






• Working group established
• Consultation commenced
• Working group report finalised





• Action plan prepared







• Legislation prepared

Ongoing



On an ongoing
basis – full extension to all schools by
December 2005





December 2001
End 2003







End 2002









Ongoing


Ongoing






End 2002








End 2002









December
2002
2002


Ongoing


Ongoing


Ongoing








Early 2002
Mid 2002
Mid 2003





End 2003







Ongoing to meet EU target of 2003

Department of Finance



Department of Education/
DoHC/health boards








DoHC/service providers








Department of the Environment (lead)
DoHC/National Safety Council/ Health and Safety
Authority





Health boards in
conjunction with Breastcheck







National Cancer Forum








Heart Health Task Force/ Health Information and Quality Authority







DoHC

DoHC


DoHC/Health boards in conjunction with Review Group on Child and
Adolescent Psychiatric Services

Health Information and Quality Authority







DoHC/Health board







DoHC







DoHC

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Objective 3: Health inequalities are reduced

Action
Deliverable
Target date
Responsibility
18 A programme of actions will be implemented to achieve National Anti-Poverty Strategy and Health targets for
the reduction of health inequalities.
• Target for premature mortality
achieved

• Target for life expectancy for the Travelling community achieved

• Targets for health of Travellers,
asylum seekers and refugees
developed

• Targets for birth weight rates achieved
2007

2007
Immediate commencement of monitoring targets developed by 2003

2007
DoHC (lead)/
Service providers/
Relevant Government departments/
Inter-Departmental Group on the National Anti-Poverty Strategy
19 Initiatives to eliminate barriers
for disadvantaged groups to achieve healthier lifestyles will be developed
and expanded.
• Implement fully existing policy in the National Health Promotion Strategy
• Community-level programmes introduced
Ongoing

Ongoing
Health boards
20 The health of Travellers will be
improved.
• Travellers Health Strategy published
• Implementation commenced
Published 2001
Immediately
DoHC/health boards
21 Initiatives to improve the health
and well-being of homeless people
will be advanced.
• Implementation of ‘Homelessness
– an Integrated Strategy’
• Implementation of Youth Homelessness Strategy
Ongoing

Implemented by End 2003
Department of Environment (lead)
DoHC/health boards/National Children’s Office
22 Initiatives to improve the health
and well-being of drug misusers will
be advanced.
• Implementation of National
Drugs Strategy
All actions
by 2008
Department of
Tourism, Sport and Recreation/DoHC/
health boards
23 The health needs of asylum seekers/refugees will be addressed. • Statement prepared and published

• Implementation commenced
5 year implementation DoHC/Department of Justice, Equality and Law Reform/health boards/service providers
24 Initiatives to improve the health of prisoners will be advanced. • Implementation commenced Ongoing Irish Prisons Service

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Objective 4: Specific quality of life issues are targeted

Action
Deliverable
Target date
Responsibility
25 A new action programme for
mental health will be developed.
• A national policy framework
prepared

• A programme of ongoing investment
in the development of specialist
services

• Report on services for people
with eating disorders prepared

• Patient advocacy services
introduced

• Programmes to promote
positive attitudes introduced

• Suicide prevention programme
will be intensified

Mid 2003


Ongoing



Following completion of second (current) report


Ongoing


Ongoing

DoHC





Review Group on
Child and Adolescent Psychiatric Services


Health boards
DoHC/health boards


DoHC/National Suicide Review Group/health boards

26 An integrated approach to
meeting the needs of ageing and
older people will be taken.
• A programme of investment

• A co-ordinated action plan to
meet the needs of ageing and
older people

• Funding of community groups

• Health Promotion Strategy implemented

• Action plan for dementia will be implemented
Ongoing

Mid 2002



Ongoing

Ongoing


7 year programme
DoHC

DoHC in conjunction with relevant Government departments

Health boards

Health boards


DoHC/health boards
27 Family support services will
be expanded.

• Percentage of child welfare
budget spent on supportive
measures increased

• Marked increase in number
of family support projects

• Wider availability of parenting programmes

• Out-of-hours service
available

• Children Act, 2001 fully
implemented

From 2002 Health boards
28 A comprehensive strategy to
address crisis pregnancy will be
prepared.
• Crisis Pregnancy Agency
established

• Strategy prepared
Immediate


To be agreed
Crisis Pregnancy Agency
29 Chronic disease management
protocols to promote integrated
care planning and support self-
management of chronic disease will
be developed.
• Protocols published 2003 Health Information and Quality Authority
30 An action plan for rehabilitation
services will be prepared.
• Working group established
• Action plan prepared
End 2001
End 2002
DoHC
31 A national palliative care service
will be developed.
• Report of Expert Group to examine design guides for specialist palliative care completed

• Research on the specialist palliative care service requirements of non-
cancer patients commissioned

• Needs assessment studies for specialist palliative care needs completed for each health board
area
2002



2002



2002
Expert Group



DoHC



DoHC/health boards
32 Entitlement to high-quality
treatment services for people with Hepatitis C, infected by blood and
blood products, will be assured.
• Services kept under review Ongoing DoHC
33 Resources will be provided to
support the full implementation of
AIDS Strategy 2000.
• Liaison nurse identified in all
health boards to act as liaison
person between patients and
medical service providers

• Uptake of routine antenatal
testing of HIV to reach 90 per
cent or more
Mid 2002




End 2003

DoHC




Service providers

34 Measures to prevent domestic
violence and to support victims will continue.
• Initiatives will be included
in health board service plans
From 2002 Health boards
35 A national policy for the provision of sheltered work for people with disabilities
will be developed.
• Policy prepared End 2002 DoHC/Department of Enterprise, Trade and Employment

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National Goal No. 2: Fair Access

Objective 1: Eligibility for health and personal social services is clearly defined

Action
Deliverable
Target date
Responsibility
36 New legislation to provide for
clear statutory provisions on entitlement
will be introduced.
• Publish Bill
2002
DoHC
37 Eligibility arrangements will be
simplified and clarified.
• Guide to schemes updated and published incorporating guidelines proposed by PPF Medical Card Review Group
Ongoing in line with changes
Actions 38-41 below
DoHC
PTER 8
Action
Deliverable
Target date
Responsibility
38 Income guidelines for the
medical card will be increased.
• Revised income Guidelines
*
DoHC
39 The number and nature of GP
visits for an infant under the Maternity
and Infant Care Scheme will be extended.
• 4 extra free GP visits under the Maternity and Infant Care Scheme to cover general childhood illnesses
*
DoHC
40 The Nursing Home Subvention
Scheme will be amended to take account
of the expenditure review of the scheme.
• Introduction of a Pilot Home
Subvention Scheme

• Increased subvention rates.
*


*
DoHC/Health boards
41 A grant will be introduced to cover
two weeks’ respite care per annum for dependent older persons.
• Scheme finalised
*
DoHC/Department of Social, Community and Family Affairs
42 Proposals on the financing of
long-term care for older people will be brought forward.
• Proposals submitted to Government
2002
Department of Social, Community and Family Affairs (lead)/Department of Health and Children/Department of Finance

* The timing of the introduction of actions 38-41 will be decided by Government in the context of the prevailing budgetary situation.

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Objective 3: Equitable access for all categories of patients in the health system is assured

Action
Deliverable
Target date
Responsibility
43 Improved access to hospital
services for public patients will be
addressed through a series of integrated measures.
• Reduction in waiting times for hospital services
See Action 81
DoHC/service providers/
National Hospitals Agency
44 Availability of information on
entitlements including use of information technology will be improved.
• Transport needs of users
considered when planning
services that cannot be provided
locally

• All health facilities designed and adapted to
March 2002

Ongoing


Ongoing
DoHC
Service providers in conjunction with Comhairle and community representative groups
DoHC/health boards
45 All reasonable steps to make
health facilities accessible will be taken.
• Transport needs of users considered when planning services that cannot be provided locally

• All health facilities designed and adapted to
Ongoing



Ongoing
Service providers


Service providers
46 Appointment planning arrangements
will be reviewed to provide greater
flexibility and specific appointment
times.
• Specific appointment times
introduced

• Extended/more user-friendly
clinic and out-patient opening times
2002


End 2003
Service providers


Service providers
47 Waiting areas in health facilities
will be upgraded.
• Improvement/adaptation of waiting facilities
End 2006
Service providers

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National Goal No 3: Responsive and appropriate care delivery

Objective 1: The patient is at the centre in the delivery of care

Action
Deliverable
Target date
Responsibility
48 A national standardised approach to measurement of patient satisfaction will be introduced.
• Agreed system published and implemented
End 2002
Health boards/Health Boards Executive Agency (HeBE)
49 Best practice models of customer care including a statutory system of complaint handling will be introduced.
• Customer care programme prepared and implemented in all boards
• Legislation on statutory complaints procedure published
June 2003

End 2002
DoHC/service providers

DoHC
50 Individuals and families will be
supported and encouraged to be involved
in the management of their own health care.
• Codes of practice for shared
decision-making developed
• Codes incorporated into
professional training programmes
• Training of existing staff
2002

2003

2003
Professional bodies

Training bodies
Service providers/
professional bodies
51 An integrated approach to care planning for individuals will become a consistent feature of the system.
• Training initiatives to promote inter-disciplinary working for existing staff delivered
• Inter-disciplinary working incorporated into professional training programmes
• Extension of key workers for older people and children with disabilities.
Programmes to commence 2002

Ongoing
Commence early 2002
Professional bodies/service providers

Training bodies
Service providers
52 Provision will be made for the participation of the community in
decisions about the delivery of health
and personal social services.
• Public information/education
campaign devised

• Regional advisory panels/co-
ordinating committees established.

• Establishment of consumer panels

• Establishment of National Strategy Forum
2002

Mid 2002

Mid 2002


Mid 2002
First meeting Oct. 2002
DoHC/HeBE

DoHC/ health boards

DoHC/Health boards


DoHC

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Objective 2: Appropriate care is delivered in the appropriate setting

Action
Deliverable
Target date
Responsibility

53 Initiatives will be developed and implemented to ensure that care is delivered in the most appropriate setting.

• Primary care development

• Review of clinical pathway systems

• Review of charges

Ongoing

Ongoing

Completed 2002

DoHC/Primary Care Task

Force Service providers

Health boards/HeBE

54 Community and voluntary activity in maintaining health will be supported.
• Programmes to support informal carers expanded and extended


• Programmes to support voluntarism developed


• First responder service developed

• Funding arrangements for national bodies streamlined

Commencing 2002 in all health boards

December 2002


Ongoing From

2002 onwards

Health boards


Steering Committee for the White Paper on Supporting Voluntary Activity

DoHC/health boards

HeBE

 

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Objective 3: The system has the capacity to deliver timely and appropriate services

Action
Deliverable
Target date
Responsibility
55 A programme of investment to provide the necessary capacity in primary care, acute hospital and other services will begin.

• Enhanced services across a range of programmes

2002- onwards

DoHC

56 The Cancer Forum and the Advisory Forum on Cardiovascular Health will work with the National Hospitals Agency and the Health Information and Quality Authority to ensure service quality, accessibility and responsiveness. • Services at local, regional and national levels agreed

• Structures and requirements for evidence-based practice agreed

• Appropriate outcome and performance indicators agreed

End 2003


End 2003


End 2003
National Cancer Forum/Advisory Forum on Cardiovascular Health, Health Information and Quality Authority
57 Measures to provide the highest standard of pre-hospital emergency care/ambulance services will be advanced.

• Development of standards

• Community training of GPs and other health care professionals

• Training in clinical protocols

• Resuscitation training for all staff in acute hospitals

All ongoing DoHC/Pre-Hospital Emergency Care Council/ service providers

58 A plan to provide responsive, high-quality maternity care will be drawn up.

• Working Party established

• Working Party report submitted to Minister

2002

2003
DoHC
59 A review of paediatric services will be undertaken. • Working Party established

• Working Party report submitted to Minister

2002

2003
DoHC
60 A national review of renal services will be undertaken. • Patients to have access to adequately resourced centres close to home

• Consultant-led nephrology services to be available in all regions

• Alternative dialysis services will be available

• The IKA supported to develop targeted programmes to address the health and social needs of the renal population

Ongoing DoHC
61 Organ transplantation services will be further developed. • Increase in organ donation and utilisation rates

Ongoing DoHC/health boards
62 Specialist dental services will be expanded. • New goals for oral health formulated


• Action plan prepared

• Recognition of additional areas of specialisation

• Establishment of training programmes

• More widespread use of private sector orthodontic services

Immediate
Mid 2002

Ongoing Ð 2003





From 2002 onwards
DoHC









DoHC/Dental Council Health boards

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National Goal No. 4: High performance

Objective 1: Standardised quality systems support best patient care and safety

Action
Deliverable
Target date
Responsibility
63 Quality systems will be integrated and expanded throughout the health system.

• National standards and protocols for quality care, patient safety and risk management drawn up for all health and personal social services


• Quality assurance systems introduced

• The Hospital Accreditation Programme extended

• The Social Services Inspectorate (SSI) to be established on a statutory basis

Commencing on establishment of Health Information and Quality Authority

Ongoing

Ongoing


2003

Health Information and Quality Authority






DoHC


Service providers/DoHC

64 A review of medicines legislation will be undertaken.

• Review to commence End 2001 DoHC
65 Licensing of alternative medicines will be examined.

• Submission of recommendations to Minister

End 2001 DoHC/Irish Medicines Board

66 The highest international standards of safety in transfusion medicine will be set and adhered to.

• Standards achieved Ongoing DoHC /Irish Blood Transfusion Service/Irish Medicines Board
67 Legislation on assisted human reproduction will be prepared.

• Bill published

On completion of the work of Commission on Assisted Human Reproduction

DoHC

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Objective 2: Evidence and strategic objectives underpin all planning/decision-making

Action
Deliverable
Target date
Responsibility
68 Decisions across the health system will be based on best available evidence.

• Part of quality programme - to include staff training

Ongoing

Health Information and Quality Authority Service providers

69 An information/education campaign will be undertaken for all decision-makers in the health system on the StrategyÕs goals and objectives.

• National, regional and local communications programme Commencing immediately DoHC/health boards/service providers
70 Accountability will be strengthened through further development of the service planning process.

• Standard formats for service plans agreed

• Standardised performance indicators agreed

• Reporting mechanisms agreed

End 2002


End 2002


End 2002

DoHC/health boards
71 Each health board will develop implementation plans.

• Format for implementation plans agreed

• Framework for linkages between service plans, national policy and implementation plans established

Early 2002

End 2002
DoHC/health boards
72 Service agreements between the health boards and the voluntary sector will be extended to all service providers and associated performance indicators will be introduced.

• Service agreements for all voluntary providers 2002-2003 Health boards/voluntary providers
73 Health research will continue to be developed to support information and quality initiatives.

• Implementation of the Health Research Strategy 2002 onwards DoHC/Health Research Board/service providers

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Frameworks for change

Primary care

Action
Deliverable
Target date
Responsibility
74 A new model of primary care will be developed. • Primary Care: A New Direction published


Immediate

Primary Care Task Force/health boards

75 A National Primary Care Task Force will be established. • National Primary Care Task Force established

January 2002 DoHC
76 Implementation projects will be put in place.

• 40-60 primary care teams and networks in place

• 400-600 primary care teams and networks in place

End 2006


End 2011
Primary Care Task Force/health boards
77 Investment will be made in extension of GP co-operatives and other specific national initiatives to complement the primary care model.

• GP co-operatives nationally


• Increase in personnel needed in both teams and networks


• New physical infrastructure and equipment


• Improved information and communications technology

End-2003


Ongoing


Ongoing



End 2011

Primary Care Task Force/health boards

Primary Care Task Force/health boards/Health Service Employers Agency

Primary Care Task Force/health boards

Primary Care Task Force/health boards/Health Information and Quality Authority

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Acute hospital services

Action
Deliverable
Target date
Responsibility
78 Additional acute hospital beds will be provided for public patients.

• 650 extra beds

• Rising to 3,000 extra beds

End 2002

2011

Health boards National Hospitals Agency/health boards

79 A strategic partnership with private hospital providers will be developed. • Forum established under National Hospitals Agency 2002 DoHC/National Hospitals Agency
80 A National Hospitals Agency will be established.

• Agency established

End 2002 DoHC
81 A comprehensive set of actions will be taken to reduce waiting times for public patients, including the establishment of a new ear-marked Treatment Purchase Fund. • Targets to ensure that no public patient will wait longer than three months for treatment following referral from an out-patient department End 2004 Intermediate targets in end 2002 and end 2003

DoHC/National Treatment Purchase Team/Health boards
82 Management and organisation of waiting lists will be reformed. • Set of measures implemented Ongoing Health Boards/service providers
83 One-day procedures will be used to the maximum consistent with international best practice.

• Increase in proportion of one-day procedures Ongoing Health Boards/service providers
84 The organisation and management of services will be enhanced to the greatest benefit of patients.

• Set of short-term measures

• Long-term measures

June 2002

Ongoing

Health Boards/service providers
85 The operation of out-patient departments will be improved.

• Provision of individual appointment times

• Referral protocols development

Immediate

Ongoing

Health Boards/service providers
86 A substantial programme of improvements in accident and emergency departments will be introduced.

• Additional A & E consultants appointed

• Assessment unit to channel patients quickly

• Advanced nurse practitioners (emergency) appointed

Ongoing Health Boards/service providers
87 Diagnostic services for GPs and hospitals will be enhanced.

• Improve facilities Ongoing Health boards
88 The extra acute beds in public hospitals will be designated for use by public patients. • Formal designation order Immediately as beds are provided

DoHC
89 Greater equity for public patients will be sought in a revised contract for hospital consultants.

• Agreement on revised contract End 2002 DoHC
90 The rules governing access to public beds will be clarified. • Implementation of rules End 2001 DoHC/health boards/hospitals
91 Action may be taken to suspend admission of private patients for elective treatment if the maximum target waiting time for public patients is exceeded.

• Monitoring of public/private mix Ongoing Health boards/service providers

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Funding

Action
Deliverable
Target date
Responsibility
92 Additional Investment will be made in the health system.

• Continued increases for specified purposes

2002 onwards

Department of Finance/DoHC

93 Capital funding will be allocated for the regular maintenance of facilities and the planned replacement of equipment.

• Facilities and equipment properly maintained Ongoing DoHC/health boards

94 Public-private partnerships will be initiated to help in the development of health infrastructure.

• Selected projects

Ongoing DoHC/health boards
95 Multi-annual budgeting will be introduced for selected programmes.

• Movement towards multi-annual budgeting and planning Ongoing Department of Finance/DoHC
96 The allocation process will be reviewed by the Department of Health and Children.

• Document on allocation system 2002 DoHC
97 Financial incentives for grater efficiency in acute hospitals will be significantly strengthened.

• Refinement of casemix budget model and extension in coverage October 2002 DoHC
98 Annual statements of funding processes and allocations will be published.

• Annual statements by Department and health boards 2002 onwards DoHC/health boards
99 The management of capital projects will be enhanced.

• Review of process completed/proposals for change December 2002 DoHC/health boards

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Human resources

Action
Deliverable
Target date
Responsibility

100 Integrated workforce planning will be introduced on a national basis.

• Integrated set of plans for health staff

Ongoing

DoHC/health boards

101 The required number of extra staff will be recruited. • Increases in each targeted area Specified increases in number trained in 2002; subsequent increases over lifetime of Strategy

Health boards/other relevant health agencies
102 The approach to regulating the number and type of consultant posts will be streamlined.

• New procedure in line with the service planning process

2002 DoHC/health boards
103 Best practice in recruitment and retention will be promoted. • Guidelines on best practice September 2002 Office for Health Management/Health Services Employers Agency
104 Greater inter-disciplinary working between professions will be promoted.

• Adaption of training programmes Ongoing DoHC/professional bodies
105 Provisions for the statutory registration of health professionals will be strengthened and expanded.

• Revise legislation on doctors

• Revise legislation on nurses

• New legislation on other health professionals

2003

2003

2003

DoHC
106 Registration of alternative/complementary therapists will be introduced.

• Independent study of the practical steps required to be published March 2002 DoHC
107 The HR function in the health system will be developed. • Flexible human resource models established December 2002 Relevant health agencies
108 A detailed Action Plan for People Management will be developed.

• Publication of Action Plan

October 2002

DoHC/Health Services Employers Agency

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Organisational reform

Action
Deliverable
Target date
Responsibility
109 The Department of Health and Children will be restructured.

• Independent review completed

• New organisational structure in place

June 2002

December 2002

DoHC/independent consultants

110 Health boards will be responsible for driving change, including a stronger focus on accountability linked to service plans, outputs and quality standards.

• Increased link between service planning and service provision Ongoing Health boards
111 An independent Health Information and Quality Authority will be established.

• Authority established

2002 DoHC

112 The Health Boards Executive (HeBE) will be developed as a key instrument in the change agenda.

• HeBE established and operational March 2002 DoHC/health boards

113 The role of the Office for Health Management will be expanded.

• Expanded role agreed with Office for Health Management 2002 DoHC/Office for Health Management
114 An independent audit of functions and structures in the health system will be carried out.

• Audit completed June 2002 DoHC/independent consultants

 

Information

Action
Deliverable
Target date
Responsibility
115 The National Health Information Strategy will be published and implemented.

• Publication of National Health Information Strategy

December 2001

DoHC

116 There will be a sustained programme of investment in the development of national health information systems as set out in the National Health Information Strategy.

• Specific developments in the information infrastructure Ongoing DoHC/health boards/Health Information and Quality Authority
117 Information and communications technology will be fully exploited in service delivery.

• Implementation of the National Health Information Strategy

Ongoing DoHC/Health boards/Health Information and Quality Authority
118 Information-sharing systems and the use of electronic patient records will be introduced on a phased basis.

• Phased implementation of the electronic health-care record in line with the National Health Information Strategy Ongoing DoHC/health boards/Health Information and Quality Authority
119 A national secure communications infrastructure will be developed for the health services.

• Health services secure network 2004 DoHC/health boards/Health Information and Quality Authority
120 Information system development will be promoted as central to the planning process.

• Enhanced planning protocols in place 2002 DoHC/health boards

121 Health information legislation will be introduced.

• Bill published 2002 DoHC

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Chapter 8 - Making change happen

Introduction

The Strategy sets out an ambitious programme of development and reform for the health system. The various initiatives have at their core the guiding principles of equity, people-centredness, quality and accountability. They are aimed at achieving the goals of better health for everyone, fair access, appropriate and responsive care delivery and high performance.

Many of the actions required for implementation have been referred to already. These are summarised in Chapter 7. The aim is to ensure that responsibility for delivering on various aspects of the Strategy is made explicit and that implementation is achieved nationally in a consistent, effective and timely manner.

The approach to implementation makes clear not just how change will be implemented, but also how outcomes will be monitored and evaluated over time. Ongoing measurement and reporting of progress against the targets set out in Chapter 7 will be an essential part of the implementation process. This will ensure that:

  • those responsible for implementation are accountable for the progress they are making
  • the return on the increased investment in health that will flow from this Strategy is measured
  • those charged with the planning, development and delivery of services can make informed choices on the continuing direction for consolidation, improvement and change.

Implementation is about the steps required to put each aspect of the strategy into operation. The Action Plan sets out who is responsible for each key element of the Strategy, how it will be implemented, and by when. Monitoring and evaluation is concerned with the means by which progress in delivering targets is monitored and the quality and effectiveness of the services are evaluated.

Implementation

The approach to implementing the Strategy is set out below. It takes account of two particularly important considerations:

  • the inter-sectoral nature of the issues that have an impact on health
  • the need to engage with and encourage the participation of health services staff, communities, voluntary organisations, patients, clients and users in progressing the reforms set out.

The approach to implementation will:

  • make explicit the responsibilities and tasks of relevant sectors, organisations and key individuals
  • have clear political leadership
  • reflect the valid expectations of users, voluntary and community interests and staff to be involved in re-shaping the health system
  • allow for responsive innovation in addressing locally identified priorities and needs.

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Implementing the Strategy across all sectors

Managing the inter-sectoral nature of health represents a significant challenge to developing a successful implementation framework. To achieve this:

  • A Cabinet Sub-Committee on Implementation of the Health Strategy chaired by An Taoiseach will be established. Membership of the Sub-Committee will include the Ministers for Health and Children; Finance; Education and Science; Environment and Local Government; Social, Community and Family Affairs; and other Ministers as issues of relevance to them arise. The Cabinet Sub-Committee will oversee progress in implementing the Strategy and review selected initiatives under the Strategy as it sees fit.
  • The Cabinet Sub-Committee will be supported in its work by an Inter-Departmental Group of senior officials drawn from the relevant departments and chaired by the Secretary General of the Department of Health and Children. It will review the implementation and impact of the Strategy on a continuing basis. It will focus in particular on high-priority cross-sectoral issues affecting health, such as accident prevention, tobacco use, alcohol and illicit drug misuse, air pollution, transport and water quality. With the support of the Committee, health proofing will be built into all public policy formulation and will feature in the strategy statements and business plans of all Government departments.
  • As indicated in Chapter 4, a new Population Health Division will be established within the Department of Health and Children. The Division will ensure a focus for population health within the department, liaise with all Government departments on health proofing policies, develop legislation requiring that future Government decisions incorporate health proofing, facilitate health impact assessments locally, regionally and nationally and assess the impact and effectiveness of population health initiatives undertaken.
  • At health board level, a population health function will be established in each of the health boards to support the boards' involvement with external agencies, to ensure that health proofing and health impact assessments are carried out locally and to develop and formulate policy for population health at a local level.

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Implementing the Strategy in the health system

  • A National Implementation Team will be established within the Department of Health and Children to drive the implementation of this Strategy within the health system at national level. It will co-ordinate and monitor actions within the Department, at Government and inter-departmental level and within the health boards and other agencies in the health services. This Unit will service the Cabinet Sub-Committee and the Inter-Departmental Group of senior officials.
  • The National Implementation Team will prepare an annual report to the Cabinet Sub-Committee on the progress achieved in implementing each key aspect of the Strategy, and identifying the next steps to be taken in the coming years. This report will be submitted to the Joint Oireachtas Committee on Health and Children, and made widely available.
  • A National Steering Group, to include a number of people outside the health sector who have practical experience of change management, will be established to work with the Department and health agencies. It will oversee and report to the Minister for Health and Children on the implementation of the Strategy. The National Steering Group will provide expertise and hands-on experience in achieving the momentum needed for the changes set out in the Strategy.

Dedicated arrangements will also be required within each of the health boards to co-ordinate and monitor the local level actions required to achieve the goals set out in the Strategy. There will be significant challenges to organisations, staff and managers within the system. Change of the level envisaged will require careful management and will involve significant development of the system's capacity and capability to achieve it. To support this an Implementation Team will be established in each health board with responsibility for driving the detailed implementation of the Strategy at local level. The boards may also decide to take joint action on aspects of the implementation process, either through the HeBE or by other means. The core purpose of the Team will be to support staff, managers and frontline services to improve health and health care by implementing the developments and initiatives set out in this Strategy. The Implementation Teams will:

  • lead implementation of the Strategy at health board level
  • work closely with the National Steering Group in achieving 'quick wins' and early implementation of change at local level, through co-operation with the key stakeholders
  • take the lead on organisation development and modernisation by
  • promoting excellence in services and spreading best practice throughout the system
  • enhancing individual and organisational leadership abilities
  • supporting policy development and implementation at health board level
  • provide input and support to the work of the Health Information and Quality Authority and the National Hospitals Agency in
  • spreading best practice,
  • establishing realistic regional and local targets for the development and improvement of services
  • implementing risk management and safe system strategies
  • focusing on improvements in high priority areas of service
  • facilitate resource allocation in a structured and systematic way to match specific goals and targets proposed within the Strategy.

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Involvement of wider stakeholders

The central contribution of staff, users, communities and voluntary organisations in shaping this Strategy will be mirrored by a continuing key role for all stakeholders in its implementation over the next seven years.

  • The partnership arrangements in place nationally and in each of the health boards will be used as a vehicle for the involvement of staff and staff groups in the implementation of the Strategy at national and local levels. The partnership structures will be invited to work alongside the National Steering Group and the Implementation Teams in each health board. A central focus of partnership will be to explore ways of achieving organisational change and new, more flexible forms of work organisation.
  • A broadly based National Consultative Forum will be convened annually to consider progress reports on the implementation of the Strategy and to comment on priorities in the light of progress and emerging trends. The Forum may review the annual reports submitted to the Cabinet Sub-Committee and any other reports on health and health care it sees as relevant.

All-Ireland and international dimension

In implementing the Health Strategy, the scope for co-operation at a North/South and international level will be utilised to the full.

All-Ireland dimension

The Department of Health and Children has for many years maintained co-operative relations and contacts with the Department of Health, Social Services and Public Safety (DHSSPS) in Northern Ireland. These arrangements were primarily conducted on an informal basis. In addition to this, however, there existed strong working relationships between individuals, health professionals and local/regional health authorities on both sides of the border ­ of which Co-operation and Working Together (CAWT) is an excellent example ­ all of whom identified the value of working together in the field of health.

The Good Friday Agreement represented a watershed in co-operation between North and South at the highest political and administrative level. Following the identification of health in the Agreement as one of the areas for North/South co-operation and implementation, the mandate that was entrusted to the Departments ­ South and North ­ was to seek opportunities for joint co-operation in five health operational areas. These are:

  • Accident and emergency planning
  • Planning for major emergencies
  • High technology equipment
  • Cancer research
  • Health promotion.

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In addition, the Agreement provided for the establishment of six Implementation Bodies of which one was to be on Food Safety. The Food Safety Promotion Board was subsequently established.

The establishment under the Agreement of the North-South Ministerial Council (NSMC) has provided a significantly greater focus, momentum and authority for developing mutual interests in the field of health through co-operative and joint action. Work in the co-operation areas is being taken forward on a structured basis by designated officials in the two Departments and in conjunction with local agencies and interests. In addition, significant research has been conducted to identify obstacles to cross-border mobility and potential areas for service-based co-operation.

The value of existing co-operation arrangements is recognised, such as those in the area of health promotion, and joint services or training initiatives at local level. There are, however, significant obstacles and challenges to co-operative action between the North and South. Some of these relate to established practices, such as professional accreditation and funding arrangements. Other challenges and opportunities now presenting would involve taking co-operation to the level of planning and delivering certain high-cost acute hospital services which require a significant population base for sustainability.

The Department of Health and Children shares the views on the need to explore and pursue the potential for cross-border co-operation in hospital services, expressed in the Report of the Northern Ireland Acute Hospitals Review Group (2001). Furthermore, it recognises the challenges and opportunities attending cross-border co-operation in health services in Ireland which were set out in the 2001 Report of the Centre for Cross-Border Studies on the subject. The Department is committed to exploring and developing opportunities for co-operation which:

  • safeguard or improve public health
  • provide greater access to services for patients
  • make good economic sense
  • are sustainable
  • involve a significant mutual benefit.

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Accordingly, during the currency of this Strategy, the Department of Health and Children, working with the DHSSPS, will:

  • continue on-going contacts and work to develop initiatives in the five areas of co-operation designated under the Good Friday Agreement (accident and emergency planning, planning for major emergencies, high technology equipment, cancer research and health promotion)
  • identify further areas for co-operation
  • commission research or evaluation to expand the evidence base for co-operative measures and best practice
  • address, to the greatest possible extent, the identified obstacles to cross-border mobility and co-operation
  • examine and, where feasible, develop joint planning and delivery of specialised acute hospital services which require the critical mass represented by the population of the island as a whole.

Both in conjunction with the DHSSPS and independently, the Department will strengthen its relationships and contacts with the relevant interested agencies, particularly CAWT.

International dimension

The protection, improvement and monitoring of public health have been long established as matters of particular international importance and concern. The need for close co-operation in the field of health is heightened by the emergence of new threats to health, technological advancement in the field of health and the ongoing search for most effective and efficient systems for delivering quality care. Accordingly, Ireland has for many years played its full part in a number of key international governmental bodies concerned with health issues including the European Union, the World Health Organisation and the Council of Europe. In these fora, the Department has contributed to, and learned from, international thinking, trends, experience and policy in relation to health.

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During the course of the period of implementation of the Health Strategy, the Department will maintain full engagement with, and involvement in, the work of these key international bodies. The aim of the Department of Health and Children will be to:

  • discharge Ireland's international responsibilities in the field of health
  • contribute to international deliberations and policy formation
  • learn from experiences and trends in other countries with a view to achieving best possible organisation and delivery of services.

Monitoring and evaluation

In addition to implementation, it will be important to put in place a system to monitor progress and systematically evaluate the quality and effectiveness of services being delivered. Monitoring and evaluation must become intrinsic to the approach taken by people at all levels of the health services. The arrangements to support these functions will be strengthened, as described below.

The use of a formal organisational function for monitoring and evaluation has been introduced in the Eastern Regional Health Authority (ERHA). This emphasis now needs to be mirrored within the Department of Health and Children and in each of the health boards so that we can develop a stronger focus on monitoring and evaluation throughout the system. A formal monitoring and evaluation function will be established within the Department and by each health board region. As in the case of the ERHA, the function at health board level will be to monitor progress against targets and to evaluate outcomes over the medium to long term.

Monitoring standards

The detailed standards against which progress will be measured will reflect targets set out in Chapter 7. These high-level monitoring standards will be set at a level that will be challenging but attainable. The standards selected will be based on robust evidence rather than on the basis of information gathering convenience and, where possible, will facilitate international comparison on the basis of WHO guidelines.

Performance indicators for service planning, monitoring and evaluation will be further developed, based on information derived directly from operational service delivery, combined with data on population health. This work will be informed by national and international research. A national set of key performance indicators will be developed jointly between the Department and the health boards, with advice from the Health Information and Quality Authority and, where relevant, the National Hospitals Agency. These indicators will be relatively small in number and will represent the key pieces of information required for communication of achievement between the health boards and the Department. Individual agencies will supplement these with specific performance indicators required by local management.

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When combined with basic information on finance and activity, good performance indicator information should enable:

  • managers to judge that service delivery is effective and quickly identify any difficulties arising
  • policy makers to judge how well policy is being implemented
  • evaluation and review of services and policy, thus informing future developments
  • better communication of achievements, understanding of actions required, and participation in management across professional boundaries
  • the public to be better informed.

The results and analysis of these performance indicators will be made available to the public in a way that will assist them in contributing to policy formation and coming to a better understanding of the health-related services available to them. Information systems will be put in place from which performance indicators can be derived automatically, without disruption to service delivery.

Evaluation

In tandem with the ongoing monitoring of performance within the health services described above, there is a need for a more focused and in-depth assessment of the quality, equity, and patient-centredness of particular services through a series of formal evaluations. While many local and national policy and service reviews and customer service initiatives are being undertaken around the country, a more systematic approach to the evaluation of services on a national basis is now needed.

At national level, this will be done externally by the Health Information and Quality Authority, as discussed in Chapter 5. At local level, the monitoring and evaluation function to be established in each health board region will carry out this function.

The Department of Health and Children will, as part of the service planning process, require each health board to specify the formal evaluations to be undertaken by their respective monitoring and evaluation units. In the case of the eastern region, the service areas selected for review will be identified by the Eastern Regional Health Authority rather than the three Area Health Boards in the region.

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External monitoring and evaluation

The Health Information and Quality Authority will have a specific remit in relation to carrying out formal independent evaluations of services at national level. The services to be reviewed will be selected in consultation with service providers, users and other stakeholders. The Authority will be charged with developing and managing an ongoing monitoring and evaluation programme which will include responsibility for the initial determination of standards, performance indicators, agreed data dictionaries and definitions, minimum data sets and resource requirements.

This responsibility will complement the Authority's remit for the overall development of information management within the health system that are also described in Chapter 5 of this Strategy.

The Authority will harness the contribution of the new National Hospitals Agency in developing and monitoring standards for the acute hospital sector. This will also provide a framework for evaluating the role and impact of third party agencies such as the professional, regulatory and training bodies on acute hospital service delivery.

The Health Information and Quality Authority will also contribute to the evaluation of services through its important role in the overall quality agenda which will involve the introduction of formal accreditation programmes that incorporate formal quality assessments, the development and dissemination of best practice standards, and the introduction of formal patient safety and adverse incident reporting systems. It will liaise with the proposed agency dealing with claims of clinical negligence.

Monitoring and evaluating other sectoral inputs

At a national level a formal mechanism for monitoring and evaluating the impact of the various non-health sectors on overall population health status, based on their explicit responsibilities and targets, will be developed through the introduction of a Government-wide system of health impact assessment.

The Health Information and Quality Authority will have a key role in developing and implementing this tool at a national level and for supporting and facilitating its use at Department of Health and Children and local health board level.

Developing monitoring and evaluation capacity

The determination and agreement of standards, definitions, data-sets, targets and reporting requirements will not in themselves achieve a robust monitoring and evaluation culture within the health services or the wider health system. Within the health services, major effort will be required to develop capacity and capability to support that culture.

This is why, rather than exercising a simple inspectorate approach from its establishment, the Health Information and Quality Authority will have an important role in working with agencies on developing standards and identifying and meeting resource requirements in a supportive and developmental manner. In developing a monitoring and evaluation culture, it will be essential to dedicate substantial resources to this capacity and capability building exercise. In particular, this will mean supporting agencies individually and through HeBE in:

  • making the major investment required in information and communication systems throughout the services
  • addressing the major programme of human resource development to go along with that. If a successful and effective monitoring and evaluation culture is to be achieved, a supportive rather than policing approach must dominate.

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Framework for implementation, monitoring and evaluation

National level

Implementation

  • Cabinet Sub-Committee on Implementation of Strategy, chaired by An Taoiseach
  • Inter-Departmental Committee to support the Cabinet Sub-Committee and review the cross-sectoral impact of the Health Strategy
  • Dedicated National Implementation Team in Department of Health and Children to drive implementation of the Strategy within the health system and to prepare published annual progress report for the Cabinet Sub-Committee and the Joint Oireachtas Committee on Health and Children
  • National Steering Group including external expertise in change management to identify approaches for implementation and to help create momentum for change.

Monitoring and evaluation

  • Dedicated monitoring and evaluation function within the Department of Health and Children
  • Department and health boards to agree a key set of nationally applicable performance indicators. (Individual agencies to supplement these as required with more detailed local indicators)
  • New division of population health in the Department of Health and Children to facilitate health impact assessment, promote health proofing of all Government decisions and ensure a population health focus at national level.

Health boards/local level

Implementation

  • Implementation Teams to implement Strategy at local level, working with local stakeholders and the National Steering Group
  • Dedicated population health function in each health board, headed by senior manager with responsibility for liaison between agencies and health impact assessment.

Monitoring and evaluation

  • Dedicated monitoring and evaluation function within each health board to review selected services as specified in service plan
  • Performance management systems to be introduced.

Wider stakeholders

  • National Forum of all stakeholders to review implementation reports of the Department's Health Strategy Unit and reports on monitoring and evaluation
  • Further development of partnership structures for staff involvement in implementation of Health Strategy at local and national level.

External assessment of progress

  • Health Information and Quality Authority to:
  • Carry out independent evaluation of selected service areas each year
  • Work with agencies to develop standards, methods and targets against which to evaluate services
  • Drive information developments in line with the National Health Information Strategy
  • Pursue national quality agenda, including accreditation, best practice guidelines and risk management
  • Develop health impact assessment tools for national and local application
  • Oversee health technology assessment.

Wider stakeholders

  • National Consultative Forum of all stakeholders to consider progress reports on the implementation of the Strategy
  • Further development of partnership structures for staff involvement in implementation of Health Strategy at national and local level.