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

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

• provide input and support to the work of the Health Information and Quality Authority and the National Hospitals Agency in

• 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:

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.