Reconfiguring the Model for Healthcare John Cole Chief Executive Health Estates Northern Ireland Verona 14 th September 2007 1
Health Estates Agency An Agency of the Department of Health and Social Services in Northern Ireland Sets estate policy for the health and social services estate in Northern Ireland Determines design standards and advises on procurement for the major capital development programme in the health sector Project manages all major health projects in the current 3 billion+ capital development programme for the Health estate in Northern Ireland. A member of the Departmental Management Board of the Department of Health and Social Services in Northern Ireland
The Strategic Vision Who owns the strategic vision? Without it how can we plan an estate that is inherently long-term Often only a fragmented series of views from an uncoordinated group of stakeholders / enthusiasts and is generally short-term Frequently the concept of a longer term vision is often initiated by the needs of those responsible for the capital development programme rather than by service visionaries However it Is absolutely essential that all those with a part of the jigsaw contribute to the creation of the overall picture: Policy-makers, Researchers, Service Planners, Providers and Managers, Clinicians, Nurses, Allied Health Professionals, Technologists, Capital Development Planners, Designers, and Public and Patient Representatives. Development without a vision is like driving without a destination.
Looking into the Future Two planning horizons: 1. Meeting specific planning requirements for the short to mid term based on reasonable statistical analysis and 5 10 year projections on service changes and models of care 2. Meeting generic planning requirements for the mid to longer term based on much less firm knowledge and greater hypothesis (not usually well done) The only thing certain about the future is its uncertainty
Key Objectives Service Vision An agreed service model reflecting projected changes in demography, epidemiology, practice, technology, service development, political thinking and consumer expectations A strategic capital development plan fully reflecting this model The right type of facilities of the right design in the right place Design Vision Establishing generic and specific quality objectives that recognise the major contribution that design can play in creating a healing environment measured in terms of impact on health and well-being Developing design solutions that allow for change of demand and use over time Creating health facilities that enhance and enrich wider community development Maximising efficiencies in whole-life costs whilst ensuring the delivery of the required quality of design and focusing on contributing to wider environmental, social and economic sustainability
The Service Vision in Northern Ireland
Health and Social Services in Northern Ireland Population of Northern Ireland approx 1.7 million. Almost 50% live within 30 minutes of the capital Belfast Integrated organisation and delivery of health services and social services under the control of the Northern Ireland Government Department of Health, Social Services and Public Safety Approx. 98% of health services and facilities are directly funded and owned by the public sector
Historic Situation Ever-increasing demand for services Surge in the number of emergency medical admissions delaying elective work Bed-blocking in acute hospitals by elderly patients waiting for care packages Large number of beds occupied by patients with chronic diseases Long waiting lists for GP referrals for OPD appointments, diagnostics and elective surgery Difficulty in staff recruitment High quality complex care increasingly unsustainable in smaller units Overcrowded Accident and Emergency Departments Limited integration between primary and acute sectors and service
Extracts from Departmental Review of the Service Model Patient care is best seen as a system in which the acute episode is an event in an unfolding and ideally seamless pattern of care We were attracted by the concept of a virtual hospital, or a hospital without walls Part of the objective is to keep people out of acute hospitals who should not or need not be there The day of the stand-alone institution attempting to do everything from its own resources, acting in isolation from the wider system is already gone
Current Departmental Strategy 1 Commissioning Body will shortly replace 4 Commissioning Bodies 5 Health and Social Services Provider Organisations have just replaced 19 (April 2007) All 5 are responsible for providing both acute services and primary and community services (previously separate organisational responsibilities) Specialist and Complex Services (Cancer Services,, Cardiac Surgery, Neuro- Surgery, Regional Paediatrics, Elective Orthopaedics etc.) have been centralised a Regional Centres of Excellence 18 Acute Centres to be reduced to 9 (facilitated by the development of managed clinical networks) The remaining 9 hospitals to be redeveloped as Local / Community Hospitals A number of hospitals designated as Protected Elective Centres (high volume) 48 new one-stop community / primary care centres (also providing a range of services previously only available in hospital settings)
Total System Design Regional Strategy and Key Service Objectives facilitated by: New Service Model Re-engineering of the work-force Optimising Information Technology Redesigning the facilities
5 Types / Levels of Facility 1 - Local Health Centres 2 - Community Health Centres 3 - Local Hospitals 4 - Acute Hospitals 5 - Regional Centres All linked by clinical and information technology networks and protocols General principles but no rigidly fixed definition of which services are delivered at each level Best fit model will vary from location to location reflecting local needs Individual projects include various combinations of services
Key Trends in Location of Services vement of outtients diagnostics d treatments from ute towards mmunity y issue is the vement of ronic disease nagement to the mmunity venting necessary spitalisation 1 - Local Health Centres 2 - Community Health Centres 3 - Local Hospitals 4 - Acute Hospitals Movement of complex specialties or specialties benefiting from higher critical mass to Centres of Excellence 5 - Regional Centres
An Integrated Services Model 4 Local Hosp. Acute Hospital 150-300 Thousand 1.7 Million Regional Hospital Acute Hospital Local Hosp. 100 Thousand+ 3 Local Hosp. CHC Non-health agencies 2 Acute Hospital CHC Individual homes HC 1 2-10 Thousand CHC HC 20 70 Thousand Other Community Facilities.
Standardisation Standardisation of briefing packages Standardisation of room types and room combinations but not buildings - community and acute Modularisation of room sizes Facilitation of off-site construction Focus on design quality with integrated building, services and furniture
Local Health Centres Level One 1 HC 2-10k population 1 5 million cost Located in smaller towns or localities Typically Containing:- General Practitioners Non-complex diagnostics Basic Treatments and Nursecare Limited Range of Therapies
Community Health Centres Level 2 2 CHC 20 70k population 5-15 million cost Located at natural public transport / retail / civic centre hubs in cities and larger towns Typically containing:- Level 1 Facilities (in most level 2) Out of Hours GP Service Out-patient Consulting Suites Minor Procedures Suite Non-complex Imaging and diagnostics Children s Services Physiotherapy Speech therapy Podiatry Dental Services Social Services Mental Health Services Multi-disciplinary outreach teams Voluntary Sector Community Facilities Pharmacy Etc.
Community Treatment and Care Centres in Belfast
Holywood Arches Centre, Belfast completed 2005
Ground Floor Plan - Public Zone and Treatment Areas
1st / 2nd Floor Plan - Consultation Zone
3rd Floor Plan - Staff Zone
The Carlisle Centre Belfast completed march 2007
Castlereagh Centre Belfast construction commenced February 2007
Shankill Centre Belfast
Local Hospital Level 3 3 Local Hospital 100 k + population 40-60m cost Dispersed across Northern Ireland between Acute Hospitals Typically containing:- Clinical Decision Unit and Observation Beds Ambulatory Care Centre Full Diagnostics Day Procedures / Day Surgery Possibly Protected Elective Centre Step-down, Rehabilitation, GP beds Support Services
Mater Infirmorium Hospital Belfast