Description (EN): People living in border regions are most impacted by the fact that there are two health systems alongside each other which are significantly different in terms of policy base, structures, coverage and funding. This means there are no universal solutions for cross border health and social care services as they need to be meticulously planned and thus are more challenging and time consuming than single jurisdiction services.
Proposed Project - The purpose of this project is to increase acute episodes of care to patients, through improved/reformed service delivery on a cross border basis. Inherent in the submission is the reassurance that all necessary consultations are embodied though the chief executives of the partners.
Partnership composition- Health Service Executive, Western/Southern Health & Social Care Trusts, Public Health Agency, Health & Social Care Board, NI/RoI/Scottish Ambulance Services.
The Partnership has developed objectives to achieve the output indicators associated with 4:118/4:119: Establish 3 cross-border frameworks, for scheduled/unscheduled care streams to benefit 13,000 Patients. The project will deliver services in a more innovative way, not only in terms of how flexibly patients might access such services but also to reorganise services so that they deliver better quality care to patients with more effective clinical outcomes.
Strategic Context - This project will transform the lives of at least 13,000 patients within the eligible area. The project aligns strongly with all the partners Strategic policies including in NI Transforming Your Care, ‘Future Health’ in Ireland and ‘20:20 Vision’ (2011) and ‘The Healthcare Quality Strategy for NHS Scotland’ (May 2010).
Need and Demand for the Proposed Programme - The demand for pre-hospital/acute services in all 3 partner areas continues to rise year on year, the demand has not been satisfied; therefore the delivery mechanisms in their current form are unsustainable. Health service pressures have risen for several reasons, for example, as new technologies and diagnostic tests develop so too does the ability to treat more intricate ailments, thereby creating new demand. In addition there is informed public expectation that conditions are treated in a timelier and more effective way. In order to meet future demands, new ways of working must be developed and put in place urgently if the health services are to deliver the level and quality of services into 2020 and beyond.
Project Options and Preferred Option - There were 3 main options considered for this project: Delivered through private providers, Delivered through public services, Mixed economy approach. The Project scale and timetable was considered, constrained by the number of frameworks and funding available. Locations were selected through natural links between neighbouring acute hospitals and shared facilities to be used where possible within these geographical adjacencies. Technological change is a component of all the frameworks where possible, particularly in Framework 3, wherein Robotic Surgery will be of a magnitude that will enable transformation in its application, not only in terms of clinical outcomes, but also advantageously providing leading-edge training for clinicians.
Risk Analysis - The Partnership collectively identified risks associated with the proposed Project including potential time delays in recruitment/procurement. A risk register incorporating mitigation strategies to minimise potential risks has been developed by the Partnership and this will continue to be monitored throughout the lifetime of the Project.
Horizontal Themes – Sustainable Development/Equality. The Project is aligned and complies with the EU Sustainable Development Strategy and partner organisation strategies.
Management/Partnership - The Partnership has developed a comprehensive delivery plan and supporting work plans to ensure that the result and output indicators 4.118 and 4.119 are delivered within the required timescales. The procurement requirements have been noted. The Project will be managed by a dedicated team. The Project has been developed on an entirely cross border partnership basis. CAWT will oversee a robust governance structure incorporating a Management Board, functional support and a Project Board.
Communications - The Partnership has developed a detailed communications strategy highlighting the added benefit that the statutory partners of CAWT bring due to their long standing relationships since 1992 and their conjoined governance and affiliation with each other.
Evaluation/Monitoring - A detailed evaluation approach has been developed incorporating the measurement and gathering of qualitative/quantitative data. The proposed system for monitoring of targets and communicating this information through CAWT structures has also been detailed.
Exit Strategy - Through experience, the Partnership is aware of the need for the Project to demonstrate its impact and effectiveness to secure sustainability into the future or alternatively to leave a lasting legacy beyond the project timelines.
Information added on 2020-05-05, regarding the mitigation of the effects of COVID-19 (the corona virus pandemic that started in 2019): It is likely that many of the Objective 4: Cross-border Health and Social Care projects will divert project staff to assist with the response to the COVID-19 crisis. Among these, it is anticipated that the Respiratory Consultant, recently recruited by the Acute project, will be involved in efforts to combat the pandemic.
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Expected Outputs (EN): Framework 1 Unscheduled Care – 6,500 beneficiaries.
Reform of A&E/ED services to improve patient flow from pre hospital care to discharge using an Emergency Clinical Care Network that will enable best practice care models. Upskilling pre-hospital care personnel using academic and vocational routes plus exchange programmes using proven patient safety and quality frameworks and different models to reduce inappropriate A&E/ED attendances. Provide innovative multidisciplinary training to facilitate care and treatment and use technologies to ensure connectivity between first response and A&E/ED to instigate treatment in the pre hospital setting when appropriate. Enable the connectivity of all 3 ambulance services to provide backup to control rooms at a time of high usage.
Framework 2 Scheduled Care - 5,000 beneficiaries.
Reform outpatient systems and diagnostics e.g. screening/near patient testing/bloods in a Primary Care setting or where feasible, in the patient’s own home. Speciality areas will be prioritised for innovative care models and will include telemedicine to support specialists to run virtual clinics with better patient access. Specialist Nurses et al will be trained to enable more autonomous practice, increasing the volume of patients seen and reducing the pressure on the scarce Consultant resource. Waiting lists for these services will be reduced on a sustained basis.
Framework 3 Scheduled Care - 1,500 beneficiaries.
Better use of new technologies, existing physical infrastructure and human resources, e.g. theatre suites/recovery areas for surgical procedures resulting in an increase in theatre utilisation in 3-5 Hospitals with some patients receiving interventions outside their normal jurisdiction in centres with specialist skills, not readily available within their own healthcare system, enabling patient pathways to become more efficient and support patient flow on a cross border basis. There will be a requirement to promote the exchange of patient records for identified programme.
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