Health and Wellbeing 2026 - Too Long; Didn’t Read

On 25th of October, informed by the Bengoa Report, the Health Minister announced the publication of the document Health and Wellbeing 2026; Delivering Together.

This document represents the outworkings of the Expert Panel's recommendations. You can read the Expert Panel's report here.

In her foreword the Minister states that the doucment sets out "a commitment to tackle the issues we face in our Health and Social Care system through decisive political leadership." Moving beyond "short term approaches" and "crisis management."

You can read the document in full here

The document runs to 25 pages, split across five chapters:

The Challenge

This chapter begins celebrating some of the successes of the where Health and Social Care, in collaboration with wider government, is making a real difference to our health and wellbeing. However the document goes on to say “The reality is that we increasingly cannot properly meet people’s needs with our current structures,” and goes on to outline the differing challenges the Health and Social Care system faces including:

  • On Organisational challenges the document states:
    • “The 20th century configuration of our services is simply not optimised to meet the needs of 21st century care.”
    • “Modern research shows that outcomes for patients requiring complex or specialist treatment improves where high levels of specialist expertise is available and these teams are able to keep pace with innovation. The current spread of such HSC resources, too often committed to buildings rather than outcomes for patients, is a central challenge we must address.”
    • “If we persist with our current models of care, even with the best efforts of all staff and more investment year on year, waiting lists will continue to grow, our expertise will continue to be diluted, and the best possible outcomes for patients will not be realised.”
    • “The way we are organised means that opportunities are being missed to create sustainable employment, drive economic investment, and maximise the contribution of the HSC to the economic goals of the Executive.”

 

  • On the workforce the document pays tribute to the hardworking staff within the HSC system and also says:
    • “We must invest in our staff and provide the environment to allow them to do what they do best - provide excellent highquality care. This means providing opportunities to develop their skills and find suitable career paths at all levels. Where necessary, we will increase the numbers we train and consider ways of delivering care more effectively through the development of new roles and skills.”

 

  • On the challenge of the needs of a rapidly changing and ageing population the document says:
    • People’s health and social care needs have changed, and their expectations are rightly higher than at any other time before. In the past, for many conditions, where there was an effective treatment available, it often required hospital attendance or an in-patient stay. Increasingly, such treatments are available in the community, or can be provided on a day care basis; which in many instances is more appropriate to the needs of people with longer-term chronic conditions.”

 

  • The document also covers the challenges of health inequalities:
    • “The differences in health and wellbeing outcomes between the most and least deprived areas are still very stark, and completely unacceptable.”
    • “Our future health and social care system needs to not only treat people who become sick or need support now, but also needs to do much more to ensure that the next generation is more healthy with more equitable life opportunities for all.”

 

  • This chapter finishes with a section entitled Our Opportunity:
    • “Both as Minister and as an Executive we believe there is now no alternative but to transform how we design and deliver health and social care services.”
    • “The advent of a new outcomes based approach in the draft Programme for Government puts an onus on us all to work together, across traditional silos and boundaries to deliver the best outcomes for the people of the North.”

 

    • “Across this island, the health and social care fabric of both jurisdictions face the same challenges. We have the opportunity to work more collaboratively with colleagues to address those challenges, and deliver services in a way that improves care for our population as a whole…. There are many more such opportunities, including the transplantation of organs and rare diseases, and we have developed a programme of work with the Department of Health in the South to identify areas of mutual benefit.”

Read more details on this chapter starting from page 4 of the document. 

The Ambition

In this section the Minister outlines her ambition to see “a future in which”:

  • “people are supported to keep well in the first place with the information, education and support to make informed choices and take control of their own health and wellbeing;
  • when they need care, people have access to safe, high quality care and are treated with dignity, respect and compassion;
  • staff are empowered and supported to do what they do best; and  
  • our services are efficient and sustainable for the future.”

These aims will “underpin a new model of person-centred care focussed on prevention, early intervention, supporting independence and wellbeing. This will enable the focus to move from the treatment of periods of acute illness and reactive crisis approaches, towards a model underpinned by a more holistic approach to health and social care.”

The ambition also focuses on how the model will be designed:

“This model will be designed for and with people and communities rather than by organisations and services.”

And where it will be delivered:

“we will deliver care and support in the most appropriate setting, ideally in people’s homes and communities.”

Read more detail on this chapter starting at page 10 of the document.

The Change Needed

This chapter is split into four sections, in order to deliver the change needed we must:

  • Build capacity in communities and in prevention to reduce inequalities and ensure the next generation is healthy and well;
  • Provide more support in primary care to enable more preventive and proactive care, and earlier detection and treatment of physical and mental health problems;
  • Reform our community and hospital services so that they are organised to provide care when and where it is needed;
  • Organise ourselves to deliver by ensuring that the administrative and management structures make it easier for staff to look after the public, patients and clients.

Under Build capacity in communities and in prevention the document says it will:

  • “work with communities to support them to develop their strengths and use their assets to tackle the determinants of health and social wellbeing”
  • “In particular, the HSC will focus on better tapping into the innovative ideas and energies in communities themselves, and in the community and voluntary sectors.”
  • “We will invest in HSC community development resources to work alongside all communities to enable social inclusion and tackle health inequalities and the underlying contributory factors including poverty, housing, education and crime.”
  • “we will link social care more strongly with improving and safeguarding the wellbeing of individuals, families and communities. We will strengthen the social work profession through by fully implementing my Department’s Improving and Safeguarding Social Wellbeing Strategy.”
  • “To give every child and young person the best start in life, we will further increase the support we provide to children, young people and families from before birth to adulthood.”
  • “I will work with other Ministers to build on the success of the Early Intervention Transformation Programme and enhance early intervention services and the Family Support Hub network by exploring ways to build on the capacity of the hub model.”
  • “For children who are in the care system we will work to improve their life chances.”

Under Enhancing support in primary care headlines in the document include:

  • “Our future model of primary care is to be based on multidisciplinary teams embedded around general practice.”
  • “This model is radically different from what we have at present. It will require significant change in the way staff across the HSC are organised and deployed, and in the way GPs and other members of the new teams work together. This new model will therefore be rolled out incrementally over the next 5 years”
  • “We will maximise the potential for developing social prescribing models in the multi-disciplinary primary care teams”

When talking about Reforming our community and hospital services the document states:

  • “in future we want to build on new services and models which are already emerging, and ensure that these are implemented across our health and social care system, working in partnership with those who deliver and use these services.”
  • “Acute Care at Home is an example of this type of service. Patients, often frail and elderly, are treated in their own homes by doctors, nurses and other staff…. Acute Care at Home is an example of this type of service. Patients, often frail and elderly, are treated in their own homes by doctors, nurses and other staff.”
  • “We are committed to the further development of Ambulatory Assessment and Treatment Centres, to provide a more joined up, 1-stop service.”
  • “Elective Care Centres will be established to provide a dedicated resource for less complex planned surgery and other procedures.”
  • “Acute inpatient care will change,… Acute inpatient care will therefore focus on complex planned surgery and emergency care of patients who need an acute inpatient setting”
  • “The North has a particular challenge with mental health… It is clear that our services need to continue to evolve and improve, building on the Bamford reforms from the last decade.”
  • “We know that the needs of carers are changing, this means the type of support we need to give them is also changing. We need to encourage greater take up of carer’s assessments and expand the options for short breaks, as well as enabling the greater use of personalisation and personal budgets where appropriate.”

 

Talking about organising ourselves to deliver the document outlines:

  • “Where services are highly specialised, they will be planned and delivered on a region-wide basis.”
  • “we will continue to explore opportunities to plan and deliver services on an all-island basis”
  • “The recent consultation on HSC structures supported the need to reduce bureaucracy and put in place a more effective streamlined mechanism for how we plan health and social care services.”

Read more detail on this chapter starting at page 12 of the document

The Approach

This chapter splits into five chapters:

  • Partnership Working
  • Improving Quality and Standards
  • Investing in our Workforce
  • Leadership and Culture
  • eHealth Care

On Partnership Working it says:

  • Building on the good practice which already exists in the HSC, such as the Mental Health Recovery Colleges, we will work collaboratively in the spirit of openness and trust to deliver agreed outcomes.”

On Improving Quality and Standards the Minister says:

  • “I intend to establish an Improvement Institute that will better align existing resources to enable improvement in our system of care”

Investing in our Workforce includes:

  • “We want to ensure that we are harnessing the skills and experience of the 72,000 individuals working in the wider HSC family.”
  • “In collaboration with stakeholders, we are committed to ensuring a Workforce Strategy is developed by Spring 2017”
  • “We will continue to invest in training by expanding GP and nurse training places”

 

Leadership and Culture refers to:

  • "We will expand the range of information and interaction available to citizens, service users and those providing services both on-line and through apps. This will include building a new patient portal which will allow secure on-line access to their own health and care information where service users want this"
  • "We still have too many different systems across the HSC making it difficult to join up data and focus on the service user… Moving to a more consolidated health record across the North will allow us to make better use of information about our population - designing new ways to intervene early and support people in managing their conditions."

Read more detail on this chapter of the document starting from page 19

The Actions

The final chapter outlines the actions the Minister intends to take over the next 12 months, under three headings, with key steps attached to each of them:

  1. Stabilisation
    • Develop a comprehensive approach for addressing waiting lists
    • Make significant investment in primary care
    • Bring forward proposals relating to the extension of placement options for Looked After Children.
    • Roll out access to the electronic care record
    • Begin development of a new framework to fully realise the potential of community pharmacy services
  2. Reconfiguration and Service Change
    • Embark on a consultation on the criteria set out in the Expert Panel Report and start a programme of service configuration reviews
    • Bring forward proposals for the location and service specification for Elective Care Centres, and Assessment and Treatment Centres
    • Reform of planning and administration
    • Identify current innovative HSC projects at the local level and develop a rolling programme and implementation plan to scale up these projects across the region.
  3. Transformation
    • Embark on a period of engagement with staff and service users to build a collective view of how our health and social care services should be configured in the future
    • Establish and seek members for a transformation oversight structure
    • Consult on proposals for the reform of adult social care and support
    • A new user feedback platform
    • Complete the initial design work for the Improvement Institute.
    • Develop a Workforce Strategy
    • Develop an HSC-wide Leadership Strategy
    • Development of a patient portal

More details on each of these steps, including timescales is available from page 25 of the document.

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