Technology at heart of NI shake-up

A new model for Northern Ireland’s health and social care services has been unveiled that mirrors many of the reform plans for the NHS in England over the past decade.

The model, unveiled by health minister Edwin Poots at the end of an independent review, calls for the individual to be put “at the centre” of care and for a significant shift of services from hospitals to nursing homes, social and community services and GP practices.

The model sees a significant role for technology in the changes, and describes it as “a key enabler of the delivery of the new model of care.”

It says a new “forum” should be set up to “take forward how technology will support the new model of care, linking the service to industry and academia to ensure the optimum and best value for money solutions are taken forward.”

It suggests the Department of Enterprise, Trade and Investment should lead on this, with input from the Ministry of Health and regional projects to test ideas.

Specific proposals include plans to create an electronic care record for every patient in Northern Ireland that will include data from GP records, community information systems, pharmacy and hospital records, and be shared through a common ECR platform.

The model also “endorses” the idea of creating a data warehouse for GP records that can be used to provide anonymised data for planning and commissioning, audit and governance, performance management and research.

And it calls for more mobile working and more use of telemedicine – or what it calls “connected health” – to support people in their own homes and reduce the number of visits made to GPs and hospitals.

At the start of the week, Poots announced an £18m telemonitoring service for Northern Ireland that will be run by a Centre for Connected Health and Social Care within the Public Health Agency, working in partnership with a business consortium.

The service will aim to reach 3,500 patients in Northern Ireland every year for the next six years.

Northern Ireland has particularly high levels of chronic disease, with some 75% of people over 75 living with a long-term condition, and 72% of acute bed days and 69% of health and social care spending soaked up in dealing with long term conditions.

Poots set up the review in June and appointed John Compton, chief executive of the Health and Social Care Board to lead it, with support from an independent panel of English and Northern Irish experts.

The review was not asked to cut the budget for health and social care, but to make recommendations about how it could be best used.

The panel included policy experts involved in 'Our Health, Our Care, Our Say' reviews of healthcare - and specificially community services - that were carried out in England towards the end of the Labour government's time in office.

They mirror many of their recommendations to move care "closer to home"; without putting the emphasis on choice and competition that the current round of 'Liberating the NHS' reforms are seeking to apply.

Even so, in the words of its report, “the review concluded that there was an unassailable case for change” to cope with a growing and ageing population, poorer health and an increasing burden of chronic conditions, and instability in the system.

It warned that this was leading to “unplanned and haphazard change”, poorer care, treatment and health outcomes, and was likely to lead to difficulties in meeting future needs.

The most controversial aspects of the changes are likely to be the review’s conclusion that Northern Ireland can support just five to seven acute centres - which would potentially halve the number of A&E units – and that it should close a significant number of its state run residential homes.

At the moment, the province, which has a population of around 1.8m, has ten major hospitals. In other parts of the UK, that size of population would typically be served by four acute facilities.

Poots told the Northern Ireland Assembly that £70m would be needed to implement the plans, but £83m currently spent in hospitals would eventually be transferred to GPs and other services.