Keeping the faith: transforming health and social care in Northern Ireland

Whilst Northern Ireland differs from much of the rest of the NHS in having an integrated health and social care system, it faces many of the same challenges and must deliver similar changes if it is to be successful and sustainable in the future.

But change is hard and at times the transition feels far from easy. We need to acknowledge that. At a leadership workshop for senior leaders within my own Trust recently I quoted Rosabeth Moss Kanter: ‘sometimes success feels like failure in the middle’. My key message was: ‘Keep the faith. We need to change, we have to change, and we are changing...but we have to keep the faith that we are on the right track and keep pressing on’.  

It’s vital we keep up morale. Once the people leading the reforms on the ground become beleaguered and start thinking that the changes won’t work or are undeliverable, we will lose our way and certainly the support of staff and the public.

The changing demographics represent one of our main strategic challenges. We are seeing increasing dependency of older people, rising chronic disease, deteriorating mental health and more complex disabilities. How can we respond to the growing demand on health and social care services, particularly given the world wide economic position and associated financial austerity?

At the moment much of our attention and resource is targeted at those already in need. At its most basic, we are reacting to illness and dependency. If the NHS is to survive into the future it must become more proactive and really be better at keeping people well and independent.

This means more focus on health promotion and preventing deterioration in health and dependency. In essence the major challenge for us is to intervene earlier in the dependency spectrum. There is much evidence that early intervention can prevent deterioration in areas of chronic disease, diseases of ageing and assist good mental health and child development.

In Northern Ireland, this approach is embodied in our regional strategic document, ‘Transforming Your Care’. A term ‘shift left’ has been coined, to represent the move from secondary to primary care. My view is this is not about shifting work from one sector to another, but the real goal is about keeping people well and thereby affecting some of the potential future demand. I believe having integrated health and social care services in Northern Ireland enhances our opportunity to do this.

In a post-Francis world, the other main strategic challenge is to provide robust assurance on standards and to regain public confidence. This follows a series of high profile failures and negative stories, of which Northern Ireland has had its local share.

We need a system which provides us with assurance about the standards of all we do and creates a culture of continual improvement where every service and every team is improving quality.

Our Trust has developed a bottom up performance system: the Safety, Quality and Experience (SQE) approach. Every service must test itself against standards; improve the quality in weaker areas and test the experience of its users. Ultimately, the programme is designed to assure us, our staff and our users that every service is safe, improving and aspiring to a gold standard culture, one which is caring and compassionate.  

Finally, all of this should be built on a platform of innovation and technology. We must aspire to find innovative ways to support the new model of care we want to achieve. This is about creating new solutions, but also about becoming early adopters of things that have already been demonstrated to work elsewhere. Technology, and its use, is a key enabler in redesigning the way we work and improving the quality of what we do.  

I recently visited a number of our new community-based facilities which illustrate for me that we are on the right track with the reforms to services. One was a new supported living scheme in Downpatrick called Cedar Court. Here, older people with mild or moderate dementia live in their own personal accommodation but with some shared common space and support. Both staff and residents think this works better than the old ‘dependency encouraging’ residential type model.

The officer in charge, Rhonda Robinson, had previously worked in a residential home and had initially been opposed to its closure. She said, ‘I never thought anything would beat Loch Cuan [home she used to work in], but this is better. This is the future’. Another member of staff told me, ‘We used to shower the residents with kindness and perhaps this added to their dependency. Now we also push them to do things for themselves in a way which helps maintain their independence’. 

The evidence is there we are making the right changes, we need to keep the faith and sustain our efforts...there is too much at stake not to.

Hugh McCaughey is Chief Executive of the South Eastern Health and Social Care Trust.