Operational Plan

Foreword from the Chief Officer

Having been recently appointed as Chief Officer I am pleased to introduce the HSE Mid-West Community Healthcare Operational Plan for 2020.  This local Operational Plan sets out detail on the services we are committed to providing and already working towards achieving.  This year will see HSE Mid-West Community Healthcare manage and deploy a resource of €421.3m and a workforce limit of 4431 Whole Time Equivalents (WTE).  This represents a 6% budget increase in 2020.

The introduction will give an overview of the headline priorities within each of our four service profiles of Primary Care, Mental Health, Social Care all underpinned by Health and Wellbeing.  The subsequent sections explore those priorities in much more detail where we not only say what we will do but in many instances publish the figures by which such achievements will be measured including dedicated sections dealing with the detail of quality and safety, finance and workforce management.

We are legally obliged to use our resources in the most efficient, effective and beneficial manner.  The National Service Plan 2020 has set challenging saving and efficiency targets and the publication of this local Operational Plan is our statement of clear intent to be accountable in the national performance framework of the HSE and to the most important stakeholder, the 385,000 people of Limerick, Clare and North Tipperary.

The Mid-West Community Healthcare is part of the overall HSE, an organisation which will see many further changes and reform in 2020.  The advancement of Sláintecare will inform our organisation and culture as much as service design and clinical governance.  We are committed to working collaboratively with our colleagues in the University of Limerick Hospital Group (ULHG) and our academic partners in University of Limerick (UL) to play our part in the implementation of Sláintecare.  Two key Sláintecare priorities of capacity and access and structural reform are outlined in section 3, ensuring that such changes are an enabler to improving how we work, providing a high quality service for the resources available.

As the population ages, the increasing levels of chronic disease will require integrated and innovative approaches as increased complex presentations in both disability and mental health services are evident, services are challenged to respond at all times in a timely and efficient way.  We equally however have a responsibility to obtain the best value for money for the public and we are committed to managing services within the resources available.

As Chief Officer I am privileged to work alongside a dedicated workforce of skilled and expert clinicians, administrative and support staff, managers in the HSE Mid-West Community Healthcare and our colleagues in our partner organisations, who delivered a successful plan in 2019 with many positive achievements.  I would like to extend my thanks to all of them and I have every confidence that the Operational Plan for 2020 will be delivered as set out.

 Maria Bridgeman
Chief Officer, HSE Mid-West Community Healthcare

Introduction

Community Healthcare

The Mid-West Community Healthcare services include primary care, social inclusion, palliative care, mental health, disability services, older persons’ services and are provided for children and adults, including those who are experiencing marginalisation and health inequalities.  Community healthcare services are provided through a mix of HSE direct provision as well as through voluntary section 38 and section 39 service providers, GPs and private providers.

Sláintecare sets out the vision to deliver a change programme which will result in more positive experiences and better outcomes for patients, service users and local communities.

As outlined in Section 3 of this plan, two Sláintecare Joint Action Programmes have been identified as a priority in transforming the way care is delivered and experienced in Ireland in 2020 and beyond. These two Programmes will build on the work undertaken in 2019 and their development and implementation will be the key priority in the reform and redesign of community healthcare services in 2020.

 

Regional Health Areas

The commencement of the process to co-design the regional organisation of health services, and the role of the Department of Health (DoH) and HSE centre is a central deliverable of the Sláintecare Action Plan 2019 and will continue, as announced by the Minister, into summer 2020.  All design work will focus on delivering the Sláintecare vision for the region with emphasis on the following:

• A population-based approach to planning for the health and social services needs of the population within each region.
• Integration of hospital, community and social services within the same geographical area.
• Empowerment of frontline staff through devolved responsibility and ownership of planning of services with appropriate flexibility, and decision-making at a regional level.
• Equitable access to services that are easier for service users to navigate.

 

Community Healthcare Networks

The Sláintecare Report 2017 identified Community Health Networks(CHN’s) as one of the core units of health service co-ordination and provision. In this context, and in line with the Joint Action Programme on National, Regional and Local Health and Social Care Delivery Structures, the development of Community Health Networks (CHN’s) is a critical step in transforming our healthcare system and will enable real change that will be experienced by all who use our services, our staff and partner agencies delivering care.  The implementation of CHNs will see a co-ordinated multi-disciplinary approach to care provision, providing better outcomes for people requiring services and supports both within and across the Community Health Network.

Similarly, it is accepted that there is a need to ensure that general practice is sustainable both for current GPs in practice and those entering the profession. Building capacity in general practice will enable GPs to play a central role in achieving this shift in emphasis towards community based care.

 

Integrated Care

A priority for the Capacity and Access Joint Action Programme is the redesign and implementation of integrated care for older people and chronic disease management across, primary care, acute hospitals, and services for older people via CHNs / regional health areas / integrated care programmes.

The work that has been undertaken by the Integrated Care Programmes for Older People~(ICPOP) and Integrated Care Programme for the Prevention and Management of Chronic Disease has shown that improved outcomes can be achieved particularly for older people who are frail, and those with chronic disease, through a model of care that allows the specialist multi-disciplinary team engage and interact with services at CHN level, in their diagnosis and on-going care. Through the strengthening of primary care, clarifying pathways of care with specialist service and providing more targeted care planning to people with complex care needs, more services can be provided in the community, with a resultant decrease of activity in acute hospitals particularly in relation to emergency department (ED) attendances.

A number of these specialist community teams will be scaled into ‘Specialist Hubs’ to support network teams in addressing the needs of older people and those with chronic disease, bridging and linking the care pathways between acute and community services with a view to improving access to and egress from acute hospital services.

 

Sláintecare Enhanced Community Care Fund

As part of the Sláintecare Enhanced Community Fund, nationally there has been an allocation of €10m in 2020.  The Mid-West Community Healthcare will review reform initiatives to enhance community care services to support the shift of care from hospital to the community.  A number of key priority areas will be advanced including:

1. Prioritisation of initiatives that will have a positive impact on waiting lists
2. Maintaining and scaling successful projects into 2021

 

Further detail in respect of these initiatives is included in the relevant sections of each care group plan. A key focus for the HSE will be to develop and agree with the Department of Health (DoH) and Sláintecare Programme Implementation Office (SPIO) a business case for the required workforce expansion and then ensure the early and effective implementation of the agreed plan.

 

Implementing the Healthy Ireland Framework

In line with the goals of the Healthy Ireland Framework 2019-2025 through:

• Working in collaboration with CHOs, Hospital Groups and external partners to support the implementation of comprehensive Healthy Ireland implementation plans in CHOs and Hospital Groups
   
• Develop an operating model for health and wellbeing in the new regional health areas, building on work to date with the CHOs and the strengths of the current model across both CHOs and Hospital Groups
   
• Expand and support the model of Making Every Contact Count to support staff promoting and the delivery of health and wellbeing initiatives for their client and patient groups
   
• As a part of the implementation of CHNs, the Mid-West Community Healthcare will continue to strengthen all programmes to work on delivering on the Healthy Ireland Framework 2019-2025 with a particular focus on supporting self- care in relation to chronic disease management and promotion of positive ageing
   
• Work with community voluntary organisations to provide a wide range of supports which are essential in sustaining people within their communities.

 

Mid-West Community Healthcare Priorities for 2020

The headline budget in 2020 for HSE Mid-West Community Healthcare is €421.3m. (with an additional accommodation for up to €2.9m in respect of budget held by the DoH for Disabilities and services for Older Persons’).  In respect of the headline budget 2020, this represents a 6% increase on the roll over 2019 budget.  This is accompanied by a workforce limit of 4431 Whole Time Equivalent (WTE) and represents a year on year increase in available resource funding targeted at different priorities.

Section 2 of this Operational Plan gives an overview of the Mid-West population which is dependent on the resource allocation to address needs.  Increased life expectancy requires all services to plan for additional dependencies as the population of older people increases.

Across the age spectrum there are many different demographic pressures evident in the increased demand for services for older people, those with a disability, prevalence of chronic disease and mental health presentations.  The four service area profiles have many responsibilities and actions clearly set out in this plan.  Within these exceptionally busy profiles there is a need to focus on key priorities which aim in various ways to achieve change through improved access, quality, safety or the model and pathway of care provided.

Two key themes of Integration and Quality and Patient Safety underpin the plan and the priorities.  These themes are essential as the Mid-West works with the National HSE, the Department of Health and local partners to deliver on the ambitious plan that is Sláintecare.  The safety improvement actions within the Mid- West Delivery Plan 2020 builds on work already underway and is aligned to the six core commitments proposed in the HSE Patient Safety Strategy. 

Some, but by no means all of the priorities, are summarised here:

 

Health and Wellbeing

Improving the health of the Mid-West population underpins many of the services that we deliver.  The implementation of the Mid-West Health and Wellbeing Strategic Plan (2018) is the key framework through which HSE Mid-West Community Healthcare will pursue the many priority initiatives aimed at improving the health status:

• A better start in life drives focus in the direction of child health and prevention.
   
• A healthy environment is a key target to be pursued with all sectors in the Mid-West.
   
• Improved lifestyle requires the pursuit of many national programmes in areas such as Tobacco Free, Alcohol awareness, Healthy Eating, Active Living and Sexual Health.
   
• Age Well is supported by many policy platforms and approaches with the specific focus of Self-Management Support for those with chronic disease.
   
• The MECC (Make Every Contact Count) Framework will be pursued as an enabler to improvement.

A critical priority in HSE Mid-West this year is to take the now developing Health and Wellbeing service and approaches and embed them deeply within each of the local service areas.

 

Primary Care, Social Inclusion and Palliative Care

Primary Care

The Primary Care services are the first port of call for many service users and these can be for short periods or a sustained period.  The responsibilities and priorities set out later in the plan reflect a breadth and scope that comprehends infancy to end of life.  Amongst the many priorities are structure, infrastructure and targeted approaches/enhancements to care.

• Structure:  the framework for organising and integrating services has been defined as the Community Healthcare Network, allowing a more local focus in populations of up to 50,000 people.  The learning site will be commissioned and evaluated in 2020.
   
• Infrastructure:  2 additional Primary Care Centres will be commissioned in 2020 at Croom and Kilmallock Co Limerick.  The development of Primary Care Centres in Newcastle West, Dooradoyle, Limerick city, Ennis Road, Caherconlish/Cappamore, Thurles, Kilalloe, Roscrea, Sixmilebridge, Ennis (x2 Primary Care Centres) and Ennistymon will be progressed.
   
• Targeted Approaches:  Primary Care Services will continue to work with the Acute Hospitals to prevent delayed discharges and facilitate early discharges.  The role out of the HPV vaccine for secondary school boys will be completed.  The Sláintecare projects will be operationalised.  Additional Allied Health Professional services will be provided with the provision of additional funding.
   
• Achievement of Saving Initiatives that require a targeted approach to stay within the current level of funding provided.

 

Social Inclusion

Many groups, because of their minority status, are at risk of additional health outcome challenges compared to the general population.  HSE Mid-West has built a strong and vibrant service over the years and in 2020 will continue to pursue excellence in opportunity of access and outcome for the Homeless, those with Addiction, Refugees, Travellers, Asylum Seekers and LGBTI+.

 

Palliative Care

HSE Mid-West is fortunate to have a very comprehensive and high standard of access to specialist and other levels of palliative care.  This is in no small part due to the progressive work of Milford Care Centre with its origins in the Trusteeship of the LCM (Little Company of Mary) based in Limerick but serving and active in Clare and North Tipperary.  The implementation of the recommendations of the joint HSE Milford Care Centre Strategic Plan for Palliative Care in the Mid-West (2020-2024) will commence.

 

Mental Health

The Mid-West Mental Health Service takes a lifespan approach in providing a comprehensive, accessible, community-based specialist service to both adults and children.  Adult Mental Health Services are provided through 11 discrete sectors encompassing 13 Community Mental Health Teams, which provide a broad range of services and supports to meet the needs of individuals in terms of their age, location and specialist care requirements of general Adult Community Mental Health Services, Rehabilitation Services, Liaison Psychiatry Services, Psychiatry for Older Persons, Forensic Services and Psychotherapy Services.  The Child and Adolescent Mental Health Services (CAMHS) are delivered by six Consultant led Multidisciplinary Teams across the Mid-West, where the service provides assessment, diagnosis and treatment for children and adolescents and their families with moderate to severe mental health difficulties. The CAMHS service operates a system where urgent referrals are responded to within 24 hours.

Key Priorities for 2020 include:

• Working closer with our colleagues in Primary Care and Social Care in exploring and developing more integrated care pathways as defined in the Sláintecare Action Plan
   
• Review the current capacity across all the Mental Health teams in order to develop  a clear plan for recruitment, retention and staff engagement
   
• Building on the solid progress to date, the implementation of the Mid- West Connecting for Life Suicide Prevention Action Plan will continue to be a priority in partnership with all stakeholders.
   
• To work together with communities, service users and staff in the development of a Mental Health Service 3 Year Strategic Plan in line with Slaintecare and Vision For Change Refresh.
   
• The continued development and implementation of the agreed Clinical Programmes and new models of care across the Mid-West.
   
• Achievement of Saving Initiatives that require a targeted approach to stay within the current level of funding provided.

 

Social Care

Disability Services

The Mid-West continues to experience an increase in demand across the range of disability services including physical, sensory, intellectual disability and autism.  This trend is consistent with other areas of the Country.  Regulatory compliance continues to present challenges given the historical basis of service provision.

• HSE Mid-West will reduce Assessment of Need(AON) waiting times with the appointment of 12 additional AON posts
   
• Optimise the use of available resources to meet the increasing needs for respite services
   
• Day services development continues to be a key focus and HSE Mid-West will aim in 2020 to appropriately place all school leavers requiring specialist day supports, this will be enhanced through the recruitment of two Day Services Opportunity Officers
   
• The increased requirements for residential placements will be managed in the context of competing priorities, increasing complexity and available resources and a variety of responses will be considered and used to deliver this.
   
• Achievement of Saving Initiatives that require a targeted approach to stay within the current level of funding provided.

 

Older People

In public residential community nursing units and home support services the HSE Mid-West has reached very significant compliance with resource management and target achievement in recent years.  Achieving environmental regulatory compliance continues to be a challenge given the ageing infrastructure of the Community Nursing Units.

Key priorities for 2020 includes:

• Continued progress of new public replacement care facilities at St. Camillus Hospital Limerick, St. Joseph’s Hospital Ennis, St. Conlon’s Community Nursing Unit Nenagh, together with advanced planning for adaptations in St Ita’s Hospital Newcastle West and Dean Maxwell Community Nursing Unit Roscrea is key to delivering the 2021 target for these facilities.
   
• Continued modernisation of the Home Support service through the new Home Help Contract and the 2018 Tender Framework will yield further benefits.
   
• Exploration of new ways of responding to the changing needs of older people through the Integrated Care Programme for Older Persons (ICPOP) Pilot commenced in County Clare.
   
• Continue to work collaboratively with Milford Care Centre in the delivery of their Palliative Care Strategy.
   
• Achievement of Saving Initiatives that require a targeted approach to stay within the current level of funding provided.

 

Preparing for Brexit

In 2019, the HSE worked closely with the DoH and other agencies on a ‘no deal’ Brexit contingency planning as part of the whole Government Brexit preparedness on a range of issues. This involved identifying, assessing and addressing the necessary contingency measures and actions required to maintain service continuity in the event of either an orderly or a disorderly Brexit in the coming months.

In 2020 the Mid-West Community Healthcare will continue to work closely with service providers, suppliers and patient groups in relation to Brexit preparedness.  In order to achieve this, we will work with the HSE Brexit Co-Ordinator to ensure that:

• The current cross-border co-operation between the Irish, Northern Irish and UK health services continues to the benefit of patients in both jurisdictions
   
• There are adequate supplies of medicines and medical devices required for the health services
   
• Personal data can be shared with Northern Irish and UK based service providers by ensuring EU Standard Contractual Clause Agreements are in place to ensure compliance with GDPR
   
• There are regular communication briefings with our staff, patients, suppliers and key stakeholders on matters relating to Brexit.

Brexit remains a key risk in healthcare and we will need to manage and monitor the impact of Brexit now and into the future.

 

Mid-West Wide Community Healthcare Priorities

• A subset of this plan will include on-going refinement of expenditure management to deal with an estimated challenge in the region of of €8.2m (excludes identified deficits in the Voluntary Agencies). subject to final confirmation by the finance section, when demand against available resource is considered.  Accountability and prudent management of resource is critical in 2020 and will form part of both local and national performance discussions throughout 2020.  Affordability and containment of expenditure will be critical in 2020.
   
• Managing the Mid-West Community Healthcare workforce will require not only adherence to the affordability of and limits of the resource available while focusing on the support and development of that workforce as an enabler to the delivery of a quality and safe service for the public, additional attractiveness in recruitment and more sustainability in retention
   
• Progressing the Sláintecare and Reform agenda in the Mid-West including the development of integrated pathways in collaboration with our colleagues in the University of Limerick Hospital Group (ULHG) and our academic partners IN University of Limerick
   
• Implement the Community Health Network learning site in Network 6 (incl Ballycummin).  The CHN structures and collaborative working will facilitate multi-disciplinary and population based planning within and across the Network
   
• Implementation of a strong performance management process and culture across the organisation
   
• Integration in all aspects both within and external to the HSE is an essential pursuit to improving the overall contribution of stakeholders to managing health and personal social service needs
   
• Transparent and public accountability of local management and services against the actions and priorities set out in this plan
   
• Develop a Contract Management Support Unit to ensure appropriate governance arrangements are in place in respect of all funding released pursuant to Section 38 and Section 39 agencies, based on the outcome of the national pilot areas and dependant on the allocated resources
   
• Implementation of the HSE Patient Safety Strategy
   
• Embed the Values In Action approach to create a positive culture within the local HSE Mid-West

 

Challenges to the Delivery of the Plan

HSE Mid-West Community Healthcare is acutely aware of the many statutory and policy responsibilities to protect and promote the health of the local population.  As both demand and costs increase and despite increased allocations, challenges are evident to both the resource (Financial and WTE) and the service delivery targets.  The challenges have their origins in maintaining current levels of service within the 2020 financial application.  Saving Initiatives have been identified,and are further outlined under each section, and the Operational Plan is predicated by the implementation of such measures:

• Primary Care            €2.0m
• Mental Health             €4.394m
• Older Persons Services        €1.775m
• Disability Services            €3.97m

Additional Challenges include:

• Pay and Staffing Strategy 2020.
   
• Achieving regulatory compliance with risk of enforcement action in residential Social Care services/Mental Health.
   
• Vulnerability and frailty of people presenting in need of care.
   
• Critical unavoidable growth in the high cost cases in the Disability sector including cases currently before the Courts and delayed transfers of care
   
• Demographic pressures.
   
• Accumulation of previous unmet need and acknowledged deficits in the HSE services and wider Voluntary Agencies.
   
• Overall increasing healthcare costs.
   
• Specialist area recruitment and retention coupled with agency dependency.
   
• Increasing capital costs.
   
• New technologies and approaches driving the type of demand and the cost of response.

 

Even with prudent resource management, cost reduction strategies and careful planning, it will not be possible to meet all demands in 2020 and where activity profiles change either in volume or cost, the area is obliged to work to a position of financial stability to ensure security of service for future years.  Value achievement in all respects will be central to responding to the challenges to this Operational Plan 2020.

 

To view the entire Operation Plan please click the link below: