Public Health

Developing Better Services
The Developing Better Services document sets out a range of proposals to modernise hospital services in response to a range of drivers for change such as demography, new technology, changing working patterns and higher public expectations. The model of future hospital services as announced by the Minister for Health in 2003 is as follows:

Model for Future Hospital Services

Further detail along with associated documentation may be found on the Department's website:www.dhsspsni.gov.uk/hss/develope.asp

Ambulatory Care
The Developing Better Services document places considerable emphasis on the future models of care within the hospital sector. While there will continue to be considerable pressure on acute hospitals in the future, an increase in our elderly population coupled with increasing rates of chronic or long term disease means that we also have to consider how services can be developed to accommodate these changes in community settings.

The EHSSB Ambulatory Care Project was established to consider how ambulatory (i.e. those not requiring a hospital admission) models of care could be developed to ensure that care was provided in the most appropriate setting. A range of specialty areas is being considered such as diabetes and chronic heart disease.

The project also aims to link with current work already underway in each community trust area. Three Community Care and Treatment centres in South and East Belfast and four Health and Well-being centres in North and West Belfast are currently at varying degrees of completion. These centres will each provide a whole range of services determined by the needs of their local populations. Two community hospitals are also operating in North Down and Ards and Down and Lisburn have advanced plans for the roles of their local hospitals.

It is hoped that this project will provide a forum for getting to grips with all of the complex changes impacting, now and in the future, on the way services are being provided.

Maternity and Gynaecology Review
In 1999, at the request of the DHSSPS Executive, the Eastern Board completed a risk review for maternity services in the Board area. The 1999 review which centred on the six consultant-led Eastern Board maternity hospitals was carried out against a background of considerable organisational change. In addition to the ministerial decision that a new maternity unit should be built on the Royal Hospitals site, approval was also given to the development of a new community hospital in Downpatrick which would not include consultant-led inpatient obstetrics in the range of services provided.

Since then maternity and related services have transferred from the Belfast City Hospital site to the Royal Hospitals site and building plans for the new Royal Jubilee Maternity Unit are well under way. The new unit is due to open in 2007. In 2003 maternity services also closed in the Downe Hospital with the transfer of services mainly to the maternity units at Lagan Valley and the Royal Jubilee.

An interim service profile for maternity and gynaecology services in Downpatrick was agreed in 2003.

In addition to an update of the 1999 risk assessment for maternity services, this report provides a range of information to inform commissioning decisions for the future for both maternity and gynaecology services. An analysis of demographic trends and projections is included along with a review of the current service profile, activity trends and a review against professional standards issued since 1999. The report also highlights current service issues from a Trust and Board perspective as well as listing recommendations for service improvement.

Implementation of the Dermatology Review
A review of dermatology services was undertaken in 2003/04 in light of increases in demand, restructuring of services through the recommendations within Developing Better Services and changes within the service itself such as new techniques. The working group made nineteen recommendations that support a multidisciplinary approach to the delivery of dermatology services. The report was published in February 2004 and an implementation group is currently being established to take forward the recommendations.

Emergency Care
Over the last number of years the EHSSB has taken forward various initiatives in relation to emergency pressures. These initiatives such as the monthly pressures meeting have sought to put processes in place across the Board area to more proactively manage the flow of emergency patients.

The importance of taking a co-ordinated approach across the entire system has been most clearly evidenced by the success of the Emergency Admissions Co-ordination Centre (EACC) established in 2004. The Eastern and Northern Boards jointly commissioned the Northern Ireland Ambulance Service (NIAS) to establish the EACC in response to the growing pressure on acute hospitals to manage the rising trend of emergency admissions. Under a quota system the EACC intervenes to share the pressure across the system on a live time basis. This is the first and only initiative of its kind in Northern Ireland.

Building on the learning from this approach Board officers have undergone specific training in systems thinking (Theory of Constraints ~TOC) and have worked with several hospitals to apply the thinking to the emergency patient journey.

Recent work with the Ulster Hospital has led to the implementation of new ways of working to improve patient access to the right part of the system in a more timely manner. This work is in keeping with the new PFA (Priorities for Action) 'streamlining' targets set by the DHSSPS.

Cancer Services
The Eastern Board is currently in the process of reviewing current cancer service provision in light of recent regional developments such as the Northern Ireland Cancer Network (NICaN) and the Regional Cancer Services Framework group. This process will also review progress against the EHSSB Cancer Commissioning Group report recommendations.

The Eastern Board Cancer Services Development Plan (available in the Publications section of this website) is a preliminary collation of available information (including future financial investments) to support the service development planning process and address specific requirements placed on the Eastern Board by the DHSSPS Priorities for Action targets 2003-04.

Social Services
The Eastern Board Social Services Directorate is currently working on the development of:

Big Lottery Fund
The National Lottery under the auspices of the Big Lottery Fund (formerly know as New Opportunities Fund or NOF) granted funding in August 2003 for the Eastern Health and Social Services Board to deliver a range of projects aimed at reducing the risk of coronary heart disease, cancer and stroke through the provision of effective evidence based prevention programmes. This is allied to working to improve access to high quality service for the detection, diagnosis and treatment of these diseases by tackling inequalities in provision, as well as improving facilities to aid early detection and effective treatment. Funding has also been granted to enhance the provision of palliative care services in the Board area by improving care for all those diagnosed with life threatening conditions and by providing increased support and information for them, their families and carers.

The National Lottery grant is being used to fund 37 projects ranging from a community based breast and cervical screening programme to offering palliative care and complementary therapies for those affected by HIV. The funding has been granted for 3 years, with most projects commencing in February/March/April 2004. A key feature of the programme is the involvement of the community and the development of effective partnerships involving statutory, community and voluntary sector organisations.

The Eastern Board act as responsible body or Umbrella Grant Holder for the £5.3 million invested by the National Lottery. The service provided by the Eastern Board is the project management of the whole programme, effectively acting as intermediary between the Big Lottery Fund and the projects.