Health & Social Care Development
Notwithstanding the sharp difference in philosophy between the UK and Northern Ireland post-war governments, the National Health Service was introduced in Northern Ireland at the same time as in Great Britain.
A social services financial agreement was entered into between the Westminster government and the Northern Ireland government, which required Northern Ireland to pay on the same scale and standard of services as Great Britain. Differences in administrative structures and systems remained at all times.
Northern Ireland Integrated Health and Social Services in 1972 in the context of the large-scale reorganization of local government at that time. In this respect, it diverged from the Great Britain model.
After 1948, personal social services were organized as part of local government structures. There were six county welfare authorities and two welfare departments in the counties and the two principal cities.
In the late 1960s, the Northern Ireland government introduced proposals for the reform of local government, and in 1969 recommended 17 authorities.
The Green Paper, the administrative structure of health and personal social services, proposed the integration of health and personal social services under four area boards. The principal purpose of the integration was to reduce duplication of administrative overhead. When the review body’s report in 1970, the Macrory Report, endorsed Green proposals and legislation followed in 1972. A final decision on health and personal social services was postponed.
Social services were removed from the local council and integrated with the health services. Boards with district substructures were created in the 17 districts or subdivisions of four health and social services boards.
The structure was reviewed in 1978, and the Department of Health and Social Services modified the structure, creating a new structure based on units of management based at individual hospitals, group hospitals, or geographical areas for health and personal social services and client care service.
24 units of management were created and were moved from integrated districts to specialist units of management towards types of services, such as acute hospitals, psychiatric hospitals, combined health hospital and community units, community and health and social services.
The 1989 NHS Reform allowed hospitals to become hospital Trusts and reconstituted health and social services boards as management bodies without local government representatives. The UK government reforms emphasized community care and #[3:09 ]between the provider and purchaser.
People First was Northern Ireland’s version of the UK white paper, Caring for People. The four boards became purchasers and enablers. The providers, which were the units of management, became Trusts who manage their own staff and control their own budgets.
The Health and Personal Social Services Order allowed the creation of health and community Trusts as well as hospital Trusts. The Trusts had separate status on the board, and there was no direct managerial line between the Trust and the board.
The integrated health and social services were provided by four boards, which geographically covered the whole of Northern Ireland. They worked in conjunction with 18 Trusts. Eleven were community health and social services Trusts based on geographically defined areas. Seven were hospital Trusts based on acute general hospitals.
The Health and Social Services Board identified needs and priorities, developed Trustees, plans, and commissioned services from the Trusts. The Boards can set statements, strategies, and plans and commission services from the Trust. They could specify how their strategy should be implemented and provide quality standards. Subject to this, Trusts maintained control of their budget and remained independent.
Healthcare and personal social services were commissioned under nine care programs. These included mental health services, persons of physical disability, services for elderly persons, persons with learning disabilities.
The community health and social services Trust provided a range of primary and community health services and social work services. Some were also responsible for hospital services, including district hospitals, local hospitals, mental hospitals, specialist hospitals.
Trusts were also accountable to the Department of Health and Social Services for how they perform.
In 1998, the existing Trusts, hospital Trusts, and the large district hospitals and surrounding community health and social services Trusts amalgamated. Since devolution, there have been a number of reviews of the Health and Social Care and Services. These have taken place in the context of wide reviews of public administration.
The review of public administration consultation documents set out principles for restructuring health and social services. It proposed the retention of the integration of health and personal care services. It was proposed to develop a partnership between commissioning and delivery across ranges of integrated services. The changes announced in 2006 changed the principles of the separation of commissioning and service provision to performance incentives.
By 2007, prior to the reestablishment of devolution, five new delivery Trusts, health and social care delivery Trusts have been established. The system was reviewed by the Northern Ireland executive and accepted with relatively few changes.
A single Health and Social Care Board replaced the existing boards and is responsible for commissioning health and social services. It is advised by five local commissioning groups. Five health and social care delivery Trusts replacing the 19 existing Trusts, creating single integrated structures across primary, secondary, and community care.
There was a new patient and client council replacing four previous councils covering health and social care. It was a single public health and well-being body. There was a common business organization covering the structures. A single regulation and improvement authority covered health and social care.
The five delivery Trusts provide integrated care programs that integrate the teams working together. There is a single employer and budget with integrated management.
Trusts had slightly different arrangements for services. Care programs operate on a multidisciplinary basis. Different teams involve different health professionals, different combinations and configurations delivering various programs.
Teams are normally based in the same offices. All staff have a single employer and a single budget. A single scheme across a range of services ranging from health needs, child protection, family intervention is provided. Posts of program manager or team leader are open to a range of professional health care workers.
The individual organization of Trusts may vary in some cases; there are separate professional, operational, and management. The integrated Trusts make provision for different professionals to meet separately to cover professional governance, matters of professional experience.