moving beyond the silos

Northern Ireland is a teeny place. The region has a population of 1.8 million, many of whom know each other/ each other’s relations. In comparison, London has over 8 million people, Los Angeles has 3.8 million, the Greater Manchester conurbation has 2.7 million, Montreal has 1.6 million. For historical, political, and “that’s how we’ve always done it” reasons, we have complex systems for delivering our public services.

The regular reader will know of my developing interest in how healthcare is designed and delivered. I’m active in rare disease charities and patient ‘involvement’ groups. I speak about my own experience, and how the patient voice brings a different, necessary view on services. I’ve found twitter to be a remarkable source of information and connection. It was there I became aware of #ehealthNI14, an inaugural conference launching consultation on the NI eHealth and Care strategy. I asked if I could go. Yes, said the organisers, apparently pleasantly surprised that patients might be interested.

I wasn’t able to attend the whole event, but what I did get to was very interesting. There was a real enthusiasm to move our systems forward, and to recognise the voice of patients. Next time, I’m hoping that patients will be encouraged to attend, that the event will be obviously open to patients from the outset. Wouldn’t it be great if patients were co designing and co producing the conference? And all healthcare conferences? The door opened a little this week, and there seems to be a willingness to keep it opening. I am not the only one who will keep on pushing.

with @Noirin0Neill, @JBBC &@DrStevenKinnear
with @Noirin0Neill, @JBBC & @DrStevenKinnear

The formal talk that I found most challenging and inspirational was that from Nigel Millar, Chief Medical Officer of Canterbury, New Zealand. He explained how, seven years ago, financial and demographic change meant the need to re-examine the healthcare system for their area (about 0.5 million people). They agreed new priorities, new ways of working together and new systems. Get this, the system is designed not to waste patients’ time- and that’s how things are measured. “We saved 1.5 million days of patients waiting for appointments”. Healthcare communities (including 60% of GPs) developed agreed pathways for conditions and then allied health information for patients. Urgent care can be provided by teams in the community, people are being kept out of hospital. There is one budget, so the priority is to problem solve, rather than pass over the issue for another budget to pay for. The push for rapid development came after the 2010 earthquake. I understand that he is cheerleading for his own system, but it was wonderful to hear about a system that was designed around what matters to the patient. Because that allows the system to deliver safer, more effective, more efficient care, and a better experience. It’s more expensive to keep on getting things wrong than it is to design them with the right priorities in the first place.

this is not gospel!
do not take this as fact- my impressions only!

The Northern Ireland system is complex, but less so than it used to be. Conference speakers talked about how they still operate in silos, but that the developing technology is beginning to break those down. Historically the system keeps specialisms separate and information held by geographically based Trusts apart. “Moving a few miles down the road and expecting to have your information come with you? What nonsense!”- those days are, at least going, if not yet totally gone.

I look forward to the next time. I’m sure I won’t have to wait a year to get back in a room with some of the patient experts and healthcare leaders I spent time with this week. Particular thanks to @soo_cchsc and @HmmMoorhead for making it happen for me.