Chief Executive's Blog

The Strategic Challenges facing 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 many of the same changes if it is to be successful and sustainable in the future.

The first strategic challenge we face is how we respond to the growing demand and associated increasing work for our services, given the world wide economic position and associated financial austerity.


Figure 1 represents the population health spectrum with the healthy, the able bodied, the well, the independent and safe children on the left hand side. As you move to the right there is increasing dependency of older people, rising chronic disease, deteriorating mental health, disabilities and children in care.

How do we deliver our services in the current model?

Figure 2 illustrates that much of our intervention, attention and resource is targeted at those already in need, those on the right hand end of the population spectrum. At its most basic, we are reacting to illness and dependency.

If the NHS is to survive into the future we must find a way of changing this model and reduce the potential demand of the future. We must aspire to keep people well and independent.


Figure 3 illustrates what we aim to do. We need to get better at prevention, health promotion and preventing deterioration in health and dependency. In essence the major challenge for us, the change we must make, is to become more pro-active and intervene earlier in the dependency spectrum. There is much evidence that early intervention can prevent deterioration in areas of chronic disease, diseases of ageing, good mental health and with child development. In Northern Ireland, this approach is embodied in the regional strategic document, “Transforming Your Care”. The term “shift left” has been coined which is meant to represent the move from secondary to primary care. Figure 3 clearly illustrates that rather shift left is really about keeping people well. Ultimately, a more pro-active health care system with earlier intervention should enable us to reduce some of the downstream demand, which might otherwise overwhelm us.

The second major strategic challenge for the health and social care system in Northern Ireland, in a post-Francis world is the need to provide a robust assurance on standards and to regain public confidence, following a series of high profile failures and negative stories, of which Northern Ireland has had its local share.


Figure 4 represents the need for us to continually have 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.

For us, in the South Eastern Trust we have 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, every service is improving and every service is 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, as represented in Figure 5. We must aspire to find innovative ways to support the new model of care we want to achieve. For us, this is not only about being the innovator and finding and creating new solutions, but being better as early embedders of things that have already been demonstrated to work elsewhere. We in the NHS, have traditionally been slow to spread and embed. Technology and its use is also core to redesigning the way we work and improving the quality of what we do.