NICON member and stakeholder views on the hospital reconfiguration framework
Key points
A Hospital Network could be instrumental in helping to deliver the ‘shift left’ in NI: moving from treatment to prevention; hospital to communities; and analogue to digital.
Attendees were largely in agreement on the need and rationale for change: to progress wider transformation efforts and ensure our system is well-equipped to meet the needs of an aging population; to improve safe and timely access to the right care; to make the best possible use of available resources; and to avoid unplanned service change/collapse.
But these changes cannot happen in isolation.
Overview
On 11 February 2025, NICON held a webinar on the Department of Health consultation, ‘Hospitals - Creating a Network for Better Outcomes’. Over 160 members and stakeholders registered for the event, chaired by NICON spokesperson, Prof Mark Taylor. Peter Jakobsen, Director of Health Service Transformation at the Department of Health presented on the framework and consultation questions. The proposed framework categorises hospitals into four main types (Local Hospital, Area Hospital, General Hospitals, and Regional Centres). Each would offer a set of core services and, together, would operate as one integrated hospital network.
The following areas of consensus reinforced many of the enablers cited in the consultation document:
Public engagement
- A values-based approach, grounded in honesty, transparency and openness can help improve public trust.
- The wider public must be meaningfully engaged in and understand the rationale underpinning any proposals:
- There must be clarity and unity in messaging on the benefits a hospital network can offer to avoid misinformation and/or an exclusive focus on specific, local-level changes.
- Evidence-based information must be well-communicated to assuage concerns that changes may infringe principles of health equity or disadvantage rural communities.
- More broadly, we should expand our ambition for public engagement beyond statutory PPI processes and towards genuine partnership.
Workforce
- Significant workforce planning and development (and appropriate funding) will be needed:
- Initiatives such as ‘provider collaboratives’ which promote system-wide collaboration should be explored fully.
- Workforce flexibility should be encouraged and embedded early in the training stage.
- Working across sites can offer benefits such as varied experience and access to state-of-the-art equipment, supporting recruitment and retention efforts and acting as a draw for talent/trainees.
- The increasing significance of multi-disciplinary teams (MDTs) underscores the need to engage with the entire health and social care workforce in the development of plans.
- Staff should be properly engaged to ensure that changes will not have an adverse impact on their service delivery/care.
Digital
- The rollout of a single digital health care record is a major advance for NI, enabling smoother transition along pathways and across the system for patients and staff alike.
- There is now a significant opportunity to build on a shared vision for the future of digital in NI, unlocking the potential of AI-based technologies and new self-care mechanisms available to the public.
- Yet adoption will be most impactful when underpinned by behavioural change
Joined-up approach
- The hospital network needs to be supported by adequate community infrastructure and models of care:
- There should be joined-up working between the hospital network and ICS to ensure that services reflect local population needs and can tap into the creativity of communities.
- There are also significant opportunities to reduce duplication and expand tried-and-tested initiatives/programmes, from MDTs to acute care at home and frailty hubs.
- Effective cross-Departmental working will be key to addressing:
- Underlying socioeconomic inequalities
- Deficiencies in infrastructure and improving transport links across NI, which will be vital for equality of access across the network
- Voluntary & Community Sector (VCS) organisations play a crucial role at the community level, helping people to manage their health and long-term conditions, keeping them out of the hospital and at home for longer, reducing demand and improving patient flow:
- This will continue to be key in the context of our aging population. The VCS should be actively involved in decision-making processes alongside statutory service providers and patients
“We have been working closely with the Department to develop a kind of ‘master plan’ - Service change in the past has tended to focus on just one part of the system… But the more we as health and social care leaders can be on one page, setting out one narrative, the more specific we can be, the more honest we can be, the better. Then people will understand [the overall hospital network picture].
It's not about a hierarchy of hospitals. Every one of the hospitals are critical to us. They have a distinctly different role, but they all make an equal contribution… Those providing clinical services are always best placed to develop them. So this needs to be driven through professional clinical advice and what's best practice in terms of patient safety.”
Roisin Coulter, Chief Executive, South Eastern HSC Trust
This webinar was held as part of NICON's 'Grasping the Nettle' webinar series, which will run throughout 2025. The series will aim to build on the momentum and theme of the NICON24 conference, held in October 2024, during which we explored what nettles need to be grasped to drive progress within the health and social care system in NI.
