1. Integrated Care: The Ultimate Outcome of Healthcare Change Mr. Leo Kearns National Lead For Transformation and Change

2. ABF Free GP Care Healthy Ireland Hospital Groups & Community Healthcare Organisations Universal Health Insurance Universal Healthcare Commissioning REFORM

3. A healthier Ireland with a high quality health service for all

4. Medical Team Specialist Autoimmune Team Renal Team Radiology Team In ward with very elderly patients; 3 nights without sleep Renal scan requested on Monday, carried out on Thursday; discharged on Friday with OPD appointment to review renal progress 25 year-old girl, diagnosed at 21 with rare autoimmune condition; triggered acute attacks – infusion treatment Contraindicated Medication Prescribed Acute attack triggered, advised by consultant to attend ED After some time, infusion (1 of 2) given, and admitted Sunday night; concern about possible renal damage Good outcome; 5 nights in hospital but should have been three; for patient complete confusion as to what was happening between teams; no-one noticed that she hadn’t slept for three days and was becoming highly distressed; why medication prescribed in first place that triggered attack; why through ED?

5. 25 year-old girl, diagnosed at 21 with rare autoimmune condition; triggered acute attacks – infusion treatment

6. Contraindicated Medication Prescribed

7. 25 year-old girl, diagnosed at 21 with rare autoimmune condition; triggered acute attacks – infusion treatment Contraindicated Medication Prescribed Acute attack triggered, advised by consultant to attend ED

8. 25 year-old girl, diagnosed at 21 with rare autoimmune condition; triggered acute attacks – infusion treatment Contraindicated Medication Prescribed Acute attack triggered, advised by consultant to attend ED After some time, infusion (1 of 2) given, and admitted Sunday night; concern about possible renal damage

9. Medical Team Specialist Autoimmune Team Renal Team Radiology Team 25 year-old girl, diagnosed at 21 with rare autoimmune condition; triggered acute attacks – infusion treatment Contraindicated Medication Prescribed Acute attack triggered, advised by consultant to attend ED After some time, infusion (1 of 2) given, and admitted Sunday night; concern about possible renal damage

10. Medical Team Specialist Autoimmune Team Renal Team Radiology Team In ward with very elderly patients; 3 nights without sleep 25 year-old girl, diagnosed at 21 with rare autoimmune condition; triggered acute attacks – infusion treatment Contraindicated Medication Prescribed Acute attack triggered, advised by consultant to attend ED After some time, infusion (1 of 2) given, and admitted Sunday night; concern about possible renal damage

11. Medical Team Specialist Autoimmune Team Renal Team Radiology Team In ward with very elderly patients; 3 nights without sleep Renal scan requested on Monday, carried out on Thursday; discharged on Friday with OPD appointment to review renal progress 25 year-old girl, diagnosed at 21 with rare autoimmune condition; triggered acute attacks – infusion treatment Contraindicated Medication Prescribed Acute attack triggered, advised by consultant to attend ED After some time, infusion (1 of 2) given, and admitted Sunday night; concern about possible renal damage

12. Medical Team Specialist Autoimmune Team Renal Team Radiology Team In ward with very elderly patients; 3 nights without sleep Renal scan requested on Monday, carried out on Thursday; discharged on Friday with OPD appointment to review renal progress 25 year-old girl, diagnosed at 21 with rare autoimmune condition; triggered acute attacks – infusion treatment Contraindicated Medication Prescribed Acute attack triggered, advised by consultant to attend ED After some time, infusion (1 of 2) given, and admitted Sunday night; concern about possible renal damage Good outcome; 5 nights in hospital but should have been three; for patient complete confusion as to what was happening between teams; no-one noticed that she hadn’t slept for three days and was becoming highly distressed; why medication prescribed in first place that triggered attack; why through ED?

13. Integrated Care Care pathways and models of care designed and delivered around the needs of patient, not the system

14. Integrated Care Clinical Processes & Clinical Roles Care pathways and models of care designed and delivered around the needs of patient, not the system

15. Systems and Data Workforce Planning & Training Integrated Care Clinical Processes & Clinical Roles Care pathways and models of care designed and delivered around the needs of patient, not the system

16. Systems and Data Workforce Planning & Training Integrated Care Clinical Processes & Clinical Roles Funding Models Care pathways and models of care designed and delivered around the needs of patient, not the system

17. Systems and Data Workforce Planning & Training Integrated Care Clinical Processes & Clinical Roles Funding Models Care pathways and models of care designed and delivered around the needs of patient, not the system Governance & Structures Performance Metrics

18. Systems and Data Workforce Planning & Training Integrated Care Clinical Processes & Clinical Roles Funding Models Care pathways and models of care designed and delivered around the needs of patient, not the system Governance & Structures Performance Metrics Wider health service and whole of society commitment to prevention

19. Achieving this requires a whole of system approach to change at all levels, sustained over a number of years

20. The building blocks for reform are in place

21. Quality Framework Integrated Care Programmes: Older Person; Chronic; Children; Maternity; Flow Hospital Groups, Community Healthcare Organisations, Ambulance Service Reform at national level to enable delivery system and to develop commissioning capability A new vision and strategy for people within the health service Knowledge & Information Strategy Healthy Ireland Implementation Finance Operating Model Activity Based Funding Service Improvement

22. By the end of 2015 we will have a prioritised action plan for reform, drawn from these programmes, showing key deliverables for each of next 12 quarters

23. Leaders make change happen; are you a leader? Am I a leader?