TSN Annual Report - Annex 6: Department of Health and Social Services Draft New TSN Action Plan

The first New TSN Annual Report

November 1999

Annex 6: Department of Health and Social Services Draft New TSN Action Plan

The mission of the Department of Health and Social Services (DHSS) is to improve the health and social wellbeing of the people of Northern Ireland. The Department administers three main programmes – health and personal social services (HPSS), social security and child support. While these programmes are different in their nature and scope, the aim of the Department is to build them into an interlocking and mutually supportive system of health and social care, coupled with income maintenance for needy and vulnerable members of society.

The Department and its Agencies are important contributors to all the New TSN objectives, in particular through tackling inequalities in health and social wellbeing. Such inequalities1 are associated with factors such as socio-economic status, gender, cultural and ethnic background, lifestyle and where people live.

Minimising inequalities, wherever and however they occur, has been a major theme (entitled Targeting Health and Social Need) of successive Regional Strategies, including Well into 2000 and Health and Wellbeing: Into the Next Millennium (the 1997-2002 Regional Strategy). The Department and its Agencies aim to pursue New TSN objectives by targeting efforts and available resources on groups and areas in greatest health and social need.

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4.1

DHSS Action Plan

The Department’s New TSN Action Plan defines the actions required, who will fulfil the tasks and when action should be taken. The ultimate ability to achieve the Plan’s targets and actions will depend critically upon partnership working between Departments, other public agencies, local government, and voluntary and community organisations.

1 Throughout this Action Plan "inequalities" refers to inequalities in population health and social wellbeing and in need for, and access to, health and social care.

4.2

The action points in the Plan will be reviewed as new information is acquired, ideas tested and progress achieved. The Department will monitor, evaluate and report on progress.

4.3

This Plan should be read in conjunction with Well into 2000, the 1997-2002 Regional Strategy and the business plans of the Child Support Agency and the Social Security Agency.

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5.1

The Department

The main functions of the Groups in the Core Department with lead responsibility for the objectives in the Plan are as follows:

Health & Social Policy Unit – the Regional Strategy, public health, health promotion, social and family policy, and equality issues.
Information & Analysis Unit – the provision of relevant, timely and accurate information on the HPSS, and statistical and economical analyses of these and other data.
Voluntary Activity Unit (VAU) – co-ordinating and enhancing the effectiveness and efficiency of Government policy on support for the voluntary sector and on community development.
Primary Care and Commissioning Development Directorate – policy, legislation and terms and conditions for primary care services.
Performance Review & Secondary Care Directorate – policy and service development for secondary care and the performance of Health and Social Services (HSS) Boards and Councils.
Financial Management Directorate – the Public Expenditure Survey, financial performance of, and financial advice and guidance to, HPSS bodies and the management of the Private Finance Initiative.
Trust and Human Resources Directorate – policy, legislation and performance monitoring of HSS Trusts, the capital development programme, appointments to HPSS bodies, and the provision of human resource management to the HPSS.
Social Security Policy and Statistics Directorate – policy and legislation on social security, child support and pension matters, and the compilation and analysis of statistical information on social security.

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6.1

Health and Social Services

The 4 HSS Boards, as agents of the Department, commission and purchase health and social care services for their resident populations from a range of providers, including HSS Trusts and voluntary and private sector bodies.

6.2

There are currently 19 HSS Trusts which provide health and social services and work within the commissioning arrangements agreed with HSS Boards. Some of the Trusts provide hospital services only, some community and social services only and some both services.

Business Area:	DHSS
Social need to be tackled:	Disadvantage experienced by people, groups and areas in Northern Ireland
Desired outcome:	a. Greater understanding and awareness of the priority to be given to New TSN in all key areas b. Policy and executive responsibilities fulfilled so that New TSN can be effectively implemented throughout DHSS and its Agencies
New TSN objectives	Targets or actions and timescales
DHSS 1 To demonstrate top level commitment to New TSN.	a. Establish and operate a high level steering group to drive forward New TSN across DHSS and its Agencies throughout the period of this Plan. b. Ensure that New TSN considerations are built into the strategic and business plans of DHSS and its Agencies throughout the period of this Plan.
DHSS 2 To raise and maintain awareness of New TSN.	a. Ensure that New TSN is built into DHSS staff training and development programmes by March 2000. b. Promote and support the inclusion of New TSN and community development in training and development programmes for HSS staff throughout the period of this Plan. c. Maintain awareness of developments in relation to New TSN within DHSS and its Agencies throughout the period of this Plan. d. By March 2000, provide HSS agencies with the information and guidance they need to produce and implement their own New TSN Action Plans. e. Provide appropriate information and guidance on New TSN to relevant voluntary and community organisations by March 2000.

Business Area:	Health and Social Policy Unit
Social need to be tackled:	Poor health and social wellbeing experienced by disadvantaged people, groups and areas
Desired outcome:	a. Reduction of inequalities experienced by disadvantaged people, groups and areas b. Greater social inclusion of disadvantaged people, groups and areas, in particular greater involvement of local people in decision making and improved access to quality childcare in areas of deprivation c. Increased capacity to determine whether the actions being taken by the DHSS and its agencies are effectively reducing the inequalities experienced by disadvantaged people, groups and areas
New TSN objectives	Targets or actions and timescales
DHSS 3 To develop and promote policies and programmes of action which aim to reduce inequalities.	a. Promote and support a public health agenda that tackles inequalities, including the formation of partnerships with other Departments and influencing public health-relevant policies, throughout the period of this Plan. b. By January 2000, produce an implementation programme setting out how the recommendations of the Acheson Inquiry might be applied inter-Departmentally and in DHSS policies and programmes. c. Establish an agreed methodology for and approach to Health Impact Assessments in all Northern Ireland Government Departments by March 2000. d. By March 2000, establish Health Action Zones (second phase) and Healthy Living Centres to tackle persistent public health problems in areas of greatest need. e. Work with DENI, T&EA and Childcare Partnerships to implement the NI Childcare Strategy Children First, targeting those in greatest need, throughout the period of this Plan. f. By April 2000, introduce legislation to strengthen enforceable rights of people with disabilities. g. Support work to promote the health and wellbeing of minority groups at risk of social exclusion throughout the period of this Plan. h. Work through the Regional Forum on Domestic Violence to prevent domestic violence and family breakdown throughout the period of this Plan.

New TSN objectives	Targets or actions and timescales
DHSS 4 To improve access to good quality childcare and family support, targeting those in greatest need.	a. Have local childcare plans in place by April 2000. b. Maximise Northern Ireland’s use of New Opportunities Fund funding available 1999-2003 for out of school childcare. c. Implement Sure Start programme targeted on families with young children in disadvantaged areas by April 2000. d. Use remaining Childhood Fund resources to sustain childcare in disadvantaged areas during 2000. e. Develop proposals for using the next round of EU Structural Funds, including the new Special Programme, to provide quality childcare and family support in disadvantaged areas. f. By March 2002, develop an easily accessible and up to date childcare information system for parents and employers. g. Work with DENI and T&EA on elements of Children First for which they are responsible, including pre school education, promoting family-friendly employment, and training for childcare workers, throughout the period of this Plan.
DHSS 5 To promote social inclusion by tackling the problems associated with teenage parenthood.	a. Lead a PSI Working Group to develop and publish a co-ordinated, cross-Departmental policy and strategy with key elements for inclusion in next Action Plan by June 2000.
DHSS 6 To promote social inclusion by involving local people in decisions about their health and social care needs and the services to be provided.	a. Encourage HSS Boards and Trusts to develop and implement arrangements to secure the involvement of local people in decision-making, and be able to point to effective examples of the involvement of users, potential users and carers, throughout the period of this Plan.

New TSN objectives

Targets or actions and timescales

DHSS 7 To measure the extent to which inequalities
are being reduced.

a. Throughout the period of this Plan, monitor and evaluate specific public health strategies, including tobacco, alcohol misuse and mental health promotion, for their ability to reduce inequalities.

b. Ensure that a method of monitoring and evaluation is built into all New TSN-related interventions, including community development initiatives, throughout the period of this Plan.

c. Encourage the use of the VAU guidance on monitoring and evaluation of community development by all Departments and agencies whose policies impact on health and social gain, throughout the period of this Plan.

Business Area:	Information and Analysis Unit
Social need to be tackled:	Poor health and social wellbeing experienced by disadvantaged people, groups and areas
Desired outcome:	a. Clearer identification of people, groups and areas with greatest health and social need b. More resources skewed to disadvantaged people, groups and areas with the greatest health and social care needs c. Increased capacity to determine whether the actions being taken by the DHSS and its agencies are effectively reducing the inequalities experienced by disadvantaged people, groups and areas
New TSN objectives	Targets or actions and timescales
DHSS 8 To identify those in greatest health and social need.	a. By June 2000, identify and make arrangements to secure the information needed to carry out effective population needs assessment covering each of the key areas in the Regional Strategy. b. Investigate the possibility of improving occupation information on the Patient Administration System by March 2001. c. Develop within available resources a Unique Patient and Client Identifier by March 2001. d. Prepare and publish a "state of the region" report based on findings of the Health and Wellbeing Survey and other sources by March 2003.
DHSS 9 To reduce inequalities by matching resources to health and social care needs.	a. Review additional needs indicators in the Physical and Sensory Disability, Health Promotion and Disease Prevention, and Primary Health and Adult Community programmes of care by December 2001. b. Refine the Acute Services programme of care formula by December 2001. c. Examine the stability of the HSS Board allocation formula for populations of varying sizes with effect from January 2000.

New TSN objectives

Targets or actions and timescales

DHSS 10 To measure the extent to which inequalities
are being reduced.

a. By March 2002 put in place an equity monitoring system regularly to review inequalities in utilisation of, and access to, services.

b. Investigate the feasibility of constructing a New TSN index for Hospital and Community Health Services and Social Services by March 2003.

DHSS 11 To provide information which supports
evidence-based decision making on tackling
inequalities.

a. Agree a programme of New TSN-related research in consultation with the Research and Development Office by March 2000.

b. By March 2000, review how best to secure the effective co-ordination and support of New TSN research, the evaluation of New TSN interventions and dissemination of related information.

Business Area:	Voluntary Activity Unit
Social need to be tackled:	Poor health and social wellbeing experienced by disadvantaged people, groups and areas
Desired outcome:	a. Efforts effectively targeted to address disadvantaged people, groups and areas with the greatest health and social care needs b. Increased participation in Community Volunteering Scheme by people in areas of deprivation c. Greater social inclusion of disadvantaged people, groups and areas d. More effective targeting of District Councils’ Community Services Programme to reflect social need e. Increased capacity to determine whether the actions being taken by the DHSS and its agencies are effectively reducing the inequalities experienced by disadvantaged people, groups and areas
New TSN objectives	Targets or actions and timescales
DHSS 12 To reduce inequalities by targeting efforts on those in greatest need.	a. Introduce a new funding formula for the District Councils’ Community Services Programme to reflect both population and social need by April 2001.
DHSS 13 To promote social inclusion by encouraging, supporting and expanding community development approaches throughout the HPSS.	a. Throughout the period of this Plan, ensure progress on implementing those recommendations of the report of the Community Development Working Group that can be taken forward within available resources. b. Ensure that HSS Boards develop and implement community development approaches and are able to demonstrate programmes in operation throughout the period of this Plan.
DHSS 14 To promote social inclusion by encouraging and supporting volunteering amongst groups under-represented in the volunteering population.	a. Restructure the Community Volunteering Scheme to make it more socially inclusive and increase the quantum of resources available throughout the period of this Plan.
DHSS 15 To measure the extent to which inequalities are being reduced.	a. Encourage HSS Boards and Trusts to evaluate routinely the effectiveness, efficiency and equity of all community development programmes throughout the period of this Plan.

Business Area:	Primary Care and Commissioning Development Directorate
Social need to be tackled:	Poor health and social wellbeing experienced by disadvantaged people, groups and areas
Desired outcome:	a. Primary care resources more effectively skewed to disadvantaged people, groups and areas with the greatest health and social care needs b. Efforts effectively targeted towards disadvantaged people, groups and areas with the greatest health and social care needs
New TSN objectives	Targets or actions and timescales
DHSS 16 To reduce inequalities by matching resources to health and social care needs.	a. Minimise "list inflation", which can affect the reliability of GP practice lists, throughout the period of this Plan. b. Develop capitation-based methodology for General Medial Services cash limited funding by June 2000. c. Ensure that GP Health Promotion payments are effectively used and targeted throughout the period of this Plan. d. Appraise the size and effectiveness of deprivation-related payments to GPs in relation to New TSN objectives by March 2002.
DHSS 17 To reduce inequalities by targeting efforts on those in greatest need.	a. By March 2001, consider the potential of Personal Dental Services pilots for addressing inequalities in oral health.

Business Area:	Performance Review and Secondary Care Directorate
Social need to be tackled:	Poor health and social wellbeing experienced by disadvantaged people, groups and areas
Desired outcome:	a. Secondary Care resources more effectively skewed to disadvantaged people, groups and areas with the greatest health and social care needs b. Efforts effectively targeted towards disadvantaged people, groups and areas with the greatest health and social care needs c. Reduction of inequalities experienced by disadvantaged people, groups and areas
New TSN objectives	Targets or actions and timescales
DHSS 18 To reduce inequalities by matching resources to health and social care needs.	a. By February 2001, agree procedures for linking allocation of resources by HSS Boards directly to needs assessments and measuring the impact of such allocations on reducing inequalities. b. Develop action programmes to agree measures and milestones, which will demonstrate that HSS Boards are taking purposeful steps to skew resources to reduce inequalities, by March 2000.
DHSS 19 To reduce inequalities by targeting efforts on those in greatest need.	a. Assist in the dissemination of examples of interventions aimed at tackling inequalities by creating a register of New TSN-relevant evaluations by March 2002. b. Ensure that relevant HSS bodies identify, implement and evaluate interventions which might be successful locally in reducing inequalities throughout the period of this Plan. c. By January 2001, ensure that HSS Boards’ New TSN Action Plans include measures for tackling inequalities in the following areas: accidents, cancers, circulatory diseases, diabetes, immunisation, infant mortality, nutrition (including breast feeding), smoking, physical activity and alcohol consumption.

Business Area:	Financial Management Directorate
Social need to be tackled:	Poor health and social wellbeing experienced by disadvantaged people, groups and areas
Desired outcome:	More resources skewed to disadvantaged people, groups and areas with the greatest health and social care needs
New TSN objectives	Targets or actions and timescales
DHSS 20 To reduce inequalities by matching resources to health and social care needs.	a. By September 2000, prepare guidelines for HSS Boards on application of the DHSS capitation formulae at sub-Board level. b. By October 2000 consider earmarking a limited amount of funds to help Boards refocus expenditure to better match identified New TSN-relevant needs with service provision.

Business Area:	Trust and Human Resources Directorate
Social need to be tackled:	Poor health and social wellbeing experienced by disadvantaged people, groups and areas
Desired outcome:	a. Increased awareness and understanding in the HPSS of the importance of community development b. Greater social inclusion of disadvantaged people, groups and areas.
New TSN objectives	Targets or actions and timescales
DHSS 21 To promote social inclusion by encouraging, supporting and expanding community development approaches throughout the HPSS.	a. By December 2000, examine the extent and nature of existing training in community development for HPSS staff and commission a training programme which will better equip staff in the HPSS and in the voluntary sector to work in partnership with other Agencies and with local people to identify and tackle the most pressing health and social needs of the community. b. Ensure that the role of community development is incorporated in whatever new structures may emerge for the HPSS during the period of this Plan.

Business Area:	Social Security Policy and Statistics Directorate
Social need to be tackled:	Poor health and social wellbeing experienced by disadvantaged people, groups and areas
Desired outcome:	Fair, efficient and effective arrangements for the payment of social security benefits to disadvantaged people, groups and areas
New TSN objectives	Targets or actions and timescales
DHSS 22 To develop and promote policies and programmes of action which aim to reduce inequalities.	a. By June 2000, undertake an appraisal of the options for an assessment of take-up of selected benefits. b. Arrange an independent evaluation of New Deal for Lone Parents, report on findings and prepare an action plan by April 2000.

Business Area:	Child Support Agency (CSA)
Social need to be tackled:	Poor health and social wellbeing experienced by disadvantaged people, groups and areas
Desired outcome:	Services effectively targeted, and employment opportunities maintained and improved for disadvantaged people, groups and areas
New TSN objectives	Targets or actions and timescales
DHSS 23 To maintain and improve employment opportunities.	a. Protect the jobs in CSA (NI) which depend on the contract with GB by delivering the service to the required standard throughout the period of this Plan. b. Ensure that New TSN is a factor in any decision on job dispersal which might arise during the period of this Plan.
DHSS 24 To contribute to improving the employability of lone parents.	a. Move the focus of collection activity from amount collected to regularity of payment, by March 2000.
DHSS 25 To meet objective need of lone parents.	a. By March 2000, commission research into the make up of the CSA’s private client base and consider how best to prioritise cases to meet the needs of deprived clients. b. Develop a new strategy on case prioritisation for introduction of new Child Support Scheme by April 2001.

Business Area:	Social Security Agency
Social need to be tackled:	Poor health and social wellbeing experienced by disadvantaged people
Desired outcome:	Greater take-up of benefits and entitlements by disadvantaged people
New TSN objectives	Targets or actions and timescales
DHSS 26 To develop and promote policies and programmes of action which aim to reduce inequalities.	a. Prepare a strategy for encouraging participation in the New Deal for Lone Parents by April 2000. b. By April 2000, prepare statements and action plans on the delivery of social security services for: disabled people, elderly people, people with literacy problems, people in isolated areas, people affected by the Troubles and minority ethnic people. c. Undertake a disability audit, evaluate findings and prepare an action plan by April 2000.

Business Area:	Health Estates Agency
Social need to be tackled:	Poor health and social wellbeing experienced by disadvantaged people, groups and areas
Desired outcome:	Increased usage of surplus DHSS property for New TSN purposes
New TSN objectives	Targets or actions and timescales
DHSS 27 To develop and promote policies and programmes of action which aim to reduce inequalities.	a. Review the legislative restriction on use of surplus DHSS property with a view to the use of such property for New TSN-related activities by Autumn 2000.