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1Reducing Acute Mental Health Admissions in Northern IrelandJohn ColeRichard Murphy
2PROBLEMS FACING THE HEALTH SERVICE• Ever-increasing demand for health and social services generally• Significant increase...
3THE GROWING PROBLEM
THE FUNDING GAP• In 2010/11 Northern Ireland health and social services budgetwas approximately £4.2 bn• To meet growing d...
THERE HAS TO BE A BETTER WAYTO CONTINUE TO DO WHAT WE AREDOING WILL ULTIMATELY LEAD TOFAILUREWE HAVE TO DO MORE WITH LESS5
6CONFIRMED SERVICE VISION• Less reliance on reactive more expensive care in hospitals witha move to creating integrated ca...
ORGANISATIONAL CHANGE TOFACILITATE IMPROVED INTEGRATION• Each of the 5 new CEOs now responsible for delivering the fullran...
8THE SHIFT RIGHT AND LEFT:• Fewer but larger hospitals providing the critical mass of staff and facilities toprovide acute...
9KEY CHANGES IN THE LOCATION OF SERVICES0 - THE HOME1 - LOCAL HEALTH CENTRES2 - COMMUNITY HEALTH CENTRES3 - LOCAL HOSPITAL...
103 - LOCAL HOSPITALSMovement of out-patients diagnosticsand treatments fromacute towardscommunityKey issue is themovement...
11=3 - LOCAL HOSPITALSMovement of out-patients diagnosticsand treatments fromacute towardscommunityKey issue is themovemen...
12Location of Level 4 FacilitiesCURRENT PROPOSAL BEING DEVELOPED TO REDUCEFROM 10 ACUTE HOSPITALS TO BETWEEN 5-7 NETWORKSA...
13Location of Level 4 Facilities6 OF EXISTING 10 ACUTE HOSPITALS TO HAVE ACUTEMENTAL HEALTH UNITS CO-LOCATED – OTHERS CLOSED
SERVICE VISION• Acute mental health units to be co-located with Acute Hospitalsfor clinical linkages and as centres of exc...
BELFAST MODEL• Closure of 3 Acute Psychiatric Units at Knockbracken (oldasylum-type site), at Mater Hospital and at Windso...
16Old See House
DESIGN VISION• The right type of facilities, of the right design, in the right place.• Quality objectives that recognise t...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
John Cole Director of the Health Estates Investment Group NI and  Richard Murphy OBE Director, Richard Murphy Architects R...
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John Cole Director of the Health Estates Investment Group NI and Richard Murphy OBE Director, Richard Murphy Architects Reducing Acute Admissions to Mental Health Facilities: the Role of the Built Environment

Architects for Health & European Health Property Network Event - How can we do more with less?

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John Cole Director of the Health Estates Investment Group NI and Richard Murphy OBE Director, Richard Murphy Architects Reducing Acute Admissions to Mental Health Facilities: the Role of the Built Environment

  1. 1. 1Reducing Acute Mental Health Admissions in Northern IrelandJohn ColeRichard Murphy
  2. 2. 2PROBLEMS FACING THE HEALTH SERVICE• Ever-increasing demand for health and social services generally• Significant increase In people suffering from mental health illnesspotentially linked to economic and social factors• Threat of real reductions in funding or non-affordability of status quo• Limited effective integration between primary / community andacute sectors
  3. 3. 3THE GROWING PROBLEM
  4. 4. THE FUNDING GAP• In 2010/11 Northern Ireland health and social services budgetwas approximately £4.2 bn• To meet growing demand of 6% per annum by 2015/16 onprevious model of health care we would need £5.4 bn• We are projected to have a budget allocation in 2015/2016 of£4.6 bn – a funding gap of £0.8bn4
  5. 5. THERE HAS TO BE A BETTER WAYTO CONTINUE TO DO WHAT WE AREDOING WILL ULTIMATELY LEAD TOFAILUREWE HAVE TO DO MORE WITH LESS5
  6. 6. 6CONFIRMED SERVICE VISION• Less reliance on reactive more expensive care in hospitals witha move to creating integrated care partnerships between hospitalstaff, GPs and community staff• Providing more efficient, effective and economic proactive healthand social care services closer to where people live.• Putting the patient at the centre of a high quality multi-disciplinaryintegrated team• Focus on preventing illness and improving health and well-being through improved life-styles, diet, exercise, amenities,education, access to information and support in the community.• Facilitating people to live longer and more independent lives in theirown homes with the support of technology where appropriate
  7. 7. ORGANISATIONAL CHANGE TOFACILITATE IMPROVED INTEGRATION• Each of the 5 new CEOs now responsible for delivering the fullrange of Hospital, Community and Mental Health Services withina specific geographic area. ( Other than Regional Services)• Removed incentive for Hospital CEOs to treat more patients inhospitals for greater income generation• Increased incentive for patients to be treated in the mostappropriate environment to meet the patients’ needs• Establishment of networked integrated teams of clinicians,nurses and health professionals working across all levels ofmodel7
  8. 8. 8THE SHIFT RIGHT AND LEFT:• Fewer but larger hospitals providing the critical mass of staff and facilities toprovide acute and complex services as Centres of Clinical Excellence• The creation of a range of Health and Care Centres as hubs in thecommunity large enough to provide the critical mass to deliver good localaccess to comprehensive range of health services, treatment and advice,some of which would only previously have been available in hospitals• Better chronic disease management reducing the need for moreexpensive hospitalisation and maintaining people in their own homes• Accessing appropriate care in less expensive settings:e.g. urgent care, out-patients ,diagnostics, minor procedures, mentalhealth services• Optimisation of technology, earlier diagnoses and interventionsleading to better patient outcomes
  9. 9. 9KEY CHANGES IN THE LOCATION OF SERVICES0 - THE HOME1 - LOCAL HEALTH CENTRES2 - COMMUNITY HEALTH CENTRES3 - LOCAL HOSPITALS4 - ACUTE HOSPITALS5 - REGIONAL CENTRESMovement of out-patients diagnosticsand treatments fromacute towardscommunityKey issue is themovement ofchronic diseasemanagement to thecommunitypreventingunnecessaryhospitalisationMovement ofcomplexspecialties orspecialtiesbenefiting fromhigher criticalmass to Centresof Excellence
  10. 10. 103 - LOCAL HOSPITALSMovement of out-patients diagnosticsand treatments fromacute towardscommunityKey issue is themovement ofchronic diseasemanagement to thecommunitypreventingunnecessaryhospitalisationMovement ofcomplexspecialties orspecialtiesbenefiting fromhigher criticalmass to Centresof ExcellencePULLPULLLOCATION OF SERVICES
  11. 11. 11=3 - LOCAL HOSPITALSMovement of out-patients diagnosticsand treatments fromacute towardscommunityKey issue is themovement ofchronic diseasemanagement to thecommunitypreventingunnecessaryhospitalisationMovement ofcomplexspecialties orspecialtiesbenefiting fromhigher criticalmass to Centresof ExcellencePULLPULL= LESS BEDSANDLESS HOSPITALSLOCATION OF SERVICES
  12. 12. 12Location of Level 4 FacilitiesCURRENT PROPOSAL BEING DEVELOPED TO REDUCEFROM 10 ACUTE HOSPITALS TO BETWEEN 5-7 NETWORKSApprox £1000m being spent reinforcing Centres of Excellence
  13. 13. 13Location of Level 4 Facilities6 OF EXISTING 10 ACUTE HOSPITALS TO HAVE ACUTEMENTAL HEALTH UNITS CO-LOCATED – OTHERS CLOSED
  14. 14. SERVICE VISION• Acute mental health units to be co-located with Acute Hospitalsfor clinical linkages and as centres of excellence• Acute mental health services no longer to be provided fromother existing stand-alone units• Acute Centres to focus on achieving earliest appropriate transferto day-patient/out-patient services in smaller community facilitiesor support in the home• Major investment in community mental health teams with earlierinterventions /crisis response services seeking to preventunnecessary hospitalisation• Mental health services to be provided within new Health andCare Centres• Development of smaller integrated crisis beds /out-patient /day-patient units in community14
  15. 15. BELFAST MODEL• Closure of 3 Acute Psychiatric Units at Knockbracken (oldasylum-type site), at Mater Hospital and at Windsor HouseBelfast City Hospital• Creation of a single central Acute Psychiatric Unit at Belfast CityHospital site with significant net reduction in acute beds from130 to 80• Development of a community facility with day and out patientfacilities and as a base for significantly increased community-based outreach mental health teams (Old See House)• Mental Health services to be available in new Health and CareCentres across the city15
  16. 16. 16Old See House
  17. 17. DESIGN VISION• The right type of facilities, of the right design, in the right place.• Quality objectives that recognise the major contribution that design canplay in creating a healing environment.• Therapeutic environment perhaps most critical for this vulnerablepatient group who are generally physically well• Non-institutional, intuitive way-finding, quality of daylight and artificiallighting, human scale, variety of spaces, conversation places, avoidingthe tyranny of the double-loaded corridor, respecting privacy anddignity, patient safety• Creating facilities that are welcomed by local communities and enhanceand enrich those communities in which they are located17

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Architects for Health & European Health Property Network Event - How can we do more with less?

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