Structure and decision making process

The respondents were asked about their knowledge of the Health and Social Services, the commissioning process, the ability of communities to have an impact on this process and how the Health and Social Services communicated with communities. Many of the respondents felt that they knew little about the processes involved and how and where the money was allocated.  More was known about the work that was carried out on the ground and that is where most of the contact between community groups and the health and social care providers has been.  Overall, it was perceived that communities were not able to have much of an impact on the decision making processes and they were unsure how the Health and Social Services communicated information on decision making to them.

The structure

Over two thirds of the respondents from the community, the health and social care issue groups and the statutory agencies (other than the Health and Social Services staff) knew very little or nothing about the structures of the Health and Social Services.  The system was considered confusing and changes over recent years had added to this confusion.  Others knew more about the Causeway HSS Trust, as they have more contact with individual health and social care workers on the ground eg Health Visitors and the Health Promotion Department. 

The majority of community group respondents perceived that they would know whom to contact if they had a problem or an issue that they needed to raise.  Who they approached depended on the problem.  After consulting family and friends, the most common responses were the local General Practitioner (GP), district or health nurse, the Health Promotion Department or somebody in the Causeway HSS Trust.  Other suggestions were using the complaints' procedure, contacting the Chief Executive in the Board and using the local community project worker (if one was accessible) to find out information.

The commissioning process

A similar number of community group respondents and half of the statutory agencies did not know who commissioned services for their area. The Partners knew more about the structure but  internally, the roles and responsibilities, and how it was decided where and how to spend the funds, were less clear.

It was unclear as to how the budget was allocated. One example was the Fit for the Future consultation.  "People did not have a clue where they were starting from … how can you give an informed opinion when they have not told you how the thing operates?"  Another felt that this was not entirely the Board’s fault, as the community may have "not been doing enough reading" around the relevant issues.

However some suggestions were put forward as to what affected the budget and the allocation of money eg "Central Government would have substantial influence, with the money feeding through to the Boards and then to the Trusts, GPs and community health people".

Allocation of the money and services Hospitals were frequently suggested as having the largest proportion of the budget allocated to them, whereas almost a third of the community respondents suggested that it was spent on staffing, administration and salaries. Other less frequent suggestions were the maintenance of buildings, equipment, social care, health centres, the elderly, children’s services, care in the community, prescription charges, and links to education and transport.   "Then down the pecking order to Health Promotion, which would get 0.0001% with community development coming out of Health Promotion". Those working for the NHSSB identified the major items of expenditure as acute and community care including the elderly, children, mental health, learning and physical disabilities. Others that were mentioned included Primary care, buildings and maintenance. The expenditure was viewed as dependent on Central Government, the Health and Social Services Executive, need, geography, demography and history. Over a quarter of the community respondents did not know what influenced the allocation of money.  Many of the other respondents suggested that it is needs based but influenced by geography and population. A variety of other influential factors suggested included: §         the unique situation in Northern Ireland, "that is, security gets the most with education, health and finally housing being less of a priority" §         the actual money available, the centralisation of services, "who knows who", the individual Board members, consultants  and GPs due to "the power they have and the money they earn", demand, historical allocations and professional guidelines §         the media, pressures from individuals and groups ie "who shouts the loudest", government and politicians. Those more involved with health and social care issues through work or in a voluntary capacity had a clearer understanding of the how the budget was allocated and what factors had an influence. Suggestions were that the Programmes of Care all put their plans forward followed by negotiations as to who gets what, with 46% of the money being spent on acute services which is a higher average than in other areas.

Needs assessment

Over three quarters of the community and health issue group respondents, all of the statutory agency workers and half of the Partners were unsure how or if the Board takes into account the views and needs of the community.

Some suggestions were that it was through the Northern Health and Social Services Council, public meetings, and feedback from local doctors’ surgeries and health and social care workers.

Those respondents working in the Board believed they currently use a number of methods to ensure they take into account the views and needs of the community.  Some of the methods are:

§         meeting with groups who request one

§         identifying interest groups who may want to be involved in specific initiatives

§         workshops at the developmental stage of a strategy and consulting on changes in strategies

§         research

§         the analysis of service use.

In general, the community, health and social care issue groups, Partners and statutory worker respondents believed that community groups and individuals could not or could only slightly influence the allocation of money.

The more positive responses were that 

§         "if groups know whom to target and present a case well, they could win and get recognition and support"

§         now there is the "requirement by government that the Board, in its commissioning role, should take on the views of the population it serves and this Project is an example of this".

Those responding from the Board felt that groups had more of an impact at a local level with the Trust and there were a few specific, discrete community projects that did have funding.  One analogy used was of the "layers of an onion" with community groups at present being on the outer layer.  The larger voluntary groups are "very mature, astute and political" and so, at present, are more involved in the commissioning process.

Those responding from the community perceived they were not having an impact because of 

§         the lack of a feedback mechanism

§         Northern Ireland people being generally very accepting

§         "some groups not being as well developed as some others".

Informing groups of their impact on decision making

The respondents were asked if the Board let communities know when they had an impact on decision making. In response, over half of the community, health and social care issue groups and statutory agency workers and Partners did not think that the Board informed communities and most of the remainder did not know. The majority perceived that there were no direct links with the community, apart from through the health and social care workers on the ground. The only other mechanism used was the media.

The views of the Board respondents varied and included the following

§         reports, leaflets, community newsletters, local newspapers, meetings with voluntary and interested groups, PR and informally through contacts with individuals and somebody "passing on the word".

homepage | Summary | Introduction | Policy Context | Model

Findings: Health and social wellbeing | Structure and decision making | Confidence | Access and contact | Influencing decisions | Information flow | Changes in structure

Analysis | Implications for the Project| Appendix 1 - Questionnaire | Appendix 2 - Respondents