Interview with Dr Stephanie O’Keeffe, National Director Health and Wellbeing Division, HSE

‘Health and Wellbeing in the context of an ageing population.’

Dr. Stephanie O’Keeffe is National Director of Health and Wellbeing in the HSE.  Dr. O’Keeffe previously was the first Director of a new Health and Wellbeing Programme in the Department of Health where she led out on the development of Ireland’s first inter-sectoral population health framework, Healthy Ireland.  Dr. O’Keeffe has a Bachelors Degree in Psychology from Trinity College Dublin, an MSc in Psychological Research Methods and Assessment and a PhD in Psychology from the University of Surrey in the UK.

Could we start with you telling me a little about your role, and the role of the Health and Wellbeing Division within the HSE?

SO’K: I am the Director of the Health and Wellbeing Division of the HSE, and the purpose of this Division is to lead out on a reform programme in the health service with a focus on improving the health of the population. There are three key strands; prevention, early detection and self care and self management approaches for people with chronic diseases.

This is particularly relevant to our conversation because of our rapidly increasing ageing population. People are living longer, but they are not necessarily living healthily in their later years, and this, in turn, introduces additional demands and new challenges on the health service. All of this means that we need to sit up and radically rethink how we deliver services outside of the hospital setting. The agencies – both statutory and non-statutory alike – need to be working very closely together. We also need to look at how technology can allow people to manage their own health. It is true to say that all developed countries are grappling with these dilemmas at present.

A focus on prevention is key to our work. We know how important lifestyle determinants are. Recent Tilda data shows us that 80% of people over 50 years of age are overweight. That is a reality that we must address.

So the Health and Wellbeing division is taking a life-course approach, but do you think that it is also useful to segment across the life-stages?

SO’K: Yes, most certainly. Context really matters and this is why we need a truly joined up cross governmental approach.

NGO’s are already playing a significant role in working to improve the health and wellbeing of older people. In particular they play a huge role in relation to combating loneliness. It’s now recognised how significant a public health issue loneliness actually is. I am familiar with the work of bodies such as Active Retirement Ireland and Age & Opportunity in this context and the significant health related dimensions to what they are doing when working with communities across the country.

The way we live and work is changing and we need to recognise this and adapt our services appropriately. To do so we in the health services need to work even more closely with the NGO’s, An Gardaí Siochana and particularly with Local Government. That is why the multi-agency Age Friendly programme offers so much promise and potential – with very practical solutions already coming to the fore.

I believe that the Local Authorities, in particular, are playing a cutting edge role in improving the health outcomes of local communities. By taking a leadership role – bringing these various key actors together to work collaboratively and to develop shared responses to what are actually shared challenges – the county and city councils are helping to bring about real improvements in the quality of life experienced by older people.

There has been considerable improvement in our approach to inter-agency working in recent years. Age Friendly Ireland, and its predecessor the Ageing Well Network, has played a key role in bringing people together across the sectors to recognise the reality of population ageing. This has encouraged the public sector to move more quickly that it usually does. What we need to do now is expand on the important developments that have happened in the positive ageing space. At the moment, our examples of good practice – with many of these coming through from the individual Age-friendly Programme areas – while innovative and impactful are often small in scale. We need to scale up on these successful examples and we need leadership to put the necessary resources in place to do this.

We know that where we live impacts very significantly on how we live; What role do you feel the local authority led Age Friendly programme can play in contributing to the goals of the Healthy Ireland Framework, and to realising the vision set out within the National Positive Ageing Strategy?

SO’K: At the moment, Local Authorities are playing a central transformative role in how we think about planning and the delivery of public services across the spectrum. Local authorities are responsible for making decisions and allocating resources that have a real impact on communities, and how they develop, the quality of their built environment, and how they can flourish. The Gardaí, NGO’s, and ourselves in the Health Service, also play a key role in this respect. The Age Friendly Programme provides both an opportunity and an infrastructure to bring these various actors together at local level to plan collaboratively, to share resources and to develop more nuanced responses to meet the needs of our older adults. Now that the Age Friendly Programme is nearing a national roll-out this collective network is set to play an increasingly important role in realising the visions that we have set for ourselves as part of these national policy documents. Without effective local implementation mechanisms national strategies can be very difficult to realise.

What role do you see the HSE playing at local level on the Age Friendly Alliances?

SO’K: I see the HSE role as being twofold: Firstly, through national support, that local HSE person should be able to contribute to an informed analysis of what the need is locally, and secondly, again with appropriate national support, should be in a position to assess where resources currently are and define how they could and should be reshaped or augmented to meet particular known needs within the community.

The portfolios of senior managers across all of the agencies are becoming more and more significant and onerous. What would you say to managers to encourage engagement with the Age Friendly Cities and Counties Programme?

SO’K: I would say to those managers; they can’t do it all by themselves and they shouldn’t be looking to do it all by themselves! If you are looking to improve population health, you can’t do it without looking at what resources the local authorities have or what is offered by local education providers…by the range of agencies within the area. Alliance membership allows all of the agencies to realise their own goals more effectively. Multi-agency working can of course be complex and demanding but when it works well it is such a good investment of time and effort.

You have to look at what other services are being delivered within a community to see if there is duplication or overlap. Are existing services fit for purpose? Needs of communities are fluid and will change over time and this must also be assessed and factored in.

But this Programme is also about the active role of the citizen. We have to make sure we talk to people about what they need. The voice of the older person is at the heart of the Age Friendly programme which is very pleasing and most relevant. Over time we will need to ask ourselves why would we talk to people separately? It makes so much more sense to identify common indicator sets and common understandings of what we can achieve together. We will need to work out what that will look like?

In relation to the implementation of the National Positive Ageing Strategy what role can research play, and more specifically what role can the joint HSE, Department of Health and Age Friendly Ireland research programme (The Healthy and Positive Ageing Outcomes Initiative) play?

SO’K: Data, information, evaluation and measurement are critical to all of this – healthy and positive ageing. We need to know that we are using public resources effectively; We need to know who the services are for; We need to have a clear understanding of what are the services that need to be provided; Most importantly we need to know what are the outcomes we want to realise. Only then will we make informed decisions and really good investments.

Having good evidence is so important and the TILDA longitudinal data set is invaluable in this context. The joint HSE, AFI, Department research initiative will allow us to get better value from the overall investment that has been made to date in the area of research. But more importantly it will allow us to continue to support, in a practical way, the interagency collaborations that have been developed to date. It will allow us to identify outstanding questions that we have in the area of ageing and to establish relevant measures that will allow us to determine if we are making progress. It will help us to plan our interagency response in a more informed, evidence based way. We have to ask ourselves, is there an easier way for us to deliver on a common set of outcome indicators on having healthier people? Can we do it in a way that is clever and uses resources wisely?

What message would you have for the now national network of Age Friendly Cities & Counties and, indeed, the individual Age Friendly City or County?

SO’K: This is really a very exciting time in Ireland in that there is a synergy happening between strategic interests across sectors culminating in a common agenda. Work around children and young people is now linking into positive ageing. Local government reform and the work of agencies such as the EPA links in with health. For the first time, our strategies now talk to one another.

As I mentioned previously, the great challenge here is how do we scale up? We need to make sure that local involvement is very strong. This requires strong membership that needs to be supported nationally. This will allow us, in the Health Service, to bring more to these local tables. At national level we should be tasked with providing the analysis that assists in this scaling up. We need to address scalability in an aggressive way; We have some great examples of good practice but now we need to know how replicable they are and where they are most needed and to act on this information.

If we were to have this conversation again in five or ten years time what progress would you like to have seen made?

SO’K: Specifically, I would like to see that that the goals of the National Positive Ageing Strategy are being realised. The Strategy sets out a very good template and if we deliver on these we will be in better shape for it.

In terms of improving health outcomes and the broader key determinants, this will be challenging, especially so in the current economic circumstances. Having better data will certainly help. Having strong partnerships will be key to delivering effectively. This is where key models such as the Age Friendly Programme have such an important role to play.

We often hear of the challenge of implementation. Do you feel that with strong partnerships in each city and county, and with strong leadership, we can be hopeful for effective implementation at local level?

SO’K: Yes, I do. The issues that we are concerned with here require a longer term approach. They transcend the political cycle and require citizen empowerment in a long term strategic way. Politicians need to be concerned about these issues. The role of the County and City manager is critical, along with the advocacy role of NGO’s. With agencies working together more effectively at local level we stand a much better chance of success. The Age Friendly Programme plays a very valuable role in this context.