Background to the Research

• The C-BAP involved a partnership between the NEHB and the CAGHT. The two organisations provide services for populations along and across the border who have been marginalized by the 'troubles' and who, it was believed, would positively benefit from closer ties between two partner healthcare providers. The first phase of the C-BAP commenced in 1998 and sought to bring together the two organisations in training, service provision, the development of joint information technology and managerial and clinical relationships. The project also concentrated on the development of both organisations capacity to work together. Phase II of the project sought to continue with all aspects of the original brief, save for the provision of joint services. Phase II was to proceed with projects in the following areas: Telemedicine in Leg Ulcer Management, Professions Allied to Medicine, General Practice Pain Clinic, Postnatal Depression Service, Integrated Pain Management, and Discharge Policy.
  

Research Approach

• A number of methodological approaches were employed. For example, semi- structured questionnaires with both patients and staff; focus groups with patients; interviews with key personnel from each of the various initiatives; and an analysis of project records, documents, relevant E.U. material and other such internal data sources.
  

Main Findings

• Several of the projects had the effect of improving access, the availability of services and awareness of service in border areas. This was clear in the Postnatal initiative where few services had previously existed and also the GP Pain clinics which confirmed findings in Phase 1 in relation to the dermatology project. This improvement in service provision was particularly significant given the extent of social and economic deprivation in some border areas.
• Although projects were set up on a cross-border basis under C-BAP, management issues of clinical governance and jurisdiction still arose on the Telemedicine in Leg Ulcer Service where the exchange of information could only be treated as advice to counterparts across the border because of the implication for clinical governance and decision making structures.
• Several of the projects demonstrated a process of professional enhancement. Thus the Telemedicine project promoted nurse-led ulcer services and the pain clinic enhanced general practitioners knowledge and expertise.
• While it was difficult to accurately determine costs and savings in the C-BAP initiatives, it did appear that the leg ulcer management initiative in particular had led to potential financial savings when compared to former practices.
• The large majority of staff involved in all the initiatives in Phase II were very positive about the advantages of working together, the potential for the development of cross-border collaboration and they shared a desire for more opportunities to network and co-operate.

Conclusions

• Concerns were raised about what would happen once initiatives came to an end and this included patient concerns. The longevity of each C-BAP initiative is not clear and may, if not mainstreamed, fail to survive beyond initial funding or enthusiasm.
• Where it is impossible to sustain a project it becomes important to have an exit strategy. This is important for all participants including staff and patients and does require an element of future planning during the life of projects.
• The difference between North and South in terms of the licensing of different drugs continued as a problem. In Phase II it was seen as a weakness in the GP initiative.
• Some of the patient groups involved are also from vulnerable groups in society and may experience special problems with loss of a service. The problems of social exclusion with which the C-BAP aimed to address are not susceptible to solution through short-term interventions.
• C-BAP originated under Peace and Reconciliation funding and it was difficult to measure the impact on community relations in any quantitative way but there was qualitative evidence in projects that involved interpersonal contact that understanding across the border was enhanced. In projects of a more clinical nature, or where patients did not cross the border, it was more difficult to address the reconciliation dimension.