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CAWT at 30

The Co-operation and Working Together (CAWT) partnership was initiated 30 years ago when the North East Health Board (NEHB) and North West Health Board (NWHB) from the Republic of Ireland and the Western Health and Social Services Board (WHSSB) and Southern Health and Social Services Board (SHSSB) from Northern Ireland signed the Ballyconnell Agreement on 10 July 1992.

Subsequently, the Agreement was reviewed to include the seven newly formed Northern Ireland Trusts in the border region; Altnagelvin Hospital HSS Trust, Armagh and Dungannon HSS Trusts, Craigavon Area Hospital Group HSS Trust, Craigavon and Banbridge Community HSS trusts, Foyle HSS Community Trusts, Newry and Mourne HSS Trusts, and Sperrin Lakeland HSC Trust.

As a result of significant transformation and reorganisation in the healthcare sector over the past number of years, the partnership now comprises the Health Service Executive in the Republic of Ireland and in Northern Ireland, the Western Health and Social Care Trust, Southern Health and Social Care Trust, the Department of Health’s Strategic Planning and Performance Group and the Public Health Agency.

The Ballyconnell Agreement was shaped by a mutual acknowledgment that both border jurisdictions shared a common demographic profile and similar challenges of poverty, isolation and peripherality. It committed the partnership to a spirit of cross border co-operation to improve the health and social well-being of people living within the border region.

During the initial years, the Partnership undertook a number of research projects in both jurisdictions and funded jointly by the health boards/authorities and trusts.  The research findings highlighted priority areas for intervention and outlined how potential funding should be targeted to ensure the greatest potential for impact.

In 1996, CAWT secured over £5 million from the EU Special Support Programme for Peace and Reconciliation (PEACE I) for a range of cross border health and social care projects, beginning to address the areas of acute and primary care. These areas were considered to have the greatest potential for cross border co-operation in a region still impacted by ‘The Troubles’.

On 10 April 1998, the Good Friday Agreement was signed, creating a new impetus for North-South co-operation.  The North-South provisions of the Agreement provided for the setting up of the North-South Ministerial Council (NSMC) and outlined a new institutional framework and context within which co-operation between the two parts of the island would be taken forward. The Special EU Programmes Body (SEUPB) was one of six new cross border implementation bodies established to facilitate the positive impact that European Regional Development Funding could have on the lives of people living across Northern Ireland, the Border Region of Ireland and Western Scotland.

Given the legacy of the initial projects, both Ministers for Health appointed CAWT as the delivery agent for INTERREG IIIA, Priority 3 Measure 2, Health and Well Being for the period from 2002 – 2008, with the Partnership delivering 44 cross border projects through the INTERREG and PEACE II programmes.

From 2008 – 2014, the CAWT Partnership continued to manage a range of cross border health and social care projects on behalf of both Departments of Health, which were part-financed by the European Union’s European Regional Development Fund through the INTERREG IVA cross border programme and managed by SEUPB.  Funding for the overall ‘Putting Patients, Clients and Families First’ 12-project programme concluded as planned in 2015, enabling a suite of cross border services and initiatives to be delivered in the border region and benefiting 53,000 citizens during its lifetime.

Following an extensive period of collaboration with project partners during 2016, CAWT submitted a range of proposals to the INTERREG VA Programme’s Health theme, focusing on improving the health and well-being of people living in the region by enabling them to access health and social care services in the most appropriate setting to their needs.  After a competitive process, grant funding was awarded in 2017, and five projects commenced – four led by CAWT and one led by NHS National Services Scotland.

The five projects were initiated and continue to be delivered against the backdrop of the 2016 Brexit vote which would complicate north/south cooperation. Throughout 2019, 2020 and 2021 both the NI and RoI Departments of Health engaged in the preparations for the UK’s withdrawal from the EU. In 2018 both Governments’ agreement to underwrite the INTERREG VA EU funding allocations was welcomed by all CAWT partners. As a result of these assurances and despite the uncertainty surrounding EU Exit arrangements, the CAWT Partnership remains cautiously optimistic that post-Brexit arrangements will not obstruct existing cross border and all-island health and social care service provision or limit future service developments.

Project 1 Acute (Connecting Services, Citizens and Communities)
Beneficiary target 14,500 patients
Project Description




This project aims to increase acute episodes of care to patients, through improved/reformed service delivery on a cross-border basis. The project focuses on Vascular, Dermatology, Urology and General Surgery services for scheduled care and 5 different areas within unscheduled care; Community Paramedics, Community Cardiac Investigations, Reform of A&E/ED within three Acute hospitals, Direct Access Unit/Clinical Decision Unit and Community Respiratory services.
Some key impacts to date




The project has allowed a number of new patient pathways to be explored and implemented to reduce hospital admissions, when appropriate, and to treat patients either at home or in the community. The shared learning, both at inter-organisational and cross border levels, between Project Board members and clinical professionals has provided opportunities for staff development and training which will ultimately improve the services provided to patients.


Project 2 Children’s Services (MACE- Breaking the Cycle Project)
Beneficiary target 3,125 interventions to vulnerable families
Project Description



The focus is on children within the age groups 0-3 and 11-13. The project aims to develop a comprehensive assessment tool to identify children and families most at risk and identify appropriate targeted interventions. Five cross border community networks of excellence have been established to deliver the interventions required and training will be delivered to a broad range of groups regarding the use of the tool.
Some key impacts to date



Early informed opinion from social workers and health visitors indicates that the MACE project is starting to impact on the quality of some services positively as practitioners are able to provide timely interventions to help vulnerable children before their situation worsens.


Project 3 Mental Health (Innovation Recovery Project)
Beneficiary target 8,000 people
Project Description



Empowering people with experience of mental illness. Service-users and mental health practitioners work together to co-produce and co-deliver a range of educational courses in response to the needs of people with mental health problems. Includes establishment of cross border recovery colleges which will include development of virtual education and support services.
Some key impacts to date






Three project hubs have made tremendous efforts to adapt to the needs of individuals and communities during COVID-19 lockdown and had adapted project delivery to online platforms and extended service and supports on offer during the height of the COVID-19 pandemic. An online /virtual recovery college has been established, enabling 24/7 access to free mental health and well-being modules that have been co-designed by health professionals and peer educators, to support individuals to self-manage their mental health and well-being on their journey of recovery. Health professionals have received WRAP (Wellness Recovery Action Plan) Facilitator and Train the Trainer training in mental health which will allow them to cascade the training to colleagues and strengthen the delivery of services across mental health settings.



Project 4 Primary Care and Older People (mPower) – Led by Scotland
Beneficiary target 7,000 clients comprising 4,500 ehealth interventions and 2,500 wellbeing plans (Scotland, NI and RoI)
Project Description




Creation of a modernised infrastructure for healthy ageing, access to personalised care services and community support systems to ensure older people can live safely and independently in their own homes. Facilitation of self-management of health and well-being through the use of digital e-health services. Provision of remote access to health services using a virtual platform to bring services to the older person’s home or local healthcare clinic thus reducing the requirement to travel significant distances to access care services’.
Some key impacts to date




The project over achieved the targets set and the learning that has been achieved paves the way for future opportunities for service transformation and for potential future cross-border collaborations. The independent project evaluation findings show that beneficiaries found interactions with mPower to be positive experiences – specifically beneficiaries highlighted feeling decreased social isolation, decreased loneliness, increased feelings of empowerment and confidence, increased digital literacy and a facilitation of self-management behaviours.


Project 5 Population Health  (Community Health Sync – CoH Sync)
Beneficiary target 10,000 people receiving a health and wellbeing plan and support to improve their health and well-being.
Project Description





Development of a network of locality Health and Well-being Hubs in the border region of RoI/NI and Western Scotland, resourced with health trainers who support individuals and groups to become more active in improving their own health and well-being by making better use of existing resources, improving access through cross border working and filling identified gaps in service provision, thus building sustainable resilience through a community assets based approach. Focus is on tackling health inequalities and reducing the impact of key risk factors in the development of long term conditions.
Some key impacts to date



Overall, CoH-Sync reached about 12,000 people: 8,376 engaged with the complete project offer by developing health and wellbeing plans, an additional 1,500 were supported through the Covid-19 emergency response, and the Hubs had brief contact with around 2,000 others. Participants saw a marked improvement in mental wellbeing, diet and physical activity levels.


Alongside the implementation of projects linked to EU funding, the CAWT Partnership has been facilitating other non EU funded cross border/North South activity including all-Island emergency planning, comprising joint academic learning and the delivery of Humanitarian Disaster Assistance training. CAWT continues to play a key role in the facilitation of North South health and social care co-operation supporting initiatives commissioned directly by the Departments of Health. This work has resulted in major developments such as the Primary Percutaneous Coronary Intervention (PCI) at Altnagelvin Hospital which has been treating patients from Donegal since May 2016 and the North West Cancer Centre at Altnagelvin (Western Health and Social Care Trust), which provides Radiotherapy services to patients from Donegal, again since 2016.

Today, CAWT partners continue to confront the challenge of recovery from the legacy of the Covid19 pandemic. The cross border healthcare sector had already faced enormous pressures prior to the pandemic, particularly around human and financial resources, so significant work is ongoing to rebuild the sector and strengthen future resilience in line with good practice.

North-South co-operation will continue to underpin all of CAWT’s health and social care activity which is driven by the needs of the region and the health priorities of all of the key partners.  While the partnership is currently focused on bringing the INTERREG VA projects to a successful conclusion in the coming months, significant collaboration is ongoing with existing and new project partners to develop proposals for PEACEPLUS.  This new EU funding programme will build upon the work of the previous PEACE and INTERREG Programme and has been designed to support peace and prosperity across Northern Ireland and the border counties of Ireland across a range of themes.  It is anticipated that the new six-year programme will be launched in spring 2023.

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