The scale and complexity of DBS make it essential that robust implementation structures are in place. The Department, Boards and Trusts, which operate the health services throughout Northern Ireland, all have important roles to play during the implementation process. Individual clinicians, nurses and other health professionals are also working to ensure that DBS is taken forward within their areas of expertise.

At a regional level, the Department of Health, Social Services and Public Safety, has established a Regional Steering with overall responsibility for the implementation of DBS. The Steering Group, which met for the first time in January 2004, comes together on a bi-monthly basis and provides strategic direction. The Group also gives guidance and support on implementation arrangements across all organisations, services and locations on a ‘whole system’ basis.

At Board level, each of the four Boards (Northern, Southern, Eastern and Western) has established an Area Programme Board which has oversight of all DBS projects undertaken within their area. Each Area Programme Board (APB) is responsible for ensuring that DBS is taken forward in a timely, effective and properly co-ordinated manner. All DBS business cases relating to a particular Board area must be signed off by the APB and the Board is also responsible for bringing to the attention of the Regional Steering Group particular local issues which may have wider significance.

In each Board area, it is likely that a number of projects will be ‘live’ at any one time. These projects may range from the construction of a new hospital, to the implementation of specific service redesign. As each project comes on line, it is managed on a day-to-day basis by a project team who are responsible for ensuring that their individual project is planned, implemented and monitored in line with best practice.

This tiered framework reflects the HPSS structure in Northern Ireland. Regional level strategic direction is combined with area level co-ordination and local level implementation to ensure that DBS is being progressed in a managed way.