Western Health & Social Care Trust: Designing a Whole-System Prevention Strategy in Northern Ireland

From Early Dialogue to Strategic Partnership
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WAVE’s relationship with the Western Health & Social Care Trust (WHSCT)began in 2010, when two WAVE-led workshops—held in March and October—combined a focus on Infant Mental Health with lessons from WAVE’s early years prevention work in Croydon. These engagements inspired the Trust to explore how shifting investment upstream might transform outcomes. Over the following years, WAVE contributed to local workshops and conferences (2011, 2014, and 2015),strengthening a shared understanding of the potential for primary prevention.

This relationship culminated in a formal strategic partnership in 2016–18 between WHSCT, Derry City & Strabane DistrictCouncil, and WAVE Trust. The shared goal: to break cycles of intergenerational harm by redesigning local systems around prevention—acting before damage occurs, not after.

Mobilising a Whole-System Response
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Under the leadership of Kieran Downey (then Director of Women and Children’sServices at WHSCT), the partners launched the Pioneer Communities project—one of the UK’s most wide-ranging attempts to embed prevention at the heart of public services. The initiative won cross-party support in Derry City & Strabane District Council and brought together more than 40 local agencies, including the PSNI, education leaders, community organisations, and charities.

A multi-agency Steering Group and working teams co-designed the new model, supported by WAVE’s research evidence, costed design frame works, and strategic facilitation.

A Blueprint for Prevention by Reallocation
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The project aimed to deliver better outcomes and long-term savings by redirecting a portion of crisis spending into relationship-based early support.Key components included:

• Family advocates offering sustained, non-stigmatising support
• Parenting programmes grounded in attunement and early emotional development
• Cross-sector workforce development in prevention-focused practice
• Strengthened community infrastructure to identify and address needs early

The resulting vision was formally endorsed in a PioneerPartnership Agreement signed in May 2017.

What Happened Next
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In January 2017, the Northern Ireland Government collapsed. Although the project continued for another 16 months with reduced funding—achieving substantial progress in designing a local prevention model—the absence of political authority made it impossible to secure endorsement for budget reallocation. With the suspension of devolved government extending to three years, the project was eventually placed on hold.

What Endures
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Although not implemented, the Pioneer Communities initiative remains one of the most comprehensive and well-developed examples of whole-system, multi-agency prevention design in the UK. It helped deepen understanding of how local systems can shift from crisis management to upstream prevention—and continues to shape WAVE’s national strategy.

As Ann McDuff, Director of Community & Public Health atWHSCT, reflected at the closure meeting:

“In good faith, George has allowed us to be part of this project. It’s an exciting project. … the political and financial climate has conspired against us … Credit to George, he had a vision and a mentality which we never fully followed because of the lack of financial backing.”

In an earlier 2016 endorsement letter, she wrote:

“WHSCT have had a lengthy and successful association with the WAVE Trust and have been specifically influenced by their work and vision.WAVE impacted the development of our Infant Mental Health and Early Years strategies especially since formally establishing contact in 2010, and assistedWHSCT to become the lead Trust in Northern Ireland in these critical areas of work. WAVE have inspired and continue to inspire our commitment to address the challenges brought about by inequalities, disadvantage and abuse.”