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Journal ArticleDOI

Integrated care cannot be designed in Whitehall.

18 May 2012-International Journal of Integrated Care (Ubiquity Press)-Vol. 12, Iss: 2

TL;DR: Although the results of the evaluation of the Integrated Care Pilots have been equivocal, this bottom-up approach must be the right way to foster integrated care.

AbstractIn recent years England has introduced a number of initiatives to promote more integrated care. Two contrasting examples are the GP-led health centres and the Integrated Care Pilots announced in the interim and final reports, respectively, of the NHS Next Stage Review in 2007-2008. The GP-led health centres were proposed as a very centralised, prescriptive approach where the aim was that all the NHS should adopt the same model of facilitating integration through co-location. Integrated Care Pilots, on the other hand, looked to the NHS to suggest their own solutions to improve integration, resulting in a variety of solutions tailored to the needs of localities. Although the results of the evaluation of the Integrated Care Pilots have been equivocal, this bottom-up approach must be the right way to foster integrated care. Long-term commitment to integrate care is needed, as well as more exploration of integration between primary care and hospitals.

Topics: Integrated care (74%), Health care (64%), Interim (51%)

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Citations
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Journal ArticleDOI
Abstract: This article was published in Public Policy and Administration on 06 August 2015 (online), available at http://dx.doi.org/10.1177/0952076715595676

16 citations


Cites background from "Integrated care cannot be designed ..."

  • ...The Welsh Government’s approach to differentiate legislation in health and social services may thus simply reflect the continuing fragmentation of care services, which is a longstanding concern in both England and Wales (Darzi and Howitt, 2012; Hudson and Henwood, 2002; Rummery and Coleman, 2003; Snape, 2003; Snape and Taylor, 2003, WAG, 2006, Welsh Local Government Association, 2012)....

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  • ...services, which is a longstanding concern in both England and Wales (Darzi and Howitt, 2012; Hudson and Henwood, 2002; Rummery and Coleman, 2003; Snape, 2003; Snape and Taylor, 2003, WAG, 2006, Welsh Local Government Association, 2012)....

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  • ...…and social services may thus simply reflect the continuing fragmentation of care services, which is a longstanding concern in both England and Wales (Darzi and Howitt, 2012; Hudson and Henwood, 2002; Rummery and Coleman, 2003; Snape, 2003; Snape and Taylor, 2003, WAG, 2006, Welsh Local Government…...

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Journal ArticleDOI
TL;DR: Insight into the existing ways that the sites were working with respect to integrated care, their perceived difficulties and their plans for working towards improvement are provided to suggest that broadly-based prevention efforts, population health promotion and community involvement remain limited.
Abstract: Integrated care programmes are increasingly being put in place to provide care to older people living at home. However, knowledge about further improving integrated care is limited. In fourteen integrated care sites in Europe, plans to improve existing ways of working were designed, implemented and evaluated to enlarge the understanding of what works and with what outcomes when improving integrated care. This paper provides insight into the existing ways that the sites were working with respect to integrated care, their perceived difficulties and their plans for working towards improvement. The seven components of the Expanded Chronic Care Model provided a conceptual framework for describing the fourteen sites. Although sites were spread across Europe and differed in basic characteristics and existing ways of working, a number of difficulties in delivering integrated care were similar. Existing ways of working and improvement plans mostly focused on three components of the Expanded Chronic Care Model: delivery system design; decision support; self-management. Two components were represented less frequently in existing ways of working and improvement plans: building healthy public policy; building community capacity. These findings suggest that broadly-based prevention efforts, population health promotion and community involvement remain limited. From the Expanded Chronic Care Model perspective, therefore, opportunities for improving integrated care outcomes may continue to be restricted by the narrow focus of developed improvement plans.

13 citations


Cites background from "Integrated care cannot be designed ..."

  • ...Such issues are more generally within the remit and influence of “higher level” policy-makers and decisionmakers than staff of local projects [41,44,45]....

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Journal ArticleDOI
TL;DR: The paper demonstrates that the wider conceptual framework of political theory has significant purchase in the field of integration studies and can help to understand the benefits and limitations of an interdisciplinary approach.
Abstract: Differences in professional values, organisational interests and access to resources are key issues to be addressed when integrating services. They are widely seen by service planners and commissioners to be matters of governance. However, they also inform critical debates in political science. In essence they revolve around the question of distribution, or (how to decide) who gets what. The purpose of this paper is to re-frame the subject of inter-organisational governance in integration by conceptualising it through the lens of three prominent politico-theoretical approaches: the liberal, the authoritarian and the radical-utopian.,A discussion paper that proceeds by utilising political science terms of reference and applying it to a public management problem.,All three theories provide particular insights into the way in which service planners and commissioners may think about the inescapable plurality of values and interests in integration programmes. Where the liberal perspective places particular emphasis on the purpose and utility of organisational autonomy and self-direction, the authoritarian model highlights the need to produce results within tight timescales. It also accords with the manner in which integration policy is normally implemented, top down. The radical-utopian model is built on the least realistic assumptions but offers researchers a useful framework to assess the rationale and effectiveness of value-based policy in integration programmes wherever robust inter-organisational structures fail to materialise.,Whilst there has been significant research on how to conceptualise integration programmes, scholars have usually championed a public management approach. The potential insights of political thought have not been explored until now. The paper demonstrates that the wider conceptual framework of political theory has significant purchase in the field of integration studies and can help us understand the benefits and limitations of an interdisciplinary approach.

10 citations


01 Aug 2014
TL;DR: A rapid review undertaken by PRUComm of the available evidence of what factors should be taken into account in planning for the closer working of primary and community health/care services in order to increase the scope of services provided outside of hospitals is summarised.
Abstract: Closer collaboration between primary care and community health services is a clear objective of the most recent NHS reforms. Currently, there is much emphasis on integrating healthcare services and in particular, moving care closer to home and out of the acute care setting by utilising Community Services and Primary Care. This report summarises the findings of a rapid review undertaken by PRUComm of the available evidence of what factors should be taken into account in planning for the closer working of primary and community health/care services in order to increase the scope of services provided outside of hospitals. We synthesised the findings of recent reviews of the published literature seeking to examine evidence relevant to answering the question: What factors should be taken into account in planning for the greater integration of primary and community care services in order to increase the scope of services provided outside hospitals? We examined evidence focused at three different levels: Micro-level – factors affecting the effectiveness of multidisciplinary team-working Meso-level- the impact of service organisation and delivery issues, including population coverage and service location Macro-level – structural issues, such as ownership models and financing

9 citations


Cites background from "Integrated care cannot be designed ..."

  • ...…and effective community engagement, Carelli (2010) argues that polysystems will cause loss of patient-doctor continuity and increase travel times for patients, whilst Darzi and Howitt (2012) suggest that the way GP Health centres (polyclinics) were introduced has not fostered integrated care....

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References
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01 Jan 2008

313 citations


01 Jan 2007
TL;DR: It is refreshing to read a policy document that focuses on real health problems and makes practical suggestions about solving them, says Stephen Thornton, chief executive of the Health Foundation.
Abstract: A Framework for Action details how Professor Ara Darzi believes London's healthcare needs to change over the next ten years. It also looks beyond the vision and identifies the key enablers that will turn the vision into reality. Download the full report and those of the working groups.

55 citations