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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.
Abstract: In 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.

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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.

21 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: In this article, the authors present a public policy and administration approach for public policy, which is based on the concept of public policy. But they do not discuss its application in policymaking.
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: 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.

14 citations

Journal ArticleDOI
TL;DR: Person‐centredness is important in delivering care for long‐term conditions and new models of care aim to co‐ordinate care through integration of health and social care which require new ways of working, often remotely from the patient.
Abstract: BACKGROUND: Person-centredness is important in delivering care for long-term conditions. New models of care aim to co-ordinate care through integration of health and social care which require new ways of working, often remotely from the patient. OBJECTIVE: To describe how person-centred care is enacted within multidisciplinary groups (MDGs) created as part of a new service, integrating health and social care for older people. METHODS: We followed the implementation of eight neighbourhood MDGs, observing and interviewing staff from three MDGs at different phases of programme implementation using semi-structured topic guides. RESULTS: Thirty-four MDG meetings were observed and 32 staff interviewed. Three core themes were identified which impacted on enactment of person-centred care: the structural context of MDGs enabling person-centred care; interaction of staff and knowledge sharing during the MDG meetings; and direct staff involvement of the person outside the MDG discussion. CONCLUSIONS: This study provides new insights into attempts to enact person-centred care within a new model of service delivery. Teams did what they could to enact person-centred care in the absence of the "real" patient within MDG meetings. They were successful in delivering and co-ordinating some aspects of care (eg prompting medication reviews, referring to social worker, health improvement and arranging further multidisciplinary team meetings for complex cases). This "absence of patients" and time pressures within the MDGs led to reliance on the "virtual" record, enhanced by additional "soft" knowledge provided by staff, rather than ensuring the patient's voice was included.

10 citations

References
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01 Jan 2008

317 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