Integrated care cannot be designed in Whitehall.
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.
Citations
More filters
24 Oct 2017
TL;DR: The bottom-up approach to study the practical implementation of mechanisms is a fruitful approach, since it brings into light the complex realities and practicalities of the mechanisms of integration and how they are shaped by local actors in local contexts.
Abstract: Background: For some time now, integrated care has been put forward to create a more demand-driven, patientcentred and cost-effective care system. Various conceptual frameworks have been developed to shed light on the complex concept. However, they lack insight into the mechanisms driving integrated care in practice. The aim of this paper is to gain insight into how integrated care is realised in practice. Methods: Six cooperation projects in Flanders were compared on five integration mechanisms. A content analysis of secondary sources on each of the cases and semi-structured interviews with representatives of these cases was conducted. The data were analysed using comparison tables. Results: Six cases representing five cooperation models in the Flemish health and social care were analysed for the presence of integrated care mechanisms. Six of the 22 mechanisms are present in all case examples. Half of the identified mechanisms concern the integration of professionals. Integrated care in these Flemish cases refers mainly to organising a case meeting, appointing a case manager and dividing the tasks between care professionals. Integration of support is less developed. Conclusions: The bottom-up approach to study the practical implementation of mechanisms is a fruitful approach, since it brings into light the complex realities and practicalities of the mechanisms of integration and how they are shaped by local actors in local contexts. The approach shows how Flemish and Belgian policy makers are struggling to scaling up these integration models, whilst at the same time responding to local conditions and needs.
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....
[...]
TL;DR: Many of the outcomes that are important to service users with LTNCs are not addressed in validated 'outcome measures', which has implications for commissioners and practitioners to ensure that service users' needs are met in practice.
Abstract: Background Failure to demonstrate the effect of integration on service users using conventional outcome measures suggests that research to date has failed to measure the outcomes that actually matter to people with complex long-term conditions and that might result from integrated health and social care. Developing outcome measures that capture the important issues for service users may also help to better reflect the particular ways integrated teams work and what such teams strive to achieve in addressing service user outcomes. Objectives The objectives of this research were to (1) identify factors that affect integration between health and social care; (2) identify outcomes important to people with long-term neurological conditions (LTNCs) who are clients of an ‘integrated’ service; (3) develop these outcomes into a checklist and explore whether or not these outcomes can be assessed in practice; and (4) understand how different models of integration affect outcomes. Design, methods and participants A case study approach, using in-depth, semistructured interviews, was adopted. The cases were four English primary care trusts (PCTs) and their associated local authorities. Case sites had a neurological-rehabilitation team (NRT), each with a different approach to health and social care integration. The research took place in three stages. In stage 1, interviews with 43 commissioners, managers, NRT staff and social care practitioners, and documentary analysis, helped to understand service contexts and approaches to assessment. Interviews, guided by earlier outcomes work, were held with 35 people with LTNCs to identify important outcomes. Interviews with 13 carers illustrated relationships between NRTs and carers. In stage 2, these outcomes were developed into a checklist in partnership with NRTs. NRTs used the outcomes checklist (OC) as part of their routine assessment, and we monitored its use. In stage 3, we conducted interviews and focus groups with 21 NRT staff and 12 clients to evaluate the use of the OC in practice. Analysis Qualitative data were managed and analysed thematically using the framework approach. Results Person, service and structural-level factors influenced integration between health and social care. Relationships between practitioners and services often drove integration in practice. However, wider structural arrangements were important and could facilitate these relationships. We identified 20 outcomes important to people with LTNCs. These were grouped into three outcome domains: personal comfort, economic and social participation, and autonomy. Use of the OC in practice was viewed differently by the NRTs. One NRT felt that it duplicated existing assessments, one felt that it covered issues outside their remit and two felt that the OC worked for them. Some of the outcomes could be difficult for staff and clients to raise but clients felt that they should all be included in assessments. Use of the OC was sometimes challenging due to staffing and caseload pressures, changes to service structures and remit, and competing demands of other compulsory paperwork. All NRTs thought that the OC had potential value as a benchmarking or training tool. Larger, more interdisciplinary models of integrated NRTs appeared to give more scope for interpreting, assessing and potentially achieving outcomes. Conclusions Many of the outcomes that are important to service users with LTNCs are not addressed in validated ‘outcome measures’. This has implications for commissioners and practitioners to ensure that service users’ needs are met in practice. Turning the OC into a measurement tool could go some way to addressing this. Many of the outcomes are interdependent; an impact on one particular outcome will have a ‘knock-on’ effect on other outcomes. These inter-relationships demonstrate the complexity of what is important in the lives of people with LTNCs. Service changes can affect integrated arrangements negatively. More research is needed to explore the longer-term effects of organisational change on integrated service provision. Funding The National Institute for Health Research Health Services and Delivery Research programme.
9 citations
30 Oct 2014
TL;DR: In this paper, the authors investigated the public consultation (stage 1) for the Social Services and Wellbeing (Wales) Bill (2013) and found that a significant number of participants use the consultation as an opportunity to engage in self-advocacy.
Abstract: Background: The Welsh Government has embarked on significant legislative projects since devolution. Welsh legislative efforts are however marked by the low scrutenizing capacity of a relatively small legislative chamber and limited civil service ability to prepare legislation. This means that the Welsh Government relies more heavily on input through public consultations prior to parliamentary scrutiny and external expertise. The study investigated the public consultation (stage 1) for the Social Services and Wellbeing (Wales) Bill (2013). 3 Aims and Objectives: This was a pilot study to develop and test a coding matrix to analyse public consultations by devolved governments. The aim was to design and test the coding matrix through a small case study (the Welsh Social Services Bill) and to assess its utility for subsequent large scale comparative studies across devolved governments in the UK. Method: Following a literature review a coding matrix was designed to analyse consultation submissions. We then fed the publicly available data of the Social Service Bill (Wales) consultation (stage 1) in 2012/13 into the matrix. Descriptive statistics were conducted and the content of a sub-sample of purposively selected submissions were analysed in more detail. Results: The public consultation contained 84 submissions from various organisations and private individuals. The results demonstrate that consultation responses come from a wide range of actors, that there is some limited amount of interaction prior to submission between respondents, and that there is a significant amount of ʻwhite noiseʼ, submissions that are not related to the topic. The analysis also revealed that a significant number of participants use the consultation as an opportunity to engage in self-advocacy. Organisational analysis of participants also reveals some imbalance of submissions by sector. Conclusion: Public consultations are a useful mechanism to improve legislation prior to parliamentary debate through canvassing stakeholders and our study showed that the consultation provoked a range of responses from a wider variety of stakeholders. There is however some serious doubt whether the chosen technique matched the aims and objective of the consultation. This raises questions about tokenism, the role of external expertise and the ability of devolved governments to use consultations as a core mechanism for citizen and stakeholder engagement.
1 citations
Cites background from "Integrated care cannot be designed ..."
...The impact on policy networks is particularly significant in the Welsh context, given that Wales has a relatively small community of policy makers and politicians and hence may lack serious network capacity that ensures sufficient preparation and scrutiny of legislation proposed....
[...]
...Examining the authorship of submissions by sector and industry also gives insights into depth and scope of the policy debate in Wales....
[...]
...Network governance and citizen engagement The study found that the public consultation for the Social Services Bill (Wales) achieved good participation from organisations in the voluntary sector....
[...]
...This paper reports the findings of a study of the public consultation for the Social Services and Wellbeing (Wales) Bill (henceforth: Social Services Bill)....
[...]
...The Welsh Governmentʼs approach to differentiate legislation in health and social services may thus one the one hand reflect the continuing fragmentation of care services, whilst also exacerbating the silo character of care services, a longstanding issue 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, Association, 2012)....
[...]
Dissertation•
01 Jan 2015
TL;DR: A mixed-methods non-participant evaluation of an integrated care pathway for adult inflammatory bowel disease patients in a North East of England health economy was undertaken utilising a realist evaluation framework to identify internal and external enablers and inhibitors to the pathway.
Abstract: A mixed-methods non-participant evaluation of an integrated care pathway for adult inflammatory bowel disease patients in a North East of England health economy was undertaken utilising a realist evaluation framework. The evaluation commenced at an early stage in the pathway’s life in October 2009 and closed two and a half years later in March 2012. The evaluation identified internal and external enablers and inhibitors to the pathway, primarily in the design and implementation phases as opposed to the operational phase. Inferences were made to contemporaneous evaluations of integrated care projects which served to validate this evaluation and identify the additional value of the evaluation to the health services research field. Contextual enabling and inhibiting factors were identified along with their associated mechanisms and actual or potential outcomes. An additional pilot project identified the scope for, and potential nature of, a role for community pharmacy in the management of adult IBD patients.
1 citations
Cites background from "Integrated care cannot be designed ..."
...[191] The general healthcare policy direction, of which integrated care in its various guises was a key component, had already persisted for a number years through numerous political changes and health service reorganisations....
[...]
References
More filters
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
33 citations