A third dimension of integration

Journal of Integrated Care

ISSN: 1476-9018

Article publication date: 30 September 2013

260

Citation

Miller, R. and Glasby, H.D.a.J. (2013), "A third dimension of integration", Journal of Integrated Care, Vol. 21 No. 5. https://doi.org/10.1108/JICA-09-2013-0036

Publisher

:

Emerald Group Publishing Limited


A third dimension of integration

Article Type: Editorial From: Journal of Integrated Care, Volume 21, Issue 5.

Third Sector Organisations (TSOs) were responding to the health and social care needs of individuals and communities before the advent of the NHS and local authority-led social care systems. They continue to play a vital role today, not only in delivering direct services but also in representing the views and interests of patients and service users, investigating and developing new treatments and practices, and generating new income beyond that provided through the state. Whilst devolution is leading to steady divergence in the organisation of health and social care between the four home nations of the UK, all of the governments retain an interest in continued involvement for TSOs within health and social care. Common expectations voiced by policy makers are that TSOs will be “innovative, personalised, trusted or responsive to local needs […] strengthen active citizenship and democracy […] nurture ‘social environments’ in which individuals and communities can develop and interact.. and embody values such as compassion and commitment” (Buckingham, 2009, p. 238). Such organisational attributes would suggest that TSOs could have a particular impact in relation to integrated care, either through providing direct care that is shaped around the individual and their families, or in facilitating dialogue and discussion between people receiving support and those responsible for designing and delivering services. Previous editions of this journal have helped to inform our knowledge of TSOs and integration, including examples of where this has been led by individual TSOs (for instance the Turning Point Connected Care projects (Bruce et al., 2011) and public sector initiatives looking to better co-ordinate the support from different TSOs (Dickinson and Neal, 2011).

There are though a number of key issues regarding the third sector that relate to their potential and actual contribution to integration. First there is an ongoing debate about the extent to which the Third Sector can be described as “a sector” at all and the need to understand changes over time regarding the focus, form and funding of the organisations within it (Alcock, 2010). Over the past decade we have seen a rise in the prominence of social enterprises, with a new legal identity of Community Interest Company and funded policy initiatives to support their work in health and social care in particular (Miller et al., 2012). Evidence to support the view that TSOs have a common distinctiveness is at best patchy, with the usual complications of trying to ascribe organisational differences to particular governance arrangements and/or missions (MacMillan, 2010). The relationship between the public sector and TSOs is not always an easy one, with concerns that the general move from grants to contracts is leading to TSOs being shaped and controlled by their purchasers and that smaller organisations may not be able to compete with the private sector (Munoz, 2009).

It seems timely then for the Journal of Integrated Care to dedicate an issue exploring the role of the Third Sector in relation to integrated care. This begins with a realistic review by Hardwick of the planned change mechanisms connected with One Stop Shops for women in the criminal justice system. This identifies how the interaction of these mechanisms with internal and external contexts shapes the outcomes that are delivered. The importance of context and in particular relationships with key professionals within a locality is further highlighted by Jenkins et al in their evaluation of a community-based stroke service. The third sector appeared to be successfully linked into integrated health and social care pathways and so “plugged the gaps” left by statutory services. There were, however, concerns that it was seen as a nicety, rather than as necessity, by the public sector and so vulnerable in times of financial austerity. Funding pressures are one of the themes raised by Ward et al in their reflection on the experiences of a centre supporting victims of sexual violence. This TSO seeks to provide integrated care through direct delivery and co-ordination with external services. One issue highlighted by the authors are the difficulties that TSOs can face in remaining independent whilst trying to also work in partnership with the public sector. This public Third Sector relationship is further considered by Miller et al in the study of preventative services for older people. Commissioners and TSOs reported positive experiences of working together due to trust between key individuals, but shared a common difficulty in how best to set and evaluate outcomes. Differences of opinion regarding the priority outcomes are further identified by Munoz in relation to the co-production of home care services in rural Scottish region, with communities emphasising the need to create employment rather than transformative models of care.

These articles highlight that in considering the role of the third sector in integration we need to be sensitive to the complexity that surrounds the history and mission of each TSO, the local context in which they work and the changing needs and policy environment of the beneficiaries they seek to serve. There are consistent messages too, such as the importance of public and third sector being open about their priorities and being willing to work through the tension between independence and financial reliance. The articles also suggest that there are grounds for optimism in relation to the potential of TSOs as facilitators of integration.

Robin Miller, Helen Dickinson and Jon Glasby

References

Alcock, P. (2010), “A strategic unity: defining the third sector in the UK”, Voluntary Sector Review, Vol. 1 No. 1, pp. 5-24
Bruce, G., Wistow, G. and Kramer, R. (2011), “Connected care re-visited: Hartlepool and beyond”, Journal of Integrated Care, Vol. 19 No. 2, pp. 13-21
Buckingham, H. (2009), “Competition and contracts in the voluntary sector: exploring the implications for homelessness service providers in Southampton”, Policy and Politics, Vol. 37 No. 2, pp. 235-254
Dickinson, H. and Neal, C. (2011), “Single point of access to third sector services: the conwy collaborative approach”, Journal of Integrated Care, Vol. 19 No. 2, pp. 37-48
MacMillan, R. (2010), “The third sector delivering public services: an evidence review”, available at: www.tsrc.ac.uk (accessed 17 September 2012)
Miller, R., Millar, R. and Hall, K. (2012), “New development: Spin-outs and social enterprise: the ‘right to request’ programme for health and social care services”, Public Money & Management, Vol. 32 No. 3, pp. 233-236
Munoz, S.A. (2009), “Social enterprise and public sector voices on procurement”, Social Enterprise Journal, Vol. 5 No. 1, pp. 69-82

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