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The purpose of this paper is to reflect on the journey so far for the North Wales Regional Single Point of Access (SPOA) through the lens of programme manager with views from the programme team. SPOA is the integration of access points to community health and social care services with strengthened links to the third sector, one SPOA in each of six local authorities in the Betsi Cadwallader University Health Board footprint.

Kotter’s 8 step theory of change model (1996) supplemented by the organisational, cultural and professional and contextual factors from research that impact on integrated working between health and social care (Cameron et al., 2012); the focus is programme level.

Kotter’s 8 step model is a useful tool for reflection on the factors identified in research that promote and hinder integrated working. Key messages and innovative ideas of interest for practitioners embarking on a similar “Quest”, including: “keep using your ‘levers for change’”, “Adopt and Adapt”, “right people in the right place”, “it’s ok to tweak your vision, ‘Make it mean something to everyone’, ‘accept and Adapt’, ‘Don’t sweat what you can’t affect’, ‘Find your allies – it’s better together’, ‘Celebrate ‘small wins’’, ‘The people’s voice drives change’ and ‘a sense of humour brings you through’”.

This is a personal reflection from the North Wales Regional SPOA Programme.

It makes use of collaborative work focused on delivering a SPOA, helping others to learn from the struggle.

Diben y papur hwn yw adlewyrchu ar y daith hyd yn hyn ar gyfer Un Pwynt Mynediad Ranbarthol Gogledd Cymru (SPOA) yn bennaf trwy olwg rheolwr y rhaglen ond mae hefyd yn cynnwys safbwyntiau tîm ehangach y rhaglen. Yn greiddiol i’r SPOA ceir integreiddio pwyntiau mynediad i wasanaethau iechyd cymunedol a gofal Cymdeithasol gyda chysylltiadau wedi eu cryfhau i’r Trydydd Sector, un SPOA ym mhob un o’r 6 Awdurdod Lleol sydd o fewn ôl troed bwrdd Iechyd Prifysgol BC.

Canfu model damcaniaeth newid (1996) 8 cam Kotter, a ategir gan y ffactorau sefydliadol, diwylliannol a phroffesiynol a’r ffactorau cyd-destunol yn sgil ymchwil mai effaith ar waith integredig rhwng iechyd a gofal cymdeithasol (Cameron et al., 2012) sy’n rhoi’r strwythur i’r papur adlewyrchol hwn; sydd, ar y pwnt hwn o’r daith, yn canolbwyntio ar lefel y rhaglen.

Roedd model 8 cam Kotter yn offeryn defnyddiol ar gyfer yr adlewyrchiad hwn ar y daith hyd yn hyn. Mae ein profiad hyd yn hyn mewn cytgord â’r ffactorau a nodir mewn ymchwil sy’n hyrwyddo ac yn rhwystro gwaith integredig. Mae ymarfer adlewyrchu wedi galluogi negeseuon allweddol a syniadau arloesol a allai fod o ddiddordeb i ymarferwyr sy’n dechrau ar ‘Gais’ tebyg, i gael eu hatgyfnerthu. Mae ein negeseuon allweddol sydd mewn cytgord ag eraill ym maes gwaith integredig fel a ganlyn: ‘Nodi a pharhau i ddefnyddio eich ‘dylanwadau ar gyfer newid’, ‘Mabwysiadu ac Addasu’ , ‘Cael y bobl iawn yn y lle iawn’ , ‘Ni fydd eich rhaglen yn dod i ben os byddwch yn addasu eich gweledigaeth, ‘Gwneud iddo feddwl rhywbeth i rywun’, ‘Derbyn ac Addasu’, ‘Peidio poeni am y pethau na allwch wneud unrhyw beth yn eu cylch’, ‘Canfod eich cynghreiriaid – mae’n well gyda’ch gilydd’, ‘Dathlu eich ‘buddugoliaethau bach’, ‘Mae llais y bobl yn bwerus i lywio newid’ a ‘chofiwch mae synnwyr digrifwch yn dod â chi drwyddi’.

Mae hwn yn adlewyrchiad personol o Raglen Un Pwynt Mynediad Rhanbarthol Gogledd Cymru.

Mae’n defnyddio gwaith cydweithredol ag yn canolbwyntio ar gyflawni SPOA, gan gynorthwyo eraill i ddysgu trwy’r her.

The purpose of this paper is to amalgamate recommendations from contemporary national reports on healthcare provision and needs of people with intellectual disabilities. The paper combines these with recommendations for undergraduate curricula of medical students from the GMC and Royal College of Psychiatrists (RCPsych).

National reports from Mencap, Department of Health, Disability rights commission, NHS Executive, the GMC and RCPsych were searched for relevant recommendations to undergraduate medical education in ID psychiatry. Recommendations were collated and grouped to form a single list for use when planning future curricula or auditing existing teaching.

In total, 13 relevant recommendations were identified in nine groups. These included that people with intellectual disabilities and their carers should be involved in the teaching. That teaching should include the ethical, moral and legal obligations and should include the mental capacity act and equality act. Institutional and individual discrimination should be highlighted as a problem and diagnostic overshadowing should be covered.

This paper has collated in a single document the combined recommendations of multiple reports. These are relevant to medical undergraduate teaching and may also be of use to other undergraduate healthcare courses. They are a useful template for others wishing to examine or benchmark the content of their medical undergraduate ID psychiatry teaching against an amalgamated list.

Connected Care, Turning Point's model for involving the community in the design and delivery of integrated health and well‐being services, aims to involve the community in the commissioning process in a way which fundamentally shifts the balance of power in favour of local people. The model has been tested in a number of areas across the country, and previous articles in the Journal of Integrated Care have charted the progress of the original pilot in Hartlepool. Cost‐benefits of the approach are now becoming clearer. Implementation of a new community‐led social enterprise in Hartlepool began in 2007, and today its Connected Care service provides community outreach, information, access to a range of health and social care services, advocacy, co‐ordination and low‐level support to the people of Owton. Key lessons, from Hartlepool and elsewhere, have centred on the value of making the case for service redesign from the ‘bottom up’ and building the capacity of the community to play a role in service delivery, while also promoting strong leadership within commissioning organisations to build ‘top‐down’ support for the implementation of outcomes defined through intensive community engagement. The new Government's ‘localism’ agenda creates new opportunities for community‐led integration, and the Connected Care pilots provide a number of learning points about how this agenda might be successfully progressed.

Local government and the NHS in Barking and Dagenham embarked on a bold initiative in 2001 to integrate health and social care management structures. Although it was not sustained, this local experience is an important source of learning as the search for improved partnership working enters yet another new phase. In particular, it demonstrates that the route to better outcomes depends on managing not only the tension between structure and culture, but also that between national targets and local discretion in services based on fundamentally different principles of governance: central management and local accountability.

Timely access to effective treatment is a primary goal for mental health services; however, when demand exceeds available resources, services may place clients on a waitlist or restrict services. This paper aims to identify approaches used by mental health services to manage service demand and waitlists.

A review of research literature between 2009 and 2019 was conducted using the Medline, PsycINFO, CINAHL, Embase and Cochrane databases. Articles were screened and assessed against inclusion criteria and the methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool.

In total, 20 articles were located that met the inclusion criteria. Five demand management approaches were identified, namely, walk-in models, triage processes, multi-disciplinary care, patient-led approaches and service delivery changes.

This review identifies effective approaches that services can consider adapting to their local setting; however, further research is needed to demonstrate the clinical effectiveness of services provided under these models.

This review makes a valuable contribution to mental health care service delivery by detailing the strategies that services have adopted to manage demand and, where available, comparative outcomes with traditional service delivery models.

Shared space is a design and engineering concept that gains attention in the context of both regeneration of, for example, former production sites and in the context of designing new building complex(es) with a multifunction strategy. But the practicalities of realising shared space are generally overlooked, despite its importance for the user experience and the degree of success with shared space initiatives. The purpose of this study is to increase the knowledge of shared space and the complex processes involved in realising multiple use of space.

To achieve the purpose stated, the paper presents a study of current literature and four cases of shared space, including a commercial building, a public sport facility, a public health centre and an educational building. The study draws on theory from the fields of property management, space management, urban design and architecture, as well as from the social sciences and geography, to provide an as complete picture as possible of the challenges related to shared spaces in practice.

The result of the study presented is increased knowledge of the processes involved in sharing space in a facilities management context, supported by specific recommendations regarding attention to issues of territoriality, involvement and practicalities.

Not much scientific work has been conducted on the topic of shared space in a facilities management context, and this study adds to the so far limited knowledge within the area.

Integrated care presents health workforce planners with significant uncertainty. This results from: (1) these workforces are likely in the future to be different from the present, (2) integrated care's variable definitions and (3) workforce policy and planning is not familiar with addressing such challenges. One means to deal with uncertainty is scenario analysis. In this study we reveal some integration-supportive workforce governance and planning policies that were derived from the application of scenario analysis.

Through a mixed methods design that applies content analysis, scenario construction and the policy Delphi method, we analysed a set of New Zealand's older persons health sector workforce scenarios. Developed from data gathered from workforce documents and studies, the scenarios were evaluated by a suitably qualified panel, and derived policy statements were assessed for desirability and feasibility.

One scenario was found to be most favourable, based on its broad focus, inclusion of prevention and references to patient dignity, although funding changes were indicated as necessary for its realisation. The integration-supportive policies are based on promoting network-based care models, patient-centric funding that promotes collaboration and the enhancement of interprofessional education and educator involvement.

Scenario analysis for policy production is rare in health workforce planning. We show how it is possible to identify policies to address an integrated care workforce's development using this method. The article provides value for planners and decision-makers by identifying the pros and cons of future situations and offers guidance on how to reduce uncertainty through policy rehearsal and reflection.

National Health Service (NHS) Emergency Department (ED) attendances are at the second highest level ever recorded, (RCEM, 2021a) and as they soar, performance plummets, putting patient safety at risk (RCEM, 2021b). Managing patient flow in the ED is critical to reduce patient safety incidents and crowding, however, this needs effective leadership (Jensen and Crane, 2014). This paper aims to introduce an innovative form of managing patient flow in ED, which is a two hourly “Board Rounds”, providing a managed process to pull patients through the system meeting pre-determined time critical standards and preventing patient harm. Board Rounds combined with effective leadership can play a contributory role preventing crowding in the ED.

An evaluation of two hourly ED Board Rounds was undertaken using the hospitals’ ED Board Round Standard Operating Procedure to develop a series of short questions. As leadership is the responsibility of all clinicians (Darzi, 2008; Moscrop, 2012), a separate survey was undertaken for clinicians of all grades and managers to self-assess their own leadership styles using the Path-Goal Leadership Theory (House and Mitchell, 1974; Indvik, 1985; Northhouse, 2013). Findings were reported to the team to explore ideas for improvement not only to develop more effective leadership in the ED but also to raise awareness of how to optimise leadership in Board Rounds.

In total, 27 (n = 27) clinicians and managers reported support for a 2 hourly Board Round, for a period of 15 min, in both minor and major injuries departments in ED. A multi-disciplinary Board meeting, led by the lead nurse with support from the Emergency Physician in Charge, was preferred, locating it at the nurse’s station. A validated Path-Goal Leadership survey instrument was returned (n = 24). The findings reveal that leaders and managers are using a high level of the directive leadership style, where there is more potential to use the supportive, participative and achievement approaches to leadership.

This was a small sample, returned from a Hospital ED located in a semi-rural location, department requiring “improvement” from the Health Regulator. This research would benefit from being undertaken in a medium/large NHS ED department to identify if the findings report on a wider leadership culture in the NHS ED. The implications for this study are that improvement interventions such as a “Board Round” can be usefully evaluated alongside a review of leadership styles and approaches to understand the wider implications for continuous improvement and change in the ED.

NHS EDs are facing unprecedented challenges and require innovative evidence-based solutions combined with leadership at this time. The evidence base for improving patient flow is limited, however, this study provides some initial findings on the positive perception and experience of staff to Board Rounds. Board Rounds combined with leadership has the potential to contribute to the wider strategy to prevent crowding in ED. This paper is the first of its kind to evaluate perceptions of Board Rounds in the ED and to engage clinicians and managers in a self-assessment of their own leadership styles to reflect on optimum leadership styles for use in ED.

The purpose of this paper is to argue that the future of social work can be situated as part of a fundamental shift towards co-located, multi-disciplinary practice and networking. It is argued that social work has a key role to play in co-located, multi-disciplinary child welfare practice, and indeed can be a leading profession in this context. Situating social work in this way involves re-conceptualising social work as a network profession, rather than a silo profession. The paper builds on an earlier study of five multi-professional, co-located teams updated with interviews with social workers currently situated in such co-located teams. An exploration of the role of social work in relation to child sexual exploitation is provided.

The first study was an ESRC-funded study and used a multi-method approach to understanding the work of five multi-disciplinary, co-located teams working with children, young people and families (Frost and Robinson, 2016). Four co-located teams with eight social workers participated in the research. This was followed up by a small scale study involving semi-structured interviews with six social workers situated in co-located, multi-disciplinary teams. The focus of the study was on professional identity and working practices with other related professionals.

The ESRC study explored the complexity of co-located, multi-disciplinary professional teams – exploring how they worked together and analysing the challenges they face. Professionals felt that such working enhanced their learning, their skill base and the process of information sharing. Challenges included structural and organisational issues and differences in ideological and explanatory frameworks. The follow up study of six social workers found that they gained satisfaction from being situated in such co-located, multi-disciplinary teams, but also faced some identified challenges. Child sexual exploitation is explored as an example of the work of co-located, multi-disciplinary teams.

Semi-structured interviews with social workers based in co-located, multi-disciplinary teams have provided valuable insights into the operation of social workers in such settings. It is acknowledged that all the interviews are with social workers in co-located settings and that further work is required on the views of other social workers in reference to their experiences and views in relation to multi-disciplinary working.

The paper brings together theoretical positions and policy contextual material with qualitative research data which situate the social worker in wider multi-disciplinary, co-located settings. Drawing on qualitative, semi-structured interviews with 14 social workers in such teams, the paper aims to contribute to an understanding and development of the future of the social work role in these contexts, arguing that this is fundamental to the future of social work.

The purpose of this paper is to increase understanding of the logic of business network formation among the co-located and external actors of a facility.

The research adopts a theory-building approach through developing propositions inductively from the empirical case study on four purposefully sampled modern service station facilities. The focus is on analyzing how a facility and its inherent co-located actors represent an entity that forms a business network with external actors in the facility’s environment.

The findings propose that when co-located with a large number of actors, the facility and its actors represent an entity that is connected to a wide business network of multiple external actors. On the other hand, when co-located with a small number of actors, the facility becomes a part of the overall supply in the surrounding business environment with a differentiated offering for competitive advantage.

The research suggests that an appropriate co-locating strategy, for example, when planning the tenant mix of the facility, can contribute to creating a vivid business network in the external environment, which raises the facility to a role of a central entity in such a network.

The findings explaining how co-location affects the businesses within the facility and within a wider networked environment are novel to the scholarly knowledge on co-location. The research bridges the theories of co-location and business networks that have been treated as separate discourses in previous research.