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This paper aims to whether current public expenditure on adult social care services might be associated with the number of delayed days of care attributable to the social care system in England.

Panel econometric models on data from local authorities with adult social care responsibilities in England between 2013–2014 and 2018–2019.

After controlling for other organisational sources of inefficiency, the level of demand in the area and the income poverty amongst the resident older population, this paper finds that a 4.5% reduction in current spending per head on adult social care per older person in one year is associated with an increase by 0.01 delayed days per head the following year.

Given the costs of adverse outcomes of delayed transfers of care reported in the literature, this paper suggests that budgetary constraints to adult social care services would represent a false economy of public funds.

This is the first paper that models the association between public spending on adult social care and delayed transfers of care due to issues originating in the social care system in England.

Delayed hospital discharge has long been of policy interest in the UK. This paper presents findings from a comparative study of policy and approaches to implementation of reimbursement, in England, and Joint Action Planning, in Scotland, designed to tackle the problem of delayed hospital discharge.

Hampshire County Council, the Hampshire and Isle of Wight Strategic Health Authority and the seven primary care trusts in the County Council area have formed a partnership to create additional nursing care capacity. This paper examines the background, identifies an approach to modelling the need for nursing home places and addresses the partnerships being put in place to create additional capacity in the public sector.

Using the findings from a CSCI study undertaken in the first months after the implementation of the Community Care (Delayed Discharges) Act 2003, this article outlines key issues for the immediate future. It is the third in a sequence of articles in the Journal of Integrated Care on this priority policy issue, and the first to report on implementation.

The ageing of the world’s population is causing an increase in the number of frail patients admitted to hospitals. In the absence of appropriate management and organisation, these patients risk an excessive length of stay and poor outcomes. To deal with this problem, the purpose of this paper is to propose a conceptual model to facilitate the pathway of frail elderly patients across acute care hospitals, focussed on avoiding improper wait times and treatment during the process.

The conceptual model is developed to enrich the standard flowchart of a clinical pathway in the hospital. The modified flowchart encompasses new organisational units and activities carried out by new dedicated professional roles. The proposed variant aims to provide a correct assessment of frailty at the entrance, a better management of the patient’s stay during different clinical stages and an early discharge, sending the patient home or to other facilities, avoiding a delayed discharge. The model is completed by a set of indicators aimed at measuring performance improvements and creating a strong database of evidence on the managing of frail elderly’s pathways, providing proper information that can validate the model when applied in current practice.

The paper proposes a design of the clinical path of frail patients in acute care hospitals, combining elements that, according to an evidence-based management approach, have proved to be effective in terms of outcomes, costs and organisational issues. The authors can, therefore, expect an improvement in the treatment of frail patients in hospital, avoiding their functional decline and worsening frailty conditions, as often happens in current practice following the standard path of other patients.

The framework proposed is a conceptual model to manage frail elderly patients in acute care wards. The research approach lacks application to real data and proof of effectiveness. Further work will be devoted to implementing a simulation model for a specific case study and verifying the impact of the conceptual model in real care settings.

The paper includes suggestions for re-engineering the management of frail elderly patients in hospitals, when a reduction of lengths of stay and the improvement of clinical outcomes is required.

This paper fulfils an identified need to study and provide solutions for the management of frail elderly patients in acute care hospitals, and generally to produce value in a patient-centred model.

The government's reimbursement policy, whereby local councils face fines if a patient cannot be discharged from hospital because they are waiting for an assessment etc, introduced new pressures into a system that was already fraught. One of the policy's aims is to allow people to exercise ‘genuine choice’ as regards their ongoing and longer‐term care. Based on their research into the policy however, Michelle Cornes et al investigate whether choice really can be exercised when lying in a hospital bed.

The purpose of this paper is to use theories of institutional logics and institutional entrepreneurship to examine how and why macro-, meso-, and micro-level influences inter-relate in the implementation of integrated transitional care out of hospital in the English National Health Service.

The authors conducted an ethnographic case study of a hospital and surrounding services within a large urban centre in England. Specific methods included qualitative interviews with patients/caregivers, health/social care providers, and organizational leaders; observations of hospital transition planning meetings, community “hub” meetings, and other instances of transition planning; reviews of patient records; and analysis of key policy documents. Analysis was iterative and informed by theory on institutional logics and institutional entrepreneurship.

Organizational leaders at the meso-level of health and social care promoted a partnership logic of integrated care in response to conflicting institutional ideas found within a key macro-level policy enacted in 2003 (The Community Care (Delayed Discharges) Act). Through institutional entrepreneurship at the micro-level, the partnership logic became manifest in the form of relationship work among health and social care providers; they sought to build strong interpersonal relationships to enact more integrated transitional care.

This study has three key implications. First, efforts to promote integrated care should strategically include institutional entrepreneurs at the organizational and clinical levels. Second, integrated care initiatives should emphasize relationship-building among health and social care providers. Finally, theoretical development on institutional logics should further examine the role of interpersonal relationships in facilitating the “spread” of logics between macro-, meso-, and micro-level influences on inter-organizational change.

In view of the decline in the number of residential and nursing homes over the last few years, East Sussex, Brighton and Hove Health Authority was concerned about optimum usage of places. This project aimed to ascertain the views of home owners and managers on their working relationship with the health authority, local hospitals and social services.Respondents felt that the incoming residents were generally frailer and more dependent than a few years ago, funding allocations were inadequate, given the standards now expected of care homes, and there were delays of up to a year in reaching agreement. Several indicated that they would no longer take publicly funded clients unless the families could top up the payments. Ten percent of the private residential homes surveyed were for sale or due to close. Between 40 and 50 older people were estimated to be awaiting transfer to EMI or nursing homes in East Sussex. Over 35% of homes complained about inappropriate discharges of their residents from hospital, and a poor standard of nursing care. Communication with hospitals was poor and relationships with the health authority and social services needed strengthening. Routine admissions were appropriate, but hospital discharges may have been premature. Home owners/managers were dissatisfied with their relationship with the NHS. Improvements are needed if partnership working is to be developed.

The purpose of this paper is to stimulate a wider debate around the coordination of workforce planning in non-statutory services (in this case, specialist housing for older people or those with long-term health and social care needs, such as learning disabilities). The authors argue that current NHS reforms do not go far enough in that they fail to include specialist housing and its workforce in integration, and by doing so, will be unable to optimise the potential efficiencies and streamlining of service delivery to this group.

The paper used exploratory study using existing research and data, enhanced by documentary analysis from industry bodies, regulators and policy think tanks.

That to achieve the greatest operational and fiscal impact upon the health care services, priority must be given to improving the efficiency and coordination of services to older people and those requiring nursing homes or registered care across the public and third sectors through the integration of service delivery and workforce planning.

Whilst generalisable and achievable, the model proposed within the paper cannot be fully tested theoretically and requires further testing the in real health and social care market to evidence its practicality, improved quality of care and financial benefits.

The paper highlights some potential limitations to the current NHS reforms: by integrating non-statutory services, planned efficiency savings may be optimised and service delivery improved.

The article outlines the approach taken in Oxfordshire to pool significant County Council Social & Community Services and Primary Care Trust budgets to purchase primarily bed‐based services to achieve the right outcomes for services users and best value for the organisations. It sets this initiative in the context of relevant Oxfordshire data. It describes the processes involved, the benefits and outcomes to date and the initial lessons learnt.