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Article
Publication date: 16 February 2015

Alison Taylor

In this paper, the Scottish Government's approach to improving outcomes for patients and service users by integrating health and social care planning and provision is…

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Abstract

Purpose

In this paper, the Scottish Government's approach to improving outcomes for patients and service users by integrating health and social care planning and provision is described. The Scottish Parliament passed primary legislation in February 2014, which places requirements on Health Boards and Local Authorities to work together more closely than ever before. The paper aims to discuss these issues.

Design/methodology/approach

This paper sets out the Scottish Government's legislative approach to integrating health and social care, based on previous experience of encouraging better partnership between health and social care working without legislative compulsion.

Findings

The Scottish Government has concluded that legislation is required to create the integrated environment necessary for health and social care provision to meet the changing needs of Scotland's ageing population.

Research limitations/implications

The paper is confined to experience in Scotland.

Practical implications

Legislation is now complete, and implementation of the new arrangements is starting. Evaluation of their impact will be ongoing.

Social implications

The new integrated arrangements in Scotland are intended to achieve a significant shift in the balance of care in favour of community-based support rather than institutional care in hospitals and care homes. Its social implications will be to support greater wellbeing, particularly for people with multimorbidities within communities.

Originality/value

Scotland is taking a unique approach to integrating health and social care, focusing on legislative duties on Health Boards and Local Authorities to work together, rather than focusing on structural change alone. The scale of planned integration is also significant, with planning for, at least, all of adult social care and primary health care, and a proportion of acute hospital care, included in the new integrated arrangements.

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Article
Publication date: 1 February 2004

J. Billings, A. Alaszewski and K. Coxon

This paper provides a European overview of alternative approaches to integrated care for older people, drawing from a wider European project entitled PROCARE. It discusses…

Abstract

This paper provides a European overview of alternative approaches to integrated care for older people, drawing from a wider European project entitled PROCARE. It discusses the structural complexities that create the challenges in integrated care, compares and contrasts approaches to integrated care through a structure and process framework, and considers the place of person‐centred seamless care in European health and social care models.

Details

Journal of Integrated Care, vol. 12 no. 1
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 28 November 2012

Derek Birrell and Deirdre Heenan

This paper assesses the recommendations and proposals contained in Transforming Your Care, the recent review of health and social care in Northern Ireland, in the context…

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220

Abstract

Purpose

This paper assesses the recommendations and proposals contained in Transforming Your Care, the recent review of health and social care in Northern Ireland, in the context of the existing integrated structures. It is designed to promote a better understanding of the implications of the proposed reconfiguration of health and social care.

Design/methodology/approach

This paper reviews a number of published documents encompassing an independent review and subsequent plans and strategies. It also draws upon a case study of a Rapid Access Clinic undertaken by the authors as part of a wider research project.

Findings

The paper concludes that the planned changes question the ability of an integrated structure operating across primary, secondary and social care. It notes that there are real concerns about the capacity of the social care workforce to deliver services. It is suggested that the proposal for Integrated Care Partnerships can be seen as a reflection of the need for a more localised approach to delivery.

Research limitations/implications

The findings are derived from a small‐scale study and as such may make generalisation difficult. There is a clear need for a more robust evidence‐based approach to the evaluation of structural integration in health and social care and a process for monitoring of this change process.

Originality/value

The article is a reminder of the unique example of structural integration within the UK. As such it could have important lessons for England, Scotland and Wales which are moving in a similar direction.

Details

Journal of Integrated Care, vol. 20 no. 6
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 26 June 2019

Siu Mee Cheng and Cristina Catallo

The purpose of this paper is to develop a case definition of integrated health and social services initiatives that serve older adults, and will provide characteristics to…

Abstract

Purpose

The purpose of this paper is to develop a case definition of integrated health and social services initiatives that serve older adults, and will provide characteristics to aid in the identification of such initiatives. The case definition is intended to ease the identification of integrated health and social care initiatives.

Design/methodology/approach

A limited search was undertaken of both scientific and gray literature that documented and/or examined integrated health and social services initiatives. In addition, literature on well-documented and generally accepted integrated healthcare and social services models that reflect collaborations from healthcare and social services organizations that support older adults was also used to develop the case definition.

Findings

The case definition is as follows: healthcare organizations from across the continuum of care working together with social services organizations, so that services are complementary and coordinated in a seamless and unified system, with care continuity for the patient/client in order to achieve desired health outcomes within a holistic perspective; the initiatives comprise at least one healthcare organization and one social care organization; and these initiatives possess 18 characteristics, grouped under 9 themes: patient care approach; program goals; measurement; service and care quality; accountability and responsibility; information sharing; culture; leadership; and staff and professional interaction.

Research limitations/implications

A limitation of this study is that the characteristics are based on a limited literature search. The quality of some of the literature both gray and published was not definitive: information on how they undertook the literature search was not provided; exclusion and inclusion criteria were not included; and there was insufficient detail on the design of the studies included. Furthermore, the literature reviews are based on integrated initiatives that target both seniors and non-senior’s based services. The cross-section of initiatives studied is also different in scale and type, and these differences were not explored.

Practical implications

The case definition is a useful tool in aiding to further the understanding of integrated health and social care initiatives. The number of definitions that exist for integrated health and social care initiatives can make it confusing to clearly understand this field and topic. The characteristics identified can assist in providing greater clarity and understanding on health and social care integration.

Originality/value

This study provides greater coherence in the literature on health and social care integration. It aids in better framing the phenomenon of healthcare and social services integration, thereby enhancing understanding. Finally, the study provides a very useful and concrete list of identifying characteristics, to aid in identifying integrated health and social care initiatives that serve older adults.

Details

Journal of Integrated Care, vol. 27 no. 4
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 12 March 2018

Sarah Anne Oakley Vicary and John Bailey

The purpose of this paper is twofold. First, to examine the impact on mental health social work of integrated care; and second, to explore the effectiveness of the use of…

Abstract

Purpose

The purpose of this paper is twofold. First, to examine the impact on mental health social work of integrated care; and second, to explore the effectiveness of the use of deliberative research, a methodology which is new to mental health social work research.

Design/methodology/approach

Developed to enable examination of policy, deliberative research is underpinned by a desire to permit choice and change brought about through an iterative dialogue. This communication is based on informed and respectful equality between policy makers or implementers and those subject to that implementation. In order to achieve this equality, participation in debate by participants is viewed as essential, including as part of the process, participants becoming better informed about the phenomenon in question.

Findings

The findings show that effective mental health social work underpins successful integrated care which, in turn, is viewed as relevant. In addition, people who access services identified that mental health social workers are well positioned as facilitators and explainers in integrated care. The issue to be further explored by research, therefore, is not whether services should be delivered separately or in an integrated way, but how to keep improving and developing integrated care and especially the impact of ongoing power differentials.

Research limitations/implications

The use of deliberative research worked reasonably well as an underpinning methodology for this study in that it sought to achieve the opinions of the public, in this instance consumers who provided or accessed mental health social work. The ethical need to ensure no harm came to this particular group meant that their opinions were not debated with the whole. This limitation to iterative dialogue is undoubtedly a consideration when undertaking deliberative research on such populations. This study offered just this, a one-off event, as in reality the commitment from participants to attend more than this one session would have been prohibitive.

Practical implications

The test, practically, comes with the events for data collection. This is not just the debate as to whether these, as one-off events, bring about agreement and not deliberation, but also whether researchers can, with a group that has particular needs, effectively integrate them into the deliberation. Given that it is an ethical priority to ensure that the participants are not harmed, this is not always going to be possible where the “public” includes those who may be vulnerable.

Originality/value

Deliberative research methodology is a new approach in mental health social work research. The influential finding is activism: people who access services recognise and suggest a challenge to the normative power differential in integrated care, as embodied in mental health social workers, and it is this aspect that warrants further investigation.

Details

The Journal of Mental Health Training, Education and Practice, vol. 13 no. 2
Type: Research Article
ISSN: 1755-6228

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Article
Publication date: 14 October 2009

Deirdre Heenan and Derek Birrell

Unlike the rest of the United Kingdom, Northern Ireland has had a system of integrated health and social care since the early 1970s. Following devolution, the…

Abstract

Unlike the rest of the United Kingdom, Northern Ireland has had a system of integrated health and social care since the early 1970s. Following devolution, the reconfiguration of services has strengthened this integration with a smaller number of trusts with responsibilities for all heath and social care. This article examines the current and planned operation of this more comprehensive form of integration of health and social care. It considers how this experience of integrated structures and working can inform approaches in other areas of the UK. Finally, it assesses the main achievements of this system and identifies remaining problems.

Details

Journal of Integrated Care, vol. 17 no. 5
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 6 October 2010

Richard Gleave, Ivy Wong, Jeremy Porteus and Edward Harding

A survey of integrated working between primary care trusts (PCTs) and adult social services across England was undertaken in December 2009 and January 2010. The survey…

Abstract

A survey of integrated working between primary care trusts (PCTs) and adult social services across England was undertaken in December 2009 and January 2010. The survey results are presented in the context of the history of integrated working between health and social care, and the recent policy announcements of the Conservative‐Liberal Democrat Coalition Government.

Details

Journal of Integrated Care, vol. 18 no. 5
Type: Research Article
ISSN: 1476-9018

Keywords

Content available
Article
Publication date: 20 March 2017

James A. Shaw, Pia Kontos, Wendy Martin and Christina Victor

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…

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2814

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

Journal of Health Organization and Management, vol. 31 no. 1
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 21 February 2020

Charlotte Klinga, Johan Hansson, Henna Hasson, Magna Andreen Sachs and Carolina Wannheden

The aim of this study was to identify key components of integrated mental health and social care services that contribute to value for service users in Sweden.

Abstract

Purpose

The aim of this study was to identify key components of integrated mental health and social care services that contribute to value for service users in Sweden.

Design/methodology/approach

An explorative research study design was used, based on data from four group interviews conducted in June and August 2017 with service user representatives.

Findings

The analysis resulted in eight subcategories reflecting components that were reported to contribute to value for service users. These subcategories were grouped into three main categories: (1) professionals who see and support the whole person, (2) organizational commitment to holistic care and (3) support for equal opportunities and active participation in society.

Research limitations/implications

The findings are primarily transferable to integrated mental health and social care services, as they emphasize key components that contribute to value for service users in these specific settings.

Practical implications

The complexity of integrated mental health and social care services requires coordination across the individual and organizational levels as well as ongoing dialogue and partnerships between service users, service user associations and health and social care organizations. In this integration, it is important that service users and service user associations not only are invited but also keen to participate in the design of care and support efforts.

Originality/value

Service User Associations (SUAs) can act as a bridge between county and municipal services through their participation in the development of local activities; at the regional and national levels, SUAs can help achieve more equitable integrated services. It is important that SUAs are not only invited but encouraged to actively participate in the design of such care and support efforts.

Details

Journal of Integrated Care, vol. 28 no. 2
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 15 December 2014

Derek Birrell and Deirdre Heenan

The purpose of this paper is to explore and assess the configuration, role and likely contribution of the new integrated care partnerships (ICPs) established in Northern…

Abstract

Purpose

The purpose of this paper is to explore and assess the configuration, role and likely contribution of the new integrated care partnerships (ICPs) established in Northern Ireland.

Design/methodology/approach

The approach is based on the assessment of policy background, strategy papers, implementation plans and initial activities of ICPs.

Findings

ICPs have been created with limited powers and an unclear relationship with the existing system of structurally integrated health and social care. The initial priorities and activities of ICPs suggest a focus on integrating health which may impede the further integration of health and social care.

Research limitations/implications

Paper concludes there is a need for robust evaluation including monitoring of progress, performance and outcomes.

Originality/value

First published paper on implementation of ICPs in Northern Ireland. Contributing to comparative studies of structures of health and social care, with particular relevance to integration.

Details

Journal of Integrated Care, vol. 22 no. 5/6
Type: Research Article
ISSN: 1476-9018

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