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1 – 10 of 64Jenny Billings and Alison Davis
Current debates surrounding the NHS contract in England are suggesting that it is in need of change to support an integrated health and social care transformation agenda that…
Abstract
Purpose
Current debates surrounding the NHS contract in England are suggesting that it is in need of change to support an integrated health and social care transformation agenda that meets the needs of an ageing chronically ill population. The purpose of this paper is to describe a three-phase project in England that sought to develop and validate a whole systems contracting model for integrated health and social care focusing on older people with long-term conditions, and based on joint outcomes.
Design/methodology/approach
A participative mixed-method approach for the development of the contracting model was used; this consisted of a literature review, a design phase drawing on consensus method through stakeholder discussions and an international validation phase.
Findings
The final contracting model consists of four overarching and interrelated core elements: outcomes; partnership, collaboration and leadership; financial: incentives and risk; and legal criteria. Each core element has a series of more detailed contracting criteria, followed by further specifications attached to each criteria.
Research limitations/implications
While the policy environment appears to be conducive to change and encourages the adoption of new ways of thinking, there are difficulties with the implementation of new innovative models that challenge the status quo, and this is discussed.
Practical implications
The paper concludes with reflections on the way forward for local development and implementation.
Originality/value
There is currently much discussion for the need to realign contracting for integrated care that has a better fit for the transformation agenda, but until now, there have been no attempts to develop a whole systems approach that focusses on joint outcomes. This research bridges the gap but recognizes the challenges to implementation.
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Jenny Billings, Rasa Mikelyte, Anna Coleman, Julie MacInnes, Pauline Allen, Sarah Croke and Kath Checkland
The purpose of this paper is to investigate the perceptions of key informants on a national support programme for the development of new care models (NCM) in England…
Abstract
Purpose
The purpose of this paper is to investigate the perceptions of key informants on a national support programme for the development of new care models (NCM) in England (2015/2016–2017/2018). It focuses on the perceived facilitators and barriers affecting the development and implementation of the NCM programme and offers some insight into the role of national level support in enabling local integration initiatives.
Design/methodology/approach
A set of 29 interviews were carried out with a variety of respondents at the national level (including current and past programme leads, strategic account managers, advisors to the programme and external regulators) between October 2017 and March 2018, and analysed thematically.
Findings
A set of facilitative elements of the programme were identified: the development of relationships and alliances, strong local and national leadership, the availability of expert knowledge and skills, and additional funding. Challenges to success included perceived expectations from the national Vanguard programme, oversight and performance monitoring, engagement with regulators, data availability and quality, as well as timetables and timescales. Crucially, the facilitators and challenges were found to interact in dynamic and complex ways, which resulted in significant tensions and ambiguities within the support programme.
Research limitations/implications
While the sample was drawn from a range of different senior players and the authors ensured a diverse sample associated with the NCM support programme, it inevitably cannot be complete and there may have been valuable perspectives absent.
Originality/value
The paper demonstrates that the analysis of facilitators and challenges with respect to the national support of implementation of integrated care initiatives should move beyond the focus on separate influencing factors and address the tensions that the complex interplay among these factors create.
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Julie MacInnes, Sabrena Jaswal, Rasa Mikelyte and Jenny Billings
The purpose of this study is to examine the implementation, care processes and sustainability of an integrated, intermediate Acute Response Team (ART) service. The primary aims of…
Abstract
Purpose
The purpose of this study is to examine the implementation, care processes and sustainability of an integrated, intermediate Acute Response Team (ART) service. The primary aims of the service are to enhance the level of health and social care integration across a range of organisations, to ensure a timelier and appropriate service for people in the community at risk of admission to hospital.
Design/methodology/approach
A qualitative methodology was employed in order to gain a deep understanding of the experiences of staff members within the ART service and external stakeholders. Twenty-one professionals took part in a focus group or one-to-one interviews. Data were analysed thematically.
Findings
The key to successful implementation was that the service was co-created from the “ground-up” with support from local provider organisations. The inclusion of general practitioners (GPs) as part of the team was instrumental in setting up and maintaining the service and seems to be unique in intermediate care settings. Referrals into the ART service were dependent on awareness of the service at the interface with mainstream services. Transitions out were sometimes delayed due lack of availability of social care packages. To ensure sustainability of the ART and other integrated intermediate care services, continued resources, especially skilled staff members, are necessary.
Originality/value
This study adds to the intermediate care and acute response service literature by offering insights into “what works” from a professional perspective in terms of service implementation, care processes and sustainability, in an integrated care system.
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Julie MacInnes, Jenny Billings, Alexandra Lelia Dima, Chris Farmer and Giel Nijpels
The purpose of this paper is to identify the range, type and outcomes of technological innovations aimed at supporting older people to maintain their independence within the…
Abstract
Purpose
The purpose of this paper is to identify the range, type and outcomes of technological innovations aimed at supporting older people to maintain their independence within the context of integrated care at home. We also discuss key emergent themes relevant to the use of person-centred technology for older people in integrated care and propose recommendations for policy and practice.
Design/methodology/approach
An integrative review methodology was used to identify and describe recent scientific publications in four stages: problem identification, literature search, data evaluation and data analysis.
Findings
Twelve studies were included in the review. Three studies described remote consultations, particularly telemedicine; five studies described tools to support self-management; three studies described the use of healthcare management tools, and one study described both remote consultation and self-care management. Emergent themes were: acceptability, accessibility and use of digital technologies; co-ordination and integration of services; the implementation of digital technologies; and safety and governance. Several recommendations are proposed relevant to integrated care teams, technology developers and researchers.
Originality/value
This review uniquely considers the extent to which novel digital technologies used in integrated care for older people are person-centred.
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This study was undertaken in response to the audit requirements for the National Service Framework for Older People Standard 1 ‘Rooting Out Ageism’. The aim of this study was to…
Abstract
This study was undertaken in response to the audit requirements for the National Service Framework for Older People Standard 1 ‘Rooting Out Ageism’. The aim of this study was to identify and describe the nature of any age‐discriminatory practice in the clinical setting through the perceptions and experiences of staff working with older people.The study adopted a qualitative approach using focus group design. Six focus groups were conducted with 57 members of staff. An aim of the study method was to isolate consensus areas of ageist practice that would facilitate targeted intervention. To assist this, statements relating to common practice experiences were developed following the first two focus groups. This was used as a discussion tool for the subsequent groups.Perceived ageist practice could be grouped under the following themes:• access to services• communication and attitudes• treatment and care• the role of relatives• resources.On the basis of the findings, greater choice and control for older people need to be key features of the recommendations, through the development of a co‐ordinated development programme involving all stakeholders
This paper aims to describe the methodological approach to and outcomes of a European multi‐consortium EU 7th Framework funded project entitled “INTERLINKS”. The project sought to…
Abstract
Purpose
This paper aims to describe the methodological approach to and outcomes of a European multi‐consortium EU 7th Framework funded project entitled “INTERLINKS”. The project sought to develop a concept and method to describe and analyse long‐term care and its links with the health and social care systems, and formal and informal care.
Design/methodology/approach
Through the development of a template, it accumulated and validated practice examples that described good policy and practice, transferable across EU member states.
Findings
The outcome was to assemble a range of themes, sub‐themes and 135 key issues into a web‐based framework for LTC that is illustrated by over 100 examples of validated practice in LTC for older people.
Research limitations/implications
Key messages emanating from the project are provided, with an emphasis on the need for greater investment and pluralist evaluation of initiatives that seek to address the interfaces and links between care services.
Originality/value
The project is unique in that it provides a comprehensive and accessible interactive European database of policy and projects that directly address the problems of interfaces between service provision for older people, and contributes towards the evidence base in discrete areas of LTC.
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Jenny Billings and Esther de Weger
Service transformation of health and social care is currently requiring commissioners to assess the suitability of their contracting mechanisms to ensure goodness of fit with the…
Abstract
Purpose
Service transformation of health and social care is currently requiring commissioners to assess the suitability of their contracting mechanisms to ensure goodness of fit with the integration agenda. The purpose of this paper is to provide a description and critical account of four models of contracting, namely Accountable Care Organisations, the Alliance Model, the Lead Provider/Prime Contractor Model, and Outcomes-based Commissioning and Contracting.
Design/methodology/approach
The approach taken to the literature review was narrative and the results were organised under an analytical framework consisting of six themes: definition and purpose; characteristics; application; benefits/success factors; use of incentives; and critique.
Findings
The review highlighted that while the models have relevance, there are a number of uncertainties regarding their direct applicability and utility for the health and social care agenda, and limited evidence of effectiveness.
Research limitations/implications
Due to the relative newness of the models and their emerging application, much of the commentary was limited to a narrow range of contributors and a broader discussion is needed. It is clear that further research is required to determine the most effective approach for integrated care contracting. It is suggested that instead of looking at individual models and assessing their transferable worth, there may be a place for examining principles that underpin the models to reshape current contracting processes.
Practical implications
What appears to be happening in practice is an organic development. With the growing number of examples emerging in health and social care, these may act as “trailblazers” and support further development.
Originality/value
There is emerging debate surrounding the best way to contract for health and social care services, but no literature review to date that takes these current models and examines their value in such critical detail. Given the pursuit for “answers” by commissioners, this review will raise awareness and provide knowledge for decision making.
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