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People experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wicked policy issue. The purpose of this paper is to examine the challenge of integrating care in this context using evidence from an evaluation of English hospital discharge services for people experiencing homelessness.

The paper undertakes secondary analysis of qualitative data from a mixed methods evaluation of hospital discharge schemes and uses an established framework for understanding integrated care, the Rainbow Model of Integrated Care (RMIC), to help examine the complexities of integration in this area.

Supporting people experiencing homelessness to have a good discharge from hospital was confirmed as a wicked policy issue. The RMIC provided a strong framework for exploring the concept of integration, demonstrating how intertwined the elements of the framework are and, hence, that solutions need to be holistically organised across the RMIC. Limitations to integration were also highlighted, such as shortages of suitable accommodation and the impacts of policies in aligned areas of the welfare state.

The data for this secondary analysis were not specifically focussed on integration which meant the themes in the RMIC could not be explored directly nor in as much depth. However, important issues raised in the data directly related to integration of support, and the RMIC emerged as a helpful organising framework for understanding integration in this wicked policy context.

Integration is happening in services directly concerned with the discharge from hospital of people experiencing homelessness. Key challenges to this integration are reported in terms of the RMIC, which would be a helpful framework for planning better integrated care for this area of practice.

Addressing homelessness not only requires careful planning of integration of services at specific pathway points, such as hospital discharge, but also integration across wider systems. A complex set of challenges are discussed to help with planning the better integration desired, and the RMIC was seen as a helpful framework for thinking about key issues and their interactions.

This paper examines an application of integrated care knowledge to a key complex, or wicked policy issue.

The purpose of this paper is to explore the impact of personalisation policy on the providers of social care services in England, mainly to older people, within the context of austerity and different conceptions of personalisation.

The paper draws on part of a longitudinal study of the care workforce, which involved 188 interviews with managers and staff, undertaken in two rounds.

Four themes were identified: changing understandings and awareness of personalisation; adapting services to fit new requirements; differences in contracting; and the impact on business viability.

The paper reflects a second look at the data focussing on a particular theme, which was not the focus of the research study. Furthermore, the data were gathered from self-selecting participants working in services in four contrasting areas, rather than a representative sample.

The research raises questions about the impact of a commercial model of “personalised care”, involving personal budgets (PBs) and spot contracts, on the stability of social care markets. Without a pluralistic, well-funded and vibrant social care market, it is hard to increase the consumer choice of services from a range of possible providers and, therefore, fulfil the government’s purposes for personalisation, particularly in a context of falling revenues from local authorities.

The research presents an analysis of interviews with care providers and care workers mainly working with older people. Their views on personalisation have not often been considered in contrast to the sizeable literature on PBs recipients and social workers.

The purpose of this paper is to present a case study describing the progress that is being made in one city in England to increase access to Care Act 2014 assessments and personal budgets among people with experiences of homelessness and multiple exclusion.

A case study employing a “study group” to describe and reflect on local development work.

The authors focus on the “systems change” activity that was undertaken by one voluntary sector partnership project to address issues of referral and access to adult social care. This included the development of a “Multiple Needs Toolkit” designed to support voluntary sector workers to communicate more effectively with adult social care around the application of the new Care Act 2014 eligibility thresholds. The authors discuss the role of “persistent advocacy” in increasing access to assessments and also the limitations of this as regard the potential for poorer joint working.

Throughout, the authors draw on the “ambiguity-conflict” model of policy implementation to assess if the learning from this single case study might be applied elsewhere.

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 discuss “system transformation” in the context of different workforces and organisations seeking to support people experiencing multiple exclusion homelessness (MEH). From a relational and integrated care perspective it aims to identify barriers to achieving more effective ways of working in the prevailing context of “managerial domination”. Communities of practice (COPs) are evaluated to identify their potential to overcome some of these barriers.

The paper presents a theoretical and conceptual discussion of a project in which a number of COPs were established and evaluated to ascertain their value in developing more relational ways of working in the context of MEH. Case studies of COPs operating in the context of MEH are explored and discussed.

It is concluded that COPs have the potential to deliver small-scale changes (“little miracles”) which are characteristically more subversive than transformative. Nevertheless, the authors still see these small gains as significant when compared to the inertia that is often found in local systems of care where more traditional management techniques (such as “payment by results”) prevail. The authors also draw attention to the scope for much improved service quality which flows from moving beyond the “tick box” and into the realms of what it really takes to tackle homelessness and multiple exclusion. In other words, although often requiring considerable amounts of “craft and graft” to deliver seemingly very small amounts of change, these “little miracles” may actually be more conducive in the long run to delivering the kind of tangible “real” change that is often aspired to by both workers and service users and their carers.

The COPs project was limited in terms of time and scale and, hence, further research would be needed to, for example, ascertain their longer-term potential.

There is merit in the theoretical perspectives discussed and, from these, of understanding how best to establish and operate COPs as a vehicle for achieving better outcomes through integrated or collaborative working.

There is much scope for better integrated or more collaborative working in the context of MEH and this paper draws attention to how COPs could be one means of achieving better outcomes for people experiencing MEH.

This is the first paper to set out the theoretical analysis of COPs as a means of achieving better integrated or collaborative working.

New service models such as intermediate care may find it difficult to involve older people in services that are time‐limited and unfamiliar. Their staff may perceive themselves as having little time to sustain or build relationships with voluntary and community‐based organisations engaged in intermediate care. This article shows how such challenges can be met by drawing on the experiences of voluntary sector projects involved in intermediate care services.

In this paper, we draw on ethnographic research which tracked older people's journeys through the health and social care system, highlighting some of the key issues which will need to be addressed if the new single assessment process is to become user‐ and carer‐friendly. We argue that the concept of the ‘whole system’ is a misnomer, and a more accurate picture is that of a world at war, with territorial disputes rife and border controls tighter than ever. We suggest that too much emphasis has been placed on IT systems and paperwork and that the real challenge is to cut through the jargon of modernisation and to see things from a wholly different perspective.

At a time of increasing interest in mental health in later life, the role of public health approaches is potentially heightened. This paper draws on interview data with older people living in London to consider the interplay between personal and public approaches to health and well‐being. The interviews were under taken as part of the midpoint review of the UK government's 10‐year strategy for older people (Healthcare Commission et al, 2006) and the social characteristics of London are considered.