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Care and support agendas have tended to focus on the need to develop effective services to meet individualised needs within communities of interest. In contrast, community development and regeneration policy have concentrated on the needs of the broader ‘community’ but with little regard to support and care. Rarely do these two important policy domains meet in practice. A three‐year pilot initiative, the Hull Community Care Development Project, aimed to develop the capacity of local communities to respond to their own support and ‘community care’ needs. An independent evaluation documented how such an approach could begin to bridge community and care, and how this produced new challenges, communities prioritising broad neighbourhood issues over specific care and support concerns.

There is a strong tradition of integration in rural community hospitals which has been largely unrecognised in the past. The national strategy for health in England now gives community hospitals a central role in providing integrated health and social care, in a policy referred to as ‘care closer to home’. The evidence emerging from international and national studies is demonstrating the benefit of the community hospital model of care. Public support for community hospitals over their 100‐year history has been strong, with value being placed on accessibility, quality and continuity. There is, however, a tension between the national policy and the current financial pressures to close or reduce services in one in three community hospitals in England. Innovative ways of owning and managing these services are being put forward by communities who are actively seeking to maintain and develop their local hospitals. The challenge is to demonstrate that community hospital services are valued models of person‐centred integrated care, and to demonstrate their contribution to the health and well‐being of their communities.

The purpose of this paper is to explore the whole system cost of the care pathway for older people (aged 65-years old and over) admitted to hospitals as a result of falls in Torbay, a community of 131,000 in the southwest of England with a high proportion of older residents, over a two-year period.

The paper analysed patient-level linked acute hospital, community care and local authority-funded social care data to track patients’ care costs – for those patients admitted to an acute hospital due to their fall – in the 12 months before and after their fall.

On average, the cost of hospital, community and social care services for each admitted for a fall were almost four times as much in the 12 months after admission, than the cost of the admission itself. Over the 12 months that followed admission for falls, costs were 70 per cent higher than in the 12 months before the fall. The most dramatic increase was in community health care costs (160 per cent), compared to a 37 per cent increase in social care costs and a 35 per cent increase in acute hospital care costs. For patients who had a minor fall and those who survived 12 months after the fall, the costs of care home services increased significantly; for patients with hip fracture, the costs of community care services increased significantly; for patients who did not survive 12 months after the fall, the cost of acute inpatient and community health visits increased significantly.

This is the only study that has assessed the costs across the acute hospital, community care and social care pathway for this group of patients, in an English population. This will help commissioners and providers understand and develop better-integrated responses to frail elderly patients needs.

This article demonstrates how the role of the community matron has developed in Cornwall over the past three years, and how this role can be understood as the lynchpin of an integrated approach to the care and management of patients with complex needs and multiple long‐term conditions. In recent years there has been growing recognition that current models of care delivery would be likely to struggle to meet the future demands of an ageing population. Cornwall's approach is to build on the introduction of the community matron service, and to support a new model of care delivery which will encompass use of assistive technology as an additional tool to support those with long‐term conditions. The article will demonstrate the current effectiveness of the service in terms of savings for the health and social care community, and presents a case study to show how integrated working can be used to facilitate improved outcomes for patients.

Community Care is a major policy initiative in Scotland, involving an annual expenditure of nearly £750m by local authority social work departments and substantial investment by health and housing agencies. The principles of the policy that people should be cared for at home or in homely settings are broadly supported, but unease about implementation remains. Scotland has retained a greater ratio of long‐stay hospital provision, and dependence on residential solutions to community care needs remain high. The inception of the new Scottish Parliament in 1999 will bring new challenges and opportunities for the development of this key policy.

Purpose: The aim is to explore how family relations are affected by societal changes in relation to informal and formal caregiving and self-determination of older adults.

Design/methodology/approach: Care managers (CMs)/social workers (SWs) (N = 124) participated in a comparative vignette study including Japan, South Korea, and Sweden. Systems theory was used.

Findings: Japanese CMs/SWs clearly describe their efforts to create networks in a relational way between formal and informal actors in the community. South Korean CMs/SWs balance between suggesting interventions to support daily life at home or a move to a nursing home, often acknowledging the family as the main caregiver. In Sweden, CMs/SWs highlight the juridical element in meeting the older adult and the interventions offered, and families primarily give social support. Regarding self-determination, the Japanese priority is for CMs/SWs to harmonize within the family and the community. South Korean CMs/SWs express ambivalent attitudes to older adults’ capability for self-determination in the intersection between formal and family care. Swedish CMs/SWs adhere to the older adult’s self-determination, while acknowledging the role of the family in persuading the older adult to accept interventions. The results suggest emerging defamilialization in South Korea, while tendencies to refamilialization are noticed in Japan and Sweden, albeit in different ways.

Research limitations/implications: In translation, nuances may be lost. A focus on changing families shows that country-specific details in care services have been reduced. For future research, perspectives of “care” need to be studied on different levels.

Originality/value: Using one vignette in three countries with different welfare regimes, discussing changing views on families’, communities’ and societal caregiving is unique. This captures changes in policy, influencing re- and defamilialization.

The purpose of this paper is to explore the presence and nature of integrated care in community hospitals.

Staff reported their views and experiences of integrated care in 48 questionnaires for a Community Hospitals Association programme. An analytical framework was developed based on eight types of integration, and the community hospital services concerned were grouped into nine service categories.

Staff reported multiple types of integration, averaging four types (median), with a range of two to eight (of the eight types studied). The types of integration most frequently reported were multidisciplinary care, and community hospital/secondary care and community hospital/primary care. Integration with communities, patients and the third sector featured in many of the services. Integration with social care and local authorities were least frequently reported. Services with the highest number of types of integration (5+) included palliative care, maternity services and health promotion. Staff reported that commitment was a positive factor whilst a lack of staff resources hindered partnership working.

Staff volunteered to be part of the programme which promoted good practice, and although the findings from the study cannot be generalised, they do contribute knowledge on key partnerships in local hospitals. Further research on the types, levels and outcomes of integrated care in a larger sample of community hospitals would build on this study and enable further exploration of partnership working.

The analytical framework developed for the study is being applied by staff and community groups as a tool to help assess appropriate partnership working and help identify the scope for further developing integrated care. The evidence of integrated working is available to inform those commissioning and providing community health services.

This study has shown that integrated working is present in community hospitals. This research provides new knowledge on the types of integrated care present in a range of community hospital services. The study shows a tradition of joint working, the presence of multiple simultaneous types of integration and demonstrated that integrated care can be provided in a range of services to patients of all ages in local communities.

The purpose of this paper is to show that not only (obviously) social enterprises but also conventional ones are based on social intentions and that these social intentions often have community dimensions. The conclusion of these findings is that conventional research, and consequently, also the public debate on entrepreneurship as well as on social and community entrepreneurship, is guided by false notions rather than on empirical facts.

The paper starts by presenting the dominating references on entrepreneurship, social entrepreneurship and community entrepreneurship and then goes on to compare them. The existence of social motives among conventional enterprises is brought to the fore, first through a presentation of the official statistics of the motives for all new starters in Sweden and then with a presentation of cases from different sectors. The cases selected to represent the starters have all expressed social motives for going into business. “Care” was the word used by the individuals themselves and therefore the care concept is introduced.

Social intentions can be found in conventional market enterprises. The intentions of the entrepreneurs' are often expressed in terms of “care”. Care for the community is often an important part of other care dimensions.

The empirical findings of care in conventional market enterprises and care for the community as an important care dimension in the cases presented have implications not only for theories on conventional, social and community entrepreneurship but also for theory building in social sciences in general. The dominance of English‐speaking researchers can be a problem from this perspective.

Both the descriptions and the analysis have practical implications for everyone interested in entrepreneurship and the circumstances for enterprises of all kinds as well as for local and regional development.

The paper questions what is taken‐for‐granted, with the help of empirical examples and not just with statements.

This paper presents findings from a qualitative study that sought to identify what works well in supporting older people to live in their own homes and local communities. Drawing on data from six focus groups conducted with key stakeholders, including older people, carers, care managers and direct service providers, the shortcomings of existing services to meet the needs of older people are recognised and the paper seeks to move discusion forward to what might help improve provision. Examples identified during the focus groups are explored and highlight the importance of enabling older people to maintain community connections and draw on existing community facilities. To be effective, support needs to be underpinned by a person‐centred approach which takes into account individual preferences and priorities, and is organised locally to where older people live. Statutory organisations are often constrained by restrictive thinking and financial pressures lead to resourcecentred rather than person‐centred responses to individuals in need. Our findings suggest that commissioners of services should be more creative in developing flexible providers in local communities and that we consider approaches that may be helpful in achieving this and transforming support arrangements. The potential of an action research programme to explore the ideas raised and enable processes for development, outcomes for older people, their carers and the communities in which they live, as well as the costs, to be tested comparatively with traditional services is noted. The importance of capacity building and investment in the independent sector and other community partners is critical to achieving change.

Palliative care requires integration between services, organisations and the community. A series of community engagement programmes, named “Listening Events”, were conducted across the Isle of Man. The aim was to involve the community in the development of Hospice strategy by sharing their views on the future of palliative and end of life care.

Three Listening Event programmes were conducted in community settings, secondary schools and the Isle of Man’s University College. The investigators facilitated discussions on current knowledge of Hospice services, what would matter to people should they need to use these, and how Hospice could best serve the community in the future. Participants and investigators noted thoughts and comments. Data were analysed using thematic analysis.

In total, 899 people participated from across the community. Main themes surrounded effective care, person-centred care and integrated care. Most themes agreed across the three programmes, despite some nuances.

The results were used as an evidence base from which Hospice Isle of Man’s new strategy was derived in order to ensure that it aligned with the community’s needs. By initiating conversations and discussions in the community, the Listening Events may have also increased understanding about hospice care.