Looking Back to the Future: Integrating Health and Social Care In Troubled Times

1
Looking Back to the Future Integrating Health
and Social Care In Troubled Times
Tom Forbes Robin Fincham, Stirling Management
School Paul Williams, Cardiff Metropolitan
University
2
The context

• There is a long and chequered history of efforts
  to integrate health and social care in the UK
• A number of apparent benefits of integration have
  been suggested
• However, a combination of professional,
  organisational, financial, statutory and other
  factors have conspired against integration
• There is now a wide literature base offering
  theoretical insights and practical guides to
  assist policy makers, managers and practitioners
  on various aspects of integration

3
Health and social care integration

• One problem that has bedeviled the policy
  community is the rate and pace of repeated change
  and lack of stability
• Another problem facing people working with
  integration is that the notion itself lacks any
  universally understood meaning
• The frustration with getting integration to work
  in practice has attracted the attention of
  researchers and policy makers
• One reflection of this work is that it often
  favours a structural and institutional focus and
  arguably underplays the role of agency
• This resonates with the type of policy
  interventions that predominate in this policy
  field which assume falsely that structural
  changes will induce changes in behaviour in key
  actors
• The institutional environment is complex . Stated
  policy direction often underplays/states or
  deliberately glosses over the institutional role
  division among groups of providers and recipients

4
Integration is.
Integration is a coherent set of methods and
models on the funding, administrative, organisatio
nal, service delivery and clinical levels
designed to create connectivity, alignment and
collaboration within and between the cure and
care sectors. The goal of these methods and
models is to enhance quality of care and quality
of life, consumer satisfaction and system
efficiency for patients with complex, long term
problems cutting across multiple services,
providers and settings. The result of such
multipronged efforts to promote integration for
the benefit of these special patient groups
is called integrated care. (Kodner and
Spreeuwenberg, 2002 3)

• Micro a diverse range of approaches to deliver
  care to individuals and their carers
• Meso focusses on the needs of particular groups
  of individuals
• Macro focusses on delivering care to specific
  populations

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Scotland

• Partnership working and integration has a had a
  key role in health and social care policy since
  1997
• However, Joint Future in 2000 the key driver for
  the integration of health and social care
  services
• Community Health Partnerships continued on this
  theme and absorbed most of the JF initiatives on
  health and social care
• CHPs mainly a health driven agenda but some NHS
  Boards/Councils saw a greater opportunity for
  integration and several integrated CHP models
  emerged
• Community Health Partnerships now to be replaced
  by Health Social Care Partnerships

6
Wales

• Health and social care agenda continues to be the
  subject of a range of legislative, organisational
  and policy drivers
• Welsh Assembly Government has chosen a
  distinctive approach to public services based on
  the need to be citizen-centered and client
  focussed
• Partnership the key delivery mechanism
• The aim is to enhance cross boundary working
  between organisations and sectors, integrate
  services and respond to citizens needs and views
• A number of health and social care partnerships
  established

7
Northern Ireland Experience of Integration

• Enhanced professional cooperation
• Efficient system for discharge from hospital
• Improved delivery of community care to vulnerable
  groups
• More efficient use of resources
• Improved focus on client need

• Junior Partner issues
• Funding locked in acute services
• Engagement of Independent contractors

The need to continue to develop a culture of
integration.
8
Some common integration issues

• Acknowledgment of the need for partnership
  working
• Skepticism about the reality of partnership
  working
• Limited sense of interdependence between Health
  Social Care staff
• Poor reward structures
• Trust important

• Confusion over role of committees
• Integration outcomes unclear
• Co-location has mixed benefits
• Partnership capacity
• Terms conditions and professional and Line
  management
• Evidence needed of the benefits on partnership
  working

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A process towards integration??

• Identify appropriate relationships
• Understand the context
• Obstacles?
• Pull factors?
• Push factors?

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Conclusions

• Managing in a partnership environments is
  materially different from other forms of
  organising
• Policy makers need to acknowledge there real
  differences between the health and social care
  sectors when it comes to partnership working
• Managers and practitioners must learn and
  practice leadership skills