Kai Leichsenring

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Developing integrated health and social care
servicesfor older persons in Europe
Integrated Care Conference 2004 Birmingham, 20-21
February 2004
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A European project to promote the integration of
health and social care services

• to search for new models of integrated health and
  social care
• to identify factors and actors that constitute an
  integrated care system
• to develop performance indicators for use in
  evidence-based policy making, planning, and
  quality assurance
• to promote the dissemination of best practice by
  involving relevant stakeholders
• www.euro.centre.org/procare

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Objectives of the presentation

• To present first results of PROCARE as a European
  project to promote integrated care provision
• To compare approaches to and definitions of
  integrated care within different discourses and
  countries
• To open the tool-box used in providing
  integrated care in Europe
• To underline the importance of the social as
  against medicalized models
• To consider some future developments

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Various discourses on integrated care

• The managed care discourse
• to introduce steering mechanisms and economic
  thinking in medical care
• The public health discourse
• E.g. European Office for Integrated Health Care
  (Barcelona)
• bringing together inputs, delivery, management
  and organization of services related to
  diagnosis, treatment, care, rehabilitation and
  health promotion
• to improve the services in relation to access,
  quality, user satisfaction and efficiency

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Various discourses on integrated care

• The person centred (social) approach
• demand-driven
• oriented on individual requests and needs of the
  client
• adequate types, accurate quantity, appropriate
  order, at the right moment in time
• Whole system approach
• services are organised around the user
• all players recognise that they are
  interdependent action in one part of the system
  has an impact elsewhere

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Various discourses on integrated care

• The institutional approach
• Consolidated Direct Service Model
• all services produced by a single organisation
  and/or a single decision-making authority (the
  Italian experience)
• unfriendly take-over of social care?
• The Brokerage Model
• Gerontological co-ordination and networking (F)
• process of pooling different persons, means,
  skills and organisations to resolve complex
  problems
• process-owner case-manager (co-ordination as a
  profession)
• temporary organisation Information, Advocacy,
  Brokerage Agency

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Main concepts of integrated care in selected EU
Member states
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Towards a comprehensive definition
Health care system
Social caresystem

• Integrated care
• system

Hospitals Services Providers Professions MPs Metho
ds Legal Framework Policies
Services Institutions Providers Professions Method
s Legal Framework Policies
Vision - Culture Strategies - Policies Methods Pro
cesses Quality criteria RD, Training
Users/clients/patients/citizens
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The tool-box for pathways towards integrated
care

• Assessment process
• Community Assessment and Rehabilitation Teams
  (CARTs) UK
• RIOs NL
• Centres Locaux dInformation et de Coordination
  (CLICs) F
• Geriatric (Multiprofessional) Assessment Unit I
• Admission Prevention
• Rapid Response Teams (mixed staff) UK
• Open Care Centres GR
• Preventive home visits DK

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The tool-box for pathways towards integrated
care

• Case and care management
• Case managers as gate-keepers UK
• Case managers as advocates of clients NL
• Care managers in hospitals model projects in A
  and D
• The transition process from hospital to
  subsequent care
• Information, early discharge, hospital at home
  schemes UK, A, D
• Transition forms I, DK
• Dialogue and Contracts DK

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The tool-box for pathways towards integrated
care

• Multidisciplinary geriatric teams and joint
  working
• One-window NL, I
• Rapid response teams UK
• Gerontological co-ordination F
• Local and regional networks A, D
• 24-hours integrated health and social care DK
• Multidisciplinary service provider networks D
• Integration of housing and care
• Staff rotation, trans-mural care NL
• Independent counselling
• Supporting family carers
• Coordinating care conferences
• Introducing a dialogue about cultural
  differences, trust building

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Different national approaches

• Integrated care by national legislation?
• long-term care schemes A, D, F, NL, AUT, UK
• coordination mechanisms I, F, D, DK, FIN
• Shifting long-term care from poor law to
  citizens rights DK, FIN, NL, I, F, D (?)
• Centralized vs decentralized structure?
• Top-down vs bottom-up
• Model projects all countries but no
  organizational learning strategy
• Integrated care by market mechanisms?
• Does the market hamper integration?
• Quality assurance
• Regulation, assessment

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Different national approaches

• Integrated care by consumer-directed services?
• The rise of vouchers and cash-benefits
• Integrated care by reforming institutions
• Phasing-in (South) and phasing-out (North) of
  institutional care
• Integrated care by demand-driven policies?
• retrieving hidden care-demand waiting-list
  management NL
• expanding intermediate care and rehabilitation
  service provision UK
• single assessment and Care Trusts UK

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The relative importance of different tools in
selected European countries
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The relative importance of different tools in
selected European countries
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Necessary debates

• Integrated policies for integrating practices
• Systemic approaches to integration
• Management is not enough
• Involvement of users and civil society
• Dialogues at the front-line
• Dialogues on priorities
• Steering mechanisms
• Who purchases services?
• Who decides on providers, quality of service and
  evaluation criteria?
• Who defines outcomes and with which tools?
• Managing diversity

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Perspectives and challenges

• The marketization track
• Consumerism vouchers, payments
• black market vs. regulated quasi-markets
• The managerial track
• Managed care, social and care management
• Professionalism? New professions?
• The techno track
• More IT
• Smart homes, tele-care
• The civil society track
• (new) volunteering?
• New solidarities? (inter- and intra-generational)
• The immigration track
• Shortage of labour in caring professions
• How to integrate foreign workers?

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Next steps for PROCARE

• Analyse empirical work
• 2 sites per country
• Individual interviews with clients, carers, and
  staff
• Lessons to learn
• Quality indicators
• Policy implications and recommendations
• Structural factors for success
• Publications
• Transversal topics
• Final public conference
• Venice, 22-23 October 2004