Integrated Care in Action

A Practical Guide for Health, Social Care and Housing Support

Robin Miller, Hilary Brown, Catherine Mangan

• Publisher: Jessica Kingsley Publishers
• Year: 2016
• ISBN:
  9781784501426
• Topic: Medizin
• Subtopic: Gesundheitsversorgung

Integration is now a key expectation within the delivery of health and social care services in the UK and internationally. However, it still remains difficult to achieve and sustain in practice. Based on learning from successful, and unsuccessful, integrated care initiatives, this book is an invaluable guide for those responsible for leading, managing and delivering integrated care across health, social care and housing.

Written by an experienced team of researchers who have studied, led and supported integrated care for many years Integrated Care in Practice draws on latest evidence, innovative practice and helpful theory. It provides insights into the common pitfalls that such initiatives can encounter and demonstrates positive approaches to anticipating and responding to such challenges. Throughout, real-case examples are provided, and concepts and models are connected with the realities of day-to-day life for those working within these services.

Integrated care is a goal to aspire to - this book helps to explain how we can turn this goal into practical action and positive outcomes.

Chapter 1

Integrated Care

An Introduction

As set out in the Preface to this book, at the heart of integrated care is a simple principle – that professionals and organisations who work with people with health, social care, housing support and other needs should collaborate around these individuals and their families to provide high quality care and treatment. This basic principle can be found within national policy, best practice guidelines and even within legislative duties in all of the home nations in the UK. It is also being promoted across Europe, North America and further afield with the World Health Organization (WHO) promoting a global strategy on person-centred and integrated care. As is so often the way, though, once we start to think what such an apparently simple principle means in practice, life becomes much more complicated and uncertain. What exactly is meant by ‘integration’ and ‘integrated care’? Is it different to ‘collaboration’, ‘joint working’ and other such concepts? Who is being integrated and who is not? Are these latter services therefore fragmented? Which integrated care model works best?

To those responsible for developing integrated care initiatives on the ground, these might seem like academic debates. However, they do highlight key issues that need to be addressed if new processes, practices and partnerships are going to have a solid chance of succeeding. Furthermore, it is difficult for professionals and their organisations to provide integrated care if they have fundamentally different views of what integration is and what it can achieve. In this chapter we cover the themes below, and also introduce a set of ‘wicked issues’ (or problems) for which integration is often seen as the solution. These problems, and the integrated care initiatives that are developed to address them, are considered as we discuss the building blocks of integration.

•Why is integration being promoted in policy and practice?

•How can we understand integration?

•What is the evidence about what works in integrated care?

Why is integration being promoted in policy and practice?

Most people naturally see the potential benefits of professionals and their organisations working together, and indeed would assume that this would normally be the case in health, social care and housing support services. A key issue that quickly comes to mind is the importance of ensuring that there is necessary coordination and communication between professionals involved with particular individuals and their families, or that there is sufficient joint planning around what services are required in a locality to meet the needs of a defined population. These, however, are only part of the motivating factors that encourage (or not) organisations and the staff within them to actively participate in integration. Understanding these, and therefore the factors behind why an integrated care initiative may be suggested, can be a helpful context (and something that we explore in more detail next, in Chapter 2). The list below contains six common reasons why governments, partnerships and organisations look to integration:

•To tackle so-called ‘wicked issues’: Wicked issues are problems within society that are seen to be long-standing, complex and resistant to change. Examples include high levels of vandalism and crime in deprived neighbourhoods, increasing levels of obesity in young people and the connected health impacts, unemployment amongst people with mental health problems, and the sexual abuse of people with a learning disability (see Table 1.1 for the particular examples of wicked issues we follow during the book). It is thought that no single agency can respond to these wicked issues in isolation, partly because their resources are insufficient, but also because such problems require a more creative and holistic approach than such agencies have previously been able to deliver.

•To ensure that individuals are protected from harm: One wicked issue in particular to which integration has been associated is preventing children and vulnerable adults being abused. The problems of fragmentation in the current system have been identified within countless serious case reviews of the abuse of children and vulnerable adults, and it is therefore often hard not to become cynical about the often used comment that ‘lessons will be learned’ about the need for agencies to work better together. Integration is seen as essential to agencies identifying those at risk of being abused and so to providing proactive preventative support, picking up any concerns at an early point, and responding quickly and thoroughly to abuse that is identified. Integration has also been connected with ensuring that the quality of services in general is of a sufficient standard and abusive regimes are not allowed to develop or continue.

•To improve people’s outcomes and experience of accessing care: Alongside the prevention of harm is increasing recognition that a key purpose of such services is to enable the people who access such support to have a better quality of life and to achieve their personal goals and aspirations. Failure by services to respond to their individual situations and needs may be because the separate services do not adequately listen to their requirements and experiences or have the necessary resources and skills to respond. These might be in place, however, but due to insufficient communication and cooperation between the agencies concerned, these are not translated into the desired outcomes. Linked to this issue is that of people’s experience of accessing services. It is extremely frustrating for all concerned if the necessary information is not passed between agencies, or if someone is caught in an argument about resources and liability, which means that the support required is not provided.

•To ensure that available resources are used efficiently: The need to use available resources as efficiently as possible has also been a necessity for health, social care and housing agencies. As demands increase through changing demographics and public expectations whilst resources are at best stagnant and in some cases declining, there is more need than ever to ensure that any funding is used as well as is possible. Integration is seen as contributing to such greater efficiency in three main ways. First, it is recognised that the support provided can be duplicated across different agencies and integration should help to flush out such overlaps and ensure that it is only provided once. Second, support from one agency may need the involvement of another organisation to be successful, and if their offers are not coordinated, this may not be forthcoming at the ...

Table of contents

• Cover
• Half Title
• Of Related Interest
• Title Page
• Copyright
• Contents
• Acknowledgements
• Preface
• Key Terms
• Chapter 1 Integrated Care: An Introduction
• Chapter 2 Establishing Purpose and Need
• Chapter 3 Engaging and Involving Individuals and Communities
• Chapter 4 Leading Self and Others
• Chapter 5 Managing Change: Processes and People
• Chapter 6 Evaluating and Reviewing Integration
• Chapter 7 Working with Service Users and Carers
• Chapter 8 Working with Staff
• Chapter 9 Working with Processes and Systems
• Chapter 10 Sustaining and Improving
• Conclusion
• References
• Resources
• Subject Index
• Author Index