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Multidisciplinary teams: Integrating care in places and neighbourhoods
- Author:
- MILLER Robin
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2022
- Pagination:
- 10
- Place of publication:
- London
Multidisciplinary teams (MDTs) are central to achieving the vision of Integrated Care Systems (ICSs) as they are a structured forum in which practitioners from across health and social care can come together around the needs of individuals and communities. This briefing highlights the key elements of MDTs; what they aim to achieve; the evidence on MDTs; what makes them work effectively; and good practice examples. MDTs need to have a clear role and purpose, be well led and organised, have sufficient diversity of professions and disciplines, and be supported by an enabling infrastructure. MDTs must be pro-active in how they engage individuals and families in their discussions and decision making. MDTs should also connect with other services and teams in their neighbourhoods and place. (Edited publisher abstract)
Transforming integration through general practice: learning from a UK primary care improvement programme
- Author:
- MILLER Robin
- Journal article citation:
- International Journal of Integrated Care, 18(2), 2018, p.13. Online only
- Publisher:
- International Foundation for Integrated Care
This article addresses the challenge of how to implement integration within primary care services. It shares learning from a UK based improvement programme which reflected international interest in transferring activities from hospital and community and developing holistic primary care that responds to the needs of the local community. Programme components included additional per capita funding for involved practices, monthly learning sets between pilot leads, and a formative evaluation. Practices had flexibility in how to use the additional funding to meet local needs and were selected through a competitive process. The programme successfully delivered diagnostic and treatment activities previously provided in acute hospital. Some practices also introduces new holistic approaches which were mostly sustained at the end of the twelve month period. The programme demonstrates that transformation of primary care requires a change in the internal paradigms held by clinicians and purchasers, careful design of learning opportunities, responding to multiple levels of motivation, and deployment of relevant change infrastructures and improvement methodologies. (Edited publisher abstract)
Reducing emergency hospital admissions: what is the role of social care? Strategic briefing
- Author:
- MILLER Robin
- Publisher:
- Research in Practice for Adults
- Publication year:
- 2017
- Pagination:
- 20
- Place of publication:
- Dartington
This briefing looks at the factors that influence emergency admission rates and the role of adult social care in preventing emergency admissions to hospital. It explores how services can adopt strengths-based approaches when working with older people. It also builds an understanding of how preventable factors, such as loneliness, contribute to hospital admissions. Case studies demonstrate how these approaches have been used successfully in practice. It also discusses the concept of 'avoidable' and presents four comprehensive models of hospital avoidance. It concludes by outlining implications for social care commissioning and workforce. The briefing is intended for senior managers, service leads and commissioners. (Edited publisher abstract)
Crossing the cultural and value divide between health and social care
- Author:
- MILLER Robin
- Journal article citation:
- International Journal of Integrated Care, 16(4), 2016, Online only
- Publisher:
- International Foundation for Integrated Care
Collaboration between health and social care services is vital if we are to truly provide integrated care. Whilst structural barriers based on policy frameworks, resource availability and organisational difference contributes to fragmentation between these sectors, it is the clashes in organisational cultures and values that can often be the most divisive. Only by being honest about our own values and the underlying assumptions that they reflect, and by being willing to challenge ourselves and others about unhelpful cultures that have developed can we ensure integration that draws successfully on both sectors. The paper argues that while there are a number of opportunities, including inter-professional learning, that may help crossing the divide they require professionals within health and social care to accept their individual responsibilities, to reflect on and where necessary confront their own values, and to be a positive contributor to a more collaborative culture even if this means going against existing cultures and traditions. (Edited publisher abstract)
Commissioning, outcomes and consortia: ten key questions for commissioners and third sector organisations from the carers tender in Birmingham
- Author:
- MILLER Robin
- Publisher:
- University of Birmingham. Health Services Management Centre
- Publication year:
- 2015
- Pagination:
- 29
- Place of publication:
- Birmingham
This report seeks to share learning from a Birmingham City Council tender for a consortium to provide carers services in March 2014. The tender was won by Midland Mencap who plan to launch a new social enterprise to undertake the integrator role. To fulfil their duties as the key commissioners of adult social care services under the Care Act, Local Authorities are encouraged to consider ‘emerging ideas and best practice’. One such idea which is receiving increasing interest is tendering with a consortium of providers rather than with multiple single agencies. The evidence for such arrangements is still evolving, with a call for experiences to be shared so a body of practice knowledge can be established. The focus of the report is on the procurement process (including the underpinning rationale for this approach, the establishment of the consortium, and the selection of the successful supplier) and the initial mobilisation of the contract. The document ends with ten key questions for other localities considering consortia arrangements. (Edited publisher abstract)
Changing organisational culture: another role for self-advocacy?
- Author:
- MILLER Robin
- Journal article citation:
- Tizard Learning Disability Review, 20(2), 2015, pp.69-76.
- Publisher:
- Emerald
Purpose: Improvements in organisational culture are a common recommendation of enquiries into system failure and an aspiration of policy. The purpose of this paper is to explore an initiative to change culture in a low-secure service for men with a learning disability and mental health needs through the introduction of a self-advocacy group. Design/methodology/approach: An independent evaluation was carried out by a university research team. A theory-based methodology was deployed with qualitative data gathered through observations, interviews and focus groups. Findings: Culture change was reported by senior managers and clinicians in relation to the transparency of the service, decision making regarding resources, and engagement of patients in redesign. Self-advocacy group members reported a different relationship with senior management which in turn enabled greater influence in the organisation. Achieving these impacts relied on independent and skilled external facilitation, support from senior managers, and a calm and democratic atmosphere in the meetings. Ward staff were kept at an arms-length from the group and were less certain that it had made any difference to the way in which the ward operated. Research limitations/implications: The research was only based in one organisation and the impacts of the initiative may vary with a different local context. Research in a wider sample of organisations and culture change initiatives will provide greater insights. Practical implications: Self-advocacy groups can lead to organisation culture change alongside benefits for individual group members but require funding, external and independent facilitation, and organisational endorsement and support. (Edited publisher abstract)
Is integration or fragmentation the starting point to improve prevention?
- Author:
- MILLER Robin
- Publisher:
- University of Birmingham. Health Services Management Centre
- Publication year:
- 2014
- Pagination:
- 19
- Place of publication:
- Birmingham
The importance of health, social care and other sectors working together has been recognised for many decades by governments of all political persuasion. This is true within the current policy environment, in which integration has been proposed as the binding force to connect an increasingly diverse range of providers around individual patients and their families. Initiatives to promote integration are being introduced at all levels of the system, with a patient experience based narrative setting the standard against which success should be judged. This integration is being encouraged not only in respect of statutorily funded clinical, public health and social care services but also with other policy areas such as housing and leisure and other sectors (in particular the third sector). Despite this continued belief in policy that integration will lead to a more preventative focus, there is not a strong research base to support this view. However, accepting the limitations of the evidence base, this Policy Paper looks at five key lessons which can still be drawn for national policy makers with responsibility for promoting integration and prevention. These are to: start with what is fragmented; be clear what is meant (by integration); know what success looks like; understand the impact; and be wary of further change. The paper draws attention to key findings from reviews of integrated care; and notes that the interventions that have been most effective have been those with more preventative approaches. It concludes that patients and service users have to integrate support from statutory services, community resources and their personal networks to improve their quality of life and maintain their health and independence. To understand how and when to integrate, we first need to be clear what links are required and how they could operate in practice. That is why fragmentation rather than integration should be the starting point to achieve a prevention orientated health and social care system. This policy paper is based on a discussion paper which was commissioned by the Institute for Social Change at Manchester University as part of a series of Knowledge Exchange Trials workshops which brought together academics, policy makers and programme stakeholders to facilitate exchange of ideas, expertise and research. (Edited publisher abstract)
Third sector organisations: unique or simply other qualified providers?
- Author:
- MILLER Robin
- Journal article citation:
- Journal of Public Mental Health, 12(2), 2013, pp.103-113.
- Publisher:
- Emerald
Based on a review of the literature, this article examines the third sector's role in mental health care and commissioning of third sector organisations. The third sector has been promoted by progressive English governments as a provider of health and social care services for people with mental health difficulties. This article aims to consider the assumptions that lie behind these polices and reviews the evidence that third sector organisations can be said to have a “unique” role and approach. The challenges and opportunities of the current market-based reforms for the third sector are discussed. The review found the third sector delivers a range of mental health services in England, in particular those related to accommodation, advice, advocacy and employment. Its activity extends into other roles such as campaigning and development of new approaches to care and support. Evidence of the distinctiveness of the sector as a whole is limited, but there are examples of such organisations providing innovative and user-led services. Market-based reforms are seen as posing a threat to smaller organisations in particular but personalised approaches (including allocation of individual budgets), outcome-based payments and a need for large-scale service redesign are seen as offering considerable opportunity for expansion. For the new market to include a strong third sector will require leadership within organisations, a collaborative approach within the sector, and commissioners that understand and engage positively with the sector in all its diversity. (Edited publisher abstract)
Ten lessons for integrated care research and policy – a personal reflection
- Authors:
- GLASBY Jon, MILLER Robin
- Journal article citation:
- Journal of Integrated Care, 28(1), 2020, pp.41-46.
- Publisher:
- Emerald
In January 2019, the University of Birmingham hosted a one-day workshop organised by the Journal of Integrated Care and the Integrated Care Researcher Network. This article offers some personal reflections from the author about the key lessons for integrated care research and policy. (Edited publisher abstract)
What the evidence tells us about improving urgent care for older people: a literature review to support the independent Commission on Improving Urgent Care for Older People
- Authors:
- APPLETON Steve, MILLER Robin
- Publisher:
- NHS Confederation
- Publication year:
- 2016
- Pagination:
- 32
- Place of publication:
- London
Reports on a literature review commissioned by the Commission on Improving Urgent Care for Older People to identify factors that deliver better outcomes and success in the improvement of urgent care for older people. Specifically the review aimed to identify current national policy for improving urgent care in both health and social care; relevant national guidance; and examples of research, best practice and innovation. The findings are presented around the themes of: demographics and the population of older people; what is meant by urgent care; the needs of older people, including needs related to multiple long term conditions; the capacity of urgent care, workforce; what works in the current NHS and Adult Social Care system. The review found limited evidence relating specifically to older people in relation to urgent care. It also identified a lack of consensus on what the term ‘urgent care’ means. Factors identified as influencing the effectiveness of urgent care delivery for older people included workforce/skill mix, competence in working with older people and awareness of their particular needs, integration, appropriateness of admission, pre-admission support, effective and safe discharge, the role of social care and capacity. The report also noted that the value of the role of community-based services, including social care, the voluntary sector, ambulatory services and of nursing and residential care homes is sometimes overlooked.