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Still a fine mess? Local government and the NHS 1962 to 2012
- Author:
- WISTOW Gerald
- Journal article citation:
- Journal of Integrated Care, 20(2), 2012, pp.101-114.
- Publisher:
- Emerald
This article examines initiatives taken to promote integration between local government and the NHS, aiming to understand why they have achieved consistently disappointing results. Based on an historical overview drawn from official documents and empirical research from the time of the creation of the NHS in 1948, it focuses on the principles shaping the reorganisations of 1974. The author suggests that the fundamental sources of integration barriers today lie in the foundational principles of basing their responsibilities on the skills of providers rather than the needs of service users and their organisational forms on separation rather than interdependence. In conclusion, a thorough analysis should be conducted of whether a free-standing national organisation still provides the most appropriate structure for delivering health services in light of changing needs, care models, and resources.
Integration and the NHS reforms
- Author:
- WISTOW Gerald
- Journal article citation:
- Journal of Integrated Care, 19(4), 2011, pp.5-13.
- Publisher:
- Emerald
Government proposals for the NHS announced in 2010 in the White Paper Equity and Excellence: Liberating the National Health Service, included proposals for integration of health and social care services and more effective relationships between the NHS and local government. This paper outlines the proposals and legislative framework for integration initiated by the White Paper, and aims to consider whether the framework is likely to be more successful than previous frameworks. It sets out 10 principles of integration identified in a review of historical evidence of arrangements and experiences of joint working between local government and the NHS, and uses these principles to analyse the White Paper proposals. The author concludes that there is a relatively good fit between the principles of integration and the proposals, but reports that gaps were identified and implementation difficulties are already becoming evident (for example in respect of the tension between localism and national accountability).
Connected care re-visited: Hartlepool and beyond
- Authors:
- BRUCE Gemma, WISTOW Gerald, KRAMER Richard
- Journal article citation:
- Journal of Integrated Care, 19(2), April 2011, pp.13-21.
- Publisher:
- Emerald
This article looks at the progress of Hartlepool’s Connected Care, a model for involving the community in the design and delivery of integrated health and well-being services. Implementation of a new community-led social enterprise in Hartlepool began in 2007, and today its Connected Care service provides community outreach, information, access to a range of health and social care services, advocacy, co-ordination and low-level support. Key lessons have centred on the value of making the case for service redesign from the bottom-up and building the capacity of the community to play a role in service delivery. It also promotes strong leadership within commissioning organisations to build top-down support for the implementation of outcomes defined through intensive community engagement. The new Government's localism agenda creates new opportunities for community-led integration, and the Connected Care pilots provide insight into how this might be successfully implemented.
Anticipating the new Health Act: messages from the innovation forum
- Authors:
- WISTOW Gerald, HENDERSON Catherine
- Journal article citation:
- Journal of Integrated Care, 18(5), October 2010, pp.4-14.
- Publisher:
- Emerald
Nine councils in the Innovation Forum for high performing local authorities voluntarily set a target of reducing unscheduled hospital bed days for people aged over 75 years by 20% over the 3 years to 2006/07. The aim was to reduce their hospital stays so that they could retain their independence and experience a better quality of life. The prospectus for the project ‘improving the future for older people’ (IFOP) was drawn up by Kent County Council and the Department of Health with inputs from other participating councils. It adopted a whole-systems perspective on needs and outcomes. The councils were required to use their commissioning expertise and their local networks to promote community health and well-being, to maintain independent living and to improve care and treatment services. Each council and its partners initiated the service developments they judged necessary to achieve the headline target. Progress was assessed for the group as a whole. Five types of project accounted for more than half the total: expansion of intermediate care services; case management of chronic conditions; falls prevention; improving care pathways from hospital to community; and supporting care homes with health staff. The headline target was exceeded by all the councils and their partners. The authors comment that this success supports the new NHS White Paper’s proposed transfer of functions and responsibilities from Primary Care Trusts (PCTs) to councils. It suggests that councils can successfully adopt, in appropriate circumstances, the lead responsibility for ensuring strategic coordination of place-based commissioning in health and well-being.
Connected care in Hartlepool re-visited: can a holistic and community-centred approach survive implementation?
- Authors:
- WISTOW Gerald, GALLAGHAN Gill
- Journal article citation:
- Journal of Integrated Care, 16(2), April 2008, pp.5-14.
- Publisher:
- Emerald
The Hartlepool connected care project aims to pilot an integrated approach to community well-being at ward level through partnerships between residents, community associations and formal services. It aims to bring together health and social care services, with housing, education, employment and community safety. This article is the second which the Journal of Integrated Care has published about the Hartlepool connected care pilot. It seeks to understand the barriers encountered as the pilot sought to implement a service model based on an audit of local needs and ambitions. It identifies the need for support outside the local policy systems if holistic, community-based initiatives are to be initiated and implemented. In addition, it considers some of the implementation dilemmas that the pilot posed for local agencies and that it had itself to face and resolve during this phase of development.
Connected care in Hartlepool: from origins towards reality
- Authors:
- WISTOW Gerald, CALLAGHAN Gill
- Journal article citation:
- Journal of Integrated Care, 14(6), December 2006, pp.11-18.
- Publisher:
- Emerald
Hartlepool's connected care pilot is a partnership between residents, councillors, Turning Point, the NHS and the local council in one of the most deprived wards in England. A local audit was conducted by residents, demonstrating the relevance of information held by the community about its needs, ambitions and interactions with services. The new service model aims to provided integrated responses to complex need, commissioned through a local partnership agreement and delivered through a social enterprise. The implementation will demonstrate how far real power is shifting to local people.
Learning from doing: implications of the Barking and Dagenham experience for integrating health and social care
- Authors:
- WISTOW Gerald, WADDINGTON Eileen
- Journal article citation:
- Journal of Integrated Care, 14(3), June 2006, pp.8-18.
- Publisher:
- Emerald
This article reports on an initiative between local government and the NHS in Barking and Dagenham in 2001 to integrate health and social care management structures. Although it was not sustained, the experience provides an important source of learning in improved partnership working. It particular it demonstrates that the route to better outcomes depends on managing not only the tension between structure and culture, but also that between national targets and local discretion in services based on fundamentally different principles of governance: central management and local accountability.