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Transformation of payment by results in mental health: ensuring a recovery focused and socially inclusive system
- Authors:
- DENHAM-VAUGHAN Sally, CLARK Michael
- Journal article citation:
- Mental Health and Social Inclusion, 16(3), 2012, pp.155-158.
- Publisher:
- Emerald
This article discusses the process of assessment within the developing model of care clusters for mental health being implemented in England as a potential basis for a payment by results (PbR) system. Assessment determines the care package individuals receive from services. Hence, assessment needs to be thorough and holistic and, it is argued, grounded in the philosophy upon which all care processes should be based. An innovative approach of recovery focused conversations is outlined to help ensure assessment processes in PbR are fit for purpose. Care clusters present opportunities to deliver high quality care, actively engaging people in their care and supporting their recovery. Further means are required to operationalise all the desirable ingredients of what care is delivered and how it is done. RFCs are outlined as an addition to the care cluster to ensure that care planning starts from a co-produced understanding between professionals and service users.
Putting personalisation and integration into practice in primary care
- Authors:
- CLARK Michael, et al
- Journal article citation:
- Journal of Integrated Care, 21(2), 2013, pp.105-120.
- Publisher:
- Emerald
Purpose: The purpose of this article is to discuss the policy developments of integration and personalisation within the context of Primary Care, specifically an innovative Memory Service provided within a General Practice. It examines how these policies work together in this context to deliver a high quality service that is responsive to individual needs in an area of care: memory disorder or dementia, which has often relied heavily on secondary care services. Design/methodology/approach: The article is a case study analysis of integration and personalisation in Primary Care, allowing for examination and elaboration of both concepts as applied in this setting; and their contribution to a better quality care Memory Service. Findings: The innovative Memory Service operates as a person-centred facility, integrating into the surgery, expertise that would traditionally be locked into secondary care health services. It makes maximum use of locally available knowledge of the patient, their family and formal and informal sources of support and therapy through links which cross agency boundaries. These links are identified and utilised in tailored support for individuals by the practice-based Dementia Advisor. Outcomes include improved dynamics of identification, diagnosis and after care, high satisfaction amongst patients and families and reduced utilisation and expenditure of other healthcare facilities. Practical implications: Personalisation and integration can be united in the development of innovative and improved Memory Services centred in Primary Care. Social implications: Maintaining a focus on the needs of people within their social contexts (being person-centred) is a powerful means of driving better integrated care in Primary Care for people living with dementia and related disorders. Originality/value: This is the first examination of personalisation and integration as coupled concepts to lead the improvement of care, specifically a Memory Service, in Primary Care. (Edited publisher abstract)
Homelessness and integrated care: an application of integrated care knowledge to understanding services for wicked issues
- Authors:
- CLARK Michael, et al
- Journal article citation:
- Journal of Integrated Care, 30(1), 2022, pp.3-19.
- Publisher:
- Emerald
Purpose: People experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wicked policy issue. The purpose of this paper is to examine the challenge of integrating care in this context using evidence from an evaluation of English hospital discharge services for people experiencing homelessness. Design/methodology/approach: The paper undertakes secondary analysis of qualitative data from a mixed methods evaluation of hospital discharge schemes and uses an established framework for understanding integrated care, the Rainbow Model of Integrated Care (RMIC), to help examine the complexities of integration in this area. Findings: Supporting people experiencing homelessness to have a good discharge from hospital was confirmed as a wicked policy issue. The RMIC provided a strong framework for exploring the concept of integration, demonstrating how intertwined the elements of the framework are and, hence, that solutions need to be holistically organised across the RMIC. Limitations to integration were also highlighted, such as shortages of suitable accommodation and the impacts of policies in aligned areas of the welfare state. Research limitations/implications: The data for this secondary analysis were not specifically focussed on integration which meant the themes in the RMIC could not be explored directly nor in as much depth. However, important issues raised in the data directly related to integration of support, and the RMIC emerged as a helpful organising framework for understanding integration in this wicked policy context. Practical implications: Integration is happening in services directly concerned with the discharge from hospital of people experiencing homelessness. Key challenges to this integration are reported in terms of the RMIC, which would be a helpful framework for planning better integrated care for this area of practice. Social implications: Addressing homelessness not only requires careful planning of integration of services at specific pathway points, such as hospital discharge, but also integration across wider systems. A complex set of challenges are discussed to help with planning the better integration desired, and the RMIC was seen as a helpful framework for thinking about key issues and their interactions. Originality/value: This paper examines an application of integrated care knowledge to a key complex, or wicked policy issue. (Edited publisher abstract)