Search results for ‘Subject term:"integrated services"’ Sort:
Results 1 - 10 of 13
Working in teams
- Authors:
- JELPHS Kim, DICKINSON Helen, MILLER Robin
- Publisher:
- Policy Press
- Publication year:
- 2016
- Pagination:
- 144
- Place of publication:
- Bristol
- Edition:
- 2nd ed.
This revised edition brings together cutting-edge thinking about team working, and considers how this can be turned into practice within the context of interagency settings. Working in teams sounds simple but the reality is often more difficult within complex health and social care systems. The book introduces a range of theories, models and research to demonstrate the benefits – and pitfalls – inherent in team working in collaborative settings. Through real-life examples the guide focuses on how inter-agency teams may be made to function more effectively. (Edited publisher abstract)
Multiple exclusion homelessness: is simplicity the answer to this complexity?
- Authors:
- MILLER Robin, APPLETON Steve
- Journal article citation:
- Journal of Integrated Care, 23(1), 2015, pp.23-34.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore integration and complexity through the evaluation of a case study service which supports multiply excluded homeless people. Design/methodology/approach: A mixed methods theory based evaluation. Data gathering included semi-structured interviews with external stakeholders, analysis of referral and outcome data, focus groups with frontline staff members and managers, and interviews with people living in the service. Findings: The service was highly rated by its stakeholders due to its ability to meet the immediate needs of many individuals and to facilitate access and engagement with community and specialist resources. However, not every individual responded to the support that was an offer, and a number were unable to access the service due to the nature of their needs or a lack of capacity in the service. Whilst the service was able to engage community and specialist services this often appeared to be within the parameters set by these services rather than flexibly around the needs of the individual. Research limitations/implications: The research is based in one case study service and findings may not be transferable to different local contexts and providers. However, the findings are consistent with previous studies. Practical implications: It is possible for commissioners to intervene in the complexities that multiply excluded homeless people experiences through the introduction of a new service. However, this is unlikely to address all of the gaps and fragmentation that people in these circumstances face. It is therefore important that partners are sensitive to such limitations and have a shared willingness to respond to continuing gaps and shortfalls. Social implications: Despite specific national policies people continue to experience multiple exclusion homelessness which suggest that more still needs to be done to prevent people from this extremely disadvantaged social circumstance. Whilst specialist services can provide excellent support the response is still fragmented for some people meaning that work to better integrate their responses must continue. Originality/value: The paper contributes to the evidence base of support models for multiple excluded homeless people and the factors that can enable a housing support service to respond to such needs. It also provides comment on the relevance of the concept of complex adaptive systems to the study of integration. (Publisher abstract)
Mental health commissioning: master or subject of change?
- Authors:
- MILLER Robin, REES James
- Journal article citation:
- Mental Health Review Journal, 19(3), 2014, pp.145-155.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore change within the commissioning of third sector mental health services in England. Design/methodology/approach: A case study methodology based on survey and interview data of a sample of third sector organisations and commissioners within an English conurbation. Findings: Normative commissioning models based on sequential cycles were not fully implemented with the main focus being on the procurement and contracting elements. There were examples of commissioning being an enabler of service improvement but overall it seems to have been limited in its ability to bring about whole system change. Barriers included commissioners’ capacity and competence, ineffectual systems within their organisations, and fragmentation in commissioning processes between user groups, organisations and sectors. Research limitations/implications: The case study conurbation may not represent practice in all urban areas of England and there may be particular issues of difference within rural localities. The view of private and public sector providers and those working in Commissioning Support Units were not sought. Practical implications: To lead whole system change the commissioning function needs to be adequately resourced and skilled with better integration across public sector functions and organisations. Greater emphasis needs to be placed on implementing the full commissioning cycle, including the engagement of relevant stakeholders throughout the process and the practical application of outcomes. Originality/value: This research adds to the limited body of empirical work regarding commissioning in mental health. (Publisher abstract)
Interprofessional workplace learning: a catalyst for strategic change?
- Authors:
- MILLER Robin, et al
- Journal article citation:
- Journal of Interprofessional Care, 28(3), 2014, pp.186-193.
- Publisher:
- Taylor and Francis
The integrated care development programme (ICDP) was a continuing interprofessional educational programme for health and social care managers and commissioners. Multi-professional strategic teams from a single locality participated in university and workplace-based learning activities centred on the development of an integrated business plan to address a local priority for improvement. The evaluation used participant self-assessment, semi-structured interviews and group discussions to assess achievement of expected impacts on the participants, their organisations and partnerships, and patient/service user outcomes. The findings indicate that whilst those employed in management and commissioning roles had considerable experience of working across professional and agency boundaries they derived individual benefits from a workplace IPE programme. The principles of design and delivery developed in pre-registration and clinician/practitioner IPE courses also applied to those working at a more strategic level. Organisational impacts were reported, but 6 months post-programme evidence was not yet available of significant improvements in patient outcomes and /or financial efficiencies. Individual motivation, team dynamics and support from line managers all affected the extent to which individual and organisational impacts were achieved. (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)
The care trust pilgrims
- Authors:
- MILLER Robin, DICKINSON Helen, GLASBY Jon
- Journal article citation:
- Journal of Integrated Care, 19(4), 2011, pp.14-21.
- Publisher:
- Emerald
Using the analogy of the pilgrim fathers and their journey into new territory based on hope, this article reflects on the development and work of English care trusts, the first of which were launched in 2002. The introduction of care trusts was designed to improve partnership working between health and social care by integrating health and social care into a single organisation. Current care trust chief executives were invited to participate in semi-structured interviews exploring their experiences, and the article brings together themes from the interviews with findings from literature and policy review. It summarises the background to care trusts and lists pilots and trusts. It discusses the strengths and weaknesses of the care trust model and looks at future directions in the light of the restructuring of the health care system in England.
Integrated care in local areas
- Authors:
- MILLER Robin, DICKINSON Helen
- Journal article citation:
- Community Care, 25.11.10, 2010, pp.32-33.
- Publisher:
- Reed Business Information
Research published by the Social Policy Research Unit on the quality of local integrated services and the continuity of care for people with long-term neurological conditions are summarised and reviewed. The study aimed to find best practice models and to develop a national benchmarking system to assess the impact of the National Service Framework. A national survey was carried out and six case studies were studied in detail. Three models of best practice were identified: nurse specialists, community interdisciplinary neurological rehabilitation teams and day opportunities. Important contributory factors in people experiencing continuity of care were care co-ordination, specialist expertise, voluntary sector involvement, and timely access.
Time for some home truths: exploring the relationship between GPs and social workers
- Authors:
- MANGAN Catherine, MILLER Robin, COOPER Jeremy
- Journal article citation:
- Journal of Integrated Care, 22(2), 2014, pp.51-61.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the relationship between general practitioners (GPs) and social care professionals by reflecting on a project (the Home Truths project) which sought to improve joint working between general practice and social care though an action-research process. Design/methodology/approach: iMPOWER's Home Truths project involved gathering local data regarding joint working in local areas and using this data as a catalyst for change. The Institute of Local Government Studies and the Health Services Management Centre at the University of Birmingham were asked to act as a critical friend to the project. This involved supporting the design of the data collection, offering advice on the process and to carrying out a short evaluation of the impact of the first wave. The paper reflects on the collected data from the sites and information from the impact evaluation. Findings: The paper highlights the poor quality of the relationship between GPs and social workers. Findings that illustrate this include GPs’ poor knowledge of social care services; a perception that social care services were of poor quality and rating the quality of their relationships with social workers as poor. However GPs felt that knowing more about social care could help prevent their patients going into residential care earlier than necessary and wanted to work more closely with social care to exploit the benefits and opportunities. The interventions that have been put in place to try and improve relationships focus on the day-to-day working lives of the professionals rather than attempting to introduce new initiatives. Research limitations/implications: The response rate from GPs in the areas was low (average response rate was 10 per cent in each area) and it may be that only those GPs who are interested in working with social care responded. The initiatives that have been developed appear to be reasonable responses to the issues identified. However, a lack of discrete outcomes through which to measure improvement will make it difficult to demonstrate the impact of the interventions. Originality/value: This paper underlines that despite many years of policy makers promoting better integration, the relationship between the key gate-keepers within the health and social care systems is still poor. The findings from the Home Truths surveys and action plans has gone some way to address the gap identified in the evidence base about the relationships between GPs and social workers. (Publisher abstract)
New conversations between old players? The relationship between general practice and social care in an era of clinical commissioning
- Authors:
- GLASBY Jon, MILLER Robin, POSANER Rachel
- Publisher:
- NIHR School for Social Care Research
- Publication year:
- 2013
- Pagination:
- 41
- Place of publication:
- London
General practice and adult social care will have to overcome a number of challenges to forge the type of strategic relationships that are needed, now that GPs have taken over the lead role in commissioning local NHS services through Clinical Commissioning Groups (CCGs). Researchers at the University of Birmingham’s Health Services Management Centre conducted this scoping review of evidence on joint working, which highlights some key issues to be resolved, including the practical difficulties of engaging GPs in inter-agency collaborations; a lack of mutual understanding; different priorities and geographical boundaries; and turbulent policy contexts in both sectors. this review looks at evidence on ‘integrated working’, at practice or operational team levels in relation to individuals and their families, and ‘partnership working’, at organisational or strategic levels in relation to the needs of populations or sub-groups of populations. In the context of integrated working, the research suggests that GPs and social workers often do not understand the other profession’s unique role, responsibilities and perspectives. In order for the key players to engage with each other, formal (e.g. shared forums) and informal (e.g. networking) opportunities are required. The report comprises an examination of the key terms (primary care, adult social care, integration and partnership); what is known from previous research; key themes form the literature and from interviews; and implications for policy, practice and research. The review identified nine empirical studies, none of which contained much information about costs and savings; and there remains insufficient evidence to know what impact joint working might have on future spending. The interviews conducted identified that recent changes have created opportunities for new relationships, but that progress may be difficult in a very complex policy environment. This review suggests that more opportunities need to be given for GPs and social workers to understand their respective roles and professional perspectives, in order to develop a reciprocal acceptance of their differing practice, financial and performance contexts. (Edited publisher abstract)
Singing from the same hymn sheet? commissioning of preventative services from the third sector
- Authors:
- MILLER Robin, et al
- Journal article citation:
- Journal of Integrated Care, 21(5), 2013, pp.288-299.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the delivery of preventative services for older people from third sector organisations (TSOs) and the extent to which current commissioning arrangements enables the aspirations of policy to be achieved. Design/methodology/approach: Semi-structured interviews with key-contacts within a sample of TSOs which had been identified by directors of Adult Social Services as delivering one of the top three preventative interventions in their local authority area. Findings: There was evidence of considerable trust between local authorities and TSOs and as a consequence TSOs were given autonomy to develop holistic and integrated models of delivery that supported rather than diverted the TSOs’ core missions. Both sectors found it difficult to set target outcomes and connected performance frameworks for preventative services. As a consequence a major element of the commissioning cycle is not being completed and TSOs cannot be confident that they are using their resources as effectively as possible. Research limitations/implications: This study was based in one English region, and would benefit from being extended to other English regions and home nations. Practical implications: Universities, policy makers, commissioners and the third sector need to work together to develop common outcome frameworks for preventative services and to gather consistent data sets that can be more easily synthesised to give a “realistic” understanding of the impact of different interventions and delivery models. Originality value: The paper contributes to the limited evidence bases of commissioning of TSOs and preventative services. (Publisher abstract)