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One person, one team, one system: report of the Independent Commission on Whole Person Care
- Authors:
- OLDHAM John, INDEPENDENT COMMISSION ON WHOLE PERSON CARE
- Publisher:
- Independent Commission on Whole Person Care
- Publication year:
- 2014
- Pagination:
- 92
- Place of publication:
- London
In April 2013, the Labour Party invited Sir John Oldham to form the Independent Commission on Whole-Person Care, to make recommendations about how we can integrate health and care services within existing resources, and without another reorganisation. This report sets out a blueprint for bringing health and care services into the 21st century. It details the major challenges for health and social care that necessitate whole-person, integrated care; and provide examples (UK and international) on how best to integrate physical and mental health and social care, It considers how we might ensure responsive, accountable services that empower users, their families and local communities - including as co-producers - of their own health and care. It outlines the development needs of the workforce and service providers necessary to achieve integrated care; and identifies the steps for moving from the current system to one where coordinated and fully integrated care is the norm., and without major structural change and within existing resources. The Independent Commission’s findings will inform Labour’s policy-making work and that of its Health and Care Policy Commission. Case studies are used throughout the report to reflect people’s good and bad experiences of care, which are based on true stories and real people, but some features have been changed to protect anonymity. (Edited publisher abstract)
Will the real “Mrs Smith” please stand up: a critical examination of the role of vignettes in integrated service development and delivery
- Authors:
- GEORGE Thomas, et al
- Journal article citation:
- Journal of Integrated Care, 29(3), 2021, pp.254-261.
- Publisher:
- Emerald
Purpose: To explore the use of fictitious vignettes representing older people and the extent to which they serve as an effective resource in developing service provision and transforming health and social care. Design/methodology/approach: Based on a critical review of research and academic discourse. Findings: Fictitious vignettes or case studies of older adults, such as “Mrs Smith”, may be a useful means to promote communication with and between health and social care colleagues about current services and transforming or re-organising service provision. However, we argue that while there may be a role for vignettes, care should be taken in their use. The potential to “homogenise” older people into the “typical” patient personified by Mrs Smith may do very little to challenge age- based stereotypes and assumptions. Moreover, vignettes cannot match the potential value and importance of older men and women directly participating in the evaluation and development of services. Practical implications: This article argues that changing the way services are organised and delivered must be underpinned by critical reflection of the assumptions which underpin attitudes towards old age, including our tendency to define older people by chronological age and to homogenise “the elderly” into a single group. The value of participatory methods which meaningfully involve older citizens in both evaluating and planning services could contribute significantly to innovation in service development. Social implications: This paper highlights the critical importance of challenging age-based stereotypes and ageist policy and practice. Recognising old age as being characterised by diversity and difference could challenge the tendency to see old age, especially advanced old age, as an inevitable problem. Originality/value: This article offers a critical perspective on the use of vignettes. (Edited publisher abstract)
Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review
- Authors:
- ANAM Ahmed, et al
- Journal article citation:
- BMJ Open, 11(4), 2021, p.e043280. Online only
- Publisher:
- BMJ Publishing Group
Objective: To identify the relationships between the context in which integrated care programmes (ICPs) for community-dwelling frail older people are applied, the mechanisms by which the programmes do (not) work and the outcomes resulting from this interaction by establishing a programme theory. Design: Rapid realist review. Inclusion criteria: Reviews and meta-analyses (January 2013–January 2019) and non-peer-reviewed literature (January 2013–December 2019) reporting on integrated care for community-dwelling frail older people (≥60 years). Analysis: Selection and appraisal of documents was based on relevance and rigour according to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards criteria. Data on context, mechanisms, programme activities and outcomes were extracted. Factors were categorised into the five strategies of the WHO framework of integrated people-centred health services (IPCHS). Results: 27 papers were included. The following programme theory was developed: it is essential to establish multidisciplinary teams of competent healthcare providers (HCPs) providing person-centred care, closely working together and communicating effectively with other stakeholders. Older people and informal caregivers should be involved in the care process. Financial support, efficient use of information technology and organisational alignment are also essential. ICPs demonstrate positive effects on the functionality of older people, satisfaction of older people, informal caregivers and HCPs, and a delayed placement in a nursing home. Heterogeneous effects were found for hospital-related outcomes, quality of life, healthcare costs and use of healthcare services. The two most prevalent WHO-IPCHS strategies as part of ICPs are ‘creating an enabling environment’, followed by ‘strengthening governance and accountability’. Conclusion: Currently, most ICPs do not address all WHO-IPCHS strategies. In order to optimise ICPs for frail older people the interaction between context items, mechanisms, programme activities and the outcomes should be taken into account from different perspectives (system, organisation, service delivery, HCP and patient). (Edited publisher abstract)
A “behind-the-scenes” look at interprofessional care coordination: how person-centered care in safety-net health system complex care clinics produce better outcomes
- Authors:
- BROOKS E. Marshall, WINSHIP Jodi M., KUZEL Anton J.
- Journal article citation:
- International Journal of Integrated Care, 20(2), 2020, Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: While the effectiveness of team-based care and wrap-around services for high utilizers is clear, how complex care clinics deliver effective, person-centered care to these vulnerable populations is not well understood. This paper describes how interactions among interprofessional team members enabled individualized, rapid responses to the complex needs of vulnerable patients at the Virginia Commonwealth University Health System’s Complex Care Clinic. Methods: Researchers attended twenty weekly care coordination meetings, audio-recorded the proceedings, and wrote brief observational field notes. Researchers also qualitatively interviewed ten clinic team members. Emergent coding based on grounded theory and a consensus process were used to identify and describe key themes. Results: Analysis resulted in three themes that evidence the structures, processes, and interactions which contributed to the ability to provide person-centred care: team-based communication strategies, interprofessional problem-solving, and personalized patient engagement efforts. Conclusion: The study suggests that in care coordination meetings team members were able to strategize, brainstorm, and reflect on how to better care for patients. Specifically, flexible team leadership opened an inter-disciplinary communicative space to foster conversations, which revealed connections between the physical, and socio-emotional components of patients’ lives and hidden factors undermining progress, while proactive strategies prevented patient’s rapid deterioration and unnecessary use of inappropriate health services. (Edited publisher abstract)
Social work: essential to integration. Advice note
- Author:
- COOPER Adi
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2017
- Pagination:
- 13
- Place of publication:
- London
This Advice note aims to support local and regional health and social care integration initiatives by explaining the contribution that social workers can make to integration. It outlines how social work is essential to the whole system and describes the necessity of support to ensure integration succeeds in providing the services that local people need. It highlights the skills that social workers can bring to integrated approaches, which include the promotion of strength and asset based approaches, ensuring services are delivered by ‘teams around the person’, and bringing risk enabling approaches, alongside risk management. It lists some key factors that support social work in integrated approaches and includes ‘top tips’ for Directors of Adult Social services and for principal social workers to assist in progressing the integration agenda. The document was developed in collaboration with the Association of Directors of Adult Social Services, the Principal Social Workers’ Network and the Department of Health. (Edited publisher abstract)
Achieving integrated care through CAS thinking and a collaborative mindset
- Authors:
- EDGREN Lars, BARNARD Keith
- Journal article citation:
- Journal of Integrated Care, 23(3), 2015, pp.108-119.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to contribute to knowledge by exploring and distilling how providers in health and social care who have adopted complex adaptive systems thinking (CAS thinking) and have a collaborative mindset are in a better position to achieve integrated care than those who adopt reductionist approaches. Design/methodology/approach: This paper is a research review and a conceptual analysis of key aspects drawn from the literature on CAS thinking and collaborative mindset applied to integrated care. By choosing this approach the authors intend to promote understanding and efforts made to put it into action. The intended audience comprises managers responsible for addressing the problem of fragmentation and the research community challenged by the task of supporting those managers. Findings: Specialisation of knowledge and skill has increased the risk of fragmentation. It is possible to reduce that risk and hence to foster integrated care when providers with different specializations stimulated by a collaborative mindset develop an understanding of how they connect with others in a CAS. The essence of CAS thinking applied to integrated care is the readiness to connect. This readiness is facilitated by adopting a collaborative mindset. Originality/value: Literature on CAS thinking and collaborative mindset have evolved independently of one another. The study points at the importance of connecting the two concepts to produce effective action (Publisher abstract)
Piecing it together: effective scrutiny of health and social care integration
- Authors:
- CENTRE FOR PUBLIC SCRUTINY, LOCAL GOVERNMENT ASSOCIATION
- Publisher:
- Centre for Public Scrutiny
- Publication year:
- 2015
- Pagination:
- 11
- Place of publication:
- London
This report summarises key lessons and messages from scrutiny inquiry days held in conjunction with Devon County Council, South Tyneside Council and Wiltshire Council, supported by the Local Government Association (LGA) and Centre for Public Scrutiny (CfPS). The inquiry days assessed the current role of scrutiny in the development of local plans for integration and how this can be improved in the future. Integration is arguably the greatest policy priority facing those who plan and deliver health and social care services. Councils are central to making integration a reality, working with clinical commissioning groups (CCGs) and providers of health and social care services to establish a shared framework for delivering seamless health and social care. The report suggests that scrutiny of integration can be valuable to councils, commissioners, providers and people who use services by: improving the evidence base for decisions about integration; holding councils, commissioners and providers to account for the level of local ambition to improve health and integrate services; and reviewing practical as well as financial impacts of integration. The overarching conclusion is that scrutiny is most effective and influential when health and wellbeing boards, commissioners/providers and voluntary and community organisations and scrutiny itself adopt a partnership approach based on integration as part of broader action to secure better health for populations. Testing some themes helped the inquiry days focus on some key questions that scrutiny can ask about integration, including: how person-centred is the local approach to integration? Are accountability arrangements for planning and delivering integrated services clear? Is the local approach to integration supported by good evidence? Do integration plans form part of a broader holistic strategy to tackle inequalities and improve health? And do plans for integration have a realistic chance of success and how will that be measured? (Edited publisher abstract)
Can GPs coordinate "whole person care"?
- Author:
- HUDSON Bob
- Journal article citation:
- Journal of Integrated Care, 23(1), 2015, pp.10-16.
- Publisher:
- Emerald
Purpose: As the notion of "integrated care" has received ever greater policy traction, so the idea that a named individual should take responsibility for coordinating the various elements of care for service users has also gained ground. The purpose of this paper is to look at the proposal to hand this role to GPs, examine the policy expectations and explore some of the implementation dilemmas. Design/methodology/approach: Review of policy documents and relevant literature. Findings: That the role of "care coordinator" has rarely succeeded in the past and that there are specific difficulties in expecting GPs to take on the task. Research limitations/implications: Review of existing literature linked to emergent policy - no original research. Originality/value: This is a new application of an enduring policy concept. Currently the literature is thin. (Publisher abstract)
The future is now
- Authors:
- HAM Chris, BROWN Anna
- Publisher:
- King's Fund
- Publication year:
- 2015
- Place of publication:
- London
This digital report brings together examples of innovative practice from England and overseas to provide insight into future ways of changing health care for the better. It draws on the work of Time to Think Differently, a programme that sought to stimulate debate about the radical changes needed for the NHS and social care to meet the challenges of the future. The report, which is highly relevant to the new models of care set out in the NHS Five Year Forward View, focuses on patients, staff and systems and includes a rich variety of video, audio and visual case studies presenting the voices of patients, volunteers, clinicians and managers. It is aimed at anyone working in, or with an interest in, health and social care. (Edited publisher abstract)
Bolder, braver and better: why we need local deals to save public services
- Author:
- PUBLIC SERVICE TRANSFORMATION NETWORK. Service Transformation Challenge Panel
- Publisher:
- Public Service Transformation Network. Service Transformation Challenge Panel
- Publication year:
- 2014
- Pagination:
- 55
This report sets out a framework for the transformation of public services across the country at a greater scale and faster pace. The report defines transformation as radically re-designed approaches to service provision that reduces unit costs and is difficult to reverse. In practice that will mean: people are the focus of delivery, regardless of the organisations providing or commissioning; outcomes for people take priority over output or process targets and measures; frequent users of public services are encouraged to make better choices, mitigate their own costs and contribute to their communities, and services designed to encourage and facilitate responsible behaviour; multi-agency provision of services, virtual and physical co-location are the norm, service silos and duplication are eliminated; and, digital technologies and big data are embedded in the design and delivery of services to improve customer experience. The report makes a number of recommendation a number of recommendations, but call for three fundamental changes: a new person centred approach to help specific groups and individuals with multiple and complex needs; more easily accessible and more flexible funding available to invest in the upfront costs of transformation; and radical improvements in how data and technology are used to provide smarter services. (Edited publisher abstract)