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The organisation, form and function of intermediate care services and systems in England: results from a national survey
- Authors:
- MARTIN Graham P., et al
- Journal article citation:
- Health and Social Care in the Community, 15(2), March 2007, pp.146-154.
- Publisher:
- Wiley
This paper reports the results of a postal survey of intermediate care coordinators (ICCs) on the organisation and delivery of intermediate care services for older people in England, conducted between November 2003 and May 2004. Questionnaires, which covered a range of issues with a variety of quantitative, tick-box and open-ended questions, were returned by 106 respondents, representing just over 35% of primary care trusts (PCTs). The authors discuss the role of ICCs, the integration of local systems of intermediate care provision, and the form, function and model of delivery of services described by respondents. Using descriptive and statistical analysis of the responses, they highlight in particular the relationship between provision of admission avoidance and supported discharge, the availability of 24-hour care, and the locations in which care is provided, and relate their findings to the emerging evidence base for intermediate care, guidance on implementation from central government, and debate in the literature. Whilst the expansion and integration of intermediate care appear to be continuing apace, much provision seems concentrated in supported discharge services rather than acute admission avoidance, and particularly in residential forms of post-acute intermediate care. Supported discharge services tend to be found in residential settings, while admission avoidance provision tends to be non-residential in nature. Twenty-four-hour care in non-residential settings is not available in several responding PCTs. These findings raise questions about the relationship between the implementation of intermediate care, and the evidence for and aims of the policy as part of National Health Service modernisation, and the extent to which intermediate care represents a genuinely novel approach to the care and rehabilitation of older people.
Psychiatric outpatients' experiences with specialized health care delivery: a Norwegian national survey
- Authors:
- OLTEDAL Sigve, GARRATT Andrew, JOHANNESSEN Jan Olav
- Journal article citation:
- Journal of Mental Health, 16(2), April 2007, pp.271-279.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
The measurement of patient experiences and satisfaction is recognized as an important component of health care evaluation, quality indicators, and performance. The aim was to identify factors of importance for perceived patient experiences among psychiatric outpatients. A validated questionnaire was administered as part of a postal survey of 15,422 adult outpatients attending psychiatric outpatient clinics across Norway. 6,677 (43.3%) responded to the survey. Analyses identified significant differences in patients' experiences related to age, gender, education, native language and daily activities. Regression analysis explained 71% of the variance in patient experiences. The three most important predictors of better experiences accounting for 45% of this variation were whether patients could influence the assignment of their own therapist, politeness and respect from the clinical staff and health professionals' cooperation with the patient's family. Patient-centeredness and staff conduct were identified as the most important aspects of health care delivery that should be considered by outpatient clinics wishing to improve patients' experiences of care.
Accounting for joined-up government: the case of intermediate care
- Authors:
- MOORE Jeanette, KEEN Justin
- Journal article citation:
- Public Money and Management, 27(1), February 2007, p.61–68.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
'Joined-up government' policies have been promoted by the government in the since 1997. To date, there have been few empirical studies of the implementation of these policies. This article presents the results of a study of expenditure on intermediate care in England undertaken over two financial years, 2002/3 and 2003/4. It highlights tensions between multi-organizational co-ordination of services on the ground and hierarchical financing and reporting arrangements.
Homecare re-ablement discussion document: executive summary
- Author:
- GREAT BRITAIN. Department of Health. Care Services Efficiency Delivery
- Publisher:
- Great Britain. Department of Health. Care Services Efficiency Delivery
- Publication year:
- 2007
- Pagination:
- 20p.
- Place of publication:
- London
Homecare Re-ablement work seeks to improve choice and quality of life for adults who need care. Through the use of timely and focused intensive interventions, it will maximise long-term independence by appropriately minimising ongoing support required thereby minimising the whole life cost of care. This approach focuses on re-abling people so that they achieve their potential in terms of a stable level of independence with the lowest appropriate level of ongoing support or care. Various examples have been seen and reported whereby focused timely bursts of therapy, intermediate care or homecare can prevent hospital admission or post hospital transfer to long-term care, or appropriately reduce the level of ongoing home care support required
Issues arising for older people at the 'interface' of intermediate care and social care issues
- Author:
- SCOURFIELD Peter
- Journal article citation:
- Research Policy and Planning, 25(1), 2007, pp.57-67.
- Publisher:
- Social Services Research Group
In recent years both the Health Act 1999 and the Health and Social Care Act 2001 have paved the way for the integrated care trusts with the aim of bringing about more flexible, person-centred services for older people. Concern to avoid both unnecessary hospital admissions and so called 'bed-blocking' has led to the expansion of intermediate care services. The National Service Framework for Older People, published in 2001, further articulated these ambitions. Evaluations to date have indicated that, whilst further research is still needed to see whether all the goals have been effectively realised, intermediate care is associated with a range of perceived benefits. However, this paper highlights the fact that, on the ground there remain certain unresolved difficulties at the point where intermediate care ends and where social care begins that needed further consideration before it can be said that services are properly 'joined-up and 'person-centred'. Implications for both practice and policy are considered.
Homecare re-ablement: discussion document
- Author:
- GREAT BRITAIN. Department of Health. Care Services Efficiency Delivery
- Publisher:
- Great Britain. Department of Health. Care Services Efficiency Delivery
- Publication year:
- 2007
- Pagination:
- 114p.
- Place of publication:
- London
Homecare Re-ablement work seeks to improve choice and quality of life for adults who need care. Through the use of timely and focused intensive interventions, it will maximise long-term independence by appropriately minimising ongoing support required thereby minimising the whole life cost of care. This approach focuses on re-abling people so that they achieve their potential in terms of a stable level of independence with the lowest appropriate level of ongoing support or care. Various examples have been seen and reported whereby focused timely bursts of therapy, intermediate care or homecare can prevent hospital admission or post hospital transfer to long-term care, or appropriately reduce the level of ongoing home care support required.
Networks and governance: the case of intermediate care
- Authors:
- MOORE Jeanette, et al
- Journal article citation:
- Health and Social Care in the Community, 15(2), March 2007, pp.155-164.
- Publisher:
- Wiley
The present paper describes a novel approach to the study of services conceptualised as networks. It uses data collected as part of a case study evaluation of intermediate care, a 'joined-up government' policy that was explicitly intended to dissolve the boundaries between health and social care services. The evaluation was undertaken in five localities in England. Routine service use data were collated and standardised for the 12-month period from November 2002 to October 2003. A cohort of 258 service users was recruited during a census month (June 2003), and more detailed data on their personal characteristics and experiences prior to and during their intermediate care episode were collected. Information was obtained for 153 of these people, covering their experience during the 6 months following discharge. A graphical method of depicting individuals' movements between services was devised and a number of measures were used to investigate the network-like features of the data. User outcomes were explored by examining the relationship of characteristics of service users to their location at 6 months after discharge. The results of the analyses show that the five sites were developing service configurations that facilitated transitions between health, social care and other services, and that individual needs were taken into account in the decisions made about which people transferred into which services. While the results cannot be said to show that joined-up government works, they are consistent with the argument that joined-up government goes beyond partnership-type concepts, and in practice, involves the creation of what might be termed integrated service networks.
Homecare re-ablement workstream: retrospective longitudinal study
- Author:
- CARE SERVICES IMPROVEMENT PARTNERSHIP. Care Services Efficiency Delivery Programme
- Publisher:
- Care Services Improvement Partnership. Care Services Efficiency Delivery Programme
- Publication year:
- 2007
- Pagination:
- 36p.
- Place of publication:
- London
Homecare Re-ablement work seeks to improve choice and quality of life for adults who need care. Through the use of timely and focused intensive interventions, it will maximise long-term independence by appropriately minimising ongoing support required thereby minimising the whole life cost of care. This approach focuses on re-abling people so that they achieve their potential in terms of a stable level of independence with the lowest appropriate level of ongoing support or care.
Change and transformation: the impact of an action-research evaluation on the development of a new service
- Authors:
- REID Gaynor, et al
- Journal article citation:
- Learning in Health and Social Care, 6(2), June 2007, pp.61-71.
- Publisher:
- Blackwell
Evaluation is an essential part of service development and quality management and this is especially pertinent when introducing new initiatives. In 2001 a new countywide assessment and rehabilitation Intermediate Care service, consisting of three care management Rehabilitation Link Teams (RLT), was implemented for older people. To monitor the implementation and impact of the service an evaluation study was conducted. The study centred on evaluating team development, interagency working, outcomes from multiple perspectives (client, carer, clinical and service) and the cost effectiveness of the service. Of particular importance to the study was the action-research approach that provided the underpinning philosophy to the study. This paper provides insight into the ways that the action-research approach was used to facilitate learning and change within the organization. To enable this to happen, it was important for the health and social care staff to understand that the researchers’ role was not to judge their role proficiency, but to gather information to facilitate learning and understanding within the organization. It was also vital that the teams being evaluated were provided with regular insight into the emerging study findings and opportunity to address these. Three examples are provided to illustrate how regular information feedback sessions influenced the implementation of the service. Insight is also provided into the participant's views of being evaluated. Although at times, the RLT members found the evaluation burdensome, almost all stated that the action-research approach allowed opportunity for reflection, catharsis and personal action planning. Overall, the action-research approach to evaluation fitted well with the organization's need to learn and change simultaneously, allowing emergent data collection to inform decision making and service and team development.
Organisation and features of hospital, intermediate care and social services in English sites with low rates of delayed discharge
- Authors:
- BAUMANN Matt, et al
- Journal article citation:
- Health and Social Care in the Community, 15(4), July 2007, pp.295-305.
- Publisher:
- Wiley
In recent years, there has been significant concern, and policy activity, in relation to the problem of delayed discharges from hospital. Key elements of policy to tackle delays include new investment, the establishment of the Health and Social Care Change Agent Team, and the implementation of the Community Care (Delayed Discharge) Act 2003. Whilst the problem of delays has been widespread, some authorities have managed to tackle delays successfully. The aim of the qualitative study reported here was to investigate discharge practice and the organisation of services at sites with consistently low rates of delay, in order to identify factors supporting such good performance. Six ‘high performing’ English sites (each including a hospital trust, a local authority, and a primary care trust) were identified using a statistical model, and 42 interviews were undertaken with health and social services staff involved in discharge arrangements. Additionally, the authors set out to investigate the experiences of patients in the sites to examine whether there was a cost to patient care and outcomes of discharge arrangements in these sites, but unfortunately, it was not possible to secure sufficient patient participation. Whilst acknowledging the lack of patient experience and outcome data, a range of service elements was identified at the sites that contribute to the avoidance of delays, either through supporting efficiency within individual agencies or enabling more efficient joint working. Sites still struggling with delays should benefit from knowledge of this range. The government's reimbursement scheme appears to have been largely helpful in the study sites, prompting efficiency-driven changes to the organisation of services and discharge systems, but further focused research is required to provide clear evidence of its impact nationally, and in particular, how it impacts on staff, and patients and their families.