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A survey of access to medical services in nursing and residential homes in England
- Authors:
- GLENDINNING Caroline, et al
- Journal article citation:
- British Journal of General Practice, 52(480), July 2002, pp.545-548.
- Publisher:
- Royal College of General Practitioners
A survey was conducted within the 72 English primary care groups/trusts (PCG/Ts) used in the National Tracker Survey of PCG/Ts to investigate patterns of access to medical services for residents in homes for older people. A structured questionnaire was used to investigate home characteristics, numbers of general practitioners (GPs) or practices per home, homes' policies for registering new residents with GPs, existence of payments to GPs, GP services provided to homes, and access to specialist medical care. Wide variations in the numbers of GPs providing services to individual homes were found and this was not entirely dependent on home size. Eight percent of homes paid local GPs for their services to residents; these were more likely to be nursing homes than residential homes and larger homes. Homes paying local GPs were more likely to receive one or more additional services, over and above GPs' core contractual obligations. Few homes had direct access to specialist clinicians. These extensive variations in homes' policies and local GP services raise serious questions about patient choice, levels of GP services and, above all, about equity between residents within homes, between homes and between those in homes and in the community.
Breaking down barriers: integrating health and care services for older people in England
- Author:
- GLENDINNING Caroline
- Journal article citation:
- Health Policy, 65(2), August 2003, pp.139-151.
- Publisher:
- Elsevier
Like many other post-industrial societies, England is facing demographic and political pressures to reduce the fragmentation of services for older people. Moreover, current government policies emphasise collaboration and ‘partnership’, particularly between health and social care services. Recently, two new policy initiatives have enabled the full integration of services to take place, involving formerly separate health and social care organisations-between family doctors (general practitioners) and community health services, and between health and social services organisations. Both initiatives also allow the pooling of previously separate funding streams. This paper presents findings from evaluations of these two initiatives. Drawing on this evidence, the paper concludes that structural integration can transform preoccupations over narrow sectoral responsibilities and boundaries to a ‘whole systems’ paradigm of service planning and delivery. However, major internal barriers to integration may remain: these include professional domains and identities, and differential power relationships between newly integrated services and professionals. Moreover, the success of these new horizontal, inter-organisational arrangements is profoundly influenced by the wider policy environment and by vertical relationships with national government. Together, these pressures exclude the voices of older people, and therefore call into question whether the considerable organisational upheaval of service integration will be able to deliver the changes valued by older people themselves. (Edited publisher abstract)
Personalisation and partnership: competing objectives in English adult social care? The individual budget pilot projects and the NHS
- Authors:
- GLENDINNING Caroline, et al
- Journal article citation:
- Social Policy and Society, 10(2), April 2011, pp.151-162.
- Publisher:
- Cambridge University Press
This paper discusses inter-sectoral and service partnerships alongside personalised approaches in delivering health and social care in England, where improving collaboration between care services is a long-established objective of social policy. A recent example has been the personalisation of social care for adults and older people through the introduction of individualised funding arrangements. This article examines interviews with lead officers responsible for implementing individual budgets (IBs). It shows how the contexts of local collaboration created problems for the implementation of the personalisation pilots, jeopardised inter-sectoral relationships and threatened some of the collaborative arrangements that had developed over the previous decade. Personal budgets for some health services have subsequently also been piloted. In conclusion, the authors suggest that these will need to build upon the experiences of the social care IB pilots, so that policy objectives of personalisation do not weaken other collaborative accomplishments.
Choice: what, when and why? Exploring the importance of choice to disabled people
- Authors:
- RABIEE Parvaneh, GLENDINNING Caroline
- Journal article citation:
- Disability and Society, 25(7), December 2010, pp.827-839.
- Publisher:
- Taylor and Francis
This paper reports evidence from an ongoing qualitative longitudinal study into the realities of exercising choice about support and related services as experienced by disabled and older people and their families. Findings are reported from the first round of interviews, conducted in 2007-08, with 27 young people (aged 13-21) with degenerative/progressive conditions and 34 of their parents, 30 adults and older people with fluctuating support needs, and 20 adults and older people who had recently experienced the sudden onset of a disabling condition. There was considerable diversity among each of these groups in terms of gender, ethnicity and household composition. Key findings are discussed under the headings of healthcare, equipment, housing and adaptations, education/training, social care, employment, and leisure and transport. Almost all respondents felt that having choice was important, however, this is only meaningful if the choices are ‘real’. The choices considered to be important and the way choice was prioritised was shaped by the respondents age and the nature and severity of their condition and also by previous experience of services, future expectations, the availability of information, individual preferences, family responsibilities and the role of others providing support. The importance of learning over time and how this can shape experiences of choice making was also highlighted. Implications of the findings for policy and practice are discussed.
Progress in partnerships
- Authors:
- GLENDINNING Caroline, et al
- Journal article citation:
- British Medical Journal, 7.7.01, 2001, pp.28-31.
- Publisher:
- British Medical Association
Primary care groups and trusts are expected to develop partnerships with local authorities, particularly for commissioning services and developing services for older people. Reports on the results of a survey which showed that nearly half of the groups and trusts surveyed do not routinely consult with social services when commissioning community health services, and even fewer consult with social services about commissioning acute care. However, relationships between front line social services staff and community based and practice based health professionals are improving.
Buying Independence: using direct payments to integrate health and social services
- Authors:
- GLENDINNING Caroline, et al
- Publisher:
- National Primary Care Research and Development Centre
- Publication year:
- 2000
- Pagination:
- 58p.
- Place of publication:
- Bristol
Shows how disabled people do not make clear distinctions between 'health' and 'social' care. Through direct payments, they are able to control and integrate into their daily routines a wide range of health-related activities, such as physiotherapy and nursing tasks, in ways which offer increased independence and better quality of life, compared with conventional health services. Is extending direct payments to older people and disabled children a shift in the boundary between 'health' and 'social' services? This book explores how direct payments can improve further the integration of services from the perspectives of the users and providers involved.
Rearranging the deckchairs on the Titanic of long-term care: is organizational integration the answer?
- Authors:
- GLENDINNING Caroline, MEANS Robin
- Journal article citation:
- Critical Social Policy, 24(4), November 2004, pp.435-457.
- Publisher:
- Sage
Since 1997 the British government has actively promoted collaboration between health and social care services, culminating in proposals for fully integrated health and social care organizations -called Care Trusts - to address problems in co-ordinating services for older people. This paper draws on historical evidence to examine the origins and development of these difficulties. A consistent theme over the past 50 years has been the changing role of health services in the provision of long-term support for older people and the consequent redefinition of the boundaries between health and social services. However, these changes have largely not been matched by corresponding transfers of resources that might enable social services to meet their increased responsibilities. Moreover, the demands of the acute hospital sector risk marginalizing the social support valued by older people themselves. The paper argues that organizational restructuring will therefore fail to improve coordination between health and social services for older people unless these underlying issues are also addressed.
Partnerships performance and primary care: developing integrated services for older people in England
- Authors:
- GLENDINNING Caroline, COLEMAN Anna, RUMMERY Kirstein
- Journal article citation:
- Ageing and Society, 22(2), March 2002, pp.185-208.
- Publisher:
- Cambridge University Press
Critically examines recent policy developments in England aimed at improving health and social services for older people. Summarises the current funding and organisation of services for older people, and highlights some key problem areas. Highlights three main policy themes that are shaping services: an emphasis on partnership; active demonstration of improved performance; and increasing involvement of frontline health professional in decisions of services development. Considers the implications and impact of these factors on the development of services for older people, and discusses whether health service developments are likely to address some of the most pressing needs of older people.
Primary care and social services: developing new partnerships for older people
- Authors:
- RUMMERY Kirstein, GLENDINNING Caroline
- Publisher:
- Radcliffe Medical Press
- Publication year:
- 2000
- Pagination:
- 122p.,bibliog.
- Place of publication:
- Abingdon, Oxon
Guide to the new initiatives in encouraging partnerships between health and social care, particularly in services for older people. Part one looks at: the problem of the health and social care divide; the new emphasis on partnerships in policy and practice; users and patients experiences of the health and social care divide; and implementing partnerships between NHS and local authority services. Part two examines joint commissioning and deals with: models of joint commissioning; a quasi single commissioning agency; a model for joint commissioning of specific services; integrated health and social care teams; a model for joint commissioning of specific services; integrated health and social care teams; and primary care groups and trusts and the potential for joint commissioning with social services partners. Part three looks at frontline collaboration between primary care and social services staff and includes sections on: community care for older people; and co-location/attachment schemes within a primary care setting. Section four is on evaluating front line collaboration projects. Section five looks at new possibilities in working in partnership for older people.
Negotiating needs, access and gatekeeping: developments in health and community care policies in the UK and the rights of disabled and older citizens
- Authors:
- RUMMERY Kirstein, GLENDINNING Caroline
- Journal article citation:
- Critical Social Policy, 19(3), August 1999, pp.335-351.
- Publisher:
- Sage
This article argues that the cumulative consequences of community care policies in the UK have resulted in a move from universal access to NHS services to discretionary access to residual local authority services. Draws on an empirical study of the experiences of disabled and older people who have tried to gain access to community care assessments.