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Care coordination: translating policy into practice for older people
- Authors:
- SEDDON Diane, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 14(2), 2013, pp.81-92.
- Publisher:
- Emerald
The findings from research on the implementation of Unified Assessment (UA) policy and the work of care coordinators who oversee the delivery of support to older people with complex needs are presented. The research used a mixed methods approach that included staff interviews (n=95) and focus groups (n=3) spanning eight local authority areas; one in North, Mid and South Wales. The care coordinator role is controversial and the lack of common terminology across health and social care obscures its importance. It is seen as a social care responsibility. Limited ownership amongst healthcare professionals leads to tensions in practice. The challenges of breaking down silo thinking embedded in established professional practices are highlighted as are infrastructural and capacity deficits. Disparities between policy intentions and practice means that UA is failing to meet core objectives relating to the delivery of seamless support. Practice implications identified are that practice development may be supported by: guidelines that are more prescriptive and include a formal role definition; joint training to promote shared understanding of key concepts; investment in administrative and IT infrastructures; and more coordinated direction at strategic level. (Edited publisher abstract)
Integration of health and social care - what can Wales learn ... and contribute?
- Author:
- MORGAN Gareth
- Journal article citation:
- Quality in Ageing and Older Adults, 14(1), 2013, pp.47-55.
- Publisher:
- Emerald
Drawing on the findings of a literature review, and on experience from the United Kingdom, Europe and Canada in particular, this paper looks at health and social care service integration and considers the situation in Wales. It summarises developments in health and social care integration in European countries and Canada, commenting on learning opportunities and challenges. It then considers health and social care integration policy and practice in Wales, with particular reference to experience of integration, person centred care, and the United Nations Principles for Older People. It concludes that integration challenges remain, but that Wales is well placed to advance the integration agenda.
Integrating occupational therapy services: playing the long game
- Author:
- KELLY Janet
- Journal article citation:
- Journal of Integrated Care, 23(4), 2015, pp.185-193.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore some of the critical areas of work in any long-term strategy to develop integrated occupational therapy services across health and social care for adults who are frail and elderly and living in their local communities. It explores the success that has been experienced in Aneurin Bevan University Health Board over the past eight years or more and proposes “keeping the faith” as a helpful personal strategy in avoiding disillusionment and disengagement in the process when setbacks occur along the way. Design/methodology/approach: The paper is a combination of personal reflection and experience, with reference to the literature and what has been written about others’ professional experiences at bringing services and professional groups together. Findings: Developing integrated occupational therapy services is not easy. However there are several critical factors, which once understood for their role in the overall process, add weight to the 'right thing to do' argument. These 'critical factors' provide a continued focus for the work when the challenges inherent in developing integrated services are in danger of outweighing the successes and the pressure is strong to revert to the default position of single agency service delivery. Originality/value: This paper makes an effort to pursue integrated occupational services to serve as an example of wider attempts to pursue collaboration and integration, highlighting the need for remaining doggedly determined on the final objective – better services for people. (Publisher abstract)
A realistic evaluation of integrated health and social care for older people in Wales, to promote independence and wellbeing: interim report
- Authors:
- CHICHLOWSKA S.Carnes, et al
- Publisher:
- Welsh Government Social Research
- Publication year:
- 2013
- Pagination:
- 123
- Place of publication:
- Cardiff
Researchers at the Centre for Innovative Ageing, Swansea University provide a critical overview of each of a range of integration projects or services across Wales, comparing them to an idealised ‘testable theory’ of how integration should work. The aim is that older people are able to maintain their wellbeing and independence whilst being able to live with a range of care needs extending to complex and chronic conditions, preferably in their own homes and their own communities. The first section of the report is a summary of the literature review related to policy strategy and provision of integrated health and social care services for older people, using literature sourced nationally across Britain and locally in Wales. The second section comprises information on the models of care of the projects and services selected, based on a small number of interviews with stakeholders. The information will be used to develop a conceptual model of integrated care that can be used to assess the impact of services to older people. The report observes the emergence of several unintended and undesirable outcomes of developing integrated care, including competition between services and alienation of GPs and other health and service professionals. Assessment, patient notes and data collection is still largely paper based, creating difficulties in sharing and disseminating information across services. Further work is required to evaluate integrated health and social care. (Original abstract)
A framework for delivering integrated health and social care for older people with complex needs: consultation document
- Author:
- WALES. Welsh Government
- Publisher:
- Welsh Government
- Publication year:
- 2013
- Pagination:
- 14
- Place of publication:
- Cardiff
Wales already has a higher proportion of people aged over 85 than the other countries of the United Kingdom, and is likely to rise further in the next decade. This framework for integrated health and social care summarises the relevant policy and key principles; and provides clear definitions. It sets out the Welsh Government’s expectations for how all the different partners need to develop and deliver integrated health and social care services, not as something extra but as the normal way of working. It identifies what the evidence indicates as the core requirements on which to base local planning and delivery; and states the outcome-based indicators that will help establish the present baseline position and measure progress. In all, care delivery must be aimed at achieving improved user and patient care through better co-ordination of services; and the the recipient will have a greater say and more control over the care received. Responses to this consultation are required by 31 October 2013. (Edited publisher abstract)
“Happily Independent” – configuring the Gwent frailty support and wellbeing worker
- Authors:
- BARBER Kevin, WALLACE Carolyn
- Journal article citation:
- Journal of Integrated Care, 20(5), 2012, pp.308-321.
- Publisher:
- Emerald
This article discusses the integrated Support and Wellbeing Worker (SWB) role in an innovative Gwent Frailty programme from 2009 until 2011. The health and social care Gwent Frailty programme used a configuration approach by adopting ‘frailty’ as its unifying theme across the seven agencies involved. In order to configure this role, the Frailty Workforce Group (FWG) identified three tasks; staff engagement, identifying the SWB worker training needs, and scoping the employment options for the new role. For others facing the same challenges there are three key principles. The first is that having a unifying concept underpinned by the commissioned Happily Independent study legitimately enabled the FWG to deliver on its three tasks identified by the Frailty Board. The second was that time spent on early staff and trade union engagement gave positive messages about their value within the role configuration. Finally, that developing an integrated role meant that core training and development had to be consistent so that registered staff were confident they could delegate accordingly.
Efficiency and innovation board: new models of service delivery
- Authors:
- PALFREMAN Martyn, JEPSON Wayne
- Publisher:
- Social Services Improvement Agency
- Publication year:
- 2011
- Pagination:
- 55p.
- Place of publication:
- Cardiff
A number of public service organisations across Wales are taking forward new integrated approaches and working practices to service delivery with the goal of promoting independence and wellbeing for people within the community. The main objective of this study was to study 13 approaches that have, or are being, designed in Wales to integrate the service delivery practices of organisations involved in improving wellbeing and prolonging independence. The study comprised 18 semi-structured interviews with strategic leads of the 13 selected approaches. The questions focussed on 5 key themes: background to the work, outcomes and impact, leadership, support, and the future. The report details the findings from the study, with a particular focus on identifying integrated working practices that are resulting in tangible improvements to service delivery and efficiency savings. The findings show a clear case for integrated models as a means to supporting and promoting independence. A single best practice model or approach for integrating services across sectors was not identified. Key enablers for effective integration, challenges to integration, and evidence of early impact from a number of the models are discussed. A number of practical steps to help increase the pace of integration are suggested.
Because it’s there …: voluntary councils reflect on contributing to strategic planning for integrated services for older people in Cwm Taf
- Authors:
- RICHARDS Sharon, MORRIS Anne, GREENWELL Stewart
- Journal article citation:
- Journal of Integrated Care, 23(4), 2015, pp.219-231.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to understand the strategic role of third-sector agencies, with a history that often left them 'sidelined' by the public sector, showing how all agencies involved can be respected and trusted, with conflicts of interest around commissioning services well managed. It highlights how power differentials between agencies/sectors influence behaviour and how a voluntary council can promote the voice of users and carers. Design/methodology/approach: A case study considering the nature of voluntary sector activity in Cwm Taf, referring to learning from elsewhere, confirming and challenging the experience. It draws on the experiences of two key third-sector workers and draws on local survey data, as well as the experiences of community co-ordinators. Findings: The importance of 'being there' in policy development, implementing change and taking action; 'being at the top table' was critical in developing a stronger third sector and user voice, supporting the ambitions of Social Services and Well-being (Wales) Act 2014. Third-sector agencies have been good and mature partners, honest brokers/commissioners, completer/finishers and critical friends. Originality/value: Power and influence are significant in changing the way that older people receive a different offer – not, 'what can we do for you?', but, 'help us to understand what will make a difference to your life. Third-sector agencies are crucial change agents, better at representing users and carers than public sector agencies doing it alone. It explores the concept of interdependence, as more energising for older people and agencies. (Edited publisher abstract)
Crimes against, and abuse of, older people in Wales: access to support and justice: working together
- Authors:
- WYDALL Sarah, ZERK Rebecca, NEWMAN Jeremy
- Publisher:
- Older People's Commissioner for Wales
- Publication year:
- 2015
- Pagination:
- 93
- Place of publication:
- Cardiff
Examines how agencies and services in Wales identify, record and transfer and share data and cases, ensuring that older people are recognised as victims of domestic abuse and have access to the full support available to them under domestic abuse legislation and domestic abuse support services, and that the abuse of older people is recognised and treated as a criminal act. The research focused on two areas: a scoping exercise, to review the effectiveness of data management system by key agencies, including the quality of intra-agency and inter-agency data collection, record-keeping and data transferral processes by key statutory agencies; and practitioners’ knowledge of information sharing protocol and data protection guidelines; and an exploration of professional agencies’ perceptions of the various stages in the referral process, from initial point of contact to case closure, to find out why and at what point clients /service users may disengage with services. Based on the findings, the report makes a number of recommendations for the improvement of data management and information sharing processes. (Edited publisher abstract)
The Integrated Care Evaluation Framework ((ICE-F): a realistic evaluation of integrated health and social care services in Wales
- Authors:
- CARNES-CHICHLOWSKA Susan, BURHOLT Vanessa, REA David
- Publisher:
- Welsh Government Social Research
- Publication year:
- 2015
- Pagination:
- 81
- Place of publication:
- Cardiff
Building on the interim report from researchers at the Centre for Innovative Ageing, Swansea University, this report sets out the Integrated Care Evaluation Framework (ICE-F) developed to help service providers to design and undertake evaluations of integrated services. Specifically the ICE-F assesses the impact of delivering integrated care to older people with the aim of improving wellbeing and independence. The model provides guidance on core elements that need to be considered in the evaluation, namely cost efficiency, effectiveness and the personal benefit of independence and wellbeing. It describes the stages necessary, the data requirements and the tools providers can use to assess the outcomes of their services.The framework is structured in four stages: describing what the service hopes to achieve and how; making a decision about what is going to be used to know whether the service will achieve it overall aims; the construction of a template for service evaluation; and the health economic evaluation of cost effectiveness, followed by a cost benefit analysis on the social return of investment. The final section provides a refined theory of integrated care, explaining why and how some aspects of the different contexts, mechanisms and outcomes work together in Wales. A series of recommendations for the Welsh Government and providers of integrated health and social care are also provided. (Edited publisher abstract)