One of 20 targeted local system reviews looking specifically at how older people move through the health and social care system, with a focus on how services work together. The review found there was a system-wide commitment to serving the people of Birmingham, but that services had not always worked effectively together. It highlighted a number of areas where improvements are needed to ensure those responsible for providing health and social care services work better together. Overall, the review found that peoples’ experience of health and social care was variable and access and availability of services was inconsistent across the city. Fewer people had the chance to exercise choice and control over their care and support - some were offered care placements in parts of the city that were not accessible to their families; some were admitted to hospital with social care needs that could have been managed more effectively and safely at home; and some people stayed in hospital for longer than they needed to. The review also found that more could be done to engage diverse communities in the planning and delivery of services to ensure that services met the specific cultural and health needs of local populations. In addition, there was not a systematic and joined up approach across the city to using feedback from people, their families and carers, about services being provided. Suggested areas for improvement include: for the system’s leadership to build on recent improvements in relationships and organisational structures by strengthening relationships, improving communication and ensuring there is a shared understanding among staff of their role in achieving the strategic vision at an operational level; and improving information sharing across health and social care, as this has proved a barrier to integrated working.
(Edited publisher abstract)
One of 20 targeted local system reviews looking specifically at how older people move through the health and social care system, with a focus on how services work together. The review found there was a system-wide commitment to serving the people of Birmingham, but that services had not always worked effectively together. It highlighted a number of areas where improvements are needed to ensure those responsible for providing health and social care services work better together. Overall, the review found that peoples’ experience of health and social care was variable and access and availability of services was inconsistent across the city. Fewer people had the chance to exercise choice and control over their care and support - some were offered care placements in parts of the city that were not accessible to their families; some were admitted to hospital with social care needs that could have been managed more effectively and safely at home; and some people stayed in hospital for longer than they needed to. The review also found that more could be done to engage diverse communities in the planning and delivery of services to ensure that services met the specific cultural and health needs of local populations. In addition, there was not a systematic and joined up approach across the city to using feedback from people, their families and carers, about services being provided. Suggested areas for improvement include: for the system’s leadership to build on recent improvements in relationships and organisational structures by strengthening relationships, improving communication and ensuring there is a shared understanding among staff of their role in achieving the strategic vision at an operational level; and improving information sharing across health and social care, as this has proved a barrier to integrated working.
(Edited publisher abstract)
Subject terms:
integrated care, older people, interagency cooperation, prevention, hospital admission, hospital discharge, access to services, joint working, commissioning, co-production;
One of 20 reviews of local areas to find out how health and care services are working together to care for older people aged 65 and over. It looks at how local systems are functioning within and across three areas: maintaining the wellbeing of a person at home, crisis management and hospital admission, and step down, return to usual place of residence and/or admission to a new place of residence. The review found there was not a single, shared vision of integrated care that could be consistently articulated across health and care agencies in Northamptonshire. Barriers to developing a strategy for integrated health and social care included severe financial pressures, a history of siloed working and poor relationships between organisations. Although there were examples of staff working in an integrated way to improve outcomes for people, such as through multidisciplinary discharge teams, most frontline staff were working towards their own organisation’s targets and performance measures. An older person admitted into hospital in Northamptonshire were more likely to experience longer lengths of stay and were not always involved in making decisions about their care when they were ready to be discharged from hospital. In addition, there was not a systematic approach to using feedback from people, their families and carers in the development of strategy and services. The report highlights a number of suggested areas for improvement.
(Edited publisher abstract)
One of 20 reviews of local areas to find out how health and care services are working together to care for older people aged 65 and over. It looks at how local systems are functioning within and across three areas: maintaining the wellbeing of a person at home, crisis management and hospital admission, and step down, return to usual place of residence and/or admission to a new place of residence. The review found there was not a single, shared vision of integrated care that could be consistently articulated across health and care agencies in Northamptonshire. Barriers to developing a strategy for integrated health and social care included severe financial pressures, a history of siloed working and poor relationships between organisations. Although there were examples of staff working in an integrated way to improve outcomes for people, such as through multidisciplinary discharge teams, most frontline staff were working towards their own organisation’s targets and performance measures. An older person admitted into hospital in Northamptonshire were more likely to experience longer lengths of stay and were not always involved in making decisions about their care when they were ready to be discharged from hospital. In addition, there was not a systematic approach to using feedback from people, their families and carers in the development of strategy and services. The report highlights a number of suggested areas for improvement.
(Edited publisher abstract)
Subject terms:
integrated care, older people, hospital admission, hospital discharge, policy, joint working, interagency cooperation, community care, multidisciplinary teams, co-production, staff development, independent living, discharge planning;
Thematic review which looks at how well care for older people is integrated across health and social care, as well as the impact on older people who use services and their families and carers. The review collected evidence from eight areas site visits, reviewed care records, spoke to older people and their carers, and held focus groups with staff. It also looked at examples of where care was coordinated effectively and identified barriers that prevent it from working well. It discusses findings around three areas: identification and prevention, covering how well older people with complex needs or at high risk of deterioration are identified; person-centred assessment and planning; and care coordination. Key findings included that there was a widespread commitment to developing and delivering coordinated care. However, organisational barriers such as a lack of consistency in the use of assessments and in the sharing of information made it difficult for services to identify older people who were at risk of deterioration or an unplanned emergency admission. Older people often had multiple care plans and there was lack of knowledge among professionals of how care plans should be written and reviewed. The review also found insufficient monitoring and evaluation of many of the initiatives in place to improve integration. Where integrated, person-centred care succeeded, local leaders worked closely across health and social care services to share information, reduce duplicated efforts and use resources more effectively. Recommendations include: the development of a methodology and data set for identifying people at risk of admission to secondary care; and the development of a set of validated data metrics and outcomes measures for integrated care.
(Edited publisher abstract)
Thematic review which looks at how well care for older people is integrated across health and social care, as well as the impact on older people who use services and their families and carers. The review collected evidence from eight areas site visits, reviewed care records, spoke to older people and their carers, and held focus groups with staff. It also looked at examples of where care was coordinated effectively and identified barriers that prevent it from working well. It discusses findings around three areas: identification and prevention, covering how well older people with complex needs or at high risk of deterioration are identified; person-centred assessment and planning; and care coordination. Key findings included that there was a widespread commitment to developing and delivering coordinated care. However, organisational barriers such as a lack of consistency in the use of assessments and in the sharing of information made it difficult for services to identify older people who were at risk of deterioration or an unplanned emergency admission. Older people often had multiple care plans and there was lack of knowledge among professionals of how care plans should be written and reviewed. The review also found insufficient monitoring and evaluation of many of the initiatives in place to improve integration. Where integrated, person-centred care succeeded, local leaders worked closely across health and social care services to share information, reduce duplicated efforts and use resources more effectively. Recommendations include: the development of a methodology and data set for identifying people at risk of admission to secondary care; and the development of a set of validated data metrics and outcomes measures for integrated care.
(Edited publisher abstract)
Subject terms:
integrated care, older people, health care, social care, carers, care planning, person-centred planning, assessment, joint working, interagency cooperation, good practice;