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Evaluating the impact of integrated health and social care teams on older people living in the community
- Authors:
- BROWN Louise, TUCKER Christine, DOMOKOS Teresa
- Journal article citation:
- Health and Social Care in the Community, 11(2), March 2003, pp.85-94.
- Publisher:
- Wiley
Although it is perceived wisdom that joint working must be beneficial there is little evidence to support this. Evaluates 2 integrated co-located health and social care teams established in a rural county to meet the needs of older people and their carers. Identifies that patients from 'integrated teams' may self-refer more and are assessed more quickly, maybe indicating the 'one-stop shop' approach is having an impact on service delivery. Findings also suggest that in integrated teams the initial stages of the process of seeking help and being assessed for a service may have improved through better communication, understanding and exchange of information among professional groups. However, the degree of 'integration' seen within these teams does not appear sufficiently well developed to have had an impact on clinical outcomes for patients/users. It appears unlikely from available evidence that measures such as co-location go far enough to produce changes in outcomes for older people. If the Department of Health wishes to see benefits in process progress to benefits to users more major structural changes will be required. The process of changing organisational structures can be enhanced where there is evidence that changes will produce better outcomes. At present this evidence does not exist, although this study suggests that benefits might be forthcoming if greater integration can be achieved. Nevertheless, until social services and NHS trusts develop more efficient and compatible information systems it will be impossible to evaluate what impact any further steps towards integration might have on older people without significant external resources.
Professional perceptions of joint working in primary care and social care services for older people in Scotland
- Authors:
- HUBBARD Gill, THEMESSL-HUBER Markus
- Journal article citation:
- Journal of Interprofessional Care, 19(4), August 2005, pp.371-385.
- Publisher:
- Taylor and Francis
The purpose of this paper is to report health and social care professionals' perceptions on joint working for the care of older people in Scotland. Semi-structured interviews were conducted with 34 primary care and social care professionals. These professionals emphasised that joint working requires a fundamental change in thinking and a scrutiny of professional roles and identities and is influenced by the given geographical and organisational infrastructure. In order to facilitate sustained joint working knowledge and models of care bespoke to joint working need to be developed. This requires health and social care organisations to focus on the co-creation and generation of new knowledge by health and social care professionals as well as the communication and exchange of existing knowledge between services. However, joint working also needs to be based on patient views to guarantee a whole systems perspective.
Cost effectiveness of using cognitive screening tests for detecting dementia and mild cognitive impairment in primary care
- Authors:
- TONG Thaison, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1392-1400.
- Publisher:
- Wiley
Introduction: The authors estimated the cost effectiveness of different cognitive screening tests for use by General Practitioners (GPs) to detect cognitive impairment in England. Methods: A patient-level cost-effectiveness model was developed using a simulated cohort that represents the elderly population in England (65 years and older). Each patient was followed over a lifetime period. Data from published sources were used to populate the model. The costs include government funded health and social care, private social care and informal care. Patient health benefit was measured and valued in Quality Adjusted Life Years (QALYs). Results: Base-case analyses found that adopting any of the three cognitive tests (Mini-Mental State Examination, 6-Item Cognitive Impairment Test or GPCOG (General Practitioner Assessment of Cognition)) delivered more QALYs for patients over their lifetime and made savings across sectors including healthcare, social care and informal care compared with GP unassisted judgement. The benefits were due to early access to medications. Among the three cognitive tests, adopting the GPCOG was considered the most cost-effective option with the highest Incremental Net Benefit (INB) at the threshold of £30 000 per QALY from both the National Health Service and Personal Social Service (NHS PSS) perspective (£195 034 per 1000 patients) and the broader perspective that includes private social care and informal care (£196 251 per 1000 patients). Uncertainty was assessed in both deterministic and probabilistic sensitivity analyses. Conclusions: The analyses indicate that the use of any of the three cognitive tests could be considered a cost-effective strategy compared with GP unassisted judgement. The most cost-effective option in the base-case was the GPCOG. (Edited publisher abstract)
New act, new opportunity for integration in Scotland
- Author:
- TAYLOR Alison
- Journal article citation:
- Journal of Integrated Care, 23(1), 2015, pp.3-9.
- Publisher:
- Emerald
Purpose: In this paper, the Scottish Government's approach to improving outcomes for patients and service users by integrating health and social care planning and provision is described. The Scottish Parliament passed primary legislation in February 2014, which places requirements on Health Boards and Local Authorities to work together more closely than ever before. The paper aims to discuss these issues. Design/methodology/approach: This paper sets out the Scottish Government's legislative approach to integrating health and social care, based on previous experience of encouraging better partnership between health and social care working without legislative compulsion. Findings: The Scottish Government has concluded that legislation is required to create the integrated environment necessary for health and social care provision to meet the changing needs of Scotland's ageing population. Research limitations/implications: The paper is confined to experience in Scotland. Practical implications: Legislation is now complete, and implementation of the new arrangements is starting. Evaluation of their impact will be ongoing. Social implications: The new integrated arrangements in Scotland are intended to achieve a significant shift in the balance of care in favour of community-based support rather than institutional care in hospitals and care homes. Its social implications will be to support greater wellbeing, particularly for people with multimorbidities within communities. Originality/value: Scotland is taking a unique approach to integrating health and social care, focusing on legislative duties on Health Boards and Local Authorities to work together, rather than focusing on structural change alone. The scale of planned integration is also significant, with planning for, at least, all of adult social care and primary health care, and a proportion of acute hospital care, included in the new integrated arrangements. (Publisher abstract)
Changing places: report on the work of the Health and Social Care Change Agent Team 2002/03
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2003
- Pagination:
- 36p.
- Place of publication:
- London
This is the first annual report on the work of the Health and Social Care Change Agent Team (CAT). ‘Delayed discharges’ are people, quite often frail and vulnerable older people whose future care is uncertain. An acute hospital is not a good place to be whilst waiting for care arrangements to be made. Hospitals make people more dependent and there is an increased risk of acquiring an infection. While older, vulnerable people are away from home, their care networks may break down and the longer the time spent away from home, the more difficult it is to set these up again. Sometimes, had the right services been in place in the community, the person need not have gone into hospital in the first place. If people are waiting in hospital beds, other people’s admissions for planned surgery such as a hip replacement may be delayed. About 60% of all people in acute hospitals are over 65 years, so many of the people waiting to come into hospital are likely to be older people. The more medically fit people waiting in hospital beds, the fewer beds are available for emergency admissions, leading to longer waits on trolleys in the Accident & Emergency department (A&E) or the Medical Assessment Unit (MAU).
The feasibility and acceptability of a specialist health and social care team for the promotion of health and independence in 'at risk' older adults
- Authors:
- DRENNAN Vari, et al
- Journal article citation:
- Health and Social Care in the Community, 13(2), March 2005, pp.136-144.
- Publisher:
- Wiley
Population ageing, escalating costs in pensions, health-care and long-term care have prompted a new policy agenda for active ageing and quality of life in old age across the European Union and other developed countries. In England, the National Service Framework for Older People (NSF OP) explicitly demands for the first time that the NHS and local authorities, in partnership, agree programmes to promote health ageing and to prevent disease in older people. These programmes are expected to improve access for older people to mainstream health promotion services and also to develop multiagency initiatives to promote health, independence and well-being in old age. This paper describes the evaluation of one interagency project team established to test out mechanisms for addressing health promotion for older people through primary care. A mixed methodology was used to understand the processes of service development, the impact of the team's intervention, and the primary and secondary outcomes for older people. The project demonstrated that multi-agency partnerships have the potential to improve the quality of the lives of older people deemed 'at risk' by their general practitioners, particularly through income generation but also in the identification of medical problems such as unrecognised hypertension, hearing loss and visual loss. It also offered some key learning points for other multi-agency groups developing similar services.
The rough road and the smooth road: comparing access to social care for older people via area teams and GP surgeries
- Authors:
- LE MESURIER Nick, CUMELLA Stuart
- Journal article citation:
- Managing Community Care, 9(1), February 2001, pp.7-13.
- Publisher:
- Pavilion
This article discusses the results of a comparative evaluation of a social worker in primary care with her equivalents in an area team. Direct referral was found to be more efficient than referral to the area team, enabling the attached social worker to manage a higher workload and improved levels of contact with service users and the primary care team. The options available for service users are thus enhanced, with consequent cost advantages for the social services department.
Meeting the holistic needs of older people in the community: an examination of a new generic health and social care worker role
- Author:
- TAYLOR Pat
- Journal article citation:
- Local Governance, 27(4), Winter 2001, pp.239-246.
- Publisher:
- University of Birmingham. Institute of Local Government Studies
This article is based on an evaluation of the first year of operation of a small joint initiative between primary care staff in three GP practices and a social services home care locality team. It was supported by a Primary Care Group (later to become a Primary Care Trust) and a Social Services department using funding available for primary care development. The project aimed to assist older people, entitled to receive home care remain in their own homes and receive a more integrated service from district nursing and home care services. The initiative aimed to provide a seamless service, which was able to assess and meet the needs of older people more holistically. A key objective was to prevent unnecessary admissions into hospital or residential care by identifying symptoms of ill health at a preventable stage. The project also aimed to improve user and staff satisfaction and to address problems in liaison between the primary agencies involved with this client group. These objectives were to be achieved by integrating the district nursing auxiliary role and the home care support worker to create a generic health and social worker. The paper outlines the context of the project and the evaluation methodology. And it then highlights aspects of joint working which underpinned and influenced the operation of this new integrated role.
Re-designing health and social care for older people: multi-skill case teams in primary care
- Authors:
- CUMELLA Stuart, LE MESURIER Nick
- Journal article citation:
- Managing Community Care, 7(6), December 1999, pp.17-24.
- Publisher:
- Pavilion
This article reviews the evidence on the benefits of innovative practice-based social work, in the context of attempts to improve multi-agency collaboration through structural change, procedural regulation and process redesign. It concludes that the model can generate improvements in productivity and in responses to customer needs.
Interprofessionality in health and social care: achilles' heel of partnership?
- Author:
- HUDSON Bob
- Journal article citation:
- Journal of Interprofessional Care, 16(1), February 2002, pp.7-17.
- Publisher:
- Taylor and Francis
Partnership working is now a central plank of public policy in the UK, especially in the field of health and social care. However, much of the policy thrust has been at the level of interorganisational working rather than at the level of interprofessional partnerships. The empirical and theoretical literature is largely sceptical about the feasibility of effective joint working between separate but related professionals--the 'pessimistic tradition'. Based upon an empirical study of general practitioners, community nurses and social workers in northern England, this article challenges such a tradition and proposes an 'optimistic hypothesis' for further investigation.