Integration presentation spa sha oct 2012 cameron


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Is integration the burning platform for change

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  • An organizational burning platform exists when maintaining the status quo becomes prohibitively expensive. Major change is costly, but when the present course of action is even more expensive, a burning-platform situation erupts.
  • Integration presentation spa sha oct 2012 cameron

    1. 1. Is integration the ‘burningplatform’ for change?Ailsa Cameron & Dr Rachel Lart, School for Policy Studies,University of Bristol
    2. 2. 2 BackgroundOur previous review of the joint working literatureconcluded that ….‘the vast majority of the studies in the review focusedtheir attention on the process of joint working and theperceptions of those involved as to its success. Very fewof the studies looked at either the prior question of whyjoint work should be seen as a ‘good thing’ andtherefore why it should be done or at the consequentquestion of what difference joint working made’(Cameron, et al. 2000)
    3. 3. 3 Since that time• Reforms introduced by New Labour have had time to effect change.• The pressures driving government interest have intensified.• Joint working & integration continue to be important strategies in the provision of adult health and social care services in England. However,• there is continuing concern that the evidence base remains inadequate(Rummery 2009)
    4. 4. 4 SCIE reviewAimed to describe:• different models of working between health and social care services at the strategic, commissioning and operational levels• evidence of effectiveness and cost-effectiveness• factors promoting and obstacles hindering the success of these models• service user and carer views46 papers were included, reporting 30 separate studies
    5. 5. 5 Models• Multiagency teams,• Placements of individual staff across agency boundaries,• Single assessment processes (SAP),• Provision of intermediate care, structurally integrated services, and• Use of pooled budgets.
    6. 6. 6 Evidence of effectiveness• Clinical outcomes - improvements in quality of life, health, well-being and coping with everyday living were reported but comparative studies suggest only marginal differences.• Avoid inappropriate admission to acute / residential care - Evaluations of intermediate care services found reduced inappropriate admission to care.• Remaining at home - the organisation of services doesn’t improve the likelihood of living at home; rather need/ access to support are key factors.
    7. 7. 7 Evidence of cost effectivenessCosts and cost effectiveness - assessing costs and cost-effectiveness was complicated making it difficult toconfirm cost effectiveness. However some evidencethat intermediate care can save costs.Service organisation, service use and costs - analysis ofcosts across districts providing community mentalhealth services demonstrated the impact of serviceneed not organisational structure on costs. But someevidence that integrated services were no more costlythan discrete services.
    8. 8. 8 User and carer experiences• Service user and carer experiences were not routinely included in evaluations.• But when they are - users report high levels of satisfaction with integrated services, valuing timely assessments, responsiveness, trusting relationships with key workers, improved communication between agencies and help navigating complex systems.• Users do not comment on how services are arranged, rather they report on the access & appropriateness of services.
    9. 9. 9 Factors promoting & hinderingOur original categories remained informative:organisational; cultural & professional and, contextual.Within these categories a number of themes receivedless attention than in our original review (co-location &coterminosity), while some new themes emerged (roleflexibility).
    10. 10. 10 Factors promoting & hindering contDisappointingly, some factors hindering joint workingwere stubbornly persistent: difficulties incommunication & information exchange, differences inprofessional perspectives, lack of trust.Consistent message about factors promoting jointworking: stability, continuity in relationships, previouspositive experiences.
    11. 11. 11 Factors hindering integrationStudies focused explicitly on service or organisationalintegration reported a number of factors that suggestsome ambivalence and even hostility towardsintegration. These included: A lack of understanding of integration; Divergent and competing organisational aims; Professional misunderstandings & rivalries; Concern that the contribution of community health and social care might be marginalised by acute care.
    12. 12. 12 Is integration the burning platform for change?The review demonstrates that more emphasis is placedon outcomes & there is evidence of impact. But theevidence is less than compelling.There is a need for:•Greater clarity about what ‘integration’ is and it’s intended purpose. Are wetalking about organisational integration or integration within health/socialcare systems?•New approaches to tackle some of the more persistent obstacles to jointworking.•More robust evidence of impact, including services users experiences ofintegrated services.
    13. 13. 13 A turbulent future?• Integration remains a key element of policy: Health and Social Care Act 2012, White Paper 2012. But different strands of health and social care reform confound the context known to support successful joint working. • Reform of community health service encouraging horizontal/ vertical integration and increasing the diversity of providers. • The development of social work practices. • Providers compete rather than collaborate for contracts. • Changes to the working conditions of professionals undermine collaborative relationships. • Government needs a more persuasive narrative.
    14. 14. 14SCIE Research briefing 41: Factors that promote andhinder joint and integrated working between healthand social care services