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The purpose of this paper is to examine research evidence on collaboration between primary and adult social care in strategic, rather than operational, activities at two different time points, following large-scale changes within the health and social care environments; and discuss the prospects for the future.

This paper reports evidence from two substantial longitudinal studies (Dowling and Glendinning, 2003; Checkland et al., 2012) which followed the development of Primary Care Groups and Trusts (PCG/Ts) and Clinical Commissioning Groups (CCGs), respectively. Each used a combination of national surveys and local in-depth case studies to trace the early development of new structures and ways of working following major changes in the NHS and local government.

PCG/Ts had limited success in collaborating with adult social care partners. Health and Well-being Boards offer a new overarching organisational framework for collaborative strategic working between GP-led CCGs and adult social care services. Mandated joint strategic needs assessments also provide a shared framework within which commissioning decisions by both CCGs and social services are made. However, there remains evidence of long-standing barriers, particularly differences in geographic boundaries and in organisational and professional cultures.

Evidence from both studies is based on the early years of the respective new organisations; later evidence may have yielded a different picture.

This is the first paper reflecting on developments in strategic relations between primary and social care from researchers involved with two longitudinal investigations of the early development of PCG/Ts (1999-2002) and CCGs (2011-ongoing).

This article proposes principles for reforming English adult social care by drawing on the experiences of other countries. These illustrate how the funding, organisation and delivery of services could be reformed, and shed light on the potential political and social factors affecting implementation of reforms.Reforms in other countries are commonly driven by the desire to develop and/or maintain universal access to social care. Formerly fragmented, un‐co‐ordinated and locally variable arrangements are being replaced with universal schemes, with national eligibility arrangements applicable to everyone regardless of age or ability to pay. Cash payments (personal budgets etc) instead of services in kind are widely used. However, such options can have different aims, including supporting family carers and stimulating local provider markets, as well as offering ‘consumer’ choice. Policies for family carers are usually integral to overall long‐term care arrangements. Finally, even in federal systems like Germany, Austria, Spain and Australia, central governments play a crucial role in ensuring universal, equitable and sustainable social care. Central government leadership: maximises risk pooling; enhances budgetary control mechanisms; safeguards equity and quality control; and provides political legitimacy.

Successful development of health and social care partnerships is contingent on the contribution of all stakeholder groups to overcome the ‘wicked’ issues that beset the field. This article explores four key issues, identified by a network of diverse stakeholders as vital to the future of health and social care partnerships, and proposes ways in which individuals and organisations from all stakeholder groups can support health and social care organisations to work together to deliver good outcomes to service users and their carers.

Primary care groups and trusts, social services and wider local authority departments are making good progress in developing partnerships in a rapidly changing policy environment. These partnerships are developing at different levels (strategic planning, operational service delivery), both with social services departments and with a wider range of local authority functions. This paper draws on the latest round of the three‐year national Tracker Survey of Primary Care Groups and Trusts. The partnerships developed by PCG/Ts are considerably broader than the original key collaboration required with local social services departments; this raises questions about the role of the social services representative on the PCG Board/PCT Executive Committee. Some of the traditional obstacles to partnerships ‐ particularly differences in organisational boundaries ‐ and the imperatives of national policy priorities are continuing to shape local collaborative activity.

Adult social care services are increasingly establishing reablement services as part of their range of home care provision, sometimes alone, sometimes jointly with NHS partners. Typically, home care reablement is a short‐term intervention, often free of charge, that aims to maximise independent living skills. This paper describes two small studies examining the impact of home care reablement on subsequent service use. The evidence so far strongly suggests that a period of home care reablement can reduce the subsequent use of home care services and that, for some people, these benefits may last for a year or more. However, a number of organisational and cultural factors can limit the immediate and longer‐term benefits of home care reablement.

This paper reviews evidence about the relationships between NHS services and nursing and residential homes in England and Wales. Since the transfer in 1993 of responsibility for funding nursing and residential home care for less affluent older people to local authority social services departments, nursing and residential care has been widely assumed to constitute part of ‘social care’ services. This obscures the fact that residents of nursing and residential care homes frequently have substantial and complex healthcare needs. While some of these healthcare needs may be met through the care provided within homes themselves, most will require substantial contributions from NHS medical, nursing, pharmaceutical and other services. The National Service Framework for Older People (Department of Health, 2001) prioritises reinvestment in intermediate care services, building on the expectation in The NHS Plan (Department of Health, 2000a) that residential and nursing homes will play a major role in the development of these services. This expectation has been further reinforced by the Concordat with the private and voluntary healthcare provider sector (Department of Health, 2000b). However there is little evidence about the NHS services which are currently provided to nursing and residential homes, nor about the capacity of mainstream NHS services to meet the projected development of intermediate care services within the independent institutional sector. This paper reviews the evidence which is available and highlights some of the priorities which primary care groups in England (local health groups in Wales) will need to consider if they are to develop integrated and good quality services for frail older people.

The purpose of this paper is to report the experiences of older people who use council-managed personal budgets (PBs) to fund home care services and their satisfaction with the level of choice and control they are able to exercise.

Data were collected from 18 older people from eight home care agencies across three councils in England. All interviews were semi-structured and face-to-face.

Despite some optimism about improvements in choice and flexibility experienced by older people using home care services, the findings from this small study suggest that the gap between the “ideal” of user choice and the “reality” of practice continues to be significant. The level of choice and control older people felt able to exercise to tailor home care services to their personal needs and preferences was restricted to low level choices. Other choices were constrained by the low levels of older people's PBs and council restrictions on what PBs can be spent on. Older people's understanding of limitations in public funding/pressures on agencies and their reluctance to play an active consumer role including willingness to “exit” from unsatisfactory care arrangements appeared to further challenge the potential for achieving greater choice and control through council-managed PBs.

The English government's policy emphasis on personalisation of care and support and new organisational arrangements for managed PBs aim to promote user choice and control. This is the first study to report the experiences of older people using managed PBs under these new arrangements. The paper highlights areas of interests and concerns that social care staff, support planners and commissioners may need to consider.

Older people with dementia living in the community are most likely to be cared for by other older people, predominantly spouses, who will be at increased risk of stress‐related health problems themselves. Appropriate support of such carers is crucial if carer breakdown and consequent care‐receiver admission to residential homes is to be avoided. This paper examines the experience of older carers of frail older people with dementia and examines the kind of support that is provided to such carers. In practice, the sole source of professional support received by older people in this study was from community psychiatric nurses (CPNs). CPNs' role did not comprise hands‐on care‐giving and family carers carried out most personal/physical and healthcare tasks themselves, aided in some cases by care workers. The paper concludes by suggesting that lack of support for carers in these activities requires redress.