Michael Clark, David Jolley, Susan Mary Benbow, Nicola Greaves and Ian Greaves
The scaling up of promising, innovative integration projects presents challenges to social and health care systems. Evidence that a new service provides (cost) effective care in a…
Abstract
Purpose
The scaling up of promising, innovative integration projects presents challenges to social and health care systems. Evidence that a new service provides (cost) effective care in a (pilot) locality can often leave us some way from understanding how the innovation worked and what was crucial about the context to achieve the goals evidenced when applied to other localities. Even unpacking the “black box” of the innovation can still leave gaps in understanding with regard to scaling it up. Theory-led approaches are increasingly proposed as a means of helping to address this knowledge gap in understanding implementation. Our particular interest here is exploring the potential use of theory to help with understanding scaling up integration models across sites. The theory under consideration is Normalisation Process Theory (NPT).
Design/methodology/approach
The article draws on a natural experiment providing a range of data from two sites working to scale up a well-thought-of, innovative integrated, primary care-based dementia service to other primary care sites. This provided an opportunity to use NPT as a means of framing understanding to explore what the theory adds to considering issues contributing to the success or failure of such a scaling up project.
Findings
NPT offers a framework to potentially develop greater consistency in understanding the roll out of models of integrated care. The knowledge gained here and through further application of NPT could be applied to inform evaluation and planning of scaling-up programmes in the future.
Research limitations/implications
The research was limited in the data collected from the case study; nevertheless, in the context of an exploration of the use of the theory, the observations provided a practical context in which to begin to examine the usefulness of NPT prior to embarking on its use in more expensive, larger-scale studies.
Practical implications
NPT provides a promising framework to better understand the detail of integrated service models from the point of view of what may contribute to their successful scaling up.
Social implications
NPT potentially provides a helpful framework to understand and manage efforts to have new integrated service models more widely adopted in practice and to help ensure that models which are effective in the small scale develop effectively when scaled up.
Originality/value
This paper examines the use of NPT as a theory to guide understanding of scaling up promising innovative integration service models.
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David Jolley, Neil Moreland, Kate Read, Harjinder Kaur, Karan Jutlla and Michael Clark
Dementia is found in all races. Within the UK, elders in black and minority ethnic (BME) communities are often unable or unwilling to access services that might help them when…
Abstract
Dementia is found in all races. Within the UK, elders in black and minority ethnic (BME) communities are often unable or unwilling to access services that might help them when they develop dementia. A series of research‐based studies in Wolverhampton have demonstrated that working with community leaders and family carers can identify strengths as well as areas for development in service arrangements. Some areas for development are those shared by all individuals and families with dementia, while others are specific to the cultural group. Areas for action include: the lack of understanding of the normal and pathological features of ageing; fear and stigma associated with mental disorders within BME communities; lack of knowledge of dementia; and insensitivity and inflexibility within some components of services. Knowledge gained from a collaborative review of the situation can be used to plan and deliver iterative improvements. The most effective single initiative is the appointment of a link nurse competent in language, culture and clinical skills. Despite progress over a 10 year period, difficulties remain and there is more to be learned.The research reported here has been conducted over a period of nine years within the city of Wolverhampton. The research has been co‐ordinated from for dementia plus (previously Dementia Plus), which has functioned as the Dementia Development Centre for the West Midlands since 2000.
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Michael Clark, Susan Benbow, Vanessa Scott, Neil Moreland and David Jolley
The important initiative from the Department of Health (Working Group on Copying Letters to Patients, 2002) to require that letters between clinicians should be copied to the…
Abstract
The important initiative from the Department of Health (Working Group on Copying Letters to Patients, 2002) to require that letters between clinicians should be copied to the patient has not been implemented as widely as was intended. There have been concerns about logistics and fears that patients might be confused or frightened by communications they are not equipped to understand. Yet, modifications of the system to allow patients the choice to receive or not receive such letters and suitable training for clinicians offer safeguards. There is no doubt that copying letters provides an inexpensive mechanism for involving patients in their own care and treatment, offering transparency and confirming respect for equality in the relationship between patient and clinician. This paper reports experience with copying letters to patients and families with dementia. The process was warmly received by patients and carers, including families in a black and minority ethnic (BME) community, and few adverse comments were made. The routine application of this initiative will have benefits for the quality of service experience for older people, including those with dementia.
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Michael Clark, Neil Moreland, Ian Greaves, Nicola Greaves and David Jolley
The purpose of this article is to discuss the policy developments of integration and personalisation within the context of Primary Care, specifically an innovative Memory Service…
Abstract
Purpose
The purpose of this article is to discuss the policy developments of integration and personalisation within the context of Primary Care, specifically an innovative Memory Service provided within a General Practice. It examines how these policies work together in this context to deliver a high quality service that is responsive to individual needs in an area of care: memory disorder or dementia, which has often relied heavily on secondary care services.
Design/methodology/approach
The article is a case study analysis of integration and personalisation in Primary Care, allowing for examination and elaboration of both concepts as applied in this setting; and their contribution to a better quality care Memory Service. The analysis is produced by independent researchers (MC and NM), background and facts by service personnel (IG, NG and DJ).
Findings
The innovative Memory Service operates as a person‐centred facility, integrating into the surgery, expertise that would traditionally be locked into secondary care health services. It makes maximum use of locally available knowledge of the patient, their family and formal and informal sources of support and therapy through links which cross agency boundaries. These links are identified and utilised in tailored support for individuals by the practice‐based Dementia Advisor. Outcomes include improved dynamics of identification, diagnosis and after care, high satisfaction amongst patients and families and reduced utilisation and expenditure of other healthcare facilities.
Practical implications
Personalisation and integration can be united in the development of innovative and improved Memory Services centred in Primary Care.
Social implications
Maintaining a focus on the needs of people within their social contexts (being person‐centred) is a powerful means of driving better integrated care in Primary Care for people living with dementia and related disorders.
Originality/value
This is the first examination of personalisation and integration as coupled concepts to lead the improvement of care, specifically a Memory Service, in Primary Care.
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The Commision for Health Improvement report on Rowan ward made for disturbing reading. But until recently the building where the abuse documented in the report took place had a…
Abstract
The Commision for Health Improvement report on Rowan ward made for disturbing reading. But until recently the building where the abuse documented in the report took place had a proud history, described in this article.
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Sadie Bawn, Susan Benbow, David Jolley, Paul Kingston and Louise Taylor
The Rowan report was published in 2003, following an investigation into allegations of abuse on a ward providing longterm care for older people with mental health problems. The…
Abstract
The Rowan report was published in 2003, following an investigation into allegations of abuse on a ward providing longterm care for older people with mental health problems. The factors identified as important were similar to those identified in other inquiries that took place before and after the Rowan inquiry. Why do organisations fail to learn the lessons of the past?This paper examines what happened following publication of the Rowan report and the ensuing publicity. Some positive outcomes are identified but, putting these in context, it seems unlikely that they will prevent further incidents. How do organisations prevent incidents/suspicions of abuse? The author suggests a multi‐level approach and argues that residential and nursing care is at least equally at risk. The fundamental problem lies in society's failure to prioritise and adequately resource the care of older people with dementia and other mental health problems.
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Michael Clark and Sandra Squires
This articles makes the case for using existing adult protection provision to improve the wellbeing of street prostitutes, whose circumstances often render them vulnerable and in…
Abstract
This articles makes the case for using existing adult protection provision to improve the wellbeing of street prostitutes, whose circumstances often render them vulnerable and in need of better co‐ordinated support.
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Jane Hughes, Saima Ahmed, Paul Clarkson, Sue Davies, Karen Stewart and David Challis
It was hypothesised that there were variations in health and social care services available for older people with dementia and their carers, and that measurement of this between…
Abstract
Purpose
It was hypothesised that there were variations in health and social care services available for older people with dementia and their carers, and that measurement of this between localities was possible. The purpose of this paper is to present a framework for examining this.
Design/methodology/approach
Using a case study approach, data from national surveys of local authorities providing social care and National Health Services Trusts providing old age mental health services conducted in 2014/2015 in England were used. From these, indicators of variation in services for people with dementia and their carers in different geographical areas were created. Measurement of the presence/absence of each service permitted the creation of a service mix score for each area.
Findings
The framework comprised 16 attributes each with indicators describing the characteristics of the organisations providing the services; the skill mix of community mental health teams for older people; and the health care and social care services available in localities. Variation was evident, confirmed by quartile analysis and exemplars, suggesting that older people with dementia and their carers in different localities are likely to experience differences in the range of provision available, particularly social care services.
Originality/value
The case study approach used achieved its objectives, and the resultant framework has potential for generalisability and utility, given acceptable ecological validity and discriminant validity in identifying variations in service mix. It could be used in both research and practice.