Axel Kaehne, Derek Birrell, Robin Miller and Alison Petch
The purpose of this paper is to outline relevant policies on the integration of health and social care (HSC) in the four home nations: Scotland, Wales, Northern Ireland and…
Abstract
Purpose
The purpose of this paper is to outline relevant policies on the integration of health and social care (HSC) in the four home nations: Scotland, Wales, Northern Ireland and England and offer a comparison of emphasis and approaches and draw out general insights on the implementation of integrated care policy.
Design/methodology/approach
The paper is written as a piece of critical reflection by drawing on the authors’ knowledge and expertise and wider evidence where available.
Findings
Since 2010, HSC integration has started to diverge significantly in the four constituent countries of the UK. Although England and Wales have undergone considerable re-organisation of the NHS, Scotland and Northern Ireland have largely been marked by organisational continuity. However, beyond organisational differences, policy approaches, policy emphases and implementation strategies have also started to show considerable dissimilarity across the UK. An important contributory factor may be different ideological perspectives on the role of competition and pilots, partnership, patient choice and organisational incentives to bring about change in the field.
Research limitations/implications
The paper identifies a serious lack of comparative research in integration policy, despite the considerable opportunities for quasi-experimental studies. This lack of empirical research impedes shared learning across the home nations.
Originality/value
The paper presents a descriptive comparison of current integration policy between HSC providers in the four home nations. It reveals considerable opportunities for further research and comparative modelling of integration approaches.
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Deirdre Heenan and Derek Birrell
Unlike the rest of the United Kingdom, Northern Ireland has had a system of integrated health and social care since the early 1970s. Following devolution, the reconfiguration of…
Abstract
Unlike the rest of the United Kingdom, Northern Ireland has had a system of integrated health and social care since the early 1970s. Following devolution, the reconfiguration of services has strengthened this integration with a smaller number of trusts with responsibilities for all heath and social care. This article examines the current and planned operation of this more comprehensive form of integration of health and social care. It considers how this experience of integrated structures and working can inform approaches in other areas of the UK. Finally, it assesses the main achievements of this system and identifies remaining problems.
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Derek Birrell and Deirdre Heenan
This paper assesses the recommendations and proposals contained in Transforming Your Care, the recent review of health and social care in Northern Ireland, in the context of the…
Abstract
Purpose
This paper assesses the recommendations and proposals contained in Transforming Your Care, the recent review of health and social care in Northern Ireland, in the context of the existing integrated structures. It is designed to promote a better understanding of the implications of the proposed reconfiguration of health and social care.
Design/methodology/approach
This paper reviews a number of published documents encompassing an independent review and subsequent plans and strategies. It also draws upon a case study of a Rapid Access Clinic undertaken by the authors as part of a wider research project.
Findings
The paper concludes that the planned changes question the ability of an integrated structure operating across primary, secondary and social care. It notes that there are real concerns about the capacity of the social care workforce to deliver services. It is suggested that the proposal for Integrated Care Partnerships can be seen as a reflection of the need for a more localised approach to delivery.
Research limitations/implications
The findings are derived from a small‐scale study and as such may make generalisation difficult. There is a clear need for a more robust evidence‐based approach to the evaluation of structural integration in health and social care and a process for monitoring of this change process.
Originality/value
The article is a reminder of the unique example of structural integration within the UK. As such it could have important lessons for England, Scotland and Wales which are moving in a similar direction.
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Ann Marie Gray and Derek Birrell
Across the UK integrated commissioning is seen as important to achieving integrated care. In Great Britain this has largely meant separate health and social care agencies coming…
Abstract
Purpose
Across the UK integrated commissioning is seen as important to achieving integrated care. In Great Britain this has largely meant separate health and social care agencies coming together to assess need and the planning and delivery of services. Achieving integrated commissioning has proved difficult in the context of different funding systems and different organisational and professional values and cultures. Northern Ireland is the only part of the United Kingdom to have a system of total structural integration of all health and social care. The purpose of this paper is to examine the challenges of operationalising integrated commissioning in Great Britain and to assess whether the Northern Ireland model of structural integration has resolved such difficulties
Design/methodology/approach
The paper reviews how integrated commissioning is working through analysis of published research. The authors draw on policy documents to assess and evaluate the structure and process of integrated commissioning in Northern Ireland.
Findings
It is concluded that structural integration is not a pre-requisite for integrated care and that there may be risks to social care in moving toward structural integration. While there is a rhetorical commitment to integrated care across the UK this is not followed through in commissioning practice.
Originality/value
The paper presents an original assessment of the operation of integrated commissioning in Northern Ireland that has relevance for debates in Britain about the integration of health and social care.
Derek Birrell and Deirdre Heenan
The purpose of this paper is to explore and assess the configuration, role and likely contribution of the new integrated care partnerships (ICPs) established in Northern Ireland…
Abstract
Purpose
The purpose of this paper is to explore and assess the configuration, role and likely contribution of the new integrated care partnerships (ICPs) established in Northern Ireland.
Design/methodology/approach
The approach is based on the assessment of policy background, strategy papers, implementation plans and initial activities of ICPs.
Findings
ICPs have been created with limited powers and an unclear relationship with the existing system of structurally integrated health and social care. The initial priorities and activities of ICPs suggest a focus on integrating health which may impede the further integration of health and social care.
Research limitations/implications
Paper concludes there is a need for robust evaluation including monitoring of progress, performance and outcomes.
Originality/value
First published paper on implementation of ICPs in Northern Ireland. Contributing to comparative studies of structures of health and social care, with particular relevance to integration.
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Derek Milne, Andrea McAnaney, Ben Pollinger, Katie Bateman and Emma Fewster
Voluntary organisations are an integral part of community care, and the available research indicates the value of their social support role. However, surprisingly little is known…
Abstract
Voluntary organisations are an integral part of community care, and the available research indicates the value of their social support role. However, surprisingly little is known about the forms and functions of this support, or the links to the formal support provided by the National Health Service (NHS), so hampering quality improvements. Therefore, a small sample of voluntary service organisations in one English county participated in a pilot study. This involved the staff and users of these organisations, and a geographically linked sample of NHS mental health professionals. Interview data indicated that the voluntary sector users and staff held similarly positive views of the appropriately varied forms and functions of the provided social support, and all participants held unusually similar and positive views of their links, although areas for improvement were suggested by both groups (e.g. links to GPs).