Transcript Powerpoint

An evidence base for the delivery
of adult services
Alison Petch
SSRG Event 27.2.12
1
Definition, definition, definition
• Integration, joint
working, merger,
collaboration,
partnership working…
• ‘methodological
anarchy and definitional
chaos’ (Ling, 2002)
• ‘a terminological
quagmire’ (Leathard,
2003)
2
The partnership continuum
Relative
autonomy
Co-ordination
Joint
appointments
Enhanced
partnership
Structural
integration
Depth of relationship
Formal merger
Partnership
organisation
Joint
management
Coordinating
activities
Consulting with
each other
Breadth of relationship
Sharing
information
Health and
social care
Health and wider
local authority
Health, local authority,
wider community
from Glasby et al (2011)
4
Help and hinder [NHSConfed/ADASS]
• Friendly relationships
• Good leadership
• Commitment form the
top
• Joint strategy and vision
• Co-terminosity
• Performance regimes
• Financial pressures
• Organisational
complexity
• Changing leadership
• Financial complexity
• Culture
5
Clarify, clarify, clarify
• Integrated organisations,
integrated care
• Macro, mezzo, micro
–
–
–
–
–
between service sectors
between professions
between settings
between organisation types
between types of care
individuals
organisations
structural
• Horizontal and vertical
integration
6
Not proven?
• Process v outcomes
• Brown et al (2003): ‘no
findings which suggest that
the integrated primarycare-based health and
social care teams are more
clinically effective than the
traditional non-integrated
method of service delivery’
• Similar – Kharicha et al,
2004; Townsley et al, 2004;
Davey et al, 2005
7
International evidence
• OnLok (PACE) – USA; SIPA – Quebec; PRISMA –
Canada; CARMEN - Europe; PROCARE Europe; Vittorio Veneto; Rovereto (Italy)
• Integrated working reduced the cumulative
number of days older people stayed in
institutional care
• Common features: case management;
specialist assessment and a multi-disciplinary
team; single point of entry; financial levers
8
In a nutshell
• ‘what sort of
partnerships can
produce what kinds of
outcomes for which
groups of people who
use services, when
and how’
Dickinson, 2006
9
“it works in Northern Ireland”
• ‘Hegemony of health’
• Priority to health
agendas and targets
• Limited focus of the
integrated approach
• The full potential of
integration has not
been realised
Heenan (2006, 2009)
The limits of structural change
• Structural change by itself rarely achieves
stated objectives
• Emphasis should be on service integration
not organisational integration
• Mergers are potentially very disruptive for
managers, staff and service users, and
can give a false impression of change
• Mergers can stall positive service
development for at least 18 months
• Mergers typically do not save money
Early adopters: Knowsley, NE Lincs,
Torbay, Somerset
• Influence of local
history and context
• ‘Outcomes for Mrs
Smith’
• Role of leadership at
the top
• Importance of
integrated health and
social care teams
• Need for evaluation
Fried or scrambled?
13
Financial evidence
• Weatherly (2010): ‘tentative
evidence that financial
integration can be beneficial.
However robust evidence for
improved health outcomes or
cost savings is lacking’
• Turning Point (2010):
‘integration in health and
well-being services can be
cost effective. However, the
evidence base is still
relatively small…’
14
In a nutshell
•
•
•
•
Integration based on outcomes not targets
Integration based on cultures not structures
Integration based on place not organisation
Integration based on delegation not transfer
of functions
• Integration based on clinical and professional
engagement
NHS Confederation (2010)
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Key dimensions
Vision
Integrated
teams
Leadership
Outcomes
Time
Culture
Place
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Personal outcomes approach
‘Outcomes for Mr McKay’
•Quality of life eg staying
well, seeing people, safe,
things to do
•Process eg choice,
listened to, reliable,
responsive
•Change eg improved
mobility, reduced
symptoms
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Time
• ‘change did not occur
overnight; time was
needed for formal
partnership agreements
to be translated into
changes in attitudes,
culture and ways of
working amongst frontline staff’
Hultberg et al, 2005
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