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Scott, Jason; Birks, Yvonne; Aspinal, Fiona; Waring, Justin
2017 Journal of Integrated Care
doi: 10.1108/JICA-01-2017-0001
PurposeKeeping individuals safe from harm and exploitation is a clearly articulated goal within both the health and social care sectors. Two key concepts associated with achieving this common aim are safety and safeguarding. The purpose of this paper is to critically appraise the differences in safety terminology used in health and social care, including opportunities and challenges for greater integration of safety systems across health and social care in England.Design/methodology/approachThis paper presents the authors’ viewpoint based on personal, professional and research experience.FindingsIn healthcare, safety is usually conceptualised as the management of error, with risk considered on a universal level. In social care, the safeguarding process balances choice and control with individualised approaches to keeping adults safe, but lacks the established reporting pathways to capture safety incidents. Efforts to safely integrate health and social care services are currently constrained by a lack of shared understanding of the concepts of safety and safeguarding without further consideration of how these approaches to keeping people safe can be better aligned. As such, there is a need for a single, unified discourse of patient safety that cuts across the patient safety and safeguarding concepts and their associated frameworks in health and social care settings.Originality/valueA single unified concept of safety in health and social care could coincide with an integrated approach to the delivery of health and social care, improving the care of patients transitioning between services.
Kaehne, Axel; Birrell, Derek; Miller, Robin; Petch, Alison
2017 Journal of Integrated Care
doi: 10.1108/JICA-12-2016-0049
PurposeThe 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/approachThe paper is written as a piece of critical reflection by drawing on the authors’ knowledge and expertise and wider evidence where available.FindingsSince 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/implicationsThe 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/valueThe 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.
Wilberforce, Mark; Hughes, Jane; Clarkson, Paul; Whyte, David; Chester, Helen; Davies, Sue; Challis, David
2017 Journal of Integrated Care
doi: 10.1108/JICA-09-2016-0034
PurposeThe purpose of this paper is to evaluate the implementation and potential value of an electronic referral system to improve integrated discharge planning for hospitalised older adults with complex care needs. This new technology formed part of the “Common Assessment Framework for Adults” policy in England.Design/methodology/approachMixed methods were undertaken as part of a case study approach within an acute hospital in the North West of England. First, qualitative interviews were undertaken with practitioners to explore early experiences using the new technology. Second, routinely collected administrative data were analysed, comparing referrals made using the new technology and those made through the usual paper-based process.FindingsQualitative interviews found that an electronic discharge system has, in principle, the potential to improve the efficiency and suitability of integrated care planning. However, the implementation proved fragile to decisions taken elsewhere in the local care system, meaning its scope was severely curtailed in practice. Several “socio-technical” issues were identified, including the loss of valuable face-to-face communication by replacing manual with electronic referrals.Research limitations/implicationsThe small number of patients referred during the implementation phase meant that patient outcomes could not be definitively judged. Research into the longer-term implications and value of electronic referral systems is needed.Originality/valueThere is concern that attempts to integrate health and social care are stymied by incompatible systems for recording service user information. This research explores a novel attempt to share assessment information and improve support planning across health and social care boundaries.
Argyle, Elaine; Kelly, Tony; Gladman, John; Jones, Rob
2017 Journal of Integrated Care
doi: 10.1108/JICA-09-2016-0032
PurposeRecent years have seen an increasing reliance on social support at home for people with dementia and the advocacy of a person centred and integrated approach in its provision. However, little is known about the effective ingredients of this support and how they differ from more generic or health-based services. The purpose of this paper is to explore the existing evidence base.Design/methodology/approachA review of relevant literature was carried out, combining a systematic search and selection of articles with a narrative analysis.FindingsThe review identified 14 relevant studies of varying research designs which yielded conflicting findings with regard to the optimal timing of interventions and their overall impact. This highlights the problems of review and generalisability when attempting to compare findings of research in this area. This was exacerbated by the blurred divide between health and social care and ambiguities in the meaning of the latter.Research limitations/implicationsThis methodological heterogeneity demonstrates the need for consistency in research approaches if comparisons are to be made. Further questions include the precise components that distinguish social care from health care, the optimal timing for the introduction of this care and whether adherence to good practice in this area can be linked to cost effectiveness.Originality/valueThe review identifies relevant issues in need of further investigation and tentative themes emerging from the literature which suggest the utility of an adequately resourced, integrated and responsive approach to intervention.
Allbutt, Helen; Colthart, Iain; El-Farargy, Nancy; Sturgeon, Caroline; Vallis, Jo; Lough, Murray
2017 Journal of Integrated Care
doi: 10.1108/JICA-11-2016-0046
PurposeThe purpose of this paper is to describe a collaborative study on supervision with health and social care practitioners in Scotland. The study attempted to gain a better understanding about the use and benefit of supervision from a multiprofessional perspective.Design/methodology/approachConsultation events with health and social care staff and 12 informant interviews were undertaken. Data analysis was via the Framework Method.FindingsManagers were more likely to conceive of supervision as a positive intervention than those in lower pay bands. The practice of supervision was variable. Not all staff appeared to take part in regular supervisory activities even when it was mandated. A lack of professional, organisational or local commitment to implement robust supervisory structures and processes was seen as the major barrier to effective supervision.Research limitations/implicationsThis was a small study, thus findings would need to be confirmed by health and social care staff working across a wider spectrum of disciplines and regions across Scotland.Practical implicationsA combination of factors would seem to determine effective supervisory practice. Supervision was perceived to be of benefit when individuals were willing to participate fully, when there was reflection and planned action, constructive challenge, respectful relationships, regular and protected sessions and processes were appropriate to an employee’s circumstances.Originality/valueThis study situates supervision in the current context of health and social care and finds it to be an irregular practice. The findings confirm the existing literature about the importance of supervisor-supervisee relationships but explain differing perceptions of supervision in terms of staff seniority.