Gerald Wistow

Interagency and interprofessional collaboration in community care: the interdependence of structures and values

This paper considers the problems of interagency and interprofessional collaboration in community care in Great Britain from the combined perspectives of UK and US researchers. The research team drew on empirical and theoretical literature from both countries to construct a framework for analysing inter- and intra-organisational theories of joint working. This analysis, supplemented and supported by local case studies conducted by the researchers, generates a framework recommendation against which the governments initiatives for partnership working in the NHS plan 2000 and subsequently can be critically reviewed. In particular, at a time when structural integration--via Care Trusts--is being seriously considered, they highlight the vital importance of integrated systems of goal setting, authority and multidisciplinary service delivery rather than a narrow focus on structural integration alone.

Inter-agency services in England and The Netherlands: A comparative study of integrated care development and delivery

In England and the Netherlands there is much comparable experience in developing and delivering integrated services, provided by different health care agencies to people with multiple care demands. The achievement of integrated care provision in such cases appears to be very difficult and laborious in both countries. This article may be considered a first step in exploring the reasons for this and in developing a framework that is not context specific, as a contribution to a more generally applicable analysis of obstacles to integration and the means for overcoming them. After analysing the English and Dutch health and social care systems and their development in recent decades, we conclude that basically there are clear system similarities which are hindering the integration of services, for instance the predominant complexity of the system with a lot of stakeholders having different roles, tasks, interests and power positions. We have identified common mechanisms that play a dominant role in both systems; not only the social, economic and political context, but also the local context, the legal context and funding streams. Other relevant factors are the procedural and structural arrangements at different system levels and the collaborative culture and tradition. The way these mechanisms work in practice, however, is different for England and the Netherlands, due to system differences. In the Netherlands for instance there is a clear emphasis on bargaining in the context of non-hierarchical structured networks, whilst in England hierarchies and the interplay between hierarchies, markets and networks play a more dominant role. In spite of the differences and problems in both countries we have found a similar recognition of interdependence and willingness to pursue integration of services for multi-problem patients.

Learning to hear voices: Listening to users of mental health services

This article reports findings from a Users Councils project developed as part of a multi-dimensional approach to the development of user-led community care services: the Birmingham Community Care Special Action Project (CCSAP). The evaluation of the user involvement dimension of CCSAP sought to answer three basic questions: Who was involved? How were they involved? What were the outcomes of involvement? This article highlights the particular significance of enabling users of mental health services to express a ‘voice’ which is recognized as valid by those professionally involved with their care. It identifies the different motivations and purposes which encourage users to become involved in user councils and emphasises the need for clarity and openness about the objectives to be achieved. It considers provider responses to those voices and discusses the importance of establishing means through which voice can be translated into action by those with responsibilities for services.

Competition in the Mixed Economy of Care

The 1990 National Health Service and Community Care Act introduced sweeping changes to health and social welfare services. The reforms to community care were dominated by the introduction of markets for social care. We argue that the new markets cannot be guaranteed to deliver the range of services required to meet community care objectives. When they began to assume their new responsibilities, few key purchasers had a basic understanding of the functioning and imperfections of markets. Consequently, they were poorly equipped to anticipate or ameliorate the sources of market failure that we identify. Like any other relatively ill-informed purchaser, local authorities risk being unable to buy what they want on behalf of their residents and at an appropriate volume, cost and quality. We discuss where and how market imperfections are likely to occur. In this context, we offer an economic framework to help in the shaping and managing of social care markets.

Still a fine mess? Local government and the NHS 1962 to 2012

Purpose – The purpose of this paper is to take “a long view” of initiatives taken to promote integration between local government and the NHS with the objective of seeking to understand why they have achieved consistently disappointing results.Design/methodology/approach – The papers analysis is based on an historical overview drawn from official documents and empirical research from the time of the creation of the NHS in 1948. It primarily focuses on the principles shaping the separate but parallel reorganisations of 1974 and their continuing influence up to and including the current White Paper “Liberating the NHS”, and the Health and Social Care Bill.Findings – The fundamental sources of integration barriers today lie in the foundational principles of basing their responsibilities on the skills of providers rather than the needs of service users and their organisational forms on separation rather than interdependence, with national uniformity driving the NHS and local diversity local authorities. In a...

Integration: work still in progress

PURPOSE The purpose of this paper is to set the context for this special issue and provide an introduction to the individual contributions. DESIGN/METHODOLOGY/APPROACH This paper uses a literature survey and analysis. FINDINGS Integration remains both a central goal and a field of limited but possibly developing achievement. Multiple meanings and usages are themselves sources of confusion and contestability that contribute to poor performance, as does an emphasis on process over outcome. This special issue provides an opportunity for the limitations and possibilities of integration to be explored from a wide range of disciplinary perspectives and international settings. Individual papers draw on a wide and innovatory range of theoretical approaches in addressing reasons for limited progress and opportunities for taking it further. Nonetheless, how far we have a good fit between this area of study and the tools we use for its evaluation remains an issue for concern and further exploration. RESEARCH LIMITATIONS/IMPLICATIONS This editorial is not a systematic review, though it draws on findings from a number of such reviews. PRACTICAL IMPLICATIONS The various contributions all have practical implications for the strategies to develop integration and its evaluation. ORIGINALITY/VALUE The special issue as a whole was designed to encourage fresh perspectives and approaches to be brought to bear on understanding, conducting and evaluating integration. This editorial introduces each of these themes.

Joint Management in Community Care

Government ministers have stressed that inter‐agency co‐ordination will be crucial to the success of their community care proposals. Yet the history of collaboration between health and local authorities has been one of limited achievements. Notwithstanding this general record there are a growing number of examples of apparently successful co‐ordination; moreover, amongst these are projects involving joint management, which is inter‐agency co‐ordination at its most complex. This article reports on a detailed study of five such projects, across a range of client groups, undertaken on behalf of the Department of Health. We found that the essence of such schemes is their fragility and vulnerability to a range of organisational pressures. We concluded that these pressures are sufficient to threaten the survival of newly established projects unless managers address certain key imperatives which we outline here.

Learning from Doing: Implications of the Barking and Dagenham Experience for Integrating Health and Social Care

Local government and the NHS in Barking and Dagenham embarked on a bold initiative in 2001 to integrate health and social care management structures. Although it was not sustained, this local experience is an important source of learning as the search for improved partnership working enters yet another new phase. In particular, it demonstrates that the route to better outcomes depends on managing not only the tension between structure and culture, but also that between national targets and local discretion in services based on fundamentally different principles of governance: central management and local accountability.

The New Management of Community Care: User Groups, Citizenship and Co-Production

One aspect of the changes taking place within the local governance of welfare is the way in which those who have been seen as passive recipients of services are taking part in their production. This has been enabled by changes within welfare systems which have separated the purchase from the production of services and by policies which have emphasised consumer responsiveness. But it has also been the result of self-organisation on the part of service users. It is this which formed the subject of our study: ‘Consumerism and Citizenship amongst Users of Health and Social Care Services’.

Integration and the NHS reforms

Purpose – The purpose of this paper is to consider whether the framework for integration initiated by the White Paper Liberating the National Health Service (NHS) is likely to be more successful than previous frameworks.Design/methodology/approach – The paper formulates ten principles of integration derived from a historical literature review, and makes the comparison with principal features of new proposals for promoting integration between NHS and Local Government in England.Findings – There is a relatively good fit between the principles and proposals but gaps were identified and implementation difficulties are already becoming evident especially in respect of the tension between localism and national accountability.Research limitations/implications – The conduct of the literature review is consistent with standard historical research methods but does not aim to comply with the protocols for systematic reviews in health sciences. It does not attempt to be based on a fully comprehensive search because o...