Jenny R. Billings

Contracting for integrated health and social care: a critical review of four models

Purpose – Service transformation of health and social care is currently requiring commissioners to assess the suitability of their contracting mechanisms to ensure goodness of fit with the integration agenda. The purpose of this paper is to provide a description and critical account of four models of contracting, namely Accountable Care Organisations, the Alliance Model, the Lead Provider/Prime Contractor Model, and Outcomes-based Commissioning and Contracting. Design/methodology/approach – The approach taken to the literature review was narrative and the results were organised under an analytical framework consisting of six themes: definition and purpose; characteristics; application; benefits/success factors; use of incentives; and critique. Findings – The review highlighted that while the models have relevance, there are a number of uncertainties regarding their direct applicability and utility for the health and social care agenda, and limited evidence of effectiveness. Research limitations/implicatio...

Potential triggers for the holistic assessment of people with severe chronic obstructive pulmonary disease: analysis of multiperspective, serial qualitative interviews

Objectives This study explores the narrative accounts of chronic obstructive pulmonary disease (COPD) to identify events that potentially could act as triggers for provision of supportive and palliative care. Trigger events must have meaning for the patient/carer, be visible to professionals, and have value in provoking useful actions. Methods A purposive sample of people with severe COPD, and their informal and professional carers, was recruited from primary/secondary care in Scotland. Indepth participant-led interviews allowed people to tell their illness story. Events occurring throughout the individuals account of the COPD journey were identified, and analysed thematically with regard to the meaning, visibility and use as potential triggers. Results Events identified from 92 transcripts (21 patients, 13 family carers, 18 professionals) punctuated the disease trajectory and crossed multiprofessional boundaries of care. These reflected advancing disease (increasing carer burden, becoming housebound, appointment frequency, increasing burden of disease, shifting priorities of care) or were an intervention addressing the consequences of advancing disease (requesting disabled parking, home adaptations, hospital admissions). Despite being meaningful in terms of increasing disability, many were invisible to professionals. Others were isolated events symptomatic of wider, ongoing disability which could potentially have use as triggers. Conclusions Meaningful events can be identified within the story of COPD which reflect wider needs, are clearly visible to alert professionals, and be of use in terms of potentially guiding supportive interventions. To achieve this level of usefulness, services will need to promote health and social care integration with clear processes to facilitate holistic assessment when a trigger is detected.

What do we Mean by Integrated Care? A European Interpretation

It is suggested that a common understanding of integrated care between multi‐professional staff is vital to prevent barriers to unification and quality of care. This paper examines qualitative data from PROCARE, a recently completed European project on integrated care for older people, to put forward an interpretation of what integrated care means to staff. Through thematic analysis, four main clusters were identified. The paper suggests that, while the analysis revealed a common and inter‐related European interpretation that was somewhat idealised and moralistic, this was countered by challenges to its implementation that were inseparable from the rhetoric. The paper suggests that a collective, morally strong understanding is unable to prevent barriers to integrated care, and that tensions between services remain a prominent impediment.

Towards Integrated Health and Social Care for Older People: A European Review

This paper provides a European overview of alternative approaches to integrated care for older people, drawing from a wider European project entitled PROCARE. It discusses the structural complexities that create the challenges in integrated care, compares and contrasts approaches to integrated care through a structure and process framework, and considers the place of person‐centred seamless care in European health and social care models.

Staff perceptions of ageist practice in the clinical setting: Practice development project

This study was undertaken in response to the audit requirements for the National Service Framework for Older People Standard 1 ‘Rooting Out Ageism’. The aim of this study was to identify and describe the nature of any age‐discriminatory practice in the clinical setting through the perceptions and experiences of staff working with older people.The study adopted a qualitative approach using focus group design. Six focus groups were conducted with 57 members of staff. An aim of the study method was to isolate consensus areas of ageist practice that would facilitate targeted intervention. To assist this, statements relating to common practice experiences were developed following the first two focus groups. This was used as a discussion tool for the subsequent groups.Perceived ageist practice could be grouped under the following themes:• access to services• communication and attitudes• treatment and care• the role of relatives• resources.On the basis of the findings, greater choice and control for older people need to be key features of the recommendations, through the development of a co‐ordinated development programme involving all stakeholders

The Role of Information Technology in Long-Term Care for Older People

The role that information technology (IT) has in assisting older people to maintain independence in their homes is increasing in many European countries (European Commission, 2010a). Advocates argue that it permits a more person-centred approach, assists carers in helping to reduce the burden, and can support older people with a wide variety of long-term conditions, not only in coping with physical conditions such as diabetes, but also conditions such as dementia. Evidence is accumulating about the value of technologies such as telecare, telemedicine and telehealth and how their use is becoming more widespread (European Commission, 2010b). However, IT solutions do not come without considerations in their application and effectiveness.

Addressing Long-Term Care as a System — Objectives and Methods of Study

One of the major achievements of humanity over the past 50 years has been the steadily rising life expectancy to which health systems all over the world have significantly contributed. Popular media coverage of this advancement however has tended to neglect the benefits of scientific progress that improves human longevity and instead portray catastrophic scenarios such as ‘demographic nightmares’ or the ‘ageing tsunami’. It is undisputed, however, that societies are struggling heavily with the consequences of demographic changes, particularly with respect to health and social care needs of a rising proportion of older people across Europe. The urgent need for policy and practice to respond to this demand has been the main trigger for the authors gathered in this book to elaborate on issues to improve and further develop long-term care (LTC) for older people in a systemic perspective. LTC in general remains a fragmented area; there is a lack of shared definitions within and between European countries, and in many countries it is only just beginning to emerge as an idea at the interfaces between informal and formal care, and between health and social care services. The economic crisis enveloping Europe with its consequent restrictions on public expenditure may also stifle momentum towards improvement and much needed change in LTC services. A number of other key challenges facing policy and practice in this area have been well documented, focusing for example on the lack of clear governance and finance mechanisms, increasing reliance on untrained migrant care workers, poor coordination between services, the burden on informal carers, and the lack of user involvement in care (European Union, 2012; Colombo et al., 2011; Bettio et al., 2006; Costa-i-Font and Courbage, 2011; Lamura et al., 2008; Bewley et al., 2011; Hofmarcher et al., 2007).

Improving the Evidence Base

One characteristic of emerging practices in long-term care (LTC) for older people is the lack of evidence concerning specific interventions that have been applied. While evidence-based medicine has started to become a mainstream issue (Long et al., 2006; Moriarty et al., 2007), practitioners and policymakers in the realm of LTC seem to lack guidance and general openness for this kind of working. This is in part due to the still-emerging nature of LTC as a discrete system, but also due to the tensions that exist in how evidence is understood and used for both health and social care practice and policy (Klein, 2000).

The INTERLINKS framework for long-term care of older people in Europe

Purpose – This paper aims to describe the methodological approach to and outcomes of a European multi‐consortium EU 7th Framework funded project entitled “INTERLINKS”. The project sought to develop a concept and method to describe and analyse long‐term care and its links with the health and social care systems, and formal and informal care.Design/methodology/approach – Through the development of a template, it accumulated and validated practice examples that described good policy and practice, transferable across EU member states.Findings – The outcome was to assemble a range of themes, sub‐themes and 135 key issues into a web‐based framework for LTC that is illustrated by over 100 examples of validated practice in LTC for older people.Research limitations/implications – Key messages emanating from the project are provided, with an emphasis on the need for greater investment and pluralist evaluation of initiatives that seek to address the interfaces and links between care services.Originality/value – The ...

Towards rigour in qualitative health and social research across European partnerships

Undertaking projects with European partners is an enterprising and rewarding activity, where societies can start to learn how to transfer knowledge and take advantage of best practices to further the benefits to health and social care service users. However, this can also be a challenging experience, more so when there is scanty guidance about the best way to conduct European partnership research. Using an on-going study of integrated care for older persons as an example (the PROCARE project), this paper provides an account of the methodological strengths and challenges of the qualitative approach used. It suggests that factors assisting a rigorous approach include sound and inclusive coordination, a strong research design, the construction of universally acceptable selection criteria, detailed interview schedules, and a transversal approach to data analysis