Going round in circles? Joint working between primary health and social care

Pursuing collaborative advantage in Swedish care for older people: stakeholders' views on trust

Purpose

The purpose of this paper is to explore stakeholder views on the policy of integrated health and social care for older people with complex needs in Sweden and the issue of trust in implementing the policy.

Design/methodology/approach

The study used a qualitative interview design and interviews with nine strategically selected stakeholders. A thematic analysis focused on trust, as defined in the theory of collaborative advantage, was used.

Findings

This study of health and social care exposed a lack of trust on political, strategic and inter-professional levels. Two opposing lines of argument were identified in the interviews. One advocated a single government authority for health and social care. The other was in accordance with recently implemented national policies, which entailed more collaboration between local government authorities, obliging them to make joint local agreements. The Swedish experience is discussed in an international context, examining the need for collaboration in integrated care services for older people.

Research limitations/implications

Although the findings are important for the current adjustment in health and social care for older people, the number of interviewees are limited. Future studies will include more regions and longitudinal studies.

Originality/value

Sweden is currently undergoing an extensive adjustment in line with recent national government policy which involves more primary health care and a corresponding reduction in the number of hospital beds. The restructuring of the care system for older people with complex needs is a paradox, as it simultaneously increases the need for centralisation while also increasing coordination and collaboration on a local basis.

Partnership or insanity: why do health partnerships do the same thing over and over again and expect a different result?

Objectives

The paper reports on an empirical study of Health and Wellbeing Boards (HWBs) in England. Established by the Health and Social Care Act 2012, HWBs act as place-based hubs for leaders in health, social care, local government and other sectors to come together to address health improvement and the wider determinants of health.

Methods

We conducted a three-year study of HWBs (2015–2017) in five localities across England. This involved collecting qualitative data from semi-structured interviews with key actors in the HWBs at strategic and operational levels, and focus group sessions with voluntary-sector participants at each HWB.

Results

HWBs have largely followed the path of previous partnerships in terms of a lack of clear aims and objectives, lack of ownership and accountability by partners, and an absence of any significant impact on health outcomes.

Conclusions

Many of the features of unsuccessful partnership working were largely displayed by HWBs. Boards require more executive power and ownership from the bottom up if they are to have any real impact.

Professionals’ views on integrated care

Purpose

Integrated care policies have been at the heart of recent health reforms in many European countries. The purpose of this paper is to study the integration from the perspective of health care personnel working in primary health care clinics.

Design/methodology/approach

The study employs data from interviews collected in a research project examining patient choice and integrated care in primary health care clinics in Finland. The interviews were conducted in five cities in Southern Finland in 17 primary health care clinics in Autumn 2014. Among the interviewees there were both doctors (n=32) and nurses (n=31).

Findings

The typical problems hindering integration were, according to the workers, poor communication and insufficient information exchange between professionals, unclear definition of responsibilities between professionals, and lacking contacts and information exchange between health and social care professionals. To secure availability and continuity of care, doctors and nurses did extra work and exceeded their duties or invented ad hoc solutions to solve the problem at hand. According to professionals, patients were forced to take an active role as coordinator of their own care when responsibilities were not clearly defined between professionals.

Originality/value

This paper highlights that successful integration requires taking into account the requirements of the day-to-day work of health care clinics, and clarifying what facilitates and what hinders practical collaboration between different actors in health care and between health care and other service providers.