Integrating health and social care in community mental health teams in the UK: a study of assessments and eligibility criteria in England

Examining the underpinnings of decisions to allocate public resources to social care: A systematic review

The increasing demand for social care, resulting from population ageing and the growing prevalence of chronic diseases and disabilities puts pressure on public resources. This trend necessitates decisions on the allocation of those resources to social care services. Several states have established explicit decision-making frameworks to inform resource-allocation decisions on healthcare to safeguard efficient and equitable access to healthcare services despite the scarcity of resources. While the theoretical and empirical underpinnings of such decisions on healthcare have been scrutinised, the underpinnings of resource-allocation decisions on social care remain unexplored. This study aims to contribute to filling this literature gap. We conducted a systematic literature search on seven databases following PRISMA guidelines. Based on the 42 articles included, we identified five different decision-makers (national, and local (health) authorities, case managers, service providers, and formal caregivers) responsible for resource-allocation decisions on social care on the macro, meso, and micro levels. We further developed a thematic framework consisting of 25 categories of underpinnings grouped under six themes that successively describe (cultural) norms and values, objectives, considerations, trade-offs, strategies, and factors that underlie and influence resource-allocation decisions. Our findings highlight the importance decision-makers attach to the provision of social care and the importance of informal caregivers for the sustainability of the social-care system on all decision levels. Furthermore, our findings highlight the strong competition with the healthcare system over resources and responsibilities, resulting in pressure on social care resource-allocation decision-makers to meet (post-)acute health needs in the short-term at the expense of longer-term social care needs. The multiplicity of decision-makers and variety of underpinnings signal the complexity of resource-allocation decisions on social care. To counterbalance the potential consequences of this complexity such as the potentially inequitable access to social care, decision-makers are advised to increase the consistency and transparency of decisions.

More that unites us than divides us? A qualitative study of integration of community health and social care services

Background

The integration of community health and social care services has been widely promoted nationally as a vital step to improve patient centred care, reduce costs, reduce admissions to hospital and facilitate timely and effective discharge from hospital. The complexities of integration raise questions about the practical challenges of integrating health and care given embedded professional and organisational boundaries in both sectors. We describe how an English city created a single, integrated care partnership, to integrate community health and social care services. This led to the development of 12 integrated neighbourhood teams, combining and co-locating professionals across three separate localities. The aim of this research is to identify the context and the factors enabling and hindering integration from a qualitative process evaluation.

Methods

Twenty-four semi-structured interviews were conducted with equal numbers of health and social care staff at strategic and operational level. The data was subjected to thematic analysis.

Results

We describe three key themes: 1) shared vision and leadership; 2) organisational factors; 3) professional workforce factors. We found a clarity of vision and purpose of integration throughout the partnership, but there were challenges related to the introduction of devolved leadership. There were widespread concerns that the specified outcome measures did not capture the complexities of integration. Organisational challenges included a lack of detail around clinical and service delivery planning, tensions around variable human resource practices and barriers to data sharing. A lack of understanding and trust meant professional workforce integration remained a key challenge, although integration was also seen as a potential solution to engender relationship building.

Conclusions

Given the long-term national policy focus on integration this ambitious approach to integrate community health and social care has highlighted implications for leadership, organisational design and inter-professional working. Given the ethos of valuing the local assets of individuals and networks within the new partnership we found the integrated neighbourhood teams could all learn from each other. Many of the challenges of integration could benefit from embracing the inherent capabilities across the integrated neighbourhood teams and localities of this city.

Elephant in the room

Purpose

The purpose of this paper is to report on the findings of the first stage of a project seeking to evaluate and overcome inter-professional barriers between health and social care staff within a single, co-located, integrated community team. The project seeks to answer the following questions: first, Do inter-professional barriers to integrated working exist between health and social care staff at the interface of care delivery? Second, If inter-professional barriers exist, can joint health and social care assessments help to overcome them? The paper develops the current evidence base through findings from a staff questionnaire and the initial findings of a pilot study of joint health and social care assessments aimed at overcoming inter-professional barriers to integration.

Design/methodology/approach

The first stage of the project involved running an anonymous, online questionnaire with health and social care staff within a single, co-located community adult health and social care team. The questionnaire aimed to explore staffs’ perceptions of inter-professional collaboration when assessing the health and care needs of service users with a high degree of complexity of need. The second element of the study presents the initial findings of a small pilot of joint health and social care assessments. A second staff survey was used in order to provide a “before and after” comparative analysis and to demonstrate the effect of joint assessments on staffs’ perceptions of inter-professional collaboration at the interface of care delivery.

Findings

Health and social care staff value joint working as a means of improving quality of care. However, they also felt that inter-professional collaboration did not occur routinely due to organisational limitations. Staff members who participated in the pilot of joint assessments believed that this collaborative approach improved their understanding of other professional roles, was an effective means of enabling others to understand their own roles and helped to better identify the health and care needs of the most complex service users on their caseloads. Initial findings suggest that joint assessments may be a practical means of overcoming inter-professional barriers related to a lack of communication and lack of understanding of job roles.

Practical implications

The questionnaires highlighted the need for integration strategies that are aimed at facilitating collaborative working between staff of different professions, in order to achieve the aims of integration, such as a reduction in duplication of work and hand-offs between services.

Originality/value

To date, few studies have explored either staff perceptions of collaborative working or the effectiveness of joint assessments as a means of overcoming inter-professional barriers. This paper adds new data to an important area of integration that legislators and researchers increasingly agree requires more focus. Although the findings are limited due to the small scale of the initial pilot, they provide interesting and original data that will provide insight into future workforce integration strategies.

Patterns of Shelter Use Among Men New to Homelessness in Later Life

People who become homeless for the first time in late life are a growing but understudied population. This study draws on administrative data from one shelter ( N = 1,214 first-time homeless) to assess the extent to which age is related to shelter stay and, to examine psychosocial factors that may be associated with shelter departure. Our bivariate and survival analysis results suggest that older homeless men stay in the shelter 2 weeks longer than younger clients. Older men with pending legal issues and mobility concerns were more likely to leave the shelter than those without such concerns. Findings highlight the impact of age and other psychosocial variables on shelter stay, and provide direction from which to address homelessness among men who are new to homelessness in later life.