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Background: In spite of ongoing UK Government recommendations for integrated health and social care, the implementation has been slow. While there are pockets of integration happening across England, many services remain isolated and fragmented. Aim: This review aims to critically review existing evidence to identify if there are any factors enabling successful implementation of integrated health and social care for people with long-term conditions in the community. Method: A review was conducted following the principles of a systematic review. Relevant data was extracted from the identified papers and the papers were quality appraised. Results: A total of seven studies were included in the review. Data analysis and synthesis identified a number of themes in relation to enablers of integrated care, including co-location of teams, communication, integrated organisations, management and leadership, capacity and resources, and information technology. Conclusion: There is a limited amount of evidence regarding integrated health and social care teams. Although there are some consistencies within the findings, further research is needed to enhance the validity of the body of evidence available. [ABSTRACT FROM AUTHOR]

As populations rise and many global health policies point towards community care, it is important that health care delivery meets demand. In Ireland, a study was undertaken on the level and context of missed care in community nursing. The study used a survey to identify the quantity of, and reasons for, missed care; a reference group to develop possible health economic implications for missed care, and a small sample of semi-structured interviews to consider the macro-environment within which missed care occurred. This paper presents the findings of the health economics and qualitative data, and the study's implications for community nursing. [ABSTRACT FROM AUTHOR]

This is the second of two papers that examine district nursing within a changing health policy and service environment. The first paper explored the current UK policy context and the way in which district nursing and community nursing services within each country are changing to meet the challenges posed. This article considers the current district nurse (DN) role, which has constantly evolved over the past 150 years, and considers the educational framework that underpins the preparation of these specialist community practitioners in relation to community colleagues such as specialist community public health nurses (SCPHNs). In the context of the current economic climate, there is concern that the apprenticeship model of staff development is replacing specialist practitioner education for DNs, solely on the basis of resource. This article explores the current challenges for DN education within the UK. The underpinning educational preparation of DN programmes is examined and key issues such as safeguarding the public are discussed. The need to develop a cohesive approach to education for post-qualification nurses in the community is advocated. These are important considerations for the future of a discipline which currently feels under threat. [ABSTRACT FROM AUTHOR]

Policies in long term conditions care continue to develop rapidly in England. Currently there is a focus on the integration of services and enabling patient and carer choice. Integration of care across disciplines and services is complex and community nursing services are commonly central to reorganization processes in long term condition care. This paper presents the findings of a mapping of the evidence on integration in long term condition services. Literature on horizontal integration including integrated teams will first be discussed, followed by an exploration of the evidence on vertical integration exemplified by integrated care pathways and disease management programmes. As a relatively recent service innovation, the mapping found a lack of evidence of the effectiveness of integration in long term conditions. Furthermore, the paper highlights the potential tension between vertical integration structures such as care pathways and the patient choice and empowerment agenda in long term conditions. [ABSTRACT FROM AUTHOR]

The Health Trainer initiative was a public policy initiative designed to tackle health inequalities. Despite considerable improvements in the health of the population in the United Kingdom, there continues to be a gap between the rich and the poor in terms of deaths from cancer, stroke and coronary heart disease. There is a relationship between these health problems and lifestyle behaviours such as smoking, physical inactivity and poor diet. The Health Trainer initiative was created as part of the white paper Choosing Health. Following initial implementation across targeted Primary Care Trusts (The Spearhead Group), a rigorous evaluation of the initiative is taking place prior to a national roll out. This paper uses Whitehead's framework to examine the decision to implement health trainers as a stated aim of tackling health inequalities. The four purposes of health policy as identified by Whitehead (1995) and the categories of healthy living initiatives (Visram and Drinkwater 2005) are examined and applied to the health trainer initiative and its potential for reducing health inequality. [ABSTRACT FROM AUTHOR]

Recent government documents (Department of Health (DH), 2009) have suggested that as a result of advances in tissue viability, more complex wound care can now be provided in the community setting and that therapies such as negative pressure wound therapy (NPWT) should be commonplace with tissue viability professionals appointed to direct service provision and ensure high standards (DH, 2009). This is a major step forward in current thinking, however, there are still gaps in our understanding of NPWT with regard to both the mechanism of action and which wound types will respond most favourably to the therapy. Managing complex patients in the community setting can be challenging, add to this scenario a device that has to remain attached for around 22 out of 24 hours a day and there is a major challenge. It yet remains to be ascertained if it is appropriate for all patients or if some definitive exclusion criteria should be agreed. This paper will seek to explore the mechanism of action, benefits, and barriers to adoption in community settings. [ABSTRACT FROM AUTHOR]

Falls prevention is an important part of national health policy and while there are many causes of falls, there is increasing evidence that advocates the use of targeted balance and stability exercise training to address the risk factor of postural instability. The introduction of these exercise programmes in primary care raise questions about the most effective implementation methods that are accessible and acceptable to older people and support maximum adherence. An understanding of factors that support adherence of older people to exercise programmes is of value to community nurses to enable them to deliver health promotion advice appropriately. The purpose of this paper is to discuss the findings from interviews with older people to explore their experiences in relation to access and acceptability of local community based postural stability exercise classes. [ABSTRACT FROM AUTHOR]

As ever greater pressure is brought to bear by the current economic climate, one simple step may yield a very significant release of time and money. Leaders from primary care and the non-prescription medicines industry are in agreement that the time has come to break the national culture of dependency on the NHS, estimated to cost every general practice in England an average of £250 000 annually, equivalent to an astonishing £2 billion across primary care. It also actively denies people the confidence to take control of their own, and their families' health and therefore 'the opportunity to set up good behaviours for the longer term' according to Dr Laurence Buckman. This paper examines the role community nurses can play in helping to change this culture. [ABSTRACT FROM AUTHOR]

The article provides information on care planning process. It states that the process should support the patient to be in control of their health. Questions that can help make the goals in a care plan achievable and realistic are listed. Self-management training programs are reportedly available to give people the skills to fully engage in their care. Also noted is the White Paper released by the British government which pledged that all people with a long-term health condition should have the opportunity to have a care plan by 2010.

The author reflects on the changes in the regulation of health professionals in Great Britain. She discusses that the Government White Paper on the regulation of health professionals were the culmination of the process that started with an initial report from the Department of Health on the issues arising from the regulation. She stressed a key principle in the regulation which is focused on sustaining, improving and assuring the professional standards of the health professionals.