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Introduction: Social Prescribing has an established recognition regarding the benefits provided to the health-related social needs of adults, but little is known about how the intervention addresses young people's needs. There is optimism regarding the central role of two core mechanisms that allows social prescribing to be effective, such as the empathetic role of Link Workers and the connection with community resources. This paper aims to describe the role played by Link Workers working a Social Prescribing intervention targeting young people. Description: This paper adopts a case study methodology to describe the role of Link Workers addressing young people's needs and implementing Social Prescribing scheme in Sheffield (UK). Data were collected through semi-structured interviews with four of the seven link workers of one organisation based in Sheffield. Data were analysed through an inductive approach for emerging themes. Discussion: We provided a description of the profiles and background of Link Workers and described the three models of referral pathways into the intervention. The paper also shows how Link Workers identify young people's needs and how they connect with the community. Conclusion: Based on the insights and the internationally accepted definition of Social Prescribing, we provide a visual representation of the Social Prescribing model and discuss challenges. The paper highlights lessons learned and future directions regarding the role of Link Workers from the case study. [ABSTRACT FROM AUTHOR]

Introduction: There are many challenges we must adapt to in healthcare - health inequalities, environmental concern, ageing populations and multimorbidity to name a few. The English health system has responded by restructuring into Integrated Care Systems1. These are collaborative, place-based partnerships tackling health inequalities and improving care coordination. Additional skills are likely needed for professionals to thrive in and potentiate the promise of ICSs for patients. One key component identified in the Future Doctor Report2, was cultivating generalism. This led to the inception of the Enhance programme for generalism3 - a developing multiprofessional educational offer in England. Aim and Method: Any change is best supported by academically rigorous evidence. Some published evidence was anticipated, as the generalism concept has existed for centuries and some professionals practice in this way today. Three literature searches were commissioned from the Health Education England library service around the evidence for generalism. This presentation will focus on "what are the benefits of generalism to patients, the healthcare system and healthcare professionals". A second search was performed by a HEE fellow. All included papers were critically analysed. Results: 32 papers were identified by the library service. No further papers were included from the second search due to their age (approx. 30 years). All were written in English, 19 from the UK and 13 from across Europe, Asia and Africa, published between 2017-2020. Papers were methodologically diverse, predominantly qualitative, reviews, opinion pieces or project evaluations. Common themes included doctor preparedness, CPD and skills learning. Two papers each, respectively, explored professional and patient satisfaction. A subset of 8 papers felt to be of most relevance to the question were then analysed. Article types were similar to the above, originating from the UK, Thailand or Norway. Four common themes were identified: QI; CPD; preparedness and professional satisfaction. Only one examined patient satisfaction. Interestingly, this paper's findings aligned closely with the principles and aims of the Enhance programme and ICSs - person-centred, well-coordinated care, understanding realworld causes of ill health4. Conclusion: Although there are some proponent opinion pieces and indirect evidence, no papers have been identified that examine this question directly. There is a distinct lack of robust academic exploration of the actual (as opposed to posited potential) benefits to patients, professionals other than doctors and system-wide impacts from generalism. Implications: This work highlights several new and exciting areas for future research - likely to be interdisciplinary. How best to research applying a generalist approach for its benefits to stakeholders in terms of the Institute of Medicine's 6 domains of quality may be a future key question to consider. [ABSTRACT FROM AUTHOR]

Continuity of care is concerned with quality of care over a period of time. It describes a process by which service users and their families are co-operatively involved with health and social care professionals in managing their care needs. Continuity of care can be divided into informational, managerial and relational and has been associated with improved user- and service-related outcomes. To date, there have been few studies which examine how continuity of care is developed and maintained in integrated primary care systems. This paper explores continuity of care in an integrated Over 75 Service for people living at home with complex health and social care needs. Using a case study approach, qualitative data was collected from multiple sources including interviews with managers and professionals, users and carers, care plans, steering group minutes and field notes. Data was analysed thematically. A number of factors are identified which characterise continuity of care, namely: information sharing through direct communication between providers and the development of trusted relationships within the team; identified care co-ordinators who acted as a conduit for information and communication; the development of ongoing relationships with users and carers requiring dedicated time and accessible and flexible services delivered in the users' own home. [ABSTRACT FROM AUTHOR]

Background and introduction: Although most developed countries are currently pursuing greater integration of health and social care, the current evidence base is limited by a number of key weaknesses in the existing literature. Chief amongst these is the tendency to focus on issues of process ('how well are we working together'?) not on outcomes (does it make any difference to people who use services?). As a result, there is a danger that integration can become an end in itself, rather than a means to an end (of better services and better outcomes). Understanding context, process and outcomes: To guard against this danger, this policy paper sets out a number of theoretical and conceptual frameworks to help policy makers, managers and practitioners remain focused on the outcomes that their joint work is meant to achieve. This includes different approaches to being clear about what integration is trying to deliver (outcomes), understanding where we are now (context) and how we get from where we are now to where we want to be (process). Conclusion: Rather than assume that integration is automatically a 'good thing', the frameworks presented in this paper suggest a more critical approach in which policy makers, managers and practitioners focus in more detail on what they are trying to achieve for the people they serve, viewing integration as a means to an end and never an end in itself. [ABSTRACT FROM AUTHOR]

Introduction: Collaboration was legislated in the delivery of integrated care in the early 2000s in the UK. This research explored how the reality of practice met the rhetoric of collaboration. Theory: The paper is situated against a theoretical framework of structure, agency, identity and empowerment. Collectively and contextually these concepts inform the proposed model of 'collaborative agency' to sustain integrated care. The paper brings sociological theory on structure and agency to the dilemma of collaboration. Methods: Participative action research was carried out in collaborative teams that aspired to achieve integrated care for children, young people and families between 2009 and 2013. It was a part time, PhD study in collaborative practice. Results: The research established that people needed to be able to be jointly aware of their context, to make joint decisions, and jointly act in order to deliver integrated services, and proposes a model of collaborative agency derived from practitioner's experiences and integrated action research and literature on agency. The model reflects the effects of a range of structures in shaping professional identity, empowerment, and agency in a dynamic. The author proposes that the collaborative agency model will support integrated care, although this is, as yet, an untested hypothesis. [ABSTRACT FROM AUTHOR]

The numbers of people with dementia are set to increase, however, people with dementia do not live in isolation and any intervention is required to support their family carers also Newbronner et al. 2013. Dementia UK offers specialist one-to-one support and expert advice in the form of Admiral Nursing AN, first piloted in 1991 and are the only group of qualified nurses in the UK who focus on working with families affected by dementia. Once a diagnosis of dementia has been made, interventions structured around a family-centred approach provide a framework to help unite families, whilst still recognising individual values. This type of collective approach can help reduce conflict and improve relationships within the family. AN has evolved from delivering an intervention specifically aimed at supporting family carers to one that supports the whole family through a case management approach Harrison Dening et al. 2017. Case management has a long and successful history in supporting people with long term conditions and people with a diagnosis of severe mental illness Challis et al. 2010. Case management is a relatively new concept in dementia with early UK research being inconclusive Iliffe et al. 2014, however, it is proving to be a successful model in Holland Van Mierlo et al. 2014: MacNeil Vroomen et al. 2016. The evidence base for AN, as with the majority of specialist nursing roles, is scant. So it became a priority of Dementia UK to develop the evidence base for AN whilst also supporting the nurses to develop the skills, tools, time and impetus to collect data about their service activity and outcomes which could build the evidence base for the model. Commissioners and employers need data that is relevant to their expected outcomes and, as the AN community grows, it is increasingly important to collect data consistently in order to identify and promote effective AN models. Whilst current evaluation methodology may focus on undergraduate and postgraduate nursing course curriculum; a wider appreciation of the importance of evaluation in practice is required Moule et al, 2016. This paper will present results of a service evaluation project; Getting Evidence into Admiral Nursing Services GEANS, a mixed methods approach to demonstrate the evidence for the AN case management approach in supporting families affected by dementia. GEANS is a national programme, funded by Dementia UK aimed to support a cohort of AN teams to evaluate their services and to demonstrate the outcomes and impact on families affected by dementia. GEANS is a co-produced evaluation framework and defines outcomes for Admiral Nursing with families and in supporting best practice in other professionals. Outcomes reflect the domains of the NHS Outcomes Framework for England and the Adult Social Care Outcomes Framework. Three themes focus data collection; 1. Improved quality of life for carers and people with dementia. 2. Positive experience for families of AN Services 3. Cost efficiencies in health and social care costs. The paper will be supported through presentation of a local service case study from the Midlands, United Kingdom. [ABSTRACT FROM AUTHOR]

Introduction: The 2004 Children Act in the UK saw the introduction of integrated working in children's services. A raft of change followed with processes designed to make joint working easier, and models and theories to support the development of integrated work. This paper explores the links between key concepts and practice. Methods: A practitioner action research approach is taken using an autoethnographic account kept over six months. The research question was, to what extent is this group collaborating? Results: When the architecture of practice was revealed, differences between espoused and real practice could be seen. Whilst understanding and displaying the outward signs of an effective multi professional group, the individuals did not trust one another. This was exhibited by covert interprofessional issues. As a result, collaborative inertia was achieved. This realisation prompted them to participate in further developmental and participative action research. Conclusion: The paper concludes that trust and relational agency are central to effective leadership of multi professional teams. [ABSTRACT FROM AUTHOR]

Introduction: Long-term neurological conditions are a major cause of disability in the UK and internationally. Their successful management, in order to enhance health and well-being, requires both sophisticated organisation across a number of health, social care and other service boundaries, and the real involvement of people with neurological conditions and members of their support networks. Policy development: This paper reports on part of the preliminary scoping phase of a study designed to evaluate the impact of the National Service Framework for long-term neurological conditions on integrated care. It describes current policies in England and reports on discussions with a range of people involved in the planning, provision or use of services, which took place during the scoping exercise. These interviews inform how policy affecting people with long-term neurological conditions has been received and implemented so far. Conclusion and discussion: Findings suggest that progress towards integrated service provision is patchy and slow. In the competing priorities within government policy, neurological conditions have tended to be marginalised, within healthcare policy generally and in initiatives to support people with long-term conditions in particular. The reasons for this are explored and will inform the next stages of the research. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the effects of health care policy on the development of integrated mental health services in England. Data sources: Drawing largely from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors, we discuss three case studies of integrated care within primary care, secondary care and across the primary/secondary interface for people with serious mental illness. Conclusion: We suggest that while the central thrust of a raft of recent Government policies in England has been towards integration of different parts of the health care system, policy waterfalls and implementation failures, the adoption of ideas before they have been thoroughly tried and tested, a lack of clarity over roles and responsibilities and poor communication have led to an integration rhetoric/reality gap in practice. This has particular implications for people with serious mental health problems. Discussion: We conclude with suggestions for strategies that may facilitate more integrated working. [ABSTRACT FROM AUTHOR]

Joint working has been mandated, or made compulsory, in a number of contexts in mental health services in England, some over many years. This presentation examines three such contexts: delayed transfers of care, (Section 117) aftercare and the use of police powers (section 136). Each context each has specific, and apparently simple, intended outcomes - for the first two, a timely and effective move from in-patient care to the most appropriate setting and for the third, a timely needs assessment - but have been the source of continual inter-organisational tension and governmental concern. The paper will draw from the first stage of an evaluation of the joint working arrangements which seek to address these contexts; this first stage is an analysis of the circumstances in which such arrangements are placed based on documentary analysis and interviews with key players in two case study sites. The paper suggests that the complexities inherent in joint working derive not only from the needs of individual people who need services, local organisational arrangements or resource availability but also the theories which underpin these specific contexts and the variety of joint working models needed to address them. [ABSTRACT FROM AUTHOR]

Introduction: With increasing attention to models of transitional support delivered through multisectoral approaches, third-sector organizations (TSOs) have supported community reintegration and independent living post-hospitalization. This study aimed to identify the core elements of these types of programs, the facilitators, and barriers to service implementation and to understand the perspectives of providers and recipients of their experiences with the programs. Methods and Analysis: A collective case study collected data from two UK-based 'Home from Hospital' programs. An inductive thematic analysis generated rich descriptions of each program, and analytical activities generated insights across the cases. Results: Programs provided a range of personalized support for older adults and addressed many post-discharge needs, including well-being assessments, support for instrumental activities of daily living, psychosocial support, and other individualized services directed by the needs and preferences of the service user. Results suggest that these programs can act as a 'safety net' and promote independent living. Skilled volunteers can positively impact older adults' experience returning home. Conclusions: When the programs under study are considered in tandem with existing evidence, it facilitates a discussion of how TSO services could be made available more widely to support older adults in their transition experiences. [ABSTRACT FROM AUTHOR]

Introduction: The mainstreaming of telehealth services is dependent largely on the engagement of clinical staff. As the largest professional group of healthcare providers, nurses have a vital role to play in ensuring the success of telehealth deployments. In the UK, the Royal College of Nursing (RCN) has endeavoured to discover more about nurses' knowledge and attitudes of telehealth through its eHealth survey. The survey has been completed on four occasions since 2004, though it is only in 2010 and 2012 that there has been any reference to telehealth. This paper describes changes in patterns and responses between the 2010 and 2012 surveys. Aims and objectives; The project aimed to: * Quantify the level of awareness and experience that nurses have regarding telehealth * Gauge the attitudes of nurses towards telehealth * Identify any changes in awareness and attitudes between 2010 and 2012 Methods: In 2010 and 2012, RCN members from across all UK countries and regions were invited to participate in the RCN eHealth survey. Both surveys were completed by respondents online. Respondents were asked about their awareness, experience and attitudes towards using eHealth in practice. The surveys sought feedback on a range of eHealth issues, such as Information Technology training and the use of Clinical Information Systems. The paper addresses only those elements of the survey focused upon telehealth. Results: 1313 nurses completed the survey in 2010, compared to 1022 in 2012. Awareness of telehealth has increased between the two surveys; 63% of respondents in 2012 had heard of telehealth, an increase from 55% in 2010. Experience of having used telehealth has not increased over time: 15% of respondents in both surveys reported previous experience of using telehealth to support their practice. Respondents were asked whether they welcomed the introduction of telehealth into nursing practice. The proportion responding positively to this question fell between 2010 and 2012 (56% vs. 43%), largely as a result of an increase in the number of people replying that they 'don't know' (45% in 2012 vs. 34% in 2010). Notably, the proportion who welcomed the introduction of telehealth in the 2012 survey was substantially higher in those who had previous experience of telehealth than in those who didn't (80% vs. 38%) Attitudes towards telehealth were also explored in both surveys and demonstrated some changes over time. Though the proportion who agreed that telehealth could enhance the care of chronic conditions remained largely unchanged (43% in 2010 vs. 41% in 2012), a smaller proportion of 2012 respondents agreed that telehealth could facilitate earlier intervention (41% in 2012 vs. 49% in 2010) or support self-management by patients (42% in 2012 vs. 48% in 2010). Conclusions: The RCN eHealth surveys of 2010 and 2012 demonstrate that awareness of telehealth amongst nurses is rising. However, there has been no increase in the proportion of nurses reporting hands-on experience of telehealth and attitudes toward the service have become less positive. More work is required to enhance the awareness, knowledge and understanding of the benefits that telehealth can bring to nursing practice. [ABSTRACT FROM AUTHOR]

Background: In response to concerns that the needs of the aging population for well-integrated care were increasing, the English National Health Service (NHS) appointed 16 Integrated Care Pilots following a national competition. The pilots have a range of aims including development of new organisational structures to support integration, changes in staff roles, reducing unscheduled emergency hospital admissions, reduced length of hospital stay, increasing patient satisfaction, and reducing cost. This paper describes the evaluation of the initiative which has been commissioned. Study design and data collection methods: A mixed methods approach has been adopted including interviews with staff and patients, non-participant observation of meetings, structured written feedback from sites, questionnaires to patients and staff, and analysis of routinely collected hospital utilisation data for patients/service users. The qualitative analysis aims to identify the approaches taken to integration by the sites, the benefits which result, the context in which benefits have resulted, and the mechanisms by which they occur. Methods of analysis: The quantitative analysis adopts a 'difference in differences' approach comparing health care utilisation before and after the intervention with risk-matched controls. The qualitative data analysis adopts a 'theory of change' approach in which we triangulate data from the quantitative analysis with qualitative data in order to describe causal effects (what happens when an independent variable changes) and causal mechanisms (what connects causes to their effects). An economic analysis will identify what incremental resources are required to make integration succeed and how they can be combined efficiently to produce better outcomes for patients. Conclusion: This evaluation will produce a portfolio of evidence aimed at strengthening the evidence base for integrated care, and in particular identifying the context in which interventions are likely to be effective. These data will support a series of evaluation judgements aimed at reducing uncertainties about the role of integrated care in improving the efficient and effective delivery of healthcare. [ABSTRACT FROM AUTHOR]

There are currently around 46.8 million people living with dementia around the world and this number is estimated to increase to 74.7 million by 2030 and to 131.5 million by 2050. Currently there is no definite cure for dementia and the cost of care for this condition is around £26 billion a year in the UK and soring dramatically. Being able to slow the decline and maintain independent living are very important goals for supporting people with dementia. At any given time in the United Kingdom, 1 in 4 hospital beds are occupied by a person with dementia, while about 22% of these hospital admissions are due to preventable causes. In this paper, we discuss the TIHM (Technology Integrated Health Management) for dementia study, which uses Internet of Things (IoT) technologies and in-home sensory devices and monitors in combination with machine learning techniques to remotely monitor the health and well-being of people with dementia. This will allow us to provide more effective and preventative care and reduce preventable hospital admissions. One of the unique aspects of this work is combining environmental data with physiological data collected via low cost in-home sensory devices and monitors to extract actionable information regarding the health and well-being of people with dementia in their own home environment. In this presentation, we collected data and on how machine learning algorithms have been used to detect different conditions such as Urinary Tract Infections (UTIs) and Agitation, Irritability and Aggression (AIA) in this group of people. The current model of care for people with dementia is heavily reliant on paid carers visiting people with dementia on a regular basis. The frequency of these visits is based on an initial assessment by Social Services. But the needs of a person with dementia can change suddenly and these changes can be missed by a carer, visiting for only short periods of time, perhaps only once a day. As a result, the person with dementia may not receive the support that is needed quickly enough and this can lead to hospital or even care home admission. TIHM for dementia continuously collects and analyses data about a person's vital signs, their patterns of behaviour, and movement inside and outside of the home, and also environment. If the technology identifies an issue, an alert is triggered on a digital dashboard and followed up by a Clinical Monitoring Team. TIHM offers a new way of providing timely care for this group of people that is adaptable and based on their needs. [ABSTRACT FROM AUTHOR]

Purpose: To explore the integration of health and social care in the UK through policy and clinical guidelines and to examine how partnership working and case management enables policy to be embedded into local practice. Context: The UK Department of Health policy document (White Paper 2006) Our Health, Our Care, Our Say: a new Direction for Community Services [1] focused on a new direction for the whole health and social care system. Description: The paper and subsequent action plans targeted the way services are provided, placing greater choice and control in the hands of people who use them. Health and Social Care services were tasked with becoming better integrated to meet the needs and wishes of individuals with chronic illness and long-term needs. The UK's National Service Frameworks and NICE guidelines are being implemented at local level to achieve management of chronic illness through effective case management and roles are being evaluated to show the effect of interventions [2]. The Government report Our NHS, Our Future [3] encourages a response to the , needs of local communities through integrating care to ensure that services are shaped around the user not the organisation. Discussion: We know that people with chronic illness are intensive users of services; that repeat admissions to hospital cause untold distress and that this vulnerable group is increasing as our population ages. We also know that inappropriate and increased use of services causes a financial burden in both primary and secondary care. Managed care through effective case management, if adopted flexibly, presents an opportunity to focus on reducing costs whilst appropriately managing the health needs of the target population. [ABSTRACT FROM AUTHOR]

Introduction: Between 2012 and 2032 it is estimated that the populations of 65-84 years old and those over 85 in the United Kingdom will increase by 39 and 106% respectively (Kings Fund 2013). Recent figures suggest that people over the age of 65 account for almost 51% of gross local authority spending on adult social care (Oliver et al 2014). Current projections indicate that a growing proportion of older people will, in the future, be living on their own and will require formal care (King's Fund 2014). While these demographic changes have significant implications for adult social care policy they also draw attention to the pressing need for sufficient and appropriate housing that enables older people to live independently (Atkinson et al 2014). Practice: Not surprisingly the provision of appropriate housing is a key element of UK government policy (Garwood 2015). Various models of housing with care have emerged in recent years with Extra Care Housing (ECH) offering the potential to combine housing and social care in the same setting. Indeed the integration of personal housing alongside individualised care means that Extra Care Housing is viewed by many to be 'a viable alternative to and possible replacement for residential care' (Beach 2015:7). Extra Care Housing, compared to other models of housing, has several characteristics: it is primarily for older people; accommodation is almost always self-contained; social care can be delivered flexibly, usually by staff based on the premises; support staff are available on the premises 24 hours a day; domestic care is available; communal facilities and services are available; meals are usually available and charged for when taken; it aims to be a home for life and finally, it offers security of tenure (Laing and Buisson 2010). Key findings: Drawing on results from the Adult Social Services in Environmental Settings (ASSET) project (https://assetproject.wordpress.com/) and initial findings from our longitudinal study of Extra Care Housing (both funded by the National Institute for Health Research, School for Social Care Research) this paper will consider what potential the integration of housing and care has for older people living in the UK. It will consider the different models of integrating social care within housing and the advantages, as well as some of the challenges therein. The implications of integrating housing and care will be considered from the perspective of those managing schemes as well as from care workers and older people themselves. Conclusion: Despite the potential of Extra Care Housing to provide integrated care for older people the current economic context of the UK threatens to undermine the model. Reduced public spending and increased targeting of social care on those people thought most in need could weaken the preventive aims of Extra Care Housing. [ABSTRACT FROM AUTHOR]

Introduction: This literature review was conducted to provide a background understanding of the literature around integrated health and social care prior to a research project evaluating two integrated health and social care teams in England, UK. Methods: A systematic literature search of relevant databases was employed to identify all articles relating to integrated health and social care teams produced in the last 10 years in the UK. Results: Sixteen articles were found and reviewed; all were reviewed by the first reviewer and half by the second reviewer. Discussion: Key themes identified were: drivers, barriers and benefits of integrated working; staff development; and meeting the needs of service users. Conclusion: Recommendations for integrated working include; a focus on the management of integrated teams; a need to invest in resources for the successful integration of teams; a need for the development of clear standards for monitoring the success and failure of integrated teams; and the need for further empirical evidence of the processes used by integrated teams. These findings will be valuable for practitioners who are establishing services or want to improve integrated care in their own practice. [ABSTRACT FROM AUTHOR]

Introduction: If integrated care approaches are to be properly adapted to local contexts, a better understanding is required of key determinants of implementation and how these might be appropriately supported. Purpose: This study applied the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to investigate factors influencing the implementation and outcomes of a complex integrated care change programme in Torbay and South Devon (TSD) and, more specifically, in one of five sub-localities, Coastal. Methods: A case study method using embedded 'Researchers in Residence' to conduct action-based participatory research and deploying mixed qualitative methods. Results: The relative importance of some domains differ between the English and Canadian studies. In this case study, physical features (structural and geographic) were found to be very pertinent to the relative success of the Coastal Locality, as were empowered clinical leadership, with readiness for change being expressed through processes and cultures that were risk-enabling, strengths-based, person-/outcomefocused. Conclusions: The CCIC Framework provided a useful tool capturing key elements of complex system change with key domains being transferable across settings, while also finding local variation in the UK. This would encourage its wider application so that further comparisons can be made of the ways in which different contextual and implementation properties impact upon delivery and outcomes. [ABSTRACT FROM AUTHOR]

Background: There is no single definition of a community hospital in the UK, despite its long history. We sought to understand the nature and scope of service provision in community hospitals, within the UK and other high-income countries. Methods: We undertook a scoping review of literature on community hospitals published from 2005 to 2014. Data were extracted on features of the hospital model and the services provided, with results presented as a narrative synthesis. Results: 75 studies were included from ten countries. Community hospitals provide a wide range of services, with wide diversity of provision appearing to reflect local needs. Community hospitals are staffed by a mixture of general practitioners (GPs), nurses, allied health professionals and healthcare assistants. We found many examples of collaborative working arrangements between community hospitals and other health care organisations, including colocation of services, shared workforce with primary care and close collaboration with acute specialists. Conclusions: Community hospitals are able to provide a diverse range of services, responding to geographical and health system contexts. Their collaborative nature may be particularly important in the design of future models of care delivery, where emphasis is placed on integration of care with a key focus on patient-centred care. [ABSTRACT FROM AUTHOR]

Introduction: We investigated the effects on collaborative work within the UK National Health Service (NHS) of an intervention for service quality improvement: informal, structured, reciprocated, multidisciplinary peer review with feedback and action plans. The setting was care for chronic obstructive pulmonary disease (COPD). Theory and methods: We analysed semi-structured interviews with 43 hospital respiratory consultants, nurses and general managers at 24 intervention and 11 control sites, as part of a UK randomised controlled study, the National COPD Resources and Outcomes Project (NCROP), using Scott's conceptual framework for action (inter-organisational, intra-organisational, inter-professional and inter-individual). Three areas of care targeted by NCROP involved collaboration across primary and secondary care. Results: Hospital respiratory department collaborations with commissioners and hospital managers varied. Analysis suggested that this is related to team responses to barriers. Clinicians in unsuccessful collaborations told 'atrocity stories' of organisational, structural and professional barriers to service improvement. The others removed barriers by working with government and commissioner agendas to ensure continued involvement in patients' care. Multidisciplinary peer review facilitated collaboration between participants, enabling them to meet, reconcile differences and exchange ideas across boundaries. Conclusions: The data come from the first randomised controlled trial of organisational peer review, adding to research into UK health service collaborative work, which has had a more restricted focus on inter-professional relations. NCROP peer review may only modestly improve collaboration but these data suggest it might be more effective than top-down exhortations to change when collaboration both across and within organisations is required. [ABSTRACT FROM AUTHOR]

Introduction: This research has considered current developments in the provision of services for people with long-term conditions within the NHS of England. Community Matrons are being employed and by adopting a case management approach they are aiming to improve patient care and reduce their demands for acute hospital care. Description: Qualitative research was undertaken to explore experiences of community matrons and service leads on the development, implementation and provision of services for people with long-term conditions. Conclusions: This research provides evidence of what is being done to meet the challenge of long-term conditions and provides lessons for similar challenges and service development for different areas of care and in other countries. Continual system and role change has had effects on service delivery and on the whole care. These effects relate to; defining the role of community matron and structure of service, training staff, identifying patients, providing infrastructure, demonstrating benefits, identifying gaps in services, ability to reduce avoidable admissions and identifying the advantages and difficulties of the role. Discussion: All of these aspects should be used to inform future development. [ABSTRACT FROM AUTHOR]