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Purpose: This paper reports the findings of the evaluation of the Supporting People Health Pilots programme, which was established to demonstrate the policy links between housing support services and health and social care services by encouraging the development of integrated services. The paper highlights the challenges of working across housing, health and social care boundaries. Method: The evaluation of the six health pilots rested on two main sources of data collection: Quarterly Project Evaluation Reports collected process data as well as reporting progress against aims and objectives. Semi-structured interviews--conducted across all key professional stakeholder groups and agencies and with people who used services--explored their experiences of these new services. Results: The ability of pilots to work across organisational boundaries to achieve their aims and objectives was associated not only with agencies sharing an understanding of the purpose of the joint venture, a history of joint working and clear and efficient governance arrangements but on two other characteristics: the extent and nature of statutory sector participation and, whether or not the service is defined by a history of voluntary sector involvement. In particular the pilots demonstrated how voluntary sector agencies appeared to be less constrained by organisational priorities and professional agenda and more able to respond flexibly to meet the complex needs of individuals. Conclusion and discussion: The pilots demonstrate that integrating services to support people with complex needs works best when the service is determined by the characteristics of those who use the service rather than pre-existing organisational structures. [ABSTRACT FROM AUTHOR]

Introduction: Faced with rising numbers of older people in need of care and restrictions on public expenditure in the UK, extra care housing (ECH) has been hailed as an integrated model of housing with care that allows older people to live independently, while also having access to care and support if required. Despite the proposed benefits of ECH, however, little is known about how responsive it is to the needs of older people as their care needs change. Theory/Methods: This presentation reports on findings from the ECHO project, which explored the perspectives and experiences of those living and working in ECH settings. Longitudinal qualitative research was undertaken at 4 ECH settings (including one dementia-specialist scheme), based in 2 areas, over the course of 2 years. Residents were interviewed on 4 occasions to explore how their care needs and experiences of ECH changed over time. Managers were interviewed twice, at the beginning and end of the study, and care workers were interviewed on one occasion. Results: Residents appreciated the flexibility in the way that care was provided and felt that the ECH model allowed them some control over when and how their care was delivered. Some residents, care workers and managers reported an increase in care needs amongst people moving into ECH and amongst existing residents as they aged in place. Interviews with care workers revealed that their work was organised in a time/task manner. This resulted in frustration for some care workers who felt unable to provide care in a flexible and personalised way. Some care workers found ways to compensate for this approach by providing 'favours', doing tasks beyond their role. Discussions: The organisation of work in the 4 ECH schemes imitated patterns of work at some traditional care homes and it appeared that there was very little slack in the system. This is problematic given that there is an expectation of ECH to meet the changing care needs of residents in a timely and responsive manner. Such problems appear to be exacerbated by the changing context of ECH which means that the population whom it serves now has higher and more complex needs. Conclusions (including key findings): ECH's integrated model of housing and care has the potential to support quality of life for older people, including those living with dementia. However, while the ECH model promises to allow for increased flexibility and a more personalised approach to care delivery, cost saving forms of work organisation can undermine this approach. Lessons learned: Longitudinal research is a beneficial way to examine how older people's care needs are responded to in integrated housing and care environments. Limitations: Though a longitudinal approach allowed us to consider how participants' experiences altered over time, and in relation to contextual change, this approach was not as effective with residents living in a dementia-specialist ECH scheme. Suggestions for future research: Further research is required to establish whether ECH is the most appropriate form of integrated housing and care for older people living with dementia. [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 : (comprising background and problem statement) In Singapore, as in other parts of the world, the healthcare system is undergoing reform. The thrust towards this is motivated by the global shared experience of a rapidly ageing population, an increasing burden of chronic diseases, decreasing old-age support across the nation, increasing healthcare costs, and a rising demand for healthcare. In response to these changes, and amongst many integrated policies and approaches, the government has looked to global partners, and has explored different approaches to integrated care that have been adopted by countries with similar experiences. This lesson-drawing from other countries, known as policy transfer, provides a framework to understand how integrated care is being developed in Singapore to address the problems that it faces. It refers to the notion of improving policy making by looking abroad and adopting policies from elsewhere as a stock response to addressing policy issues. In Singapore, where this Project is based, the Regional Health Systems (RHSs) were created in 2010, and they are tasked with implementing the integrated care policy through innovative methods of care coordination. Within this, there is an expectation that the RHSs will demonstrate public sector entrepreneurism and lead in the development of health systems to enhance the quality of care at reduced costs. This same leadership is expected of the other policy agents, such as the Voluntary Welfare Organisations and General Practitioners in the RHSs, which provide services at the community level. However, it is unclear how integrated care is being developed at the RHS level in Singapore, and the extent to which policy transfer in integrated care has taken place. This is likely to be due to the fact that policy transfer of integrated care is largely undocumented, which makes evaluating the policy problematic. The associated challenges in the development of integrated care are also unknown. Some of these challenges may include the influence of the political economy of integrated care, which is often not explicitly considered. The role of constructivism in the micro-political environment of the organisation is also yet to be explored in the local context. Such local political, cultural, social, economic and administrative contexts are however central to the thesis on policy transfer and for appropriate policy adoptions. The aim of the research is thus to understand how integrated care is being developed specifically at the Outram RHS in Singapore, the extent to which this reflects processes of policy transfer, and the associated challenges involved. Theory/Methods: This study adopts a qualitative approach as the primary theoretical methodological approach to address the research questions. The qualitative approach could help unravel micro-macro interactions between individuals and social structures and institutions, and connect generic and abstract questions with the individuals' specific experiences. As policy actors, state, and non-state actors are involved in developing policy ideas on integrated care, the study will adopt an actor-based approach, utilising a two-pronged method to answer the research question. It will involve semi-structured interviews with these policy agents, which constitute an elite group, and document reviews of the existing materials internal to their organisation in relation to integrated care development. The prospective respondents will be purposively sampled with maximum variation from five distinct clusters of policy agents. They include government officials, Singapore Health Services, service providers (Outram RHS), professional associations, and academic institutions/think-tanks. The data will be analysed using interpretative phenomenological analysis and documentary analysis. The documentary analysis component consists of a two-fold analytic approach: content and textual analyses. Results :(or 'progress report' where results not yet available) Fieldwork will begin in December 2015. Preliminary ideas from the findings will be shared at the conference. Discussion: Policy transfer as a theoretical framework facilitates the examination of barriers and enablers in the study of integrated care development in Singapore. It goes beyond the institutional-structural concerns, to understanding the global and systemic influences, and their roles and limitations. It furthers the exploration and understanding of the nation-state's interests and history, socio-cultural values, and politico-administrative structure on integrated care development. Conclusion: (key findings to date, lessons learned, limitations, suggestions for future research). This paper, which is part of a PhD work, advances policy transfer as an arguably novel approach to explaining integrated care development; this is distinct from the existing approaches in integrated care theories and frameworks. It seeks to make useful contributions to the debate over the development of integrated care, with specific reference to Singapore, and to wider arguments on integrated care development in other parts of the world. [ABSTRACT FROM AUTHOR]