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Purpose: Although the UK construction sector has enjoyed a significant rise in the number of women joining the industry, there is undoubtedly more room for improvement. Numerous schemes have been initiated by government and other professional bodies to encourage more women to undertake a career in construction. The purpose of this paper is to shed light on the organisational complexities of problems faced by women working in professional roles in construction. It thus initiates a dialogue on the lack of workplace flexibility and discriminatory practices that prevent many more women from joining. Design/methodology/approach: A phenomenological philosophy is adopted. The research critically explores the views of women working in professional roles in six large construction firms in England. Findings: It was widely acknowledged that the industry had improved significantly, however there are still concerns yet to be addressed. It was identified that women face new challenges when they attain senior roles. Furthermore, it is believed that the current glass ceiling theory and leaky pipeline theory are not adequate to study these issues. Research limitations/implications: Sample size and narrow focus on large construction firms are the limitations of the paper. Practical implications: Through academic and industry dissemination, the findings from this research encourage both men and women working in the construction industry to adopt inclusive practices that will help widen the pool of knowledge and expertise. Social implications: This paper sheds light on a problem that is assumed to be eradicated once women progress to senior management roles. Originality/value: This research presents an in-depth critical perspective of challenges faced by women construction professionals occupying decision-making positions. [ABSTRACT FROM AUTHOR]

Statutory regional spatial strategies were abolished in England, United Kingdom in 2010. There are, however, increasing calls in favour of a re-introduction of statutory comprehensive spatial strategies at the regional level to enhance integrated economic growth and address exacerbating spatial inequalities. Through a survey and in-depth interviews conducted with experts and policymakers of the North-West region of England, this paper explores whether the introduction of such statutory strategies could find justificative grounds through policy integration of transportation, housing, and employment policies. We conclude with a set of mechanisms that could foster this re-introduction serving regional geographies beyond the North-West. [ABSTRACT FROM AUTHOR]

The contribution of this paper is to analyse statistical data to assess whether homelessness among people who have recently been granted refugee status in England is concentrated amongst particular groups of these refugees. The methodology was quantitative analysis using logistic regression of the Home Office's Survey of New Refugees (SNR), which they carried out in 2005-7. We tested the relative role played by pre-migration demographic factors, post-migration life experience factors, and government immigration policy in accounting for patterns found, and drew on literature to interpret the meaning of our statistical results. Our analysis clearly suggests that refugee and asylum policy contribute to homelessness among newly-recognised refugees. This interpretation is supported by the qualitative evidence from services providing assistance to refugees, and evidence put to the All Party Parliamentary Group on Refugees (2017). Action to address the housing problems of refugees moving on from accommodation provided for asylum seekers should be considered a high policy priority, albeit that associations between homelessness, household size, and age also present intervention opportunities. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe the approach adopted to building relationships between health and social care in Birmingham. Design/methodology/approach -- This is a practical case study, reflecting on personal experience of being directly involved in the situations and discussions described. It supplements a 2012 paper (Lotinga and Glasby, 2012) on the creation of Birmingham's Health and Well-being Board. Findings -- Local history and context is crucial in shaping the nature of local joint working initiatives -- understanding where local services have come from and why they have made the choices they have is a crucial pre-requisite for understanding current and future opportunities. Research limitations/implications -- This paper aims to place joint working between general practice and social work in a broader organisational, financial and policy setting -- and placing local developments in this wider context is crucial for understanding barriers and opportunities locally. Originality/value -- In the absence of a detailed evidence base, front-line practice is often far ahead of the current research evidence. This means that local case studies like this are crucial in terms of sharing learning with other areas of the country, with policy makers and with researchers. While many case studies of joint working are small in nature, Birmingham is the largest local authority in Europe -- so this paper also contributes learning based on trying to develop joint working in very large, complex authorities. [ABSTRACT FROM AUTHOR]

Purpose: This paper explores residents' perceptions and experiences of extra care housing as an integrated model of housing with care. Design/methodology/approach: Data were collected in a longitudinal qualitative study based on four extra care housing schemes. Data from interviews with residents, care workers, managers and local commissioners were analysed thematically. Findings: The integration of housing with care enabled many older people to manage their care proactively. However, the increasing number of residents with complex health and care needs, including chronic illness, led some residents to question the ability of the model to support residents to live independently. Research limitations/implications: The study struggled to recruit sufficient residents from the specialist dementia setting who were able to communicate their consent to take part in the research. In addition, the quality of qualitative data collected in interviews with participants at this setting reduced over successive rounds of interviews. Practical implications: The study suggests the need to ensure that residents are fully informed about levels of care and support is available when considering a move into extra care housing. Originality/value: This paper provides a timely opportunity to consider extra care housing as an example of an integrated housing service, particularly in light of the current challenges facing the sector. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to provide a summary of some of the lessons about implementing different types of integrated care. Design/methodology/approach: The author used evidence from the author's own evaluations and the findings of other researchers to identify some important lessons for policy makers and practitioners. Findings: The author identifies eight high-level lessons which may be of interest to policy makers and practitioners working in the field. Research limitations/implications: The lessons outlined in the paper provide only a starting point for those designing interventions or evaluation. Practical implications: The changes required to implement integrated care are complex and are embedded in a complex context. Change of this type is difficult and generally takes longer to deliver than expected. The evaluation of these models often requires longer than is often available and needs to focus on the impact on the whole system rather than narrow measures, e.g. hospital utilisation. Originality/value: This is a viewpoint paper synthesising evidence from the English pilot programmes in integrated care. [ABSTRACT FROM AUTHOR]

This paper examines how integration across policy sectors was achieved under the spatial planning agenda in England, focusing on the case of delivering growth in a subregion in the east of England. The findings highlight the importance of both ‘hands-on’ and ‘hands-off’ meta-governance – in other words, high-level steering by central government – in enhancing sectoral integration. This has significant implications for the ongoing debate on planning in England, where the language of spatial planning is no longer in fashion, but where the need for effective integration continues to exist. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide an update to a review of the joint working literature in the field of health and social care for adults, with particular emphasis given to the experiences of users and carers. Design/methodology/approach – The aims of the literature review remained largely the same as those of the original, they were to identify: models of joint working, evidence of effectiveness and cost-effectiveness and the factors promoting or hindering the models. However, to reflect the growing interest in the experiences of users and carers a fourth aim was added to map these experiences. Given their prominence in terms of policy debates about integration, the review focused on jointly organised services for older people and people with mental health problems in the UK only. Findings – The review demonstrates tentative signs that some initiatives designed to join-up or integrate services can deliver outcomes desired by government. Importantly some studies that report the experiences of users of services and carers suggest that they perceive benefits from efforts to join-up or integrate services. However it is our contention that the evidence is less than compelling and does not justify the faith invested in the strategy by current or previous governments. Originality/value – The study updates our knowledge of the impact of joint working in the field of health and social care for adults. Importantly the paper highlights what is known about the experiences of users and carers of joint/integrated services. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to discuss the different meanings of integration as expressed in dementia care practice and service organisation in England. Dementia is frequently complicated by concurrent illnesses or long-term conditions at the end of life. Design/methodology/approach - This is a policy discussion. Findings - The paper describes three forms of integration: linkage, co-ordination of care, and full integration. Each form or level is related to dementia as a progressive neurological disorder with multiple symptoms, which also overlaps with other long-term conditions, making each individual's dementia unique. Linkage means being able to identify appropriate resources to meet the needs of the individual and their family. Co-ordination usually means multi-disciplinary working at least with general practice and often wider practitioner input. Full integration is best expressed by the work of care homes, which co-ordinate care and often draws on diverse funding streams. Practical implications - Greater specificity of the meaning of integration may be helpful to policy makers and practitioners. The care and treatment of people with dementia may be optimised if practitioners think about work styles and engagement with other sectors, agencies and professionals rather than pursuing all-encompassing organisational integration. Care homes may have much to teach other practice settings about full integration. Originality/value - Integration is often seen uncritically as the solution to all problems; this paper explores the varieties of integration and explores their implications for practitioners and policy makers supporting people with dementia and their carers. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to outline relevant policies on the integration of health and social care (HSC) in the four home nations: Scotland, Wales, Northern Ireland and England and offer a comparison of emphasis and approaches and draw out general insights on the implementation of integrated care policy.Design/methodology/approach The paper is written as a piece of critical reflection by drawing on the authors’ knowledge and expertise and wider evidence where available.Findings Since 2010, HSC integration has started to diverge significantly in the four constituent countries of the UK. Although England and Wales have undergone considerable re-organisation of the NHS, Scotland and Northern Ireland have largely been marked by organisational continuity. However, beyond organisational differences, policy approaches, policy emphases and implementation strategies have also started to show considerable dissimilarity across the UK. An important contributory factor may be different ideological perspectives on the role of competition and pilots, partnership, patient choice and organisational incentives to bring about change in the field.Research limitations/implications The paper identifies a serious lack of comparative research in integration policy, despite the considerable opportunities for quasi-experimental studies. This lack of empirical research impedes shared learning across the home nations.Originality/value The paper presents a descriptive comparison of current integration policy between HSC providers in the four home nations. It reveals considerable opportunities for further research and comparative modelling of integration approaches. [ABSTRACT FROM AUTHOR]

Purpose: Sustainability and transformation partnerships (STPs) were introduced to England, asking 44 local areas to submit their health and social care plans for the period from October 2016 to March 2021. This study aims to offer a deeper understanding of the complex structure in the local practice, and to discuss the associated challenges and chances. Design/methodology/approach: Documentary analysis, qualitative interviews and questionnaire survey are used for this study. Findings have been compared and analysed thematically. Findings: The study participants reported that apart from pooled budgets, past collaborative experience and local leadership are crucial elements for transforming health and social care integration in Greater Manchester (GM). Also, this study provides policy recommendations to promote effective collaborative partnerships in local practices and mitigate local inequity of funding progress. Research limitations/implications: The findings of this paper cannot be extrapolated to all stakeholders due to the limited samples. Meanwhile, some of the discussions about the case of GM may not be transferrable to other STPs. Originality/value: This study argues that the success of pooled budgets is the result, rather than the cause, of effective negotiations between various stakeholders; and therefore, there is no evidence suggesting that pooled budgets can resolve the discoordination of health and social care. Moreover, due to the bottom-up approach adopted by STPs, more effective boroughs tend to receive additional funding, resulting in an increasing gap of development between effective and ineffective boroughs. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to evaluate the Supported Discharge Service as a case study of integrated care. The paper will critically evaluate integrated care with regard to patient outcomes, patient satisfaction and cost and productivity.Design/methodology/approach A retrospective mixed methods case study design was adopted utilising patient satisfaction questionnaires, therapy outcome measure and a performance dashboard to measure improvements in patient satisfaction, patient outcomes and cost and productivity.Findings Measured improvements were observed in the integrated discharge process and analysis of the findings demonstrated a statistically significant improvement in patient outcomes, high levels of patient satisfaction and improved productivity subsequently leading to financial savings.Research limitations/implications Due to convenience sampling, the small sample size and a short time frame when analysing patient outcomes, the generalisability of results is limited. Despite this, with integrated care being polymorphous the findings can be utilised to develop theoretical principles to make assertions about integration (Wikfeldt, 1993).Originality/value This paper draws on the importance of integration as the principal driver of reform within the healthcare system. Even though on a small scale, the case study provides evidence to support the use of integration to improve patient outcomes, patient satisfaction and financial savings. [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]

This paper builds upon major ongoing work into the experiences of new migrants seeking to construct new lives in the UK (Aldridge and Waddington 2002; Goodson and Phillimore 2005; Goodson et al. 2005; Phillimore et a!. 2003; 2004; Phillimore and Goodson 2002; Robinson et a!. 2003; Zetter et a!. 2003) and focuses upon the experiences of refugees who have arrived in Birmingham since the early 1990s. The paper outlines the indicators of integration proposed by Ager and Strang (2004) for the United Kingdom's Home Office. It then uses data from household surveys, in-depth interviews and focus groups conducted in the West Midlands to explore how useful indicators might be in evaluating progress towards integration within new migrant communities. The paper specifically examines the efficacy of functional indicators, which in Ager and Strang's (2004) framework are represented as 'means and markers' and include employment, housing, education and health. It aims to consider the usefulness of these functional indicators as a measure of integration and the ways in which the indicators might be shaped to help policy makers work towards promoting integration in a multi-cultural global city such as Birmingham. [ABSTRACT FROM AUTHOR]

Background Since 2015, NHS England has facilitated the recruitment of pharmacists in general practice (GP) to reduce workload of general practitioners. The role of pharmacists is therefore expected to become more clinical and patient oriented. However, little is known about the current roles performed and the integration of GP pharmacists. Objective To assess the role performed by GP pharmacists and their integration into practice exploring facilitators and barriers to integration. Setting A cross-sectional survey of GP pharmacists in England. Method This study used both online and paper-based questionnaires for a period of six months. Survey items included demographics, roles performed, integration including available support and practice environment. Quantitative data were analysed using descriptive statistics and 95% confidence intervals. Open comments were analysed thematically to identify pharmacists' perceptions of barriers and facilitators to their integration into practice. Main outcome measure Current role and integration of pharmacists into GP. Results 195 participants completed the questionnaire. Three quarters of pharmacists (76%) had only been in GP since 2015. Most pharmacists (81%) were independent prescribers (PIPs). The most reported pharmacists' roles were medicine reconciliation (95%), telephone support for patients (95%) and face-to-face medication review (91%). 82% (95% CI: 76% to 86.8%) were satisfied with their overall integration into practice. Half of pharmacists (45%) were working in a shared office or at a hot desk and 9% had no designated workspace. PIPs had more access to a convenient workplace (p = 0.016) compared to non-IPs. Conclusion Practice pharmacists are fulfilling a wide range of clinical and non-clinical roles in England. Findings highlight relatively a satisfactory level of pharmacists' integration into practice and shed the light on their integration issues. These findings could be significant for the development of future roles of pharmacists in GP. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to detail the research and findings from a piece of work commissioned by the Local Government Association in England, in May 2013 into the current implementation of integrated care Design/methodology/approach - The field research was carried out by Integrating Care, a collaborative drawn from leading academics, health and social care executives, analysts and clinicians working in the field of integrated care; along with consultancy support from public sector consultancies PPL and GE Healthcare Finnamore. It comprised a series of local interviews, workshops, modelling and analysis and ongoing engagement. Findings - The paper describes the outputs that were delivered to support the development of "whole-system" integrated health and social care drawing on national and international best-practice, and knowledge gained from experiences of implementation. Social implications - The paper concludes by drawing together the key lessons from the overarching analysis of whole-system integration. This includes the opportunities and the complexities of redesigning and re-implementing better co-ordinated health and social care provision at scale, as experienced in England currently. Originality/value - The paper describes the specific challenges posed through the fieldwork and ongoing development process of integration in England, and the paper reflects upon some of the deeper questions that this has led to. The paper then draws together the research and analysis with emerging, strategic questions around the concept of value in health provision; and begins to question whether this has yet been demonstrated; and, if not, what a demonstration and evidencing of "value" in this context might look like [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to offer a hypothesis about the core elements of an effective transition process in a system of self-directed support and to suggest that the approach to integration in public services may need to radically change. Design/methodology/approach - This a reflective piece, drawing on decades of practical work by the authors, combined with an understanding of the literature and the social policy context. Findings - Typical solutions to the problem of transition focus on system change instead of ensuring that power and control shifts to families and young people. A change in starting point opens up more empowering and practical solutions for the real world. Originality/value - This paper goes deeper than others on the same subject by moving beyond the outcomes and issues, to suggest some lessons for social policy makers, professionals and citizens. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to illustrate the potential for service integration by focusing at the level of the individual rather than through structural integration or care coordination. The paper illustrates the potential for integration through the experience of the personal health budgets pilot programme. Design/methodology/approach - This paper is based on a review of the experience of personal health budget pilot sites, drawing on the national evaluation of the pilot programme and the author's experience of working with pilot sites between 2010 and 2013. It also draws on the experience of similar programmes in the USA. Findings Personal health budgets support integration in two distinct ways. First, they can support the delivery of more holistic, whole-person care in line with the principles of shared decision making. Second, by bringing personal budgets in social care and personal health budgets together, they can provide a vehicle for integration across health and social care systems. If integration starts from, and responds to, what matters most to individuals rather than with the development of joint structures and processes, the result is more likely to be integrated care. Originality/value - This is one of only a small number of papers that discusses the scope for personal health budgets to improve the integration of care. Integration between the NHS and social care, in particular, has been identified as a central priority for the NHS. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe the work between statutory sector partners in Staffordshire to establish a transformational rather than transactional health and well being board and its approach to resource allocation. Design/methodology/approach – The paper describes the principles and process of achieving a shared ambition for Staffordshire, and the practical and strategic considerations of taking a broader and more ambitious approach than current guidance recommends. Findings – Supporting individual organisations to achieve their statutory requirements within the context of the shared vision, and using customer insight intelligently to influence the decision-making process, are critical to success. The challenge of moving resources in times of financial hardship and organisational flux should not be underestimated. Practical implications – The process of moving resources into prevention and early intervention cannot be done in a "one size fits all" way and has to be considered as part of a differentiated approach. In addition, organisations must be willing to cede influence and resources to support the vision, thus challenging culture and traditional organisational boundaries and structures. Social implications – The process described in the paper is designed to improve health and well being for citizens in Staffordshire, tackling inequality in an integrated, targeted and proportionate way. Originality/value – This is an emerging example of "whole system" integration. [ABSTRACT FROM AUTHOR]

This paper critically analyses discourses of educational inclusion in England through the lens of Derridean deconstruction. Linking Derrida’s thesis on writing and speech to presence and absence, the paper contends that inclusion acts as a suppléance to previous policies of integration. The paper suggests that, for many teachers, inclusion is grounded upon the forced absence of children rather than upon any notions of equality or justice. [ABSTRACT FROM PUBLISHER]

Purpose - This paper seeks to report key findings of a study, whose purpose was to: understand what helps or hinders the commissioning and provision of integrated services for people with long-term neurological conditions (LTNCs); identify models of best practice from the perspectives of people with LTNCs and the professionals who work with them; and develop a benchmarking system to assess the extent to which these models are available in England.Design/methodology/approach - The research had three main components: a rapid systematic literature review of evidence; in-depth case studies of six neurology "service systems"; and a survey of all English PCTs to audit progress towards implementation of the National Service Framework (NSF) for LTNCs.Findings - A number of elements that contribute to the experience of continuity and three service models that incorporate these elements were identified: community interdisciplinary neurological rehabilitation teams; nurse specialists and proactive, holistic day opportunities services. The survey results reinforced many of the case study findings, particularly around the varying levels of service available depending on diagnosis and location, and problems of access even where high-quality services existed. The paper concludes that the systematic approach to delivering treatment and care for people with LTNCs envisaged in the NSF has not yet been achieved.Originality/value - This study uses a mix of methods to assess progress towards national service improvement, based on evidence from people with LTNCs and those who work with them. As such, it provides a comprehensive benchmark at a critical point in the implementation of the NSF for LTNCs. [ABSTRACT FROM AUTHOR]

The achievement of integration and a reduction in the social exclusion of ethnic minority communities in England are policy matters of major concern. This paper argues that policy-makers and service providers pursuing these aims need to understand the language support needs of minority ethnic groups at a fine level of detail: groupings such as 'Black' or even 'Black African' are of limited utility. Although much ethnicity research has tended to view Black Africans as a homogenous group, appreciation of their diverse language use is important because people from different parts of sub-Saharan Africa face different language barriers on arrival in the UK. This paper examines evidence available from large-scale survey data on the association between language and indicators often used to assess integration and social exclusion. The paper provides empirical statistical evidence on Black Africans living in England and languages in the form of tables and maps using data-sets not previously analysed for this purpose. These are (1) the Labour Force Survey (LFS); and (2) the National Pupil Database (NPD). The results show that Black Africans speak a very wide range of languages at home. Somalis are by far the least integrated and most socially excluded of the major language groups, followed by Ghanaians. Zimbabweans and Nigerians, on the other hand, face only slight language barriers. The paper concludes with some implications of the findings for policy-makers and service providers. [ABSTRACT FROM AUTHOR]

The Jewish population living in Britain has commonly been depicted as a 'model of integration'. This paper explores the social and spatial transitions made by the Jewish community over the course of more than a century of settlement and adaptation, with particular reference to Leeds. Using an historical perspective, the paper traces the changing 'place' of Jews in wider society in terms of their socio-economic status and how they construct themselves as a religious and ethnic minority in Britain. Drawing on a mixed methods approach, the paper reveals how Leeds Jews' understandings of community, identity, integration and citizenship have evolved over time. The research uncovers diverse and complex interpretations of Jewishness and integration, which unsettle the idealised notions of community, the straightforward trajectory of adaptation, and unproblematic conceptions of identity embedded in the Jewish model of integration. The paper reflects on the implications of the Jewish experience for current debates and discourses on 'race', difference and social integration in twenty-first-century Britain. [ABSTRACT FROM AUTHOR]

The paper outlines the findings from a literature review of the English government's response to the issue of training pre-service teachers in the delivery of effective special educational needs support. The review's findings detail that although educational practice in mainstream classrooms has changed considerably since the 1970s the training of pre-service teachers with regards to special educational needs has seemingly changed very little. The paper argues that the government needs to re-think radically its policy of inclusion to ensure that a coherent plan is formulated which enables higher education institutions' initial teacher training programmes to train students who are competent and confident in their abilities to work with children with special educational needs and/or disabilities. [ABSTRACT FROM AUTHOR]

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Integrating health and social care services remains one of the most difficult undertakings in the field of care delivery. One of the key requirements for success in integration programmes is a shared vision amongst care providers. Shared visions may contain views as to what the new services should look like, how it should operate and what it should be able to achieve. The paper reports findings of an evaluation of a service integration programme in the North of England. It confirms that a programme consensus on issues such as aims and objectives and programme logics is seen by participants as a key to success. Yet, the study also found that there is a specific window of opportunity in integration programmes when participating organisations start on relatively high levels of commitment and enthusiasm which tend to tail off relatively quickly. The paper closes with a discussion about the implications of the findings for programme designers and service planners. [ABSTRACT FROM AUTHOR]

The overcoming of professional boundaries to collaboration in patient care has become one of the goals of mental health service policy in England over the past 25 years, predominantly through the creation of community mental health teams. However, research has shown that these boundaries have been slow to come down, and some commentators have pointed to the benefits of appropriate boundaries. This paper introduces a theoretical framework, which seeks to categorise boundary activity in organisations and then examines the boundary activity of professional groups and community teams during the integration of mental health and social care service provision in one locality in the southwest of England. The paper identifies the ways in which this integration impacted on boundary activity and draws out the messages for mental health policy and practice that emerge. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the association between multi-agency working and psychosocial characteristics of work, practitioner time-use and job satisfaction. Design/methodology/approach – A comparison of practitioners working in multi-agency (health and social care) and single-agency (social care-only) teams, using data from the 2008 evaluation of individual budgets pilots in England. Participants worked in care manager roles supporting adult social care service users, and comprised social workers and a smaller number of health professionals. Data were collected using a self-completed questionnaire. Findings – Data were returned from 249 respondents (a 29 per cent response rate), with two-thirds working in single-agency teams. No significant differences were found between team type and job satisfaction. Respondents in multi-agency teams reported greater decision authority but poorer supervisory support than those in single-agency teams. The latter finding was robust to further exploration using regression to control for confounding factors. Research limitations/implications – These data were not specifically collected for the study and response rates were relatively low due to organisational upheaval at the time of data collection, which may affect interpretation. Practical implications – Government policy is dedicated to extending integrated forms of working, including multi-agency teamwork. This research suggests that such structures need careful planning for them to work effectively, with particular attention to supervision arrangements. Originality/value – This research gives a systematic and objective exploration of the relationship between job characteristics, time-use and satisfaction of practitioners in single as compared to multi-agency teams. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the NHS England Vanguards of new care models was to improve healthcare provision and integration through the coordination of services, seeking to deliver the Five Year Forward View. The purpose of this paper is to report on an extensive analysis of one of the Vanguard programmes, exploring whether the implemented integrated response service (IRS) based in Harrogate, England, resulted in any meaningful change in secondary healthcare activity. Design/methodology/approach: The authors used an interrupted time series framework applied to aggregate secondary care data, specifically emergency attendances for patients 65+, emergency bed days for all adults and non-elective admissions for 65+. Synthetic and geographic comparator data were employed to inform additional scenario analyses. Findings: The majority of the analyses conducted found no statistically significant effect of the IRS team in either direction, suggesting that there was no change in the metrics that could be separated from natural variation. The data correlated with the findings of a qualitative analysis and challenges faced in staffing the team towards the end of the analysis period and the eventual disbanding of the IRS. Research limitations/implications: The analysis was partially hampered by data access challenges, limited to poorly specified aggregate secondary care data, and a poorly specified intervention. Furthermore, the follow-up period was limited by the disbanding of the service. Originality/value: This analysis indicates that the Harrogate-based IRS team is unlikely to have delivered any sustained quantifiable impact on the intended secondary care outcomes. While this does not necessarily demonstrate a failure of the core principle behind the drive for integrated care, it is an important exploration of the challenges of evaluating such a service. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to present a case study of one element of the integrated work which has taken place in Central Manchester, the development of multi-disciplinary Practice-Integrated Care Teams (PICT). The paper will show how working together has become a practical reality for members of these teams, and is forming the building blocks for further integration across neighbourhoods. Design/methodology/approach -- This paper draws on the author's experience of working in the PICT project from 2012 to 2014. The report will draw on the evaluation work which took place during the project, and will include reflections from others involved in the project and members of the teams. Findings -- The integrated care teams which have been developed in Central Manchester have started to make significant changes to the ways that professionals work together, to the experience that patients have and to the costs of urgent care provision. Whilst there is still a long way to go, there has been significant learning from the PICT. This includes improved patient outcomes and experience. There has been an overall reduction in secondary care activity for patients the teams have been working with, with the largest reduction being in emergency admissions. Alongside this, patient feedback has reinforced the value of this personalised approach and increased overall satisfaction with the care and advice received from health and social care professionals and an improved professional experience. Evaluation has demonstrated that amongst professionals involved in the team there is a strong commitment to the principles of integrated care and that the confidence, skills and capacity of the teams have strengthened since this way of working has been introduced. As monitoring of financial impact continues to develop, cost savings from secondary care, particularly around emergency unplanned care, are encouraging. Originality/value -- This paper draws on the recent experience of designing and delivering integrated care across a range of multi-agency, multi-professional partners. The model which has been developed centres around the role of general practice, and has enabled primary care to take a key role in the development of an out-of-hospital integrated care system. This has enabled community professionals such as nurses and social workers to build a much stronger relationship with general practice and enable system linkages which will be essential to the delivery of joined-up health and social care in the future. The project has been accompanied by thorough and ongoing evaluation to support the validity of the learnings which have been reported. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to identify features of community mental health teams (CMHTs) for older people valued by their managers, and those they would most like to change. Design/methodology/approach: Content analysis was used to analyse "free text" responses to open questions from a national survey about CMHTs' organisational structures and processes. Responses were sorted into statements which were categorised into content areas and higher level dimensions. Findings: Free text information was provided by 376 teams (an 88 per cent response rate). Eight higher level dimensions were identified. One related specifically to integration with social care services, whilst several more included material about other aspects of intra-team integration (e.g. documentation and location). The largest proportion of statements related to staffing and teamwork. Statements about inter-personal and inter-professional issues were largely positive, whilst statements about resources, bureaucracy and integration with social care services typically detailed desired changes. Practical implications: Four key issues emerged comprising a high level of support from managers to develop integrated practices; a need to define the focus of CMHTs for older people and to be fully resourced; and the importance of a nurturing and supportive team environment. Originality/value: The methodology provides a bridge between qualitative and quantitative research, exploring the volume of statements on particular topics and their meaning. [ABSTRACT FROM AUTHOR]

This article focuses specifically on the incorporation of ethnic minority children within the education systems of England, France and Germany. The trends in policy development after World War II in these countries are examined through the prism of three ideal-typical incorporation strategies – integration, assimilation and separation. This is done to test the theories of universalism, parallel development and particularism, which anticipate different trajectories with regard to these strategies. The paper finds evidence for convergence towards integration with regard to provisions for extra support in the host country’s language. This supports the theory of universalism. However, no evidence of convergence towards integration is found in four other policy areas. For instance, country-specific trends emerge on minority religious education and enrolment into mainstream schools, which is consistent with the particularist perspective. As there is little evidence of the three countries drawing closer in terms of all three adopting a strategy of incorporation promoted by transnational agencies, the expectation that national states can borrow in a straightforward fashion from internationally advocated models of ethnic minority incorporation appears unfounded. The paper further finds that local practices are sometimes significantly at odds with national educational policy, suggesting that future research should be directed more at the local level to determine the policies affecting ethnic minority children. [ABSTRACT FROM PUBLISHER]

Purpose – The purpose of this paper is to explore the value of the “capability approach” as an alternative framework for understanding and conceptualising the role of Refugee Community Organisations (RCOs) and other providers for groups conventionally considered “hard to reach”. Design/methodology/approach – A study of the education services of RCOs, drawing primarily on semi-structured interviews with 71 users, is put forward as a case study for how the capability approach can be operationalised. Findings – The capability approach is found to offer various valuable insights, relating to its appreciation of the multi-dimensional nature of human wellbeing, the significance of individual diversity, and the importance of human agency. Research limitations/implications – The case study is based on a relatively small purposive sample, and may have limited external validity. As the research design proved strong for exploring how RCOs develop their users’ capabilities but weak for exploring if and how they may also constrict them, further research in this area is required. Practical implications – A number of valuable attributes of the capability approach are highlighted for broadening the understanding, the role of RCOs and other service providers. Social implications – The paper outlines the potential of the capability approach to contribute to policymaking related to RCOs and other providers, and to debates relating to social exclusion, cohesion and integration. Originality/value – The paper draws attention to the value of the capability approach within the field of migration research. [ABSTRACT FROM AUTHOR]

Background: In 2022, England embarked on an ambitious and innovative re-organisation to produce an integrated health and care system with a greater focus on improving population health. This study aimed to understand how nascent ICSs are developing and to identify the key challenges and enablers to integration. Methods: Four ICSs participated in the study between November 2021 and May 2022. Semi-structured interviews with system leaders (n = 67) from health, social and voluntary care as well as representatives of local communities were held. A thematic framework approach supported by Leutz's five laws of integration framework was used to analyse the data. Results: The benefits of ICSs include enhancing the delivery of good quality care, improving population health and providing more person-centred care in the community. However, differences between health and social care such as accountability, organisational/professional cultures, risks of duplicating efforts, tensions over funding allocation, issues of data integration and struggles in engaging local communities threaten to hamper integration. Conclusions: Despite ICS's investing in the structural and relational components of integrated care, the unprecedented pressures on systems to reduce demand on primary and emergency care tackling elective backlogs may detract from a key goal of ICSs, improving population health and prevention. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the delivery of preventative services for older people from third sector organisations (TSOs) and the extent to which current commissioning arrangements enables the aspirations of policy to be achieved. Design/methodology/approach – Semi-structured interviews with key-contacts within a sample of TSOs which had been identified by directors of Adult Social Services as delivering one of the top three preventative interventions in their local authority area. Findings – There was evidence of considerable trust between local authorities and TSOs and as a consequence TSOs were given autonomy to develop holistic and integrated models of delivery that supported rather than diverted the TSOs' core missions. Both sectors found it difficult to set target outcomes and connected performance frameworks for preventative services. As a consequence a major element of the commissioning cycle is not being completed and TSOs cannot be confident that they are using their resources as effectively as possible. Research limitations/implications – This study was based in one English region, and would benefit from being extended to other English regions and home nations. Practical implications – Universities, policy makers, commissioners and the third sector need to work together to develop common outcome frameworks for preventative services and to gather consistent data sets that can be more easily synthesised to give a "realistic" understanding of the impact of different interventions and delivery models. Originality value – The paper contributes to the limited evidence bases of commissioning of TSOs and preventative services. [ABSTRACT FROM AUTHOR]

This paper conducts a form of racial archaeology in relation to the areas of Brixton and Brick Lane in London. Both inner-city areas are strongly associated with meanings related to race and difference. This paper examines some of the dominant ways though which Brixton and Brick Lane became represented in key policy texts. It investigates how these representations changed through time and identifies three different moments that have dominated the evolution of multiculturalism in local political discourse: a moment of racial pathology, where race is viewed as a problem of space or in space; a moment of reflection, where race is perceived through the lens of cultural difference; and a moment of celebration, where cultural difference is represented as an asset to be capitalised upon by acts of local regeneration. [ABSTRACT FROM AUTHOR]

The losses associated with exile often leave refugees with limited resources to face the challenge of adjusting to a new society. To enhance the successful integration of refugees, it is important to assist them in their efforts in rebuilding and extending their support systems. By matching refugees with volunteers, Befriending Programs aim at creating a supportive environment. Based on information provided by twenty-five organizations that offer befriending programs in Australia, Canada, England, and the United States, this paper explores obstacles they face in the recruitment and retention of befrienders as well as their strategies in overcoming challenges. [ABSTRACT FROM AUTHOR]

The effect of immigration on social cohesion is a political issue, expressed as a fear that racially skewed residential patterns represent ghettos which prevent integration. Residential patterns have been measured by indices of segregation. The range of indices is reviewed in the paper and measured empirically for England and Wales by using census data for 1991 and 2001, including a new index of migration dispersal. There has been an increase in residential mixing as a result of growing minority populations and their more even spread across localities. These two trends are identified by two commonly used indices of segregation which are moving in opposite directions for the most recent immigrant groups. The sensitivity of each index to modifiable area boundaries makes them unsuitable for evaluation of cities’ relative performance. The residential patterns of cities after immigration are more clearly understood by using demographic measures of migration and age structure. [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]

In light of the demands of the revised National Curriculum for Physical Education in England (DfEE/QCA, 1999) and the Special Educational Needs and Disability Discrimination Act (DfES, 2001a), this paper presents some preliminary observations on how PE teachers endeavour to include pupils with special educational needs (SEN) in secondary school physical education (PE). Findings from a small-scale study revealed that whilst teachers expressed a commitment to providing pupils with SEN with `equal opportunities'--to participate in the same learning contexts as their `more-able' peers--in practice, this was not always the case. The paper concludes by suggesting that the apparent tendency of teachers to prioritise `traditional' team games within PE serves to exclude, rather than facilitate the full inclusion of many pupils with SEN. Moreover, it appears that these pupils are in effect being integrated into, rather than included in, PE. [ABSTRACT FROM AUTHOR]

National implementation of the Floods Directive required the member states to each designate a 'competent authority'. This raises the question of what are the necessary competencies of the designated authority and what are the necessary powers required to deliver the directive. A fundamental problem in water governance is the 'vertical-horizontal problem' of integration but rules necessarily fragment and water management is highly coupled with many other policy areas. This paper reviews how the emphasis on vertical and horizontal integration in flood risk management has evolved over time and argues that vertical integration has been promoted at increasing cost to horizontal integration. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to use theories of institutional logics and institutional entrepreneurship to examine how and why macro-, meso-, and micro-level influences inter-relate in the implementation of integrated transitional care out of hospital in the English National Health Service. Design/methodology/approach The authors conducted an ethnographic case study of a hospital and surrounding services within a large urban centre in England. Specific methods included qualitative interviews with patients/caregivers, health/social care providers, and organizational leaders; observations of hospital transition planning meetings, community "hub" meetings, and other instances of transition planning; reviews of patient records; and analysis of key policy documents. Analysis was iterative and informed by theory on institutional logics and institutional entrepreneurship. Findings Organizational leaders at the meso-level of health and social care promoted a partnership logic of integrated care in response to conflicting institutional ideas found within a key macro-level policy enacted in 2003 (The Community Care (Delayed Discharges) Act). Through institutional entrepreneurship at the micro-level, the partnership logic became manifest in the form of relationship work among health and social care providers; they sought to build strong interpersonal relationships to enact more integrated transitional care. Originality/value This study has three key implications. First, efforts to promote integrated care should strategically include institutional entrepreneurs at the organizational and clinical levels. Second, integrated care initiatives should emphasize relationship-building among health and social care providers. Finally, theoretical development on institutional logics should further examine the role of interpersonal relationships in facilitating the "spread" of logics between macro-, meso-, and micro-level influences on inter-organizational change. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report the preliminary evaluation findings of an integration programme in the children’s health care sector in the North West of England. The programme was led by the local Clinical Commissioning Group (CCG) utilising a semi-autonomous working group model. It comprised horizontal and vertical integration. The evaluation reflects the emerging policy context of CCG leadership in the field of health care planning and commissioning. Design/methodology/approach – The evaluation used a mixed method observational study design to obtain the views and opinions of stakeholders and measured their change over time. A series of initial semi-structured interviews was conducted with purposively selected key professionals in strategic positions to assist in designing a survey instrument. An online survey was launched at programme inception and repeated at five months. Respondents were members of five implementation working groups. Survey responses were subjected to a descriptive analysis and tests of correlation. Findings – The data showed high levels of commitment and perceptions of shared vision and goals amongst respondents which were relatively stable over time. Responses also indicated that the programme was perceived to have a considerable impact on collaborative work but that this initial effect decreased over time. There were no significant attitudinal differences across sectors or professional groups. Originality/value – The study demonstrates the strengths and weaknesses of the multi-agency working group model to implement change. Whilst confirming initial positive effects of integration programmes on collaborative work, over time this appears to wear off to be replaced by increased levels of skepticism amongst participants. The author findings have implications for service commissioners and service planners engaging in vertical or horizontal integration of children’s services. [ABSTRACT FROM AUTHOR]

Health and social care integration has been promoted by successive governments as the answer to meeting increased need within limited budgets. However, there has been little research in the UK regarding Social Workers working in integrated health teams. This study explores how social work is perceived by a range of professionals working within three different models of integration in the same acute hospital in the South-East of England. The research team (all practicing social workers) used a mixed method approach - combining questionnaires and focus groups – to explore similarities and differences in the perception of the social work role held by professionals working within contexts which had different types or models of integration. Thematic analysis of the qualitative data identified five key themes. These included social workers: providing 'checks and balances' to health professionals, 'linking and bridging' between the hospital, the community and patients, holding 'mysterious knowledge', having 'strong interpersonal skills' and providing a 'function in team dynamics".We conclude by outlining recommendations for practice and further research, the limitations of our study and our approach to reflexivity as research practitioners. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to explore change within the commissioning of third sector mental health services in England. Design/methodology/approach -- A case study methodology based on survey and interview data of a sample of third sector organisations and commissioners within an English conurbation. Findings -- Normative commissioning models based on sequential cycles were not fully implemented with the main focus being on the procurement and contracting elements. There were examples of commissioning being an enabler of service improvement but overall it seems to have been limited in its ability to bring about whole system change. Barriers included commissioners' capacity and competence, ineffectual systems within their organisations, and fragmentation in commissioning processes between user groups, organisations and sectors. Research limitations/implications -- The case study conurbation may not represent practice in all urban areas of England and there may be particular issues of difference within rural localities. The view of private and public sector providers and those working in Commissioning Support Units were not sought. Practical implications -- To lead whole system change the commissioning function needs to be adequately resourced and skilled with better integration across public sector functions and organisations. Greater emphasis needs to be placed on implementing the full commissioning cycle, including the engagement of relevant stakeholders throughout the process and the practical application of outcomes. Originality/value -- This research adds to the limited body of empirical work regarding commissioning in mental health. [ABSTRACT FROM AUTHOR]

Discussions about belonging, national identity and social cohesion are part of a broader debate that emerges from a number of concerns, mainly to do with identity and specifically with ethnic or religious identities versus the perceived homogeneous national identity. One major concern in immigration countries is that many immigrants and ethnic minorities are not integrating into the destination or receiving societies. This perceived lack of integration creates fears about whether newcomers are developing a shared sense of belonging to the national identity. Without this commitment it is feared that social cohesion and indeed the very basis of liberal democracy is under threat. In this paper, I question whether this fear is valid by exploring the relationship between the individual and society through the notion of ‘sense of belonging’ – to a community, to a polity and to the nation. What does this mean in terms of national identity and social cohesion? In other words, do we have to have a shared sense of belonging to the nation to be responsible citizens? First, I will briefly explore some of the theoretical debates about belonging to the nation. Second, by analysing immigrant narratives on citizenship, belonging and community in London, I examine the multifaceted modes of belonging and whether migrants and ethnic minorities, who do not have a sense of belonging to the nation or who have a sense of belonging to more than one symbolic or material locality, can still have a sense of belonging and commitment to the common good which in turn contributes to societal cohesion. [ABSTRACT FROM PUBLISHER]

Positioning itself with regards to debates on the role of regionalization in the industrial revolution and on consumer and retailing revolutions, this paper uses the records of John Shaw, hardware factor of Wolverhampton, to examine how commercial travel created real spatial interactions across the industrializing economy of northern England in the period 1810–15. The paper argues that by integrating production and consumption, commercial travel played a vital part in advancing and reconciling the concurrent but apparently conflicting processes of economic regionalization and economic integration that characterized the period. Empirically, the paper contributes original data indicating concrete patterns of interaction across the space economy of early nineteenth century northern England in terms of both ‘routes’ and the intensity of interactions. The empirical material also allows for discussion of customer identities, the structure of geographically dispersed commodity chains and regional variations, if any, the nature of customer relationships. [Copyright &y& Elsevier]

This article describes a C-SAP-funded project evaluating the introduction of a new tutorial programme for first year Sociology students, which sought to integrate a 'skills framework' to enable students to develop a range of academic skills alongside their study of the subject. The pegagogical and institutional background to the decision to adopt this 'integrated' approach is summarised and the staff and student experiences are then evaluated using both quantitative and qualitative methods. Primarily concerned with evaluating staff and student responses to the new programme, this paper also raises some issues with regard to the methodologies of evaluation. [ABSTRACT FROM AUTHOR]

Young Muslims form a growing part of the population yet the mainstream services struggle to meet their needs (Ashrif 2007). It has been argued (Sallah 2007) that there is a strong historical link between their presence and the services they receive which is at times dogmatic, in that the services are delivered from a Eurocentric perspective with very little sensitivity to their different cultural and religious values and needs or relativist, where service provision assumes that "everything under the sun goes by" with very little critical interrogation of delivery. Constituting a significant percentage of the population and a projected majority in some areas in the UK by the next census, it is cardinal that we locate this within the wider discourse around the "politicisation" of young Muslims in Europe and the global "war on terror". This research addresses this area by examining barriers that face young Muslims and its impact on community cohesion, using a representative sample from Leicester, one of UK's most diverse cities. This takes into consideration that there has been a shift in UK policy from multiculturalism to integration signalled by the setting up of the Commission on Integration and Cohesion in August 2006. This paper will be based on research carried out in Leicester, United Kingdom, between February and March 2007. It explores barriers young Muslims face in accessing mainstream provision as well as make recommendations for best practice. It is based on questionnaires to young Muslims between the ages of 13 -19, parents of young Muslims, key mainstream service providers and a representative sample of key stakeholders within the Muslim community. [ABSTRACT FROM AUTHOR]

There has been an ongoing national debate over the causes and consequences of the evolution of patterns of residence of ethnic minority populations in British cities. This has gained particular prominence since the publication of the Cantle Report, which highlighted ethnic segregation as one of the causes underlying the racialised disturbances in certain northern cities in 2001. In this paper, the geographies of ethnic populations are identified in Leeds, a northern city affected by minor disturbances within its multi-ethnic inner-city. A newly developed set of ‘community areas’ is used to examine the extent to which specific ethnic minority groups are spatially concentrated within the city. The analysis focuses upon Leeds’ South Asian population, highlighting the spatial diversity of sub-groups within it and contrasting their geographies with those of other ethnic groups. Change between 1991 and 2001 is examined in inner Leeds at ward level, where geographical boundaries have remained consistent; evidence is found for deconcentration. Thereafter, each of the main forces responsible for shaping the patterns of ethnic settlement is considered in more detail, drawing on data from a survey of South Asian households in the city. [ABSTRACT FROM AUTHOR]