Search

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]

Objectives: In 2022, England embarked on an ambitious reorganisation to produce an integrated health and care system, intended also to maximise population health. The newly created integrated care systems (ICSs) aim to improve quality of care, by achieving the best outcomes for individuals and populations through the provision of evidence-based services. An emerging approach for managing quality in organisations is the Quality Management System (QMS) framework. Using the framework, this study assessed how ICSs are managing and improving quality. Methods: Four ICSs were purposively sampled, with the data collected between November 2021 and May 2022. Semi-structured interviews with system leaders (n =60) from health and social care, public health and local representatives were held. We also observed key ICS meetings and reviewed relevant documents. A thematic framework approach based on the QMS framework was used to analyse the data. Results: The ICSs placed an emphasis on population health, reducing inequity and improving access. This represents a shift in focus from the traditional clinical approach to quality. There were tensions between quality assurance and improvement, with concerns that a narrow focus on assurance would impede ICSs from addressing broader quality issues, such as tackling inequalities and unwarranted variation in care and outcomes. Partnerships, a key enabler for integration, was seen as integral to achieving improvements in quality. Overall, the ICSs expressed concerns that any progress made in quality development and in improving population health would be tempered by unprecedented system pressures. Conclusion: It is unclear whether ICSs can achieve their ambition. As they move away from an assurance-dominated model of quality to one that emphasises openness, learning and improvement, they must simultaneously build the digital infrastructure, staff expertise and culture to support such a shift. [ABSTRACT FROM AUTHOR]

In an attempt to support care integration that promotes joined up service provision and patient‐centred care across care boundaries, local health and social care organisations have embarked on several initiatives and approaches. A key component of service integration is the co‐location of different professional groups. In this study, we consider the extent to which co‐location is an enabler for service integration by examining multi‐professional community care teams. The study presents findings from a qualitative evaluation of integrated care initiatives in a borough of East London, England, undertaken between 2017 and 2018. The evaluation employed a participatory approach, the Researcher‐in‐Residence model. Participant observation (n = 80 hr) and both semi‐structured individual (n = 16) and group interviews (six groups, n = 17 participants) were carried out. Thematic analysis of the data was undertaken. The findings show that co‐location can be an effective enabler for service integration providing a basis for joint working, fostering improved communication and information sharing if conditions such as shared information systems and professional cultures (shared beliefs and values) are met. Organisations must consider the potential barriers to service integration such as differing professional identity, limited understanding of roles and responsibilities and a lack of continuity in personnel. Co‐location remains an important facet in the development of multi‐professional teams and local service integration arrangements, but as yet, has not been widely acknowledged as a priority in care practice. Organisations that are committed to greying care boundaries and providing joined up patient care must ensure that sufficient focus is provided at the service delivery level and not assume that decades of silo working in health and social care and strong professional cultures will be resolved by co‐location. [ABSTRACT FROM AUTHOR]

This paper contributes to the literature on ethics in Participatory Research by looking at the Researcher-in-Residence model and its application within health services research in three East London boroughs. The Researcher-in-Residence is embedded in the organisation to enable knowledge mobilisation and knowledge coproduction. Whereas negotiation of different types of expertise to coproduce evidence might raise issues of power differentials, the embedded nature of the role also requires careful negotiating of relationships. As the researcher is immersed in the context under evaluation, the boundaries between the researcher and the participants' everyday working life can become blurred. The paper explores these ethical issues and suggests that, whereas the requirements of ethics committees, based on an ethics of principle, at times fail to offer appropriate guidelines for this methodological approach, an ethics of care based on relationships can offer a complementary framework to address some of the thorny challenges that emerge from everyday practice in participatory research. [ABSTRACT FROM AUTHOR]

Integrated care has been proposed as an organising principle to address the challenges of the rising demand for care services and limited resources. There is limited understanding of the role of learning in integrated care systems. Organisational Learning (OL) theory in the guise of 'Learning Practice' can offer a lens to study service integration and reflect on some of the challenges faced by multi-professional teams in developing a learning culture. The study presents findings from two qualitative evaluations of integrated care initiatives in three East London boroughs, England, undertaken between 2017 and 2018. The evaluations employed a participatory approach, the researcher-in-residence model, to coproduce findings with frontline staff working in multi-professional teams in community care. Thematic analysis was undertaken using an adapted version of the 'Learning Practice' framework. The majority of learning in the teams was single loop i.e. learning was mainly reactive to issues that arise. Developing a learning culture in the three boroughs was hindered by the differences in the professional and organisational cultures of health and social care and challenges in developing effective structures for learning. Individual organisational priorities and pressures inhibited both the embedding of learning and effective integration of care services at the frontline. Currently, learning is not inherent in integrated care planning. The adoption of the principles of OL optimising learning opportunities, support of innovation, managed risk taking and capitalising on the will of staff to work in multidisciplinary teams might positively contribute to the development of service integration. • Organisational learning can foster the development of service integration. • Learning bridges the gap between the rhetoric of integrated care and service outcomes. • Frontline staff have demonstrated the potential for change and innovation. • Relational aspects of integrated care are integral in enabling the success of initiatives. [ABSTRACT FROM AUTHOR]