Suchergebnisse

This workshop examines the rise of integrated care as a central component of the UK Government's current reforms to its health and social care system. In particular, the workshop presents the key debates and conclusions from work undertaken by The King's Fund and the Nuffield Trust [1]—two key health policy 'think tanks' in the UK—in direct support of the UK Government's emerging legislation and strategy. This work included a review of the evidence-base for integrated care; workshops and interviews with managers and clinicians across health and social care and at the forefront of integrated care delivery; and meetings with policy-makers to discuss and refine key messages. The workshop will examine the report's conclusions and its ten key recommendations for the effective development of integrated care in England. In particular, it will examine how a clear, ambitious and measurable set of goals are required if the experiences and outcomes to patients and service users is to be improved.

The current Labour Government has embarked on radical public sector reform in England. A so-called 'Modernisation Agenda' has been developed that is encapsulated in the NHS Plan—a document that details a long-term vision for health care. This plan involves a five-fold strategy: investment through greater public funding; quality assurance; improving access; service integration and inter-professional working; and providing a public health focus. The principles of Labour's vision have been broadly supported. However, achieving its aims appears reliant on two key factors. First, appropriate resources are required to create capacity, particularly management capacity, to enable new functions to develop. Second, promoting access and service integration requires the development of significant co-ordination, collaboration and networking between agencies and individuals. This is particularly important for health and social care professionals. Their historically separate professions suggest that a significant period of change management is required to allow new roles and partnerships to evolve. In an attempt to secure delivery of its goals, however, the Government has placed the emphasis on further organisational restructuring. In doing so, the Government may have missed the key challenges faced in delivering its NHS Plan. As this paper argues, cultural and behavioural change is probably a far more appropriate and important requirement for success than a centrally directed approach that emphasises the rearrangement of structural furniture.

The current Labour Government has embarked on radical public sector reform in England. A so-called 'Modernisation Agenda' has been developed that is encapsulated in the NHS Plan—a document that details a long-term vision for health care. This plan involves a five-fold strategy: investment through greater public funding; quality assurance; improving access; service integration and inter-professional working; and providing a public health focus.

Purpose: This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Theory: Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital) services and also, potentially, social care. Method: This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Results: Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. Conclusions: The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

English
This article discusses the experiences of the NHS Service Delivery and Organisation Research and Development Programme (the SDO) in transferring knowledge from research into practice. In the context of relevant theories, four main difficulties in achieving knowledge transfer are described and two modes of knowledge production are uncovered: one being discipline based, and the other valuing research for its usefulness. In attempting to hold a balance between the two modes, the article shows how the SDO has dealt with the difficulties in knowledge transfer and concludes that a key to successful knowledge transfer is to achieve significant interaction between decision makers and research commissioners at the earliest possible stage.

This article summarises the results of a review of the impact of research funded by the NHS Service Delivery and Organisation Research and Development (SDO) Programme. The review draws primarily on the HERG Payback model, and the outputs and outcomes of SDO research are summarised in each of the five Payback domains: service delivery, policy, practice, research and capacity building. The article also discusses conceptual and methodological problems in identifying and attributing research impact that have been raised by the SDO impact review.