Jo Moriarty is Senior Research Fellow and Deputy Director at the Social Care Workforce Research Unit. (578 words)
The 18th International Conference on Integrated Care was hosted by the International Foundation of Integrated Care (IFIC) in partnership with the National Institute of Public Health and the Environment (RIVM and Vilans (the National Centre of Expertise for Long-term Care in the Netherlands) in Utrecht from 23-25 May 2018. Michelle Cornes and I were both fortunate to be among the 800 or so delegates attending the conference.
The increase in the number of people with complex long-term conditions whose support needs span traditional boundaries across health, social care and housing has led to many developments aimed at improving collaboration across different organisations and enhancing quality of care for individuals. However, there is no single definition of what is meant by ‘integrated care’.
In the same way, one of the Dutch delegates spoke of the policy of providing ‘care closer to home’. In England, this phrase refers to plans to deliver more healthcare away from acute hospitals and into community-based settings. In The Netherlands, it refers to a decision taken in 2015 to make municipalities responsible for healthcare services for older people and those with long term conditions, youth care, and help for jobseekers. As there are 380 municipalities in The Netherlands serving a population of 17 million, it makes for a system in which there is much more emphasis on devolution and ‘neighbourhoods’. It was an interesting insight into alternative models of funding and structures.
The conference was also a chance for the Social Care Workforce Research Unit to introduce its new project funded by the Dunhill Medical Trust on relations between primary care workers and directly employed care workers or personal assistants. This complements other Unit work on personal assistants and personal budgets. While there is an established body of work on interprofessional relationships in integrated care, we know almost nothing about the triangular relationships between older people who employ their own care workers, the directly employed care workers themselves, and primary care professionals. If you’re a primary care practitioner, directly employed worker, or older person or care directly employing a care worker using a direct payment or your own funds, then do please contact us if you’re interested in taking part.
In a conference in which the overwhelming number of presenters came from a healthcare background, it was a huge compliment to Michelle’s expertise and a sign of the quality of work undertaken within the Unit that hers was one of just five papers shortlisted for the best paper award which is given to the most innovative, relevant and impactful presentation. In a very lively and engaging session, Michelle presented findings from the Unit study comparing standard hospital discharge arrangements for homeless people with specialist integrated care services. This study is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research and is due to report later in the year.
Overall, the conference highlighted the huge range of services that come under the ‘integrated care’ umbrella and illustrated how the form that it takes is located in wider decisions about organisational structure and culture, the extent to which consumers (in the form of the general public, patients and family carers) are involved in decisions about services, and different funding arrangements. The conference couldn’t provide a definitive answer to the ‘holy grail’ question about how best to integrate services but it certainly showcased many examples of good practice and effectiveness.
Jo Moriarty is Senior Research Fellow and Deputy Director at the Social Care Workforce Research Unit.
My problem with the integrated care stuff is that we’ve been there so often and keep going back without seeming to learn all that much. Some of us were there in the brave new world of the Griffiths report in 1984 and integrated community mental health, a time so long ago it barely exists on the internet when you try to look up the history of health policy development. So in spite of having worked in lot of integrated care services for about 30 of years (oh no!) and even invented a few variants I’m perplexed as to why it keeps getting ‘rediscovered’. A couple of further points, one of which I think is covered in your blog but I think is really important, support from formal and informal systems, including paid for carers, is hugely important in sustaining quality of life in long term care and support in community settings, yet too much research focus is on the role of the highly trained professional. Sadly this is someone that many people with substantial care needs see very rarely and then only for what is primarily a brief check up. The further area in which we know pretty much nowt is in what will be the growing area of self-managed care supported by digital systems. This should be a bit of a concern as while some apps and digital support arrangements are very useful for some people there is an awful lot of the digital equivalent of snake oil out there too.