Integrating health and social care : a mixed methods case study of the strategic development and implementation of integrated care services

The integration of health and social care services aims to overcome organisational boundaries, in order to promote person-centred care, and improve patient outcomes, satisfaction and value for money. However, health and social care services are currently faced with the challenge of providing high quality care, to a population who are increasingly living with multiple complex long-term conditions. This often results in care being delivered from multiple providers, subsequently increasing the risk of duplication, inefficiency, poor coordination and experience. Services therefore need to work in partnership and collaboration in order to deliver integrated and person-centred care. A mixed-methods study was conducted in order to explore the feasibility and practicalities of delivering integrated and person-centred care across organisational boundaries. This included a review of the literature, which informed a case study of integrated Neighbourhood Teams within a rural setting in the United Kingdom. This included a shift from working in organisational silos, to delivering integrated care to the whole population. Participants included staff members working at various levels within the integrated initiative. In-depth interviews with strategic and transformation leaders were conducted in order to enable qualitative explorations of developing and implementing integrated services. Data were transcribed and analysed using a thematic analysis approach. A Partnership Assessment Tool was also distributed in order to assess the operational and practitioner perspective of six key principles of partnership working. Despite extensive research and policy changes, results revealed that initiatives continue to experience similar barriers in progressing with integration and population health management. Nonetheless, robust case study designs and in-depth qualitative explorations into the experiences of those developing approaches to improve care delivery, add essential value to understanding associated barriers and facilitators. These findings are therefore highly relevant to those developing integrated care initiatives across international contexts. For example, irrespective of national iv differences, countries face similar challenges of fragmented services, with partnerships and networks viewed as an international political concepts. Transferable key enablers for progression included a clear shared vision, organisational commitment, investing time in building relationships, a cultural change, and a period of stability in workforce and leadership. The need to start small and scale up, peer support, developing approaches to measuring outcomes (accounting for impacts at the individual patient and professional level), and a focus on proactively supporting people before expanding models were also highlighted. The systemic, organisational, and professional challenges which were experienced are also likely to be represented across initiatives aiming to integrate care. While integrating care around the needs of the patient is a desirable objective for increases quality care, this is often met with significant challenges once attempts are made to develop strategies within an environment of uncertainty. In light of the often underestimated lengthy process of large-scale transformation, it was apparent that the initiative remained in its infancy, with full integration yet to be seen. While a combination of relational and technical aspects of integration are necessary for progression, the success of the initiative was largely perceived to be dependent upon the workforce, rather than processes and structures. Relational aspects and increased workforce investment may therefore hold increasing potential to the success of integrated approaches to care delivery and the sustainability of large-scale transformation.