Editorial

Citation

(2013), "Editorial", Journal of Integrated Care, Vol. 21 No. 3. https://doi.org/10.1108/jica.2013.55321caa.001

Editorial

Editorial

Article Type: Editorial From: Journal of Integrated Care, Volume 21, Issue 3.

It is often said that the only thing that never changes in health and social care is the presence of change. Never has this been more true than in the current context where the components of the Health and Social Care Act are working their way into practice in England and at a time where significant cost savings are being made in health and social care services. Alongside these changes to practice, debates continue about the Care and Support Bill which proposes to create a single law for adult care replacing the existing complex and outdated legislation. In Scotland debates over the proposed integration of health and social care have raised a number of practical issues over the day-to-day working of these organisations. All of this suggests that the infrastructures surrounding integrated care will be shifting for some time yet.

This issue of the Journal of Integrated Care examines a number of initiatives that have been created surrounding this change agenda, analysing early and suggested impacts and issues arising out of these changes to date. What is clear from these papers is that there remains a certain amount of ambiguity in the policy context and it is as yet unclear how these initiatives might operate in practice.

We start with a paper on the research programme INTERLINKS which describes and analyses long-term care and its links with the health and social care systems, and formal and informal care to accumulate good practice that is transferable across EU member states. Jenny Billings describes this process and signposts us to the many resources available through INTERLINKS including a large number of practice examples in relation to a range of themes pertaining to integrated working. The INTERLINKS project sought to generate a series of transferable lessons concerning long-term care, although struggled in this process given the challenges of differences in national and local contexts. However, as Billings describes, this project has started the conversation towards a comparative perspective on long-term care across Europe and one that we hope the Journal of Integrated Care will contribute further to in the future

In England a statutory duty for some time now has required Primary Care Trusts and Local Authorities to undertake Joint Strategic Needs Assessments in order to provide commissioners and other decision makers with an evidence base for prioritising action on the basis of the health and well-being needs of their local population. To date there is a general sense that these have not always been as successful as they might have been, but there is much optimism concerning the future strategic role of JSNAs. One of the criticisms of JSNAs is their sensitivity to data on minority ethnic groups. The paper by John Skinner and colleagues explores the possibilities that open up if the JSNA is combined with the Equality Delivery System – a tool that allows NHS organisations to self-assess and improve their equality and diversity performance. Skinner et al. find a clear case for connecting these tools although some practical challenges in delivering this, many of which relate to clarity over aims and the sorts of evidences that are used in practice.

Like JSNAs, personalisation is an agenda that has been in place for some years now. In the next paper Val Williams and colleagues explore the issue of support planning within personal budgets for disabled and older people. This paper finds that although there is high agreement about what the desired outcomes are for personal budget users and what good support planning looks like there are significant concerns that current budgetary cuts are causing challenges in allowing this to happen. In particular support planning is being “re-colonised” by social services in some areas, forcing out third sector organisations and in the process restricting the choice and control of disabled and older people.

The draft English Care and Support Bill currently favours the introduction of new mandatory duties to help ensure that local authorities and Health and Wellbeing Boards meet their obligations to provide services for carers. Carers are often the lynchpin in the provision of care and often responsible for joining up aspects of care in practice. Angela Burrows examines a new programme which provides health and well-being checks and six months of support to unpaid carers. Nearly 400 carers were recruited to this programme and 348 received support. Findings show that levels of stress reduced in the group although the programme had a greater impact on those with lower levels of stress. Those carers with severe levels of stress seemed to benefit less from the programme. These findings echo those of previous research and raise important issues relating to the evidence surrounding experiences of carers and their support.

Local Education and Training Boards are another relatively new initiative that are starting to develop, with a remit to perform workforce planning and education of commissioning functions in health care. Many of the areas that LETBs focus on, such as care of older people, end of life care and supporting people with multiple long-term conditions are also of concern to local authorities. Rhidian Hughes and Virginia McCririck explore LETBs and emerging lessons about how to promote integrated care. Hughes and McCririck conclude that LETBs can play a vital role in joining up the health and social care workforce although there are a range of areas that need careful consideration.

Our final paper is a regular feature by Ed Mitchell on aspects of law. In this issue Ed compares the different legislative approaches that are being used to promote integrated care in England and Wales. Both countries are currently in the process of putting forward significant proposals for integrated care in the two countries, although the legislative process is probably slightly more advanced in Wales. The different approaches being adopted in the two countries set up the possibility of a fascinating “natural experiment” with the opportunity to compare the impact of the two Bills on the outcomes of integrated care. Interestingly, while promoting integration, neither country defines what is actually meant by integration. Which perhaps raises a question about clarity and how we will know when organisations at a local level are “doing” integration.

As these papers indicate we are currently seeing a wealth of changes which will variously effect different parts of health and social care organisations and their partners. Some are large-scale changes, such as the proposed changes to legal powers, and others are more gradual, such as carer assessments. All are driven by a desire to deliver better and more integrated services for users and carers. In the process of turning aspiration into practice it is important that we do not lose sight of this.