scholarly journals Integrated care in mental health: next steps after the NHS Long Term Plan

2019 ◽  
Vol 214 (06) ◽  
pp. 315-317 ◽  
Author(s):  
Derek K. Tracy ◽  
Kara Hanson ◽  
Tom Brown ◽  
Adrian J. B. James ◽  
Holly Paulsen ◽  
...  
Keyword(s):  
Integrated Care ◽  
Royal College ◽  
Ageing Population ◽  
Select Committee ◽  
Complex Needs ◽  
Health And Social Care ◽  
Care Systems ◽  
The Uk

SummaryHealth and social care face growing and conflicting pressures: mounting complex needs of an ageing population, restricted funding and a workforce recruitment and retention crisis. In response, in the UK the NHS Long Term Plan promises increased investment and an emphasis on better ‘integrated’ care. We describe key aspects of integration that need addressing.Declaration of interestD.K.T. and S.S.S. are on the editorial board of the British Journal of Psychiatry and executives of the Academic Faculty at the Royal College of Psychiatrists. A.J.B.J., H.P. and Z.M. have roles at the Royal College of Psychiatrists that include evaluation of integrated care systems. A.J.B.J. is married to Dr Sarah Wollaston, Member of Parliament for Totnes and Chair of the Health Select Committee.

Dementia and Healthy Ageing in Older People

2020 ◽  
pp. 135-146
Author(s):  
Katsunori Kondo
Keyword(s):  
Public Health ◽  
Population Ageing ◽  
Ageing Population ◽  
Social Challenges ◽  
Policy Responses ◽  
Subsequent Decrease ◽  
Health And Social Care ◽  
Care Systems ◽  
The Uk ◽  
Ongoing Dialogue

As a front runner of population ageing, Japan faces a future that the human species has never experienced. While we rejoice in longevity, it can bring financial and social challenges resulting from loss of independence. Frailty and dementia are important in this context. To meet those challenges, the Japanese government has been making efforts to reform public health and social care systems, and to develop a trans-sectoral social policy programme for dementia. Culturally, the Japanese value seniority and family traditions of caregiving. Drastic demographic change, and the subsequent decrease in household capacity for informal caregiving, requires a cultural and normative reform in society. An ongoing dialogue between social determinants of health and policy responses in Japan can provide valuable lessons for other countries with a growing ageing population, including the UK.

Why care about integrated care? Part I. Demographics, finances and workforce: immovable objects facing mental health services

2020 ◽  
pp. 1-11
Author(s):  
Derek K. Tracy ◽  
Frank Holloway ◽  
Kara Hanson ◽  
Adrian James ◽  
Geraldine Strathdee ◽  
...  
Keyword(s):  
Mental Health ◽  
Integrated Care ◽  
Public Service ◽  
Social Care ◽  
Financial Resources ◽  
The Public ◽  
Health And Social Care ◽  
Care Systems ◽  
Changing Demographics

SUMMARY Demands on health and social care are growing in quantity and complexity, with resources and staffing not projected to match this. The landmark NHS Long Term Plan calls for services in England to be delivered differently through integrated care systems (ICSs) that will better join commissioners and providers, and health and social care. The scale of these changes is immense, and the detail can feel confusing. However, they are important and will affect all clinicians in the public service. This three-part series provides a primer on integrated care, explaining why it is happening, how services are changing and why clinicians should get involved. In this first article we focus on the changing demographics, and the workforce and financial resources required to address these.

scholarly journals Háziorvosok és idősellátás egy kérdőíves kutatás tükrében

2018 ◽  
Vol 159 (8) ◽  
pp. 312-319
Author(s):  
Anett Mária Tróbert ◽  
Zsuzsanna Széman
Keyword(s):  
Health Care ◽  
General Practitioners ◽  
Social Care ◽  
The Elderly ◽  
Care Process ◽  
Efficient Operation ◽  
Health And Social Care ◽  
Care Systems ◽  
Care System

Abstract: According to statistical data, the number of healthy life years is not increasing in proportion with the longer average life expectancy. In the ageing societies, the long-term care systems are increasingly overburdened; cost-efficient operation and the related coordination of services is one of the key questions for their sustainability. The present separation of the health care and social care systems causes numerous difficulties. One aim of the online research by questionnaire was to survey the attitude of general practitioners – who play a very important part in care for the elderly – towards their elder patients, the patients’ family members, and social workers providing eldercare. The other aim was to gather information on shortcomings experienced by doctors in the care system and on what possibilities general practitioners see for the improvement of eldercare. Semi-structured questionnaires were applied and analysed by descriptive and content methodology. The questionnaires were sent out to 5060 addresses around the country: a total of 145 were returned filled in. The respondents made many recommendations for the improvement of eldercare in the categories of development of social services, family support, development of health services, and societal cooperation. The areas in need of development named by the general practitioners are closely interrelated: the reform of social care would support the health care system and vice versa. More effective operation of the health and social care systems would ease the burdens of families, and at the same time encourage more active participation of families in the care process. And the systematic education of society and communities is a long-term investment that would strengthen a positive attitude towards old age and a value-oriented view of the ageing process that is one of the basic conditions for successful social integration of the elderly. Orv Hetil. 2018; 159(8): 312–319.

Beyond healthcare leadership? The imperative for health and social care systems

2020 ◽  
Vol 33 (4) ◽  
pp. 351-363
Author(s):  
John Duncan Edmonstone
Keyword(s):  
Health Care ◽  
Leadership Development ◽  
Social Care ◽  
Current Model ◽  
Healthcare Leadership ◽  
Content Type ◽  
Health And Social Care ◽  
The Future ◽  
Care Systems ◽  
The Uk

Purpose This paper aims to make the case that there is a need to move beyond a focus on an approach to leadership development which is confined to health care only. It argues that, given the economic, financial, social and organisational context within which health and social care organisations in the UK operate, there is a need to develop leadership within health and social care systems, rather than within the existing “siloed” sectors. Design/methodology/approach The paper considers the context within which health and social care organisations in the UK operate; examines the nature of those organisations; makes the case for focusing on the health and social car system through systems leadership; and identifies the need for leadership, rather than leader development. Findings There is a danger of health and social care organisations “walking backwards into the future” with eyes fixed on the past. The future lies with treating health and social care as a system, rather than focusing on organisations. The current model is individual leader focused, but the emerging model is one of collective multi-agency teams. Originality/value The paper seeks to go beyond a health-care-only focus, by asserting that there is a need to regard health and social care as a single system, delivered by a multiplicity of different organisations. This has implications for the kind of leadership involved and for how this might be developed.

scholarly journals Creating allegiance: leading transformational change within the NHS

BMJ Leader ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 110-114 ◽  
Author(s):  
Alison Tweed ◽  
Andrew Singfield ◽  
Julia R A Taylor ◽  
Lucy Gilbert ◽  
Paul Mount
Keyword(s):  
Social Care ◽  
Transformational Change ◽  
System Level ◽  
Senior Leaders ◽  
Template Analysis ◽  
Health And Social Care ◽  
Care Systems ◽  
Uk National Health Service ◽  
The Uk ◽  
Healthcare Transformation

BackgroundWithin the UK National Health Service (NHS) the move to Sustainable Transformation Plans/Partnerships and Integrated Care Systems reflect the increasing need and expectation for transformational change at a system level across both health and social care boundaries. Transformational change is complex, emergent and dynamic requiring new, non-traditional forms of leadership which are highly relational and persuasive.Aim of the studyThe current study aimed to explore a small number of NHS senior leaders’ experiences of undertaking transformational change within their localities over a period of a year following participation in a national transformational change programme designed to enhance personal capabilities.MethodFour pairs of leaders working on different change programmes took part in the study and were interviewed at three time points about their approach to their change work. The data were analysed qualitatively using template analysis.ResultsA core theme of Creating Allegiance to an Emergent Future World was developed. The senior leaders created allegiance to the transformational change through a process of Connecting on three levels: relational, with purpose and vision and through practice. Allegiance creation was attempted even if the transformational change work at the year-end was deemed successful or not.ConclusionsThe study highlights the types of leadership behaviours employed by the participants reflecting the complexity and social construction of their transformational work. The findings provide further evidence to the existing system leadership literature as well as emphasising the importance of creating stakeholder, multilevel buy-in to healthcare transformation.

scholarly journals SYSTEMATIC REVIEW OF THE EFFECTS OF NON-VR EXERGAMING ON MOBILITY OUTCOMES OF OLDER ADULTS LIVING IN LONG-TERM CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S473-S474
Author(s):  
Charlene H Chu ◽  
Renee Biss ◽  
Afroza Sultana ◽  
Amelie Gauthier-Beaupré ◽  
Arezoo Talebzadeh
Keyword(s):  
Older Adults ◽  
Long Term Care ◽  
Meta Analysis ◽  
Berg Balance Scale ◽  
Poor Quality ◽  
Ageing Population ◽  
Timed Up And Go ◽  
Term Care ◽  
Complex Needs

Abstract Introduction: Institutionalized older adults have high-rates of mobility decline resulting in reduced quality of life and increased dependency. Given the ageing population, there has been a proliferation of exergaming technology targeting older adults to maintain their physical activity (PA) levels and prevent decline. However, it is unclear if exergaming is effective to maintain or improve the PA of institutionalized older adults. Method: Four databases (MEDLINE/CINAHL/PsycINFO/Compendex) were systematically searched (key terms like “nursing homes”, exergaming”). Quantitative manuscripts examining the effects of exergaming on PA measures of institutionalized older adults published in English between 2006-present were eligible. Virtual reality was excluded from the search. No meta-analysis was conducted due to hetereogeneity of the results. Results: 11 studies were included from a search that yielded 208 results. The exergaming platforms that were used the most were the Kinect and Wii. The most commonly used PA measures were the Berg Balance Scale and the Timed-up-and-Go (n=4 studies) with no other measures being used in more than one study. Interventions ranged in exercise (e.g. cognitive-motor training, strength training, balance, etc), frequency, duration, and modality. Study designs were also heterogeneous. Articles were of very poor to poor quality. There was minimal reporting on adverse events. Older adults with cognitive impairment were commonly excluded. Challenges in current technology and studying this group are highlighted. Conclusion: Exergaming may be promising to maintain PA but more robust research is needed. More exergaming technology designed for long-term care to meet the specific complex needs of this population is warranted.

scholarly journals Participatory approach in developing the long-term care strategy in Slovakia

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Z Katreniakova ◽  
M Levyova ◽  
M Giertl ◽  
I Nagyova
Keyword(s):  
Online Survey ◽  
Long Term Care ◽  
Social Care ◽  
Slovak Republic ◽  
Participatory Approach ◽  
Term Care ◽  
Starting Point ◽  
Health And Social Care ◽  
Care Systems

Abstract Issue/problem In Slovak Republic (SR) old-age dependency will rise rapidly in the near future and will more than double in the next 15 years. This profound demographic changes will require restructuring of health and social care systems with more people working in the long-term care (LTC) sector and most likely a higher level of public spending to cover the growing LTC needs. Description of the problem Providing LTC in Slovakia has many problem areas. It is governed by several acts and regulations, which are not always linked and sometimes do not cover the situation entirely. There is not coordinated and integrated LTC model implemented and the distribution of the roles between the health and social care systems is lacking. Results Since 2017 a policy dialog between the key stakeholders - the Ministry of Health of the SR; the Ministry of Labour, Social Affairs and Family of the SR; and civic societies led by the Association for the Patients’ Rights Protection has been in place with aim to improve the current LTC Strategy Proposal. Online survey was carried out in May - June 2018, which brought deeper insights into the needs regarding demand and supply, and uncovered the main limitations of the current LTC system, e.g. insufficient capacity of LTC beds or a malfunctioning information system. This was followed by six workshops for professional and lay public, organised between February and March 2019 with aim to collect further evidence on regional level. Lessons The LTC Strategy Proposal development is one of 12 pilot projects within the national project - Promoting partnership and dialogue on participatory public policy making in SR. The initiative takes into account the needs and demands of LTC target groups and will serve as a starting point for further action in this area. [Grant Support: APVV-15-0719]. Key messages In Slovakia, a complex solution of long-term care issues is essential. Developing the LTC Strategy Proposal through participatory approach is an important starting point for future action.

scholarly journals P111 Should standing consultations be offered throughout the NHS? An investigation into patient attitude towards standing consultations in a rheumatological department

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Andrew Oliver ◽  
Graham Raftery ◽  
David Coady
Keyword(s):  
Healthcare Professionals ◽  
Energy Levels ◽  
Healthcare Setting ◽  
Consultation Room ◽  
Sedentary Population ◽  
Lifestyle Choices ◽  
Health And Social Care ◽  
Care Systems ◽  
Increase Productivity ◽  
The Uk

Abstract Background Britain is becoming an increasingly sedentary society; public health statistics tell us our health is being affected by our everyday lifestyle choices with reduced levels of physical activity and increasing levels of obesity contributing to increased demands on health and social care systems. On average, the UK workforce spends 9 hours sitting down per day. This is particularly prominent amongst GPs and certain senior physician roles in hospital, where clinics contribute to a large amount of the workload. Standing has been shown to put less stress on the lower back and other joints, burn more energy than sitting down and increase productivity and energy levels. Thus, evidence shows it is healthier to stand more during the day, but is it feasible in a healthcare setting? The aim of this study was to investigate whether patients would prefer to sit or stand for their consultations and the reasoning behind their choices. Methods A consultation room within the rheumatology outpatient department in Sunderland Royal Hospital was fitted with an adjustable standing desk. During clinics, patients were offered a standing consultation on entry to the room. A focused questionnaire was created and given to patients, consisting of 6 questions on the demographics of the patients, whether they wanted a standing consultation or not and what their reasoning was for their decision. This was an opportunistic study that included 39 patients over a 3-week period. Results In total, 39 questionnaires were given out, with each patient being offered a standing consultation. The results found that 13 patients opted for a standing consultation and 23 patients preferred to sit down. Not wanting to stand due to an MSK problem was the most prevalent answer with 16 patients using that as their reasoning. Conclusion In an increasingly sedentary population, the introduction of standing desks could help to reduce this behaviour in healthcare professionals and contribute positively to health. This study also highlights the question of positive modelling of patient behaviours, by healthcare professionals demonstrating the benefits of standing, it could encourage patients to begin to integrate it into their own lives. If we remove the 16 patients that did not want to stand due to an MSK problem, then the results show that 13/23 (56%) of patients wanted a standing consultation, so why not offer the choice? Increasing the sample size and trialling the desk in another department, where MSK problems are less prevalent, is the logical next step to develop this research. Following further investigation, the implementation of standing desks throughout more healthcare departments could help to reduce sedentary behaviour, increase productivity, lessen sick days amongst staff and demonstrate healthy living to patients. Disclosures A. Oliver None. G. Raftery None. D. Coady None.

Why care about integrated care? Part 2. Integrated care systems: an irresistible force changing mental health services

2020 ◽  
pp. 1-12 ◽  
Author(s):  
Derek K. Tracy ◽  
Frank Holloway ◽  
Kara Hanson ◽  
Nikita Kanani ◽  
Matthew Trainer ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Integrated Care ◽  
Healthcare Delivery ◽  
Local Implementation ◽  
The Past ◽  
Care Systems

SUMMARY Part 1 of this three-part series on integrated care discussed the drivers for change in healthcare delivery in England set out in the NHS Long Term Plan. This second part explores the evolution of mental health services within the wider National Health Service (NHS), and describes important relevant legislation and policy over the past decade, leading up to the 2019 Long Term Plan. We explain the implications of this, including the detail of emerging structures such as integrated care systems (ICSs) and primary care networks (PCNs), and conclude with challenges facing these novel systems. Part 3 will address the practical local implementation of integrated care.

scholarly journals International experiments with different models of allocating funds to facilitate integrated care: a scoping review protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e021374
Author(s):  
Akram Khayatzadeh-Mahani ◽  
Ellen Nolte ◽  
Jason Sutherland ◽  
Pierre-Gerlier Forest
Keyword(s):  
Integrated Care ◽  
Scoping Review ◽  
Care Coordination ◽  
Social Care ◽  
Service Providers ◽  
Research Question ◽  
Major Barrier ◽  
Health And Social Care ◽  
Wide Range ◽  
Care Systems

IntroductionIntegrated care is viewed widely as a potential solution to some of the major challenges faced by health and social care systems, such as those posed by service duplication, fragmentation and poor care coordination, and associated impacts on the quality and cost of services. Fragmented models of allocating funds to and across sectors, programmes and providers are frequently cited as a major barrier to integration and countries have experimented with different models of allocating funds to enhance care coordination among service providers and to reduce ineffective care and avoid costly adverse events. This scoping review aims to assess published international experiences of different models of allocating funds to facilitate integration and the evidence on their impacts.Methods and analysisWe will adopt a scoping review methodology due to the potentially vast and multidisciplinary nature of the literature on different models of allocating funds in health and social care systems, as well as the scarcity of existing knowledge syntheses. The framework developed by Arksey and O’Malley will be followed that entails six steps: (1) identifying the research question(s), (2) searching for relevant studies, (3) selecting studies, (4) charting the data, (5) collating, summarising and reporting the results and (6) and conducting consultation exercises. These steps will be conducted iteratively and reflexively, making adjustments and repetitions when appropriate to make sure the literature has been covered as comprehensively as possible. To ensure comprehensiveness of our literature review, we also search a wide range of sources.Ethics and disseminationAn integrated knowledge translation strategy will be pursued by engaging our knowledge users through all stages of the review. We will organise two workshops or policy roundtables/policy dialogues in Alberta and British Columbia with participation of diverse knowledge users to discuss and interpret the findings of our review and to draw out policy opportunities and lessons that can be applied to the context of these two provinces.

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