Challenges and chances for local health and social care integration – Lessons from Greater Manchester, England

PurposeSustainability and transformation partnerships (STPs) were introduced to England, asking 44 local areas to submit their health and social care plans for the period from October 2016 to March 2021. This study aims to offer a deeper understanding of the complex structure in the local practice, and to discuss the associated challenges and chances.Design/methodology/approachDocumentary analysis, qualitative interviews and questionnaire survey are used for this study. Findings have been compared and analysed thematically.FindingsThe study participants reported that apart from pooled budgets, past collaborative experience and local leadership are crucial elements for transforming health and social care integration in Greater Manchester (GM). Also, this study provides policy recommendations to promote effective collaborative partnerships in local practices and mitigate local inequity of funding progress.Research limitations/implicationsThe findings of this paper cannot be extrapolated to all stakeholders due to the limited samples. Meanwhile, some of the discussions about the case of GM may not be transferrable to other STPs.Originality/valueThis study argues that the success of pooled budgets is the result, rather than the cause, of effective negotiations between various stakeholders; and therefore, there is no evidence suggesting that pooled budgets can resolve the discoordination of health and social care. Moreover, due to the bottom-up approach adopted by STPs, more effective boroughs tend to receive additional funding, resulting in an increasing gap of development between effective and ineffective boroughs.

Research on risk management of medical and health care integration projects based on fuzzy WINGS-G1

PurposeThis study establishes a risk management system for medical and health care integration projects to address the problem of high-risk potential and a strong correlation between risk factors.Design/methodology/approachA new fuzzy WINGS-G1 model for identifying key risk factors in medical and health care integration projects is proposed by introducing the fuzzy theory and the concept of risk incidence into the Weighted Influence Non-linear Gauge System (WINGS) method.FindingsThe authors analyze the fluidity of project risk factors through complex networks to control direct risks and cut off risk transmission paths to provide a reference for risk control and prevention of medical and health care integration projects.Originality/value(1) The integration of fuzzy theory into the WINGS method solves the problem of strong subjectivity of expert scoring in the traditional WINGS method; (2) By the different probabilities of risk factors, the concept of risk incidence is introduced in the WINGS model, which is more conducive to the identification of the critical risk factors and the rational allocation and utilization of organizational resources; (3) The use of the complex network for risk interactivity analysis fully reflects the dynamic nature of risk factors in medical and health care integration projects.

How to Integrate Palliative Care Within Primary Healthcare- Perspectives of People Living With Serious Illnesses, Their Family Caregivers and Primary Healthcare Professionals in Nigeria

Background Palliative care should be integrated into primary healthcare systems within low- and middle-income countries to achieve Universal Health Coverage goals. We aimed to identify preferences and expectations for primary healthcare support among people living with serious illness and their families in Nigeria, and to determine feasible steps palliative care integration within the health system. Methods Qualitative interview study with 48 participants including people living with serious illnesses (n=21) and their family caregivers (n=15) recruited from specialist clinics at a Teaching hospital in Nigeria; and healthcare providers (n=12) recruited from three primary healthcare facilities in Nigeria. Data were analysed using thematic analysis. Results Three major themes were identified. 1) Balancing patients and families’ expectations and preferences for easily accessible service and opportunities for social interaction and adequate communication with available human resource. 2) Engaging patients requires existing trust and bonds from their current use of primary healthcare and support to develop patients’ agency. 3) Development of healthcare providers is needed to ensure an appropriate clinical response, manage interprofessional trust and ensure clear role delineation. Conclusions Palliative care integration within primary healthcare in Nigeria can be achieved through building information and communication skills of healthcare providers, engaging and empowering patients to exercise their agency in care decisions, and adequately delineating healthcare providers’ roles to ensure staff work within their competencies and training.

P.018 The Ottawa Epilepsy Program: region-wide coordinated and multidisciplinary care in the 21st century

Background: Epilepsy is the most common chronic neurological illness worldwide, affecting more than 330, 000 people in Canada, 10, 000 of which reside in the Ottawa area. Despite facing higher mortality, stigma and social barriers, PLE (people living with epilepsy) incur treatment gaps even in high income countries like ours. Our goal was to address this burden locally with the creation of novel, community-integrated, care delivery for PLE in our area; we describe its inception. Methods: A transition program bridging pediatric and adult institutions was created to address the care continuity gap in 2017. Following a meeting of key stakeholders in the region in 2019, the community group was integrated into the model of care and the city-wide program was created incorporating adult, pediatric, transition and community pillars. A patient friendly website was launched in 2020 (ottawaepilepsyprogram.ca). Results: 170 patients were followed in the transition program since 2017. Adult and pediatric pillars have referred 70 patients to the community program between 2019-2020, 48 between 2020-2021. Through this, PLE are able to access the Clinic to community (C2C) and UPLIFT programs for social support services and mental health, respectively. Conclusions: An interconnected region-wide program can support PLE and foster innovative care integration across disciplines.

Palliative care integration: a critical review of nurse migration effect in Jamaica

Background Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering. Palliative care is slowly gaining momentum in Jamaica but requires a highly skilled workforce, including nurses. Out-migration of nurses to wealthier countries negatively impacts the delivery of health care services and may impede palliative care capacity-building. This critical review aimed to explore the evidence pertaining to the nurse migration effect on the integration of palliative care services in Jamaica and to formulate hypotheses about potential mitigating strategies. Methods A comprehensive search in the PubMed, CINAHL, and ProQuest PAIS databases aimed to identify articles pertinent to nurse migration in the Caribbean context. Grant and Booth’s methodologic framework for critical reviews was used to evaluate the literature. This methodology uses a narrative, chronologic synthesis and was guided by the World Health Organization (WHO) Public Health Model and the Model of Sustainability in Global Nursing. Results Data from 14 articles were extracted and mapped. Poorer patient outcomes were in part attributed to the out-migration of the most skilled nurses. ‘Push-factors’ such as aggressive recruitment by wealthier countries, lack of continuing educational opportunities, disparate wages, and a lack of professional autonomy and respect were clear contributors. Gender inequalities negatively impacted females and children left behind. Poor working conditions were not necessarily a primary reason for nurse migration. Four main themes were identified across articles: (a) globalization creating opportunities for migration, (b) recruitment of skilled professionals from CARICOM by high income countries, (c) imbalance and inequities resulting from migration, and (d) mitigation strategies. Thirteen articles suggested education, partnerships, policy, and incentives as mitigation strategies. Those strategies directly align with the WHO Public Health Model drivers to palliative care integration. Conclusion Emerged evidence supports that nurse migration is an ongoing phenomenon that strains health systems in Caribbean Community and Common Market (CARICOM) countries, with Jamaica being deeply impacted. This critical review demonstrates the importance of strategically addressing nurse migration as part of palliative care integration efforts in Jamaica. Future studies should include targeted migration mitigation interventions and should be guided by the three working hypotheses derived from this review.