An exploration of how neighbourhood team members experience the transition from traditional health and social care teams to integrated care systems, within a defined health and social care economy

Abstract

The following abstract presents a profesional doctorate study that explored how integration is experienced by the teams tasked with implementing the changes. Background: In the UK, the demographics of the population have significantly shifted dramatically. The median age rose from 33.9 years in 1974 to 40 years in 2014, a rise of 6.1 years. By 2024, it is predicted that there will be more people aged over 65 than aged 0-151. The population in the UK is getting older with 18% aged 65 and over and 2.4% aged 85 and over. However, perhaps of more relevant to the integration debate is not the changing age, but the shift in health conditions towards more people having long-term conditions and multiple co-morbidities. there are 15 million people in England with one or more long-term condition2. Which, has led to an increased drive towards integrated services that can provide a joined-up care across whole systems. Methods: The study is an Institutional Ethnographic conducted over nine months as part of a professional doctorate. Sample: The purposefully selected sample was a neighbourhood team in the north west of England. The team were selected due to their position as being at risk of being marginalised by the integration process and their experience of ‘doing’ integration. Ethics: University Ethics approval was obtained for the study, all participants were consented for observations and interviews and confidentiality was maintained across the study and presentation of the finding Results: The data was analysed using thematic analysis. The themes that emerged are briefly discribed below Integration as an idea - Before integration was real, it existed for the participants as ideas. One of the foremost ideas that immerged was that of ‘hopefulness’, which formed a powerful driver in the delivery of the changes required. Integration as practice - Practical issues plagued the early integration. Issues such as parking and IT were significant as they came to symbolise a divide between the local team and the wider organisation. Which, had an impacted the implementation of the organisational vision. Integration as professional practice - Previous studies have identified professional identity as a barrier; however, the study found that practitioner saw each other’s identity as an essential part of the development of their new integrated identity. Conclusion: The study supported previous studies that had demonstrated that ‘human factors’ were a key factor in the success of integration. However, the study also demonstrated that the teams observed viewed integration with hope and aspiration for improved practice. Professional Identity viewed as assets in developing team identity. Finally, team identity was a quickly established however; this led to the team distancing themselves from the identity of the wider organisation. Limitation: As an ethnography the finding of the study are not generalizable Time scale: as integration developed there could be challenges that had not yet emerged