Abstract
Introduction:Care coordination is intended to ensure needs are met and integrated services are provided. Formalised processes for the coordination of mental health care arrived in the UK with the introduction of the care programme approach in the early 1990s. Since then the care coordinator role has become a central one within mental health systems.Theory and methods:This paper contrasts care coordination as work that is imagined with care coordination as work that is done. This is achieved via a critical review of policy followed by a qualitative analysis of interviews, focusing on day-to-day work, conducted with 28 care coordinators employed in four NHS organisations in England and two in Wales.Findings:Care coordination is imagined as a vehicle for the provision of collaborative, recovery-focused, care. Those who practise care coordination are concerned with the quality of their relationships with service users and the tailoring of services, but limits exist to collaboration and open discussion. Care coordinators describe doing necessary work connecting people and the system of care. However, this work also brings significant administrative demands, is subject to performance management which distorts its primary purpose, and in a context of scarce resources promotes generic professional roles.Conclusion:Care coordination must be done. However, it is not consistently being done in the way policymakers imagine, and in the real world of work can be done differently.
Highlights
Care coordination is intended to ensure needs are met and integrated services are provided
A recent paper highlights the dangerous consequences for patient safety of designing medical devices for an imagined clinical world, rather than for the actual clinical world which is inhabited by healthcare professionals [66]
Another points to the challenges of implementing clinical guidelines in real-life practice when these have been written for workplaces which do not exist [67], and a third reveals the difficulties and tensions practitioners face when standardised procedures clash with professional judgment [68]
Summary
Guidance on the CPA at the end of the 1990s was directive, introducing for the first time at national level two tiers of care planning and coordination based on assessments of service users’ needs and complexity and dropping the term ‘keyworker’ in favour of ‘care coordinator’ [41] This policy attempted to close the gap between the NHS-led CPA and local authority-led care management, stating that the two systems should be fully integrated in the case of people with mental health difficulties. The study A protocol for the project from which data are drawn in the sections following has been published previously [54] This was a cross-national comparative case study across six sites (four NHS trusts in England and two local health boards in Wales) which aimed to investigate care planning and coordination in the context of community mental health care. In response to a question about what they believe service users get from care coordinators, one participant said how: They get a full package of care from somebody who does what she says she is going to do, is reliable, gives them a sense of, that their problems are
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