Abstract
PurposeThe purpose of this paper is to explore stakeholder views on the policy of integrated health and social care for older people with complex needs in Sweden and the issue of trust in implementing the policy.Design/methodology/approachThe study used a qualitative interview design and interviews with nine strategically selected stakeholders. A thematic analysis focused on trust, as defined in the theory of collaborative advantage, was used.FindingsThis study of health and social care exposed a lack of trust on political, strategic and inter-professional levels. Two opposing lines of argument were identified in the interviews. One advocated a single government authority for health and social care. The other was in accordance with recently implemented national policies, which entailed more collaboration between local government authorities, obliging them to make joint local agreements. The Swedish experience is discussed in an international context, examining the need for collaboration in integrated care services for older people.Research limitations/implicationsAlthough the findings are important for the current adjustment in health and social care for older people, the number of interviewees are limited. Future studies will include more regions and longitudinal studies.Originality/valueSweden is currently undergoing an extensive adjustment in line with recent national government policy which involves more primary health care and a corresponding reduction in the number of hospital beds. The restructuring of the care system for older people with complex needs is a paradox, as it simultaneously increases the need for centralisation while also increasing coordination and collaboration on a local basis.
Highlights
Across Europe, increases in the ageing population have led to national government initiatives in the care of older people, advancing different models of integrated care
Sharing resources was put forth as an urgent issue by the interviewees as was joint recordkeeping. This is in line with reported challenges with implementing integrated care in the European Union (EU) (European Commission, 2017) such as limitations of information and communications technology (ICT), information structure and organisational structures relating to the divided roles between department and professionals
Despite the obvious conflict areas, power imbalances, lack of ICT and the need for encouraging social care skills described by the stakeholders, one interviewee emphasised that older people themselves described improvements in the coordination of care services
Summary
Across Europe, increases in the ageing population have led to national government initiatives in the care of older people (including home and residential care), advancing different models of integrated care. The integrated care for older people involves decentralised coordination between the regional (county) and local (municipal) authorities and inter-organisational collaboration between providers of regional healthcare agencies and local municipal social care. The regional authority was responsible for medical expertise and health care, and the local authority for social care, including home and residential care for older people. The CCR contained administrative reforms, including a new law, the Liability Payment Act (1990:1404) (Table 1) This forced local municipalities to pay for hospital care for older people ready for discharge if the municipalities could not make appropriate provision for these older people within five days. How this should be implemented was, to a large degree, left to the local authorities and regions, which were expected to reach their own mutual agreements
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