Social Care Reform Research Articles

Assessing the maturity of integration of health and social care in Finland – findings from a pilot study

PurposeIntegrated care is the leading approach to developing health and social care services in Finland. After the national health and social care reform, the importance of assessing integration has been emphasized. The aim of this study was to pilot the SCIROCCO tool, which assesses integration maturity, in Finland. The SCIROCCO tool was translated and adapted to the Finnish health and social care context. The feasibility and utility of this tool for assessing the maturity for integration across health and social care in Finland were evaluated using empirical pilot data collected among employees of selected well-being service counties. The study also provided baseline information on the maturity of integration after the national health and social care reform.Design/methodology/approachEmployees (n = 111) of different personnel groups in health and social care services in four well-being service counties assessed the maturity of integration using a web-based survey. A pilot study design was used.FindingsThe SCIROCCO tool was found to be useful for assessing the maturity of integration in health and social care within the well-being service counties. However, the tool requires further development to be fully adapted to the Finnish health and social care system and to assess integration across sectors. The results emphasize the need to understand the perspectives of different personnel groups on integration and to consider them in the development work.Originality/valueThis was the first study conducted in Finland that provided valuable insights into the assessment of integration across the health and social care sectors. This study establishes the foundation for future research and development in the field of integration assessment.

Where Next? The Conflicts of Centralisation, Personalisation, and Human Rights in the Reform of Social Care

Where Next? The Conflicts of Centralisation, Personalisation, and Human Rights in the Reform of Social Care

Key children's services challenges to shape next ADCS presidency

The new president of the Association of Directors of Children's Services Andy Smith identifies tackling social care reforms, workforce pressures and demand for SEND support as priorities for his year in office

Becoming Healthier

To meet the challenges of an ageing population, increasing chronic diseases, and rising healthcare costs, Singapore is embarking on a long-term, multi-year strategic reform to shift care to the community, to improve value for resources expended, and to make the prevention of diseases and complications the focus of the health and social care system. Healthier SG will launch in the middle of 2023 for those aged 60 and above.
 The reform will enlist, integrate and enhance the mostly-private primary care sector into primary care networks. Residents will enrol to a selected primary care provider for long-term care relationships based on individualised health plans incorporating primary and secondary preventive activities like lifestyle improvements, health screenings and vaccinations. Social prescribing to community partners will enhance the prevention of disease and complications. Corollary enablers will also be enhanced, from health and social information sharing, to manpower development, to financial incentives and support. Digital Health capabilities like the national patient information repositories and personal trackers will be part of the intended new health ecology.
 This presentation will describe the health and social care reform, its origins and drivers and currently intended plan and desired outcomes, and discuss its theory of change, implementational challenges and potential enablers and barriers for success. In particular, we will discuss the difficulties in the systematic measurement, monitoring and evaluation of a large-scale multi-year reform, and the governance and leadership challenges to maintaining coherence and shaping trajectories in such complex endeavours.

Integration of maternity care as a part of social welfare and health care reform in Finland

Introduction: The vertical integration of primary and specialized care has been identified as a key challenge internationally. In Finland, 23 wellbeing services counties will be responsible for organizing integrated social and health care of primary and specialized care starting 2023. Primary maternity care services are offered in antenatal clinics. Specialized care is offered at 23 maternity hospitals including specialized ante- and postnatal care and childbirth. Specialized maternity care has been burdened due to the ever-increasing number of visits and the insufficient information flow between primary and specialized care. In some wellbeing services counties, services have already been integrated, but no information is available whether this integration has improved processes, outcomes or customer satisfaction. 
 Aims and methods: The first aim is to investigate whether there are differences in maternity care service processes, outcomes and customer satisfaction between the wellbeing services counties. The second aim is to find out perceptions of maternity care managers about the integration of maternity care. Three data sets will be used: the Finnish Medical Birth Register data on all newborns in Finland in 2021 (N=49 726), FinChildren survey on parents with 3-6 months old babies (N=14 820) and qualitative thematic interview among maternity care managers (N=8). All data have been collected and analysis of register and survey data is ongoing. Interview data have been analyzed. 
 Highlights: There are differences in the outcomes and customer satisfaction between the wellbeing services counties. However, more detailed data analyses are needed by adjusting for the most evident confounders and comparing the counties with integrated care to the other counties. These results will be presented at the conference. Maternity care managers felt that the structures within maternity care together with organizational boundaries pose a challenge to integration. Political decision-making was considered to have an influence on maternity care structures. Furthermore, more expertise in maternity care was expected from policy makers to support decision-making. Shared maternity care structure, management, and information systems were seen as factors promoting integration. A partial ambiguity or overlap in the roles between maternity clinics and maternity care at hospitals was observed, as well as inter-professional tensions between public health nurses who are working on primary maternity care and midwives who are working both in primary and specialized maternity care.
 Conclusions: The maternity care system should be more integrated in terms of governance structures, resources, and management. The expertise of maternity care professionals should be utilized in a customer-oriented and cost-effective way. More conclusions will be drawn after finalizing the quantitative analyses.
 Implications: New models of integrated maternity care should be developed, paying attention to the optimal continuity of care from the perspective of pregnant mothers and families. The results of this study can be used to develop the maternity care systems in different countries.

The Impact of COVID-19 on Social Care and Social Work in the UK: A Scoping Review

Abstract Prior to the COVID pandemic, staffing levels, staff turnover and vacancies in adult social care and social work within the UK were a major concern, with staff experiencing high workloads, burnout, stress and poor morale. The paucity of published evidence in a rapidly evolving contemporary situation indicated the suitability of a scoping review. Systematic searching produced evidence published between 1 December 2019 and 9 May 2023. Out of ninety-seven articles retrieved, the final analysis included thirty nine articles. To report the review findings clearly and accessibly, the analysis used the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework. Abundant evidence emerged on psychological distress and the impact of COVID-19 on the working environment for social care and social workers, but a paucity of psychosocial resilience, supporting social care managers, Personal Assistants and moral injury. Social care needs and the statutory duties of social work are likely to become even more intense. The COVID pandemic magnified a chronic lack of funding, staffing, support and regard for adult social care, with no future planning compared to the NHS. This legacy and backlogs of social care assessment and service delivery are of concern despite the proposed actions of the Adult Social Care Reform Act in England.

Commentary: Finnish health and social care reform in the European perspective

Abstract In the commentary, the Finnish health and social care reform and its objectives to foster integrate health and social services are addressed in terms of current European health system reform trends. The focus is on the challenges facing the Finnish government in the large structural reform and lessons to be learnt by other European countries.

What a journey! – A short history of the Finnish health care and social service reform and administrative integration of health care and social services

Abstract Finland is a Nordic welfare state with universal access to tax-funded health care. While the health system performs relatively well when measured in terms of avoidable mortality, several measures indicate that access to care, especially primary care, is poor. There are also relatively large geographical and socioeconomic inequities in access, utilization, and quality of services. To tackle these issues, a process to reform the health system was initiated in the early 2000s. However, it was not until 2021 when the large-scale reform of the system was enacted and not until 2023 when the new structure was implemented. The process involved several different reform proposals which all shaped the outcome of the reform. The key feature in almost all the reform proposals and in the final reform plan has been fostering vertical integration in health care and horizontal integration of health and social services both at the level of administration and organization as well as through processes and patient pathways. In this presentation we describe the history of the Finnish health and social care reform process and discuss, how integrated care as a policy idea and tool has shaped the reform agenda and reform proposals.

Health and Social Care Reform in Scotland: What Next?

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Resilient Housing and Care Services for Aging Municipalities

The Social welfare and health care reform in Finland will have an impact on the services provided by the municipalities. The housing services, health promotion and wellbeing of residents will remain in charge of the local authorities. Environmental factors are important for independent coping of older people who live in their own homes assisted by peers or by home care staff. Therefore, architects need to anticipate the demographic change in housing design and urban planning.
 The Government Key project TÄYTYY (2017 – 2018) was a research and development project targeting at efficient and operational service network, combining housing, home care and remote care services. The objective was to provide a resilient service structure for small municipalities through resource efficiency, complementing the urban structure and sharing existing facilities and resources locally.
 The multiple case study method was used to promote shared use of resources and spaces in local context. The project was carried out with cross-sectoral collaboration together with Aalto University, municipalities, health care service providers and local associations. As result, the project provided a model and a process of development for small municipalities. TÄYTYY project was carried out in collaboration with the Ministry of the Social Affairs and Health and the Ministry of the Environment.

Dealing with drift: Comparing social care reform in the four nations of the UK

AbstractReform of social care for older and disabled people has become a pressing political issue, given demographic change and shifting public expectations. In the UK, social insurance for long‐term care wasn't included in the post‐war welfare state and remains unfinished business. Drawing on semi‐structured interviews with policy stakeholders and analysis of policy documents, the concept of policy drift is used here to explain the incomplete and variable progress on social care funding reform in England, Scotland, Wales and Northern Ireland. Each nation has jurisdiction over its own care system and each has taken a different path towards introducing a form of risk pooling for social care. Of the factors which are known to create policy drift (e.g., veto players, complexity, agenda overload), Scotland has the least of these and England the most. This is consistent with the reform trajectories in which Scotland has gone furthest on care funding reform, introducing free personal care in 2002, whereas England has lagged behind the others and is only now introducing reform. The article contributes to the drift literature by exposing its comparative element: polities define their progress or justify their delays in reference to their neighbours.

‘When it comes to carers, you've got to be grateful that you've got a carer coming’: older people's narratives of self-funding social care in England

AbstractThe number of older self-funders in England is growing in the context of tight eligibility criteria and fixed financial thresholds to access statutory adult social care. Older people who self-fund their social care fall largely under the radar of statutory services and of research. Our study aimed to listen closely to the stories that older people tell about finding, managing and paying for their care. We interviewed 65 older people living in the community who were funding all or some of their social care. This paper focuses on narrative analysis of selected transcripts from these interviews. It sheds light on how older people represent their experiences of self-funding and what underpins these constructions. A key finding is that the disjunctions within older people's accounts between the care they want and the care they receive reflect wider political and structural tensions in the funding and delivery of care. Older self-funders temper their expectations in light of their experience of shortfalls in the system. This enables them to adjust to the deficiencies but obscures and perpetuates poor care. The discussion considers the findings in relation to: the fundamental incompatability of body labour and commodified care; the shared precarity of older people and care workers; and the individualisation of risks that makes older people and their carers responsible for making a failing care system ‘work’. Our analysis adds to the case for major reform of adult social care, including a revaluing of the status and employment conditions of front-line care workers.

The role of the community nurse in population health management.

British Journal of Community NursingVol. 27, No. 6 ProfessionalThe role of the community nurse in population health managementMargaret Khumalo, Nicky BrownMargaret KhumaloE-mail Address: [email protected]Community Nursing Fellow (Population Health Management), Nursing Directorate, NHS England and NHS ImprovementSearch for more papers by this author, Nicky BrownCommunity Nursing Fellow (Population Health Management), Nursing Directorate, NHS England and NHS ImprovementSearch for more papers by this authorMargaret Khumalo; Nicky BrownPublished Online:7 Jun 2022https://doi.org/10.12968/bjcn.2022.27.6.302AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Ariosto DA, Harper EM, Wilson ML, Hull SC, Nahm ES, Sylvia ML. Population health: a nursing action plan. JAMIA Open. 2018; May 16;1(1):7-10 https://doi.org/10.1093/jamiaopen/ooy003 Crossref, Medline, Google ScholarDuncan M. Population health management and its relevance to community nurses. Br J Community Nurs. 2019; Dec 2;24(12):596-599. https://doi.org/10.12968/bjcn.2019.24.12.596 Link, Google ScholarGreen J, Doyle C, Hayes S, Newnham W, Hill S, Zeller I, Graffin M, Goddard G. District and community nursing-'still doing what we do’ through the pandemic. Br J Community Nurs. 2020 Aug 2;25(8):388-389. https://doi.org/10.12968/bjcn.2020.25.8.388 Link, Google ScholarNational Advisory Council on Nurse Education and Practice (NACNEP). Preparing Nurses for New Roles in Population Health Management. 2016; https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/nursing/reports/2016-fourteenthreport.pdf Google ScholarNHS. Core20PLUS5 – An approach to reducing health inequalities. 2021; https://www.england.nhs.uk/about/equality/equality-hub/core20plus5/ Google ScholarRace Disparity Unit. Final report on progress to address COVID-19 health inequalities. 2021; https://www.gov.uk/government/publications/final-report-on-progress-to-address-covid-19-health-inequalities Google ScholarRashid T, Bennett JE, Paciorek CJ, Doyle Y, Pearson-Stuttard J, Flaxman S, Fecht D, Toledano MB, Li G, Daby HI, Johnson E, Davies B, Ezzati M. Life expectancy and risk of death in 6791 communities in England from 2002 to 2019: high-resolution spatiotemporal analysis of civil registration data. Lancet Public Health. 2021 Nov;6(11):e805-e816. https://doi.org/10.1016/S2468-2667(21)00205-X Crossref, Medline, Google ScholarNHS. The NHS Long Term Plan. 2019; https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan-june-2019.pdf Google ScholarThe Government's White Paper proposals for the reform of Health and Social Care: First Report of Session 2021-22 Published on 14 May 2021 by authority of the House of Commons https://committees.parliament.uk/publications/5827/documents/67112/default/ Google Scholar FiguresReferencesRelatedDetails 2 June 2022Volume 27Issue 6ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Accepted 1 May 2022 Published online 7 June 2022 Published in print 2 June 2022 Information© MA Healthcare LimitedPDF download

Is Finnish early childhood education going private? – Legislative steps and local policy actors’ representations of privatisation

In this article, we contribute to the research on the process of privatisation of Finnish early childhood education (ECE), describe how the privatisation has proceeded within the legal framework and how profit making has become possible in ECE. Furthermore, we analyse how local key policy actors justify the privatisation of ECE and what the problems represented to be in local privatisation policy are. The data for the first part of this research were chosen from critical legislative changes concerning private daycare/ECE from a period 1973 to 2018. The second part of our research data consists of in-depth interviews with two leading managers in ECE administration and two politicians in one Finnish municipality. The findings reveal that privatisation has become part of Finnish ECE through tacit and invisible steps, both in legislation and in municipal services illustrating hidden privatisation. At the national level, the process towards private ECE has been a part of social and health care reforms without a deep analysis of daycare/ECE and the needs of this service. At the local level, the privatisation of ECE was seen as an attempt to address economic problems as well as challenges in the balance between the supply of and the demand for ECE services.

Impact of the COVID-19 pandemic on family carers in the community: A scoping review.

The COVID-19 pandemic has led to the closure or reduction in support services for family carers, resulting in increased social isolation and stress for this population. The current scoping review aimed to identify the impact of COVID-19 upon carers and support provided for them during the pandemic. Four online databases (CINAHL, Medline, PsycINFO and PubMed) were systematically searched on 16th December 2020 and updated on 16th July 2021 for articles written in English and published after January 2020, focused on the carer and the impact of COVID-19. Google scholar and reference lists of relevant papers were checked, and key authors were contacted for further relevant information. The database searches identified 976 citations, which resulted in 670 unique articles following the removal of duplicates. Title and abstract screening identified 63 articles for full-text review, 11 of which were subsequently excluded, leaving 52 articles which were subject to inductive thematic analysis. Four key themes were identified. Whilst a number of issues were identified that were exacerbated by the pandemic, others directly resulting from it were revealed. Few studies discussed support measures for carers and only one trial evaluated an intervention. This review identifies the impact of COVID-19 on carers, but there is a dearth of evidence to inform appropriate tailored support. Governments need to identify carers as a priority group in social care reform and commission co-produced, evidence and experience informed pathways to reinstate support services, potentially modelled on pandemic plans following the example currently being considered for the paid healthcare workforce.

Health and Social Care Reform in Scotland - What Next?

Introduction:This paper analyses the important enablers, barriers and impacts of country-wide implementation of integrated health and social care in Scotland. It offers insights for other systems seeking to advance similar policy and practice.Description:Landmark legislation was based on a shared vision and narrative about improving outcomes for people and communities. Implementation has involved coordination of multiple policies and interventions for different life stages, care groups, care settings and local context within a dynamic and complex system.Discussion:Relational and citizen led approaches are critical for success, but it takes time to build trusting relationships, influence organisational and professional cultures and cede power. Assessing national impacts is challenging and progress at a national level can seem slower than local experience suggests, due in part to the relative immaturity of national datasets for community interventions. Five years on there are many examples of innovation and positive outcomes despite increasing demographic, workforce, and financial challenges. However, inequalities continue to increase.Conclusion:Realising the true value from integration will require a stronger focus on place-based prevention and early intervention to achieve a fairer Scotland where everybody thrives. Solidarity, equity, and human rights must guide the next phase of Scotland’s story.

Policy Alienation in Frontline Social Work – A Study of Social Workers’ Responses to a Major Anticipated Social and Health Care Reform in Finland

ABSTRACT Change in the policy and ideology governing social and health care has been much debated in the Western welfare states, including in Finland, where the public sector has witnessed a shift towards a market and managerial ideology in a climate of austerity. These changes affect organisations as well as individual workers. Social workers implement social policies in their daily work, and are thus positioned in between policies and clients. This may expose them to feelings of unease in the implementation of certain policies. In this study, we apply the policy alienation framework of Tummers and colleagues (2009. “Policy Alienation of Public Professionals: Application in a new Public Management Context.” Public Management Review 11 (5): 685–706) in analysing the responses of social workers to a major social and health care reform prepared in Finland in 2015–2019. By applying problem-driven content analysis to interview data, we study how social workers responded to the proposals for reform, and how the two dimensions of policy alienation, i.e. experiences of meaninglessness and powerlessness, were manifested. The findings suggest that policy alienation is widespread among social workers and that experiences of powerlessness and meaninglessness are common. The social workers experienced powerlessness in relation to specific policies and practices. They also viewed the reform as meaningless, as it lacked socially relevant goals.

Regional approaches for integrating health and social services in Finland

Introduction Government policies in Finland have supported administrative and operative coordination of health and social care to create larger authorities for organising services and to strengthen integration of social services, and primary and specialised care. While nationally the policies have led to attempts to reform and consolidate the service system, in several areas, regional joint health and social care authorities have been established to boost administrative integration and to facilitate the implementation of innovative forms of integrated care (IC). Although the governments’ reform proposals for health and social care system have failed, within the preparation, many regional authorities have drafted new operations for strengthening integration of health and social services. The paper explores and systematises these regional plans to identify feasible models for developing IC in the Finnish context.Methods The study draws on extensive collection of administrative and planning documents on regional health and social services within 20 hospital care authorities in Finland. The documents collected in May-June 2019 included the annual reports of the authorities, service organisation plans and agreements between the authorities and local governments (municipalities), and regional preparatory plans for the health and social care reform. The data were complemented with interviews of regional decision makers and managers. In analysis, we identified conceptual approaches to IC, and operational preconditions and governance models of IC applied regionally.Results The authorities varied substantially in approaches to IC. Some had formed a regional IC authority for managing health and social services or decided to establish such an authority. Administrative integration did not, however, determine directly operational IC approaches, of which we identified four broad categories: 1) designers of IC-preconditions, 2) developers of IC-models, 3) IC-investigators and 4) rookies. While all authorities had established at least some preconditions for integration, such as case management, multi-professional collaboration, and integrated care pathways, the stages of their development varied and in some areas plans to proceed with integration were unspecified.Discussions For policy development, our findings indicate a wide preparedness to implement comprehensive regional IC models in Finnish health and social care. Established tools to improve integration have particularly focused on primary and specialised health care and designated care pathways. IC schemes between health and social services are less frequent, often local and focusing on multi-professional teamwork. Integration has also encompassed services for the elderly, families, and young people drawing on case-manager models and joint facilities with professionals from multiple sectors. More investment is needed for mental health and substance abuse services. ConclusionsWhile the delay of the national health and social care reform has impeded the development of a common IC framework in Finland, local approaches proceeding out of step have emerged requesting collaboration between regional health and social care authorities for identifying good IC practices.Limitations While the study is based on policy and planning documents complemented with interviews, the actual implementation of IC models has not been comprehensively analysed.Suggestions for future research Research on good practices to improve care integration is needed to support the implementation of IC models.

A multiple perspective view of personhood in dementia

AbstractPersonhood has been a key influence on the development of person-centred care models in dementia. However, there is ambiguity around the concept and interpretation of personhood, and what it means in practical terms for the delivery of care to people with dementia. This study examines the conceptualisation of personhood within the formal care system for people with dementia in Ireland. A multiple perspective study design examines the experiences of personhood in dementia from the perspectives of people with dementia, family carers and a range of formal carers. Semi-structured interviews with participants were conducted in both community and long-term care settings. Interpretative phenomenological analysis is used to examine the data. A total of 31 participants were interviewed: eight people with dementia, eight family carers and 15 formal carers. There is general consensus on the core elements of personhood among all participants: interests and preferences; lifecourse experiences; social interaction; family; and place. However, there is ambiguity among family carers and formal carers in the interpretation of changes to personhood as the disease progresses. Interpersonal and structural barriers to supporting personhood are identified by all participants. The findings provide guidance on the traits of personhood-enhancing care, including effective communication skills, and the potential of health and social care reform to support the core elements of personhood among people with dementia.

Škola a sociální pomoc ve druhé polovině 19. století

The paper deals with the forms of social assistance provided to poor children and youth in schools. The specific examples are illustrated by the example of Pardubice town. The article mainly deals with the second half of the 19th century, when under the influence of social changes the charitable activities aimed at children and young people were developed. The article mentions also the end of the 18th century, when education and social care reforms took place, and influenced the development of social assistance in the following century. Two types of institutions were established at schools; on one hand, associations providing financial or material support, on the other, groups providing out-of-school activities for children and youth. These organizations had the same goal – the discipline of the poor in society.